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Dixit S, Borghi-Silva A, Gular K, Reddy RS, Kakaraparthi VN, Ribeiro IL, Tedla JS, Girish S. Exercise modulates the immune system in cardiorespiratory disease patients: Implications for clinical practice during the COVID-19 pandemic. Heart Lung 2023; 57:161-172. [PMID: 36219921 PMCID: PMC9515346 DOI: 10.1016/j.hrtlng.2022.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with cardiorespiratory problems often suffer from systemic inflammation. Stress due to the disease and continuous inflammation can undermine the success of the rehabilitation program. OBJECTIVE This review has been undertaken primarily to understand the effectiveness of exercise training on the immune system in individuals undergoing cardiorespiratory rehabilitation and its implications for further management during the COVID-19 pandemic. METHODS Assessors analyzed related studies identified in the MEDLINE, PROQUEST, PUBMED, Cochrane Library, CINAHL, EMBASE, Google Scholar, Physiotherapy Evidence, and Science Direct databases. The studies were divided into groups focused on the effect of exercise on blood leukocytes, the anti-inflammatory effect, and the role of nutrition and exercise in resolving inflammation. RESULTS Twenty-eight studies were included in this review. The number of studies included in each section was as follows: the effects of exercise training on leukocytes in cardiorespiratory conditions (n = 8), anti-inflammatory effect (n = 6), and the role of nutrition and exercise in resolving inflammation (n = 14). The bias risk assessment showed poor internal validity; most included studies were assigned no and unclear descriptors. CONCLUSIONS Substantive evidence is presented that emphasizes the role of moderate-intensity exercise in boosting the immune system in patients with cardiorespiratory diseases. Exercise has anti-inflammatory effects that are vital for overall well-being and resolving longstanding inflammation. Individuals with an active lifestyle had a better pathogen immune response than more sedentary individuals. Our findings highlight the current need to investigate the long-term effects of cardiorespiratory rehabilitation programs.
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Affiliation(s)
- Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ivana Leão Ribeiro
- Department of Kinesiology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Srilatha Girish
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, UAE
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Vidal-Almela S, Terada T, Cole CA, O’Neill CD, Comeau K, Marçal IR, Pipe AL, Reed JL. A case series of acute responses to high-intensity interval training in four males with permanent atrial fibrillation. Eur Heart J Case Rep 2022; 6:ytac320. [PMID: 35965609 PMCID: PMC9366644 DOI: 10.1093/ehjcr/ytac320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 07/29/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Atrial fibrillation (AF) is a serious medical condition and a burgeoning patient population. Chronic exercise training, including high-intensity interval training (HIIT), has been shown to improve symptoms and quality of life in patients with AF. Yet, the acute responses to HIIT in this population remain understudied, leaving clinicians and patients hesitant about prescribing and engaging in high-intensity exercise, respectively.
Case summary
This case series describes acute exercise responses [i.e. power output, heart rate (HR), blood pressure (BP), ratings of perceived exertion (RPE), symptoms] to 10 weeks (3 days/week) of HIIT. Participants were four white males (58–80 years old) with permanent AF, co-morbidities (diabetes, coronary artery disease, Parkinson’s disease), and physical limitations. The increases in HR and BP during HIIT were modest across all participants, regardless of age and medication use. Differences in RPE were observed; the oldest participant perceived the sessions as more challenging despite a lower HR response. All patients complied with the HIIT prescription of 80–100% of peak power output by week 4. No adverse events were reported.
Discussion
Patients’ concerns regarding high-intensity exercise may discourage them from participating in HIIT, our results demonstrated no abnormal HR or BP (e.g. hypotension) responses during HIIT or cool-down. These findings align with the typical exercise responses noted in other cardiovascular populations. Notwithstanding the high metabolic demands of HIIT, male patients with permanent AF tolerated HIIT without problem. Further investigation of HIIT as an approach to enable those with AF to recover physical capacity and minimize symptomatology is warranted.
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Affiliation(s)
- Sol Vidal-Almela
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Christie A Cole
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Carley D O’Neill
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
| | - Katelyn Comeau
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Isabela R Marçal
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
| | - Andrew L Pipe
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Medicine, Faculty of Medicine, University of Ottawa , Ottawa , Canada K1H 8M5
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute , Ottawa, 40 Ruskin Street, Ontario , Canada K1Y 4W7
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa , Ottawa , Canada K1Y 4W7
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa , Ottawa , Canada K1H 8M5
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Karatzanos E, Ferentinos P, Mitsiou G, Dimopoulos S, Ntalianis A, Nanas S. Acute Cardiorespiratory Responses to Different Exercise Modalities in Chronic Heart Failure Patients-A Pilot Study. J Cardiovasc Dev Dis 2021; 8:jcdd8120164. [PMID: 34940519 PMCID: PMC8708548 DOI: 10.3390/jcdd8120164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study was to compare the acute cardiorespiratory responses and time spent above different %VO2peak intensities between three "iso-work" protocols: (a) a high intensity interval training protocol (HIIT), (b) a higher intensity continuous protocol (CON70) and (c) a lower intensity continuous protocol (CON50) in patients with chronic heart failure (CHF). Ten male CHF patients (aged 55.1 ± 16.2 years) performed in separate days a single session of a HIIT protocol consisted of 4 sets × 4 min cycling at 80% VO2peak with 3 min of recovery at 50% VO2peak, a CON70 protocol corresponding to 70% VO2peak and a CON50 protocol corresponding to 50% VO2peak. Cardiopulmonary data were collected by an online gas analysis system. The HIIT and CON70 elicited higher cardiorespiratory responses compared to CON50 with no differences between them (p > 0.05). In HIIT and CON70, patients exercised longer at >80% and >90% VO2peak. The completion rate was 100% for the three protocols. Not any adverse events were observed in either protocol. Both HIIT and CON70 elicited a stronger physiological stimulus and required shorter time than CON50. Both HIIT and CON70 also induced comparable hemodynamic responses and ventilatory demand.
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Affiliation(s)
- Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
- Correspondence: or ; Tel.: +30-2132043385
| | | | - Georgios Mitsiou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
| | - Argyrios Ntalianis
- Heart Failure and Cardio-Oncology Unit, Alexandra Hospital, 115 28 Athens, Greece;
| | - Serafeim Nanas
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, 106 75 Athens, Greece; (G.M.); (S.D.); (S.N.)
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Falahati A, Arazi H, Suzuki K. Acute Responses of Cardiac Biomarkers to Intermittent and Continuous Exercise Are Related to Age Difference but Not I/D Polymorphism in the ACE Gene. Front Physiol 2020; 11:665. [PMID: 32774305 PMCID: PMC7381388 DOI: 10.3389/fphys.2020.00665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/25/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to determine the (i) cardiac biomarker (cTnI and NT-proBNP) responses to moderate-intensity continuous exercise (MICE) and high-intensity interval exercise (HIIE) in the middle-aged and young groups, (ii) relationship of post-exercise cardiac biomarker release between these two age groups, and (iii) investigate whether insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene is associated with predisposition to cardiac damage after exercise in Iranian men. Methods We examined cTnI and NT-proBNP in 29 middle-aged (54.5 ± 4.6 years) and 28 young (22.7 ± 4.2 years) soccer players before and after HIIE and MICE running tests. Results The middle-aged soccer players had higher baseline cTnI (0.015 ± 0.007 ng/ml vs. 0.010 ± 0.006 ng/ml; P = 0.01) and NT-proBNP (30.7 ± 13.6 ng/L vs. 18.4 ± 8.3 ng/L; P < 0.001) values compared with the young group. The changes with exercise (ΔcTnI: 13 vs. 11 ng/ml and ΔNT-proBNP: 18 vs. 11 ng/L) were also higher in the middle-aged group. No subject exceeded the upper reference limit for cTnI and NT-proBNP. Considering three ACE genotypes, the mean cTnI and NT-proBNP values of middle-aged and young groups did not show any significant difference. Conclusion Marked differences in baseline and post-exercise cTnI and NT-proBNP values were observed, which were related to age differences but not to ACE genotypes.
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Affiliation(s)
- Akram Falahati
- Department of Exercise Physiology, University of Guilan, Rasht, Iran
| | - Hamid Arazi
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht, Iran
- *Correspondence: Hamid Arazi,
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Thomakos P, Geladas N, Paschalis V, Giannopoulou I, Varouhakis G, Behrakis P. Interval exercise induces milder respiratory responses compared to continuous exercise. J Sports Sci 2020; 38:576-581. [PMID: 31992141 DOI: 10.1080/02640414.2020.1719801] [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: 10/25/2022]
Abstract
The purpose of this study was to explore the respiratory response of acute interval and continuous exercise (CE) of low and high intensity. Fourteen recreational athletes (7 men and 7 women; VO2max = 35.7 ± 6.1 mlkg-1min-1) performed a bout of continuous and a bout of interval exercise (IE) both consisted of 5-min cycling at low intensity [80% of the power output (W) of the predetermined gas exchange threshold (GET) (80%WGET)] and 5-min cycling at high intensity {WGET plus the work rate corresponding to 50% of the difference between peak power output (PPO) at oxygen uptake (VO2max) test and the WGET [WGET + 0.50 Δ(PPO - WGET)]}. CE compared to IE induced significant higher heart rate and ventilation as well as significant higher levels of mouth occlusion pressure for 0.1 s (P0.1) (P < 0.05) during low and high intensities. Our results indicate that CE stimulates respiration more than IE when the exercise is performed at the same relative intensity.
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Affiliation(s)
- Pierros Thomakos
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Geladas
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilis Paschalis
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Ifigenia Giannopoulou
- Department of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.,School of Sport and Service Management, University of Brighton, Brighton, UK
| | | | - Panagiotis Behrakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Short-term effects of a 3-week interval training program on heart rate variability in chronic heart failure. A randomised controlled trial. Ann Phys Rehabil Med 2019; 62:321-328. [DOI: 10.1016/j.rehab.2019.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 01/08/2023]
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7
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Influence of High-Intensity Interval Training Versus Continuous Training on Functional Capacity in Individuals With Heart Failure. J Cardiopulm Rehabil Prev 2019; 39:293-298. [DOI: 10.1097/hcr.0000000000000424] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ranjbar R, Ahmadi MA, Zar A, Krustrup P. Acute effect of intermittent and continuous aerobic exercise on release of cardiac troponin T in sedentary men. Int J Cardiol 2017; 236:493-497. [PMID: 28096042 DOI: 10.1016/j.ijcard.2017.01.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/06/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies have shown that acute exercise can increase serum concentrations of cardiac biomarkers, including cardiac troponin T (cTnT). We investigated the acute effects of intermittent (IE) and continuous (CE) exercise at the same cardiac workload on myocardial necrosis biomarkers in sedentary men. METHODS Eleven sedentary healthy men aged 22.3±1.9years completed the study. The subjects were divided into two groups and performed, in random order, IE (intensity alternating between 50% (2min) and 80% (1min) HRreserve) or CE (60% HRreserve). The study was designed as a single-blinded randomised crossover trial performed on two distinct experimental days separated by a 1-week washout period. Each session consisted of 40min of aerobic exercise, either IE or CE, on a treadmill. Blood samples were taken before (PRE), immediately after (POST) and 1h after (POST-1) each exercise session. RESULTS hs-cTnT significantly increased immediately after exercise in both protocols and remained elevated at POST-1 (P<0.05). There was no significant difference between POST and POST-1 values(P>0.05). Neither CE nor IE caused any significant change in CK-MB (P>0.05). The results also showed that HR and RPP increased significantly following both exercise protocols (P=0.001). CONCLUSIONS In summary, both CE and IE results in increased serum concentrations of hs-cTnT in sedentary men. However, this increase does not seem to be caused by the irreversible death of cardiomyocytes. CE resulted in a greater hs-cTnT concentration than IE.
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Affiliation(s)
- Rouhollah Ranjbar
- Department of Exercise Physiology, Faculty of Physical Education and Sport Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Mohammad Amin Ahmadi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran.
| | - Abdossaleh Zar
- Department of Sport Science, Jahrom University, Jahrom, Iran
| | - Peter Krustrup
- College of Life and Environmental Sciences, St Luke's Campus, University of Exeter, Exeter, UK; Department of Nutrition, Exercise and Sports, The August Krogh Building, University of Copenhagen, Copenhagen, Denmark
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Comparison of Carbohydrate and Lipid Oxidation During Different High-Intensity Interval Exercise in Patients with Chronic Heart Failure. Am J Phys Med Rehabil 2016; 96:50-54. [PMID: 27175565 DOI: 10.1097/phm.0000000000000545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Substrate oxidation was compared during different high-intensity intermittent exercise (HIIE) protocols in patients with heart failure and reduced ejection fraction (HFREF). Eighteen males with HFREF (58.8 ± 9 years) were randomly assigned to 4 different HIIEs: 30 seconds (A and B) or 90 seconds (C and D) at 100% peak power output, with passive (A and C) or active recovery (50% of peak power output; B and D). Each HIIE protocol was separated by 1 week. Substrate oxidation (carbohydrate [CHO] and lipid: in g/min and in %) was calculated with gas exchange analysis. A 2-way analysis of variance and Bonferroni post hoc test were used (P ≤ 0.05) to compare CHO and lipid oxidation during the 4 HIIEs. Protocols with passive recovery (A and C) resulted in significantly lower quantitative CHO oxidation (g/min) (interaction, P < 0.001) compared to modes with active recovery (B and D). Quantitative lipid oxidation (g/min) was significantly lower in protocol C compared to the 3 other HIIE protocols (interaction, P < 0.001). In patients with HFREF, shorter HIIE bouts with passive recovery oxidize less CHO and more lipids (quantitatively) compared to the other HIIE protocols. This might be taken into account the exercise training prescription and might influence muscle metabolism adaptations.
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Gayda M, Desjardins A, Lapierre G, Dupuy O, Fraser S, Bherer L, Juneau M, White M, Gremeaux V, Labelle V, Nigam A. Cerebral Hemodynamics During Exercise and Recovery in Heart Transplant Recipients. Can J Cardiol 2016; 32:539-46. [DOI: 10.1016/j.cjca.2015.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 11/24/2022] Open
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Gayda M, Ribeiro PAB, Juneau M, Nigam A. Comparison of Different Forms of Exercise Training in Patients With Cardiac Disease: Where Does High-Intensity Interval Training Fit? Can J Cardiol 2016; 32:485-94. [PMID: 26927863 DOI: 10.1016/j.cjca.2016.01.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 12/12/2022] Open
Abstract
In this review, we discuss the most recent forms of exercise training available to patients with cardiac disease and their comparison or their combination (or both) during short- and long-term (phase II and III) cardiac rehabilitation programs. Exercise training modalities to be discussed include inspiratory muscle training (IMT), resistance training (RT), continuous aerobic exercise training (CAET), and high-intensity interval training (HIIT). Particular emphasis is placed on HIIT compared or combined (or both) with other forms such as CAET or RT. For example, IMT combined with CAET was shown to be superior to CAET alone for improving functional capacity, ventilatory function, and quality of life in patients with chronic heart failure. Similarly, RT combined with CAET was shown to optimize benefits with respect to functional capacity, muscle function, and quality of life. Furthermore, in recent years, HIIT has emerged as an alternative or complementary (or both) exercise modality to CAET, providing equivalent if not superior benefits to conventional continuous aerobic training with respect to aerobic fitness, cardiovascular function, quality of life, efficiency, safety, tolerance, and exercise adherence in both short- and long-term training studies. Finally, short-interval HIIT was shown to be useful in the initiation and improvement phases of cardiac rehabilitation, whereas moderate- or longer-interval (or both) HIIT protocols appear to be more appropriate for the improvement and maintenance phases because of their high physiological stimulus. We now propose progressive models of exercise training (phases II-III) for patients with cardiac disease, including a more appropriate application of HIIT based on the scientific literature in the context of a multimodal cardiac rehabilitation program.
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Affiliation(s)
- Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada.
| | - Paula A B Ribeiro
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and University of Montréal, Québec, Canada; Research Center, Montréal Heart Institute and University of Montréal, Montréal, Québec, Canada; Department of Medicine, University of Montréal, Montréal, Québec, Canada
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Reed JL, Nery PB, Birnie DH, Tulloch HE, Pipe AL. High-intensity interval training improves cardiovascular health, exercise capacity, and quality of life in permanent atrial fibrillation: a case study. Appl Physiol Nutr Metab 2015; 40:1321-3. [DOI: 10.1139/apnm-2015-0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Persons with permanent atrial fibrillation experience reduced exercise tolerance, weight gain, and an associated decline in overall health. We report on a 74-year-old man with permanent atrial fibrillation who underwent a 10-week high-intensity interval training program. Substantial improvements in heart rate, blood pressure, aerobic and functional capacity, and quality of life were observed. These are desirable as these patients are not candidates for other treatment options and more effective therapies for the treatment of atrial fibrillation are needed.
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Affiliation(s)
- Jennifer L. Reed
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Pablo B. Nery
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - David H. Birnie
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Heather E. Tulloch
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
| | - Andrew L. Pipe
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
- University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7, Canada
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Charlot K, Waltz X, Hedreville M, Sinnapah S, Lemonne N, Etienne-Julan M, Soter V, Hue O, Hardy-Dessources MD, Connes P. Impaired oxygen uptake efficiency slope and off-transient kinetics of pulmonary oxygen uptake in sickle cell anemia are associated with hemorheological abnormalities. Clin Hemorheol Microcirc 2015; 60:413-21. [PMID: 25261432 DOI: 10.3233/ch-141891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Keyne Charlot
- Laboratory ACTES (EA 3596), Department of Physiology, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- UMR Inserm U1134, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- Laboratoire d’Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Xavier Waltz
- Laboratory ACTES (EA 3596), Department of Physiology, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- UMR Inserm U1134, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- Laboratoire d’Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Mona Hedreville
- Laboratory ACTES (EA 3596), Department of Physiology, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- Emergency Care Department, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Stéphane Sinnapah
- Laboratory ACTES (EA 3596), Department of Physiology, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
| | - Nathalie Lemonne
- Sickle cell Center, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Maryse Etienne-Julan
- Laboratoire d’Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
- Sickle cell Center, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Valérie Soter
- Direction of Research and Innovation, Academic Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe, France
| | - Olivier Hue
- Laboratory ACTES (EA 3596), Department of Physiology, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
| | - Marie-Dominique Hardy-Dessources
- UMR Inserm U1134, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- Laboratoire d’Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - Philippe Connes
- UMR Inserm U1134, French West Indies and Guiana University, Pointe-à-Pitre, Guadeloupe, France
- Laboratoire d’Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
- Institut Universitaire de France (IUF), Paris, France
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Levinger I, Shaw CS, Stepto NK, Cassar S, McAinch AJ, Cheetham C, Maiorana AJ. What Doesn't Kill You Makes You Fitter: A Systematic Review of High-Intensity Interval Exercise for Patients with Cardiovascular and Metabolic Diseases. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:53-63. [PMID: 26157337 PMCID: PMC4482383 DOI: 10.4137/cmc.s26230] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 03/18/2015] [Accepted: 05/27/2015] [Indexed: 12/11/2022]
Abstract
High-intensity interval exercise (HIIE) has gained popularity in recent years for patients with cardiovascular and metabolic diseases. Despite potential benefits, concerns remain about the safety of the acute response (during and/or within 24 hours postexercise) to a single session of HIIE for these cohorts. Therefore, the aim of this study was to perform a systematic review to evaluate the safety of acute HIIE for people with cardiometabolic diseases. Electronic databases were searched for studies published prior to January 2015, which reported the acute responses of patients with cardiometabolic diseases to HIIE (≥80% peak power output or ≥85% peak aerobic power, VO2peak). Eleven studies met the inclusion criteria (n = 156; clinically stable, aged 27-66 years), with 13 adverse responses reported (~8% of individuals). The rate of adverse responses is somewhat higher compared to the previously reported risk during moderate-intensity exercise. Caution must be taken when prescribing HIIE to patients with cardiometabolic disease. Patients who wish to perform HIIE should be clinically stable, have had recent exposure to at least regular moderate-intensity exercise, and have appropriate supervision and monitoring during and after the exercise session.
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Affiliation(s)
- Itamar Levinger
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia. ; College of Sport and Exercise Science, Victoria University, Melbourne, Australia. ; Department of Cardiology, Austin Health, Melbourne, Australia
| | - Christopher S Shaw
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nigel K Stepto
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia. ; College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - Samantha Cassar
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia. ; College of Sport and Exercise Science, Victoria University, Melbourne, Australia
| | - Andrew J McAinch
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia. ; Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Craig Cheetham
- Cardiovascular Prevention and Rehabilitation Western Australia, Hollywood Private Hospital, Nedlands. ; School of Sport Sciences, Exercise and Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Andrew J Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth. ; School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia. ; Allied Health Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Gayda M, Nigam A, Juneau M. Letter regarding the article: Changes in BNP and cardiac troponin I after high-intensity interval and endurance exercise in heart failure patients and healthy controls. Int J Cardiol 2015; 187:151. [PMID: 25828341 DOI: 10.1016/j.ijcard.2015.03.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation Centre (ÉPIC), Montreal Heart Institute and University of Montreal, Quebec, Canada; Research Center, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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16
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Provocative issues in heart disease prevention. Can J Cardiol 2014; 30:S401-9. [PMID: 25444498 DOI: 10.1016/j.cjca.2014.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 09/18/2014] [Accepted: 09/18/2014] [Indexed: 12/25/2022] Open
Abstract
In this article, new areas of cardiovascular (CV) prevention and rehabilitation research are discussed: high-intensity interval training (HIIT) and new concepts in nutrition. HIIT consists of brief periods of high-intensity exercise interspersed by periods of low-intensity exercise or rest. The optimal mode according our work (15-second exercise intervals at peak power with passive recovery intervals of the same duration) is associated with longer total exercise time, similar time spent near peak oxygen uptake (VO2 peak) VO2 peak, and lesser perceived exertion relative to other protocols that use longer intervals and active recovery periods. Evidence also suggests that compared with moderate-intensity continuous exercise training, HIIT has superior effects on cardiorespiratory function and on the attenuation of multiple cardiac and peripheral abnormalities. With respect to nutrition, a growing body of evidence suggests that the gut microbiota is influenced by lifestyle choices and might play a pivotal role in modulating CV disease development. For example, recent evidence linking processed (but not unprocessed) meats to increased CV risk pointed to the gut microbial metabolite trimethylamine N-oxide as a potential culprit. In addition, altered gut microbiota could also mediate the proinflammatory and cardiometabolic abnormalities associated with excess added free sugar consumption, and in particular high-fructose corn syrup. Substantially more research is required, however, to fully understand how and which alterations in gut flora can prevent or lead to CV disease and other chronic illnesses. We conclude with thoughts about the appropriate role for HIIT in CV training and future research in the role of gut flora-directed interventions in CV prevention.
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Guiraud T, Labrunee M, Gaucher-Cazalis K, Despas F, Meyer P, Bosquet L, Gales C, Vaccaro A, Bousquet M, Galinier M, Sénard JM, Pathak A. High-intensity interval exercise improves vagal tone and decreases arrhythmias in chronic heart failure. Med Sci Sports Exerc 2014; 45:1861-7. [PMID: 23591293 DOI: 10.1249/mss.0b013e3182967559] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Autonomic dysfunction including sympathetic activation and vagal withdrawal has been reported in patients with chronic heart failure (CHF). We tested the hypotheses that high-intensity interval exercise (HIIE) in CHF patients would enhance vagal modulation and thus decrease arrhythmic events. METHODS Eighteen CHF patients underwent a baseline assessment (CON) and were then randomized to a single session of HIIE and to an isocaloric moderate-intensity continuous exercise (MICE). We evaluated the HR, HR variability parameters, and arrhythmic events by 24-h Holter ECG recordings after HIIE, MICE, and CON sessions. RESULTS We found that HR was significantly decreased after HIIE (68 ± 3 bpm, P < 0.01) when compared with CON and MICE values (71.1 ± 2 and 69 ± 3 bpm, respectively). HIIE led to a significant increase in normalized high-frequency power (35.95% ± 2.83% vs 31.56% ± 1.93% and 24.61% ± 2.62% for CON and MICE, respectively, P < 0.01). Both exercise conditions were associated with an increase in very low frequency power comparative to CON. After HIIE, premature ventricular contractions were significantly decreased (531 ± 338 vs 1007 ± 693 and 1671 ± 1604 for CON and MICE, respectively, P < 0.01). An association was found between the changes in premature ventricular contraction and the changes in low-frequency/high-frequency ratio (r = 0.66, P < 0.01) in patients exposed to HIIE. CONCLUSION We demonstrate that a single session of HIIE improves autonomic profile of CHF patients, leading to significant reductions of HR and arrhythmic events in a 24-h posttraining period. Cardioprotective effects of HIIE in CHF patients need to be confirmed in a larger study population and on a long-term basis.
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Affiliation(s)
- Thibaut Guiraud
- 1Institute of Cardiovascular and Metabolic Diseases, National Institute of Health and Medical Research (INSERM), UMR-1048, Toulouse, FRANCE; 2Clinic of Saint-Orens, Cardiovascular and Pulmonary Rehabilitation Center, Saint-Orens-de-Gameville, FRANCE; 3University of Toulouse III: Paul Sabatier, Toulouse, FRANCE; 4Department of Rehabilitation, Toulouse University Hospital, Toulouse, FRANCE; 5Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, FRANCE; 6University Hospital of Geneva, Geneva, SWITZERLAND; and 7Faculty of Sports Sciences and MOVE Laboratory (EA 6314), University of Poitiers, Poitiers, FRANCE
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Time-Course of the Effects of QSYQ in Promoting Heart Function in Ameroid Constrictor-Induced Myocardial Ischemia Pigs. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:571076. [PMID: 24817898 PMCID: PMC4003740 DOI: 10.1155/2014/571076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/09/2014] [Accepted: 03/09/2014] [Indexed: 11/17/2022]
Abstract
We aim to investigate the therapeutic effects of QSYQ on a pig myocardial ischemia (MI) model and to determine its mechanism of action. The MI model was induced by Ameroid constriction of the left anterior descending coronary (LAD) in Ba-Ma miniature pigs. Four groups were created: model group, digoxin group, QSYQ group, and sham-operated group. Heart function, Ang II, CGMP, TXB2, BNP, and cTnT were evaluated before (3 weeks after operation: 0 weeks) and at 2, 4, and 8 weeks after drug administration. After 8 weeks of administration, the pigs were sacrificed for cardiac injury measurements. Pigs with MI showed obvious histological changes, including BNP, cTnT, Ang II, CGRP, TXB2, and ET, deregulated heart function, and increased levels of apoptotic cells in myocardial tissue. Treatment with QSYQ improved cardiac remodeling by counteracting those events. The administration of QSYQ was accompanied by a restoration of heart function and of the levels of Ang II, CGRP, TXB2, ET BNP, and cTnT. In addition, QSYQ attenuated administration, reduced the apoptosis, and decreased the level of TNF- α and active caspase-3. In conclusion, administration of QSYQ could attenuate Ameroid constrictor induced myocardial ischemia, and TNF- α and active caspase-3 seemed to be the critical potential target of QSYQ.
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Changes in cardiopulmonary reserve and peripheral arterial function concomitantly with subclinical inflammation and oxidative stress in patients with heart failure with preserved ejection fraction. Int J Vasc Med 2014; 2014:917271. [PMID: 24719767 PMCID: PMC3955597 DOI: 10.1155/2014/917271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/14/2014] [Indexed: 11/24/2022] Open
Abstract
Background. Changes in cardiopulmonary reserve and biomarkers related to wall stress, inflammation, and oxidative stress concomitantly with the evaluation of peripheral arterial blood flow have not been investigated in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy subjects (CTL). Methods and Results. Eighteen HFpEF patients and 14 CTL were recruited. Plasma levels of inflammatory and oxidative stress biomarkers were measured at rest. Brain natriuretic peptide (BNP) was measured at rest and peak exercise. Cardiopulmonary reserve was assessed using an exercise protocol with gas exchange analyses. Peripheral arterial blood flow was determined by strain gauge plethysmography. Peak VO2 (12.0 ± 0.4 versus 19.1 ± 1.1 mL/min/kg, P < 0.001) and oxygen uptake efficiency slope (1.55 ± 0.12 versus 2.06 ± 0.14, P < 0.05) were significantly decreased in HFpEF patients compared with CTL. BNP at rest and following stress, C-reactive-protein, interleukin-6, and TBARS were significantly elevated in HFpEF. Both basal and posthyperemic arterial blood flow were not significantly different between the HFpEF patients and CTL. Conclusions. HFpEF exhibits a severe reduction in cardiopulmonary reserve and oxygen uptake efficiency concomitantly with an elevation in a broad spectrum of biomarkers confirming an inflammatory and prooxidative status in patients with HFpEF.
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The Effects of Chronic Exercise Training in Individuals With Permanent Atrial Fibrillation: A Systematic Review. Can J Cardiol 2013; 29:1721-8. [DOI: 10.1016/j.cjca.2013.09.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/20/2013] [Accepted: 09/22/2013] [Indexed: 12/19/2022] Open
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21
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Moe GW, Ezekowitz JA, O'Meara E, Howlett JG, Fremes SE, Al-Hesayen A, Heckman GA, Ducharme A, Estrella-Holder E, Grzeslo A, Harkness K, Lepage S, McDonald M, McKelvie RS, Nigam A, Rajda M, Rao V, Swiggum E, Virani S, Van Le V, Zieroth S, Arnold JMO, Ashton T, D'Astous M, Dorian P, Giannetti N, Haddad H, Isaac DL, Kouz S, Leblanc MH, Liu P, Ross HJ, Sussex B, White M. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: focus on rehabilitation and exercise and surgical coronary revascularization. Can J Cardiol 2013; 30:249-63. [PMID: 24480445 DOI: 10.1016/j.cjca.2013.10.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/25/2022] Open
Abstract
The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure.
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Affiliation(s)
- Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | | | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | | | - Steve E Fremes
- Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Abdul Al-Hesayen
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Anique Ducharme
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | | | - Adam Grzeslo
- Joseph Brant Memorial Hospital, Burlington, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Serge Lepage
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael McDonald
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert S McKelvie
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Anil Nigam
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
| | - Miroslaw Rajda
- QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vivek Rao
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Vy Van Le
- Centre Hospitalier Universitaire de l'Université de Montréal, Québec, Canada
| | - Shelley Zieroth
- Cardiac Sciences Program, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | | | | | | | - Paul Dorian
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, and Université Laval, Québec, Canada
| | | | - Peter Liu
- Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Heather J Ross
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Sussex
- Health Sciences Centre, St John's, Newfoundland, Canada
| | - Michel White
- Institut de Cardiologie de Montréal, Montreal, Québec, Canada
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Gayda M, Normandin E, Meyer P, Juneau M, Nigam A. Comparison of Carbohydrate and Lipid Oxidation During Continuous and Intermittent Exercise in Patients With Chronic Heart Failure. Can J Cardiol 2013; 29:990-2. [DOI: 10.1016/j.cjca.2012.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/29/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022] Open
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