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Singh B, Cadenas-Sanchez C, da Costa BGG, Castro-Piñero J, Chaput JP, Cuenca-García M, Maher C, Marín-Jiménez N, McGrath R, Molina-Garcí P, Myers J, Gower B, Ortega FB, Lang JJ, Tomkinson GR. Comparison of objectively measured and estimated cardiorespiratory fitness to predict all-cause and cardiovascular disease mortality in adults: A systematic review and meta-analysis of 42 studies representing 35 cohorts and 3.8 million observations. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100986. [PMID: 39271056 DOI: 10.1016/j.jshs.2024.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/29/2024] [Accepted: 06/11/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is a powerful health marker recommended by the American Heart Association as a clinical vital sign. Comparing the predictive validity of objectively measured CRF (the "gold standard") and estimated CRF is clinically relevant because estimated CRF is more feasible. Our objective was to meta-analyze cohort studies to compare the associations of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and cardiovascular disease (CVD) mortality in adults. METHODS Systematic searches were conducted in 9 databases (MEDLINE, SPORTDiscus, Embase, Scopus, PsycINFO, Web of Science, PubMed, CINAHL, and the Cochrane Library) up to April 11, 2024. We included full-text refereed cohort studies published in English that quantified the association (using risk estimates with 95% confidence intervals (95%CIs)) of objectively measured, exercise-estimated, and non-exercise-estimated CRF with all-cause and CVD mortality in adults. CRF was expressed as metabolic equivalents (METs) of task. Pooled relative risks (RR) for all-cause and CVD mortality per 1-MET (3.5 mL/kg/min) higher level of CRF were quantified using random-effects models. RESULTS Forty-two studies representing 35 cohorts and 3,813,484 observations (81% male) (362,771 all-cause and 56,471 CVD deaths) were included. The pooled RRs for all-cause and CVD mortality per higher MET were 0.86 (95%CI: 0.83-0.88) and 0.84 (95%CI: 0.80-0.87), respectively. For both all-cause and CVD mortality, there were no statistically significant differences in RR per higher MET between objectively measured (RR range: 0.86-0.90) and maximal exercise-estimated (RR range: 0.85-0.86), submaximal exercise-estimated (RR range: 0.91-0.94), and non-exercise-estimated CRF (RR range: 0.81-0.85). CONCLUSION Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults. Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations. Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.
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Affiliation(s)
- Ben Singh
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia.
| | - Cristina Cadenas-Sanchez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada 18071, Spain
| | - Bruno G G da Costa
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC H2W 1S4, Canada
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real 11519, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz 11009, Spain
| | - Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Magdalena Cuenca-García
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real 11519, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz 11009, Spain
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Nuria Marín-Jiménez
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real 11519, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz 11009, Spain
| | - Ryan McGrath
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA; Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND 58108, USA; Fargo VA Healthcare System, Fargo, ND 58102, USA; Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
| | - Pablo Molina-Garcí
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Instituto de Investigación Biosanitaria ibs. Granada, Granada 18014, Spain
| | - Jonathan Myers
- Department of Cardiology, Stanford University, Stanford, CA 94305, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Bethany Gower
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
| | - Francisco B Ortega
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18071, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Granada 18071, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40014, Finland
| | - Justin J Lang
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia; Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A 0K9, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Grant R Tomkinson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5000, Australia
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Abstract
Physical activity and its sustained and purposeful performance-exercise-promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one's global cardiovascular, pulmonary and metabolic health, and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs ("exerkines") highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.
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Affiliation(s)
| | - Prashant Rao
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jeremy M. Robbins
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Cardiovascular Research Center, Beth Israel Deaconess Medical Center, Boston, MA
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Bortolozo HI, Derchain S, Vechin FC, Maginador GF, Santos IS, Torresan R, de Nazaré Silva Dos Santos P, Sarian LO, Conceição MS. Aerobic Fitness is a Predictor of Body Composition in Women With Breast Cancer at Diagnosis. Clin Breast Cancer 2020; 21:e245-e251. [PMID: 34159902 DOI: 10.1016/j.clbc.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to investigate the relationship of aerobic fitness (AF) at diagnosis, before treatment and its relationship with body composition, physical function, lipidic profile, comorbidities, tumor characteristics, and quality of life of women with breast cancer (BC) PATIENTS AND METHODS: This cross-sectional cohort study included 78 women with BC that were assessed before treatment. A 6-minute walk test was used to evaluate the subjects' AF, estimating the maximum oxygen consumption (VO2max) to classify the women with BC into 2 groups: good/excellent AF or fair/weak/very weak AF. Dual-energy x-ray absorptiometry was performed to assess body composition. The International Global Physical Activity Questionnaire and the Functional Assessment of Cancer Therapy - Fatigue questionnaires were applied to assess the level of physical activity and the quality of life, respectively. RESULTS Among the women included, the majority (81%) had the luminal subtype of BC. Most of the women were diagnosed with T1/T2 tumors and with negative axillary lymph nodes. We found that women with BC with good/excellent AF (VO2max = 32.9 ± 6.0 mL/kg/min-1) presented significantly lower weight, body mass index, abdominal circumference, percentual and total body fat, and bone mineral density compared with women with fair/weak/very weak AF (VO2max = 21.8 ± 6.9 mL/kg/min-1). Also, women with BC with good/excellent AF showed better performance on physical functional tests. No relationship between estimated VO2max and comorbidities, tumor characteristics, or quality of life was found. CONCLUSION AF is a predictor of body composition and physical function in women with BC. These data suggest that women with BC with higher AF can decrease the chance of adverse effects during BC treatment.
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Affiliation(s)
- Henrique Ims Bortolozo
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Felipe C Vechin
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Guilherme F Maginador
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Izabella Silva Santos
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Renato Torresan
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Miguel S Conceição
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil; School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; Faculty of Physical Education, University of Campinas, Campinas, São Paulo, Brazil.
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Bonikowske AR, Lopez-Jimenez F, Barillas-Lara MI, Barout A, Fortin-Gamero S, Sydo N, Allison TG. Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification. Int J Cardiol 2019; 292:212-217. [DOI: 10.1016/j.ijcard.2019.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/21/2019] [Accepted: 04/09/2019] [Indexed: 02/07/2023]
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5
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Sharma S, Mehta PK, Arsanjani R, Sedlak T, Hobel Z, Shufelt C, Jones E, Kligfield P, Mortara D, Laks M, Diniz M, Bairey Merz CN. False-positive stress testing: Does endothelial vascular dysfunction contribute to ST-segment depression in women? A pilot study. Clin Cardiol 2018; 41:1044-1048. [PMID: 29920702 PMCID: PMC6153069 DOI: 10.1002/clc.23000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The utility of exercise-induced ST-segment depression for diagnosing ischemic heart disease (IHD) in women is unclear. HYPOTHESIS Based on evidence that IHD pathophysiology in women involves coronary vascular dysfunction, we hypothesized that coronary vascular dysfunction contributes to exercise electrocardiography (Ex-ECG) ST-depression in the absence of obstructive coronary artery disease, so-called false positive results. We tested our hypothesis in a pilot study evaluating the relationship between peripheral vascular endothelial function and Ex-ECG. METHODS Twenty-nine asymptomatic women without cardiac risk factors underwent maximal Bruce protocol exercise treadmill testing and peripheral endothelial function assessment using peripheral arterial tonometry (Itamar EndoPAT 2000) to measure reactive hyperemia index (RHI). The relationship between RHI and Ex-ECG ST-segment depression was evaluated using logistic regression and differences in subgroups using 2-tailed t tests. RESULTS Mean age was 54 ± 7 years, body mass index 25 ± 4 kg/m2 , and RHI 2.51 ± 0.66. Three women (10%) had RHI <1.68, consistent with abnormal peripheral endothelial function, whereas 18 women (62%) met criteria for positive Ex-ECG based on ST-segment depression in contiguous leads. Women with and without ST-segment depression had similar baseline and exercise vital signs, metabolic equivalents achieved, and RHI (all P > 0.05). RHI did not predict ST-segment depression. CONCLUSIONS Our pilot study demonstrates high prevalence of exercise-induced ST-segment depression in asymptomatic, middle-aged, overweight women. Peripheral vascular endothelial dysfunction did not predict Ex-ECG ST-segment depression. Further work is needed to investigate the utility of vascular endothelial testing and Ex-ECG for IHD diagnostic and management purposes in women.
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Grants
- U01HL649241 NIA NIH HHS
- N01 HV068161 NHLBI NIH HHS
- U01 HL064829 NHLBI NIH HHS
- 1R03AG032631 NIA NIH HHS
- R03 AG032631 NIA NIH HHS
- K23HL105787 NIA NIH HHS
- N01-HV-68162 NHLBI NIH HHS
- U01HL649141 NIA NIH HHS
- UL1TR000124 NCATS NIH HHS
- N01-HV-68161 NHLBI NIH HHS
- Linda Joy Pollin Women's Heart Health Program and the Erika Glazer Women's Heart Health Project, Cedars-Sinai Medical Center, Los Angeles, CA
- M01 RR000425 NCRR NIH HHS
- K23 HL105787 NHLBI NIH HHS
- UL1 TR001881 NCATS NIH HHS
- R01 HL090957 NHLBI NIH HHS
- UL1 TR000064 NCATS NIH HHS
- Barbra Streisand Women's Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, CA
- N01-HV-68163 NHLBI NIH HHS
- R01HL090957 NIA NIH HHS
- U0164829 NIA NIH HHS
- UL1TR000064 NCATS NIH HHS
- N01-HV-68164 NHLBI NIH HHS
- Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA
- Edythe L. Broad and the Constance Austin Women's Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, California
- T32HL69751 NIA NIH HHS
- UL1 TR000124 NCATS NIH HHS
- QMED, Inc., Laurence Harbor, NJ
- Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ
- K23 HL127262 NHLBI NIH HHS
- N01 HV068164 NHLBI NIH HHS
- K23HL127262 NIA NIH HHS
- MO1-RR00425 NCRR NIH HHS
- N01 HV068163 NHLBI NIH HHS
- N01 HV068162 NHLBI NIH HHS
- Women's Guild of Cedars-Sinai Medical Center, Los Angeles, CA
- Society for Women's Health Research (SWHR), Washington, DC
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Affiliation(s)
- Shilpa Sharma
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
| | - Puja K. Mehta
- Emory Women's Heart CenterEmory UniversityAtlantaGeorgia
| | - Reza Arsanjani
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
| | - Tara Sedlak
- Gordon and Leslie Diamond Health Care CentreVancouver General HospitalVancouverBritish ColumbiaCanada
| | - Zachary Hobel
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
| | - Erika Jones
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
| | - Paul Kligfield
- Department of MedicineNew York Presbyterian/Weill Cornell Medical CollegeNew YorkNew York
| | | | - Michael Laks
- UCLA David Geffen School of MedicineLos AngelesCalifornia
| | - Márcio Diniz
- Samuel Oschin Cancer InstituteCedars‐Sinai Medical CenterLos AngelesCalifornia
| | - C. Noel Bairey Merz
- Barbra Streisand Women's Heart CenterCedars‐Sinai Smidt Heart InstituteLos AngelesCalifornia
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Thompson HJ, Jones LW, Koch LG, Britton SL, Neil ES, McGinley JN. Inherent aerobic capacity-dependent differences in breast carcinogenesis. Carcinogenesis 2017; 38:920-928. [PMID: 28911004 DOI: 10.1093/carcin/bgx066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/22/2017] [Indexed: 12/22/2022] Open
Abstract
Although regular physical activity is associated with improvement in aerobic capacity and lower breast cancer risk, there are heritable sets of traits that affect improvement in aerobic capacity in response to physical activity. Although aerobic capacity segregates risk for a number of chronic diseases, the effect of the heritable component on cancer risk has not been evaluated. Therefore, we investigated breast carcinogenesis in rodent models of heritable fitness in the absence of induced physical activity. Female offspring of N:NIH rats selectively bred for low (LIAC) or high (HIAC) inherent aerobic capacity were injected intraperitoneally with 1-methyl-1-nitrosurea (70 mg/kg body wt). At study termination 33 weeks post-carcinogen, cancer incidence (14.0 versus 47.3%; P < 0.001) and multiplicity (0.18 versus 0.85 cancers per rat; P < 0.0001) were significantly decreased in HIAC versus LIAC rats, respectively. HIAC had smaller visceral and subcutaneous body fat depots than LIAC and activity of two proteins that regulated the mammalian target of rapamycin, protein kinase B (Akt), and adenosine monophosphate-activated protein kinase were suppressed and activated, respectively, in HIAC. Although many factors distinguish between HIAC and LIAC, it appears that the protective effect of HIAC against breast carcinogenesis is mediated, at least in part, via alterations in core metabolic signaling pathways deregulated in the majority of human breast cancers.
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Affiliation(s)
- Henry J Thompson
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO 80523-1173, USA
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY 10065, USA
| | - Lauren G Koch
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Steven L Britton
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.,Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Elizabeth S Neil
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO 80523-1173, USA
| | - John N McGinley
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO 80523-1173, USA
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Zafrir B. The prognostic value of exercise testing: Exercise capacity, hemodynamic response, and cardio-metabolic risk factors. Eur J Prev Cardiol 2017; 24:1624-1626. [PMID: 28825312 DOI: 10.1177/2047487317727337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Israel
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Zafrir B, Azencot M, Dobrecky-Mery I, Lewis BS, Flugelman MY, Halon DA. Resting heart rate and measures of effort-related cardiac autonomic dysfunction predict cardiovascular events in asymptomatic type 2 diabetes. Eur J Prev Cardiol 2015; 23:1298-306. [PMID: 26701872 DOI: 10.1177/2047487315624747] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes. METHODS We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute. Cox proportional hazards analysis was used to determine the association of exercise parameters with a composite outcome of all-cause mortality, myocardial infarction or stroke. RESULTS Resting heart rate >100 beats/minute was observed in 18% of patients, chronotropic incompetence in 30% and heart rate recovery at 1 minute <18 beats/minute in 35%. Over 79 ± 16 months, there were 72 (12%) events. Each parameter was significantly associated with event risk in an adjusted multivariate analysis: chronotropic incompetence (hazard ratio 1.89, 95% confidence interval 1.18-3.01; P = 0.008), resting heart rate ≥100 beats/minute (hazard ratio 1.97, 95% confidence interval 1.19-3.26; P = 0.008) and heart rate recovery at 1 minute <18 beats (hazard ratio 1.77, 95% confidence interval 1.12-2.81; P = 0.015). A progressive relationship between the number of abnormal parameters and event risk was observed (log rank P < 0.001). CONCLUSIONS Chronotropic incompetence, resting tachycardia and reduced heart rate recovery are independently and additively associated with long-term mortality, myocardial infarction or stroke in type 2 diabetes without known coronary heart disease.
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Affiliation(s)
- Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Mali Azencot
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | | | - Basil S Lewis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - Moshe Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
| | - David A Halon
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel; the Ruth and Bruce Rappaport School of Medicine, New York, USA
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Hanifah RA, Majid HA, Jalaludin MY, Al-Sadat N, Murray LJ, Cantwell M, Su TT, Nahar AM. Fitness level and body composition indices: cross-sectional study among Malaysian adolescent. BMC Public Health 2014; 14 Suppl 3:S5. [PMID: 25436933 PMCID: PMC4251133 DOI: 10.1186/1471-2458-14-s3-s5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of fitness level on the well-being of children and adolescent has long been recognised. The aim of this study was to investigate the fitness level of school-going Malaysian adolescent, and its association with body composition indices. METHODS 1071 healthy secondary school students participated in the fitness assessment for the Malaysian Health and Adolescents Longitudinal Research Team (MyHEART) study. Body composition indices such as body mass index for age, waist circumference and waist height ratio were measured. Fitness level was assessed with Modified Harvard Step Test. Physical Fitness Score was calculated using total time of step test exercise and resting heart rates. Fitness levels were divided into 3 categories - unacceptable, marginally acceptable, and acceptable. Partial correlation analysis was used to determine the association between fitness score and body composition, by controlling age, gender, locality, ethnicity, smoking status and sexual maturation. Multiple regression analysis was conducted to determine which body composition was the strongest predictor for fitness. RESULTS 43.3% of the participants were categorised into the unacceptable fitness group, 47.1% were considered marginally acceptable, and 9.6% were acceptable. There was a significant moderate inverse association (p < 0.001) between body composition with fitness score (r = -0.360, -0.413 and -0.403 for body mass index for age, waist circumference and waist height ratio, respectively). Waist circumference was the strongest and significant predictor for fitness (ß = -0.318, p = 0.002). CONCLUSION Only 9.6% of the students were fit. There was also an inverse association between body composition and fitness score among apparently healthy adolescents, with waist circumference indicated as the strongest predictor. The low fitness level among the Malaysian adolescent should necessitate the value of healthy lifestyle starting at a young age.
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Dhoble A, Lahr BD, Allison TG, Kopecky SL. Cardiopulmonary fitness and heart rate recovery as predictors of mortality in a referral population. J Am Heart Assoc 2014; 3:e000559. [PMID: 24663334 PMCID: PMC4187478 DOI: 10.1161/jaha.113.000559] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Exercise testing provides valuable information in addition to ST-segment changes. The present study evaluated the associations among exercise test parameters and all-cause mortality in a referral population. METHODS AND RESULTS We examined conventional cardiovascular risk factors and exercise test parameters in 6546 individuals (mean age 49 years, 58% men) with no known cardiovascular disease who were referred to our clinic for exercise stress testing between 1993 and 2003. The association of exercise parameters with mortality was assessed during a follow-up of 8.1±3.7 years. A total of 285 patients died during the follow-up period. Adjusting for age and sex, the variables associated with mortality were: smoking, diabetes, functional aerobic capacity (FAC), heart rate recovery (HRR), chronotropic incompetence, and angina during the exercise. Adjusting for cardiovascular risk factors (diabetes, smoking, body mass index, blood pressure, serum total, HDL, LDL cholesterol, and triglycerides) and other exercise variables in a multivariable model, the only exercise parameters independently associated with mortality were lower FAC (adjusted hazard ratio [HR] per 10% decrease in FAC, 1.21; 95% confidence interval [CI], 1.13 to 1.29; P<0.001), and abnormal HRR, defined as failure to decrease heart rate by 12 beats at 1 minute recovery (adjusted HR per 1-beat decrease, 1.05; 95% CI, 1.03 to 1.07; P<0.001). The additive effects of FAC and HRR on mortality were also highly significant when considered as categorical variables. CONCLUSION In this cohort of patients with no known cardiovascular disease who were referred for exercise electrocardiography, FAC and HRR were independently associated with all-cause mortality.
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Affiliation(s)
- Abhijeet Dhoble
- Cardiovascular Health Clinic, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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Zheng H, Li Y, Dai W, Wei C, Sun K, Tong Y. Role of Endogenous Estrogen on the Incidence of Coronary Heart Disease in Men. Angiology 2012; 63:591-6. [PMID: 22241543 DOI: 10.1177/0003319711432626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estrogens protect the vascular system in women, but its effect in men is unclear. We evaluated the impact of estrogen on the male cardiovascular system. Of 140 Chinese males, 55 (aged 61.2 ± 3.5) were cases and 60 (aged 59.5 ± 4.6) were controls. Compared with the control group, only serum estradiol ([E2]; P < .01) levels but not testosterone ([T]; P = .21) were significantly lower in the cases. Linear and multiple regression analysis showed that serum T was positively associated with triglycerides ([TG]; r = .439, P < .01) and d-dimer ( r = .258, P < .05) but negatively associated with high-density lipoprotein cholesterol (HDL-C) levels ( r = −.267, P < .05) and C-reactive protein (CRP; r = −.214, P < .05). Estradiol was highly associated with TG ( r = .783, P < .01) and HDL-C ( r = .515, P < .01) but was negatively related with low-density lipoprotein cholesterol (LDL-C; P < .05), total cholesterol/HDL-C ( P < .05), CRP ( P < .01), and d-dimer ( P < .01). In conclusion, serum E2 and T levels affect coronary heart disease risk factors in males.
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Affiliation(s)
- Hongyun Zheng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wen Dai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chuandong Wei
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kaisheng Sun
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yongqing Tong
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
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12
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de Liefde II, Verhagen HJM, Stolker RJ, van Domburg RT, Poldermans D. The value of treadmill exercise test parameters together in patients with known or suspected peripheral arterial disease. Eur J Prev Cardiol 2011; 19:192-8. [PMID: 21450584 DOI: 10.1177/1741826711399986] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise test parameters (exercise ankle brachial index (ABI), walking distance and blood pressure response) separately are associated with long-term outcome in patients with known or suspected peripheral arterial disease (PAD). However, the clinical value of the combination of these parameters together is unknown. METHODS 2165 patients performed a treadmill exercise test to diagnose or to evaluate their PAD. Resting ABI, exercise ABI, abnormal blood pressure response (hypotensive and hypertensive) and walking distance (impairment <150 m) were measured. The study population was divided into patients with a resting ABI ≥ 0.90 and patients with PAD (resting ABI < 0.90). RESULTS The mean follow-up period was 5 years (0.5-14 years). Long-term mortality rate and risks increases when more exercise parameters became abnormal (p-value = 0.001). Patients with a normal resting ABI but with an abnormal exercise test had a higher mortality risk--HR 1.90 (1.32-2.73)--than patients with a normal exercise test. The highest mortality risk and cardiac death was observed in PAD patients with a walking impairment together with an abnormal blood pressure response--HR 3.48 (2.22-5.46). CONCLUSION Exercise tests give multiple parameters, which together provide important prognostic information on long-term outcome in both patients with normal resting ABI and PAD.
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Affiliation(s)
- Inge I de Liefde
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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13
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Ho JS, FitzGerald SJ, Barlow CE, Cannaday JJ, Kohl HW, Haskell WL, Cooper KH. Risk of mortality increases with increasing number of abnormal non-ST parameters recorded during exercise testing. ACTA ACUST UNITED AC 2010; 17:462-8. [DOI: 10.1097/hjr.0b013e328336a10d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Harold W. Kohl
- University of Texas Health Science Center and University of Texas, Austin, Texas
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14
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Lyerly GW, Sui X, Church TS, Lavie CJ, Hand GA, Blair SN. Maximal exercise electrocardiographic responses and coronary heart disease mortality among men with metabolic syndrome. Mayo Clin Proc 2010; 85:239-46. [PMID: 20160139 PMCID: PMC2843111 DOI: 10.4065/mcp.2009.0509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the association between abnormal exercise electrocardiographic (E-ECG) test results and mortality (all-cause and that resulting from coronary heart disease [CHD] or cardiovascular disease [CVD]) in a large population of asymptomatic men with metabolic syndrome (MetS). PATIENTS AND METHODS A total of 9191 men (mean age, 46.9 years) met the criteria of having MetS. All completed a maximal E-ECG treadmill test (May 14, 1979, through April 9, 2001) and were without a previous CVD event or diabetes at baseline. Main outcomes were all-cause mortality, mortality due to CHD, and mortality due to CVD. Cox regression analysis was used to quantify the mortality risk according to E-ECG responses. RESULTS During a follow-up of 14 years, 633 deaths (242 CVD and 150 CHD) were identified. Mortality rates and hazard ratios (HRs) across E-ECG responses were the following: for all-cause mortality: HR, 1.36; 95% confidence interval (CI), 1.09-1.70 for equivocal responses and HR, 1.41; 95% CI, 1.12-1.77 for abnormal responses (P(trend)<.001); for mortality due to CVD: HR, 1.29; 95% CI, 0.88-1.88 for equivocal responses and HR, 2.04; 95% CI, 1.46-2.84 for abnormal responses (P(trend)<.001); and for mortality due to CHD: HR, 1.62; 95% CI, 1.02-2.56 for equivocal responses and HR, 2.45; 95% CI, 1.62-3.69 for abnormal responses (P(trend)<.001). A positive gradient for CHD, CVD, and all-cause mortality rates across E-ECG categories within 3, 4, or 5 MetS components was observed (P<.001 for all). CONCLUSION Among men with MetS, an abnormal E-ECG response was associated with higher risk of all-cause, CVD, and CHD mortality. These findings underscore the importance of E-ECG tests to identify men with MetS who are at risk of dying.
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Affiliation(s)
- G William Lyerly
- Department of Kinesiology, School of Health, Kinesiology, and Sport Studies, Coastal Carolina University, PO Box 261954, Conway, SC 29528, USA.
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15
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Lavie CJ, Thomas RJ, Squires RW, Allison TG, Milani RV. Exercise training and cardiac rehabilitation in primary and secondary prevention of coronary heart disease. Mayo Clin Proc 2009; 84:373-83. [PMID: 19339657 PMCID: PMC2665984 DOI: 10.1016/s0025-6196(11)60548-x] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Substantial data have established a sedentary lifestyle as a major modifiable risk factor for coronary heart disease (CHD). Increased levels of physical activity, exercise training, and overall cardiorespiratory fitness have provided protection in the primary and secondary prevention of CHD. This review surveys data from observational studies supporting the benefits of physical activity, exercise training, and overall cardiorespiratory fitness in primary prevention. Clearly, cardiac rehabilitation/secondary prevention (CRSP) programs have been greatly underused by patients with CHD. We review the benefits of CRSP programs on CHD risk factors, psychological factors, and overall CHD morbidity and mortality. These data support the routine referral of patients with CHD to CRSP programs. Patients should be vigorously encouraged to attend these programs.
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Affiliation(s)
- Carl J Lavie
- Cardiac Rehabilitation and Exercise Laboratories, Ochsner Medical Center, New Orleans, LA 70121-2483, USA.
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