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Patel KV, Saha A, Ayers CR, Rohatgi A, Berry JD, Almandoz JP, Johannsen NM, deFilippi C, Church TS, de Lemos JA, Pandey A. Exercise Training, Cardiac Biomarkers, and Cardiorespiratory Fitness in Type 2 Diabetes: The HART-D Study. JACC. ADVANCES 2023; 2:100174. [PMID: 38939024 PMCID: PMC11198483 DOI: 10.1016/j.jacadv.2022.100174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 06/29/2024]
Abstract
Background High-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are cardiac biomarkers commonly detected in adults with type 2 diabetes (T2D) and are associated with heart failure risk. Objectives The purpose of this study was to evaluate the effects of exercise training (ET) on hs-cTnT and NT-proBNP and evaluate the associations of these biomarkers with cardiorespiratory fitness among adults with T2D. Methods Participants of the HART-D (Health Benefits of Aerobic and Resistance Training in Individuals with Type 2 Diabetes) trial who were randomly assigned to one of 3 ET groups or a non-exercise control group were included. Cardiac biomarkers and cardiorespiratory fitness (evaluated by peak oxygen uptake [VO2peak]) were assessed at baseline and after 9 months. The effects of ET (3 ET groups pooled) vs non-exercise control on hs-cTnT and NT-proBNP were assessed using separate analysis of covariance models. Multivariable-adjusted linear regression was performed to identify factors associated with follow-up biomarkers and ΔVO2peak. Results The present study included 166 participants randomized to the ET (n = 135) and non-exercise control (n = 31) groups. Compared with the non-exercise control, ET did not significantly change hs-cTnT or NT-proBNP. In adjusted analysis, each ET group and ΔVO2peak were not significantly associated with hs-cTnT or NT-proBNP levels on follow-up. Among individuals in the ET group, baseline hs-cTnT was inversely associated with ΔVO2peak [per 1 SD higher log (hs-cTnT): β = -0.08 (95% CI = -0.15 to -0.01)]. Conclusions Among individuals with T2D, ET did not modify cardiac biomarkers. Higher baseline hs-cTnT was associated with blunted cardiorespiratory fitness improvement in response to exercise.
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Affiliation(s)
- Kershaw V. Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Amit Saha
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Colby R. Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaime P. Almandoz
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil M. Johannsen
- School of Kinesiology, College of Human Sciences & Education, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Timothy S. Church
- Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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2
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Pandey A, Segar MW, Singh S, Reeves G, O'Connor C, Pina I, Whellan D, Kraus W, Mentz R, Kitzman D. Frailty Status Modifies the Efficacy of Exercise Training Among Patients With Chronic Heart Failure and Reduced Ejection Fraction: An Analysis From the HF-ACTION Trial. Circulation 2022; 146:80-90. [PMID: 35616018 DOI: 10.1161/circulationaha.122.059983] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Supervised aerobic exercise training (ET) is recommended for stable outpatients with heart failure (HF) with reduced ejection fraction (HFrEF). Frailty, a syndrome characterized by increased vulnerability and decreased physiologic reserve, is common in patients with HFrEF and associated with a higher risk of adverse outcomes. The effect modification of baseline frailty on the efficacy of aerobic ET in HFrEF is not known. METHODS Stable outpatients with HFrEF randomized to aerobic ET versus usual care in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) trial were included. Baseline frailty was estimated using the Rockwood frailty index (FI), a deficit accumulation-based model of frailty assessment; participants with FI scores >0.21 were identified as frail. Multivariable Cox proportional hazard models with multiplicative interaction terms (frailty treatment arm) were constructed to evaluate whether frailty modified the treatment effect of aerobic ET on the primary composite end point (all-cause hospitalization and mortality), secondary end points (composite of cardiovascular death or cardiovascular hospitalization, and cardiovascular death or HF hospitalization), and Kansas City Cardiomyopathy Questionnaire score. Separate models were constructed for continuous (FI) and categorical (frail versus not frail) measures of frailty. RESULTS Among 2130 study participants (age, 59±13 years; 28% women), 1266 (59%) were characterized as frail (FI>0.21). Baseline frailty burden significantly modified the treatment effect of aerobic ET (P interaction: FI × treatment arm=0.02; frail status [frail versus nonfrail] × treatment arm=0.04) with a lower risk of primary end point in frail (hazard ratio [HR], 0.83 [95% CI, 0.72-0.95]) but not nonfrail (HR, 1.04 [95% CI, 0.87-1.25]) participants. The favorable effect of aerobic ET among frail participants was driven by a significant reduction in the risk of all-cause hospitalization (HR, 0.84 [95% CI, 0.72-0.99]). The treatment effect of aerobic ET on all-cause mortality and other secondary endpoints was not different between frail and nonfrail patients (P interaction>0.1 for each). Aerobic ET was associated with a nominally greater improvement in Kansas City Cardiomyopathy Questionnaire scores at 3 months among frail versus nonfrail participants without a significant treatment interaction by frailty status (P interaction>0.2). CONCLUSION Among patients with chronic stable HFrEF, baseline frailty modified the treatment effect of aerobic ET with a greater reduction in the risk of all-cause hospitalization but not mortality.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Matthew W Segar
- Department of Cardiology, Texas Heart Institute, Houston (M.W.S.)
| | - Sumitabh Singh
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P., S.S.)
| | - Gordon Reeves
- Cardiovascular Disease, Heart Failure and Transplant, Novant Health, Charlotte, NC (G.R.)
| | - Christopher O'Connor
- Inova Heart and Vascular Institute, Falls Church, VA (C.O.).,Duke University Medical Center, Durham, NC. (C.O.).,Duke Clinical Research Institute, Durham, NC. (C.O., R.M.)
| | | | - David Whellan
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, PA (D.W.)
| | - William Kraus
- Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Robert Mentz
- Duke Clinical Research Institute, Durham, NC. (C.O., R.M.).,Division of Cardiology, Duke University School of Medicine, Durham, NC. (W.K., R.M.)
| | - Dalane Kitzman
- Cardiovascular Medicine and Geriatrics Sections, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (D.K.)
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Yu F, Mathiason MA, Han S, Gunter JL, Jones D, Botha H, Jack C. Mechanistic Effects of Aerobic Exercise in Alzheimer's Disease: Imaging Findings From the Pilot FIT-AD Trial. Front Aging Neurosci 2021; 13:703691. [PMID: 34690736 PMCID: PMC8530186 DOI: 10.3389/fnagi.2021.703691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
Despite strong evidence from animal models of Alzheimer's disease (AD) supporting aerobic exercise as a disease-modifying treatment for AD, human mechanistic studies are limited with mixed findings. The objective of this pilot randomized controlled trial was to examine the effects of 6-month aerobic exercise on hippocampal volume, temporal meta-regions of interest (ROI) cortical thickness, white matter hyperintensity (WMH) volume, and network failure quotient (NFQ), measured with MRI, in community-dwelling older adults with AD dementia. Additionally, the relationships between 6- and 12-month changes in MRI biomarkers and the AD Assessment Scale-Cognition (ADAS-Cog) were examined. Sixty participants were randomized, but one was excluded because baseline MRI failed quality control: 38 randomized to cycling and 21 to stretching. The intervention was moderate-intensity cycling for 20-50 mins, three times a week for 6 months. Control was low-intensity stretching. The study outcomes include hippocampal volume, temporal meta-ROI cortical thickness, WMH volume, and NFQ. Outcomes were measured at baseline, 6 months, and 12 months. The sample averaged 77.3 ± 6.3 years old with 15.6 ± 2.9 years of education and 53% men. Both groups experienced significant declines over 6 months in hippocampal volume (2.64% in cycling vs. 2.89% in stretching) and temporal meta-ROI cortical thickness (0.94 vs. 1.54%), and over 12 months in hippocampal volume (4.47 vs. 3.84%) and temporal meta-ROI cortical thickness (2.27 vs. 1.79%). These declines did not differ between groups. WMH volume increased significantly with the cycling group increasing less (10.9%) than stretching (24.5%) over 6 months (f = 4.47, p = 0.04) and over 12 months (12.1 vs. 27.6%, f = 5.88, p = 0.02). NFQ did not change significantly over time. Pairwise correlational analyses showed a significant negative correlation between 6-month changes in hippocampal volume and ADAS-Cog (r = -0.34, p < 0.05). To conclude, aerobic exercise may reduce the decline in hippocampal volume and temporal meta-ROI cortical thickness during the intervention period, but the effect sizes are likely to be very small and dose-dependent and reverse once the intervention stops. Aerobic exercise is effective on slowing down WMH progression but has no effect on NFQ. Hippocampal atrophy was associated with cognitive decline during the intervention period. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01954550.
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Affiliation(s)
- Fang Yu
- Arizona State University Edson College of Nursing and Health Innovation, Phoenix, AZ, United States
- University of Minnesota School of Nursing, Minneapolis, MN, United States
| | | | - SeungYong Han
- Arizona State University Edson College of Nursing and Health Innovation, Phoenix, AZ, United States
| | | | - David Jones
- Mayo Clinic Department of Radiology, Rochester, MN, United States
| | - Hugo Botha
- Mayo Clinic Department of Radiology, Rochester, MN, United States
| | - Clifford Jack
- Mayo Clinic Department of Radiology, Rochester, MN, United States
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Meyler S, Bottoms L, Muniz-Pumares D. Biological and methodological factors affecting V ̇ O 2 max response variability to endurance training and the influence of exercise intensity prescription. Exp Physiol 2021; 106:1410-1424. [PMID: 34036650 DOI: 10.1113/ep089565] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/07/2021] [Indexed: 12/21/2022]
Abstract
NEW FINDINGS What is the topic of this review? Biological and methodological factors associated with the variable changes in cardiorespiratory fitness in response to endurance training. What advances does it highlight? Several biological and methodological factors exist that each contribute, to a given extent, to response variability. Notably, prescribing exercise intensity relative to physiological thresholds reportedly increases cardiorespiratory fitness response rates compared to when prescribed relative to maximum physiological values. As threshold-based approaches elicit more homogeneous acute physiological responses among individuals, when repeated over time, these uniform responses may manifest as more homogeneous chronic adaptations thereby reducing response variability. ABSTRACT Changes in cardiorespiratory fitness (CRF) in response to endurance training (ET) exhibit large variations, possibly due to a multitude of biological and methodological factors. It is acknowledged that ∼20% of individuals may not achieve meaningful increases in CRF in response to ET. Genetics, the most potent biological contributor, has been shown to explain ∼50% of response variability, whilst age, sex and baseline CRF appear to explain a smaller proportion. Methodological factors represent the characteristics of the ET itself, including the type, volume and intensity of exercise, as well as the method used to prescribe and control exercise intensity. Notably, methodological factors are modifiable and, upon manipulation, alter response rates to ET, eliciting increases in CRF regardless of an individual's biological predisposition. Particularly, prescribing exercise intensity relative to a physiological threshold (e.g., ventilatory threshold) is shown to increase CRF response rates compared to when intensity is anchored relative to a maximum physiological value (e.g., maximum heart rate). It is, however, uncertain whether the increased response rates are primarily attributable to reduced response variability, greater mean changes in CRF or both. Future research is warranted to elucidate whether more homogeneous chronic adaptations manifest over time among individuals, as a result of exposure to more homogeneous exercise stimuli elicited by threshold-based practices.
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Affiliation(s)
- Samuel Meyler
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Lindsay Bottoms
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Pandey A, Johnson JL, Slentz CA, Ross LM, Agusala V, Berry JD, Kraus WE. Short-Term Changes in Cardiorespiratory Fitness in Response to Exercise Training and the Association with Long-Term Cardiorespiratory Fitness Decline: The STRRIDE Reunion Study. J Am Heart Assoc 2019; 8:e012876. [PMID: 31597504 PMCID: PMC6818024 DOI: 10.1161/jaha.119.012876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Substantial heterogeneity exists in the cardiorespiratory fitness (CRF) change in response to exercise training, and its long‐term prognostic implication is not well understood. We evaluated the association between the short‐term supervised training‐related changes in CRF and CRF levels 10 years later. Methods and Results STRRIDE (Studies of a Targeted Risk Reduction Intervention Through Defined Exercise) trial participants who were originally randomized to exercise training for 8 months and participated in the 10‐year follow‐up visit were included. CRF levels were measured at baseline, after training (8 months), and at 10‐year follow‐up as peak oxygen uptake (vo2, mL/kg per min) using the maximal treadmill test. Participants were stratified into low, moderate, and high CRF response groups according to the training regimen–specific tertiles of CRF change. The study included 80 participants (age: 52 years; 35% female). At 10‐year follow‐up, the high‐response CRF group had the least decline in CRF compared with the moderate‐ and low‐response CRF groups (−0.35 versus −2.20 and −4.25 mL/kg per minute, respectively; P=0.02). This result was largely related to the differential age‐related changes in peak oxygen pulse across the 3 groups (0.58, −0.23, and −0.86 mL/beat, respectively; P=0.03) with no difference in the peak heart rate change. In adjusted linear regression analysis, high response was significantly associated with greater CRF at follow‐up independent of other baseline characteristics (high versus low [reference] CRF response: standard β=0.25; P=0.004). Conclusions Greater CRF improvement in response to short‐term training is associated with higher CRF levels 10 years later. Lack of CRF improvements in response to short‐term training may identify individuals at risk for exaggerated CRF decline with aging.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Johanna L Johnson
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Cris A Slentz
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Leanna M Ross
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC
| | - Vijay Agusala
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - Jarett D Berry
- Division of Cardiology Department of Internal Medicine UT Southwestern Medical Center Dallas TX
| | - William E Kraus
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC.,Division of Cardiology Medicine Duke University School of Medicine Durham NC
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Bakker EA, Snoek JA, Meindersma EP, Hopman MTE, Bellersen L, Verbeek ALM, Thijssen DHJ, Eijsvogels TMH. Absence of Fitness Improvement Is Associated with Outcomes in Heart Failure Patients. Med Sci Sports Exerc 2018; 50:196-203. [PMID: 28938249 DOI: 10.1249/mss.0000000000001429] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study aimed to examine the clinical effect of cardiorespiratory fitness (CRF) and improvements in CRF after cardiac rehabilitation (CR) in heart failure (HF) patients for their risk for all-cause mortality and unplanned hospitalization and to investigate possible factors associated with the absence of improvement in CRF after rehabilitation. METHODS We included 155 HF patients receiving CR between October 2009 and January 2015. Patients performed an incremental bicycle test to assess CRF through peak oxygen uptake (V˙O2-peak) before and after CR-based supervised exercise training. Patients were classified as responders or nonresponders on the basis of pre-to-post CR changes in V˙O2-peak (≥6% and <6%, respectively). Cox proportional hazards models evaluated all-cause mortality and unplanned hospitalization during 5 yr of follow-up. Patient characteristics, HF features, and comorbidities were used to predict changes in V˙O2-peak using logistic regression analysis. RESULTS Seventy HF patients (45%) were classified as responder. Nonresponders had a significantly higher risk for all-cause mortality or hospitalization (hazard ratio, 2.15; 95% confidence interval (CI), 1.17-3.94) compared with responders. This was even higher in nonresponders with low CRF at baseline (hazard ratio, 4.88; 95% CI, 1.71-13.93). Factors associated with nonresponse to CR were age (odds ratio (OR), 1.07/yr; 95% CI, 1.03-1.11), baseline V˙O2-peak (OR, 1.16 mL·min·kg; 95% CI, 1.06-1.26), and adherence to CR (OR, 0.98/percentage; 95% CI, 0.96-0.998). CONCLUSIONS Independent from baseline CRF, the inability to improve V˙O2-peak by CR doubled the risk for death or unplanned hospitalization. The combination of lower baseline CRF and nonresponse was associated with even poorer clinical outcomes. Especially older HF patients with higher baseline V˙O2-peak and lower adherence have a higher probability of becoming a nonresponder.
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Affiliation(s)
- Esmée A Bakker
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Johan A Snoek
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Esther P Meindersma
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Maria T E Hopman
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Louise Bellersen
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - André L M Verbeek
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Dick H J Thijssen
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS.,Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, THE NETHERLANDS
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Williamson PJ, Atkinson G, Batterham AM. Inter-Individual Responses of Maximal Oxygen Uptake to Exercise Training: A Critical Review. Sports Med 2018; 47:1501-1513. [PMID: 28097487 DOI: 10.1007/s40279-017-0680-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It has recently been reported how to quantify inter-individual differences in the response to an exercise intervention using the standard deviation of the change scores, as well as how to appraise these differences for clinical relevance. In a parallel-group randomised controlled trial, the key trigger for further investigation into inter-individual responses is when the standard deviation of change in the intervention sample is substantially larger than the same standard deviation derived from a suitable comparator sample. 'True' and clinically relevant inter-individual differences in response can then be plausibly expected, and potential moderators and mediators of the inter-individual differences can be explored. We now aim to critically review the research on the inter-individual differences in response to exercise training, focusing on maximal oxygen uptake (VO2max). A literature search through the relevant bibliographic databases resulted in the identification of six relevant studies that were published prior to the influential HEalth, RIsk factors, exercise Training And GEnetics (HERITAGE) Family Study. Only one of these studies was found to include a comparator arm. Re-analysis of the data from this study, accounting for random within-subjects variation, revealed an absence of clinically important inter-individual differences in the response of VO2max to exercise training. The standard deviation of change was, in fact, larger (±5.6 mL/kg/min) for the comparator than the intervention group (±3.7 mL/kg/min). We located over 180 publications that resulted from the HERITAGE Family Study, but we could not find a comparator arm in any of these studies. Some authors did not explain this absence, while others reasoned that only inter-individual differences in exercise response were of interest, thus the intervention sample was investigated solely. We also found this absence of a comparator sample in on-going studies. A perceived high test-retest reliability is offered as a justification for the absence of a comparator arm, but the test-retest reliability analysis for the HERITAGE Family Study was over a much shorter term than the length of the actual training period between baseline and follow-up measurements of VO2max. We also scrutinised the studies in which twins have been investigated, resulting in concerns about how genetic influences on the magnitude of general within-subjects variability has been partitioned out (again in the absence of a comparator no-training group), as well as with the intra-class correlation coefficient approach to data analysis. Twin pairs were found to be sometimes heterogeneous for the obviously influential factors of sex, age and fitness, thereby inflating an unadjusted coefficient. We conclude that most studies on inter-individual differences in VO2max response to exercise training have no comparator sample. Therefore, true inter-individual differences in response cannot be quantified, let alone appraised for clinical relevance. For those studies with a comparator sample, we found that the inter-individual differences in training response were not larger than random within-subjects variation in VO2max over the same time period as the training intervention.
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Affiliation(s)
- Philip J Williamson
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BX, UK.
| | - Greg Atkinson
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BX, UK
| | - Alan M Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough, TS1 3BX, UK
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Omar W, Pandey A, Haykowsky MJ, Berry JD, Lavie CJ. The Evolving Role of Cardiorespiratory Fitness and Exercise in Prevention and Management of Heart Failure. Curr Heart Fail Rep 2018. [DOI: 10.1007/s11897-018-0382-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pandey A, Kitzman DW, Brubaker P, Haykowsky MJ, Morgan T, Becton JT, Berry JD. Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction. J Am Geriatr Soc 2017; 65:1698-1704. [PMID: 28338229 DOI: 10.1111/jgs.14867] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). DESIGN Secondary analysis of a randomized controlled trial. SETTING Outpatient cardiac rehabilitation program. PARTICIPANTS Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. MEASUREMENTS The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak ) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. RESULTS Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak . CONCLUSION The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Peter Brubaker
- Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.,Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Timothy Morgan
- Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - J Thomas Becton
- Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jarett D Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Pandey A, Swift DL, McGuire DK, Ayers CR, Neeland IJ, Blair SN, Johannsen N, Earnest CP, Berry JD, Church TS. Metabolic Effects of Exercise Training Among Fitness-Nonresponsive Patients With Type 2 Diabetes: The HART-D Study. Diabetes Care 2015; 38:1494-501. [PMID: 26084342 PMCID: PMC4512133 DOI: 10.2337/dc14-2378] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/27/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the impact of exercise training (ET) on metabolic parameters among participants with type 2 diabetes mellitus (T2DM) who do not improve their cardiorespiratory fitness (CRF) with training. RESEARCH DESIGN AND METHODS We studied participants with T2DM participating in the Health Benefits of Aerobic and Resistance Training in Individuals With Type 2 Diabetes (HART-D) trial who were randomized to a control group or one of three supervised ET groups for 9 months. Fitness response to ET was defined as a change in measured peak absolute oxygen uptake (ΔVO(2peak), in liters per minute) from baseline to follow-up. ET participants were classified based on ΔVO(2peak) into fitness responders (ΔVO(2peak) ≥5%) and nonresponders (ΔVO(2peak) <5%), and changes in metabolic profiles were compared across control, fitness responder, and fitness nonresponder groups. RESULTS A total of 202 participants (mean age 57.1 ± 7.9 years, 63% women) were included. Among the exercise groups (n = 161), there was substantial heterogeneity in ΔVO(2peak); 57% had some improvement in CRF (ΔVO(2peak) >0), with only 36.6% having a ≥5% increase in VO(2peak). Both fitness responders and nonresponders (respectively) had significant improvements in hemoglobin A1c and measures of adiposity (ΔHbA(1c): -0.26% [95% CI -0.5 to -0.01] and -0.26% [-0.45 to -0.08]; Δwaist circumference: -2.6 cm [-3.7 to -1.5] and -1.8 cm [-2.6 to -1.0]; Δbody fat: -1.07% [-1.5 to -0.62] and -0.75% [-1.09 to -0.41]). No significant differences were observed in the degree of change of these metabolic parameters between fitness responders and nonresponders. Control group participants had no significant changes in any of these metabolic parameters. CONCLUSIONS ET is associated with significant improvements in metabolic parameters irrespective of improvement in cardiorespiratory fitness.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Damon L Swift
- Department of Kinesiology, East Carolina University, Greenville, NC
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Colby R Ayers
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ian J Neeland
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven N Blair
- Department of Exercise Science, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Neil Johannsen
- School of Kinesiology, College of Human Sciences & Education, Louisiana State University, Baton Rouge, LA
| | - Conrad P Earnest
- Department for Health & Kinesiology, Texas A&M University, College Station, TX
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Timothy S Church
- Preventive Medicine Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA
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