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West K, Spears K, Joyner B, Smith C, Jenkins NDM, Grosicki GJ, Siekirk NJ. The acute effect of passively assisted trunk stretching on central arterial stiffness and blood pressure in middle-aged to older adults. Eur J Appl Physiol 2024; 124:1683-1692. [PMID: 38217670 DOI: 10.1007/s00421-023-05389-9] [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: 07/20/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE We examined the effects of acute trunk stretching on central arterial stiffness and central and peripheral blood pressure in middle-aged to older adults. METHODS Twenty-eight middle-aged to older adults (14M/14F, 72 ± 7 years, 28.5 ± 5.3 kg/m2) completed this randomized, controlled, crossover design trial. We measured carotid-femoral pulse wave velocity (cf-PWV) and central and peripheral blood pressures (BP) before and after a single bout of passively assisted trunk stretching (i.e., five rounds of six 30-s stretches) and a time-matched seated control visit (i.e., 30-min). Changes (Δ; post - pre) in cf-PWV and central and peripheral BP were compared between visits and sexes using separate linear mixed-effects models controlling for baseline values. RESULTS Compared with seated control, central (systolic: - 3 ± 7 mmHg; diastolic: - 2 ± 5 mmHg) and peripheral (systolic: - 2 ± 8 mmHg; diastolic: - 1 ± 4 mmHg) BP were reduced following acute trunk stretching (ps ≤ 0.001). Between-visit differences for ∆cf-PWV (stretch: 0.09 ± 0.61 m/s; control: 0.37 ± 0.68 m/s, p = 0.038) were abolished when controlling for change in mean arterial pressure (∆MAP) (p = 0.687). The main effects of sex were detected for changes in systolic BPs (ps ≤ 0.029); more males (n = 13) saw BP reductions than females (n = 7). CONCLUSION These findings demonstrate the superiority of acute trunk stretching over passive sitting of equated duration for BP in middle-aged to older adults, with an appreciable effect in males compared to females.
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Affiliation(s)
- Kylee West
- Biomechanics Laboratory, Department of Health Sciences and Kinesiology, Georgia Southern University, P.O. Box 8076, Statesboro, GA, 30460, USA
- Biodynamics and Human Performance Center, Department of Health Sciences and Kinesiology, Georgia Southern University, Savannah, GA, USA
| | - Kaelyn Spears
- Biodynamics and Human Performance Center, Department of Health Sciences and Kinesiology, Georgia Southern University, Savannah, GA, USA
| | - Barry Joyner
- Center for Rehabilitation and Independent Living, Waters College of Health Professions, Georgia Southern University, Statesboro, GA, USA
| | - Collin Smith
- Internal Medicine, East Georgia Regional Medical Center, Statesboro, GA, USA
| | - Nathaniel D M Jenkins
- Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA
- Francois M. Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA
| | - Gregory J Grosicki
- Biodynamics and Human Performance Center, Department of Health Sciences and Kinesiology, Georgia Southern University, Savannah, GA, USA
| | - Nicholas J Siekirk
- Biomechanics Laboratory, Department of Health Sciences and Kinesiology, Georgia Southern University, P.O. Box 8076, Statesboro, GA, 30460, USA.
- Center for Rehabilitation and Independent Living, Waters College of Health Professions, Georgia Southern University, Statesboro, GA, USA.
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Bonikowske AR, Taylor JL, Larson KF, Hardwick J, Ozemek C, Harber MP, Kaminsky LA, Arena R, Lavie CJ. Evaluating current assessment techniques of cardiorespiratory fitness. Expert Rev Cardiovasc Ther 2024; 22:231-241. [PMID: 38855917 DOI: 10.1080/14779072.2024.2363393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Considerable and convincing global data from cohorts across the health spectrum (i.e. apparently healthy to known disease) indicate that cardiorespiratory fitness (CRF) is a major predictor of overall and cardiovascular disease (CVD)-survival, seemingly with greater prognostic resolution compared to other traditional CVD risk factors. Therefore, the assessment of CRF in research and clinical settings is of major importance. AREAS COVERED In this manuscript, we review the technology of measuring CRF assessed by the 'gold standard,' cardiopulmonary exercise testing (CPET), as well as with various other methods (e.g. estimated metabolic equivalents, 6-minute walk tests, shuttle tests, and non-exercise equations that estimate CRF), all of which provide significant prognostic information for CVD- and all-cause survival. The literature through May 2024 has been cited. EXPERT OPINION The promotion of physical activity in efforts to improve levels of CRF is needed throughout the world to improve lifespan and, more importantly, healthspan. The routine assessment of CRF should be considered a vital sign that is routinely assessed in clinical practice.
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Affiliation(s)
| | - Jenna L Taylor
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn F Larson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Cemal Ozemek
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
| | - Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Lenny A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, USA
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Dias KJ, McPherson A, Mason K, Dowling K, Smith-Beaver LP, Nadler DR. Assessment of Exercise Capacity in Home Healthcare: Differences in Three Self-Paced Tests. Home Healthc Now 2024; 42:150-160. [PMID: 38709581 DOI: 10.1097/nhh.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Submaximal functional tests of endurance are ubiquitous in clinical practice. This investigation compared cardiovascular responses, perceived exertion, and performance measures following the completion of three self-paced, 2-minute, functional tests of endurance. A pilot prospective, observational, cross-sectional design with 16 community-dwelling older participants compared heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rating of perceived exertion (RPE), and performance measures following the completion of three randomly allocated self-paced activities. The three activities included 2 minutes of stepping in standing (2MSTD), 2 minutes of seated stepping (2MSIT), and a 2-minute walk test (2MWT). A within-subjects repeated measures ANOVA analyzed differences in change scores for cardiovascular and RPE responses. Pearson's correlations assessed associations in performance measures between the three tests. Standing stepping compared to seated stepping produced statistically higher change scores in HR, SBP, DBP, and RPE (p < .05). Further, 2MSTD revealed statistically higher SBP and RPE scores compared to 2MWT (p < .05). Large and moderate correlations were observed between number of steps completed in sitting and standing (r = 0.83, p < .01) and between standing steps and distance walked (r = 0.56, p = .02), respectively. This pilot investigation informs home care physical therapists that 2 minutes of self-paced stepping in standing produced the greatest change scores in all cardiovascular and perceived exertion responses. No significant differences were noted in HR between self-paced walking and standing stepping, and between standing and seated stepping. For patients unable to walk or step in standing, self-paced seated stepping may be a viable alternative.
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4
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Tao Z, Sun X, Sun J, Zhu E. Dose-response relationship between 15 weeks of running and aerobic fitness: a retrospective analysis based on the fun running program. BMC Public Health 2024; 24:1019. [PMID: 38609934 PMCID: PMC11010386 DOI: 10.1186/s12889-024-18484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Students' physical fitness, particularly aerobic fitness, has seriously declined during the COVID-19 epidemic. However, in the post-epidemic era, there are few studies on the methods of improving aerobic fitness. Understanding the dose-response relationship between physical activity and aerobic fitness is crucial for developing effective exercise prescriptions. METHOD This retrospective study reviewed the Fun Running program at Wannan Medical College in China. We conducted a pre-post study design to analyze the impact of 15 weeks of Fun Running training on aerobic fitness. Middle and long-distance running pace (MLDR-P) was used as the primary indicator of aerobic fitness. A paired sample T-test was used to analyze the differences between the two MLDR-Ps. Pearson's correlation was used to examine the correlation between variables. Multiple linear regression was used to determine the extent to which Fun Running components explain the variance in MLDR-P. RESULTS A total of 3244 college students participated in this study. 15 weeks of Fun Running training can significantly improve the MLDR-P in both females (P < 0.001, ES = 0.68) and males (P < 0.001, ES = 0.72). The MLDR-P was significantly correlated with Fun Running (R2 = 0.95, p < 0.05, for females; R2 = 0.96, p < 0.05, for males). The component that had the greatest impact on MLDR-P was pace (β = 1.39, for females; β = 1.09, for males), followed by distance (β = 0.49, for females; β = 0.15, for males), and last frequency (β = -0.03, for all). CONCLUSION This study fills the gap in research on the dose-response relationship between running and aerobic fitness among college students in the post-epidemic era. The results show that 15 weeks of Fun Running training can significantly improve aerobic fitness. Examination of the dose-response relationship between Fun Running and MLDR-P provides practitioners with valuable insights into prescribing aerobic fitness training, allowing them to develop more effective training programs. Future research should focus on how to implement a hierarchical Fun Running program effectively.
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Affiliation(s)
- Zhixuan Tao
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China
| | - Xugui Sun
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China
| | - Jun Sun
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China.
| | - Ergang Zhu
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China.
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Zhang B, Zheng C, Hu M, Fang Y, Shi Y, Tse ACY, Lo SK, Wong SHS, Sun F. The effect of different high-intensity interval training protocols on cardiometabolic and inflammatory markers in sedentary young women: A randomized controlled trial. J Sports Sci 2024; 42:751-762. [PMID: 38864405 DOI: 10.1080/02640414.2024.2363708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
Few studies have reported the cardiovascular health effects of different high-intensity interval training (HIIT) protocols among sedentary young women. We investigated the impact of a traditional HIIT programme and a high-intensity circuit training (HICT) programme on lipid profiles and inflammatory cytokine levels in sedentary young women. Forty-two women were randomly assigned to HICT (body weight-based training), HIIT (cycling-based training), or control groups (n = 14 each). HICT and HIIT participants completed an 8-week training programme of three sessions per week. Total cholesterol (TC), triglyceride, high- and low-density lipoprotein, leptin, resistin, tumour necrosis factor-alpha (TNF-α), interleukin-8, and interferon-gamma levels were measured before and after the intervention. Post-intervention, TC and leptin were decreased in the HICT group. The HICT group also demonstrated increased lean mass, upper and lower limb strength, and balance, while the HIIT group displayed improved lower limb strength. Additionally, the control group showed significant increases in triglyceride levels, weight, body mass index, and fat mass. In conclusion, although both HICT and HIIT interventions showed improvements in cardiovascular health and physical fitness, participants in the HICT group experienced more health benefits.
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Affiliation(s)
- Borui Zhang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Chen Zheng
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Ming Hu
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Yan Shi
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Andy Choi-Yeung Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Sing-Kai Lo
- Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Hong Kong, China
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Fenghua Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
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6
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Zatloukal J, Zylla S, Markus MRP, Ewert R, Gläser S, Völzke H, Albrecht D, Friedrich N, Nauck M, Peterson LR, Jiang X, Schaffer JE, Felix SB, Dörr M, Bahls M, Gross S. The Association Between C24:0/C16:0 Ceramide Ratio and Cardiorespiratory Fitness is Robust to Effect Modifications by Age and Sex. Adv Biol (Weinh) 2024; 8:e2300633. [PMID: 38342586 PMCID: PMC11149399 DOI: 10.1002/adbi.202300633] [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: 11/20/2023] [Indexed: 02/13/2024]
Abstract
Ceramides and cardiorespiratory (CR) fitness are both related to cardiovascular diseases. The associations of three blood plasma ceramides (C16:0, C22:0, and C24:0) with CR fitness in the population-based Study of Health in Pomerania (SHIP-START-1; n = 1,102; mean age 50.3 years, 51.5% women) are investigated. In addition, subgroup analysis according to age (≥54 years) and sex (female/male) is performed. Ceramides are quantified by liquid chromatography/mass spectrometry (LC/MS). CR fitness is assessed by a cardiopulmonary exercise test. Sex and age independent associations are found for higher levels of C24:0 and C24:0/C16:0 ratio with higher maximal oxygen consumption (VO2peak) kg-1 and oxygen consumption at the anaerobic threshold (VO2@AT1) as well as for the relation of C24:0/C16:0 with maximum workload (Wattmax kg-1). In contrast, age/sex subgroup specific inverse associations with Wattmax kg-1 are found in women <54 years for C22:0, while a positive association in men ≥54 years. Higher levels of C24:0 are associated with higher Wattmax kg-1, except for women <54 years, where no significant association can be found. The findings suggest that the use of single ceramides as cardiovascular biomarkers may be inferior, compared to ceramide ratio C24:0/C16:0. Therefore C24:0/C16:0 ratio may be a more suitable and robust cardiovascular biomarker and should be preferred over single ceramides.
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Affiliation(s)
- Jule Zatloukal
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
| | - Stephanie Zylla
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Marcello R P Markus
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
| | - Ralf Ewert
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Sven Gläser
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- Clinic for Internal Medicine, Vivantes Klinikum Spandau/Neukölln, 12351, Berlin, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
- Institute of Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Diana Albrecht
- Institute of Community Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
- Leibniz Institute for Plasma Science and Technology, 17489, Greifswald, Germany
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Matthias Nauck
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Linda R Peterson
- Division of Cardiology, Department of Medicine, Washington University, St Louis, MO, 63110, USA
| | - Xuntian Jiang
- Division of Cardiology, Department of Medicine, Washington University, St Louis, MO, 63110, USA
| | - Jean E Schaffer
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Stephan B Felix
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
| | - Marcus Dörr
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
| | - Martin Bahls
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
| | - Stefan Gross
- Dept. of Internal Medicine B, University Medicine Greifswald, 17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), 17475, Partner-site Greifswald, Germany
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Harber MP, Myers J, Bonikowske AR, Muntaner-Mas A, Molina-Garcia P, Arena R, Ortega FB. Assessing cardiorespiratory fitness in clinical and community settings: Lessons and advancements in the 100th year anniversary of VO 2max. Prog Cardiovasc Dis 2024; 83:36-42. [PMID: 38417771 DOI: 10.1016/j.pcad.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Cardiorespiratory fitness (CRF) is a well-established biomarker that has applications to all adults across the health and disease spectrum. Despite overwhelming evidence supporting the prognostic utility of CRF, it remains vastly underutilized. CRF is optimally measured via cardiopulmonary exercise testing which may not be feasible to implement on a large scale. Therefore, it is prudent to develop ways to accurately estimate CRF that can be applied in clinical and community settings. As such, several prediction equations incorporating non-exercise information that is readily available from routine clinical encounters have been developed that provide an adequate reflection of CRF that could be implemented to raise awareness of the importance of CRF. Further, technological advances in smartphone apps and consumer-grade wearables have demonstrated promise to provide reasonable estimates of CRF that are widely available, which could enhance the utilization of CRF in both clinical and community settings.
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Affiliation(s)
- Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | | | - Adria Muntaner-Mas
- GICAFE "Physical Activity and Exercise Sciences Research Group", Faculty of Education, University of Balearic Islands, 07122 Palma, Spain
| | | | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America
| | - Francisco B Ortega
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
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Kaminsky LA, Myers J, Brubaker PH, Franklin BA, Bonikowske AR, German C, Arena R. 2023 update: The importance of cardiorespiratory fitness in the United States. Prog Cardiovasc Dis 2024; 83:3-9. [PMID: 38360462 DOI: 10.1016/j.pcad.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
The American Heart Association issued a Policy Statement in 2013 that characterized the importance of cardiorespiratory fitness (CRF) as an essential marker of health outcomes and specifically the need for increased assessment of CRF. This statement summarized the evidence demonstrating that CRF is "one of the most important correlates of overall health status and a potent predictor of an individual's future risk of cardiovascular disease." Subsequently, this Policy Statement led to the development of a National Registry for CRF (Fitness Registry and the Importance of Exercise: A National Data Base [FRIEND]) which established normative reference values for CRF for adults in the United States (US). This review provides an overview of the progress made in the past decade to further our understanding of the importance of CRF, specifically related to prevention and for clinical populations. Additionally, this review overviews the evolvement and additional uses of FRIEND and summarizes a hierarchy of assessment methods for CRF. In summary, continued efforts are needed to expand the representation of data from across the US, and to include data from pediatric populations, to further develop the CRF Reference Standards for the US as well as further develop Global CRF Reference Standards.
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Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, United States of America; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, United States of America
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, United States of America
| | - Barry A Franklin
- Corewell Health East, William Beaumont University Hospital, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, Royal Oak, MI, United States of America
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
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9
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Carrick L, Doleman B, Wall J, Gates A, Lund JN, Williams JP, Phillips BE. Exploring the utility of bedside tests for predicting cardiorespiratory fitness in older adults. Aging Med (Milton) 2024; 7:60-66. [PMID: 38571675 PMCID: PMC10985776 DOI: 10.1002/agm2.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 04/05/2024] Open
Abstract
Objectives Cardiorespiratory fitness (CRF) declines with advancing and has also, independent of age, been shown to be predictive of all-cause mortality, morbidity, and poor clinical outcomes. In relation to the older patient, there is a particular wealth of evidence highlighting the relationship between low CRF and poor surgical outcomes. Cardiopulmonary exercise testing (CPET) is accepted as the gold-standard measure of CRF. However, this form of assessment has significant personnel and equipment demands and is not feasible for those with certain age-associated physical limitations, including joint and cardiovascular comorbidities. As such, alternative ways to assess the CRF of older patients are very much needed. Methods Sixty-four participants (45% female) with a median age of 74 (65-90) years were recruited to this study via community-based advertisements. All participants completed three tests of physical function: (1) a step-box test; (2) handgrip strength dynamometry; and (3) a CPET on a cycle ergometer; and also had their muscle architecture (vastus lateralis) assessed by B-mode ultrasonography to provide measures of muscle thickness, pennation angle, and fascicle length. Multivariate linear regression was then used to ascertain bedside predictors of CPET parameters from the alternative measures of physical function and demographic (age, gender, body mass index (BMI)) data. Results There was no significant association between ultrasound-assessed parameters of muscle architecture and measures of CRF. VO2peak was predicted to some extent from fast step time during the step-box test, gender, and BMI, leading to a model that achieved an R 2 of 0.40 (p < 0.001). Further, in aiming to develop a model with minimal assessment demands (i.e., using handgrip dynamometry rather than the step-box test), replacing fast step time with non-dominant HGS led to a model which achieved an R 2 of 0.36 (p < 0.001). Non-dominant handgrip strength combined with the step-box test parameter of fast step time and BMI delivered the most predictive model for VO2peak with an R 2 of 0.45 (p < 0.001). Conclusions Our findings show that simple-to-ascertain patient characteristics and bedside assessments of physical function are able to predict CPET-derived CRF. Combined with gender and BMI, both handgrip strength and fast step time during a step-box test were predictive for VO2peak. Future work should apply this model to a clinical population to determine its utility in this setting and to explore if simple bedside tests are predictive of important clinical outcomes in older adults (i.e., post-surgical complications).
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Affiliation(s)
- Laura Carrick
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - Brett Doleman
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - Joshua Wall
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - Amanda Gates
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
| | - Jon N. Lund
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - John P. Williams
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
- Department of Surgery and AnaestheticsRoyal Derby HospitalDerbyUK
| | - Bethan E. Phillips
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC‐Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and Nottingham NIHR Biomedical Research Centre, School of MedicineUniversity of NottinghamDerbyUK
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H Fosstveit S, Lohne-Seiler H, Feron J, Lucas SJE, Ivarsson A, Berntsen S. The intensity paradox: A systematic review and meta-analysis of its impact on the cardiorespiratory fitness of older adults. Scand J Med Sci Sports 2024; 34:e14573. [PMID: 38389140 DOI: 10.1111/sms.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
AIM The present systematic review and meta-analysis aimed to compare the effect of moderate- versus high-intensity aerobic exercise on cardiorespiratory fitness (CRF) in older adults, taking into account the volume of exercise completed. METHODS The databases MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Cochrane Library) were searched to identify randomized controlled trials (RCTs). Two reviewers extracted data and assessed bias. Comprehensive Meta-Analysis software calculated overall effect size, intensity differences, and performed meta-regression analyses using pre-to-post intervention or change scores of peak oxygen uptake (V̇O2 peak). The review included 23 RCTs with 1332 older adults (intervention group: n = 932; control group: n = 400), divided into moderate-intensity (435 older adults) and high-intensity (476 older adults) groups. RESULTS Meta-regression analysis showed a moderate, but not significant, relationship between exercise intensity and improvements in V̇O2 peak after accounting for the completed exercise volume (β = 0.31, 95% CI = [-0.04; 0.67]). Additionally, studies comparing moderate- versus high-intensity revealed a small, but not significant, effect in favor of high-intensity (Hedges' g = 0.20, 95% CI = [-0.02; 0.41]). Finally, no significant differences in V̇O2 peak improvements were found across exercise groups employing various methods, modalities, and intensity monitoring strategies. CONCLUSION Findings challenge the notion that high-intensity exercise is inherently superior and indicate that regular aerobic exercise, irrespective of the specific approach and intensity, provides the primary benefits to CRF in older adults. Future RCTs should prioritize valid and reliable methodologies for monitoring and reporting exercise volume and adherence among older adults.
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Affiliation(s)
- Sindre H Fosstveit
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Hilde Lohne-Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Jack Feron
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Andreas Ivarsson
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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11
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Zaman S, Raj IS, Yang AWH, Lindner R, Denham J. Exercise training reduces arterial stiffness in women with high blood pressure: a systematic review and meta-analysis. J Hypertens 2024; 42:197-204. [PMID: 37851002 DOI: 10.1097/hjh.0000000000003594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The acute and long-term benefits of exercise on cardiovascular health are well established, yet the optimal mode of exercise training that improves arterial stiffness in women with high blood pressure remains unclear. The aim of this systematic review and meta-analysis was to assess the influence of aerobic and resistance training on arterial stiffness in women with high blood pressure. After an extensive search of four online databases, six randomized controlled trials met the inclusion criteria and were included in meta-analyses. Data were extracted from six studies examining the influence of exercise on arterial stiffness assessed by pulse wave velocity (PWV) and were expressed as standardized mean difference (SMD). Whereas aerobic exercise significantly reduced arterial PWV in women with high blood pressure after long-term training [SMD -1.87, 95% confidence interval (CI) -2.34 to -1.40], resistance training had a more modest effect that was borderline statistically significant (SMD -0.31, 95% CI -0.65 to 0.03). These findings suggest regular long-term aerobic exercise training (i.e. 12-20 week interventions) reduces arterial stiffness in women with high blood pressure. Although not statistically significant, the modest number of included trials and lack of publication bias encourages further assessments on the efficacy of resistance exercise for improving arterial stiffness in women with high blood pressure. Given the unique benefits of aerobic and resistance training, particularly for postmenopausal women (e.g. bone health and muscular strength), both modes of training should be encouraged for women with high blood pressure to enhance arterial function and support favorable cardiovascular outcomes.
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Affiliation(s)
- Shadman Zaman
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Victoria
| | - Isaac Selva Raj
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Victoria
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Western Australia
| | | | - Robert Lindner
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Victoria
| | - Joshua Denham
- RMIT University, School of Health and Biomedical Sciences, Melbourne, Victoria
- University of Southern Queensland, School of Health and Medical Sciences
- Centre for Health Research, Toowoomba, Queensland, Australia
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12
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Røysland IØ, Ueland VI, Larsen AI. Reassured on a background of vulnerability - people with microvascular angina 12 months after high-intensity physical exercise program. Int J Qual Stud Health Well-being 2023; 18:2162452. [PMID: 36578152 PMCID: PMC9809340 DOI: 10.1080/17482631.2022.2162452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Physical activity is recommended for patients with coronary microvascular dysfunction, however, avoided due to fear about the heart. The aim is to achieve an understanding of the meaning of physical activity one year after participating in a high-intensity exercise training program. METHOD Twelve people were interviewed using a phenomenological hermeneutic approach. RESULTS Four themes were formulated and revealed that one year after participating in high-intensity exercise training participants had an awareness of the meaning of the project, their chest pain and daily life: Being reassured, Daily life's impact on chest pain and continuing doing high-intensity exercise training, A strengthened body and mind, Being part of a group of people with similar problems.Comprehensive understanding was formulated as "Being reassured according being physically active in a background of vulnerability". CONCLUSION This study indicates that by going through the high-intensity exercise training program the person regains more unity with the lived body and an unfolding life. A person-centred approach is suggested including an underlying dimension of vulnerability. A lifeworld led care means meeting the patient in their way of relating to the world bodily and existentially. Taking this understanding into consideration will advance the requirements for establishing person-centred care.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway,CONTACT Ingrid Ølfarnes Røysland Department of Health Studies, Faculty of Health Sciences, University of Stavanger, StavangerN-4036, Norway
| | - Venke Irene Ueland
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Britton RC, Beamish NF. The Impact of Testosterone Therapy on Cardiovascular Risk Among Postmenopausal Women. J Endocr Soc 2023; 8:bvad132. [PMID: 38178905 PMCID: PMC10765381 DOI: 10.1210/jendso/bvad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 01/06/2024] Open
Abstract
Purpose To summarize the current state of knowledge surrounding the impact of testosterone therapy on cardiovascular risk factors in postmenopausal women. Methodology In this scoping review, a comprehensive search of peer-reviewed literature was conducted in adherence to a methodological framework comprising 4 distinct stages: conceptualizing a comprehensive search strategy, screening relevant publications, extracting pertinent data, and organizing and synthesizing the resultant findings. The search used electronic databases, including MEDLINE, Embase, and Google Scholar, to ensure an exhaustive survey of the available literature. Results The database search yielded 150 articles, including systematic reviews, registered trials, and peer-reviewed studies, of which 48 duplicates were removed. Following the title/abstract screening, 36 publications were included in the full-text review. On completion of the full-text review, using the inclusion/exclusion criteria, 29 articles were excluded and 7 remained for data extraction and qualitative synthesis. Main Conclusion Existing research provides promising insights into the benefits of low-dose testosterone therapy, typically combined with estrogen therapy. These benefits may include positive impacts on body composition, functional capacity, insulin sensitivity, inflammatory markers, and cholesterol. However, there remains a substantial lack of knowledge surrounding the effects and mechanisms behind testosterone therapy in postmenopausal women in relation to its impacts on cardiovascular risk. High-quality, evidence-based clinical intervention research is needed to investigate testosterone therapy's potential implication on cardiovascular risk factors in post-menopausal women.
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Affiliation(s)
- Rhys C Britton
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Nicole F Beamish
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario K7L 3N6, Canada
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14
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Salmons H, Ahmed SI, Billingsley HE, Markley R, Damonte JI, Del Buono MG, Kirkman DL, Bohmke NJ, Franco RL, Garten R, Makkiya M, Abbate A, Carbone S. Skeletal muscle quality, measured via phase angle, and cardiorespiratory fitness in patients with obesity and heart failure with preserved ejection fraction. Nutrition 2023; 116:112163. [PMID: 37562184 PMCID: PMC10792099 DOI: 10.1016/j.nut.2023.112163] [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: 05/15/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Cardiorespiratory fitness (CRF) is influenced by body composition quantity and quality in heart failure with preserved ejection fraction (HFpEF) and obesity. Bioelectrical impedance analysis (BIA) provides a noninvasive quantitative and qualitative body composition assessment. The aim of this study was to determine the role of phase angle (PhA), a BIA-measure of skeletal muscle quality and body cell mass, on CRF in patients with obesity and HFpEF. METHODS Fifty-nine consecutive outpatients with HFpEF underwent cardiopulmonary exercise testing to measure CRF. Single-frequency segmental BIA was used to measure PhA and body composition quantity. Resting Doppler echocardiography and biomarkers were measured to assess cardiac function and systemic inflammation. RESULTS Compared with patients with lower PhA, patients with higher PhA (above mean 5.8°) presented a greater absolute peak oxygen consumption (VO2; 1.83 [1.3-2.1] versus 1.39 [1.1-1.6] L/min, P = 0.003), VO2 peak adjusted for body weight (17.5 [12.3-18.1] versus 13.3 [12.7-15.2] mL/kg/min, P = 0.040), and a lower edema index (48.7 [2.9] versus 51.4% [2.7], P < 0.001) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; 64 [50-121] versus 183 [68-343.5] pg/dL, P < 0.001). In the overall sample, PhA was correlated with absolute VO2 peak (r = 0.468, P < 0.001), VO2 peak adjusted for body weight (r = 0.368, P = 0.004), VO2 peak adjusted for fat-free mass (r = 0.315, P = 0.015), edema index (r = -0.508, P < 0.001), and NT-proBNP (r = -0.579, P < 0.001). PhA remained a significant predictor for CRF even after adjustment for potential confounders and HFpEF severity. CONCLUSION In patients with obesity and HFpEF, a greater PhA is an independent predictor for favorable CRF.
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Affiliation(s)
- Hannah Salmons
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Syed Imran Ahmed
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hayley E Billingsley
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roshanak Markley
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Juan Ignacio Damonte
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA; Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marco Giuseppe Del Buono
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Danielle L Kirkman
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Natalie J Bohmke
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robert L Franco
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ryan Garten
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mohammed Makkiya
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA; Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
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15
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Liu Y, Zhu J, Guo Z, Yu J, Zhang X, Ge H, Zhu Y. Estimated cardiorespiratory fitness and incident risk of cardiovascular disease in China. BMC Public Health 2023; 23:2338. [PMID: 38001416 PMCID: PMC10675970 DOI: 10.1186/s12889-023-16864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/29/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Limited evidence is available on the association between estimated cardiorespiratory fitness (e-CRF) and incidence of cardiovascular disease (CVD) in Chinese population. METHODS A total of 10,507 adults including 5084 men (48.4%) and 5423 (51.6%) women with a median age of 56.0 (25% quantile: 49, 75% quantile 63) years from the China Health and Retirement Longitudinal Study (CHARLS) was recruited in 2011 as baseline. The CVD incident events were followed-up until 2018. e-CRF was calculated from sex-specific longitudinal non-exercise equations and further grouped into quartiles. Cox proportional models were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for incidence risks of CVD, heart disease and stroke. RESULTS During a median follow-up of 7 years, a total of 1862 CVD, 1409 heart disease and 612 stroke events occurred. In fully adjusted models, each one MET increment of e-CRF was associated with lower risk of CVD (HR = 0.91, 95%CI = 0.85-0.96 for males, HR = 0.87, 95%CI = 0.81-0.94 for females). Compared with the Quartile (Q)1 group, the HRs (95%CI) of the Q2, Q3 and Q4 groups were 0.84 (0.63-1.03), 0.72 (0.57-0.91) and 0.66 (0.51-0.87) for CVD in males. Females had HRs of 0.79 (0.66-0.96) in Q2, 0.71 (0.57-0.88) in Q3 and 0.58 (0.45-0.75) in Q4 for CVD. The associations between e-CRF and heart disease and stroke were slightly weaker than that for CVD in both males and females. CONCLUSIONS Higher e-CRF decreases the incident risk of CVD, heart disease and stroke.
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Affiliation(s)
- Yuanjiao Liu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinghan Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Ziye Guo
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiazhou Yu
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Xuhui Zhang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China.
| | - Huiqing Ge
- Department of Respiratory Care of Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Cancer Center, Zhejiang University, Zhejiang, China.
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16
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Navarro-Lomas G, Plaza-Florido A, De-la-O A, Castillo MJ, Amaro-Gahete FJ. Fit-Fat Index is better associated with heart rate variability compared to fitness and fatness alone as indicators of cardiometabolic human health. Am J Hum Biol 2023; 35:e23945. [PMID: 37337972 DOI: 10.1002/ajhb.23945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES Cardiorespiratory fitness and fatness indicators have been related to heart rate variability (HRV) parameters. The Fit-Fat Index (FFI) is a single index combining cardiorespiratory fitness and fatness indicators. To the best of our knowledge, no studies have previously analyzed whether FFI are related to cardiac autonomic nervous system activity assessed through HRV parameters. This study aimed (i) to examine the association of cardiorespiratory fitness, fatness indicators, and FFI with HRV parameters; and (ii) to report what of the different fatness indicators included in FFI is better associated with HRV parameters in sedentary adults. METHODS One hundred and fifty healthy adults (74 women; 76 men), aged between 18 and 65 years old, participated in this cross-sectional study. We measured cardiorespiratory fitness (maximal oxygen consumption) and fatness indicators (waist-to-height ratio [WHR], fat mass percentage [FM%] and visceral adipose tissue [VAT]). Three FFIs were calculated as the quotient between cardiorespiratory fitness and one out of three possible fatness indicators: Fit-Fat Index calculated waist-to-height ratio (FFIWHR ), Fit-Fat Index calculated with FM% (FFIFM% ), and Fit-Fat Index calculated with VAT (FFIVAT ). HRV parameters were measured in resting conditions using a Polar RS800CX. RESULTS FFIWTHR , FFIFM% and FFIVAT were related to different HRV parameters (β ranges between -0.507 and 0.529; R2 ranges between 0.096 and 0.275; all p < .001) and the association was stronger with HRV parameters than the isolated fitness or fatness indicators (β ranges between -0.483 and 0.518; R2 ranges between 0.071 and 0.263; all p < .001). FFIVAT was the index more consistently associated with HRV parameters (β ranges between -0.507 and 0.529; R2 ranges between 0.235 and 0.275; all p < .001). CONCLUSION Our study suggests that compound FFIs are better predictors of HRV parameters than either cardiorespiratory fitness or fatness indicators alone. The FFIVAT was the best index in terms of its association to HRV.
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Affiliation(s)
- Ginés Navarro-Lomas
- EFFECTS-262 Research Group, Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Abel Plaza-Florido
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California at Irvine, Irvine, California, USA
| | - Alejandro De-la-O
- EFFECTS-262 Research Group, Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Manuel J Castillo
- EFFECTS-262 Research Group, Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Francisco J Amaro-Gahete
- EFFECTS-262 Research Group, Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain
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Haidar A, Horwich T. Obesity, Cardiorespiratory Fitness, and Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1565-1571. [PMID: 37831388 PMCID: PMC10682063 DOI: 10.1007/s11886-023-01975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE OF REVIEW Obesity, generally defined by body mass index (BMI), is an established risk factor for the development of cardiovascular disease (CVD), while cardiorespiratory fitness (CRF) decreases risk. In chronic CVD, an obesity survival paradox in which higher BMI is associated with improved prognosis has been reported. This paper will examine the effect of obesity on CVD risk, explore obesity as a risk factor in patients with established CVD, and investigate the relationship between CRF, obesity, and CVD. RECENT FINDINGS Through metabolic and hemodynamic changes, obesity increases the risk for CVD and contributes to the development of other cardiovascular risk factors such as diabetes, dyslipidemia, and hypertension. Obesity is associated with metabolic, hormonal, and inflammatory changes that leads to atherosclerosis increasing the risk for coronary artery disease, and myocardial remodeling increasing the risk for heart failure. However, it has also been observed that overweight/obese patients with established CVD have a better prognosis when compared to non-obese individuals termed the obesity paradox. CRF is a vital component of health associated with improved cardiovascular outcomes and furthermore has been shown to markedly attenuate or nullify the relationship between obesity and CVD risk/prognosis. Increasing CRF mitigates CVD risk factors and improves overall prognosis in CVD regardless of obesity status.
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Affiliation(s)
- Amier Haidar
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Tamara Horwich
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Ittermann T, Ewert R, Habedank D, Kaczmarek S, Felix SB, Dörr M, Stubbe B, Bahls M. Proportional Internal Work-a New Parameter of Exercise Testing in Study of Health in Pomerania (SHIP). J Cardiopulm Rehabil Prev 2023; 43:460-466. [PMID: 37184451 DOI: 10.1097/hcr.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Cardiopulmonary exercise testing usually requires a maximal exhaustive effort by the patient and is time consuming. The purpose of this study was to assess whether the cost to initiate exercise termed "proportional internal work" (PIW) was related to cardiovascular disease (CVD) risk factors, ventilatory parameters, and mortality. METHODS We used data from population-based Study of Health in Pomerania. A total of 2829 (49.5% female) study participants with a median age of 52 (42-62) yr were included. Standardized questionnaires were used to assess CV risk factors. The cardiopulmonary exercise testing was performed using a modified Jones protocol. Regression models adjusted for sex and age were used to relate PIW with CVD risk factors and ventilatory parameters. The PIW was calculated by the following formula: (Oxygen uptake at rest - Oxygen uptake without load)/V˙ o2peak ) × 100. Cox regression analysis was used to relate PIW and all-cause mortality. RESULTS We identified a nonlinear association between PIW and percent predicted V˙ o2peak . Women had a 2.96 (95% CI, 2.61-3.32) greater PIW than men. With each year of age and every point in body mass index, the PWI increased by 0.04 (95% CI, 0.03-0.05) and 0.16 (95% CI, 0.12-0.20), respectively. After adjustment for age, sex, smoking, and body mass index, a 1-point greater PIW was associated with a 5% higher risk to die (HR = 1.05; 95% CI, 1.01-1.07). CONCLUSIONS The PIW is a new cardiopulmonary exercise testing parameter related to CVD risk and all-cause mortality. Future studies should assess the prognostic relevance of PIW for CVD prevention.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine (Dr Ittermann) and Department of Internal Medicine B (Drs Ewert, Habedank, Kaczmarek, Felix, Dörr, Stubbe, and Bahls), University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany (Drs Ittermann, Kaczmarek, Felix, Dörr, and Bahls); and Department of Internal Medicine, DRK Krankenhaus Berlin, Berlin, Germany (Dr Habedank)
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Vähä-Ypyä H, Husu P, Sievänen H, Vasankari T. What Can One Minute of the Day Tell about Physical Activity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6852. [PMID: 37835123 PMCID: PMC10572772 DOI: 10.3390/ijerph20196852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
High cardiorespiratory fitness (CRF) allows individuals to perform daily activities and operate at a higher intensity level. This study investigates the connection between the CRF and peak intensity of physical activity (PA) in absolute and relative terms. A total of 3587 participants (1447 men, 51.9 ± 13.0 years; 2140 women, 50.0 ± 13.0 years) provided substantial accelerometer wear time, and their CRF was estimated via the 6 min walking test. Participants were divided into CRF thirds by age group and sex. Daily one-minute peak intensities were captured in both absolute terms and relative to individual CRF levels. In absolute terms, the highest CRF third had the highest intensity value for men (6.4 ± 1.7 MET; 5.9 ± 1.4 MET; 5.3 ± 1.0 MET) and for women (6.4 ± 1.6 MET; 5.9 ± 1.3 MET; 5.4 ± 1.1 MET). In relative terms, the highest CRF third utilized the least aerobic capacity for men (49 ± 14%; 51 ± 13%; 56 ± 14%) and for women (52 ± 13%; 54 ± 12%; 62 ± 15%). One minute of daily activity offers valuable insights into an individual's CRF and the effort demanded during PA. Fitter individuals can sustain higher PA intensity levels in absolute terms, whereas individuals with lower CRF utilize a greater fraction of their aerobic capacity. Consequently, heightened CRF not only allows for enhanced intensity levels but also safeguards against strenuous PA during daily routines.
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Affiliation(s)
- Henri Vähä-Ypyä
- UKK-Institute, 33500 Tampere, Finland; (P.H.); (H.S.); (T.V.)
| | - Pauliina Husu
- UKK-Institute, 33500 Tampere, Finland; (P.H.); (H.S.); (T.V.)
| | - Harri Sievänen
- UKK-Institute, 33500 Tampere, Finland; (P.H.); (H.S.); (T.V.)
| | - Tommi Vasankari
- UKK-Institute, 33500 Tampere, Finland; (P.H.); (H.S.); (T.V.)
- Faculty of Medicine and Health Technology, Tampere University, 33014 Tampere, Finland
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Zadarko-Domaradzka M, Sobolewski M, Zadarko E. Comparison of Several Anthropometric Indices Related to Body Fat in Predicting Cardiorespiratory Fitness in School-Aged Children-A Single-Center Cross-Sectional Study. J Clin Med 2023; 12:6226. [PMID: 37834868 PMCID: PMC10573168 DOI: 10.3390/jcm12196226] [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: 09/05/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Body fat (BF) and cardiorespiratory fitness (CRF) are important health markers that ought to be considered in screening exams. The aim of this study was to assess the value of six indicators, i.e., tri-ponderal mass index (TMI), relative fat mass (RFM), waist-BMI ratio, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and body mass index (BMI) in predicting CRF in school-aged children. The analysis was based on the data coming from the examination of 190 children participating in school physical education (PE) classes. Their body weight (BW) and height (BH), waist and hip circumference (WC; HC) and percentage of body fat (%BF) were measured; the CRF test was performed with the use of the 20 m shuttle run test (20 mSRT); peak heart rate (HRpeak) was measured; TMI, relative fat mass pediatric (RFMp), waist-BMI ratio, WHtR, BMI and WHR were calculated. Statistical analysis was mainly conducted using regression models. The developed regression models, with respect to the sex and age of the children, revealed RFMp as the strongest CRF indicator (R2 = 51.1%) and WHR as well as waist-BMI ratio as the weakest ones (R2 = 39.2% and R2 = 40.5%, respectively). In predicting CRF in school-aged children, RFMp turned out to be comparable to body fat percentage obtained by means of the bioimpedance analysis (BIA) (R2 = 50.3%), and as such it can be used as a simple screening measure in prophylactic exams of school children. All of these models were statistically significant (p < 0.001).
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Affiliation(s)
- Maria Zadarko-Domaradzka
- Institute of Physical Culture Sciences, College of Medical Sciences, Rzeszow University, 35-959 Rzeszow, Poland;
| | - Marek Sobolewski
- Department of Quantitative Methods Rzeszow, University of Technology, 35-959 Rzeszow, Poland;
| | - Emilian Zadarko
- Institute of Physical Culture Sciences, College of Medical Sciences, Rzeszow University, 35-959 Rzeszow, Poland;
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21
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Røysland IØ. Moving from one state to another among patients experiencing unexplained chest pain during physical activity: A secondary qualitative analysis by Meleis transition theory. Scand J Caring Sci 2023; 37:851-861. [PMID: 36808758 DOI: 10.1111/scs.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Unexplained chest pain is a common condition in medical settings. Nurses usually coordinate the rehabilitation of patients. Physical activity is recommended; however, it is one of the major avoidance behaviours in patients with coronary heart disease. There is a need for a deeper understanding of the transition that patients with unexplained chest pain undergo during physical activity. AIM To develop deeper understanding about experiences of transition in patients with unexplained chest pain during physical activity. DESIGN Secondary qualitative analysis of data from three exploratory studies. METHOD Meleis et al.'s transition theory was used as a framework for the secondary analysis. FINDINGS The transition was complex and multidimensional. The participants experienced personal processes of change toward health within the illness, corresponding to indicators of healthy transitions. CONCLUSION The process can be identified as a transition from an uncertain and often sick role to a healthy role. Knowledge regarding transition promotes a person-centred approach in which patients' perspectives are included. Nurses and other health professionals can better direct and plan the caring and rehabilitation of patients with unexplained chest pain by deepening their knowledge of the transition process based on physical activity.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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22
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da Silva VL, Mota GAF, de Souza SLB, de Campos DHS, Melo AB, Vileigas DF, Coelho PM, Sant’Ana PG, Padovani C, Lima-Leopoldo AP, Bazan SGZ, Leopoldo AS, Cicogna AC. Aerobic Exercise Training Improves Calcium Handling and Cardiac Function in Rats with Heart Failure Resulting from Aortic Stenosis. Int J Mol Sci 2023; 24:12306. [PMID: 37569680 PMCID: PMC10418739 DOI: 10.3390/ijms241512306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Aerobic exercise training (AET) has been used to manage heart disease. AET may totally or partially restore the activity and/or expression of proteins that regulate calcium (Ca2+) handling, optimize intracellular Ca2+ flow, and attenuate cardiac functional impairment in failing hearts. However, the literature presents conflicting data regarding the effects of AET on Ca2+ transit and cardiac function in rats with heart failure resulting from aortic stenosis (AoS). This study aimed to evaluate the impact of AET on Ca2+ handling and cardiac function in rats with heart failure due to AoS. Wistar rats were distributed into two groups: control (Sham; n = 61) and aortic stenosis (AoS; n = 44). After 18 weeks, the groups were redistributed into: non-exposed to exercise training (Sham, n = 28 and AoS, n = 22) and trained (Sham-ET, n = 33 and AoS-ET, n = 22) for 10 weeks. Treadmill exercise training was performed with a velocity equivalent to the lactate threshold. The cardiac function was analyzed by echocardiogram, isolated papillary muscles, and isolated cardiomyocytes. During assays of isolated papillary muscles and isolated cardiomyocytes, the Ca2+ concentrations were evaluated. The expression of regulatory proteins for diastolic Ca2+ was assessed via Western Blot. AET attenuated the diastolic dysfunction and improved the systolic function. AoS-ET animals presented an enhanced response to post-rest contraction and SERCA2a and L-type Ca2+ channel blockage compared to the AoS. Furthermore, AET was able to improve aspects of the mechanical function and the responsiveness of the myofilaments to the Ca2+ of the AoS-ET animals. AoS animals presented an alteration in the protein expression of SERCA2a and NCX, and AET restored SERCA2a and NCX levels near normal values. Therefore, AET increased SERCA2a activity and myofilament responsiveness to Ca2+ and improved the cellular Ca2+ influx mechanism, attenuating cardiac dysfunction at cellular, tissue, and chamber levels in animals with AoS and heart failure.
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Affiliation(s)
- Vítor Loureiro da Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Gustavo Augusto Ferreira Mota
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Sérgio Luiz Borges de Souza
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Dijon Henrique Salomé de Campos
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Alexandre Barroso Melo
- Department of Sports, Federal University of Espirito Santo, Vitória 29075-910, Brazil; alexandre-- (A.B.M.); (P.M.C.); (A.P.L.-L.); (A.S.L.)
| | - Danielle Fernandes Vileigas
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Priscila Murucci Coelho
- Department of Sports, Federal University of Espirito Santo, Vitória 29075-910, Brazil; alexandre-- (A.B.M.); (P.M.C.); (A.P.L.-L.); (A.S.L.)
| | - Paula Grippa Sant’Ana
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - Carlos Padovani
- Department of Biostatistics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu 18618-689, Brazil;
| | - Ana Paula Lima-Leopoldo
- Department of Sports, Federal University of Espirito Santo, Vitória 29075-910, Brazil; alexandre-- (A.B.M.); (P.M.C.); (A.P.L.-L.); (A.S.L.)
| | - Silméia Garcia Zanati Bazan
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
| | - André Soares Leopoldo
- Department of Sports, Federal University of Espirito Santo, Vitória 29075-910, Brazil; alexandre-- (A.B.M.); (P.M.C.); (A.P.L.-L.); (A.S.L.)
| | - Antonio Carlos Cicogna
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil; (G.A.F.M.); (S.L.B.d.S.); (D.H.S.d.C.); (D.F.V.); (P.G.S.); (S.G.Z.B.); (A.C.C.)
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McCarthy MM, Szerencsy A, Fletcher J, Taza-Rocano L, Weintraub H, Hopkins S, Applebaum R, Schwartzbard A, Mann D, D'Eramo Melkus G, Vorderstrasse A, Katz SD. The Impact of an Electronic Best Practice Advisory on Patients' Physical Activity and Cardiovascular Risk Profile. J Cardiovasc Nurs 2023:00005082-990000000-00107. [PMID: 37467192 PMCID: PMC10787798 DOI: 10.1097/jcn.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Regular physical activity (PA) is a component of cardiovascular health and is associated with a lower risk of cardiovascular disease (CVD). However, only about half of US adults achieved the current PA recommendations. OBJECTIVE The study purpose was to implement PA counseling using a clinical decision support tool in a preventive cardiology clinic and to assess changes in CVD risk factors in a sample of patients enrolled over 12 weeks of PA monitoring. METHODS This intervention, piloted for 1 year, had 3 components embedded in the electronic health record: assessment of patients' PA, an electronic prompt for providers to counsel patients reporting low PA, and patient monitoring using a Fitbit. Cardiovascular disease risk factors included PA (self-report and Fitbit), body mass index, blood pressure, lipids, and cardiorespiratory fitness assessed with the 6-minute walk test. Depression and quality of life were also assessed. Paired t tests assessed changes in CVD risk. RESULTS The sample who enrolled in the remote patient monitoring (n = 59) were primarily female (51%), White adults (76%) with a mean age of 61.13 ± 11.6 years. Self-reported PA significantly improved over 12 weeks (P = .005), but not Fitbit steps (P = .07). There was a significant improvement in cardiorespiratory fitness (469 ± 108 vs 494 ± 132 m, P = .0034), and 23 participants (42%) improved at least 25 m, signifying a clinically meaningful improvement. Only 4 participants were lost to follow-up over 12 weeks of monitoring. CONCLUSIONS Patients may need more frequent reminders to be active after an initial counseling session, perhaps getting automated messages based on their step counts syncing to their electronic health record.
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24
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Gaalema DE, Khadanga S, Pack QR. Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking. Expert Rev Cardiovasc Ther 2023; 21:733-745. [PMID: 37938825 DOI: 10.1080/14779072.2023.2282026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is highly effective at reducing morbidity and mortality. However, CR is underutilized, and adherence remains challenging. In no group is CR attendance more challenging than among patients who smoke. Despite being more likely to be referred to CR, they are less likely to enroll, and much more likely to drop out. CR programs generally do not optimally engage and treat those who smoke, but this population is critical to engage given the high-risk nature of continued smoking in those with cardiovascular disease. AREAS COVERED This review covers four areas relating to CR in those who smoke. First, we review the evidence of the association between smoking and lack of participation in CR. Second, we examine how smoking has historically been identified in this population and propose objective screening measures for all patients. Third, we discuss the optimal treatment of smoking within CR. Fourth, we review select populations within those who smoke (those with lower-socioeconomic status, females) that require additional research and attention. EXPERT OPINION Smoking poses a challenge on multiple fronts, being a significant predictor of future morbidity and mortality, as well as being strongly associated with not completing the secondary prevention program (CR) that could benefit those who smoke the most.
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Affiliation(s)
- Diann E Gaalema
- Department of Psychiatry, University of Vermont, Burlington, VT, United States of America
| | - Sherrie Khadanga
- Cardiac Rehabilitation and Prevention, University of Vermont Medical Center, South Burlington, VT, United States of America
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, United States of America
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25
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de Leeuw MJ, Oppewal A, Elbers RG, Hilgenkamp TIM, Bindels PJE, Maes-Festen DAM. Associations between physical fitness and cardiovascular disease in older adults with intellectual disabilities: Results of the Healthy Ageing and Intellectual Disability study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:547-559. [PMID: 36918714 DOI: 10.1111/jir.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/23/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Reduced physical fitness is a cardiovascular disease (CVD) risk factor in the general population. However, generalising these results to older adults with intellectual disabilities (ID) may be inappropriate given their pre-existing low physical fitness levels and high prevalence of co-morbidities. Therefore, the aim of this study is to investigate the difference in physical fitness between older adults with ID with and without CVD. METHOD Baseline data of a cohort of older adults with borderline to profound ID (HA-ID study) were used (n = 684; 61.6 ± 8.2 years; 51.3% male). CVD status (coronary artery disease, heart failure, stroke) was obtained from medical files. Cardiorespiratory fitness (10-m incremental shuttle walking test), comfortable and fast gait speed (over 5 m distance) and grip strength (hand dynamometer) were measured. Multivariable linear regression models were used to investigate the association between these physical fitness components and the presence of CVD, adjusted for participant characteristics. RESULTS Of the 684 participants 78 (11.4%) had CVD. Participants with CVD scored lower on cardiorespiratory fitness (-81.4 m, P = 0.002), comfortable gait speed (-0.3 km/h, P = 0.04) and fast gait speed (-1.1 km/h, P = 0.04). No significant differences were found for grip strength (-0.2 kg, P = 0.89). CONCLUSIONS Older adults with CVD had significantly lower physical fitness levels than those without CVD, except for grip strength. Longitudinal research is needed to investigate causality.
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Affiliation(s)
- M J de Leeuw
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - A Oppewal
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - R G Elbers
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - T I M Hilgenkamp
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - P J E Bindels
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - D A M Maes-Festen
- Department of General Practice, Intellectual Disability Medicine - Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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26
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Berlanga LA, Matos-Duarte M, Abdalla P, Alves E, Mota J, Bohn L. Validity of the two-minute step test for healthy older adults. Geriatr Nurs 2023; 51:415-421. [PMID: 37146558 DOI: 10.1016/j.gerinurse.2023.04.009] [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: 02/09/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND In healthy older adults, the two-minute step test (2MST) does not have its concurrent validity tested against the six-minute walk test (6MWT), which is a valid cardiorespiratory fitness test frequently applied in geriatric samples. OBJECTIVE To derive an equation to predict 6MWT from 2MST and to observe the agreement between observed and estimated 6MWT distances. METHODS 6MWT and 2MST were measured in 51 older adults (72.9±4.6 years) from community multicomponent exercise programs. Multiple linear regression derives the predictive equation of 6MWT walked distance (dependent outcome) from steps obtained in 2MST, age, sex, and body mass index (independent outcomes). RESULTS Correlation between 6MWT and 2MST was strong (r=0.696, p<0.001). The regression equation showed good agreement with measured values, when 6MWT was below 600 m. CONCLUSION The equation stands as a novel approach to obtaining a valid 6MWT estimation from the 2MST. 2MST is easier and faster, representing an alternative approach when time and space are limited.
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Affiliation(s)
- Luis A Berlanga
- Department of Physical Activity and Sport, Centro de Estudios Universitarios Cardenal Spínola CEU, Sevilla, Spain; Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Pedro Abdalla
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), Porto, Portugal
| | - Emília Alves
- Departament of Sport, Higher Institute of Educational Sciences of the Douro, Penafiel, Portugal; Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), Porto, Portugal
| | - Jorge Mota
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Lucimere Bohn
- Research Center in Physical Activity, Health, and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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Kaminsky LA, Imboden MT, Ozemek C. It's Time to (Again) Recognize the Considerable Clinical and Public Health Significance of Cardiorespiratory Fitness. J Am Coll Cardiol 2023; 81:1148-1150. [PMID: 36948730 DOI: 10.1016/j.jacc.2023.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA.
| | - Mary T Imboden
- Department of Kinesiology, George Fox University, Newberg, Oregon, USA; Health Enhancement Research Organization, Raleigh, North Carolina, USA
| | - Cemal Ozemek
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA; Cardiac Rehabilitation, Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
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Feasibility and Reliability of Health-Related Physical Fitness Tests in Children and Adolescents with Hearing Impairment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020353. [PMID: 36832482 PMCID: PMC9955734 DOI: 10.3390/children10020353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
Although research supports the feasibility and reliability of health-related physical fitness (HRPF) tests in typically developing children and adolescents, little is known regarding the feasibility and reliability of these tests for those with hearing impairments (HI). The aim of this study was to evaluate the feasibility and reliability of a HRPF test battery for children and adolescents with HI. A test-retest design with a one-week interval was conducted with 26 participants with HI (mean age: 12.7 ± 2.8 years; 9 male). The feasibility and reliability of seven field-based HRPF tests (i.e., body mass index, grip strength, standing long jump, vital capacity, long distance run, sit-and-reach, one leg stand) were evaluated. All the tests showed high feasibility (completion rate > 90%). Six tests indicated good to excellent test-retest reliability (all intraclass correlation coefficient [ICC] > 0.75) while the one leg stand test showed poor reliability (ICC = 0.36). Relatively large percentages of standard error of measurement (SEM%) and minimal detectable change (MDC%) were observed in the sit-and-reach test (SEM% = 52.4%, MDC% = 145.2%) and one leg stand test (SEM% = 107.9%, MDC% = 299.2%), whereas the rest of the tests demonstrated reasonable SEM% and MDC% values. Collectively, most of the tests can be feasibly and reliably used to assess HRPF for children and adolescents with HI.
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Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: A systematic review and meta-analysis. Ann Phys Rehabil Med 2023; 66:101637. [PMID: 35091111 DOI: 10.1016/j.rehab.2022.101637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aerobic exercise aims to improve aerobic capacity. OBJECTIVE To summarize the evidence on the efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases (NMDs). METHODS We searched the electronic databases MEDLINE, EMBASE, SPORTDiscus and Web of Science Conference Proceedings Index for articles published up to June 17, 2021, selecting randomized controlled trials that included adults with slowly progressive NMDs and compared aerobic exercise to no aerobic exercise. The primary outcome was peak oxygen uptake (VO2peak) directly post-intervention. Secondary outcomes included other peak test parameters, submaximal test parameters, long-term outcomes ≥8 weeks post-intervention, adherence and adverse events. Meta-analyses were performed for the primary outcome and for secondary outcomes when reported in more than 2 studies. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to GRADE. RESULTS Nine studies were included (195 participants with 8 different NMDs). Eight studies were rated at high risk of bias and 1 study was rated at some concerns. Duration of exercise programs ranged from 6 to 26 weeks, with 3 weekly training sessions of 20 to 40 min, based on maximal capacity. Meta-analyses revealed short-term moderate beneficial effects of aerobic exercise on VO2peak (standardized mean difference [SMD] 0.55, 95% CI 0.23; 0.86) and peak workload (SMD 0.61, 95% CI 0.24; 0.99). Long-term effects were not assessed. Most training sessions (83-97%) were completed, but time spent in target intensity zones was not reported. Included studies lacked detailed adverse event reporting. CONCLUSIONS There is low-quality evidence that aerobic exercise is safe and leads to moderate improvement of aerobic capacity directly post-intervention in slowly progressive NMDs, but the long-term efficacy remains unclear. Detailed information about the time spent in target intensity zones and adverse events is lacking. PROSPERO CRD42020200083.
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30
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Blackwell JA, Stanford KI. Exercise-induced intertissue communication: adipose tissue and the heart. CURRENT OPINION IN PHYSIOLOGY 2023; 31:100626. [PMID: 36588657 PMCID: PMC9802643 DOI: 10.1016/j.cophys.2022.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Exercise leads to numerous beneficial whole-body effects and can protect against the development of obesity, cardiometabolic, and neurodegenerative diseases. Recent studies have highlighted the importance of inter-organ crosstalk with a focus on secretory factors that mediate communication among organs, including adipose tissue and the heart. Studies investigating the effects of exercise on brown adipose tissue (BAT) and white adipose tissue (WAT) demonstrated that adipokines are released in response to exercise and act on the heart to decrease inflammation, alter gene expression, increase angiogenesis, and improve cardiac function. This review discusses the exercise-induced adaptations to BAT and WAT and how these adaptations affect heart health and function, while highlighting the importance of tissue crosstalk.
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Affiliation(s)
- Jade A. Blackwell
- Dorothy M. Davis Heart and Lung Research Institute; Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kristin I. Stanford
- Dorothy M. Davis Heart and Lung Research Institute; Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH
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31
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Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings. Eur J Appl Physiol 2023; 123:945-964. [PMID: 36683091 PMCID: PMC10119074 DOI: 10.1007/s00421-022-05114-y] [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: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/24/2023]
Abstract
Given their importance in predicting clinical outcomes, cardiorespiratory fitness (CRF) and muscle status can be considered new vital signs. However, they are not routinely evaluated in healthcare settings. Here, we present a comprehensive review of the epidemiological, mechanistic, and practical bases of the evaluation of CRF and muscle status in adults in primary healthcare settings. We highlight the importance of CRF and muscle status as predictors of morbidity and mortality, focusing on their association with cardiovascular and metabolic outcomes. Notably, adults in the best quartile of CRF and muscle status have as low as one-fourth the risk of developing some of the most common chronic metabolic and cardiovascular diseases than those in the poorest quartile. The physiological mechanisms that underlie these epidemiological associations are addressed. These mechanisms include the fact that both CRF and muscle status reflect an integrative response to the body function. Indeed, muscle plays an active role in the development of many diseases by regulating the body's metabolic rate and releasing myokines, which modulate metabolic and cardiovascular functions. We also go over the most relevant techniques for assessing peak oxygen uptake as a surrogate of CRF and muscle strength, mass, and quality as surrogates of muscle status in adults. Finally, a clinical case of a middle-aged adult is discussed to integrate and summarize the practical aspects of the information presented throughout. Their clinical importance, the ease with which we can assess CRF and muscle status using affordable techniques, and the availability of reference values, justify their routine evaluation in adults across primary healthcare settings.
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Velázquez-Díaz D, Cadenas-Sanchez C, Molina-Guzmán FA, Sáenz-Carrasco JA, Gonzalez-Rosa JJ, Erickson KI, Carbonell-Baeza A, Jiménez-Pavón D. A new set of estimated cardiorespiratory fitness equations are associated with cognitive performance in older adults. GeroScience 2023:10.1007/s11357-022-00718-w. [PMID: 36653578 PMCID: PMC10400484 DOI: 10.1007/s11357-022-00718-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023] Open
Abstract
This study aimed to develop new equations to estimate cardiorespiratory fitness specifically for older adults and, secondly, to analyze the associations of cardiorespiratory fitness, both objectively measured and estimated using new equations, with cognitive performance. Ninety-two older adults (41 females, 65-75 years) from baseline data of a randomized controlled trial were analyzed ("ClinicalTrials.gov" Identifier: NCT03923712). Participants completed 4 measurement sessions including (i) physiological and health indicators in a laboratory setting, (ii) field-based fitness tests, (iii) sociodemographic and physical activity questionnaires, and (iv) a battery of neuropsychological tests to evaluate cognitive performance. The main findings were as follows: (i) a set of new equations with good predictive value for estimated cardiorespiratory fitness were developed (74-87%), using different scenarios of complexity and/or equipment requirements, and (ii) higher estimated cardiorespiratory fitness, even using its simplest equation (eCRF = - 1261.99 + 1.97 × 6 min walking test (m) + 1.12 × bioimpedance basal metabolic rate (kcal/day) + 5.25 × basal heart rate (bpm)), was associated with better cognitive performance evaluated by several neuropsychological tests (i.e., language, cognitive flexibility, fluency, attention, and working memory), similar to using objectively measured cardiorespiratory fitness. In summary, a new set of estimated cardiorespiratory fitness equations have been developed with predictive values ranging from 74 to 87% that could be used based on necessity, availability of equipment, resources, or measurement context. Moreover, similar to objectively measured cardiorespiratory fitness, this measure of estimated cardiorespiratory fitness was positively associated with performance on language, fluency, cognitive flexibility, attention, and working memory, independently of sex, age, and education level.
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Affiliation(s)
- Daniel Velázquez-Díaz
- ExPhy Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.,Brain Aging & Cognitive Health Lab, Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
| | - Cristina Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Flor Abril Molina-Guzmán
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.,MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
| | - Jesús Alfredo Sáenz-Carrasco
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.,MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
| | - Javier J Gonzalez-Rosa
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.,Department of Psychology, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
| | - Kirk I Erickson
- Brain Aging & Cognitive Health Lab, Department of Psychology, University of Pittsburgh, Pittsburgh, PA, 15260, USA.,PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.,AdventHealth Research Institute, Neuroscience Institute, Orlando, FL, USA
| | - Ana Carbonell-Baeza
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain. .,MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain.
| | - David Jiménez-Pavón
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain.,MOVE-IT Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Zadarko-Domaradzka M, Sobolewski M, Nizioł-Babiarz E, Barabasz Z, Warchoł K, Niewczas-Czarna K, Zadarko E. An Investigation of the Utility of Waist Circumference Predicting Cardiorespiratory Fitness in School Children: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20010851. [PMID: 36613173 PMCID: PMC9820009 DOI: 10.3390/ijerph20010851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 05/21/2023]
Abstract
The early identification of modifiable risk factors and their monitoring, also within school physical education (PE) classes, are becoming indispensable in the context of public health. The aim of this study was to test whether making use of waist circumference (WC) measurements increases the possibility of predicting the results of cardiorespiratory fitness (CRF) in school-age children, as compared with body mass index (BMI) and other somatic indicators related to body fat. The cross-sectional study covered 190 children aged 10 to 15 years, participating in school PE classes. Body height (BH), body weight (BW), WC, hip circumference (HC) and percentage of body fat (BF%) were measured. BMI, waist to hip ratio (WHR) and waist to height ratio (WHtR) were calculated, and a CRF test was performed by means of a 20 m shuttle run test (20mSRT). The peak heart rate (HRpeak) of the children was also measured. The regression model that was developed showed that WC (R2 = 47.1%), beyond BF% (R2 = 50.3%) and WHtR (R2 = 50.0%), was a useful measure of CRF, and stronger than BMI (R2 = 45.8%) or WHR (R2 = 39.2%). The risk of obtaining the CRF result classified below a good level (below the percentile range of P60-P80) was significantly higher in children with a larger WC (odds ratio (OR) for the WC change of 1 cm equals 1.14 (95% CI: 1.09-1.20; p < 0.001)). The simplicity of measuring WC and the possibility of using this measurement in the calculation of WHtR with reference to CRF indicate its usefulness in the prophylactic exams of school children.
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Affiliation(s)
- Maria Zadarko-Domaradzka
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Marek Sobolewski
- Department of Quantitative Methods, Rzeszow University of Technology, 35-959 Rzeszow, Poland
| | - Edyta Nizioł-Babiarz
- Department of Physical Education, Carpathian State College in Krosno, 38-400 Krosno, Poland
| | - Zbigniew Barabasz
- Department of Physical Education, Carpathian State College in Krosno, 38-400 Krosno, Poland
| | - Krzysztof Warchoł
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Klaudia Niewczas-Czarna
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
| | - Emilian Zadarko
- Institute of Physical Culture Sciences, Medical College of Rzeszow University, 35-959 Rzeszow, Poland
- Correspondence:
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Taylor JL, Barnes JN, Johnson BD. The Utility of High Intensity Interval Training to Improve Cognitive Aging in Heart Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16926. [PMID: 36554807 PMCID: PMC9778921 DOI: 10.3390/ijerph192416926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Adults with cardiovascular disease and heart failure are at higher risk of cognitive decline. Cerebral hypoperfusion appears to be a significant contributor, which can result from vascular dysfunction and impairment of cerebral blood flow regulation. In contrast, higher cardiorespiratory fitness shows protection against brain atrophy, reductions in cerebral blood flow, and cognitive decline. Given that high intensity interval training (HIIT) has been shown to be a potent stimulus for improving cardiorespiratory fitness and peripheral vascular function, its utility for improving cognitive aging is an important area of research. This article will review the physiology related to cerebral blood flow regulation and cognitive decline in adults with cardiovascular disease and heart failure, and how HIIT may provide a more optimal stimulus for improving cognitive aging in this population.
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Affiliation(s)
- Jenna L. Taylor
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Jill N. Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Franklin BA, Eijsvogels TM, Pandey A, Quindry J, Toth PP. Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the ASPC Part I: Bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations. Am J Prev Cardiol 2022; 12:100424. [PMID: 36281324 PMCID: PMC9586848 DOI: 10.1016/j.ajpc.2022.100424] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Regular moderate-to-vigorous physical activity (PA) and increased levels of cardiorespiratory fitness (CRF) or aerobic capacity are widely promoted as cardioprotective measures in the primary and secondary prevention of atherosclerotic cardiovascular (CV) disease (CVD). Nevertheless, physical inactivity and sedentary behaviors remain a worldwide concern. The continuing coronavirus (COVID-19) pandemic has been especially devastating to patients with known or occult CVD since sitting time and recreational PA have been reported to increase and decrease by 28% and 33%, respectively. Herein, in this first of a 2-part series, we discuss foundational factors in exercise programming, with specific reference to energy metabolism, contemporary PA recommendations, the dose-response relationship of exercise as medicine, the benefits of regular exercise training, including the exercise preconditioning cardioprotective phenotype, as well as the CV risks of PA. Finally, we discuss the 'extreme exercise hypothesis,' specifically the potential maladaptations resulting from high-volume, high-intensity training programs, including accelerated coronary artery calcification and incident atrial fibrillation. The latter is commonly depicted by a reverse J-shaped or U-shaped curve. On the other hand, longevity data argue against this relationship, as elite endurance athletes live 3-6 years longer than the general population.
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Affiliation(s)
- Barry A. Franklin
- Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, Michigan, USA
- Professor, Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Thijs M.H. Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ambarish Pandey
- Department of Internal Medicine at UT Southwestern Medical Center, Dallas, TX, Michigan, USA
| | - John Quindry
- Integrative Physiology and Athletic Training, University of Montana, Missoula, Montana and International Heart Institute – St. Patrick's Hospital, Providence Medical Center, Missoula, Montana, USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mendoza MF, Lavie CJ. Clinical associations between exercise and lipoproteins. Curr Opin Lipidol 2022; 33:364-373. [PMID: 36305382 DOI: 10.1097/mol.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW One of the major concerns in global health is the deteriorating control of dyslipidemia (DLD), which is a very strong modifiable risk factor for untoward cardiovascular disease (CVD) outcomes. It serves as a foundation for atherosclerotic lesions that can be destabilized by co-inflammatory processes leading to distal clot migration and other related CVD events. There are many misconceptions regarding the management of DLD. Many health sectors advocate for weight loss without a clear-cut target to achieve better CVD outcomes. There is growing evidence that exercise training compliance regardless of weight change is a more reliable indicator of favorable outcomes. This review is intended to understand the relationship between exercise training, lipoprotein readings, and with CVD and all-cause morbidity and mortality. RECENT FINDINGS Aerobic exercise training (aET) and resistance exercise training (rET) increase cardiorespiratory fitness (CRF) and muscular strength (MusS), respectively. Regardless of weight loss, aET and rET are both known to independently reduce mortality possibly partly through improvement of lipid profiles. Of the two modes of exercise, rET has propensity for enhanced compliance because of its significant lipid and mortality-attenuating effect even with just brief exercise sessions. However, there are several studies showing that participation in both modes of exercise causes more pronounced improvements in DLD and CVD-related mortality compared with either mode of exercise training alone. In addition, Lipoprotein-a [Lp(a)] has been increasingly acknowledged to be atherogenic because of its LDL core. The close proximity of Lp(a) with macrophages triggers the development of atheromas, plaque formation, and growth. This causes a cascade of inflammatory processes that increase the development of ischemic CVD and calcific aortic valve stenosis. Although exercise training is known to reduce plasma LDL-C levels, it has no direct effect on Lp(a) levels as the latter lipoprotein is not influenced by motion nor exercise. Reviews of multiple studies lead us to infer that exercise training may potentially have an indirect impact on Lp(a) attenuation because of the ability of exercise training to inhibit Proprotein Convertase Subtisilin/Kexin type-9 (PCSK-9), as some studies using pharmacologic therapy with PCSK-9 inhibitors were able to show a concomitant decrease in Lp(a) levels. SUMMARY It is clear that normal-to-overweight populations who are highly active have better CVD outcomes and lipid profiles than their sedentary counterparts, and those who were underweight and unfit fared much worse. This allows us to take a more precise approach in the management of DLD rather than plainly focusing on gross weight in patients. Exercise training certainly has beneficial impact on longevity owing to its advantageous effect on lipoprotein levels and particle size. As such, reputable health societies, such as the ESC, ACC, and AHA have prescribed the ideal exercise training regimen, which have noticeable similarities. Increasing the use of wearable devices may help improve our ability to prescribe, quantify, and precisely track physical activity in our continuing efforts to combat increasing morbidity related to unhealthy lifestyles and inactivity.
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Affiliation(s)
- Michael F Mendoza
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine
- The Gayle and Tom Benson Cancer Center, New Orleans, Louisiana, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine
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Oxygen Uptake Efficiency Slope as a Predictor of Mortality Risk. J Cardiopulm Rehabil Prev 2022:01273116-990000000-00045. [DOI: 10.1097/hcr.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Peterman JE, Harber MP, Fleenor BS, Whaley MH, Araújo CG, Kaminsky LA. Cardiorespiratory Optimal Point Is a Submaximal Exercise Test Variable and a Predictor of Mortality Risk: THE BALL STATE ADULT FITNESS LONGITUDINAL LIFESTYLE STUDY (BALL ST). J Cardiopulm Rehabil Prev 2022; 42:E90-E96. [PMID: 35861956 PMCID: PMC9662820 DOI: 10.1097/hcr.0000000000000711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The cardiorespiratory optimal point (COP) is the minimum ventilatory equivalent for oxygen. The COP can be determined during a submaximal incremental exercise test. Reflecting the optimal interaction between the respiratory and cardiovascular systems, COP may have prognostic utility. The aim of this investigation was to determine the relationship between COP and all-cause mortality in a cohort of apparently healthy adults. METHODS The sample included 3160 apparently healthy adults (46% females) with a mean age of 44.0 ± 12.5 yr who performed a cardiopulmonary exercise test. Cox proportional hazards models were performed to assess the relationship between COP and mortality risk. Prognostic peak oxygen uptake (V˙ o2peak ) and COP models were compared using the concordance index. RESULTS There were 558 deaths (31% females) over a follow-up period of 23.0 ± 11.9 yr. For males, all Cox proportional hazards models, including the model adjusted for traditional risk factors and V˙ o2peak , had a positive association with risk for mortality ( P < .05). For females, only the unadjusted COP model was associated with risk for mortality ( P < .05). The concordance index values indicated that unadjusted COP models had lower discrimination compared with unadjusted V˙ o2peak models ( P < .05) and V˙ o2peak did not complement COP models ( P ≥ .13). CONCLUSIONS Cardiorespiratory optimal point is related to all-cause mortality in males but not females. These findings suggest that a determination of COP can have prognostic utility in apparently healthy males aged 18-85 yr, which may be relevant when a maximal exercise test is not feasible or desirable.
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Affiliation(s)
- James E. Peterman
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Matthew P. Harber
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Bradley S. Fleenor
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Mitchell H. Whaley
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Claudio G. Araújo
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
| | - Leonard A. Kaminsky
- Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana (Drs Peterman and Kaminsky); Clinical Exercise Physiology Laboratory, Ball State University, Muncie, Indiana (Drs Harber, Fleenor, and Whaley); and Medical Department, Exercise Medicine Clinic (CLINIMEX), Rio de Janeiro, Brazil (Dr Araújo)
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Abstract
Cardiovascular diseases (CVD) remain the leading cause of death globally, and further efforts are being undertaken to understand and modify CVD risk factors, such as dyslipidemia (DLD), hypertension, and diabetes. The sedentary lifestyle of most individuals today contributes to the prevalence of these conditions. Uncontrolled dyslipidemia serves as a fertile ground for atherosclerotic plaque formation, while lipoproteins (Lp) act as cofactors for inflammatory processes that cause plaque destabilization leading to subsequent CVD events. As such, many health experts and institutions continue to emphasize the importance of cardiorespiratory fitness (CRF) and muscular strength (MusS) with the intent to reduce atherogenic lipoproteins and proprotein convertase subtilisin kexin type 9 (PCSK-9) expression. Concordantly, the two modes of exercise training (ET), such as aerobic ET (aET) and resistance ET (rET) have both demonstrated to improve CRF and MusS, respectively. Although both modes of ET were shown to independently reduce mortality, participation in both forms resulted in a more pronounced improvement in cholesterol levels and CVD-related mortality. Though reduction of adiposity is not a pre-requisite to achieve better control of DLD through increased CRF and MusS, the beneficial effects of physical activity on the inflammatory processes linked to atherosclerosis are almost always associated with a simultaneous decrease in overall adiposity. It is therefore essential to promote both aET and rET, including weight loss in order to attenuate the risks stemming from atherosclerosis and its proinflammatory components.
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Rissanen APE, Rottensteiner M, Kujala UM, Kurkela JLO, Wikgren J, Laukkanen JA. Cardiorespiratory Fitness Estimation Based on Heart Rate and Body Acceleration in Adults With Cardiovascular Risk Factors: Validation Study. JMIR Cardio 2022; 6:e35796. [PMID: 36282560 PMCID: PMC9644248 DOI: 10.2196/35796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/17/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality. Adding CRF to conventional risk factors (eg, smoking, hypertension, impaired glucose metabolism, and dyslipidemia) improves the prediction of an individual’s risk for adverse health outcomes such as those related to cardiovascular disease. Consequently, it is recommended to determine CRF as part of individualized risk prediction. However, CRF is not determined routinely in everyday clinical practice. Wearable technologies provide a potential strategy to estimate CRF on a daily basis, and such technologies, which provide CRF estimates based on heart rate and body acceleration, have been developed. However, the validity of such technologies in estimating individual CRF in clinically relevant populations is poorly known. Objective The objective of this study is to evaluate the validity of a wearable technology, which provides estimated CRF based on heart rate and body acceleration, in working-aged adults with cardiovascular risk factors. Methods In total, 74 adults (age range 35-64 years; n=56, 76% were women; mean BMI 28.7, SD 4.6 kg/m2) with frequent cardiovascular risk factors (eg, n=64, 86% hypertension; n=18, 24% prediabetes; n=14, 19% type 2 diabetes; and n=51, 69% metabolic syndrome) performed a 30-minute self-paced walk on an indoor track and a cardiopulmonary exercise test on a treadmill. CRF, quantified as peak O2 uptake, was both estimated (self-paced walk: a wearable single-lead electrocardiogram device worn to record continuous beat-to-beat R-R intervals and triaxial body acceleration) and measured (cardiopulmonary exercise test: ventilatory gas analysis). The accuracy of the estimated CRF was evaluated against that of the measured CRF. Results Measured CRF averaged 30.6 (SD 6.3; range 20.1-49.6) mL/kg/min. In all participants (74/74, 100%), mean difference between estimated and measured CRF was −0.1 mL/kg/min (P=.90), mean absolute error was 3.1 mL/kg/min (95% CI 2.6-3.7), mean absolute percentage error was 10.4% (95% CI 8.5-12.5), and intraclass correlation coefficient was 0.88 (95% CI 0.80-0.92). Similar accuracy was observed in various subgroups (sexes, age, BMI categories, hypertension, prediabetes, and metabolic syndrome). However, mean absolute error was 4.2 mL/kg/min (95% CI 2.6-6.1) and mean absolute percentage error was 16.5% (95% CI 8.6-24.4) in the subgroup of patients with type 2 diabetes (14/74, 19%). Conclusions The error of the CRF estimate, provided by the wearable technology, was likely below or at least very close to the clinically significant level of 3.5 mL/kg/min in working-aged adults with cardiovascular risk factors, but not in the relatively small subgroup of patients with type 2 diabetes. From a large-scale clinical perspective, the findings suggest that wearable technologies have the potential to estimate individual CRF with acceptable accuracy in clinically relevant populations.
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Affiliation(s)
- Antti-Pekka E Rissanen
- Central Finland Health Care District, Jyväskylä, Finland
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland
- HULA - Helsinki Sports and Exercise Medicine Clinic, Foundation for Sports and Exercise Medicine, Helsinki, Finland
| | - Mirva Rottensteiner
- Central Finland Health Care District, Jyväskylä, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jari L O Kurkela
- Centre for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jan Wikgren
- Centre for Interdisciplinary Brain Research, Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jari A Laukkanen
- Central Finland Health Care District, Jyväskylä, Finland
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
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Cuenca-Martínez F, Sempere-Rubio N, Varangot-Reille C, Fernández-Carnero J, Suso-Martí L, Alba-Quesada P, Touche RL. Effects of High-Intensity Interval Training (HIIT) on Patients with Musculoskeletal Disorders: A Systematic Review and Meta-Analysis with a Meta-Regression and Mapping Report. Diagnostics (Basel) 2022; 12:diagnostics12102532. [PMID: 36292221 PMCID: PMC9601160 DOI: 10.3390/diagnostics12102532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO2 max), disability, and quality of life (QoL). We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect (SMD = −0.73; 95% CI: −1.40–−0.06), and in VO2 max, with a moderate clinical-effect (SMD = 0.69; 95% CI: 0.42–0.97). However, the meta-analysis showed no statistically significant results for disability (SMD = −0.34; 95% CI: −0.92–0.24) and QoL (SMD = 0.40; 95% CI: −0.80–1.60). We compared HIIT against other exercise models for reducing pain intensity and increasing VO2 max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO2 max (R2 = 82.99%, p = 0.003). There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO2 max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO2 max.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 Valencia, Spain
| | - Clovis Varangot-Reille
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28933 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Correspondence: (J.F.-C.); (L.S.-M.); Tel.: +34-914-88-88-00 (J.F.-C.); +34-963-98-38-55 (L.S.-M.)
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
- Correspondence: (J.F.-C.); (L.S.-M.); Tel.: +34-914-88-88-00 (J.F.-C.); +34-963-98-38-55 (L.S.-M.)
| | - Patricio Alba-Quesada
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28003 Madrid, Spain
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Papadakis Z, Etchebaster M, Garcia-Retortillo S. Cardiorespiratory Coordination in Collegiate Rowing: A Network Approach to Cardiorespiratory Exercise Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13250. [PMID: 36293862 PMCID: PMC9603738 DOI: 10.3390/ijerph192013250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Collegiate rowing performance is often assessed by a cardiopulmonary exercise test (CPET). Rowers' on-water performance involves non-linear dynamic interactions and synergetic reconfigurations of the cardiorespiratory system. Cardiorespiratory coordination (CRC) method measures the co-variation among cardiorespiratory variables. Novice (n = 9) vs. Intermediate (n = 9) rowers' CRC (H0: Novice CRC = Intermediate CRC; HA: Novice CRC < Intermediate CRC) was evaluated through principal components analysis (PCA). A female NCAA Division II team (N = 18) grouped based on their off-water performance on 6000 m time trial. Rowers completed a customized CPET to exhaustion and a variety of cardiorespiratory values were recorded. The number of principal components (PCs) and respective PC eigenvalues per group were computed on SPSS vs28. Intermediate (77%) and Novice (33%) groups showed one PC1. Novice group formed an added PC2 due to the shift of expired fraction of oxygen or, alternatively, heart rate/ventilation, from the PC1 cluster of examined variables. Intermediate rowers presented a higher degree of CRC, possible due to their increased ability to utilize the bicarbonate buffering system during the CPET. CRC may be an alternative measure to assess aerobic fitness providing insights to the complex cardiorespiratory interactions involved in rowing during a CPET.
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Affiliation(s)
- Zacharias Papadakis
- Human Performance Laboratory, Department of Health Promotion and Clinical Practice, College of Health and Wellness, Barry University, Miami Shores, FL 33161, USA
| | - Michelle Etchebaster
- Human Performance Laboratory, Department of Health Promotion and Clinical Practice, College of Health and Wellness, Barry University, Miami Shores, FL 33161, USA
| | - Sergi Garcia-Retortillo
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
- Complex Systems in Sport Research Group, Institut Nacional d’Educació Física de Catalunya (INEFC) University of Barcelona, 08007 Barcelona, Spain
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van der Schoot GG, Ormel HL, Westerink NDL, May AM, Elias SG, Hummel YM, Lefrandt JD, van der Meer P, van Melle JP, Poppema BJ, Stel JM, van der Velden AW, Vrieling AH, Wempe JB, ten Wolde MG, Nijland M, de Vries EG, Gietema JA, Walenkamp AM. Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness. JACC CardioOncol 2022; 4:491-503. [DOI: 10.1016/j.jaccao.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
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Røysland IØ, Patel H. Experiences of unexplained chest pain and physical activity: A Meta-Ethnography. J Clin Nurs 2022. [PMID: 36028954 DOI: 10.1111/jocn.16496] [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: 05/25/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim was to examine the experiences of physical activity in the patients with unexplained chest pain. BACKGROUND Previous qualitative studies have compiled data on the physical activity experiences of people with unexplained chest pain. Nevertheless, no meta-synthesis exists on this topic to advance the theoretical development of future-related studies. DESIGN A meta-ethnographic synthesis of qualitative studies was conducted. Original qualitative studies on the physical activity experiences of people with unexplained chest pain were identified and systematically synthesised using a meta-ethnographic approach. METHODS Seven databases were searched for relevant full-text articles in English, Danish, Norwegian and Swedish. There were no limitations concerning year of publication. Articles were first screened against inclusion criteria for eligibility and then assessed for quality and analysed using Noblit and Hare's seven-step meta-ethnography process. The ENTREQ checklist for systematic reviews was used. RESULTS Nine qualitative studies were included in the analysis. The physical activity experiences of people with unexplained chest pain illuminates the metaphor: "Physical activity means balancing uncertainty" with four themes: looking for possible explanations, feeling vulnerable, feeling uncertain of consequences and being physically active may mean becoming more capable. CONCLUSION For people with unexplained chest pain, being physically active meant moving toward being more capable. The participants felt vulnerable and physical activity helped in balancing uncertainty. A comprehensive model illustrates the antecedents and succedent for the physical activity experiences of individuals with unexplained chest pains. RELEVANCE TO CLINICAL PRACTICE An approach to care which considers the patient's experience might be applicable; however, it needs to be accompanied with a biomedical perspective. Nurses and other health professionals need to provide a bridge between the patient's experiences and health professionals' advice and recommendations.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Harshida Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Wang Z, Zhang Q, Lan K, Yang Z, Gao X, Wu A, Xin Y, Zhang Z. Enhancing instantaneous oxygen uptake estimation by non-linear model using cardio-pulmonary physiological and motion signals. Front Physiol 2022; 13:897412. [PMID: 36105296 PMCID: PMC9465676 DOI: 10.3389/fphys.2022.897412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Oxygen uptake (VO2) is an important parameter in sports medicine, health assessment and clinical treatment. At present, more and more wearable devices are used in daily life, clinical treatment and health care. The parameters obtained by wearables have great research potential and application prospect. In this paper, an instantaneous VO2 estimation model based on XGBoost was proposed and verified by using data obtained from a medical-grade wearable device (Beijing SensEcho) at different posture and activity levels. Furthermore, physiological characteristics extracted from single-lead electrocardiogram, thoracic and abdominal respiration signal and tri-axial acceleration signal were studied to optimize the model. There were 29 healthy volunteers recruited for the study to collect data while stationary (lying, sitting, standing), walking, Bruce treadmill test and recuperating with SensEcho and the gas analyzer (Metalyzer 3B). The results show that the VO2 values estimated by the proposed model are in good agreement with the true values measured by the gas analyzer (R2 = 0.94 ± 0.03, n = 72,235), and the mean absolute error (MAE) is 1.83 ± 0.59 ml/kg/min. Compared with the estimation method using a separate heart rate as input, our method reduced MAE by 54.70%. At the same time, other factors affecting the performance of the model were studied, including the influence of different input signals, gender and movement intensity, which provided more enlightenment for the estimation of VO2. The results show that the proposed model based on cardio-pulmonary physiological signals as inputs can effectively improve the accuracy of instantaneous VO2 estimation in various scenarios of activities and was robust between different motion modes and state. The VO2 estimation method proposed in this paper has the potential to be used in daily life covering the scenario of stationary, walking and maximal exercise.
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Affiliation(s)
- Zhao Wang
- Medical School of Chinese PLA, Beijing, China
| | - Qiang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ke Lan
- Beijing SensEcho Science and Technology Co Ltd, Beijing, China
| | - Zhicheng Yang
- PAII Inc., Palo Alto, Santa Clara, CA, United States
| | - Xiaolin Gao
- Institute of Sports Science, General Administration of Sport of China, Beijing, China
| | - Anshuo Wu
- The Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
| | - Yi Xin
- School of Life Science, Beijing Institute of Technology, Beijing, China
- *Correspondence: Yi Xin, ; Zhengbo Zhang,
| | - Zhengbo Zhang
- Center for Artificial Intelligence in Medicine, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Yi Xin, ; Zhengbo Zhang,
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Physical activity on cardiorespiratory fitness and cardiovascular risk in premenopausal and postmenopausal women: a systematic review of randomized controlled trials. Menopause 2022; 29:1222-1229. [PMID: 35969888 DOI: 10.1097/gme.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels. OBJECTIVE This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials. EVIDENCE REVIEW A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles. FINDINGS Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states. CONCLUSIONS AND RELEVANCE To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity.
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Esmaili H, Tajik B, Tuomainen TP, Kurl S, Salonen JT, Virtanen JK. Associations of the serum n-6 PUFA with exercise cardiac power in men. Br J Nutr 2022; 129:1-10. [PMID: 35929337 PMCID: PMC10024979 DOI: 10.1017/s0007114522002501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/09/2022] [Accepted: 07/26/2022] [Indexed: 11/06/2022]
Abstract
Low intake or tissue concentrations of the n-6 PUFA, especially to the major n-6 PUFA linoleic acid (LA), and low exercise cardiac power (ECP) are both associated with CVD risk. However, associations of the n-6 PUFA with ECP are unknown. The aim of the present study was to explore cross-sectional associations of the serum total n-6 PUFA, LA, arachidonic acid (AA), γ-linolenic acid (GLA) and dihomo-γ-linolenic acid (DGLA) concentrations with ECP and its components. In total, 1685 men aged 42-60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study and free of CVD were included. ANCOVA was used to examine the mean values of ECP (maximal oxygen uptake (VO2max)/maximal systolic blood pressure (SBP)) and its components in quartiles of the serum total and individual n-6 PUFA concentrations. After multivariable adjustments, higher serum total n-6 PUFA concentration was associated with higher ECP and VO2max (for ECP, the extreme-quartile difference was 0·77 ml/mmHg (95 % CI 0·38, 1·16, Pfor trend across quartiles < 0·001) and for VO2max 157 ml/min (95 % CI 85, 230, Pfor trend < 0·001), but not with maximal SBP. Similar associations were observed with serum LA concentration. Higher serum AA concentration was associated with higher ECP but not with VO2max or maximal SBP. The minor serum n-6 PUFA GLA and DGLA were associated with higher maximal SBP during exercise test and DGLA also with higher VO2max but neither with ECP. In conclusion, especially LA concentration was associated with higher ECP. This may provide one mechanism for the cardioprotective properties of, especially, LA.
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Affiliation(s)
- Haleh Esmaili
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Behnam Tajik
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Sudhir Kurl
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Jukka T. Salonen
- University of Helsinki, the Faculty of Medicine, Department of Public Health, Helsinki, Finland
- Metabolic Analytical Services Oy, Helsinki, Finland
| | - Jyrki K. Virtanen
- University of Eastern Finland, Kuopio Campus, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
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48
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Quantile Differences in the Age-Related Decline in Cardiorespiratory Fitness Between Sexes in Adults Without Type 2 Diabetes Mellitus in the United States. Mayo Clin Proc Innov Qual Outcomes 2022; 6:302-310. [PMID: 35769223 PMCID: PMC9234339 DOI: 10.1016/j.mayocpiqo.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To comprehensively assess the extent to which the decline in cardiorespiratory fitness (CRF) with age differs between sexes. Participants and Methods This study used data from the Aerobics Center Longitudinal Study, conducted between September 1974 and August 2006, consisting primarily of White adults from middle-to-upper socioeconomic strata restricted to adults without type 2 diabetes mellitus (33,742 men and 9,415 women). Quantile regression models were used to estimate the differences in age-associated changes in CRF between the sexes, estimated using a maximal treadmill test. Results For adults aged up to 45 years, significant differences in slopes relating to age and CRF between men and women were observed for all adjusted percentiles of CRF other than the 90th percentile; women reported significantly greater declines in CRF per year. For those aged 45-60 years and those older than 60 years, no significant differences in age-related declines in CRF were observed between the sexes. Conclusion This study found that compared with men, the onset of decline in CRF was found to occur earlier and at lower CRF percentiles in women. This is of particular concern, given that compared with men, women already tend to have lower CRF levels. These findings suggest that maintaining the levels of physical activity sufficient to maintain moderate-to-high levels of fitness is particularly important for women earlier during adulthood.
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Cuenca-Garcia M, Marin-Jimenez N, Perez-Bey A, Sánchez-Oliva D, Camiletti-Moiron D, Alvarez-Gallardo IC, Ortega FB, Castro-Piñero J. Reliability of Field-Based Fitness Tests in Adults: A Systematic Review. Sports Med 2022; 52:1961-1979. [PMID: 35064915 DOI: 10.1007/s40279-021-01635-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Physical fitness is a powerful predictor of morbidity and mortality, and is therefore a useful indicator for public health monitoring. To assess physical fitness, field-based tests are time-efficient, inexpensive, have minimal equipment requirements, and can be easily administered to a large number of individuals. OBJECTIVE The objective of this systematic review was to examine the reliability of existing field-based fitness tests used in adults aged 19-64 years. METHODS A systematic search of two electronic databases (MEDLINE and Web of Science) was conducted from inception to 8 June 2021 by two independent researchers. Each study was classified as high, low, or very low quality according to the description of the participants, the time interval between measurements, the description of the results, and the appropriateness of statistics. Three levels of evidence (strong, moderate, and limited) were established according to the number of studies and the consistency of their findings. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO reference number, CRD42019118480). RESULTS Of 17,010 records identified, 129 original studies examining the reliability of field-based fitness tests in adults were considered eligible. The reliability was assessed of tests of cardiorespiratory fitness (33 studies: 30 of high quality), musculoskeletal fitness (92 studies: 78 of high quality), and motor fitness (22 studies, all of high quality). There was strong evidence indicating: (i) the high reliability of the cardiorespiratory fitness tests: 20-m shuttle run, 6-min step, and 6-min walk; (ii) the high reliability of the musculoskeletal fitness tests: handgrip strength, back-leg strength, Sorensen, trunk flexion sustained, 5-reps sit-to-stand, sit-and-reach and toe-touch, and moderate reliability bilateral side bridge and prone bridge tests; and (iii) the moderate reliability and low reliability, respectively, of the motor fitness tests T-test and single-leg stand. We found moderate evidence indicating the moderate or high reliability of the following tests: Chester, sit-up, partial curl-up, flexion-rotation trunk, timed stair ascent, pull-up, bent-arm hang, standing broad jump, hop sequence, trunk lift, timed-up-and-go, and hexagon agility. Evidence for the reliability of balance and gait speed tests was inconclusive. Other field-based fitness tests demonstrated limited evidence, mainly due to there being only few studies. CONCLUSIONS This review provides an evidence-based proposal of the more reliable field-based fitness tests for adults aged 19-64 years. Our findings identified a need for more high-quality studies designed to assess the reliability of field-based tests of lower and upper body explosive and endurance muscular strength, and motor fitness (i.e., balance and gait speed tests) in adults.
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Affiliation(s)
- Magdalena Cuenca-Garcia
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Nuria Marin-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain.
| | - Alejandro Perez-Bey
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - David Sánchez-Oliva
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
- ACAFYDE Research Group, Faculty of Sport Sciences, University of Extremadura, Caceres, Spain
| | - Daniel Camiletti-Moiron
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Inmaculada C Alvarez-Gallardo
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
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Chen KY, Shin J, Hasan MAM, Liaw JJ, Yuichi O, Tomioka Y. Fitness Movement Types and Completeness Detection Using a Transfer-Learning-Based Deep Neural Network. SENSORS (BASEL, SWITZERLAND) 2022; 22:5700. [PMID: 35957257 PMCID: PMC9371130 DOI: 10.3390/s22155700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Fitness is important in people's lives. Good fitness habits can improve cardiopulmonary capacity, increase concentration, prevent obesity, and effectively reduce the risk of death. Home fitness does not require large equipment but uses dumbbells, yoga mats, and horizontal bars to complete fitness exercises and can effectively avoid contact with people, so it is deeply loved by people. People who work out at home use social media to obtain fitness knowledge, but learning ability is limited. Incomplete fitness is likely to lead to injury, and a cheap, timely, and accurate fitness detection system can reduce the risk of fitness injuries and can effectively improve people's fitness awareness. In the past, many studies have engaged in the detection of fitness movements, among which the detection of fitness movements based on wearable devices, body nodes, and image deep learning has achieved better performance. However, a wearable device cannot detect a variety of fitness movements, may hinder the exercise of the fitness user, and has a high cost. Both body-node-based and image-deep-learning-based methods have lower costs, but each has some drawbacks. Therefore, this paper used a method based on deep transfer learning to establish a fitness database. After that, a deep neural network was trained to detect the type and completeness of fitness movements. We used Yolov4 and Mediapipe to instantly detect fitness movements and stored the 1D fitness signal of movement to build a database. Finally, MLP was used to classify the 1D signal waveform of fitness. In the performance of the classification of fitness movement types, the mAP was 99.71%, accuracy was 98.56%, precision was 97.9%, recall was 98.56%, and the F1-score was 98.23%, which is quite a high performance. In the performance of fitness movement completeness classification, accuracy was 92.84%, precision was 92.85, recall was 92.84%, and the F1-score was 92.83%. The average FPS in detection was 17.5. Experimental results show that our method achieves higher accuracy compared to other methods.
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Affiliation(s)
- Kuan-Yu Chen
- School of Computer Science and Engineering, The University of Aizu Fukushima, Aizuwakamatsu 9658580, Japan; (K.-Y.C.); (M.A.M.H.); (O.Y.); (Y.T.)
- Department of Information and Communication Engineering, Chaoyang University of Technology Taichung, Taichung 41349, Taiwan;
| | - Jungpil Shin
- School of Computer Science and Engineering, The University of Aizu Fukushima, Aizuwakamatsu 9658580, Japan; (K.-Y.C.); (M.A.M.H.); (O.Y.); (Y.T.)
| | - Md. Al Mehedi Hasan
- School of Computer Science and Engineering, The University of Aizu Fukushima, Aizuwakamatsu 9658580, Japan; (K.-Y.C.); (M.A.M.H.); (O.Y.); (Y.T.)
| | - Jiun-Jian Liaw
- Department of Information and Communication Engineering, Chaoyang University of Technology Taichung, Taichung 41349, Taiwan;
| | - Okuyama Yuichi
- School of Computer Science and Engineering, The University of Aizu Fukushima, Aizuwakamatsu 9658580, Japan; (K.-Y.C.); (M.A.M.H.); (O.Y.); (Y.T.)
| | - Yoichi Tomioka
- School of Computer Science and Engineering, The University of Aizu Fukushima, Aizuwakamatsu 9658580, Japan; (K.-Y.C.); (M.A.M.H.); (O.Y.); (Y.T.)
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