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Ołpińska B, Wyderka R, Łoboz-Rudnicka M, Brzezińska B, Łoboz-Grudzień K, Jaroch J. Early Cardiac Rehabilitation Improves Carotid Arterial Stiffness in Patients with Myocardial Infarction. Clin Interv Aging 2024; 19:471-480. [PMID: 38504777 PMCID: PMC10948328 DOI: 10.2147/cia.s452362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024] Open
Abstract
Background Little is known about the effect of cardiac rehabilitation (CR) on carotid arterial stiffness (CAS) in patients with myocardial infarction (MI). Patients and Methods Rehabilitation group (B) included 90 patients with MI subjected to CR, control group (K) consisted of 30 patients with MI not participating in CR, and healthy group comprised 38 persons without cardiovascular risk factors. CAS was determined using echo-tracking before and after CR. Results At baseline, patients with MI (B+K) presented with significantly higher mean values of CAS parameters: beta-stiffness index (7.1 vs 6.4, p = 0.004), Peterson's elastic modulus (96 kPa vs 77 kPa, p < 0.001) and PWV-beta (6.1 m/s vs 5.2 m/s, p < 0.001) than healthy persons. Age (beta: r = 0.242, p = 0.008; EP: r = 0.250, p = 0.006; PWV-beta: r = 0.224, p = 0.014) and blood pressure: SBP (EP: r = 0.388, PWV-beta: r = 0.360), DBP (AC: r = 0.225) and PP (PWV-beta: r = 0.221) correlated positively with the initial parameters of CAS. Beta-stiffness index (Rho=-0.26, p = 0.04) and PWV-beta (Rho = 0.29, p = 0.03) correlated inversely with peak exercise capacity expressed in METs. After CR, mean values of beta-stiffness index (6.2 vs 7.1, p = 0.016), EP (78 kPa vs 101 kPa, p = 0.001) and PWV-beta (5.4 m/s vs 6.2 m/s, p = 0.001) in group B were significantly lower than in group K. In group B, CAS parameters decreased significantly after CR. Univariate analysis demonstrated that the likelihood of an improvement in CAS after CR was significantly higher in patients with baseline systolic blood pressure <120 mm Hg (OR = 2.74, p = 0.009) and left ventricular ejection fraction <43% (OR = 5.05, p = 0.005). Conclusion In patients with MI, CR exerted a beneficial effect on CAS parameters. The improvement in CAS was predicted by lower SBP and LVEF at baseline.
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Affiliation(s)
- Bogusława Ołpińska
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Rafał Wyderka
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
- Faculty of Medicine, University of Science and Technology, Wrocław, Poland
| | - Maria Łoboz-Rudnicka
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Barbara Brzezińska
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Krystyna Łoboz-Grudzień
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
| | - Joanna Jaroch
- Department of Cardiology, T Marciniak Lower Silesian Specialist Hospital, Emergency Medicine Center, Wrocław, Poland
- Faculty of Medicine, University of Science and Technology, Wrocław, Poland
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Bakali M, Ward TC, Daynes E, Jones AV, Hawthorne GM, Latimer L, Divall P, Graham-Brown M, McCann GP, Yates T, Steiner MC, Evans RA. Effect of aerobic exercise training on pulse wave velocity in adults with and without long-term conditions: a systematic review and meta-analysis. Open Heart 2023; 10:e002384. [PMID: 38101857 PMCID: PMC10729135 DOI: 10.1136/openhrt-2023-002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023] Open
Abstract
RATIONALE There is conflicting evidence whether aerobic exercise training (AET) reduces pulse wave velocity (PWV) in adults with and without long-term conditions (LTCs). OBJECTIVE To explore whether PWV improves with AET in adults with and without LTC, to quantify the magnitude of any effect and understand the influence of the exercise prescription. DATA SOURCES CENTRAL, MEDLINE and EMBASE were among the databases searched. ELIGIBILITY CRITERIA We included studies with a PWV measurement before and after supervised AET of at least 3 weeks duration. Exclusion criteria included resistance exercise and alternative measures of arterial stiffness. DESIGN Controlled trials were included in a random effects meta-analysis to explore the effect of AET on PWV. Uncontrolled studies were included in a secondary meta-analysis and meta-regression exploring the effect of patient and programme factors on change in PWV. The relevant risk of bias tool was used for each study design. RESULTS 79 studies (n=3729) were included: 35 controlled studies (21 randomised control trials (RCT) (n=1240) and 12 non-RCT (n=463)) and 44 uncontrolled (n=2026). In the controlled meta- analysis, PWV was significantly reduced following AET (mean (SD) 11 (7) weeks) in adults with and without LTC (mean difference -0.63; 95% CI -0.82 to -0.44; p<0.0001). PWV was similarly reduced between adults with and without LTC (p<0.001). Age, but not specific programme factors, was inversely associated with a reduction in PWV -0.010 (-0.020 to -0.010) m/s, p<0.001. DISCUSSION Short-term AET similarly reduces PWV in adults with and without LTC. Whether this effect is sustained and the clinical implications require further investigation.
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Affiliation(s)
- Majda Bakali
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Cj Ward
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Enya Daynes
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Amy V Jones
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Grace M Hawthorne
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Lorna Latimer
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Pip Divall
- Education Centre Library, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Matt Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Michael C Steiner
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael Andrea Evans
- NIHR Leicester Biomedical Research Centre -Respiratory, Department of Respiratory Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- Centre of Exercise and Reshabilitaiton Sciences, NIHR Leicester Biomedical Research Centre, Leicester, UK
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Lee SJ, Hwan Choi J, Kim SY, Lee JG, Lee SY, Jung Lee H. The effect of home-based cardiac rehabilitation on arterial stiffness and peak oxygen consumption in patients with myocardial infarction. Turk J Phys Med Rehabil 2023; 69:444-452. [PMID: 38766593 PMCID: PMC11099851 DOI: 10.5606/tftrd.2023.11637] [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: 08/28/2022] [Accepted: 03/22/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives This study aims to investigate the effectiveness of home-based cardiac rehabilitation (CR) on arterial stiffness in patients with acute myocardial infarction (AMI). Patients and methods Between January 2015 and December 2017, a total of 135 patients (120 males, 15 females; mean age: 58.8±11.1 years) with AMI who were referred for CR were included. Home-based CR was prescribed based on a cardiopulmonary exercise test (CPET) for at least six months. All patients completed three consecutive CPETs and brachial-ankle pulse wave velocity (baPWV) measurements at one, four, and seven months after onset. Results After six months of CR, there was an improvement in peak oxygen consumption (pVO2) (Month 1, 28.7±6.4 mL/kg/min; Month 4, 31.6±6.3 mL/kg/min; Month 7, 31.2±7.1 mL/kg/min, p<0.001) and a reduction in baPWV (Month 1, left, 1546.0±311.2 cm/sec, right 1545.5±301.5 cm/sec; Month 4, left, 1374.9±282.5 cm/sec, right 1371.6±287.5 cm/sec; Month 7, left, 1362.9±287.0 cm/sec, right 1365.5±281.1 cm/sec, p<0.001). Conclusion In patients with AMI, arterial stiffness and aerobic capacity improved after six months of home-based CR, particularly in the early stages of rehabilitation. These results suggest that changes in baPWV are useful in determining the effectiveness of CR and pVO2 in the initial stages of CR.
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Affiliation(s)
- Su Jong Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jun Hwan Choi
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Hyun Jung Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
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Coombs GB, Al-Khazraji BK, Suskin N, Shoemaker JK. Impact of ischemic heart disease and cardiac rehabilitation on cerebrovascular compliance. J Appl Physiol (1985) 2023; 135:753-762. [PMID: 37616337 DOI: 10.1152/japplphysiol.00654.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
We aimed to determine the influence of ischemic heart disease (IHD) and cardiac rehabilitation (CR) on cerebrovascular compliance index (Ci). Eleven (one female) patients with IHD (mean[SD]: 61[11] yr, 29[4] kg/m2) underwent 6 mo of CR, which consisted of ≥3 sessions/wk of aerobic and resistance training (20-60 min each). Ten (three female) similarly aged controls (CON) were tested at baseline as a comparator group. Middle cerebral artery velocity (MCAv) and mean arterial pressure were monitored continuously using transcranial Doppler ultrasound and finger photoplethysmography, respectively, during a rapid sit-to-stand maneuver. A Windkessel model was used to estimate cerebrovascular Ci every five cardiac cycles for a duration of 30 s. Cerebrovascular resistance was calculated as the quotient of MAP and MCAv. Two-way ANOVAs were used to determine whether cerebrovascular variables differ during postural transitions between groups and after CR. Baseline MCAv was higher in CON versus IHD (P = 0.014) and a time × group interaction was observed (P = 0.045) where MCAv decreased more in CON after standing. Compared with the precondition, CR had no effect on MCAv (condition P = 0.950) but a main effect of time indicated that MCAv decreased from the seated position in both conditions (time P = 0.013). Baseline cerebrovascular Ci was greater in IHD versus CON (P = 0.049) and the peak cerebrovascular Ci during the transition to standing was significantly higher in IHD compared with CON (interaction P = 0.047). CR did not affect cerebrovascular compliance (P = 0.452) and no time-by-condition interaction upon standing was present (P = 0.174). Baseline cerebrovascular Ci is higher in IHD at baseline compared with CON, but 6 mo of CR did not modify the transient increase in cerebrovascular Ci during sit-to-stand maneuvers.NEW & NOTEWORTHY Post-cardiac event cognitive impairment is common and exercise-based rehabilitation may be an effective intervention to mitigate cognitive decline. Microvascular damage due to high blood pressure pulsatility entering the brain is the putative mechanism of vascular dementia. Whether patients with ischemic heart disease exhibit lower cerebrovascular compliance, and if cardiac rehabilitation can improve cerebrovascular compliance is unknown. We observed that patients with ischemic heart disease have paradoxically higher cerebrovascular compliance, which is not affected by cardiac rehabilitation.
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Affiliation(s)
- Geoff B Coombs
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
| | - Baraa K Al-Khazraji
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Neville Suskin
- Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
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Li G, Lv Y, Su Q, You Q, Yu L. The effect of aerobic exercise on pulse wave velocity in middle-aged and elderly people: A systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:960096. [PMID: 36061566 PMCID: PMC9433655 DOI: 10.3389/fcvm.2022.960096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
A growing body of research examines the effect of aerobic exercise on pulse wave velocity (PWV) in middle-aged and elderly people, while findings of available studies were conflicting. The aim of this study was to explore the effect of aerobic exercise on PWV in middle-aged and elderly people. Searches were performed in PubMed, Web of Science, and EBSCO databases. Cochrane risk assessment tool was used to evaluate the methodological quality of the included literature. We included studies that satisfied the following criteria: (1) eligible studies should be randomized controlled trials (RCTs); (2) eligible studies should include both an intervention and a control group; (3) eligible studies should use the middle-aged or elderly people as subjects; and (4) eligible studies should use PWV as the outcome measure. From 972 search records initially identified, 11 studies with a total of 12 exercise groups (n = 245) and 11 control groups (n = 239) were eligible for meta-analysis. There was a significant effect of aerobic exercise on reducing PWV in middle-aged and elderly people [weighted mean difference (WMD), –0.75 (95% CI, –1.21 to –0.28), p = 0.002]. Specifically, a higher intensity [vigorous-intensity, –0.74 (–1.34 to –0.14), p = 0.02; moderate-intensity, –0.68 (–1.49 to 0.12), p = 0.10], a younger age [45 years ≤ age < 60 years, –0.57 (–0.78 to –0.37), p < 0.00001; age ≥ 60 years, –0.91 (–2.10 to 0.27), p = 0.13], a better health status [healthy, –1.19 (–2.06 to –0.31), p = 0.008; diseased, –0.32 (–0.64 to –0.01), p = 0.04], and a lower basal body mass index (BMI) [BMI < 25, –1.19 (–2.06 to –0.31), p = 0.008; 25 ≤ BMI < 30, –0.52 (–0.92 to –0.12), p = 0.01; BMI ≥ 30, –0.09 (–0.93 to 0.76), p = 0.84] were associatedwith larger reductions in PWV. Aerobic exercise, especially vigorous-intensity aerobic exercise, contributed to reducing PWV in middle-aged and elderly people. The effect of aerobic exercise on improving PWV was associated with characteristics of the participants. Specifically, a younger age, a better health status, and a lower basal BMI contributed to more significant reductions in PWV.
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Affiliation(s)
- Gen Li
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Qing Su
- Ersha Sports Training Center of Guangdong Province, Guangzhou, China
| | - Qiuping You
- Sports Coaching College, Beijing Sport University, Beijing, China
| | - Laikang Yu
- Key Laboratory of Physical Fitness and Exercise, Ministry of Education, Beijing Sport University, Beijing, China
- Department of Strength and Conditioning Training, Beijing Sport University, Beijing, China
- *Correspondence: Laikang Yu,
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Mystakidi VC, Goliopoulou A, Anastasiou M, Christoforatou E, Tousoulis D. The Association of Physical Activity with Arterial Stiffness and Inflammation: Insight from the "Corinthia" Study. Angiology 2022; 73:716-723. [PMID: 35138950 DOI: 10.1177/00033197211065795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Diminished physical activity is a frequent phenomenon leading to a higher incidence of cardiovascular morbidity and mortality. Our study aimed to assess the impact of physical activity on arterial stiffness and inflammation. Classification of physical activity was performed in 1945 individuals of the cross-sectional "Corinthia" study using the International Physical Activity Questionnaire. Demographic and clinical characteristics were obtained via a standardized questionnaire. Arterial stiffness was estimated via carotid-femoral pulse wave velocity evaluation, and the inflammatory burden was assessed via high sensitivity C reactive protein (hsCRP) measurement. Participants with low physical activity had the most impaired carotid-femoral pulse wave velocity values while abnormally increased measurements-adjusted for age and blood pressure-were more frequently encountered in individuals with low physical activity. Participants characterized as having vigorous physical activity had the lowest inflammatory burden, as estimated by hsCRP levels. The results remained unaffected even after adjustment for confounders. In a subgroup analysis according to sex, increased arterial stiffness and inflammatory burden were noted similarly in female and male subjects within the lowest percentile of physical activity. In conclusion, a significant association between physical activity, arterial stiffness, and inflammation was observed, even after adjusting for known cardiovascular risk factors.
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Affiliation(s)
- Panagiotis Theofilis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - George Lazaros
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Georgia Vogiatzi
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Vasiliki C Mystakidi
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Athina Goliopoulou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Maria Anastasiou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelia Christoforatou
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - Dimitris Tousoulis
- Cardiology Department, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2021; 11:CD001800. [PMID: 34741536 PMCID: PMC8571912 DOI: 10.1002/14651858.cd001800.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. We are uncertain about the effects of exercise-based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.
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Affiliation(s)
- Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - James Faulkner
- Faculty Health and Wellbeing, School of Sport, Health and Community, University of Winchester, Winchester, UK
| | - Neil Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Exercise and Cardioprotection in Coronary Artery Disease: A Pilot Quasi-Experimental Study. J Aging Phys Act 2021; 30:281-296. [PMID: 34453025 DOI: 10.1123/japa.2021-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
Sirtuin-1 is a protein that may orchestrate the cardioprotective effect of exercise by controlling cellular processes. This pilot study assessed the feasibility of performing a quasi-experimental study in this area. Patients with postacute myocardial infarction were recruited across four hospital sites in the United Kingdom. The participants were offered one weekly exercise session at Phase-III and Phase-IV cardiac rehabilitation (CR). Measurements were obtained pre-Phase-III CR (Week 1), post-Phase-III CR (Week 8), and post-Phase-IV CR (Week 22). Twenty-eight patients were recruited (79% male, 100% White, 60.2 ± 10.5 years old). The recruitment rate was not fulfilled (<70% eligible patients recruited; 0.9 participants recruited per week over 30 weeks). The success criteria for dropout rate, adherence rate, and collection of sirtuin-1 measures were satisfied. A large increase in sirtuin-1 (0.14 ± 0.03, d ≥ 0.8) was seen after Phase-III and Phase-IV CR. Collectively, a quasi-experimental study is feasible with a revised recruitment strategy.
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New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation. J Clin Med 2020; 9:jcm9103131. [PMID: 32998251 PMCID: PMC7599992 DOI: 10.3390/jcm9103131] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Owing to its ease of application, noninvasive nature, and safety, echocardiography is an essential imaging modality to assess cardiac function in patients affected by ischemic heart disease (IHD). Over the past few decades, we have witnessed a continuous series of evolutions in the ultrasound field that have led to the introduction of innovative echocardiographic modalities which allowed to better understand the morphofunctional abnormalities occurring in cardiovascular diseases. This article offers an overview of some of the newest echocardiographic modalities and their promising application in IHD diagnosis, risk stratification, management, and monitoring after cardiac rehabilitation.
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10
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Cardiac Rehabilitation and Endothelial Function. J Clin Med 2020; 9:jcm9082487. [PMID: 32756306 PMCID: PMC7463659 DOI: 10.3390/jcm9082487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022] Open
Abstract
Endothelial dysfunction is an early abnormality in the process of atherosclerosis and cardiovascular disease and has been associated with worse clinical outcome. Cardiac rehabilitation (CR) has been reported to be helpful to reduce cardiovascular events in various types of cardiac disease, but the mechanisms of its beneficial effects remain only partially known. In this article, we review the studies that assessed the effect of CR on endothelial function in patients with various cardiac conditions. Available data show that CR significantly improves impaired endothelial function in these patients, which may contribute to the beneficial effects of CR on clinical outcome.
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11
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Hwang CL, Elokda A, Ozemek C, Arena R, Phillips SA. More than a matter of the heart: the concept of intravascular multimorbidity in cardiac rehabilitation. Expert Rev Cardiovasc Ther 2020; 18:557-562. [PMID: 32700592 DOI: 10.1080/14779072.2020.1798761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Coronary artery disease (CAD) is the major cause of death of cardiovascular disease. It is initiated by atherosclerosis, which narrows the coronary arteries and limits blood flow and oxygen to the heart. Multiple pathophysiological conditions within the arteries, such as arterial wall thickening, endothelial dysfunction, and arterial stiffening, are associated with the development of atherosclerosis. AREAS COVERED We introduce a new concept of 'intravascular multimorbidity,' the presence and integration of multiple pathophysiological conditions within the arteries. We also introduce some measurements of intravascular multimorbidity and discuss how these measurements can be utilized in cardiac rehabilitation (CR). EXPERT OPINION We propose that the measures of intravascular multimorbidity in different arteries may provide information on disease severity and serve as unique prognostic 'barometers' to disease progression in patients with CAD. By measuring the underlying disease mechanisms within the arteries and understanding individual variability of disease progression/regression, these measures may also provide a unique prognostic window in CR. The window into intravascular multimorbidity can help guide clinical strategies, for example, assessing progress and appropriate titration of exercise. Intravascular multimorbidity may represent an important opportunity for more researchers and clinical professions to evaluate patients in CR.
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Affiliation(s)
- Chueh-Lung Hwang
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Ahmed Elokda
- Department of Rehabilitation Sciences, Florida Golf Coast University , Fort Myers, FL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago , Chicago, IL, USA
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12
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Trovato GM. Non-alcoholic fatty liver disease and Atherosclerosis at a crossroad: The overlap of a theory of change and bioinformatics. World J Gastrointest Pathophysiol 2020; 11:57-63. [PMID: 32435522 PMCID: PMC7226912 DOI: 10.4291/wjgp.v11.i3.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 02/06/2023] Open
Abstract
Atherosclerosis (ATH) and non-alcoholic fatty liver disease (NAFLD) are medical conditions that straddle a communal epidemiology, underlying mechanism and a clinical syndrome that has protean manifestations, touching every organ in the body. These twin partners, ATH and NAFLD, are seemingly straightforward and relatively simple topics when considered alone, but their interdependence calls for more thought. The study of the mutual relationship of NAFLD and ATH should involve big data analytics approaches, given that they encompass a constellation of diseases and are related to several recognized risk factors and health determinants and calls to an explicit theory of change, to justify intervention. Research studies on the “association between aortic stiffness and liver steatosis in morbidly obese patients”, published recently, sparsely hypothesize new mechanisms of disease, claiming the “long shadow of NAFLD” as a risk factor, if not as a causative factor of arterial stiffness and ATH. This statement is probably overreaching the argument and harmful for the scientific credence of this area of medicine. Despite the verification that NAFLD and cardiovascular disease are strongly interrelated, current evidence is that NAFLD may be a useful indicator for flagging early arteriosclerosis, and not a likely causative factor. Greater sustainable contribution by precision medicine tools, by validated bioinformatics approaches, is needed for substantiating conjectures, assumptions and inferences related to the management of big data and addressed to intervention for behavioral changes within an explicit theory of change.
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Affiliation(s)
- Guglielmo M Trovato
- Department of Clinical and Experimental Medicine, the School of Medicine of the University of Catania, Catania 95125, Italy
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13
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Nichols S, Taylor C, Goodman T, Page R, Kallvikbacka-Bennett A, Nation F, Clark A, Birkett S, Carroll S, Ingle L. Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study. Int J Cardiol 2020; 305:25-34. [DOI: 10.1016/j.ijcard.2020.01.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
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14
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Thompson G, Davison GW, Crawford J, Hughes CM. Exercise and inflammation in coronary artery disease: A systematic review and meta-analysis of randomised trials. J Sports Sci 2020; 38:814-826. [DOI: 10.1080/02640414.2020.1735684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gareth Thompson
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim
| | - Gareth W. Davison
- Sport and Exercise Sciences Research Institute, Ulster University, Newtownabbey, County Antrim
| | - Jacqui Crawford
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim
| | - Ciara M. Hughes
- Institute of Nursing and Health Research, Ulster University, Jordanstown Campus, Newtownabbey, County Antrim
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15
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Acanfora D, Fuschillo S, Provitera V, Motta A, Maniscalco M. Biomarkers in cardiac rehabilitation: can they be applied in clinical practice? Biomark Med 2019; 13:701-705. [PMID: 31157979 DOI: 10.2217/bmm-2019-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Domenico Acanfora
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Vincenzo Provitera
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078 Pozzuoli, Naples, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Benevento, Italy
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16
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Arterial Stiffness is Associated With Moderate to Vigorous Physical Activity Levels in Post-Myocardial Infarction Patients. J Cardiopulm Rehabil Prev 2019; 39:325-330. [PMID: 30913044 DOI: 10.1097/hcr.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Arterial stiffness has shown independent predictive value for all-cause and cardiovascular mortalities, as well as fatal and nonfatal coronary events. Physical activity (PA) is associated with reduced cardiovascular morbidity and mortality. The study aims to analyze the cross-sectional association of arterial stiffness with objectively measured PA in patients following acute myocardial infarction. METHODS One hundred patients were consecutively recruited after experiencing an acute myocardial infarction. Central arterial stiffness was measured through carotid-femoral pulse wave velocity (cf-PWV) and daily PA was assessed objectively during 7 consecutive days with accelerometers. To be valid, data required recordings of at least 8 hr/d on 5 d. RESULTS The cf-PWV showed a negative and significant association with total weekly time spent in moderate to vigorous PA (MVPA) (r = -0.416, P < .001). Patients classified as having higher risk according to arterial stiffness values (cf-PWV ≥10 m/sec) showed significantly lower time spent in MVPA than those below that threshold. The cf-PWV was significantly lower in patients performing >300 min of MVPA/wk than in those performing <150 min/wk (8.53 ± 2.08 vs 10.3 ± 2.44 m/sec, P = .021). Differences remained significant after adjustment for several confounders. CONCLUSIONS Moderate to vigorous PA was inversely associated with arterial stiffness and time spent in MVPA was lower in patients after acute myocardial infarction, with cf-PWV above the risk threshold value (≥10 m/sec). These results seem to reinforce the importance of PA as a nonpharmacological tool for secondary cardiovascular prevention.
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17
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Zhang Y, Qi L, Xu L, Sun X, Liu W, Zhou S, van de Vosse F, Greenwald SE. Effects of exercise modalities on central hemodynamics, arterial stiffness and cardiac function in cardiovascular disease: Systematic review and meta-analysis of randomized controlled trials. PLoS One 2018; 13:e0200829. [PMID: 30036390 PMCID: PMC6056055 DOI: 10.1371/journal.pone.0200829] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/29/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Exercise is accepted as an important contribution to the rehabilitation of patients with cardiovascular disease (CVD). This study aims to better understand the possible causes for lack of consensus and reviews the effects of three exercise modalities (aerobic, resistance and combined exercise) on central hemodynamics, arterial stiffness and cardiac function for better rehabilitation strategies in CVD. METHODS The electronic data sources, Cochrane Library, MEDLINE, Web of Science, EBSCO (CINAHL), and ScienceDirect from inception to July 2017 were searched for randomized controlled trials (RCTs) investigating the effect of exercise modalities in adult patients with CVD. The effect size was estimated as mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis and meta-regression were used to study potential moderating factors. RESULTS Thirty-eight articles describing RCTs with a total of 2089 patients with CVD were included. The pooling revealed that aerobic exercise [MD(95%CI) = -5.87 (-8.85, -2.88), P = 0.0001] and resistance exercise [MD(95%CI) = -7.62 (-10.69, -4.54), P<0.00001] significantly decreased aortic systolic pressure (ASP). Resistance exercise significantly decreased aortic diastolic pressure [MD(95%CI) = -4(-5.63, -2.37), P<0.00001]. Aerobic exercise significantly decreased augmentation index (AIx) based on 24-week exercise duration and patients aged 50-60 years. Meanwhile, aerobic exercise significantly improved carotid-femoral pulse wave velocity (cf-PWV) [MD(95%CI) = -0.42 (-0.83, -0.01), P = 0.04], cardiac output (CO) [MD(95% CI) = 0.36(0.08, 0.64), P = 0.01] and left ventricular ejection fraction (LVEF) [MD(95%CI) = 3.02 (2.11, 3.93), P<0.00001]. Combined exercise significantly improved cf-PWV [MD(95%CI) = -1.15 (-1.95, -0.36), P = 0.004] and CO [MD(95% CI) = 0.9 (0.39, 1.41), P = 0.0006]. CONCLUSIONS Aerobic and resistance exercise significantly decreased ASP, and long-term aerobic exercise reduced AIx. Meanwhile, aerobic and combined exercise significantly improved central arterial stiffness and cardiac function in patients with CVD. These findings suggest that a well-planned regime could optimize the beneficial effects of exercise and can provide some evidence-based guidance for those involved in cardiovascular rehabilitation of patients with CVD.
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Affiliation(s)
- Yahui Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Lin Qi
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Lisheng Xu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
- Key Laboratory of Medical Image Computing, Ministry of Education, Northeastern University, Shenyang, Liaoning, China
| | - Xingguo Sun
- Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Beijing, China
| | - Wenyan Liu
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Shuran Zhou
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
| | - Frans van de Vosse
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, Liaoning, China
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stephen E. Greenwald
- Blizard Institute, Barts & The London School of Medicine &Dentistry, Queen Mary University of London, London, United Kingdom
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18
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Ahmed AM, Qureshi WT, Sakr S, Blaha MJ, Brawner CA, Ehrman JK, Keteyian SJ, Al-Mallah MH. Prognostic value of exercise capacity among patients with treated depression: The Henry Ford Exercise Testing (FIT) Project. Clin Cardiol 2018; 41:532-538. [PMID: 29665017 DOI: 10.1002/clc.22923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/28/2018] [Accepted: 02/04/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Exercise capacity is associated with survival in the general population. Whether this applies to patients with treated depression is not clear. HYPOTHESIS High exercise capacity remains associated with lower risk of all-cause mortality (ACM) and nonfatal myocardial infraction (MI) among patients with treated depression. METHODS We included 5128 patients on antidepressant medications who completed a clinically indicated exercise stress test between 1991 and 2009. Patients were followed for a median duration of 9.4 years for ACM and 4.5 years for MI. Exercise capacity was estimated in metabolic equivalents of tasks (METs). Cox proportional hazards regression models were used. RESULTS Patients with treated depression who achieved ≥12 METs (vs those achieving <6 METs) were younger (age 46 ± 9 vs 61 ± 12 years), more often male (60% vs 23%), less often black (10% vs 27%), and less likely to be hypertensive (51% vs 86%), have DM (9% vs 38%), or be obese (11% vs 36%) or dyslipidemic (45% vs 54%). In the fully adjusted Cox proportional hazard regression model, exercise capacity was associated with a lower ACM (HR per 1-MET increase in exercise capacity: 0.82, 95% CI: 0.79-0.85, P < 0.001) and nonfatal MI (HR: 0.92, 95% CI: 0.87-0.97, P = 0.004). CONCLUSIONS Exercise capacity had an inverse association with both ACM and nonfatal MI in patients with treated depression, independent of cardiovascular risk factors. These results highlight the potential impact of assessing exercise capacity to identify risk, as well as promoting an active lifestyle among treated depression patients.
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Affiliation(s)
- Amjad M Ahmed
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Waqas T Qureshi
- Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Sherif Sakr
- Department of Public Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Clinton A Brawner
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
| | - Jonathan K Ehrman
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Steven J Keteyian
- Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
| | - Mouaz H Al-Mallah
- King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of medicine, King Saud bin Abdulaziz for Health Sciences, Riyadh, Saudi Arabia
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19
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Ouédraogo V, Connes P, Tripette J, Tiendrébéogo AJF, Sow AK, Diaw M, Seck M, Diop M, Hallab M, Belue R, Samb A, Ba A, Lefthériotis G. Pulse wave velocity is lower in trained than in untrained sickle cell trait carriers. Clin Hemorheol Microcirc 2018; 69:417-424. [PMID: 29660907 DOI: 10.3233/ch-170310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sickle cell trait (SCT) is a benign condition of sickle cell disease. Nevertheless, previous reports showed that SCT carriers have increased blood viscosity and decreased vascular reactivity compared to non-SCT carrier. The benefit of regular exercise on vascular function has been well documented in the general population but no study focused on the SCT population. PURPOSE The aim of our study was to compare arterial stiffness and blood viscosity between trained and untrained SCT carriers, as well as a group of untrained non-SCT. METHODS Arterial stiffness (finger-toe pulse wave velocity) and blood viscosity were evaluated in untrained non-SCT carriers (n = 10), untrained SCT carriers (n = 23) and trained SCT carriers (n = 17) who reported at least 10 hours of physical exercise per week. RESULTS Untrained SCT carriers had higher pulse wave velocity (p = 0.032) and blood viscosity (p < 0.001) than their trained counterparts. In addition, untrained SCT carriers had higher blood viscosity (p < 0.001) than the untrained non-SCT group. A positive association was noted between blood viscosity and pulse wave velocity in the whole study population. CONCLUSION Our study suggests that regular exercise may be beneficial for the vascular function of SCT carriers.
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Affiliation(s)
- Valentin Ouédraogo
- Laboratoire de Physiologie Humaine, Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Sénégal
| | - Philippe Connes
- Laboratoire LIBM EA7424, Equipe "Biologie vasculaire et du globule rouge", Université Claude Bernard Lyon 1, Villeurbanne, France; Laboratoire d'Excellence sur le Globule Rouge (GR-Ex), Paris, France; Institut Universitaire de France, Paris, France
| | - Julien Tripette
- Ochanomizu University, 2-1-1 Otsuka, Bunkyo District, Tokyo, Japan
| | | | - Abdou Khadir Sow
- Laboratoire de Physiologie Humaine, Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Sénégal
| | - Mor Diaw
- Laboratoire de Physiologie Humaine, Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Sénégal
| | - Moussa Seck
- Laboratoire d'Hémato-Immunologie, FMPO, UCAD, Dakar, Sénégal
| | - Mountaga Diop
- Institut National Supérieur de l'Education Populaire et du Sport, UCAD, Dakar, Sénégal
| | - Magid Hallab
- Hôpital Universitaire de Nantes, Place Ricordeau, Nantes, France
| | - Rhonda Belue
- The Pennsylvania State University, University Park, PA, USA
| | - Abdoulaye Samb
- Laboratoire de Physiologie Humaine, Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Sénégal.,Unité Mixte Internationale (UMI 3189), "Environnement, Santé, Sociétés" CNRS, UCAD, CNRST, USTTB, UGB, Dakar, Sénégal
| | - Abdoulaye Ba
- Laboratoire de Physiologie Humaine, Faculté de Médecine, de Pharmacie et d'Odontologie, UCAD, Sénégal.,Unité Mixte Internationale (UMI 3189), "Environnement, Santé, Sociétés" CNRS, UCAD, CNRST, USTTB, UGB, Dakar, Sénégal
| | - Georges Lefthériotis
- Laboratoire de Biologie Neuro-vasculaire et Mitochondriale Intégrée UMR CNRS 6214 - Inserm, Faculté de Médecine Angers, Angers, France
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20
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Zhang Y, Yang Y. Arctigenin exerts protective effects against myocardial infarction via regulation of iNOS, COX‑2, ERK1/2 and HO‑1 in rats. Mol Med Rep 2018; 17:4839-4845. [PMID: 29328478 DOI: 10.3892/mmr.2018.8420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 09/05/2017] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to determine the protective effects of arctigenin against myocardial infarction (MI), and its effects on oxidative stress and inflammation in rats. Left anterior coronary arteries of Sprague‑Dawley rats were ligated, in order to generate an acute MI (AMI) model. Arctigenin was administered to AMI rats at 0, 50, 100 or 200 µmol/kg. Western blotting and ELISAs were performed to analyze protein expression and enzyme activity. Arctigenin was demonstrated to effectively inhibit the levels of alanine transaminase, creatine kinase‑MB and lactate dehydrogenase, and to reduce infarct size in AMI rats. In addition, the activity levels of malondialdehyde, interleukin (IL)‑1β and IL‑6 were significantly suppressed, and the levels of glutathione peroxidase, catalase and superoxide dismutase were significantly increased by arctigenin treatment. Arctigenin treatment also suppressed the protein expression levels of inducible nitric oxide synthase (iNOS), cyclooxygenase 2 (COX‑2) and heme oxygenase 1 (HO‑1), and increased the protein expression levels of phosphorylated‑extracellular signal‑regulated kinase 1/2 (p‑ERK1/2) in AMI rats. Overall, the results of the present study suggest that arctigenin may inhibit MI, and exhibits antioxidative and anti‑inflammatory effects through regulation of the iNOS, COX‑2, ERK1/2 and HO‑1 pathways in a rat model of AMI.
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Affiliation(s)
- Yanmin Zhang
- Department of Emergency, Liaocheng People's Hospital of Shandong, Liaocheng, Shandong 252000, P.R. China
| | - Yong Yang
- Department of Cardiology, Liaocheng People's Hospital of Shandong, Liaocheng, Shandong 252000, P.R. China
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21
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Kraal JJ, Vromen T, Spee R, Kemps HMC, Peek N. The influence of training characteristics on the effect of exercise training in patients with coronary artery disease: Systematic review and meta-regression analysis. Int J Cardiol 2017; 245:52-58. [PMID: 28735757 DOI: 10.1016/j.ijcard.2017.07.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/31/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exercise-based cardiac rehabilitation improves exercise capacity of coronary artery disease patients, it is unclear which training characteristic determines this improvement. Total energy expenditure and its constituent training characteristics (training intensity, session frequency, session duration and programme length) vary considerably among clinical trials, making it hard to compare studies directly. Therefore, we performed a systematic review and meta-regression analysis to assess the effect of total energy expenditure and its constituent training characteristics on exercise capacity. METHODS We identified randomised controlled trials comparing continuous aerobic exercise training with usual care for patients with coronary artery disease. Studies were included when training intensity, session frequency, session duration and programme length was described, and exercise capacity was reported in peakVO2. Energy expenditure was calculated from the four training characteristics. The effect of training characteristics on exercise capacity was determined using mixed effects linear regression analyses. The analyses were performed with and without total energy expenditure as covariate. RESULTS Twenty studies were included in the analyses. The mean difference in peakVO2 between the intervention group and control group was 3.97ml·min-1·kg-1 (p<0.01, 95% CI 2.86 to 5.07). Total energy expenditure was significantly related to improvement of exercise capacity (effect size 0.91ml·min-1·kg-1 per 100J·kg, p<0.01, 95% CI 0.77 to 1.06), no effect was found for its constituent training characteristics after adjustment for total energy expenditure. CONCLUSIONS We conclude that the design of an exercise programme should primarily be aimed at optimising total energy expenditure rather than on one specific training characteristic.
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Affiliation(s)
- Jos J Kraal
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Tom Vromen
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruud Spee
- Department of Cardiology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Maxima Medical Center, Veldhoven, The Netherlands
| | - Niels Peek
- Health eResearch Centre, Farr Institute of Health Informatics Research, The University of Manchester, Manchester, United Kingdom
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22
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Liberman K, Forti LN, Beyer I, Bautmans I. The effects of exercise on muscle strength, body composition, physical functioning and the inflammatory profile of older adults: a systematic review. Curr Opin Clin Nutr Metab Care 2017; 20:30-53. [PMID: 27755209 DOI: 10.1097/mco.0000000000000335] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW This systematic review reports the most recent literature regarding the effects of physical exercise on muscle strength, body composition, physical functioning and inflammation in older adults. All articles were assessed for methodological quality and where possible effect size was calculated. RECENT FINDINGS Thirty-four articles were included - four involving frail, 24 healthy and five older adults with a specific disease. One reported on both frail and nonfrail patients. Several types of exercise were used: resistance training, aerobic training, combined resistance training and aerobic training and others. In frail older persons, moderate-to-large beneficial exercise effects were noted on inflammation, muscle strength and physical functioning. In healthy older persons, effects of resistance training (most frequently investigated) on inflammation or muscle strength can be influenced by the exercise modalities (intensity and rest interval between sets). Muscle strength seemed the most frequently used outcome measure, with moderate-to-large effects obtained regardless the exercise intervention studied. Similar effects were found in patients with specific diseases. SUMMARY Exercise has moderate-to-large effects on muscle strength, body composition, physical functioning and inflammation in older adults. Future studies should focus on the influence of specific exercise modalities and target the frail population more.
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Affiliation(s)
- Keliane Liberman
- aFrailty in Ageing Research Unit bGerontology Department, Vrije Universiteit Brussel cGeriatrics Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Tanaka S, Masuda T, Kamiya K, Hamazaki N, Akiyama A, Kamada Y, Maekawa E, Noda C, Yamaoka-Tojo M, Ako J. A Single Session of Neuromuscular Electrical Stimulation Enhances Vascular Endothelial Function and Peripheral Blood Circulation in Patients With Acute Myocardial Infarction. Int Heart J 2016; 57:676-681. [PMID: 27818472 DOI: 10.1536/ihj.15-493] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate whether a single session of neuromuscular electrical stimulation (NMES) can enhance vascular endothelial function and peripheral blood circulation in patients with acute myocardial infarction (AMI). Thirty-four male patients with AMI were alternately assigned to 2 groups, and received NMES with muscle contraction (NMES group, n = 17) or without muscle contraction (control group, n = 17) after admission. NMES was performed for quadriceps and gastrocnemius muscles of both legs for 30 minutes. We measured systolic blood pressure as a parameter of cardiovascular responses and the low-frequency component of blood pressure variability as an index of sympathetic activity. Reactive hyperemia peripheral arterial tonometry (RH-PAT) index and transcutaneous oxygen pressure in foot (Foot-tcPO2) were also measured as parameters of vascular endothelial function and peripheral blood circulation, respectively. All patients completed the study without severe adverse events. Systolic blood pressure and the low-frequency component increased significantly during the NMES session in both groups (P < 0.01 and P < 0.05, respectively). However, elevation from systolic blood pressure at rest was < 10 mmHg in both groups. In the NMES group, the RH-PAT index and Foot-tcPO2 increased significantly after NMES (P < 0.05 and P < 0.001, respectively). No significant changes were observed in these parameters throughout the session in the control group. In conclusion, a single session of NMES with muscle contraction enhanced vascular endothelial function, leading to improvement in peripheral blood circulation without inducing excessive cardiovascular and autonomic responses in patients with AMI (UMIN000014196).
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Affiliation(s)
- Shinya Tanaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University
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Alves AJ, Viana JL, Cavalcante SL, Oliveira NL, Duarte JA, Mota J, Oliveira J, Ribeiro F. Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated. World J Cardiol 2016; 8:575-583. [PMID: 27847558 PMCID: PMC5088363 DOI: 10.4330/wjc.v8.i10.575] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/14/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.
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Toohey K, Pumpa KL, Arnolda L, Cooke J, Yip D, Craft PS, Semple S. A pilot study examining the effects of low-volume high-intensity interval training and continuous low to moderate intensity training on quality of life, functional capacity and cardiovascular risk factors in cancer survivors. PeerJ 2016; 4:e2613. [PMID: 27781180 PMCID: PMC5075690 DOI: 10.7717/peerj.2613] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/27/2016] [Indexed: 12/14/2022] Open
Abstract
Purpose The aim of this study was to evaluate the effects of low-volume high-intensity interval training and continuous low to moderate intensity training on quality of life, functional capacity and cardiovascular disease risk factors in cancer survivors. Methods Cancer survivors within 24 months post-diagnosis were randomly assigned into the low-volume high-intensity interval training group (n = 8) or the continuous low to moderate intensity training group (n = 8) group for 36 sessions (12 weeks) of supervised exercise. The low-volume high-intensity interval training (LVHIIT) group performed 7 × 30 s intervals (≥85% maximal heart rate) and the continuous low to moderate intensity training (CLMIT) group performed continuous aerobic training for 20 min (≤55% maximal heart rate) on a stationary bike or treadmill. Results Significant improvements (time) were observed for 13 of the 23 dependent variables (ES 0.05–0.61, p ≤ 0.05). An interaction effect was observed for six minute walk test (18.53% [32.43–4.63] ES 0.50, p ≤ 0.01) with the LVHIIT group demonstrating greater improvements. Conclusion These preliminary findings suggest that both interventions can induce improvements in quality of life, functional capacity and selected cardiovascular disease risk factors. The LVHIIT program was well tolerated by the participants and our results suggest that LVHIIT is the preferred modality to improve fitness (6MWT); it remains to be seen which intervention elicits the most clinically relevant outcomes for patients. A larger sample size with a control group is required to confirm the significance of these findings.
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Affiliation(s)
- Kellie Toohey
- Discipline of Sport and Exercise Science/Faculty of Health, University of Canberra, Canberra, ACT, Australia; Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Kate L Pumpa
- Discipline of Sport and Exercise Science/Faculty of Health, University of Canberra, Canberra, ACT, Australia; Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Leonard Arnolda
- ANU Medical School, Australian National University , Canberra , ACT , Australia
| | - Julie Cooke
- Discipline of Sport and Exercise Science/Faculty of Health, University of Canberra, Canberra, ACT, Australia; Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - Desmond Yip
- ANU Medical School, Australian National University , Canberra , ACT , Australia
| | - Paul S Craft
- ANU Medical School, Australian National University , Canberra , ACT , Australia
| | - Stuart Semple
- Discipline of Sport and Exercise Science/Faculty of Health, University of Canberra, Canberra, ACT, Australia; Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
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Pedersen LR, Olsen RH, Anholm C, Walzem RL, Fenger M, Eugen-Olsen J, Haugaard SB, Prescott E. Weight loss is superior to exercise in improving the atherogenic lipid profile in a sedentary, overweight population with stable coronary artery disease: A randomized trial. Atherosclerosis 2016; 246:221-8. [DOI: 10.1016/j.atherosclerosis.2016.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/26/2015] [Accepted: 01/01/2016] [Indexed: 11/28/2022]
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Huang C, Wang J, Deng S, She Q, Wu L. The effects of aerobic endurance exercise on pulse wave velocity and intima media thickness in adults: A systematic review and meta-analysis. Scand J Med Sci Sports 2015; 26:478-87. [PMID: 26059748 DOI: 10.1111/sms.12495] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- C. Huang
- Department of Cardiology; The Second Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - J. Wang
- Department of Cardiology; The Second Affiliated Hospital of Chongqing Medical University; Chongqing China
- Department of Cardiology; The Medical Emergency Center of Chongqing; Chongqing China
| | - S. Deng
- Department of Cardiology; The Second Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - Q. She
- Department of Cardiology; The Second Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - L. Wu
- Department of Cardiology; The Second Affiliated Hospital of Chongqing Medical University; Chongqing China
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