1
|
Zhang Z, Wang L, Xi J, Sun X, Sun X. Impact of Exercise Training at Different Intensity Levels on Cardiac Function and Exercise Capacity in Patients with Chronic Heart Failure: A Prospective Cohort Study. J Rehabil Med 2022; 54:jrm00347. [PMID: 36264054 PMCID: PMC9682663 DOI: 10.2340/jrm.v54.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate training at different intensity levels on cardiac function, exercise capacity, and health-related quality of life in patients with chronic heart failure. METHODS This prospective cohort study enrolled patients with chronic heart failure at Beijing Rehabilitation Hospital, Beijing, China from January 2018 to January 2020. Participants received conventional therapy (non-exercise group) or therapy plus cycle ergometer exercises at an intensity of 80% anaerobic threshold (EA group) and Δ50% power above anaerobic threshold (EB group) for 12 weeks. The primary outcome was peak oxygen uptake. RESULTS Forty-five patients (15/group) completed the study without serious complications. Exercise training at an intensity of Δ50% power above anaerobic threshold had better effects on exercise capacity than exercise at an intensity of 80% anaerobic threshold, as shown by a greater improvement in peak oxygen uptake (20.3 ± 4.1 vs 16.8 ± 3.2 mL/min/kg), peak O2 pulse (12.5 ± 2.3 vs 10.1 ± 2.1 mL/beat), and peak workload (123.1 ± 26.9 vs 102.8 ± 29.5 W) in patients with chronic heart failure (all p < 0.001). Exercise improved the 6-min walk test distance (control: 394.0 ± 74.1; EA: 481.4 ± 89.4; EB: 508.9 ± 92.5 m; p < 0.001) and health-related quality of life (control: 40.7 ± 12.3; EA: 16.2 ± 8.6; EB: 11.5 ± 6.4; p < 0.001). CONCLUSION Compared with an intensity of 80% anaerobic threshold, exercise training at an intensity of Δ 50% power above anaerobic threshold was safe and had better effects on cardiac function, exercise capacity, and health-related quality of life.
Collapse
Affiliation(s)
- Zhenying Zhang
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University
| | - Lizhong Wang
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University
| | - Jianing Xi
- Cardiac Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University.
| | - Xiaojing Sun
- National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingguo Sun
- National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
2
|
Abstract
In this review, we highlight recent studies from our group and others that have characterized the cardiovascular adjustments that occur after acute heat exposure. Special emphasis will be placed on underlying mechanisms and clinical implications. Finally, we postulate that these acute cardiovascular adjustments may predict the long-term adaptive response to chronic heat therapy.
Collapse
Affiliation(s)
- Steven A. Romero
- Human Vascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center
| | - Rauchelle E. Richey
- Human Vascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center
| | - Holden W. Hemingway
- Human Vascular Physiology Laboratory, Department of Physiology and Anatomy, University of North Texas Health Science Center
| |
Collapse
|
3
|
Woessner MN, Welsch MA, VanBruggen MD, Johannsen NM, Credeur DP, Pieper CF, Sloane R, Earnest CP, Ortiz De Zevallos Munoz J, Church TS, Ravussin E, Kraus WE, Allen JD. Impact of a Novel Training Approach on Hemodynamic and Vascular Profiles in Older Adults. J Aging Phys Act 2022; 30:196-203. [PMID: 34348230 PMCID: PMC9182940 DOI: 10.1123/japa.2020-0509] [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: 01/11/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
Exercise training beneficially moderates the effects of vascular aging. This study compared the efficacy of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME), a novel training regimen, versus aerobic training on hemodynamic profiles in participants ≥70 years at risk for losing functional independence. Seventy-five participants (52 females, age: 76 ± 5 years) were assessed for hemodynamic and vascular function at baseline, after 4 weeks of either PRIME or aerobic training (Phase 1) and again after a further 8 weeks of aerobic and resistance training (Phase 2). Data were analyzed using 2 × 2 repeated-measures analysis of variance models on the change in each dependent variable. PRIME demonstrated reductions in brachial and aortic mean arterial pressure and diastolic blood pressure (p < .05) from baseline after Phase 1, which were sustained throughout Phase 2. Earlier and greater reductions in blood pressure following PRIME support the proposal that peripheral muscular training could beneficial for older individuals commencing an exercise program.
Collapse
|
4
|
Giuliano C, Levinger I, Vogrin S, Neil CJ, Allen JD. PRIME-HF: Novel Exercise for Older Patients with Heart Failure. A Pilot Randomized Controlled Study. J Am Geriatr Soc 2020; 68:1954-1961. [PMID: 32293033 PMCID: PMC7540058 DOI: 10.1111/jgs.16428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To test the hypothesis that (1) older patients with heart failure (HF) can tolerate COMBined moderate-intensity aerobic and resistance training (COMBO), and (2) 4 weeks of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME) before 4 weeks of COMBO will improve aerobic capacity and muscle strength to a greater extent than 8 weeks of COMBO. DESIGN Prospective randomized parallel open-label blinded end point. SETTING Single-site Australian metropolitan hospital. PARTICIPANTS Nineteen adults (72.8 ± 8.4 years of age) with heart failure with reduced ejection fraction (HFrEF). INTERVENTION Participants were randomized to 4 weeks of PRIME or COMBO (phase 1). All participants subsequently completed 4 weeks of COMBO (phase 2). Sessions were twice a week for 60 minutes. PRIME is a low-mass, high-repetition regime (40% one-repetition maximum [1RM], eight strength exercises, 5 minutes each). COMBO training involved combined aerobic (40%-60% of peak aerobic capacity [VO2peak ], up to 20 minutes) and resistance training (50-70% 1RM, eight exercises, two sets of 10 repetitions). MEASUREMENTS We measured VO2peak , VO2 at anaerobic threshold (AT), and muscle voluntary contraction (MVC). RESULTS The PRIME group significantly increased VO2peak after 8 weeks (2.4 mL/kg/min; 95% confidence interval [CI] = .7-4.1; P = .004), whereas the COMBO group showed minimal change (.2; 95% CI -1.5 to 1.8). This produced a large between-group effect size of 1.0. VO2 at AT increased in the PRIME group (1.6 mL/kg/min; 95% CI .0-3.2) but not in the COMBO group (-1.2; 95% CI -2.9 to .4), producing a large between-group effect size. Total MVC increased significantly in both groups in comparison with baseline; however, the change was larger in the COMBO group (effect size = .6). CONCLUSION Traditional exercise approaches (COMBO) and PRIME improved strength. Only PRIME training produced statistically and clinically significant improvements to aerobic capacity. Taken together, these findings support the hypothesis that PRIME may have potential advantages for older patients with HFrEF and could be a possible alternative exercise modality.
Collapse
Affiliation(s)
- Catherine Giuliano
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
| | - Itamar Levinger
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
- Australian Institute for Musculoskeletal Science (AIMSS)MelbourneAustralia
| | - Sara Vogrin
- Australian Institute for Musculoskeletal Science (AIMSS)MelbourneAustralia
- Department of Medicine – Western HealthThe University of MelbourneAustralia
| | - Christopher James Neil
- Institute for Health and Sport (IHES)Victoria UniversityMelbourneAustralia
- Department of CardiologyWestern Health, Sunshine HospitalMelbourneAustralia
- Department of Medicine – Western HealthThe University of MelbourneAustralia
| | - Jason David Allen
- Department of Kinesiology, Curry School of Education & Division of Cardiovascular MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| |
Collapse
|
5
|
Engelland RE, Hemingway HW, Tomasco OG, Olivencia-Yurvati AH, Romero SA. Neural control of blood pressure is altered following isolated leg heating in aged humans. Am J Physiol Heart Circ Physiol 2020; 318:H976-H984. [PMID: 32142377 DOI: 10.1152/ajpheart.00019.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is a sustained reduction in arterial blood pressure that occurs in aged adults following exposure to acute leg heating. We tested the hypothesis that acute leg heating would decrease arterial blood pressure in aged adults secondary to sympathoinhibition. We exposed 13 young and 10 aged adults to 45 min of leg heating. Muscle sympathetic nerve activity (radial nerve) was measured before leg heating (preheat) and 30 min after (recovery) and is expressed as burst frequency. Neurovascular transduction was examined by assessing the slope of the relation between muscle sympathetic nerve activity and leg vascular conductance measured at rest and during isometric handgrip exercise performed to fatigue. Arterial blood pressure was well maintained in young adults (preheat, 86 ± 6 mmHg vs. recovery, 88 ± 7 mmHg; P = 0.4) due to increased sympathetic nerve activity (preheat, 16 ± 7 bursts/min vs. recovery, 22 ± 10 bursts/min; P < 0.01). However, in aged adults, sympathetic nerve activity did not differ from preheat (37 ± 5 bursts/min) to recovery (33 ± 6 bursts/min, P = 0.1), despite a marked reduction in arterial blood pressure (preheat, 101 ± 7 mmHg vs. recovery, 94 ± 6 mmHg; P < 0.01). Neurovascular transduction did not differ from preheat to recovery for either age group (P ≥ 0.1). The reduction in arterial blood pressure that occurs in aged adults following exposure to acute leg heating is mediated, in part, by a sympathoinhibitory effect that alters the compensatory neural response to hypotension.NEW & NOTEWORTHY There is a sustained reduction in arterial blood pressure that occurs in aged adults following exposure to acute leg heating. However, the neurovascular mechanisms mediating this response remain unknown. Our findings demonstrate for the first time that this reduction in arterial blood pressure is mediated, in part, by a sympathoinhibitory effect that alters the compensatory neural response to hypotension in aged adults.
Collapse
Affiliation(s)
- Rachel E Engelland
- Department of Physiology and Anatomy, Human Vascular Physiology Laboratory, University of North Texas Health Science Center, Ft. Worth, Texas
| | - Holden W Hemingway
- Department of Physiology and Anatomy, Human Vascular Physiology Laboratory, University of North Texas Health Science Center, Ft. Worth, Texas
| | - Olivia G Tomasco
- Department of Physiology and Anatomy, Human Vascular Physiology Laboratory, University of North Texas Health Science Center, Ft. Worth, Texas
| | - Albert H Olivencia-Yurvati
- Department of Physiology and Anatomy, Human Vascular Physiology Laboratory, University of North Texas Health Science Center, Ft. Worth, Texas.,Department of Surgery, University of North Texas Health Science Center, Ft. Worth, Texas
| | - Steven A Romero
- Department of Physiology and Anatomy, Human Vascular Physiology Laboratory, University of North Texas Health Science Center, Ft. Worth, Texas
| |
Collapse
|
6
|
Karlson CW, Delozier AM, Seals SR, Britt AB, Stone AL, Reneker JC, Jackson EA, McNaull MM, Credeur DP, Welsch MA. Physical Activity and Pain in Youth With Sickle Cell Disease. FAMILY & COMMUNITY HEALTH 2020; 43:1-9. [PMID: 31764301 DOI: 10.1097/fch.0000000000000241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Study objectives were to examine the relationships between physical activity, pain, and psychological distress in youth 8 to 17 years of age with sickle cell disease. Participants were 206 youth with sickle cell disease (M = 11.73 years, 54.9% female, 99.5% African American). Caregivers and youth completed a clinical psychosocial screening battery. Results revealed frequent pain (37.6%), moderate median pain intensity, and elevated median pain interference in youth. Lower caregiver-reported physical activity was associated with worse pain outcomes. Increased anxiety was also associated with worse pain outcomes. A better understanding of the relationship between physical activity/inactivity and pain will guide multifactorial treatment interventions.
Collapse
Affiliation(s)
- Cynthia W Karlson
- Departments of Pediatrics, Division of Hematology/Oncology (Drs Karlson, Jackson, and McNaull and Ms Britt), Psychiatry and Human Behavior (Drs Karlson and Delozier), Population Health Science (Drs Reneker and Welsch), and Physical Therapy (Dr Reneker), The University of Mississippi Medical Center, Jackson; Department of Mathematics and Statistics, University of West Florida, Pensacola (Dr Seals); Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Stone); and School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg (Dr Credeur)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Allen JD, Vanbruggen MD, Johannsen NM, Robbins JL, Credeur DP, Pieper CF, Sloane R, Earnest CP, Church TS, Ravussin E, Kraus WE, Welsch MA. PRIME: A Novel Low-Mass, High-Repetition Approach to Improve Function in Older Adults. Med Sci Sports Exerc 2018; 50:1005-1014. [PMID: 29232316 PMCID: PMC5899050 DOI: 10.1249/mss.0000000000001518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The ability to maintain functional independence in a rapidly aging population results in an increased life expectancy without corresponding increases in health care costs. The accelerated decline in V˙O2peak after the age of 65 yr is primarily due to peripheral tissue changes rather than centrally mediated factors. The purpose of this study was to determine whether the Peripheral Remodeling through Intermittent Muscular Exercise (PRIME) approach, consisting of a low-mass, high-repetition/duration skeletal muscle focused training regimen would provide superior functional benefits in participants older than 70 yr old and at risk for losing functional independence. METHODS In this clinical trial, 107 participants were randomized to 4 wk of either standard aerobic training (AT) or PRIME (phase 1). This was followed by 8 wk of a progressive whole-body aerobic and resistance training (AT + RT) for all participants (phase 2). The major outcome measures were cardiorespiratory fitness (peak oxygen consumption [V˙O2peak]), muscular fitness (1 repetition maximal strength [1RM]), and physical function (Senior Fitness Test [SFT] scores). Results were analyzed under a per-protocol criterion. RESULTS Thirty-eight PRIME and 38 AT participants completed the 3-month protocols. V˙O2peak, 1RM, and SFT scores all increased significantly after 12 wk for both treatment groups (P < 0.05). However, relative to AT, participants randomized to PRIME demonstrated a greater increase in V˙O2peak (2.37 + 1.83 vs 1.50 + 1.82 mL·kg·min, P < 0.05), 1RM (48.52 + 27.03 vs 28.01 + 26.15 kg, P < 0.01) and SFT (22.50 + 9.98 vs 18.66 + 9.60 percentile, P < 0.05). CONCLUSIONS Participants experienced greater increases in cardiorespiratory and muscular fitness and physical function when PRIME training was initiated before a combined AT + RT program. This novel exercise approach may be advantageous to individuals with other chronic disease conditions characterized by low functional capacity.
Collapse
Affiliation(s)
- Jason D Allen
- Department of Kinesiology, University of Virginia, Charlottesville, VA
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | | | - Neil M Johannsen
- Department of Kinesiology, University of Virginia, Charlottesville, VA
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | | | - Daniel P Credeur
- Department of Kinesiology, University of Virginia, Charlottesville, VA
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Carl F Pieper
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Richard Sloane
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Conrad P Earnest
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Timothy S Church
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Eric Ravussin
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - William E Kraus
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| | - Michael A Welsch
- Department of Kinesiology, University of Virginia, Charlottesville, VA
- Department of Kinesiology, University of Virginia, Charlottesville, VA
| |
Collapse
|
8
|
Falls R, Seman M, Braat S, Sortino J, Allen JD, Neil CJ. Inorganic nitrate as a treatment for acute heart failure: a protocol for a single center, randomized, double-blind, placebo-controlled pilot and feasibility study. J Transl Med 2017; 15:172. [PMID: 28789663 PMCID: PMC5549289 DOI: 10.1186/s12967-017-1271-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 07/24/2017] [Indexed: 01/07/2023] Open
Abstract
Background Acute heart failure (AHF) is a frequent reason for hospitalization worldwide and effective treatment options are limited. It is known that AHF is a condition characterized by impaired vasorelaxation, together with reduced nitric oxide (NO) bioavailability, an endogenous vasodilatory compound. Supplementation of inorganic sodium nitrate (NaNO3) is an indirect dietary source of NO, through bioconversion. It is proposed that oral sodium nitrate will favorably affect levels of circulating NO precursors (nitrate and nitrite) in AHF patients, resulting in reduced systemic vascular resistance, without significant hypotension. Methods and outcomes We propose a single center, randomized, double-blind, placebo-controlled pilot trial, evaluating the feasibility of sodium nitrate as a treatment for AHF. The primary hypothesis that sodium nitrate treatment will result in increased systemic levels of nitric oxide pre-cursors (nitrate and nitrite) in plasma, in parallel with improved vasorelaxation, as assessed by non-invasively derived systemic vascular resistance index. Additional surrogate measures relevant to the known pathophysiology of AHF will be obtained in order to assess clinical effect on dyspnea and renal function. Discussion The results of this study will provide evidence of the feasibility of this novel approach and will be of interest to the heart failure community. This trial may inform a larger study.
Collapse
Affiliation(s)
- Roman Falls
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Michael Seman
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Sabine Braat
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Melbourne School of Population and Global Health and Melbourne Clinical and Translational Sciences Platform (MCATS), Parkville, Australia
| | - Joshua Sortino
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia
| | - Jason D Allen
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia.,Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Melbourne, Australia
| | - Christopher J Neil
- Western Centre for Health Research and Education, Western Health, Melbourne, Australia. .,Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. .,Clinical Exercise Science Research Program, Institute of Sport Exercise and Active Living (ISEAL), Melbourne, Australia. .,Western Health Cardiology, Footscray Hospital, Gordon St, Locked Bag 2, Footscray, VIC, 3011, Australia.
| |
Collapse
|