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Narendrula A, Brinza E, Horvat Davey C, Longenecker CT, Webel AR. Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001596. [PMID: 38292295 PMCID: PMC10826575 DOI: 10.1136/bmjsem-2023-001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies. Methods We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review. Results Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA. Conclusions PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions. PROSPERO registration number CRD42021226089.
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Affiliation(s)
- Aparna Narendrula
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ellen Brinza
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Horvat Davey
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, Washington, USA
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Brian MS, Blier AR, Alward BM, Waite EE, D'Amelio MP, Shaw MA, O'Neill DF, Chaidarun SS. Excess adiposity contributes to higher ambulatory central blood pressure and arterial stiffness in physically inactive young adults. J Sports Med Phys Fitness 2023; 63:912-920. [PMID: 37158798 PMCID: PMC11382482 DOI: 10.23736/s0022-4707.23.14860-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND It remains unknown if physical inactivity and excess adiposity increases 24-h central blood pressure and arterial stiffness in young adults. This study examined 24-h central blood pressure and indirect measures of arterial stiffness (e.g., central pulse pressure) in physically inactive young adults with and without excess adiposity. METHODS Body fat and ambulatory 24-h blood pressure were measured in 31 young adults (men: 22±4 years, N.=15; women: 22±5 years, N=16). Multi-frequency bioelectrical impedance measured body fat. Normal adiposity was defined as <20% body fat in men and <32% body fat in women, whereas excess adiposity was defined as ≥20% and ≥32% in men and women, respectively. Ambulatory 24-h central blood pressure was calculated based on brachial blood pressure and volumetric displacement waveforms. RESULTS By design, the normal adiposity group had a lower body fat percentage (men: 15.5±4.6%; women: 20.8±2.5%) compared to the physically inactive excess adiposity group (men: 29.8±5.4%; women: 34.3±7.5%). Men and women with excess adiposity group had elevated central blood pressure (central systolic, P<0.05 vs. normal adiposity groups). Central pulse pressure was elevated in the excess adiposity group (men: 45±5 mmHg; women: 41±9 mmHg) compared to normal adiposity groups (men: 36±4 mmHg; women: 32±3 mmHg, P<0.05 for both), while other arterial stiffness (augmentation index and ambulatory arterial stiffness index) measures trended toward significance only in men with excess adiposity. CONCLUSIONS Physically inactive men and women with excess adiposity have increased 24h central blood pressure and pulse pressure compared to physically inactive young adults with normal adiposity.
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Affiliation(s)
- Michael S Brian
- Department Health and Human Performance, Plymouth State University, Plymouth, NH, USA -
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA -
| | - Amanda R Blier
- Department Health and Human Performance, Plymouth State University, Plymouth, NH, USA
| | - Braeden M Alward
- Department Health and Human Performance, Plymouth State University, Plymouth, NH, USA
| | - Emily E Waite
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Maison P D'Amelio
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Marialena A Shaw
- Department Health and Human Performance, Plymouth State University, Plymouth, NH, USA
| | | | - Sushela S Chaidarun
- Endocrine Section, Department of Medicine, Dartmouth Hitchcock Medical Center, Dartmouth, NH, USA
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Evenson KR, Scherer E, Peter KM, Cuthbertson CC, Eckman S. Historical development of accelerometry measures and methods for physical activity and sedentary behavior research worldwide: A scoping review of observational studies of adults. PLoS One 2022; 17:e0276890. [PMID: 36409738 PMCID: PMC9678297 DOI: 10.1371/journal.pone.0276890] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 10/15/2022] [Indexed: 11/22/2022] Open
Abstract
This scoping review identified observational studies of adults that utilized accelerometry to assess physical activity and sedentary behavior. Key elements on accelerometry data collection were abstracted to describe current practices and completeness of reporting. We searched three databases (PubMed, Web of Science, and SPORTDiscus) on June 1, 2021 for articles published up to that date. We included studies of non-institutionalized adults with an analytic sample size of at least 500. The search returned 5686 unique records. After reviewing 1027 full-text publications, we identified and abstracted accelerometry characteristics on 155 unique observational studies (154 cross-sectional/cohort studies and 1 case control study). The countries with the highest number of studies included the United States, the United Kingdom, and Japan. Fewer studies were identified from the continent of Africa. Five of these studies were distributed donor studies, where participants connected their devices to an application and voluntarily shared data with researchers. Data collection occurred between 1999 to 2019. Most studies used one accelerometer (94.2%), but 8 studies (5.2%) used 2 accelerometers and 1 study (0.6%) used 4 accelerometers. Accelerometers were more commonly worn on the hip (48.4%) as compared to the wrist (22.3%), thigh (5.4%), other locations (14.9%), or not reported (9.0%). Overall, 12.7% of the accelerometers collected raw accelerations and 44.6% were worn for 24 hours/day throughout the collection period. The review identified 155 observational studies of adults that collected accelerometry, utilizing a wide range of accelerometer data processing methods. Researchers inconsistently reported key aspects of the process from collection to analysis, which needs addressing to support accurate comparisons across studies.
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Affiliation(s)
- Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elissa Scherer
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Kennedy M. Peter
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carmen C. Cuthbertson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephanie Eckman
- RTI International, Research Triangle Park, North Carolina, United States of America
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Llamas-Ramos I, Llamas-Ramos R, Alonso-Domínguez R, Gómez-Sánchez L, Tamayo-Morales O, Lugones-Sánchez C, Rodríguez-Sánchez E, García-Ortiz L, Gómez-Marcos MA. Sedentary Behaviour and Its Relationship with Early Vascular Ageing in the General Spanish Population: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095450. [PMID: 35564843 PMCID: PMC9101612 DOI: 10.3390/ijerph19095450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/21/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022]
Abstract
Sedentary behaviour is associated with a greater predisposition to developing cardiovascular diseases. The aim of the study was to analyse the relationship between sedentary time and early vascular ageing. A total of 501 participants (49.70% men) were recruited through random sampling stratified by age group and sex. Vascular ageing was evaluated considering three criteria: (1) the vascular ageing index (VAI); (2) the carotid−femoral pulse wave velocity (cfPWV) 10th and 90th percentiles of the reference values in the European population by age; and (3) the Framingham’s heart age. The carotid intima−media thickness was measured using a Sonosite Micromaxx ultrasound, the presence of peripheral artery disease was assessed by calculating the ankle−brachial index using a VaSera VS-1500, and the cfPWV was measured with a SphygmoCor® device. Weekly sedentary hours were evaluated through a sitting time questionnaire. The average age of the population was 55.90 ± 14.24 years. The men spent more hours sitting per week (47.6 ± 16.6 vs. 36.8 ± 17.3 h/W), at work (16.7 ± 16.2 vs. 9.73 ± 14.9 h/W), and watching TV (21.6 ± 12.5 vs. 18.7 ± 11.9 h/W). In the logistic regression analysis, the individuals with early vascular aging (EVA), with respect to those with healthy vascular aging (HVA), spent more hours sitting per week (OR = 1.03 vs. OR = 1.02; p < 0.05) and watching TV (OR = 1.03 vs. OR = 1.03; p < 0.05), using the criteria of the European guideline and VAI, and more hours sitting when commuting (OR = 1.04; p < 0.05), using Framingham’s heart age to define EVA. The results of this study indicate that sedentary time is associated with early vascular ageing. Therefore, reducing sedentary time would improve vascular health.
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Affiliation(s)
- Inés Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- University Hospital of Salamanca, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-663005052
| | - Rocío Llamas-Ramos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Rosario Alonso-Domínguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Department of Nursing and Physiotherapy, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Leticia Gómez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Cristina Lugones-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Manuel A. Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), 37005 Salamanca, Spain; (R.L.-R.); (R.A.-D.); (L.G.-S.); (O.T.-M.); (C.L.-S.); (E.R.-S.); (L.G.-O.); (M.A.G.-M.)
- Health Service of Castilla and Leon (SACyL), 37005 Salamanca, Spain
- Department of Medicine, Universidad de Salamanca, 37007 Salamanca, Spain
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Blauth FG, Vilar LADS, Pontes VDCB, Moriguti JC, Ferriolli E, Lima NKDC. The effect of frailty on the 24-hour blood pressure pattern in the very elderly. J Clin Hypertens (Greenwich) 2022; 24:67-73. [PMID: 34882943 PMCID: PMC8783362 DOI: 10.1111/jch.14409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.
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Affiliation(s)
- Fernando Gioppo Blauth
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Laís Araújo dos Santos Vilar
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Victor de Carvalho Brito Pontes
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Júlio César Moriguti
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Eduardo Ferriolli
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
| | - Nereida Kilza da Costa Lima
- Division of Internal Medicine and GeriatricsDepartment of Internal MedicineRibeirão Preto Medical SchoolUniversity of São Paulo, Ribeirão PretoBrazil
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Villarín-Castro A, Rodríguez-Roca GC, Segura-Fragoso A, Alonso-Moreno FJ, Rojas-Martelo GA, Rodríguez-Padial L, Fernández-Conde JA, Lorenzo-Lozano MC, Menchén-Herreros A, Fernández-Martín J. [Vascular age in a sample of general population of the sanitary area of Toledo (Spain). RICARTO study]. Med Clin (Barc) 2021; 157:513-523. [PMID: 33183766 DOI: 10.1016/j.medcli.2020.08.008] [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: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To know the vascular age (VA) of a sample of general population included in the RICARTO study. PATIENTS AND METHOD Epidemiological study of the general population aged ≥18 from the Health Area of Toledo, based on the health card database. VA was calculated from the absolute cardiovascular risk (CVR) estimated with the Framingham and SCORE equations (type2 diabetes increased CVR in SCORE 2-fold in men and 4-fold in women). Patients with cardiovascular or renal disease were excluded. An ANCOVA analysis was conducted to adjust and compare the mean of VA by age and sex. RESULTS 1,496 subjects (53.54% women) were analyzed. Mean (SD) age was 48.77 (14.89) years old and. Mean VA was 51.37 (19.13) with Framingham equation and 57.09 (17.63) years old with SCORE equation. VA was significantly higher in men, low education level, arterial hypertension, dyslipidemia, hypertriglyceridemia, diabetes mellitus, abdominal obesity, general obesity, smoking and in individuals with 5CVR factors vs none (P<.001 in all). Higher differences (Cohen's D >0.5) were found in non-diabetic vs diabetic people (1.58 Framingham; 2.44 SCORE), normotensive vs hypertensive subjects (1.64 Framingham; 1.19 SCORE), and non-dyslipidemia vs presence of dyslipidemia (0.95 Framingham; 0.66 SCORE). CONCLUSIONS VA of our sample is two and a half years older than chronological one with Framingham equation and more than eight years with SCORE equation. Control of CVR factors is the key to get a VA closer to real and to obtain a better cardiovascular health in the population.
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Affiliation(s)
| | | | - Antonio Segura-Fragoso
- Medicina Preventiva y Salud Pública. Asesor en Metodología de la Investigación de la Fundación de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Facultad de Ciencias de la Salud, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España
| | | | | | - Luis Rodríguez-Padial
- Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | | | | | | | - Juan Fernández-Martín
- Medicina Preventiva y Salud Pública, Servicio de Investigación e Innovación, Dirección General de Asistencia Sanitaria, Servicio de Salud de Castilla-La Mancha (SESCAM), Toledo, España
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Noninvasive validation of central and peripheral augmentation index estimated by a novel wrist-worn tonometer. J Hypertens 2019; 36:2204-2214. [PMID: 29846328 DOI: 10.1097/hjh.0000000000001806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The validation of new blood pressure devices with easier use and more rapid data collection may facilitate the incorporation of these measures into clinical practice. We analyze the reliability and validity of Pulse Wave Analysis as reported by a novel wrist-worn device, easy and quick to use, comparing central and peripheral augmentation index (AIx) with the same measures from the SphygmoCor. Additionally, we analyzed clinical relevance through the association of the Pulse Wave Analysis, as reported by a novel wrist-worn device, with other cardiovascular parameters. METHODS Cross-sectional study including 254 participants. Mean age was 51.9 ± 13.4 years and 53% were women. MEASUREMENTS peripheral AIx (PAIx) and central AIx (CAIx) by the wrist-worn device and SphygmoCor (MM3); carotid-femoral (cf) pulse wave velocity (PWV) by SphygmoCor (MM3); cardioankle-vascular index (CAVI), ankle-brachial index (ABI) and brachial-ankle (ba) PWV by the Vasera device and carotid-intima media thickness (IMT) by ultrasonography. RESULTS Intra-observer intra-class correlation coefficient (ICC) for PAIx was 0.886 (95% CI 0.803-0.934) and for CAIx 0.943 (95% CI 0.901-0.968) with Bland Altman limits of agreement -0.75 (-23.8 to 21.8) and 0.08 (-15.7 to 15.9), respectively. Inter-observer ICC for PAIx was 0.952 (95% CI 0.915-0.972) and CAIx 0.893 (95% CI 0.811-0.939) with limits of agreement -0.45 (-13.7 to 12.8) and 0.43 (-17.7 to 18.5), respectively. Comparing the wrist-worn device with SphygmoCor, the ICC was 0.849 (95% CI 0.798-0.887) for PAIx, and 0.783 (95% CI 0.711-0.838) for CAIx. In Bland-Altman, limits of agreement for PAIx 1.03 (-20.67 to 22.73), and for CAIx -2.14 (-24.79 to 20.50). PAIx and CAIx, from the wrist-worn device, correlated with age, CAVI, ABI, baPWV, cfPWV, IMT, glomerular filtration and cardiovascular risk. CONCLUSION AIx measurements by wrist-worn device shows a good intra-observer and inter-observer reliability, inter-device noninvasive reliability and validity when compared with SphygmoCor, and clinical relevance by association with measures of vascular structure and function, end-organ damage and cardiovascular risk. TRIAL REGISTRATION Clinicaltrials.gov NCT02623894; https://clinicaltrials.gov/ct2/show/NCT02623894.
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Lin M, Chan GC, Chan KW, Lai KN, Tang SC. Vascular age is associated with the risk of dialysis or death in chronic kidney disease. Nephrology (Carlton) 2019; 25:314-322. [PMID: 31226224 DOI: 10.1111/nep.13624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 12/20/2022]
Abstract
AIM Increased arterial stiffness is associated with progressive renal deterioration and poor clinical outcomes in patients with chronic kidney disease (CKD). Assessment of vascular age as derived from arterial stiffness parameters might be an important clinical marker of cardiovascular risks. The aim of the present study is to evaluate whether the difference (△age) between vascular age and chronological age can predict the risk of reaching dialysis or death in patients with known CKD. METHODS This longitudinal study enrolled 94 male Chinese CKD patients, aged 40-62 years. Vascular age was calculated by brachial-ankle pulse wave velocity, and measured by an ankle-brachial index-form device. The study endpoints were the commencement of renal replacement therapy or death. RESULTS After a stepwise multivariate analysis, △age was associated independently with increased urine protein-to-creatinine ratio (β = 0.32; P = 0.001) and decreased baseline estimated glomerular filtration rate (β = -0.24; P = 0.008). During a median follow-up period of 62 (interquartile range = 55-66) months, the 4-year cumulative incidence of reaching the study endpoint in patients with △age = 0 and △age > 0 year was 4.9% and 25%, respectively (log-rank test, P = 0.009). Multivariate forward Cox regression analysis identified that higher △age (hazard ratio (HR) = 1.05; P = 0.027), lower baseline estimated glomerular filtration rate (HR = 0.93; P < 0.001), and history of cardiovascular disease (HR = 5.90; P = 0.031) were independently associated with progression to commencement of dialysis or death. CONCLUSION Thus, the assessment of the difference between vascular age and chronological age may provide an alternative method to identify CKD patients at a high risk of progression to dialysis or death.
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Affiliation(s)
- Miao Lin
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.,Division of Nephrology, Fujian Provincial Clinical College, Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Gary Cw Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kam W Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Kar N Lai
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Sydney Cw Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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9
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Combined use of a healthy lifestyle smartphone application and usual primary care counseling to improve arterial stiffness, blood pressure and wave reflections: a Randomized Controlled Trial (EVIDENT II Study). Hypertens Res 2018; 42:852-862. [DOI: 10.1038/s41440-018-0182-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/21/2018] [Accepted: 11/05/2018] [Indexed: 12/17/2022]
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Lemke D, Pledl HW, Zorn M, Jugold M, Green E, Blaes J, Löw S, Hertenstein A, Ott M, Sahm F, Steffen AC, Weiler M, Winkler F, Platten M, Dong Z, Wick W. Slowing down glioblastoma progression in mice by running or the anti-malarial drug dihydroartemisinin? Induction of oxidative stress in murine glioblastoma therapy. Oncotarget 2018; 7:56713-56725. [PMID: 27447560 PMCID: PMC5302947 DOI: 10.18632/oncotarget.10723] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
Influencing cancer metabolism by lifestyle changes is an attractive strategy as - if effective - exercise-induced problems may be less severe than those induced by classical anti-cancer therapies. Pursuing this idea, clinical trials evaluated the benefit of e.g. different diets such as the ketogenic diet, intermittent caloric restriction and physical exercise (PE) in the primary and secondary prevention of different cancer types. PE proved to be beneficial in the context of breast and colon cancer.Glioblastoma has a dismal prognosis, with an average overall survival of about one year despite maximal safe resection, concomitant radiochemotherapy with temozolomide followed by adjuvant temozolomide therapy. Here, we focused on the influence of PE as an isolated and adjuvant treatment in murine GB therapy.PE did not reduce toxic side effects of chemotherapy in mice administered in a dose escalating scheme as shown before for starvation. Although regular treadmill training on its own had no obvious beneficial effects, its combination with temozolomide was beneficial in the treatment of glioblastoma-bearing mice. As PE might partly act through the induction of reactive oxygen species, dihydroartemisinin - an approved anti-malarial drug which induces oxidative stress in glioma cells - was further evaluated in vitro and in vivo. Dihydroartemisinin showed anti-glioma activity by promoting autophagy, reduced the clonogenic survival and proliferation capacity of glioma cells, and prolonged the survival of tumor bearing mice. Using the reactive oxygen species scavenger n-acetyl-cysteine these effects were in part reversible, suggesting that dihydroartemisinin partly acts through the generation of reactive oxygen species.
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Affiliation(s)
- Dieter Lemke
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Werner Pledl
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Zorn
- Central Laboratory of Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Manfred Jugold
- Core Facility Small Animal Imaging Center, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ed Green
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jonas Blaes
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sarah Löw
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anne Hertenstein
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martina Ott
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ann-Catherine Steffen
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Weiler
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Winkler
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Platten
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Zhen Dong
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wolfgang Wick
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, University of Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Appiah D, Capistrant BD. Cardiovascular Disease Risk Assessment in the United States and Low- and Middle-Income Countries Using Predicted Heart/Vascular Age. Sci Rep 2017; 7:16673. [PMID: 29192146 PMCID: PMC5709399 DOI: 10.1038/s41598-017-16901-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/15/2017] [Indexed: 12/27/2022] Open
Abstract
Almost 80% of the global burden of cardiovascular disease (CVD) occurs in low- and middle-income countries (LMICs). However, LMICs do not have well-established, low-technology ways to quantify and communicate CVD risk at population or individual levels. We examined predicted heart/vascular age (PHA) in six LMICs and the United States. Data were from CVD-free adults in World Health Organization Study on Global Aging and Adult Health (n = 29094) and US National Health and Nutritional Examination Survey (n = 6726). PHA was calculated using the non-laboratory Framingham CVD risk equation. High excess PHA (HEPHA) was defined as the differences between PHA and chronological age >5 years. Logistic regression models were used to identify factors associated with HEPHA. Age-standardized prevalence of HEPHA was higher in Russia 52%; China 56%; Mexico 59%; and South Africa 65% compared to the US 45%, Ghana 36%; and India 38%. In LMICs, higher income, being divorced/widowed, alcohol intake and abdominal obesity had higher odds of HEPHA; higher education, fruit intake and physical activity had lower odds of HEPHA. The use of PHA may offer a useful avenue to communicate CVD risk. Interventions tailored at socioeconomic and cultural factors that influence CVD risk factors may be necessary to prevent CVD in LMICs.
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Affiliation(s)
- Duke Appiah
- Department of Public Health, Texas Tech University Health Sciences Center, Abilene, TX, USA.
| | - Beatrix D. Capistrant
- Statistical & Data Sciences, Smith College, Northampton, MA, USA
- Division of Epidemiology and Community Health, University of Minnesota Minneapolis, Minneapolis, MN, USA
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12
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Park K, Park BJ. High Level Physical Activity and Prevalence of Cardiovascular Disease Using the Korea National Health and Nutrition Examination Survey Data, 2007-2013. J Prev Med Public Health 2017; 50:320-327. [PMID: 29020758 PMCID: PMC5637061 DOI: 10.3961/jpmph.17.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives The purpose of our study was to evaluate the association between the intensity of physical activity (PA) and prevalence of cardiovascular disease (CVD) using Korean representative data. Methods We analyzed 39 804 participant data from the Korea National Health and Nutrition Examination Survey, 2007-2013. Exposure variable was three levels of PA (low, medium, and high) in a week, and outcome variable was prevalence of CVD based on patient self-recognition and doctor’s diagnosis. Complex logistic regression analysis was performed to evaluate the relationship between level of PA and CVD adjusted by body mass index, hypertension, hypercholesterolemia, diabetes mellitus, stress recognition, household income, smoking, and current drinking. The indices of association w ere estimated as crude prevalence odds ratio (POR), adjusted POR, and their 95% confidence interval (CI). All statistical analyzes were performed using complex sample analysis procedure of the SPSS version 23.0. Results When all variables were adjusted, only high level PA in women showed a significant association with stroke (adjusted POR by patient’s self-recognition, 0.57; 95% CI, 0.32 to 0.99, adjusted POR by doctor’s diagnosis, 0.55; 95% CI, 0.34 to 0.87) and CVD (adjusted POR by doctor’s diagnosis, 0.68; 95% CI, 0.48 to 0.96). Conclusions High level PA in women has a significant reverse association with prevalence of stroke and CVD in Korea. Further study for elucidating the mechanism will be needed.
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Affiliation(s)
- Kyounghoon Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
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13
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Endes S, Schaffner E, Caviezel S, Dratva J, Stolz D, Schindler C, Künzli N, Schmidt-Trucksäss A, Probst-Hensch N. Is physical activity a modifier of the association between air pollution and arterial stiffness in older adults: The SAPALDIA cohort study. Int J Hyg Environ Health 2017. [PMID: 28629640 DOI: 10.1016/j.ijheh.2017.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Air pollution and insufficient physical activity have been associated with inflammation and oxidative stress, molecular mechanisms linked to arterial stiffness and cardiovascular disease. There are no studies on how physical activity modifies the association between air pollution and arterial stiffness. We examined whether the adverse cardiovascular effects of air pollution were modified by individual physical activity levels in 2823 adults aged 50-81 years from the well-characterized Swiss Cohort Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). METHODS We assessed arterial stiffness as the brachial-ankle pulse wave velocity (baPWV [m/s]) with an oscillometric device. We administered a self-reported physical activity questionnaire to classify each subject's physical activity level. Air pollution exposure was estimated by the annual average individual home outdoor PM10 and PM2.5 (particulate matter <10μm and <2.5μm in diameter, respectively) and NO2 (nitrogen dioxide) exposure estimated for the year preceding the survey. Exposure estimates for ultrafine particles calculated as particle number concentration (PNC) and lung deposited surface area (LDSA) were available for a subsample (N=1353). We used mixed effects logistic regression models to regress increased arterial stiffness (baPWV≥14.4m/s) on air pollution exposure and physical activity while adjusting for relevant confounders. RESULTS We found evidence that the association of air pollution exposure with baPWV was different between inactive and active participants. The probability of having increased baPWV was significantly higher with higher PM10, PM2.5, NO2, PNC and LDSA exposure in inactive, but not in physically active participants. We found some evidence of an interaction between physical activity and ambient air pollution exposure for PM10, PM2.5 and NO2 (pinteraction=0.06, 0.09, and 0.04, respectively), but not PNC and LDSA (pinteraction=0.32 and 0.35). CONCLUSIONS Our study provides some indication that physical activity may protect against the adverse vascular effects of air pollution in low pollution settings. Additional research in large prospective cohorts is needed to assess whether the observed effect modification translates to high pollution settings in mega-cities of middle and low-income countries.
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Affiliation(s)
- Simon Endes
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Switzerland.
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Seraina Caviezel
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Julia Dratva
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pneumology and Respiratory Cell Research, University Hospital, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Department of Sport, Exercise and Health, Div. Sports and Exercise Medicine, University of Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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14
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Shen H, Zhao J, Zhou X, Li J, Wan Q, Huang J, Li H, Wu L, Yang S, Wang P. Impaired chronotropic response to physical activities in heart failure patients. BMC Cardiovasc Disord 2017; 17:136. [PMID: 28545575 PMCID: PMC5445286 DOI: 10.1186/s12872-017-0571-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
Abstract
Background While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients. Methods Forty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed. Results Of 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients. Conclusion The study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients. Trial registration ClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.
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Affiliation(s)
- Hong Shen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Zhao
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA
| | - Jingbo Li
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Qing Wan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Huang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Li
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shungang Yang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Ping Wang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
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15
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Recio-Rodriguez JI, Agudo-Conde C, Martin-Cantera C, González-Viejo MN, Fernandez-Alonso MDC, Arietaleanizbeaskoa MS, Schmolling-Guinovart Y, Maderuelo-Fernandez JA, Rodriguez-Sanchez E, Gomez-Marcos MA, Garcia-Ortiz L. Short-Term Effectiveness of a Mobile Phone App for Increasing Physical Activity and Adherence to the Mediterranean Diet in Primary Care: A Randomized Controlled Trial (EVIDENT II Study). J Med Internet Res 2016; 18:e331. [PMID: 27993759 PMCID: PMC5206481 DOI: 10.2196/jmir.6814] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022] Open
Abstract
Background The use of mobile phone apps for improving lifestyles has become generalized in the population, although little is still known about their effectiveness in improving health. Objective We evaluate the effect of adding an app to standard counseling on increased physical activity (PA) and adherence to the Mediterranean diet, 3 months after implementation. Methods A randomized, multicenter clinical trial was carried out. A total of 833 participants were recruited in six primary care centers in Spain through random sampling: 415 in the app+counseling group and 418 in the counseling only group. Counseling on PA and the Mediterranean diet was given to both groups. The app+counseling participants additionally received training in the use of an app designed to promote PA and the Mediterranean diet over a 3-month period. PA was measured with the 7-day Physical Activity Recall (PAR) questionnaire and an accelerometer; adherence to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener questionnaire. Results Participants were predominantly female in both the app+counseling (249/415, 60.0%) and counseling only (268/418, 64.1%) groups, with a mean age of 51.4 (SD 12.1) and 52.3 (SD 12.0) years, respectively. Leisure-time moderate-to-vigorous physical activity (MVPA) by 7-day PAR increased in the app+counseling (mean 29, 95% CI 5-53 min/week; P=.02) but not in the counseling only group (mean 17.4, 95% CI –18 to 53 min/week; P=.38). No differences in increase of activity were found between the two groups. The accelerometer recorded a decrease in PA after 3 months in both groups: MVPA mean –55.3 (95% CI –75.8 to –34.9) min/week in app+counseling group and mean –30.1 (95% CI –51.8 to –8.4) min/week in counseling only group. Adherence to the Mediterranean diet increased in both groups (8.4% in app+counseling and 10.4% in counseling only group), with an increase in score of 0.42 and 0.53 points, respectively (P<.001), but no difference between groups (P=.86). Conclusions Leisure-time MVPA increased more in the app+counseling than counseling only group, although no difference was found when comparing the increase between the two groups. Counseling accompanied by printed materials appears to be effective in improving adherence to the Mediterranean diet, although the app does not increase adherence. ClinicalTrial Clinicaltrials.gov NCT02016014; https://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/6mnopADbf)
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Affiliation(s)
- Jose I Recio-Rodriguez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.,University of Salamanca, Department of Nursing and Physiotherapy, Salamanca, Spain
| | - Cristina Agudo-Conde
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain
| | - Carlos Martin-Cantera
- Primary Health Care University Research Institute IDIAP-Jordi Gol, Passeig de Sant Joan Health Center, Catalan Health Service, Department of Medicine. University Autonoma of Barcelona, Barcelona, Spain
| | | | | | | | - Yolanda Schmolling-Guinovart
- Río Tajo Health Center, Castilla-La Mancha Health Service, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Jose-Angel Maderuelo-Fernandez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.,University of Salamanca, Department of Medicine, Salamanca, Spain
| | - Manuel A Gomez-Marcos
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.,University of Salamanca, Department of Medicine, Salamanca, Spain
| | - Luis Garcia-Ortiz
- Biomedical Research Institute of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center, Castilla León Health Service, Salamanca, Spain.,University of Salamanca, Department of Biomedical and Diagnostic Sciences, Salamanca, Spain
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- EVIDENT Investigators. redIAPP: Spanish Research Network for Preventive Activities and Health Promotion in Primary Care, Salamanca, Spain
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16
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Li H, Li J, Zhou X, Zhao J, Zhang F, Wu L, Shen H, Wan Q, Huang J, Yang S, Wang P. Clinical feasibility of a new method to identify chronotropic incompetence in heart failure patients. Physiol Meas 2016; 37:1968-1980. [PMID: 27754982 DOI: 10.1088/0967-3334/37/11/1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Heart failure patients have a high incidence of chronotropic incompetence (CI) that receives less clinical attention. This study assessed a method using wearable devices to identify CI in heart failure patients. Twenty-six heart failure patients (LVEF: 43.9 ± 5.7% with LVEF ⩾40% in 19 patients; age: 52.8 ± 12.4 years, female patients = 6) were enrolled. Each patient underwent symptom-limited treadmill maximal exercise testing during which the simultaneous recording of ECG Holter and physical activity using Actigraph was conducted. The APMHR ratio, the maximal heart rate during peak exercise over the age-predicted maximal heart rate (APMHR, 220-age), was determined. CI was diagnosed in patients who failed to reach at least 0.70 APMHR ratio. Holter-Actigraph recording was also applied during a 6 min hall walk (6MHW) and for 24 h to validate the method to assess impaired chronotropic response. Based on the reports of exercise testing in 26 patients, 13 patients (50%) failed to reach at least 0.70 APMHR ratio while the remaining 13 patients achieved ⩾0.70 APMHR ratio. The APMHR ratio measured by Holter-Actigraph recording was significantly correlated with the APMHR ratio based on exercise test reports (R = 0.99, P < 0.001). The cut-off values of APMHR ratio (0.65) measured during 6MHW, APMHR ratio (0.69) measured during daily activities, and maximum Δ heart rate (37.8 bpm) measured during daily activities significantly predicted the results of exercise test reports with an area under the ROC curve of 0.7337, 0.7544 and 0.7870, respectively (all P values < 0.05). This pilot study found that the wearable device can potentially help in the identification of chronotropic incompetence in heart failure patients.
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Affiliation(s)
- Hui Li
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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17
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Iadecola C, Yaffe K, Biller J, Bratzke LC, Faraci FM, Gorelick PB, Gulati M, Kamel H, Knopman DS, Launer LJ, Saczynski JS, Seshadri S, Zeki Al Hazzouri A. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension 2016; 68:e67-e94. [PMID: 27977393 DOI: 10.1161/hyp.0000000000000053] [Citation(s) in RCA: 437] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Age-related dementia, most commonly caused by Alzheimer disease or cerebrovascular factors (vascular dementia), is a major public health threat. Chronic arterial hypertension is a well-established risk factor for both types of dementia, but the link between hypertension and its treatment and cognition remains poorly understood. In this scientific statement, a multidisciplinary team of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. METHODS Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS Hypertension disrupts the structure and function of cerebral blood vessels, leads to ischemic damage of white matter regions critical for cognitive function, and may promote Alzheimer pathology. There is strong evidence of a deleterious influence of midlife hypertension on late-life cognitive function, but the cognitive impact of late-life hypertension is less clear. Observational studies demonstrated a cumulative effect of hypertension on cerebrovascular damage, but evidence from clinical trials that antihypertensive treatment improves cognition is not conclusive. CONCLUSIONS After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health.
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18
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Gonzales JU. Do older adults with higher daily ambulatory activity have lower central blood pressure? Aging Clin Exp Res 2016; 28:965-71. [PMID: 25998953 DOI: 10.1007/s40520-015-0384-6] [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: 03/31/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS We aimed to test the hypothesis that central blood pressure (BP) would be lower in healthy older adults with greater daily ambulatory activity. METHODS Forty-three (24 women, 19 men) older adults wore a triaxial accelerometer at the hip for 1 week. The volume of ambulatory activity was estimated by average steps per day. As a proxy of intensity of ambulatory activity, 1-min peak step accumulation, or the maximum number of steps taken within a minute was averaged from each day. Participants were considered "active" if they had >7500 steps per day or >105 steps per min. Radial arterial tonometry was used to estimate central (aortic) BP from pulse wave analysis. RESULTS After adjusting for age and sex, adults with higher steps per day (n = 18) tended to have lower central pulse pressure (p = 0.08). Interestingly, adults with higher peak step accumulation (n = 25) had significantly lower central pulse pressure (40.4 ± 1.6 vs. 46.8 ± 2.0 mmHg; p = 0.02) after adjusting for age and sex. Stepwise regression including age, sex, body mass index, and peak step accumulation found body mass index to be the strongest predictor of central systolic BP [β = 0.42, 95 % CI (0.13, 0.70), p = 0.004] while peak step accumulation was the strongest predictor of central pulse pressure [β = -0.31, 95 % CI (-0.01, -0.60), p = 0.043]. CONCLUSIONS These results find older adults with an "active" daily walking pattern, particularly having a higher number of maximal steps in a minute, have lower central pulse pressure than older adults with lower daily ambulatory activity.
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Affiliation(s)
- Joaquin U Gonzales
- Department of Health, Exercise and Sport Sciences, Texas Tech University, Box 43011, Lubbock, TX, 7409-3011, USA.
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Gomez-Marcos MA, Martinez-Salgado C, Gonzalez-Sarmiento R, Hernandez-Rivas JM, Sanchez-Fernandez PL, Recio-Rodriguez JI, Rodriguez-Sanchez E, García-Ortiz L. Association between different risk factors and vascular accelerated ageing (EVA study): study protocol for a cross-sectional, descriptive observational study. BMJ Open 2016; 6:e011031. [PMID: 27267107 PMCID: PMC4908886 DOI: 10.1136/bmjopen-2016-011031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/19/2016] [Accepted: 05/13/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The process of population ageing that is occurring in developed societies represents a major challenge for the health system. The aim of this study is to analyse factors that have an influence on early vascular ageing (EVA), estimated by carotid-femoral pulse wave velocity (cf-PWV) and Cardio Ankle Vascular Index (CAVI), and to determine differences by gender in a Spanish population. METHODS AND ANALYSIS An observational, descriptive, cross-sectional study. STUDY POPULATION From the population assigned to the participating healthcare centres, a cluster random sampling stratified by age and gender will be performed to obtain 500 participants aged between 35 and 75. Those who meet the inclusion criteria and give written informed consent will be included in the study. MEASUREMENTS Main dependent variables: cf-PWV determined using the SphygmoCor System and CAVI estimated using VASERA. Secondary dependent variables: telomere length, carotid intima-media thickness, central and peripheral augmentation index, ankle-brachial pulse wave velocity, ankle-brachial index, retinal arteriovenous index, and renal and cardiac organ damage. INDEPENDENT VARIABLES lifestyles (physical activity, adherence to the Mediterranean diet, alcohol and tobacco consumption); psychological factors (depression, anxiety and chronic stress); inflammatory factors and oxidative stress. ETHICS AND DISSEMINATION The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent form agreeing to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow the understanding of the relationship of the different influencing factors and their relative weight in the development of EVA. At least 5 publications in first-quartile scientific journals are planned. TRIAL REGISTRATION NUMBER NCT02623894; Pre-results.
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Affiliation(s)
- Manuel A Gomez-Marcos
- Primary Care Research Unit, Instituto of Investigación Biomédica of Salamanca (IBSAL), The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
| | - Carlos Martinez-Salgado
- Unit Renal Physiology and Pathophysiology Cardiovascular Unit, Department of Physiology and Pharmacology, IBSAL, Queen Sofia Institute of Nephrology Research, University of Salamanca, Salamanca, Castile and León, Spain
| | - Rogelio Gonzalez-Sarmiento
- IBSAL and Instituto of Biología Molecular and Celular of Cáncer (IBMCC), University of Salamanca–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, University of Salamanca, Castile and León, Spain
| | - Jesus Ma Hernandez-Rivas
- IBSAL, IBMCC, Cancer Research Center, University of Salamanca, CSIC, University Hospital of Salamanca, Salamanca, Castile and León, Spain
- Department of Hematology, University of Salamanca, Salamanca, Castile and León, Spain
- Department of Medicine, University of Salamanca, Salamanca, Castile and León, Spain
| | - Pedro L Sanchez-Fernandez
- IBSAL, University Hospital of Salamanca, Salamanca, Castile and León, Spain
- Cardiology Department, University of Salamanca, Salamanca, Castile and León, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit, IBSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL, REDIAPP, Salamanca, Castile and León, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, Instituto of Investigación Biomédica of Salamanca (IBSAL), The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit, BSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Biomedical and Diagnostic Sciences Department, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
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Rastrelli G, Corona G, Mannucci E, Maggi M. Vascular and Chronological Age in Subjects with Erectile Dysfunction: A Cross-Sectional Study. J Sex Med 2015; 12:2303-12. [PMID: 26632075 DOI: 10.1111/jsm.13044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Vascular age, as derived from the SCORE project algorithm for cardiovascular (CV) risk estimation, is an effective way for communicating CV risk. However, studies on its clinical correlates are scanty. AIM To evaluate if the difference between vascular and chronological age (Δage), in a population of subjects with erectile dysfunction (ED), can identify men with a worse risk profile. METHODS A consecutive series of 2,853 male patients attending the outpatient clinic for erectile dysfunction (ED) for the first time was retrospectively studied. Among them, 85.4% (n = 2,437) were free of previous MACE and were analyzed. MAIN OUTCOME MEASURES Several clinical, biochemical, and penile color Doppler parameters were studied. Vascular age was derived from the SCORE project algorithm, and the Δage was considered. RESULTS Higher Δage is associated with several conventional (family history of CV diseases, hyperglycemia, elevated triglycerides, and increased prevalence of metabolic syndrome) and unconventional (severity of ED, frequency of sexual activity, alcohol abuse, lower education level, fatherhood, extramarital affairs, compensated hypogonadism, and low prolactin levels) risk factors. Δage is inversely related to penile color Doppler parameters, including flaccid and dynamic peak systolic velocity and flaccid acceleration (β = -0.125, -0.113, and -0.134, respectively, all P < 0.0001). CONCLUSIONS In subjects referring for ED without a personal history of CV events, Δage is associated with an adverse cardio-metabolic profile and worse penile color Doppler ultrasound parameters. Δage provides a simple method for identifying high-risk men that must undergo significant modification in their lifestyle and risk factors. In addition, it can be considered a simple, inexpensive, and safe surrogate marker of penile arterial damage.
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Affiliation(s)
- Giulia Rastrelli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Corona
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Endocrinology Section, Maggiore Hospital, Bologna, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Section, Maggiore Hospital, Bologna, Italy
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García-Hermoso A, Notario-Pacheco B, Recio-Rodríguez J, Martínez-Vizcaíno V, Rodrigo de Pablo E, Magdalena Belio J, Gómez-Marcos M, García-Ortiz L. Sedentary behaviour patterns and arterial stiffness in a Spanish adult population – The EVIDENT trial. Atherosclerosis 2015; 243:516-22. [DOI: 10.1016/j.atherosclerosis.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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Gatti AA, Stratford PW, Brenneman EC, Maly MR. GT3X+ accelerometer placement affects the reliability of step-counts measured during running and pedal-revolution counts measured during bicycling. J Sports Sci 2015; 34:1168-75. [PMID: 26487374 DOI: 10.1080/02640414.2015.1096018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Accelerometers provide a measure of step-count. Reliability and validity of step-count and pedal-revolution count measurements by the GT3X+ accelerometer, placed at different anatomical locations, is absent in the literature. The purpose of this study was to investigate the reliability and validity of step and pedal-revolution counts produced by the GT3X+ placed at different anatomical locations during running and bicycling. Twenty-two healthy adults (14 men and 8 women) completed running and bicycling activity bouts (5 minutes each) while wearing 6 accelerometers: 2 each at the waist, thigh and shank. Accelerometer and video data were collected during activity. Excellent reliability and validity were found for measurements taken from accelerometers mounted at the waist and shank during running (Reliability: intraclass correlation (ICC) ≥ 0.99; standard error of measurement (SEM) ≤1.0 steps; VALIDITY Pearson ≥ 0.99) and at the thigh and shank during bicycling (Reliability: ICC ≥ 0.99; SEM ≤1.0 revolutions; VALIDITY Pearson ≥ 0.99). Excellent reliability was found between measurements taken at the waist and shank during running (ICC ≥ 0.98; SEM ≤1.6 steps) and between measurements taken at the thigh and shank during bicycling (ICC ≥ 0.99; SEM ≤1.0 revolutions). These data suggest that the GT3X+ can be used for measuring step-count during running and pedal-revolution count during bicycling. Only shank placement is recommended for both activities.
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Affiliation(s)
- Anthony A Gatti
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - Paul W Stratford
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - Elora C Brenneman
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
| | - Monica R Maly
- a School of Rehabilitation Science , McMaster University , Hamilton , Canada
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Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Puigdomenech E, Notario-Pacheco B, Mendizabal-Gallastegui N, de la Fuente ADLC, Otegui-Ilarduya L, Maderuelo-Fernandez JA, de Cabo Laso A, Agudo-Conde C, Garcia-Ortiz L. Effects of kiwi consumption on plasma lipids, fibrinogen and insulin resistance in the context of a normal diet. Nutr J 2015; 14:97. [PMID: 26374292 PMCID: PMC4572627 DOI: 10.1186/s12937-015-0086-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background and aims Among fruits, kiwi is one of the richest in vitamins and polyphenols and has strong anti-oxidant effects. We aimed to analyze the relationship between the consumption of kiwi and plasma lipid values, fibrinogen, and insulin resistance in adults within the context of a normal diet and physical-activity. Methods Cross-sectional study. Participants (N = 1469), who were free of cardiovascular diseases, completed a visit, which included the collection of information concerning the participant’s usual diet and kiwi consumption using a previously validated, semi-quantitative, 137-item food-frequency-questionnaire. Fasting laboratory determinations included plasma lipids, fibrinogen and insulin resistance. Regular physical-activity was determined using accelerometry. Results Consumers of at least 1 kiwi/week presented higher plasma values of HDL-cholesterol (mean difference 4.50 [95 % CI: 2.63 to 6.36]) and lower triglyceride values (mean difference −20.03 [95 % CI: −6.77 to −33.29]), fibrinogen values (mean difference −13.22 [95 % CI: −2.18 to −24.26]) and HOMAir values (mean difference −0.30 [95 % CI: −0.09 to −0.50]) (p < 0.05, for all comparisons) than those who consumed less than 1 kiwi per week. In an adjusted logistic regression analysis, this group had a lower odds-ratio for presenting plasmatic fibrinogen concentrations above 400 mg/dL (OR = 0.68, 95 % CI 0.49 to 0.95), HDL-Cholesterol plasma values below 45 mg/dL (OR = 0.57, 95 % CI 0.36 to 0.91) and a HOMAir above 3 (OR = 0.61, 95 % CI 0.37 to 1.00). Conclusions Consumption of at least one kiwi/week is associated with lower plasma concentrations of fibrinogen and improved plasma lipid profile in the context of a normal diet and regular exercise.
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Affiliation(s)
- Jose I Recio-Rodriguez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain. .,Unidad de Investigación, Centro de Salud La Alamedilla, Avda. Comuneros 27-31, 37003, Salamanca, Spain.
| | - Manuel A Gomez-Marcos
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | | | - Elisa Puigdomenech
- Passeig de Sant Joan Health Center, Catalan Health Center, Barcelona, Spain
| | | | | | | | | | | | - Angela de Cabo Laso
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - Cristina Agudo-Conde
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - Luis Garcia-Ortiz
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
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Self-Selected Walking Speed is Predictive of Daily Ambulatory Activity in Older Adults. J Aging Phys Act 2015; 24:214-22. [PMID: 26371593 DOI: 10.1123/japa.2015-0104] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R2 = .51), MWS (R2 = .35), and WSR calculated as a ratio (R2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 -LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 -LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.
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Bowry ADK, Lewey J, Dugani SB, Choudhry NK. The Burden of Cardiovascular Disease in Low- and Middle-Income Countries: Epidemiology and Management. Can J Cardiol 2015; 31:1151-9. [PMID: 26321437 DOI: 10.1016/j.cjca.2015.06.028] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 01/07/2023] Open
Abstract
Cardiovascular disease (CVD) is the second leading cause of mortality worldwide, accounting for 17 million deaths in 2013. More than 80% of these cases were in low- and middle-income countries (LMICs). Although the risk factors for the development of CVD are similar throughout the world, the evolving change in lifestyle and health behaviours in LMICs-including tobacco use, decreased physical activity, and obesity-are contributing to the escalating presence of CVD and mortality. Although CVD mortality is falling in high-income settings because of more effective preventive and management programs, access to evidence-based interventions for combating CVD in resource-limited settings is variable. The existing pressures on both human and financial resources impact the efforts of controlling CVD. The implementation of emerging innovative interventions to improve medication adherence, introducing m-health programs, and decentralizing the management of chronic diseases are promising methods to reduce the burden of chronic disease management on such fragile health care systems.
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Affiliation(s)
- Ashna D K Bowry
- Department of Community and Family Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Lewey
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Sagar B Dugani
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Gómez-Sánchez L, García-Ortiz L, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Gómez-Marcos MA. [Relationship between physical activity and hemodynamic parameters in adults]. HIPERTENSION Y RIESGO VASCULAR 2015; 32:113-8. [PMID: 26180035 DOI: 10.1016/j.hipert.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 03/06/2015] [Accepted: 03/10/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults. METHODS This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx). RESULTS Mean age 55.85±12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77mmHg. Mean physician activity counts/min was 244.37 and 2.63±10.26min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r=-0.179; P<.01) and vigorous activity day time with IMT(r=-0.174; P<.01), CAIx (r=-0.217; P<.01) and PAIx (r=-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained. CONCLUSION The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults.
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Affiliation(s)
- L Gómez-Sánchez
- Unidad de Investigación de la Alamedilla, Medicina de Familia, Centro de Salud Monovar, Atención Primaria, Servicio Madrileño de Salud, Madrid, España
| | - L García-Ortiz
- Unidad de Investigación de la Alamedilla, Medicina de Familia, Centro de Salud de la Alamedilla, Servicio de Salud de Castilla y León, Salamanca, España; Departamento de Medicina de la Universidad de Salamanca, IBSAL, Salamanca, España
| | | | - M C Patino-Alonso
- Departamento de Estadística, Universidad de Salamanca, IBSAL, Salamanca, España
| | - C Agudo-Conde
- Departamento de Estadística, Universidad de Salamanca, IBSAL, Salamanca, España
| | - M A Gómez-Marcos
- Unidad de Investigación de la Alamedilla, Medicina de Familia, Centro de Salud de la Alamedilla, Servicio de Salud de Castilla y León, Salamanca, España.
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Laursen ASD, Hansen ALS, Wiinberg N, Brage S, Sandbæk A, Lauritzen T, Witte DR, Jørgensen ME, Johansen NB. Higher physical activity is associated with lower aortic stiffness but not with central blood pressure: the ADDITION-Pro Study. Medicine (Baltimore) 2015; 94:e485. [PMID: 25654392 PMCID: PMC4602712 DOI: 10.1097/md.0000000000000485] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Physical activity is associated with reduced cardiovascular disease risk. However, improvements in conventional risk factors due to physical activity do not explain its full benefit. Therefore, we examined associations of objectively measured physical activity energy expenditure and intensity with central hemodynamics to provide new insight into the link between physical activity and cardiovascular disease. We analyzed data from 1816 Danes (median age: 66 years) without cardiovascular disease. Physical activity was estimated using combined accelerometry and heart rate monitoring. Aortic stiffness was assessed by applanation tonometry, as aortic pulse wave velocity, and central blood pressure was estimated from radial waveforms. Associations between physical activity energy expenditure and central hemodynamics were examined by linear regression. Furthermore, the consequence of substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity on central hemodynamics was examined. Median physical activity energy expenditure was 28.0 kJ/kg/d (IQR: 19.8; 38.7). A 10 kJ/kg/d higher energy expenditure was associated with 0.75% lower aortic pulse wave velocity (CI: -1.47; -0.03). Associations with central systolic blood pressure and central pulse pressure were not statistically significant. We observed no difference in central hemodynamics when substituting 1 hour sedentary behavior with 1 hour light or moderate-to-vigorous physical activity. In this relatively inactive population, higher physical activity energy expenditure was associated with lower aortic stiffness, while there was no statistically significant association between substitution of activity intensity and central hemodynamics. This suggests that lower aortic stiffness is one of a number of health benefits attributed to higher habitual physical activity.
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Affiliation(s)
- Anne Sofie Dam Laursen
- From the Steno Diabetes Center, Gentofte, Denmark (ASDL, MEJ, NBJ); Department of Public Health, Section of General Practice, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark (A-LSH, AS, TL); Department of Clinical Physiology, Frederiksberg Hospital, Copenhagen, Denmark (NW); MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom (SB); Centre de Recherche Public de la Santé, Strassen, Luxembourg (DRW); and Danish Diabetes Academy, Odense, Denmark (NBJ)
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Groenewegen KA, den Ruijter HM, Pasterkamp G, Polak JF, Bots ML, Peters SA. Vascular age to determine cardiovascular disease risk: A systematic review of its concepts, definitions, and clinical applications. Eur J Prev Cardiol 2015; 23:264-74. [PMID: 25609227 DOI: 10.1177/2047487314566999] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vascular age is an alternate means of representing an individual's cardiovascular risk. Little consensus exists on what vascular age represents and its clinical utility has not been determined. We systematically reviewed the literature to provide a comprehensive overview of different methods that have been used to define vascular age, and to examine its potential clinical value in patient communication and risk prediction. DESIGN This was a systematic review with data sources of PubMed and Embase. RESULTS We identified 39 articles on vascular age, 20 proposed to use vascular age as a communication tool and 19 proposed to use vascular age as a means to improve cardiovascular risk prediction. Eight papers were methodological and 31 papers reported on vascular age in study populations. Of these 31 papers, vascular age was a direct translation of the absolute risk estimated by existing cardiovascular risk prediction models in 15 papers, 12 derived vascular age from the reference values of an additional test, and in three papers vascular age was defined as the age at which the estimated cardiovascular risk equals the risk from non-invasive imaging observed degree of atherosclerosis. One trial found a small effect on risk factor levels when vascular age was communicated instead of cardiovascular risk. CONCLUSION Despite sharing a common name, various studies have proposed distinct ways to define and measure vascular age. Studies into the effects of vascular age as a tool to improve cardiovascular risk prediction or patient communication are scarce but will be required before its clinical use can be justified.
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Affiliation(s)
- K A Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - H M den Ruijter
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands Department of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
| | - G Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
| | - J F Polak
- Tufts University School of Medicine, Tufts Medical Center, USA
| | - M L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Sanne Ae Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands The George Institute for Global Health, University of Oxford, UK
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Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Rodrigo-De Pablo E, Cabrejas-Sánchez A, Arietaleanizbeaskoa MS, Repiso-Gento I, Gonzalez-Viejo N, Maderuelo-Fernandez JA, Agudo-Conde C, Garcia-Ortiz L. Glycemic index, glycemic load, and pulse wave reflection in adults. Nutr Metab Cardiovasc Dis 2015; 25:68-74. [PMID: 25315672 DOI: 10.1016/j.numecd.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.
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Affiliation(s)
- J I Recio-Rodriguez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain.
| | - M A Gomez-Marcos
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | | | - E Rodrigo-De Pablo
- Passeig de Sant Joan Health Center, Catalan Health Center, Barcelona, Spain
| | - A Cabrejas-Sánchez
- Cuenca III Health Centre, Castilla La Mancha Health Service-SESCAM, Cuenca, Spain
| | | | - I Repiso-Gento
- Casa del Barco Health Center, Castilla and León Health Service-SACYL, Valladolid, Spain
| | - N Gonzalez-Viejo
- Torre Ramona Health Center, Aragón Health Service-Salud, Zaragoza, Spain
| | - J A Maderuelo-Fernandez
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - C Agudo-Conde
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
| | - L Garcia-Ortiz
- La Alamedilla Health Centre, Castilla and León Health Service-SACYL, redIAPP, IBSAL, Salamanca, Spain
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Calcaterra V, Vandoni M, Correale L, Larizza D, DeBarbieri G, Albertini R, Tinelli C, Arpesella M, Bernardi L. Deep breathing acutely improves arterial dysfunction in obese children: evidence of functional impairment? Nutr Metab Cardiovasc Dis 2014; 24:1301-1309. [PMID: 25156892 DOI: 10.1016/j.numecd.2014.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 06/25/2014] [Accepted: 06/30/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Similarly to diabetes type 2, patients with obesity show insulin resistance and autonomic and vascular abnormalities associated with increased morbidity and mortality. We tested whether arterial dysfunction in obese children may have a functional nature, reversible with appropriate interventions (e.g., by reduction of sympathetic activity), or else results from anatomic arterial modifications (likely irreversible). For this purpose, we tested whether deep breathing (an intervention known to transiently reduce sympathetic activity) could acutely improve arterial function, hence showing a functional abnormality. METHODS AND RESULTS A total of 130 obese children and 67 age-matched healthy normal-weight control children were recruited. Arterial function was measured by augmentation index (AIx), by direct analysis of blood pressure contour, and by pulse wave velocity (PWV), during spontaneous and controlled breathing. The markers of metabolic syndrome were evaluated at baseline. AIx showed increased values in obese male participants as compared with the control group. Slow breathing acutely reduced Aix in obese children, to a greater extent than in normal-weight control children. Similarly, the blood pressure contour showed higher values in obese children that were significantly attenuated by slow breathing. Baseline PWV was not altered in obese participants. The markers of metabolic syndrome correlated with AIx and PWV. CONCLUSIONS Obese subjects showed impaired arterial function. The acute improvement in vascular abnormalities with reduction in sympathetic activity indicates that this alteration was largely functional, likely related to initial autonomic dysfunction and to metabolic abnormalities. As a consequence, this study provides a rationale for strategies aiming at preventing arterial function deterioration in the early ages.
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Affiliation(s)
- V Calcaterra
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - M Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
| | - L Correale
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
| | - D Larizza
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Department of the Mother and Child Health, Pediatric Unit, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - G DeBarbieri
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - R Albertini
- Laboratory of Clinical Chemistry, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - C Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - M Arpesella
- Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
| | - L Bernardi
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Folkhälsan Institute of Genetics, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland.
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Recio-Rodríguez JI, Martín-Cantera C, González-Viejo N, Gómez-Arranz A, Arietaleanizbeascoa MS, Schmolling-Guinovart Y, Maderuelo-Fernandez JA, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gómez-Marcos MA, García-Ortiz L. Effectiveness of a smartphone application for improving healthy lifestyles, a randomized clinical trial (EVIDENT II): study protocol. BMC Public Health 2014; 14:254. [PMID: 24628961 PMCID: PMC4003852 DOI: 10.1186/1471-2458-14-254] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New technologies could facilitate changes in lifestyle and improve public health. However, no large randomized, controlled studies providing scientific evidence of the benefits of their use have been made. The aims of this study are to develop and validate a smartphone application, and to evaluate the effect of adding this tool to a standardized intervention designed to improve adherence to the Mediterranean diet and to physical activity. An evaluation is also made of the effect of modifying habits upon vascular structure and function, and therefore on arterial aging. METHODS/DESIGN A randomized, double-blind, multicenter, parallel group clinical trial will be carried out. A total of 1215 subjects under 70 years of age from the EVIDENT trial will be included. Counseling common to both groups (control and intervention) will be provided on adaptation to the Mediterranean diet and on physical activity. The intervention group moreover will receive training on the use of a smartphone application designed to promote a healthy diet and increased physical activity, and will use the application for three months. The main study endpoints will be the changes in physical activity, assessed by accelerometer and the 7-day Physical Activity Recall (PAR) interview, and adaptation to the Mediterranean diet, as evaluated by an adherence questionnaire and a food frequency questionnaire (FFQ). Evaluation also will be made of vascular structure and function based on central arterial pressure, the radial augmentation index, pulse velocity, the cardio-ankle vascular index, and carotid intima-media thickness. DISCUSSION Confirmation that the new technologies are useful for promoting healthier lifestyles and that their effects are beneficial in terms of arterial aging will have important clinical implications, and may contribute to generalize their application in favor of improved population health. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02016014.
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Affiliation(s)
- José I Recio-Rodríguez
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Carlos Martín-Cantera
- Primary Health care Research Unit of Barcelona, Primary Healthcare University Research Institute IDIAP-Jordi Gol, Barcelona, Spain
| | | | - Amparo Gómez-Arranz
- Casa de Barco Health Center, Castilla y León Health Service, Valladolid, Spain
| | | | - Yolanda Schmolling-Guinovart
- Río Tajo Health Center, Castilla-La Mancha Health Service, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | | | | | | | - Manuel A Gómez-Marcos
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
| | - Luis García-Ortiz
- The Alamedilla Health Center, Castilla y León Health Service, USAL, IBSAL, Salamanca, Spain
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