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Andrades-Ramírez O, Ulloa-Díaz D, Alfaro Castillo B, Arroyo-Jofré P, Castillo-Paredes A, Chirosa-Ríos L. Test-Retest Reliability of an Isometric and Isometric/Vibratory Muscular Strength Protocol with Functional Electro-Mechanical Dynamometry. Sports (Basel) 2024; 12:175. [PMID: 39058066 PMCID: PMC11280515 DOI: 10.3390/sports12070175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 07/28/2024] Open
Abstract
The purpose of the study was to analyze the test-retest reliability of an isometric and isometric/vibratory muscular strength protocol in the bilateral seated bench press (BSBP), bilateral seated rowing (BSR), unilateral seated right knee extension (USKER), and left knee extension (USKEL) tests controlled using functional electromechanical dynamometry (FEMD) in healthy young adults. A repeated measures design was used to determine the reliability of a muscular strength protocol in isometric and isometric vibration modes with FEMD. No significant differences were found in test-retest analysis (p > 0.05; ES < 0.20); and high reliability (CV = 4.65-5.02%; ICC = 0.99-0.98) was found for BSBP measures, and acceptable reliability (CV = 3.71-9.61%; ICC = 0.98-0.95) was found for BSR, USKER, and USKEL. Furthermore, the coefficients between the two measures were strong (r = 0.963-0.839) and highly significant (p = 0.001) for maximal strength in the isometric and maximal isometric/vibratory assessment of muscle strength in all muscle strength tests. This study demonstrates that isometric and maximal isometric/vibratory strength in the BSBP, BSR, USKER, and USKEL tests can be measured with high reliability and reproducibility using the FEMD.
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Affiliation(s)
- Oscar Andrades-Ramírez
- Facultad de Salud y Ciencias Sociales, Escuela de Ciencias de la Actividad Física, Universidad de las Américas, Concepción 4030000, Chile
| | - David Ulloa-Díaz
- Department of Sports Sciences and Physical Conditioning, Universidad Católica de la Santísima Concepción, Concepción 4030000, Chile;
| | | | | | - Antonio Castillo-Paredes
- Grupo AFySE, Investigación en Actividad Física y Salud Escolar, Escuela de Pedagogía en Educación Física, Facultad de Educación, Universidad de las Américas, Santiago 8370040, Chile;
| | - Luis Chirosa-Ríos
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain;
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Feuerstein A, Schoenrath F, Belyavskiy E, Knierim J, Friede T, Placzek M, Bach D, Pieske-Kraigher E, Herrmann-Lingen C, Westenfeld R, Roden M, Rybczynski M, Verheyen N, Dörr M, von Haehling S, Störk S, Halle M, Falk V, Pieske B, Edelmann F. Supervised exercise training in patients with advanced heart failure and left ventricular assist device: A multicentre randomized controlled trial (Ex-VAD trial). Eur J Heart Fail 2023; 25:2252-2262. [PMID: 37702315 DOI: 10.1002/ejhf.3032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 09/14/2023] Open
Abstract
AIMS Small studies and observations suggested that exercise training may improve peak oxygen consumption (peakVO2 ) in patients with advanced heart failure and left ventricular assist device (LVAD). We investigated whether in this patient group a supervised exercise training can improve exercise capacity. METHODS AND RESULTS In this multicentre, prospective, randomized, controlled trial, patients with stable heart failure and LVAD were randomly assigned (2:1) to 12 weeks of supervised exercise training or usual care, with 12 weeks of follow-up. The primary endpoint was the change in peakVO2 after 12 weeks (51 patients provided a power of 90% with an expected group difference in peakVO2 of 3 ml/kg/min). Secondary endpoints included changes in submaximal exercise capacity and quality of life. Among 64 patients enrolled (97% male, mean age 56 years), 54 were included in the analysis. Mean difference in the change of peakVO2 after 12 weeks was 0.826 ml/min/kg (95% confidence interval [CI] -0.37, 2.03; p = 0.183). There was a positive effect of exercise training on 6-min walk distance with a mean increase in the intervention group by 43.4 m (95% CI 16.9, 69.9; p = 0.0024), and on the Kansas City Cardiomyopathy Questionnaire physical domain score (mean 14.3, 95% CI 3.7, 24.9; p = 0.0124), both after 12 weeks. The overall adherence was high (71%), and there were no differences in adverse events between groups. CONCLUSION In patients with advanced heart failure and LVAD, 12 weeks of exercise training did not improve peakVO2 but demonstrated positive effects on submaximal exercise capacity and physical quality of life.
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Affiliation(s)
- Anna Feuerstein
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Evgeny Belyavskiy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité, Medizinisches Versorgungszentrum, Berlin, Germany
| | - Jan Knierim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Paulinenkrankenhaus gGmbH, Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Marius Placzek
- Department of Medical Statistics, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Doris Bach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elisabeth Pieske-Kraigher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Heinrich Heine University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, München-Neuherberg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan von Haehling
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Volkmar Falk
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
| | - Burkert Pieske
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) - Medical Heart Center of Charité and German Heart Institute Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Dwiputra B, Santoso A, Purwowiyoto BS, Radi B, Ambari AM. The effect of resistance training on PCSK9 levels in patients undergoing cardiac rehabilitation after coronary artery bypass grafting: a randomized study. BMC Cardiovasc Disord 2023; 23:549. [PMID: 37946122 PMCID: PMC10636968 DOI: 10.1186/s12872-023-03571-7] [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: 01/25/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Resistance training is commonly recommended as part of secondary prevention for post-coronary artery bypass graft (CABG) patients in conjunction with aerobic exercise. Despite its potential benefits, there is currently a lack of studies investigating the impact of resistance training on proprotein convertase subtilisin kexin 9 (PCSK9). AIM To evaluate the effect of intensive resistance training on proprotein convertase subtilisin kexin 9 (PCSK9) levels among post-CABG patients undergoing cardiac rehabilitation (CR). METHODS In this prospective, open-label, randomized trial, 87 post-coronary artery bypass graft (CABG) patients were randomly assigned into two groups: moderate to high intensity resistance training and aerobic training (n = 44) or aerobic training alone (n = 43) for a total of 12 sessions. Changes in PCSK9 levels was determined as a primary endpoint, while secondary endpoints included changes in the six-minute walk test (6-MWT) results, aerobic capacity, WHO-5 well-being index, fasting blood glucose, and lipid profile. Both groups underwent intention-to-treat analysis. RESULTS Following completion of cardiac rehabilitation program, the intervention group demonstrated a significant decrease in mean PCSK9 levels when compared to the control group (β = -55 ng/ml, 95% CI -6.7 to -103.3, p = 0.026), as well as significant improvements in the 6-MWT result (β = 28.2 m, 95% CI 2.4-53.9, p = 0.033), aerobic capacity (β = 0.9 Mets, 95% CI 0.1-1.7, p = 0.021), and WHO-5 well-being index (β = 8.1, 95% CI 2.0-14.4, p = 0.011) in patients who received resistance and aerobic training. No statistically significant changes were observed in fasting blood glucose, cholesterol, LDL-C, HDL-C, and triglyceride levels. CONCLUSION Resistance training in CR significantly reduced PCSK-9 levels and increases patient's functional capacity and quality of life. (NCT02674659 04/02/2016).
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Affiliation(s)
- Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia.
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Budhi Setianto Purwowiyoto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ Harapan Kita National Cardiovascular Center, Jl Letjen S Parman Kav 87, Palmerah, Jakarta Barat, 11420, Indonesia
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Gallagher H, Hendrickse PW, Pereira MG, Bowen TS. Skeletal muscle atrophy, regeneration, and dysfunction in heart failure: Impact of exercise training. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:557-567. [PMID: 37040849 PMCID: PMC10466197 DOI: 10.1016/j.jshs.2023.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/30/2022] [Accepted: 02/20/2023] [Indexed: 05/31/2023]
Abstract
This review highlights some established and some more contemporary mechanisms responsible for heart failure (HF)-induced skeletal muscle wasting and weakness. We first describe the effects of HF on the relationship between protein synthesis and degradation rates, which determine muscle mass, the involvement of the satellite cells for continual muscle regeneration, and changes in myofiber calcium homeostasis linked to contractile dysfunction. We then highlight key mechanistic effects of both aerobic and resistance exercise training on skeletal muscle in HF and outline its application as a beneficial treatment. Overall, HF causes multiple impairments related to autophagy, anabolic-catabolic signaling, satellite cell proliferation, and calcium homeostasis, which together promote fiber atrophy, contractile dysfunction, and impaired regeneration. Although both wasting and weakness are partly rescued by aerobic and resistance exercise training in HF, the effects of satellite cell dynamics remain poorly explored.
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Affiliation(s)
- Harrison Gallagher
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Paul W Hendrickse
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Marcelo G Pereira
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK.
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The Evaluation of Functional Abilities Using the Modified Fullerton Functional Fitness Test Is a Valuable Accessory in Diagnosing Men with Heart Failure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159210. [PMID: 35954574 PMCID: PMC9367744 DOI: 10.3390/ijerph19159210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022]
Abstract
The assessment of functional abilities reflects the ability to perform everyday life activities that require specific endurance and physical fitness. The Fullerton functional fitness test (FFFT) seems to be the most appropriate for assessing physical fitness in heart failure (HF) patients. The study group consisted of 30 consecutive patients hospitalized for the routine assessment of HF with a reduced ejection fraction (HFrEF). They formed the study group, and 24 healthy subjects formed the control group. Each patient underwent a cardiopulmonary exercise test (CPET), transthoracic echocardiography and FFFT modified by adding the measurement of the handgrip force of the dominant limb with the digital dynamometer. The HF patients had significantly lower peak oxygen uptake (peakVO2), maximal minute ventilation, and higher ventilatory equivalent (VE/VCO2). The concentrations of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were significantly higher in the study group. The results of all the FFFT items were significantly worse in the study group. FFFT parameters, together with the assessment of the strength of the handgrip, strongly correlated with the results of standard tests in HF. FFFT is an effective and safe tool for the functional evaluation of patients with HFrEF. Simple muscle strength measurement with a hand-held dynamometer can become a convenient and practical indicator of muscle strength in HF patients.
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Sadek Z, Ahmaidi S, Youness M, Awada C, Joumaa WH, Ramadan W. Combining aerobic interval, inspiratory and resistance trainings induces better cardiac remodelling and exercise capacity in heart failure patients. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.2017477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zahra Sadek
- Rammal Hassan Rammal Laboratory « PhyToxE Physio-toxicité environnemental », Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
- Laboratory EA-3300 (APERE) « Adaptations Physiologiques à l’Exercice et Réadaptation à l’Effort », Picardie Jules Verne University, Amiens, France
- Physical Therapy Department, Islamic University of Lebanon, Beirut, Lebanon
| | - Said Ahmaidi
- Laboratory EA-3300 (APERE) « Adaptations Physiologiques à l’Exercice et Réadaptation à l’Effort », Picardie Jules Verne University, Amiens, France
| | - Mahmoud Youness
- Medical Research Center of Beirut Cardiac Institute, Beirut, Lebanon
| | - Charifa Awada
- Rammal Hassan Rammal Laboratory « PhyToxE Physio-toxicité environnemental », Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Wissam H. Joumaa
- Rammal Hassan Rammal Laboratory « PhyToxE Physio-toxicité environnemental », Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
| | - Wiam Ramadan
- Rammal Hassan Rammal Laboratory « PhyToxE Physio-toxicité environnemental », Faculty of Sciences, Lebanese University, Nabatieh, Lebanon
- Lebanese Institutes for Biomedical Research and Application (LIBRA), Lebanese International University and International University of Beirut (BIU), Beirut, Lebanon
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7
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Righi GDA, Schuch FB, Tolves T, De Nardi AT, Righi NC, Signori LU, da Silva AMV. Combined aerobic and strength training for fitness outcomes in heart failure: meta-analysis and meta-regression. Disabil Rehabil 2021; 44:4149-4160. [PMID: 33789068 DOI: 10.1080/09638288.2021.1900411] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the effects of combined training (CT) versus aerobic training (AT) or versus control on VO2 peak and quadriceps muscle strength in patients with heart failure (HF). MATERIALS AND METHODS Major electronic databases were searched, from inception to November 2020, for randomized clinical trials comparing the effects of CT against AT or control on VO2 peak and/or quadriceps muscle strength in patients with HF. Random effects meta-analyses were conducted, calculating the standardized mean difference (SMD). RESULTS Twenty-eight articles were included. An increase on VO2 peak (SMD = 0.77, 95%CI 0.39-1.14, I2=80.1%) and quadriceps muscle strength (SMD = 0.67, 95%CI 0.18-1.16, I2=0%) was found in CT compared to control. CT increased quadriceps muscle strength, versus AT (SMD = 0.44, 95%CI 0.15-0.74, I2=0%). There were no differences between CT and AT on VO2 peak (SMD=-0.01, 95%CI -0.36 to 0.34, I2=65%). Time of session and training duration moderate the effects of CT over control on VO2 peak. CONCLUSIONS CT promotes increases on quadriceps muscle strength and aerobic capacity over control and provides additional gains on quadriceps muscle strength, having the same effects on VO2 peak compared to AT. A longer time of session is associated with greater benefits to aerobic capacity.Implications for rehabilitationCombining aerobic and strength training increases the functional capacity and quadriceps muscle strength in heart failure patients.Using longer sessions of training has a greater impact on aerobic capacity.
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Affiliation(s)
| | - Felipe Barreto Schuch
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Tainara Tolves
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | | | | | - Luis Ulisses Signori
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
| | - Antônio Marcos Vargas da Silva
- Program in Functional Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil.,Department of Physiotherapy and Rehabilitation, Federal University of Santa Maria, Santa Maria, Brazil
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Youn JC, Choi SW, Lee HS, Han S, Shin EC, Baek SH, Kang SMI. Prognostic Value of Leg Muscle Strength in Acute Heart Failure Syndrome. Med Sci Sports Exerc 2021; 53:19-25. [PMID: 32694371 DOI: 10.1249/mss.0000000000002432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Leg muscle strength (LMS) may be useful as a frailty index in patients with heart failure. However, LMS, until recently, has been indirectly estimated, and its prognostic value in acute heart failure syndrome (AHFS) is unclear. Therefore, we evaluated the prognostic value of direct LMS assessment and its relationship with proinflammatory mediators in patients with AHFS. METHODS We directly measured LMS at predischarge using a dynamometer in 110 prospectively and consecutively enrolled patients with AHFS (75 male; 60 ± 14 yr; mean ejection fraction, 29.9% ± 14.6%). The primary end point was cardiovascular (CV) events, defined as CV mortality, cardiac transplantation, or rehospitalization due to heart failure aggravation. Patients were divided into impaired and preserved LMS groups according to Contal and O'Quigley's method. RESULTS CV events occurred in 28 patients (25.5%) (including 5 CV deaths and 6 cardiac transplantations) during follow-up (median, 246 d; range = 11-888 d). Impaired LMS was associated with significantly higher levels of serum monokine induced by gamma interferon and poor clinical outcomes (P < 0.001). Multivariable Cox proportional hazard analysis (controlling for age, sex, body mass index, heart failure type, hemoglobin level, N-terminal pro-b-type natriuretic peptide level, and beta-blocker use) revealed LMS as an independent predictor of CV events (P = 0.017). CONCLUSION Impaired LMS, which might be used as a marker of frailty, is associated with increased levels of a proinflammatory chemokine and independently predicts clinical outcomes in patients with AHFS. The direct measurement of LMS is simple and feasible and might have important implications for the risk stratification of patients with AHFS.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, REPUBLIC OF KOREA
| | - Suk-Won Choi
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, REPUBLIC OF KOREA
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, REPUBLIC OF KOREA
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, REPUBLIC OF KOREA
| | - Eui-Cheol Shin
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, REPUBLIC OF KOREA
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, REPUBLIC OF KOREA
| | - Seok-MIn Kang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, REPUBLIC OF KOREA
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Tucker WJ, Haykowsky MJ, Seo Y, Stehling E, Forman DE. Impaired Exercise Tolerance in Heart Failure: Role of Skeletal Muscle Morphology and Function. Curr Heart Fail Rep 2019; 15:323-331. [PMID: 30178183 DOI: 10.1007/s11897-018-0408-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To discuss the impact of deleterious changes in skeletal muscle morphology and function on exercise intolerance in patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as the utility of exercise training and the potential of novel treatment strategies to preserve or improve skeletal muscle morphology and function. RECENT FINDINGS Both HFrEF and HFpEF patients exhibit a reduction in percent of type I (oxidative) muscle fibers and oxidative enzymes coupled with abnormal mitochondrial respiration. These skeletal muscle abnormalities contribute to impaired oxidative metabolism with an earlier shift towards glycolytic metabolism during exercise that is strongly associated with exercise intolerance. In both HFrEF and HFpEF patients, peripheral "non-cardiac" factors are important determinants of the improvement in exercise tolerance following aerobic exercise training. Adjunctive strategies that include nutritional supplementation with amino acids and/or anabolic drugs to stimulate anabolic molecular pathways in skeletal muscle show great promise for improving exercise tolerance and treating heart failure-associated sarcopenia, but these efforts remain early in their evolution, with no immediate clinical applications. There is consistent evidence that heart failure is associated with multiple skeletal muscle abnormalities which impair oxygen uptake and utilization and contribute greatly to exercise intolerance. Exercise training induces favorable adaptations in skeletal muscle morphology and function that contribute to improvements in exercise tolerance in patients with HFrEF. The contribution of skeletal muscle adaptations to improved exercise tolerance following exercise training in HFpEF remains unknown and warrants further investigation.
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Affiliation(s)
| | | | - Yaewon Seo
- The University of Texas at Arlington, Arlington, TX, USA
| | - Elisa Stehling
- The University of Texas at Arlington, Arlington, TX, USA
| | - Daniel E Forman
- Department of Medicine, Section of Geriatric Cardiology, Veterans Affairs Geriatric Research Education, and Clinical Center, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA, 15213, USA.
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Kono Y, Izawa H, Aoyagi Y, Ishikawa A, Sugiura T, Mori E, Ueda S, Fujiwara W, Hayashi M, Saitoh E. The difference in determinant factor of six-minute walking distance between sarcopenic and non-sarcopenic elderly patients with heart failure. J Cardiol 2019; 75:42-46. [PMID: 31387751 DOI: 10.1016/j.jjcc.2019.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this study was to identify the factors determining exercise capacity in elderly patients with heart failure (HF) with and without sarcopenia. METHODS We studied 186 consecutive patients with HF who met the criteria of being >60 years, with no physical disability. During hospitalization, we measured the 6-min walking distance (6MWD) and other physical functional parameters and evaluated echocardiographic and laboratory measurements indicating the severity of HF. First, we divided patients into two groups (the sarcopenia group and the nonsarcopenia group) according to the presence of sarcopenia defined as fulfilling more than or equal to two criteria-body mass index <18.5, walking speed <0.8m/s, and grip strength <26kg in males, or <18kg in females. Then the association between the 6MWD and the clinical variables mentioned above was analyzed by univariate and multiple logistic regression analyses. RESULTS The sarcopenia group comprised 77 patients (41.2%). In univariate analysis, age, grip strength, walking speed, and knee extensor muscle strength were significantly correlated with the 6MWD (p<0.05), whereas other clinical parameters were not. In multivariate analysis, walking speed was selected as an independent factor determining the 6MWD in both groups; however, knee extensor muscle strength was selected as an independent factor determining the 6MWD only in the sarcopenia group. CONCLUSION We demonstrated that knee extensor muscle strength was an independent factor determining exercise capacity-especially in elderly patients with HF with sarcopenia, and provided useful information in terms of exercise prescription.
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Affiliation(s)
- Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan.
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
| | - Ayako Ishikawa
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Tsubasa Sugiura
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Etsuko Mori
- Department of Rehabilitation, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Sayano Ueda
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Wakaya Fujiwara
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Mutsuharu Hayashi
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, Fujita Health University, Toyoake, Japan
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11
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Sarcopenia in adults with congenital heart disease: Nutritional status, dietary intake, and resistance training. J Cardiol 2019; 74:84-89. [DOI: 10.1016/j.jjcc.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/22/2018] [Accepted: 01/18/2019] [Indexed: 12/30/2022]
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12
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A Review of Exercise Interventions in Pulmonary Arterial Hypertension and Recommendations for Rehabilitation Programing. J Cardiopulm Rehabil Prev 2019; 39:138-145. [DOI: 10.1097/hcr.0000000000000402] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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13
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Marume K, Takashio S, Nakanishi M, Kumasaka L, Fukui S, Nakao K, Arakawa T, Yanase M, Noguchi T, Yasuda S, Goto Y. Efficacy of Cardiac Rehabilitation in Heart Failure Patients With Low Body Mass Index. Circ J 2019; 83:334-341. [PMID: 30651408 DOI: 10.1253/circj.cj-18-0852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Low body mass index (BMI) is a relevant prognostic factor for heart failure (HF), but HF patients with low BMI are reported to be at risk of not receiving optimal drug treatment. We sought to evaluate the efficacy of cardiac rehabilitation (CR) in patients with low vs. normal BMI. Methods and Results: We studied 152 consecutive patients (low BMI, n=32; normal BMI, n=119) who participated in a 3-month CR program. Low BMI was defined as <18.5 kg/m2and normal BMI, as 18.5≤BMI<25 kg/m2. All patients underwent cardiopulmonary exercise testing and muscle strength testing at the beginning and end of the 3-month CR program. After CR, a significantly greater proportion of HF patients with low BMI had a positive change in peak V̇O2than in the normal BMI group (91% vs. 70%; P=0.010). Average percent change in peak V̇O2was significantly greater in patients with low vs. normal BMI (17.1±2.8% vs. 7.8±1.5%; P<0.001). In addition, on multivariable logistic regression, low BMI was an independent predictor of a positive change in peak V̇O2after CR (OR, 3.97; 95% CI: 1.10-14.31; P=0.035). CONCLUSIONS CR has a greater effect in patients with low than normal BMI, and low BMI is an independent predictor of a positive change in peak V̇O2. Thus, CR should be strongly recommended for HF patients with low BMI.
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Affiliation(s)
- Kyohei Marume
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.,Division of Cardiovascular Medicine, Graduate School of Medicine, Kumamoto University
| | - Seiji Takashio
- Division of Cardiovascular Medicine, Graduate School of Medicine, Kumamoto University
| | - Michio Nakanishi
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Leon Kumasaka
- Department of Cardiovascular Medicine, Saitama Sekishinkai Hospital
| | - Shigefumi Fukui
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kazuhiro Nakao
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tetsuo Arakawa
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masanobu Yanase
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Teruo Noguchi
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Division of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoichi Goto
- Department of Cardiovascular Medicine, Yoka Hospital
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14
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Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic Heart Failure and Exercise Rehabilitation: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:2570-2582. [DOI: 10.1016/j.apmr.2018.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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15
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Iliopoulos F, Mazis N. Exercise training in heart failure patients: effects on skeletal muscle abnormalities and sympathetic nervous activity—a literature review. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Lim FY, Yap J, Gao F, Teo LL, Lam CS, Yeo KK. Correlation of the New York Heart Association classification and the cardiopulmonary exercise test: A systematic review. Int J Cardiol 2018; 263:88-93. [DOI: 10.1016/j.ijcard.2018.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/09/2018] [Accepted: 04/05/2018] [Indexed: 02/07/2023]
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17
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Laoutaris ID. The ‘aerobic/resistance/inspiratory muscle training hypothesis in heart failure’. Eur J Prev Cardiol 2018; 25:1257-1262. [DOI: 10.1177/2047487318776097] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Evidence from large multicentre exercise intervention trials in heart failure patients, investigating both moderate continuous aerobic training and high intensity interval training, indicates that the ‘crème de la crème’ exercise programme for this population remains to be found. The ‘aerobic/resistance/inspiratory (ARIS) muscle training hypothesis in heart failure’ is introduced, suggesting that combined ARIS muscle training may result in maximal exercise pathophysiological and functional benefits in heart failure patients. The hypothesis is based on the decoding of the ‘skeletal muscle hypothesis in heart failure’ and on revision of experimental evidence to date showing that exercise and functional intolerance in heart failure patients are associated not only with reduced muscle endurance, indication for aerobic training (AT), but also with reduced muscle strength and decreased inspiratory muscle function contributing to weakness, dyspnoea, fatigue and low aerobic capacity, forming the grounds for the addition of both resistance training (RT) and inspiratory muscle training (IMT) to AT. The hypothesis will be tested by comparing all potential exercise combinations, ARIS, AT/RT, AT/IMT, AT, evaluating both functional and cardiac indices in a large sample of heart failure patients of New York Heart Association class II–III and left ventricular ejection fraction ≤35% ad hoc by the multicentre randomized clinical trial, Aerobic Resistance, InSpiratory Training OutcomeS in Heart Failure (ARISTOS-HF trial).
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18
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Efficacy of Elastic Resistance Training Program for the Institutionalized Elderly. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Lans C, Cider Å, Nylander E, Brudin L. Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study. ESC Heart Fail 2017; 5:241-248. [PMID: 29168621 PMCID: PMC5880672 DOI: 10.1002/ehf2.12230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 04/17/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023] Open
Abstract
Aims This study aimed to describe a method of peripheral muscle training with resistance bands in patients with chronic heart failure (CHF) and to evaluate its effects on the 6 min walk test and quality of life up to 12 months using a home‐based programme. Methods and results Twenty‐two patients with stable CHF (19 men and 3 women), mean age 63.2 years (SD 8.1), New York Heart Association class II–III were randomized to individual home‐based training (HT group), or home‐based training with a group‐based start‐up in a hospital setting (GT group). A 6 min walk test, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and Short Form with 36 items (SF‐36) were administered at baseline and after 3, 6, 9, and 12 months. Exercise training resulted in statistically significant increased walking distance in both groups. The HT group increased on average 107 (80) m from baseline to 12 months, and the GT group by 100 (96) m. Health‐related quality of life, measured with MLHFQ and SF‐36, reached statistically significant improvements in both groups but at different time points. There were no statistically significant differences between groups on any parameters or follow‐ups. Conclusions Long‐term home‐based peripheral muscle training in patients with CHF, with or without an introductory period in a hospital setting, can be used for initial improvement and retention of walking distance and health‐related quality of life.
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Affiliation(s)
- Charlotta Lans
- Department of Physiotherapy, Kalmar County Hospital, Kalmar, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Nylander
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Linköping University, Linköping, Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden
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20
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Giuliano C, Karahalios A, Neil C, Allen J, Levinger I. The effects of resistance training on muscle strength, quality of life and aerobic capacity in patients with chronic heart failure - A meta-analysis. Int J Cardiol 2016; 227:413-423. [PMID: 27843045 DOI: 10.1016/j.ijcard.2016.11.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/04/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Resistance training (RT) has been utilised to target muscle dysfunction associated with Chronic Heart Failure (CHF). However, there is limited meta-analysis evidence to support its use as a standalone therapy. This meta-analysis examined the effects of RT on muscle strength (one repetition maximum, 1RM and Peak Torque), aerobic capacity (VO2peak and 6min walk distance) and quality of life (QoL) in patients with CHF. METHODS We searched Medline, EMBASE, Cochrane and CINAHL for studies published up to July 2016, combining terms related to the population (eg, heart failure, CHF) with terms for the intervention (eg, resistance, strength training) and the outcomes (eg, QoL, VO2peak,strength, aerobic capacity). RESULTS Ten studies including 240 participants were included in our meta-analysis (aged 48-76years, Ejection Fraction 18-37%). Training duration ranged from 8 to 24weeks and intensity up to 80% of 1RM. RT increased 1RM (standardised change score=0.60; 95% Confidence Interval: 0.43, 0.77) but not strength measured via peak torque at 60°/s-1 and 180°/s-1. RT increased VO2peak (CSMD: 2.71ml/kg/min; 1.96, 3.45) and QoL (CSMD: -5.71; -9.85, -1.56). CONCLUSION RT as a single intervention can increase muscle strength, aerobic capacity and QoL in patients with CHF and may offer an alternative approach, particularly for those unable to participate in aerobic training. The effect of RT on muscle strength is mainly during slow controlled movements and not during rapid movements. Older adults and patients with advanced CHF are underrepresented in RT trials and future studies should seek to optimise their inclusion.
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Affiliation(s)
- Catherine Giuliano
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia; Western Health, Melbourne, Australia.
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - Christopher Neil
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia; Western Health, Melbourne, Australia; Department of Medicine-Western Precinct at the University of Melbourne, Australia.
| | - Jason Allen
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia; Western Health, Melbourne, Australia.
| | - Itamar Levinger
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Australia; Western Health, Melbourne, Australia; Department of Cardiology, Austin Health, Melbourne, Australia.
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21
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Comparative effects of high intensity interval training versus moderate intensity continuous training on quality of life in patients with heart failure: Study protocol for a randomized controlled trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2015.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Simpson KA, Mavros Y, Kay S, Meiklejohn J, de Vos N, Wang Y, Guo Q, Zhao R, Climstein M, Baune BT, Blair S, O'Sullivan AJ, Simar D, Singh N, Singh MAF. Graded Resistance Exercise And Type 2 Diabetes in Older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial. Trials 2015; 16:512. [PMID: 26554457 PMCID: PMC4640163 DOI: 10.1186/s13063-015-1037-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/27/2015] [Indexed: 12/16/2022] Open
Abstract
Background Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes. Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control group for 12 months. Intervention group participants performed whole body machine-based power training at 80%1RM, 3 days per week. The control group undertook the same volume of non-progressive, low-intensity training. Participants were assessed at baseline, 6 months and 12 months and followed for a further 5 years, during which time participants were advised to exercise at moderate-high intensity. Glycemic control (HbA1c) and insulin resistance as measured by the homeostatic model assessment 2 (HOMA2-IR) were the primary outcomes of the trial. Outcome assessors were blinded to group assignment and participants were blinded to the investigators’ hypothesis regarding the most effective intervention. Results We recruited 103 participants (48.5 % women, 71.6 ± 5.6 years). Participants had 5.1 ± 1.8 chronic diseases, had been diagnosed with T2D for 8 ± 6 years and had a body mass index (BMI) of 31.6 ± 4.0 kg/m2. Fasting glucose and insulin were 7.3 ± 2.4 mmol/L and 10.6 ± 6.3 mU/L, respectively. HbA1c was 54 ± 12 mmol/mol. Eighty-six participants completed the 12-month assessment and follow-up is ongoing. This cohort had a lower-than-expected dropout (n = 14, 14 %) over the 12-month intervention period. Conclusions Power training may be a feasible adjunctive therapy for improving glycemic control for the growing epidemic of T2D in older adults. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12606000436572 (24 September 2006).
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Affiliation(s)
- Kylie A Simpson
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Yorgi Mavros
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Shelley Kay
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Jacinda Meiklejohn
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Nathan de Vos
- The Center for STRONG Medicine, Balmain Hospital, 29 Booth St, Balmain, NSW, 2041, Australia.
| | - Yi Wang
- San Francisco, Diabetes Center, University of California, Box 0540, 513 Parnassus Ave 1119, San Francisco, CA, 94143-0540, USA.
| | - Qianyu Guo
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Renru Zhao
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Mike Climstein
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Bernard T Baune
- Discipline of Psychiatry, The University of Adelaide, Level 4, Eleanor Harrold Building, Royal Adelaide Hospital, Adelaide, SA, 5005, Australia.
| | - Steven Blair
- Department of Exercise Science, Public Health Research Building, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA.
| | - Anthony J O'Sullivan
- Department of Medicine, University of New South Wales, St George and Sutherland Clinical School, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia.
| | - David Simar
- Faculty of Medicine, Metabolic Disorders Research Group, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Nalin Singh
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia.
| | - Maria A Fiatarone Singh
- Faculty of Health Science, Exercise, Health and Performance Faculty Research Group, University of Sydney, 75 East St, Lidcombe, NSW, 2750, Australia. .,Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia. .,Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Center on Aging, Tufts University, Boston, MA, USA.
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Hydrotherapy on exercise capacity, muscle strength and quality of life in patients with heart failure: A meta-analysis. Int J Cardiol 2015; 198:216-9. [PMID: 26173056 DOI: 10.1016/j.ijcard.2014.10.132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/21/2014] [Indexed: 11/24/2022]
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24
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Yap J, Lim FY, Gao F, Teo LL, Lam CSP, Yeo KK. Correlation of the New York Heart Association Classification and the 6-Minute Walk Distance: A Systematic Review. Clin Cardiol 2015; 38:621-8. [PMID: 26442458 DOI: 10.1002/clc.22468] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/19/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Functional status assessment is the cornerstone of heart failure management and trials. The New York Heart Association (NYHA) classification and 6-minute walk distance (6MWD) are commonly used tools; however, the correlation between them is not well understood. HYPOTHESIS We hypothesised that the relationship between the NYHA classification and 6MWD might vary across studies. METHODS A systematic literature search was performed to identify all studies reporting both NYHA class and 6MWD. Two reviewers independently assessed study eligibility and extracted data. Thirty-seven studies involving 5678 patients were included. RESULTS There was significant heterogeneity across studies in 6MWD within all NYHA classes: I (n = 16, Q = 934.2; P < 0.001), II (n = 25, Q = 1658.3; P < 0.001), III (n = 30, Q = 1020.1; P < 0.001), and IV (n = 6, Q = 335.5; P < 0.001). There was no significant difference in average 6MWD between NYHA I and II (420 m vs 393 m; P = 0.416). There was a significant difference in average 6MWD between NYHA II and III (393 m vs 321 m; P = 0.014) and III and IV (321 m vs 224 m; P = 0.027). This remained significant after adjusting for region of study, age, and sex. CONCLUSIONS Although there is an inverse correlation between NYHA II-IV and 6MWD, there is significant heterogeneity across studies in 6MWD within each NYHA class and overlap in 6MWD between NYHA I and II. The NYHA classification performs well in more symptomatic patients (NYHA III/IV) but less so in asymptomatic/mildly symptomatic patients (NYHA I/II). Nonetheless, the NYHA classification is an easily applied first-line tool in everyday clinical practice, but its potential subjectivity should be considered when performing comparisons across studies.
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Affiliation(s)
- Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Fang Yi Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fei Gao
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Ling Li Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carolyn Su Ping Lam
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore
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25
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Boyd AM. Regular exercise improves weight stability in patients with advanced heart failure. Ther Adv Cardiovasc Dis 2015; 9:297-304. [PMID: 25944851 DOI: 10.1177/1753944715581146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The purpose of this study was to determine if a progressive, prescribed home-based aerobic exercise program would alter the natural physiological processes that maintain fluid balance stability in patients with New York Heart Association (NYHA) class III/IV heart failure after medical optimization (titration of oral medical therapy with or without the infusion of an intravenous inotrope). METHODS A total of 56 men and women from a large tertiary trauma I hospital were enrolled with 56 subjects contributing to baseline analysis and 42 subjects at 24 weeks. Subjects were diagnosed with heart failure via NYHA classification IV or III for at least 6 months and were hospitalized for a current acute decompensation exacerbation in which they were being medically optimized. The exercise intervention was a home-based, prescribed, progressive aerobic exercise program lasting for 24 weeks. The exercise participants had weekly phone calls to gather data and progress the exercise program and one 12-week follow up. The usual care participants received random phone calls to collect data and had one 12-week follow up visit to attain physical assessment values. RESULTS Subjects were primarily female (59%), nonwhite (54%), and NYHA class IV (52%) versus class III (48%). The mean age was 58 years (±11.8 years). The subjects had a mean ejection fraction of 17.7 % (±7%) and mean maximal oxygen consumption of 12.1 (±3.4). Using a hierarchical multiple regression model, it was demonstrated that an exercise prescription (intensity, frequency, duration) significantly predicted 24 h weight fluctuations within a NYHA class III/IV heart failure population after medical optimization (R(2) linear = 0.713, F = 3.224, p = 0.015). CONCLUSION This study demonstrated that exercise is a successful adjunctive therapy to managing the daily weight variability or fluid status instability of patients with NYHA class III/IV heart failure that is often a debilitating aspect of the syndrome.
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Affiliation(s)
- Andrea M Boyd
- William J.B. Dorn VAMC, 6439 Garners Ferry Road, Columbia, SC 29209, USA
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26
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A novel application of salivary testosterone in systolic heart failure. Cardiovasc Endocrinol 2015. [DOI: 10.1097/xce.0000000000000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Alves JP, Nunes RB, Stefani GP, Dal Lago P. Resistance training improves hemodynamic function, collagen deposition and inflammatory profiles: experimental model of heart failure. PLoS One 2014; 9:e110317. [PMID: 25340545 PMCID: PMC4207701 DOI: 10.1371/journal.pone.0110317] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022] Open
Abstract
The role of resistance training on collagen deposition, the inflammatory profile and muscle weakness in heart failure remains unclear. Therefore, this study evaluated the influence of a resistance training program on hemodynamic function, maximum strength gain, collagen deposition and inflammatory profile in chronic heart failure rats. Thirty-two male Wistar rats submitted to myocardial infarction by coronary artery ligation or sham surgery were assigned into four groups: sedentary sham (S-Sham, n = 8); trained sham (T-Sham, n = 8); sedentary chronic heart failure (S-CHF, n = 8) and trained chronic heart failure (T-CHF, n = 8). The maximum strength capacity was evaluated by the one maximum repetition test. Trained groups were submitted to an 8-week resistance training program (4 days/week, 4 sets of 10-12 repetitions/session, at 65% to 75% of one maximum repetition). After 8 weeks of the resistance training program, the T-CHF group showed lower left ventricular end diastolic pressure (P<0.001), higher left ventricular systolic pressure (P<0.05), higher systolic blood pressure (P<0.05), an improvement in the maximal positive derivative of ventricular pressure (P<0.05) and maximal negative derivative of ventricular pressure (P<0.05) when compared to the S-CHF group; no differences were observed when compared to Sham groups. In addition, resistance training was able to reduce myocardial hypertrophy (P<0.05), left ventricular total collagen volume fraction (P<0.01), IL-6 (P<0.05), and TNF-α/IL-10 ratio (P<0.05), as well as increasing IL-10 (P<0.05) in chronic heart failure rats when compared to the S-CHF group. Eight weeks of resistance training promotes an improvement of cardiac function, strength gain, collagen deposition and inflammatory profile in chronic heart failure rats.
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Affiliation(s)
- Jadson P. Alves
- Laboratory of Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ramiro B. Nunes
- Laboratory of Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Giuseppe P. Stefani
- Laboratory of Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Dal Lago
- Laboratory of Physiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
- Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
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Effects of a short-term resistance program using elastic bands or weight machines in cardiac rehabilitation. Sci Sports 2014. [DOI: 10.1016/j.scispo.2013.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mara LSD, Valente Filho JM, Ribeiro EP, Ulbrich AZ, Lineburger AA, Angarten V, Sties SW, Pacheco JA, Carvalho TD. Exercício intenso e suplementação de testosterona em portadores de insuficiência cardíaca. REV BRAS MED ESPORTE 2014. [DOI: 10.1590/1517-86922014200201600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O sono é um estado natural e recorrente, no qual acontecem processos neurobiológicos importantes. A má qualidade do sono está diretamente A insuficiência cardíaca (IC) é uma síndrome com alterações neuroendócrinas, limitações funcionais associadas à baixa qualidade de vida. Há pouco conhecimento dos efeitos do exercício físico de alta intensidade e terapia de suplementação de testosterona (TST) em portadores de IC e hipotestosteronemia.OBJETIVO: Avaliar os efeitos do exercício de alta intensidade associado a TST na qualidade de vida e potência aeróbia destes pacientes.MÉTODOS: Dezenove pacientes portadores de IC (idade media, 58 ± 10 anos; fração de ejeção, 34 ± 8%) foram randomizados para o grupo exercício de alta intensidade (controle; n=9) e exercício de alta intensidade com suplementação hormonal (intervenção; n=10). Os Pacientes exercitaram-se (40 minutos, 90% do consumo máximo de oxigênio) três vezes semanalmente durante 12 semanas. O grupo intervenção recebeu testosterona na primeira e sexta semanas. Antes e após o período de estudo foram obtidas medidas da capacidade funcional e escores do Minnesota Living with Heart Failure Questionnaire.RESULTADOS: No intragrupo controle e intervenção, respectivamente, houve aumento do pico de consumo de oxigênio (12% vs. 15%; p CONCLUSÃO: Exercício de alta intensidade melhora a capacidade funcional e escores da QV após 12 semanas de tratamento.
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Makowska A, Rydlewska A, Krakowiak B, Kuczyńska A, Sorokowski P, Danel D, Pawłowski B, Banasiak W, Ponikowski P, Jankowska EA. Psychological Gender of Men With Systolic Heart Failure. Am J Mens Health 2013; 8:249-57. [DOI: 10.1177/1557988313508429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Diminished exercise capacity is a fundamental symptom of heart failure (HF), which is particularly disadvantageous for men for whom exercise capacity contributes significantly to their gender identity, self-esteem, and quality of life. In this study, we aimed to examine whether psychological gender would be different in men with systolic HF as compared with their healthy peers. The authors examined 48 men with systolic HF (age = 64 ± 10 years; body mass index = 28.3 ± 3.4 kg/m2; NYHA I/II/III [%] = 25/65/10; left ventricular ejection fraction [LVEF] = 32.1 ± 7.8%) and 15 age-matched healthy men. Based on the results of the Polish version of the Bem Sex Role Inventory, the examined men were divided into four types of psychological gender: “masculine” (M), “feminine” (F), “unspecified” (U), and “androgynous” (A). None of the men with HF presented M type of psychological gender, whereas this type was found in 27% of the healthy men ( p = .0002). The prevalence of both A (38% vs. 47%) and F (10% vs. 20%, both p > .05) types of psychological gender was similar between men with HF versus without HF. More men with HF fulfilled the criteria of the U type of psychological gender as compared with healthy peers (51% vs. 7%, p = .002). Men with HF and the F type of psychological gender were treated with spironolactone more frequently than those classified with the U and A types (both p < .05). The lack of “psychologically masculine” and the overrepresentation of “psychologically unspecified” gender types in the HF group suggests that psychological gender may be affected among men with HF.
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Affiliation(s)
- Agata Makowska
- Students’ Scientific Association, Laboratory for Applied Research on Cardiovascular System
| | - Agnieszka Rydlewska
- Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Krakowiak
- Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland
| | | | | | - Dariusz Danel
- Polish Academy of Sciences, Anthropology Unit in Wroclaw, Wroclaw, Poland
| | - Bogusław Pawłowski
- Polish Academy of Sciences, Anthropology Unit in Wroclaw, Wroclaw, Poland
- Department of Human Biology, University of Wroclaw, Poland
| | - Waldemar Banasiak
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa A. Jankowska
- Polish Academy of Sciences, Anthropology Unit in Wroclaw, Wroclaw, Poland
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Li Z, Huang IC, Thompson L, Tuli S, Huang SW, DeWalt D, Revicki D, Shenkman E. The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis. Sleep Med 2013; 14:641-7. [PMID: 23684939 DOI: 10.1016/j.sleep.2013.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL. METHODS 160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure children's daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL. RESULTS Poorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P<.05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P<.01). CONCLUSIONS Asthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.
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Affiliation(s)
- Zheng Li
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Chatziefstratiou AA, Giakoumidakis K, Brokalaki H. Cardiac rehabilitation outcomes: modifiable risk factors. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/bjon.2013.22.4.200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Hero Brokalaki
- Faculty of Nursing, National and Kapodistrian University of Athens, Greece
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van Venrooij LM, Visser M, de Vos R, van Leeuwen PA, Peters RJ, de Mol BA. Cardiac Surgery–Specific Screening Tool Identifies Preoperative Undernutrition in Cardiac Surgery. Ann Thorac Surg 2013; 95:642-7. [DOI: 10.1016/j.athoracsur.2012.08.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 08/22/2012] [Accepted: 08/24/2012] [Indexed: 01/10/2023]
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Stout M, Tew GA, Doll H, Zwierska I, Woodroofe N, Channer KS, Saxton JM. Testosterone therapy during exercise rehabilitation in male patients with chronic heart failure who have low testosterone status: a double-blind randomized controlled feasibility study. Am Heart J 2012. [PMID: 23194490 DOI: 10.1016/j.ahj.2012.09.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study assessed the feasibility of a 12-week program of exercise, with and without intramuscular testosterone supplementation, in male patients with chronic heart failure (CHF) and low testosterone status and collected preliminary data for key health outcomes. METHODS Male patients with CHF (n = 41, age 67.2 years, range 51-84 years) with mean ± SD testosterone levels of 10.7 ± 2.6 nmol/L (309 ± 76 ng/dL) were randomly allocated to exercise with testosterone or placebo groups. Feasibility was assessed in terms of recruitment, intervention compliance, and attrition. Outcomes included an incremental shuttle walk test, peak oxygen uptake, muscular strength, echocardiographic measures, N-terminal pro-brain natriuretic peptide, inflammatory markers, depression (Beck Depression Inventory), and health-related quality of life (Minnesota Living with Heart Failure Questionnaire and Medical Outcomes Study Short-Form). RESULTS Attrition was 30% but with 100% compliance to exercise and injections in patients who completed the study. Similar improvements in shuttle walk test (18% vs 19%), body mass (-1.3 kg vs -1.0 kg), and hand grip strength (2.1 kg vs 2.5 kg) from baseline were observed in both groups. The exercise with testosterone group showed improvements from baseline in peak oxygen uptake (P < .01), Beck Depression Inventory (P < .05), leg strength (P < .05), and several Medical Outcomes Study Short-Form quality of life domains (P < .05), which were generally not apparent in the exercise with placebo group. Echocardiographic measures, N-terminal pro-brain natriuretic peptide, and inflammatory markers were mostly unchanged. CONCLUSIONS This study shows for the first time that testosterone supplementation during a program of exercise rehabilitation is feasible and can positively impact on a range of key health outcomes in elderly male patients with CHF who have a low testosterone status.
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Wang HJ, Zucker IH, Wang W. Muscle reflex in heart failure: the role of exercise training. Front Physiol 2012; 3:398. [PMID: 23060821 PMCID: PMC3464681 DOI: 10.3389/fphys.2012.00398] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/20/2012] [Indexed: 12/25/2022] Open
Abstract
Exercise evokes sympathetic activation and increases blood pressure and heart rate (HR). Two neural mechanisms that cause the exercise-induced increase in sympathetic discharge are central command and the exercise pressor reflex (EPR). The former suggests that a volitional signal emanating from central motor areas leads to increased sympathetic activation during exercise. The latter is a reflex originating in skeletal muscle which contributes significantly to the regulation of the cardiovascular and respiratory systems during exercise. The afferent arm of this reflex is composed of metabolically sensitive (predominantly group IV, C-fibers) and mechanically sensitive (predominately group III, A-delta fibers) afferent fibers. Activation of these receptors and their associated afferent fibers reflexively adjusts sympathetic and parasympathetic nerve activity during exercise. In heart failure, the sympathetic activation during exercise is exaggerated, which potentially increases cardiovascular risk and contributes to exercise intolerance during physical activity in chronic heart failure (CHF) patients. A therapeutic strategy for preventing or slowing the progression of the exaggerated EPR may be of benefit in CHF patients. Long-term exercise training (ExT), as a non-pharmacological treatment for CHF increases exercise capacity, reduces sympatho-excitation and improves cardiovascular function in CHF animals and patients. In this review, we will discuss the effects of ExT and the mechanisms that contribute to the exaggerated EPR in the CHF state.
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Affiliation(s)
- Han-Jun Wang
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
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Benefits of combined aerobic/resistance/inspiratory training in patients with chronic heart failure. A complete exercise model? A prospective randomised study. Int J Cardiol 2012; 167:1967-72. [PMID: 22658571 DOI: 10.1016/j.ijcard.2012.05.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 05/04/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND We hypothesised that combined aerobic training (AT) with resistance training (RT) and inspiratory muscle training (IMT) could result in additional benefits over AT alone in patients with chronic heart failure (CHF). METHODS Twenty-seven patients, age 58 ± 9 years, NYHA II/III and LVEF 29 ± 7% were randomly assigned to a 12-week AT (n=14) or a combined AT/RT/IMT (ARIS) (n=13) exercise program. AT consisted of bike exercise at 70-80% of max heart rate. ARIS training consisted of AT with RT of the quadriceps at 50% of 1 repetition maximum (1RM) and upper limb exercises using dumbbells of 1-2 kg as well as IMT at 60% of sustained maximal inspiratory pressure (SPI(max)). At baseline and after intervention patients underwent cardiopulmonary exercise testing, echocardiography, evaluation of dyspnea, muscle function and quality of life (QoL) scores. RESULTS The ARIS program as compared to AT alone, resulted in additional improvement in quadriceps muscle strength (1RM, p=0.005) and endurance (50%1 RM × number of max repetitions, p=0.01), SPI(max) (p<0.001), exercise time (p=0.01), circulatory power (peak oxygen consumption × peak systolic blood pressure, p=0.05), dyspnea (p=0.03) and QoL (p=0.03). CONCLUSIONS ARIS training was safe and resulted in incremental benefits in both peripheral and respiratory muscle weakness, cardiopulmonary function and QoL compared to that of AT. The present findings may add a new prospective to cardiac rehabilitation programs of heart failure patients whilst the clinical significance of these outcomes need to be addressed in larger randomised studies.
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Ferreira ADS, Oliveira JFD, Cordovil I, Barbosa Filho J. Quadriceps short-term resistance exercise in subjects with resistant hypertension. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000400006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Resistant arterial hypertension may lead to muscle disuse and reduced functional capacity due to arterial and target-organs lesions. The main objective of this work is to evaluate the quadriceps strength and fatigue tolerance after a program of resistance exercise in subjects with resistant primary hypertension. METHODS: Six patients under pharmacological treatment were submitted to a four-week resistance exercise training program for the quadriceps (8-14 repetitions, 3 sets, 3 days per week). Strength was evaluated by isometric dynamometry, as the percentage change in maximum voluntary contraction over the four week program. Fatigue was analyzed by surface electromyography, as the change in both root mean square value and intercept of median frequency slope of vastus medialis and vastus lateralis. RESULTS: Significant increase in the maximum voluntary contraction was observed (p = 0.04). Fatigue tolerance was not improved as seen by root mean square as well as in the intercept of median frequency (p > 0.05). Additionally, no significant changes were observed in resting arterial blood pressure and heart rate throughout the training period. CONCLUSION: The prescribed protocol seemed to successfully increase localized muscle strength without negatively affecting the monitored cardiovascular variables in patients with resistant hypertension under pharmacological treatment.
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The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: A prospective cohort study. J Thorac Cardiovasc Surg 2011; 142:1263-9. [DOI: 10.1016/j.jtcvs.2011.07.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 06/27/2011] [Accepted: 07/19/2011] [Indexed: 01/06/2023]
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Local and systemic treatments for acute edema after burn injury: a systematic review of the literature. J Burn Care Res 2011; 32:334-47. [PMID: 21252688 DOI: 10.1097/bcr.0b013e31820ab019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the objective was to assess the evidence for the effectiveness of local and systemic treatments for edema management immediately after burn injury. Searches for randomized controlled trials were conducted of online databases, research and thesis registers, and grey literature repositories. Handsearches included journals, bibliographies, and proceedings. Authors were contacted to clarify and submit extra study details. Eight studies were included. Management of acute major burn resuscitation including colloid increases lung edema (mean difference [MD], 0.04 ml/ml alv vol; 95% confidence interval [CI], 0.03-0.04; P < .00001) and mortality (risk ratio, 3.67; 95% CI, 1.16-11.58; P = .03). Continuous administration of vitamin C in acute burn resuscitation reduces local wound edema (MD, -3.50 ml/g; 95% CI, -4.63 to -2.37; P < .00001) and systemic fluid retention (MD, -8.60 kg; 95% CI, -13.47 to -3.73; P = .0005). Local acute hand burn edema is reduced (MD, -29.00 ml; 95% CI, -53.14 to -4.86; P = .02), and active hand motion increased (MD, 10.00°; 95% CI, 4.58-15.42; P = .0003), using electrical stimulation with usual physiotherapy. Each review outcome was based on a small single-facility study. Thus, future research in intervention for acute burn edema must focus on multicentre trials and validation of outcome measures in the burn population.
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van Venrooij LMW, Verberne HJ, de Vos R, Borgmeijer-Hoelen MMMJ, van Leeuwen PAM, de Mol BAJM. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition 2011; 28:40-5. [PMID: 21621393 DOI: 10.1016/j.nut.2011.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/20/2010] [Accepted: 02/12/2011] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The objective of this study was to describe postoperative undernutrition in terms of postoperative losses of appendicular skeletal muscle mass (ASMM) with respect to complications, quality of life, readmission, and 1-y mortality after cardiac surgery. METHODS Patients undergoing cardiac surgery were prospectively followed. ASMM was measured 2 wk before and 2 mo after surgery using dual-energy X-ray absorptiometry. ASMM consists of arm skeletal muscle mass (SMM) and leg SMM. The association between ≥5% of ASMM decrease and postoperative outcome was analyzed using the chi-square test. A similar approach was used to analyze arm SMM and leg SMM decreases separately. RESULTS Twenty-nine patients were included (23 male, 34.5% ≥65 y old). Postoperatively, seven patients (24.1%) lost ≥5% ASMM. When analyzed separately, a ≥5% decrease in leg SMM was associated with a decrease in experienced vitality (odds ratio 13.0, 95% confidence interval 1.32-128.11, P = 0.03). In contrast, a ≥5% loss of arm SMM was associated with fewer in-hospital complications (odds ratio 0.20, 95% confidence interval 0.04-0.98, P = 0.04). These patients were characterized by a higher preoperative fat-free mass index (kilograms per meter squared; P = 0.01). CONCLUSIONS The results suggest that a preoperatively higher fat-free mass index indicates better ability to cope with operative stress, resulting in fewer complications. In addition, postoperative loss of muscle mass was associated with decreased vitality. We advocate further research investigating the effect of preoperative and postoperative nutritional intervention combined with physical exercise programs to increase lean body mass and thereby improve postoperative recovery after cardiac surgery.
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Affiliation(s)
- Lenny M W van Venrooij
- Department of Dietetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Bouchla A, Karatzanos E, Dimopoulos S, Tasoulis A, Agapitou V, Diakos N, Tseliou E, Terrovitis J, Nanas S. The addition of strength training to aerobic interval training: effects on muscle strength and body composition in CHF patients. J Cardiopulm Rehabil Prev 2011; 31:47-51. [PMID: 20562711 DOI: 10.1097/hcr.0b013e3181e174d7] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The loss of lean muscle mass and muscle strength is a common problem in chronic heart failure (CHF) patients. Endurance training is efficient in improving patient exercise capacity. This study sought to evaluate the additional effects of strength training on muscle strength and body composition in chf patients participating in an interval training program. METHODS Twenty consecutive, stable CHF patients participated in a rehabilitation program. Subjects were randomly assigned to aerobic (n = 10) or combined aerobic plus strength training group (n = 10). Aerobic group performed interval training on cycle ergometers. Strength training incorporated exercises for various muscle groups, including quadriceps, hamstrings, biceps brachii, and the deltoids. Both regimes were of the same duration. Body composition was evaluated by whole-body dual energy x-ray absorptiometry and quadriceps strength by the sum of the 2-repetition maximum (2-RM) test for each leg. Peak oxygen uptake (.VO(2peak)) and peak work load (W(peak)) as well as oxygen uptake (.VO(2AT)) and workload at anaerobic threshold (W(AT)) were evaluated by a symptom limited cardiopulmonary exercise testing. RESULTS Concerning leg lean mass, no significant within-subjects or between-groups changes were observed (P > .05). Both groups improved in 2-RM test (P < .05), while a significant difference was observed between groups (P < .05). .VO(2peak) and .VO(2AT) and W(peak) and W(AT) were equally improved between training groups (P < .05). CONCLUSIONS Combined aerobic interval and strength training induces a greater benefit than interval training alone on muscle strength in CHF patients. Adaptations other than hypertrophy, such as muscle fiber type alterations and/or neuromuscular adjustments, may account for these results.
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Affiliation(s)
- Anthi Bouchla
- Pulmonary & Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, National Kapodistrian University of Athens, 20 Papadiamantopoulou St., Athens, Greece
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Ravaglia S, Pichiecchio A, Ponzio M, Danesino C, Saeidi Garaghani K, Poloni GU, Toscano A, Moglia A, Carlucci A, Bini P, Ceroni M, Bastianello S. Changes in skeletal muscle qualities during enzyme replacement therapy in late-onset type II glycogenosis: temporal and spatial pattern of mass vs. strength response. J Inherit Metab Dis 2010; 33:737-45. [PMID: 20844963 DOI: 10.1007/s10545-010-9204-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 08/24/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
Muscle quality is defined as muscle strength generated per unit muscle mass. If enzyme replacement therapy (ERT) has some effects on type II glycogenosis (GSDII) skeletal muscle pathology, we should be able to measure a change in strength and mass. We conducted a prospective study including 11 patients aged 54.2 ± 11.2 years, referring to a single institution and receiving ERT for ≥2 years. Median Walton score was 3 (2.5-6). Lower limb skeletal muscles were assessed by dynamometry and quantitative muscle MRI. Three segments (anterior thigh, posterior thigh, leg) were analysed separately. Clinical-MRI correlations were searched for at T0, T6/T8, and T18/24. Changes in lean and fat body composition were assessed by bioelectrical impedance analysis. We found that the anterior thigh showed the best therapeutic response, with an improvement in muscle quality (muscle mass: +7.5%, p = 0.035; strength: +45%, p = 0.002). BMI and lean body mass increased (p = 0.007). Patients with low BMI showed a better outcome. Intramuscular fat accumulation significantly progressed in spite of ERT (+3.7%, p = 0.001), especially in the poorly responsive posterior thigh muscles. Both clinical assessment and MRI revealed a definite improvement in the anterior thigh muscles. However, progression of intramuscular fat accumulation during ERT, as well as the limited responsiveness of posterior thigh muscles, suggests the necessity for early treatment intervention. The better outcome of patients with low BMI, if confirmed, may indicate that dietary protocols could be adopted as adjuvant measures to ERT in adult GSDII.
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Affiliation(s)
- Sabrina Ravaglia
- Department of Neurological Sciences, University of Pavia, Pavia, Italy.
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Wang E, Helgerud J, Loe H, Indseth K, Kaehler N, Hoff J. Maximal strength training improves walking performance in peripheral arterial disease patients. Scand J Med Sci Sports 2010; 20:764-70. [DOI: 10.1111/j.1600-0838.2009.01014.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hwang CL, Chien CL, Wu YT. Resistance training increases 6-minute walk distance in people with chronic heart failure: a systematic review. J Physiother 2010; 56:87-96. [PMID: 20482475 DOI: 10.1016/s1836-9553(10)70038-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
QUESTION Does resistance training, either alone or as an adjunct to aerobic training, improve cardiac function, exercise capacity and quality of life in people with chronic heart failure? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults with stable chronic heart failure. INTERVENTION Progressive resistance exercise training, alone or as an adjunct to aerobic training. OUTCOME MEASURES Cardiac function, exercise capacity and quality of life. RESULTS 241 participants from eight trials performed 2 to 6 months of moderate-intensity resistance training (50-75% of 1RM). Most programs consisted of 5 to 6 exercises for large limb and trunk muscles with two sets of 8 to 12 repetitions, three times a week. Resistance training significantly increased 6-minute walk distance (WMD 52 m, 95% CI 19 to 85) but not peak oxygen consumption (WMD 1.4 ml/kg/min, 95% CI -0.3 to 3.1). When used as an adjunct to aerobic training, resistance training did not significantly alter left ventricular ejection fraction (WMD -0.5%, 95% CI -4.3 to 3.3), peak oxygen consumption (WMD -0.7 ml/kg/min, 95% CI -2.3 to 1.0), or Minnesota Living with Heart Failure Questionnaire scores (WMD -0.9, 95% CI -5.4 to 3.7), compared with aerobic training alone. CONCLUSION Resistance training increased 6-minute walk distance compared to no training, but had no other benefits on cardiac function, exercise capacity, or quality of life if used alone or as an adjunct to aerobic training in people with chronic heart failure. However, further high quality, large scale, randomised trials are needed.
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Wang HJ, Pan YX, Wang WZ, Gao L, Zimmerman MC, Zucker IH, Wang W. Exercise training prevents the exaggerated exercise pressor reflex in rats with chronic heart failure. J Appl Physiol (1985) 2010; 108:1365-75. [PMID: 20185628 DOI: 10.1152/japplphysiol.01273.2009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
An exaggerated exercise pressor reflex (EPR) occurs in the chronic heart failure (CHF) state, which contributes to exercise intolerance and excessive sympathoexcitation during exercise. Exercise training (ExT) improves abnormal cardiovascular reflexes in CHF. Whether ExT can normalize the exaggerated EPR function remains to be determined. This study was designed to investigate the effects of ExT on the EPR and on the mechanical or metabolic components of this reflex in sham-operated and CHF rats. The EPR was activated by static contraction induced by electrical stimulation of L4/L5 ventral roots. The afferent fibers associated with the mechanoreflex and metaboreflex were activated by passive stretch and hindlimb arterial injection of capsaicin (0.1 and 1 microg/kg, 0.2 ml), respectively. Heart rate, blood pressure, and sympathoexcitatory responses during the activation of these reflexes were compared in sham+sedentary (Sed), sham+ExT, CHF+Sed, and CHF+ExT rats. Compared with sham+Sed rats, CHF+Sed rats exhibited exaggerated heart rate and pressor and sympathoexcitatory responses to either static contraction or passive stretch, whereas the cardiovascular responses to injection of capsaicin were blunted. Eight to ten weeks of ExT normalized the exaggerated responses induced by static contraction or passive stretch and partially improved the blunted responses due to intra-arterial capsaicin in CHF rats. ExT had no significant effect on the EPR and mechanoreflex and metaboreflex functions in sham rats. These findings suggest a potential therapeutic role for ExT in minimizing arterial pressure and sympathetic outflow following activation of the EPR in the CHF state.
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Affiliation(s)
- Han-Jun Wang
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198-5850, USA
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Baum K, Hildebrandt U, Edel K, Bertram R, Hahmann H, Bremer FJ, Böhmen S, Kammerlander C, Serafin M, Rüther T, Miche E. Comparison of skeletal muscle strength between cardiac patients and age-matched healthy controls. Int J Med Sci 2009; 6:184-91. [PMID: 19584952 PMCID: PMC2706425 DOI: 10.7150/ijms.6.184] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/06/2009] [Indexed: 12/02/2022] Open
Abstract
The purpose of the present study was to compare muscular strength of knee extensors and arm flexor muscles of cardiac patients (n = 638) and healthy controls (n = 961) in different age groups. Isometric torques were measured in a sitting position with the elbow, hip, and knee flexed to 90(0). For statistical analysis, age groups were pooled in decades from the age of 30 to 90 years. Additionally, the influence of physical lifestyle prior to disease on muscular strength was obtained in the patients. For statistical analysis three-way ANOVA (factors age, gender, and physical activity level) was used.Both in patients and in controls a significant age-dependent decline in maximal torque could be observed for arm flexors and knee extensors. Maximal leg extensor muscle showed statistically significant differences between healthy controls and cardiac patients as well as between subgroups of patients: Physically inactive patients showed lowest torques (male: 148 +/- 18 Nm; female: 82 +/- 25 Nm) while highest values were measured in control subjects (male: 167 +/- 16 Nm; female: 93 +/- 17 Nm). In contrast, arm flexor muscles did not show any significant influence of health status or sports history.This qualitative difference between weight-bearing leg muscles and the muscle group of the upper extremity suggest that lower skeletal muscle strength in heart patients is mainly a consequence of selective disuse of leg muscles rather than any pathological skeletal muscle metabolism. Since a certain level of skeletal muscle strength is a prerequisite to cope with everyday activities, strength training is recommended as an important part of cardiac rehabilitation.
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Affiliation(s)
- K Baum
- Institut für Physiologie und Anatomie, Deutsche Sporthochschule Köln, und Trainingsinstitut Prof. Dr. Baum, Wilhelm-Schlombs-Allee 1, Köln, Germany.
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