Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations

Do Lifestyle Interventions Mitigate the Oxidative Damage and Inflammation Induced by Obesity in the Testis?

Obesity results from a disproportionate accumulation of fat and has become a global health concern. The increase in adipose tissue is responsible for several systemic and testicular changes including hormone levels (leptin, adiponectin, testosterone, estrogen), inflammatory cytokines (increase in TNF-α and IL-6 and decrease in IL-10), and redox state (increase in reactive oxygen species and reduction in antioxidant enzymes). This results in poor sperm quality and compromised fertility in men with obesity. Lifestyle modifications, particularly diet transition to caloric restriction and physical exercise, are reported to reverse these negative effects. Nevertheless, precise mechanisms mediating these benefits, including how they modulate testicular oxidative stress, inflammation, and metabolism, remain to be fully elucidated. The main pathway described by which these lifestyle interventions reverse obesity-induced oxidative damage is the Nrf2-SIRT1 axis, which modulates the overexpression of antioxidant defenses. Of note, some of the detrimental effects of obesity on the testis are inherited by the descendants of individuals with obesity, and while caloric restriction reverses some of these effects, no significant work has been carried out regarding physical exercise. This review discusses the consequences of obesity-induced testicular oxidative stress on adult and pediatric populations, emphasizing the therapeutic potential of lifestyle to mitigate these detrimental effects.

Proteomic analysis of spinal dorsal horn in prior exercise protection against neuropathic pain

Neuropathic pain (NP) is a complex and prevalent chronic pain condition that affects millions of individuals worldwide. Previous studies have shown that prior exercise protects against NP caused by nerve injury. However, the underlying mechanisms of this protective effect remain to be uncovered. Therefore, the purpose of this study is to investigate how prior exercise affects protein expression in NP model rats and thus gain comprehensive insights into the molecular mechanisms involved. To achieve this objective, 6-week-old male Sprague-Dawley rats were randomly assigned into three groups, named as chronic constriction injury (CCI) of the sciatic nerve, CCI with prior 6-week swimming training (CCI_Ex), and sham operated (Sham). The CCI_Ex group underwent 6 weeks of swimming training before CCI surgery, while the CCI and sham groups had no intervention. Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were used as the main observation indicators to evaluate the behavioral changes associated with pain. Tissues from the spinal dorsal horn of the rats in the three groups were collected at 4 weeks after operation. LC-MS/MS proteomic analysis based on the label-free approach was used to detect protein profiles, and volcano plots, Venn diagrams, and clustering heatmaps were used to identify differentially expressed proteins (DEPs). Gene Ontology (GO) annotations, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and protein-protein interaction networks were employed to explore the biological importance of DEPs. At 14, 21, and 28 days following CCI, CCI rats with prior exercise showed a significant increase in the MWT and TWL of the injured lateral hind paw compared with those without exercise. A total of 122 proteins with significant changes in abundance were detected after CCI surgery, and 55 proteins were detected in the comparison between the CCI_Ex and CCI groups. GO and KEGG enrichment analysis revealed that oxygen transport capacity and the complement and coagulation cascades may be the critical mechanism by which prior exercise protects against NP. Serpina1, DHX9, and Alb are the key proteins in this process and warrant further attention, as confirmed by the results of Western blot analysis. In conclusion, this study provides new evidence that active physical activity can accelerate the relief of hyperalgesia after NP. Proteomic analyses revealed the potential target proteins and pathways for this process, offering valuable data resources and new insights into the pathogenesis and therapeutic targets of NP.

Exercise and Fitness Quantification in Clinical Practice: Why and How; and Where Are We Going?

Exercise and fitness quantification is increasingly recognized as a critical component in clinical practice, particularly within preventive cardiology. In this article we explore the multifaceted importance of exercise quantification in clinical settings, addressing preventive care, cost-effectiveness, psychosocial benefits, treatment planning, and monitoring progress. Quantifying exercise habits allows clinicians to evaluate risk profiles, prescribe tailored interventions, and monitor patient progress. The methodologies for exercise quantification are discussed. In preventive cardiology, adherence to guidelines from organizations such as the American Heart Association, the European Society of Cardiology, and the Canadian Cardiovascular Society is emphasized, with particular focus on high-intensity interval training and the central role of physical therapists/kinesiologists. Special populations, such as weekend warriors, those reflecting the "fat and fit" concept, athletes, and those at risk of overtraining syndrome, are considered in prescribing exercise. Future directions in exercise and fitness quantification include the integration of advanced wearable technology, personalized medicine, telemedicine, and promotion of active, walkable communities. The incorporation of behavioral science is highlighted as a missing component that can enhance long-term adherence to exercise regimens through motivation, behavior change techniques, patient-centered approaches, and continuous monitoring and feedback. This comprehensive approach aims to optimize cardiovascular health and overall well-being through individualized, evidence-based exercise interventions that are both effective and sustainable.

Time to Elicit Physiological and Exertional Vigorous Responses from Daily Living Activities: Setting Foundations of an Empirical Definition of VILPA

PURPOSE

Vigorous intermittent lifestyle physical activity (VILPA) are bursts of incidental vigorous activity that occur during day-to-day activities outside of the exercise-domain. Vigorous intermittent lifestyle physical activity has shown promise in lowering risk of mortality and chronic disease. However, there is an absence of an empirically derived definition. Using physiological and effort-based metrics commonly used to define vigorous intensity, we investigated the minimum time needed to elicit physiological and perceived exertion responses to standardized activities of daily living.

METHODS

Seventy adults (age = 58.0 ± 9.6 yr; 35 female) completed 9 VILPA activities of daily living in a randomized order, which included fast walking, fast incline walking, stair climbing, stationary cycling, and carrying external weight equal to 5% and 10% of body weight. Metabolic rate (by continuous indirect calorimetry), heart rate (telemetry) and perceived effort (Borg Scale) were measured during exercise. Time to reach VILPA was assessed using %V̇O 2max , %HRmax, and rating of perceived exertion thresholds.

RESULTS

The mean time to elicit VILPA ranged from 65 to 95 s (mean ± sd = 76.7 ± 3.8 s) for %V̇O 2max , 68 to 105 s (mean ± sd = 82.8 ± 6.8 s) for %HRmax, and 20 to 60 s (mean ± sd = 44.6 ± 6.7 s) for rating of perceived exertion. For each of the three indices, there was no difference in the time to elicit VILPA responses by sex or age ( P > 0.08), and times were also consistent between activities of daily living tasks. For example, for females and males, the average time to elicit vigorous responses while walking on a flat surface was 85.8 s (±16.9 s) and 80 s (±13.9 s), respectively, and for stair climbing while carrying 10% of body weight the duration was 78.4 s (±17.6 s) and 76.9 (±17.7 s).

CONCLUSIONS

When participants undertook activities of daily living, VILPA elicited a physiological response at an average of 77 to 83 s for %V̇O 2max and %HRmax, and 45 s for perceived exertion. The absence of a difference in the time to reach VILPA between sex and age suggests that a consistent behavioral VILPA translation can be used in interventions and population-based studies designed to assess the health effects of incidental physical activity.

Meeting Aerobic Physical Activity Guidelines and Associations With Physical Fitness in Men With Metastatic Prostate Cancer: Baseline Results of the Multicentre INTERVAL-GAP4 Trial

BACKGROUND

This study compared the physical activity level of men with metastatic prostate cancer at baseline of the multicentre INTERVAL-GAP4 trial to the American Cancer Society guidelines and examined associations with physical fitness.

METHODS

A total of 140 men on androgen deprivation therapy (ADT) were included in this cross-sectional analysis of baseline data from the INTERVAL-GAP4 trial. Exclusion criteria included a maximum of 1 h of vigorous aerobic exercise or one structured resistance exercise session per week but no restrictions on habitual physical activity. Moderate-to-vigorous physical activity (MVPA) was assessed using a modified Godin-Shephard Leisure-Time Physical Activity Questionnaire. Physical fitness measurements included peak oxygen consumption (VO2peak), maximal power output (Wmax), 400 m walk time, one-repetition maximum (1RM) of leg extension, leg press, chest press and seated row, and handgrip strength. Quantile regression was used to analyse associations of MVPA with physical fitness outcomes at the 25th, 50th and 75th percentiles of the physical fitness distributions.

RESULTS

Total self-reported MVPA was 60 (IQR: 0, 180) min per week, with 29% meeting the aerobic physical activity guidelines. There was a statistically significant association of higher MVPA with higher relative VO2peak at the 25th (β = 0.53, p = 0.020) and 75th percentiles (β = 0.66, p = 0.001), relative Wmax at the 25th (β = 0.05, p = 0.003), 50th (β = 0.05, p = 0.009) and 75th percentiles (β = 0.07, p = 0.004) and reduced 400 m walk time at the 75th percentile (β = -4.26, p = 0.023), with β corresponding to the change in the dependent variable for each one-hour increase in weekly MVPA.

CONCLUSION

Few men recruited to the INTERVAL-GAP4 trial were meeting aerobic physical activity guidelines at baseline. Higher MVPA was associated with better aerobic capacity and walking performance but not maximal strength in men with metastatic prostate cancer on ADT.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02730338; German Clinical Trials Register: DRKS00010310.

A comparative study of university training of sports and physical activity kinesiologist

BACKGROUND

In Italy, Legislative Decree No. 36/2021 and Ministerial Decree (MD) No. 1649/2023 have redefined the professional landscape of the physical activity and health sectors, emphasizing interdisciplinary and wellness-oriented education. The current disparity in the weighting of formative elements among the biomedical, psycho-pedagogical, and Exercise and Sport Sciences (ESS) fields in the configuration of degree courses in ESS has led to a need for reform. MD No. 1649/2023 offers an opportunity to reform these courses to emphasize interdisciplinary and wellness-oriented objectives, including at least 20 ECTS credits of practical activities in ESS disciplines. However, the impact of practical and laboratory activities on future kinesiologists has never been studied. This study aims to evaluate the impact of physical activity habits on the performance and self-assessment of ESS students.

METHOD

A sample of 56 students enrolled in the Master of Science in Sport Science and Techniques at the University of Salerno was divided into "active" and "inactive" groups based on their physical activity levels, according to WHO guidelines. Both groups underwent anthropometric and functional tests, including the Squat Jump (SJ) and Countermovement Jump (CMJ). Descriptive statistics and t-tests assessed the differences between and within groups.

RESULTS

The "active" group exhibited significantly higher performance in SJ (15.7% higher) and CMJ (18.5% higher) compared to the "inactive" group. Both groups showed significant improvements in jump height from SJ to CMJ, with the "active" group improving by 11.04% and the 'non-active' group by 7.38%.

CONCLUSION

Continuous physical activity enhances functional efficiency, with significant gains in explosive and reactive strength. Practical, evidence-based training is crucial for future kinesiologists to provide specialized services and promote health, underscoring the importance of integrating substantial practical activities in ESS degree courses.

Facilitators and barriers of initiation and maintenance of physical activity among people with coronary heart disease: a qualitative study

PURPOSE

We aimed to describe the facilitators and barriers of physical activity for patients with coronary heart disease.

METHODS

A qualitative descriptive study using semi-structured interviews was conducted with 15 participants with coronary heart disease. The interview guide was developed based on a multi-theory model. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis.

RESULTS

Two main themes were identified: facilitators of initiation and maintenance of physical activity (behavioral motivation, perceived benefits, behavioral confidence, supportive physical environment, positive emotional experience, self-regulation, supportive social environment, illness perception, and excellent self-control), barriers of initiation and maintenance of physical activity (perceived barriers, restricted physical environment, psychological distress, insufficient social support, and poor self-control).

CONCLUSIONS

This study presents an in-depth theory-based exploration of facilitators and barriers to initiating and maintaining physical activity among people with coronary heart disease. Relevant factors should be taken into account to increase their effectiveness when designing the target interventions to encourage a physically active lifestyle in this population.

A geographic perspective of the association between physical activity and cardiovascular health: A need for community-level intervention

Cardiovascular diseases (CVDs) are a major cause of death globally, and minority communities are at higher risk of chronic health outcomes. A combination of lifestyle, including physical activity (PA), good nutrition, and reduced stress, can improve life expectancy. This study aimed to analyze the association between CVDs and PA among the adult population (N = 3,956) based on the World Health Organization (WHO) STEPwise Approach to Surveillance (STEPS) survey in Afghanistan. Descriptive statistics, logistic regression, and spatial analytical techniques were used to analyze the data. Based on the WHO STEPS data, the computed prevalence of CVDs, obesity, hypertension, diabetes, and high cholesterol were 7.41%, 45.57%, 34.06%, 9.51%, and 12.16%, respectively. Multivariate logistic analysis indicated that moderate work-related PA was associated with higher odds of CVDs and high cholesterol while inversely associated with obesity. Moderate leisure-related PA was positively associated with obesity. Vigorous leisure-related PA was associated with lower risks of CVDs, obesity, and high cholesterol but had a positive association with hypertension. Spatial analysis revealed a CVD hotspot in the southern region and the risk factors clustered in the northern region. These findings offer valuable insights for community and public health practitioners to design targeted interventions for reducing the burden of CVDs and risk factors in communities in developing countries.

Liver at crossroads: unraveling the links between obesity, chronic liver diseases, and the mysterious obesity paradox

Obesity is a global health issue that is intricately linked to the development and progression of chronic liver disease (CLD). This bidirectional connection, coupled with the obesity paradox (OP), presents a management dilemma. The established influence of obesity on the development and progression of chronic liver disease (CLD) is surpassed by the liver's impact on the onset and advancement of obesity. Patients with CLD always experience increased energy expenditure, reduced appetite, and low protein synthesis, all of which might lead to weight loss. However, metabolic disturbances, hormonal imbalances, inflammatory signaling, immobility, drugs, and alterations in nutrient metabolism can contribute to the development and exacerbation of obesity. Despite the propagation of the OP concept, none of the guidelines has changed, recommending being overweight. Research bias and confounders might be the lifebuoy explanation. Additionally, overlooking the lethal morbidities of obesity for survival benefits full of suffering seems to be an illogical idea. Therefore, rather than endorsing an overweight status, emphasis should be placed on improving cardiorespiratory fitness and preventing sarcopenia to achieve better outcomes in patients with CLD. Accordingly, the complex interplay between obesity, CLD, and the concept of OP requires a sophisticated individualized management approach. Maximizing cardiorespiratory fitness and mitigating sarcopenia should be considered essential strategies for attaining the most favourable outcomes in patients with chronic liver disease (CLD).

Community-Based Physical Activity Programs for Blood Pressure Management in African Americans: A Scoping Review

BACKGROUND

Hypertension is a significant risk factor for cardiovascular disease, with a higher prevalence among African Americans (AA) than other racial groups. The impact of community-based interventions on managing blood pressure (BP) in AA communities is not fully understood. The purpose of this review was to synthesize literature on community-based physical activity (PA) programs designed to manage BP in AA populations.

METHODS

We conducted a scoping review by searching 4 databases (PubMed, CINAHL, MEDLINE, and APA PsycInfo) and reference lists of studies. Search terms included community PA, community-based, hypertension, high BP, AA, Black Americans, PA, and exercise. Inclusion criteria were studies (1) conducted in the United States and (2) published in English language from January 2013 to September 2023, with community-based interventions that included PA for BP management among AA aged ≥18 years.

RESULTS

Search results yielded 260 studies, of which 11 met the inclusion criteria. BP decreased over time in studies that incorporated PA, faith-based therapeutic lifestyle changes with nutritional education. The duration of the PA interventions varied, with moderate to vigorous PAs implemented for 12 weeks or longer having a greater impact on BP management.

CONCLUSIONS

Evidence suggests that community-based PA programs can potentially reduce BP among AA. PA programs incorporating faith-based therapeutic lifestyle change with nutritional education appear to reduce BP. Practitioners should consider multicomponent community-based PA initiatives to improve BP outcomes in AA communities.

Prevention and control of risk factors in metabolic and alcohol-associated steatotic liver disease

Steatotic liver disease (SLD), including metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD), is the primary cause of illness and mortality. In particular, MASLD affects more than 30% of the global population, while ALD accounts for 5.1% of all diseases and injuries worldwide. The SLD spectrum includes a variety of clinical conditions, from mild fatty liver and inflammation to different stages of liver fibrosis. Additionally, both conditions (MASLD and ALD) can be complicated by hepatocellular carcinoma (HCC), while around one-third of ALD patients can also develop at least one alcohol‐associated hepatitis (AH) episode. Both of these diseases are also associated with multiple extrahepatic complications, such as cardiovascular disease, chronic kidney disease, and malignancies. In MASLD, the rapid rise in global obesity and type 2 diabetes mellitus (T2DM) prevalence due to Westernized lifestyles has led to an increase in the prevalence of MASLD. Thus, the prevention and control of cardiometabolic risk factors (CMRFs) are the cornerstone of its treatment. Hypertension and atherogenic dyslipidemia are also important CMRFs associated with MASLD. Susceptible individuals with MASLD are adversely affected by even a small amount of alcohol consumption (though there is no agreed definition of a small amount), increasing the risk of severe outcomes and a faster progression of liver disease. This review explores factors that play a role in the development of SLD, especially focusing on the management of CMRFs and levels of alcohol use to prevent liver disease progression.

Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial

Background

Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined.

Methods

A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed.

Results

The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study.

Conclusion

Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.

New Public Health and Sport Medicine Institutions Guidelines of Physical Activity Intensity for Pregnancy-A Scoping Review

Background: Before starting PA, pregnant women should select the appropriate type of training and adjust its components to the development of pregnancy and her capabilities. This review aimed to analyze current recommendations for pregnant women on methods for determining and assessing PA intensity levels and characterize the extent and nature of the information provided to pregnant women in official documents published by public health and sports medicine institutions. Methods: The review was conducted as per the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched scientific databases (PubMed, ScienceDirect, Web of Science, Academic Search Complete, and SPORTDiscus with Full Text via EBSCO) and the Internet to identify papers regarding recommendations for the PA intensity level for pregnant women. We analyzed 22 eligible guidelines, published over the last 10 years in English, from nine countries and three international organizations. Results: The PA of pregnant women should be at a moderate level. As for higher levels, the analyzed recommendations are contradictory. Methods for assessing PA intensity levels are often not included. The most frequently recommended methods for determining and assessing the PA intensity level for pregnant women are the rating of perceived exertion, the Talk Test, and heart rate measurements. Few guidelines offer specific advice for highly active women (e.g., elite athletes) or trimester-specific considerations. Conclusions: The number of published recommendations regarding PA during pregnancy has increased over the last decade. The amount of information on PA intensity levels is still insufficient. There is a need to update them, based on high-quality scientific work.

Lifestyle Intervention for the Prevention of Cardiovascular Disease

Lifestyle medicine is a cornerstone of cardiovascular disease prevention and early disease intervention. A leading cause of death in developed countries, modifiable risk factors of cardiovascular disease like diet, exercise, substance use, and sleep hygiene have significant impacts on population morbidity and mortality. One should address these amendable risks in all patients, independently, and stress the importance of intervention adherence while avoiding the sacrifice of patient trust. One must also understand a patient's psychological well-being can be compromised by organic chronic disease states, and poor psychological well-being can have a negative impact on patient compliance and overall health.

Associations Between Risk Factors of Cardiovascular Disease in Young Adults

Introduction

Cardiovascular disease (CVD) impacts 50% of U.S. adults although few studies evaluate young adults' cardiovascular disease risk. Early identification of cardiovascular disease risk may mitigate increased adulthood incidence. We analyzed (CVD) risk factors and their association with cardiovascular fitness (V ˙ o2max) to devise effective strategies to improve cardiovascular health across the lifespan.

Methods

A cross-sectional study evaluated the effect of a single bout of aerobic exercise on cardiovascular disease risk factors in adults aged 18 to 36 years. Glycemic control (HbA1C), cardiovascular fitness (V ˙ o2max), percent body fat, lean body mass, waist circumference, and body mass index (BMI) were analyzed using correlation analysis and multiple linear regression.

Results

Statistically significant relationships were observed between percent body fat (r = .83, P < .001) and BMI, and waist circumference (r = .83, P < .001) and BMI. Percent body fat (P < .001) and race (P = .018) predicted exercise time, with Asians exercising the longest. Percent fat (P < .001) and HbA1C (P = .039) were identified as predictors of cardiovascular fitness which was low in spite of primarily normal average HbA1C levels.

Conclusions

HbA1C and body fat negatively influence cardiovascular fitness (V ˙ o2max) in young adults increasing adulthood cardiovascular disease risk. Research investigating the effect of HbA1C on cardiovascular health especially in youth is warranted.

Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study

OBJECTIVE

To examine the joint associations between physical activity and abdominal obesity with the risk of cardiovascular disease (CVD) events.

METHODS

We included 70 830 UK Biobank participants (mean age±SD=61.6 ± 7.9 years; 56.4% women) with physical activity measured by wrist-worn accelerometers and without major chronic diseases. Participants were jointly categorised into six groups based on their physical activity level (tertiles of total volume and specific intensity levels) and presence or absence of abdominal obesity based on measured waist circumference. Associations with incident CVD (fatal and non-fatal events) were determined using proportional subdistribution hazard models with multivariable adjustment.

RESULTS

After excluding events during the first 2 years of follow-up, participants were followed for a median of 6.8 years, during which 2795 CVD events were recorded. Compared with the low abdominal adiposity and highest tertile of physical activity, abdominal obesity was associated with higher risk of incident CVD, especially in those with low levels of vigorous-intensity physical activity (HR 1.42, 95% CI 1.22 to 1.64). Approximately 500 min per week of moderate-to-vigorous intensity and approximately 30-35 min of vigorous-intensity physical activity offset the association of abdominal obesity and the risk of having a CVD event.

CONCLUSION

Physical activity equivalent to approximately 30-35 min of vigorous intensity per week appears to offset the association between abdominal obesity and incident CVD. About 15 times more physical activity of at least moderate intensity is needed to achieve similar results.

Full Familiarisation Is Not Required for the Self-Paced 1 km Treadmill Walk to Predict Peak Oxygen Uptake in Phase IV Cardiac Patients

Exercise is a recommended part of phase IV cardiovascular rehabilitation (CR). The 1 km treadmill walk test (1-KTWT) is a submaximal continuous exercise test to predict cardiorespiratory fitness in patients with cardiovascular disease. We examined physiological, metabolic and subjective responses in patients with cardiovascular disease with self-selected, unchanging walking speed for two 1-KTWTs. Fifteen men (age: 65 ± 9 yr, height: 174 ± 5 cm, body mass: 86 ± 17 kg, BMI: 28.5 ± 5.5 kg·m-2, body fat%: 27.7 ± 7.5%, 10 on beta-blockers) were recruited from phase IV CR groups in the United Kingdom. Participants established a self-selected walking speed for the 1-KTWT and performed the 1-KTWT on separate days with recording of physiological responses to predict V˙O2peak with equations. For the two 1-KTWTs, no differences existed for walking speed, mean and maximal heart rates, oxygen uptake, predicted V˙O2peak (1st 1-KTWT (range: 41-78% V˙O2peak, 95%CI, 53-65; 2nd 1-KTWT range: 43-78% V˙O2peak, 95%CI, 52-65) and rating of perceived exertion. In phase IV cardiac patients, the 1-KTWT with self-selected, unchanging walking speed can be used for V˙O2peak prediction without the need for a full familiarisation. The self-selected constant walking speed for the first 1-KTWT can be used to support nonsupervised physical activity for phase IV CR patients.

Physical Activity, Cardiorespiratory Fitness, and Atherosclerotic Cardiovascular Disease: Part 2

Background

In this second section of our 2-part review on the role of physical activity (PA) and cardiorespiratory fitness (CRF) in preventing and treating atherosclerotic cardiovascular disease (CVD), we expand on topics covered in part 1, including a comparison of moderate-intensity continuous training versus high-intensity interval training, the beneficial role of PA and CRF in heart failure, potential mal-adaptations that may result from extreme endurance exercise regimens, and the incidence of cardiac arrest and sudden cardiac death during marathon running and triathlon participation. Further, we review the principles of exercise prescription for patients with known or suspected CVD, with specific reference to exercise modalities, contemporary guidelines, the minimum exercise training intensity to promote survival benefits, and long-term goal training intensities, based on age-, sex-, and fitness-adjusted targets. Finally, we provide practical "prescription pearls" for the clinician, including a simple rule to estimate metabolic equivalents (METs) during level and graded treadmill walking, research-based exercise training recommendations, using steps per day, MET-minutes per week, and personal activity intelligence to achieve beneficial treatment outcomes, as well as the heart rate index equation to estimate energy expenditure, expressed as METs, during recreational and leisure-time PA.

Summary

This review compares moderate-intensity continuous training and high-intensity interval training, examines the role of PA and CRF in managing heart failure, and discusses the cardiovascular risks associated with extreme endurance exercise. It also provides practical guidelines for exercise prescription tailored to patients with CVD, highlighting advanced exercise prescription strategies to optimize cardiovascular health.

Key Messages

Physicians and healthcare providers should prioritize referring patients to home-based or medically supervised exercise programs to leverage the cardioprotective benefits of regular PA. For most inactive patients, an exercise prescription is essential for improving overall health.

Aquatic high-intensity interval training (HIIT) may be similarly effective to land-based HIIT in improving exercise capacity in people with chronic conditions: a systematic review and meta-analysis

Objective

To investigate the effect of aquatic high-intensity interval training (AHIIT) on exercise capacity in people with chronic conditions.

Design

Systematic review and meta-analysis.

Participants

Adults (age ≥18 years) with any chronic conditions (long duration, continuing health problems).

Data sources

The databases Medline, EMBASE, CINAHL, SPORTSDiscus, PEDro and The Cochrane Library were searched from inception to 11 August 2023.

Eligibility criteria

Randomised or non-randomised controlled trials of adults reporting one or more chronic conditions were included, comparing the effect of AHIIT with a non-exercising control group, land-based high-intensity interval training (LBHIIT) or aquatic moderate-intensity continuous training (AMICT).

Results

Eighteen trials with 868 participants with chronic musculoskeletal, respiratory, cardiovascular, metabolic or neurological conditions were included. Adherence to AHIIT was high, ranging from 84% to 100%. There was moderate certainty in evidence according to the Grading of Recommendations Assessment, Development and Evaluation system for a moderate beneficial effect on exercise capacity standardised mean differences (SMD) 0.78 (95% CI 0.48 to 1.08), p<0.00001) of AHIIT compared with a non-exercising control group. There was moderate certainty in evidence for no difference of effects on exercise capacity (SMD 0.28 (95% CI -0.04 to 0.60), p=0.08) of AHIIT compared with LBHIIT. There was moderate certainty in evidence for small effect on exercise capacity (SMD 0.45 (95% CI 0.10 to 0.80), p=0.01) of AHIIT compared with AMICT.

Conclusion

There are beneficial effects of AHIIT on exercise capacity in people with a range of chronic conditions. AHIIT has similar effects on exercise capacity as LBHIIT and may represent an alternative for people unable to perform LBHIIT.

PROSPERO registration number

CRD42022289001.

A Machine Learning Approach to Developing an Accurate Prediction of Maximal Heart Rate During Exercise Testing in Apparently Healthy Adults

PURPOSE

Maximal heart rate (HR max ) continues to be an important measure of adequate effort during an exercise test. The aim of this study was to improve the accuracy of HR max prediction using a machine learning (ML) approach.

METHODS

We used a sample from the Fitness Registry of the Importance of Exercise National Database, which included 17 325 apparently healthy individuals (81% males) who performed a maximal cardiopulmonary exercise test. Two standard formulas for HR max prediction were tested: Formula1 = 220 - age (yr), root-mean-squared error (RMSE) 21.9, relative root-mean-squared error (RRMSE) 1.1; and Formula2 = 209.3 - 0.72 × age (yr), RMSE 22.7 and RRMSE 1.1. For ML model prediction, we used age, weight, height, resting HR, and systolic and diastolic blood pressure. The following ML algorithms to predict HR max were applied: lasso regression (LR), neural networks (NN), support vector machine (SVM) and random forests (RF). An evaluation was performed using cross-validation and by computing the RMSE and RRMSE, Pearson correlation, and Bland-Altman plots. The best predictive model was explained with Shapley Additive Explanations (SHAP).

RESULTS

The HR max for the cohort was 162 ± 20 bpm. All ML models improved HR max prediction and reduced RMSE and RRMSE compared with Formula1 (LR: 20.2%, NN: 20.4%, SVM: 22.2%, and RF: 24.7%). The predictions of all algorithms significantly correlated with HR max ( r = 0.49, 0.51, 0.54, 0.57, respectively; P < .001). Bland-Altman analysis demonstrated lower bias and 95% CI for all ML models in comparison with standard equations. The SHAP explanation showed a high impact of all selected variables.

CONCLUSIONS

Machine learning, particularly the RF model, improved prediction of HR max using readily available measures. This approach should be considered for clinical application to refine HR max prediction.

Quantifying the benefits of inefficient walking: Monty Python inspired laboratory based experimental study

OBJECTIVE

To compare the rate of energy expenditure of low efficiency walking with high efficiency walking.

DESIGN

Laboratory based experimental study.

SETTING

United States.

PARTICIPANTS

13 healthy adults (six women, seven men) with no known gait disorder, mean (±standard deviation) age 34.2±16.1 years, height 174.2±12.6 cm, weight 78.2±22.5 kg, and body mass index 25.6±6.0.

INTERVENTION

Participants performed three, five minute walking trials around an indoor 30 m course. The first trial consisted of walking at a freely chosen walking speed in the participant's usual style. The next two trials consisted of low efficiency walks in which participants were asked to duplicate the walks of Mr Teabag and Mr Putey (acted by John Cleese and Michael Palin, respectively) in the legendary Monty Python Ministry of Silly Walks (MoSW) skit that first aired in 1970. Distance covered during the five minute walks was used to calculate average speed. Ventilation and gas exchange were collected throughout to determine oxygen uptake (V̇O₂; mL O₂/kg/min) and energy expenditure (EE; kcal/kg/min; 1 kcal=4.18 kJ), reported as mean±standard deviation.

MAIN OUTCOME MEASURES

V̇O₂ and EE.

RESULTS

V̇O₂ and EE were about 2.5 times higher (P<0.001) during the Teabag walk compared with participants' usual walk (27.9±4.8 v 11.3±1.9 mL O₂/kg/min; 0.14±0.03 v 0.06±0.01 kcal/kg/min), but were not different during the Putey walk (12.3±1.8 mL/kg/min; 0.06±0.01 kcal/kg/min). Each minute of Teabag walking increased EE over participants' usual walking by an average of 8.0 kcal (range 5.5-12.0) in men and by 5.2 kcal (range 3.9-6.2) in women, and qualified as vigorous intensity physical activity (>6 resting metabolic equivalents).

CONCLUSIONS

For adults with no known gait disorder who average approximately 5000 steps/day, exchanging about 22%-34% of their daily steps with higher energy, low efficiency walking in Teabag style-requiring around 12-19 min-could increase daily EE by 100 kcal. Adults could achieve 75 minutes of vigorous intensity physical activity per week by walking inefficiently for about 11 min/day. Had an initiative to promote inefficient movement been adopted in the early 1970s, we might now be living among a healthier society. Efforts to promote higher energy-and perhaps more joyful-walking should ensure inclusivity and inefficiency for all.