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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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2
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Kwon Y, Kang KW, Chang JS. The talk test as a useful tool to monitor aerobic exercise intensity in healthy population. J Exerc Rehabil 2023; 19:163-169. [PMID: 37435593 PMCID: PMC10331140 DOI: 10.12965/jer.2346170.085] [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] [Received: 04/09/2023] [Accepted: 05/04/2023] [Indexed: 07/13/2023] Open
Abstract
The talk test (TT) is subjective method to measure exercise intensity in costless and feasible manner, compared to sophisticated laboratory equipment. We attempted to investigate whether the TT was a valid method for evaluation of exercise intensity, by comparing with values derived from various physiologic markers during cardiopulmonary exercise testing on treadmill in healthy population. A total of 17 healthy subjects (12 males and 5 females) participated in this study. The TT was applied, which consisted of 3-stages difficulties demanding respiratory load while they performed the cardiopulmonary exercise testing on treadmill. In each of the TT stages, ergospirometric and psychophysiologic response marker were collected such as heart rate, oxygen consumption, respiratory exchange ratio, minute ventilation, carbon dioxide output, tidal volume, respiratory rate, and rating of perceived exertion of breathing. Statistical analyses revealed a significant difference of all dependent variables in each of three TT stages, comparing with the resting phase before the TT. The TT showed strong correlation coefficient with all variables except for rating of perceived exertion during the resting phase before the TT. According to increase of exercise intensity, all dependent variables showed a linear tendency with the stages of the TT. Our findings indicated that each of the TT stages was strongly correlated with ergospirometric variables as well as psychophysiologic response during cardiopulmonary exercise testing on treadmill. We suggested that the TT can be used to evaluate and prescribe exercise intensity of aerobic activity in cardiovascular and pulmonary rehabilitation settings.
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Affiliation(s)
| | | | - Jong Sung Chang
- Corresponding author: Jong Sung Chang, https://orcid.org/0009-0002-9467-4294, Department of Physical Therapy, Yeungnam University College, 170 Hyunchung-ro, Nam-gu, Daegu 42415, Korea,
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3
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Saeki H, Kuramoto M, Iida Y, Yasumura K, Arita Y, Ogasawara N. Effect of Constant vs. Variable Moderate-Intensity Load on Peak Oxygen Uptake in Outpatient Cardiac Rehabilitation. Circ Rep 2023; 5:167-176. [PMID: 37180472 PMCID: PMC10166670 DOI: 10.1253/circrep.cr-23-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Background: In outpatient center-based cardiac rehabilitation (O-CBCR), moderate-intensity continuous training (MICT) based on the anaerobic threshold (AT) determined by cardiopulmonary exercise stress testing is recommended. However, it is unclear whether differences in exercise intensity within the MICT domain affect peak oxygen uptake (%peakV̇O2). Methods and Results: We retrospectively evaluated patients who underwent O-CBCR at Japan Community Healthcare Organization Osaka Hospital. Those treated with the constant-load method were designated as Group A (n=38), whereas those treated with the variable-load method were designated as Group B (n=48). Although the change in exercise intensity was significantly greater in Group B by approximately 4.5 W, the change in %peakV̇O2 was not significantly different between groups. Group A had a significantly longer exercise time than Group B (by approximately 4-5 min). No deaths or hospitalizations occurred in either group. The percentage of episodes with exercise cessation was similar between the 2 groups, but the percentage of episodes with load reduction was significantly higher in Group B, mostly because of the increased heart rate. Conclusions: In supervised MICT based on AT, the variable-load method increased exercise intensity more than the constant-load method without severe complications, but did not improve %peakV̇O2.
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Affiliation(s)
- Hajime Saeki
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Miho Kuramoto
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoshinori Iida
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Kaori Yasumura
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoh Arita
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
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Santos V, Massuça LM, Monteiro L, Angarten V, Abel MG, Fernhall B, Santa-Clara H. Comparison of Acute Arterial Responses Following a Rescue Simulation and Maximal Exercise in Professional Firefighters. Healthcare (Basel) 2023; 11:healthcare11071032. [PMID: 37046959 PMCID: PMC10093883 DOI: 10.3390/healthcare11071032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
Cardiovascular events are the leading cause of on-duty deaths among firefighters. Screening firefighters for risk of sudden cardiac event is a critical element of a comprehensive medical program. Although intense physical exertion has been shown to trigger sudden cardiac events in the general population, it is unclear how hemodynamic responses following clinical exercise testing compare to that of performing firefighting tasks in personal protective equipment. Therefore, the purpose of this study was to compare hemodynamic responses following rescue simulation (RS) and maximal exercise in firefighters. This was a cross-over repeated measures study. Thirty-eight professional firefighters (31.8 ± 5.2 yr; VO2peak: 57.9 mL/kg/min) completed a maximal aerobic exercise test (MAET) and an RS. Pulse wave velocity (PWV), pulse pressure (PP), and brachial and central mean arterial pressure (MAP) were measured before and 5 and 15 min post-exercise. The findings indicated that femoral PWV decreased after MAET and RS at both time points (p < 0.005). No significant differences were found in aortic and carotid PWV over time or between conditions (p ≥ 0.05). Significant increases in brachial and central PP and MAP were noted 5 min post-MAET and RS (p = 0.004). In conclusion, the present study demonstrated that peripheral arterial stiffness (AS) decreased in firefighters following both conditions, with no differences in central AS. Our findings provide valuable information on hemodynamic responses similar between RS and MAET, and are important for controlling CVD risk and the AS response.
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Affiliation(s)
- Vanessa Santos
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
- Kinesio Lab, Research Unit in Human Movement Analysis, Instituto Piaget, 2805-059 Almada, Portugal
- First Responder Research Laboratory, University of Kentucky, Lexington, KY 40506, USA
| | - Luís Miguel Massuça
- First Responder Research Laboratory, University of Kentucky, Lexington, KY 40506, USA
- CIDEFES, Lusófona University, 1749-024 Lisbon, Portugal
- ICPOL Research Center, Higher Institute of Police Sciences and Internal Security, 1300-352 Lisbon, Portugal
| | - Luís Monteiro
- First Responder Research Laboratory, University of Kentucky, Lexington, KY 40506, USA
- CIDEFES, Lusófona University, 1749-024 Lisbon, Portugal
- ICPOL Research Center, Higher Institute of Police Sciences and Internal Security, 1300-352 Lisbon, Portugal
| | - Vítor Angarten
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
| | - Mark G. Abel
- First Responder Research Laboratory, University of Kentucky, Lexington, KY 40506, USA
- ICPOL Research Center, Higher Institute of Police Sciences and Internal Security, 1300-352 Lisbon, Portugal
| | - Bo Fernhall
- College of Nursing and Health Sciences, University of Massachusetts, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | - Helena Santa-Clara
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
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Santos V, Massuça LM, Angarten V, Melo X, Pinto R, Fernhall B, Santa-Clara H. Arterial Stiffness Response to Acute Combined Training with Different Volumes in Coronary Artery Disease and Heart Failure Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14994. [PMID: 36429714 PMCID: PMC9690817 DOI: 10.3390/ijerph192214994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Resistance training has been shown to acutely increase arterial stiffness (AS), while endurance training appears to decrease AS. However, the findings are from studies in apparently healthy subjects and have limited applicability to patients at low and high cardiovascular risk, for whom combined exercise is recommended. We compared the time course of changes in local and regional indices of AS in response to high-volume combined endurance training (CET) and high-volume combined resistance training (CRT) in patients with coronary artery disease (CAD) and heart failure (HF). We studied 20 men with CAD and HF (10 each) aged 68.3 ± 9.6 years. AS was measured by pulse wave velocity (PWV), and brachial and central blood pressure (BP) were determined after 15 min of rest and 5 and 15 min after the exercise session. All patients completed two sessions on nonconsecutive days. A protocol by time interaction effect was observed for carotid (η2 = 0.21, p = 0.02), aortic (η2 = 0.60, p < 0.001), and femoral (η2 = 0.46, p = 0.01) PWV after CET and CRT, suggesting that PWV decreased after CET and increased after CRT. Decreases in the brachial and central variables of BP across time points were observed in both protocols. CET decreased whereas CRT increased carotid, aortic, and femoral PWV at 15 min after exercise in patients with CAD and HF.
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Affiliation(s)
- Vanessa Santos
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
- KinesioLab, Research Unit in Human Movement Analysis, Instituto Piaget, 2805-059 Almada, Portugal
| | - Luís Miguel Massuça
- ICPOL Research Center, Higher Institute of Police Sciences and Internal Security, 1300-352 Lisbon, Portugal
- CIDEFES—Research Center in Sport, Physical Education, Exercise and Health, Lusófona University, 1749-024 Lisbon, Portugal
| | - Vitor Angarten
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
| | - Xavier Melo
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health, 2829-511 Almada, Portugal
| | - Rita Pinto
- Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculty of Medicine, University of Lisbon, 1649-004 Lisboa, Portugal
| | - Bo Fernhall
- College of Nursing and Health Sciences, University of Massachusetts, 100 Morrissey Boulevard, Boston, MA 02125, USA
| | - Helena Santa-Clara
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisboa, Portugal
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6
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Santos V, Massuça LM, Angarten V, Melo X, Pinto R, Fernhall B, Santa-Clara H. Arterial Stiffness following Endurance and Resistance Exercise Sessions in Older Patients with Coronary Artery Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14697. [PMID: 36429412 PMCID: PMC9690428 DOI: 10.3390/ijerph192214697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Arterial stiffness (AS) is associated with coronary artery disease (CAD). Acute endurance training decreases AS, whereas acute resistance training increases it. However, these results are from studies in apparently healthy adults, and there is no information on the effects of such afterload AS in elderly patients with CAD. We aimed to investigate the effect of acute endurance or resistance training on the time course of changes in the indices of AS in elderly patients with CAD in order to understand how stiffness responds after training. We tested 18 trained men with CAD. AS was measured using central and peripheral pulse wave velocity (PWV) after 15 min of rest and after 5, 15, and 30 min of endurance and resistance training sessions. The endurance session consisted of high-intensity interval walking at 85-90% of maximum heart rate, and the resistance session consisted of 70% of the maximum of one repetition. An interaction effect was found for central and peripheral PWV (p ≤ 0.001; carotid, η2 = 0.72; aortic, η2 = 0.90; femoral, η2 = 0.74), which was due to an increase in PWV after resistance and a decrease in central and peripheral PWV after endurance. This study demonstrates that training mode influences the time course of AS responses to acute exercise in these patients. Acute endurance training decreased AS, whereas resistance training significantly increased it.
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Affiliation(s)
- Vanessa Santos
- CIPER, Exercise and Health Laboratory, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisbon, Portugal
- KinesioLab, Research Unit in Human Movement Analysis, Instituto Piaget, 2805-059 Almada, Portugal
| | - Luís Miguel Massuça
- ICPOL Research Center, Higher Institute of Police Sciences and Internal Security, 1349-040 Lisbon, Portugal
- CIDEFES—Research Center in Sport, Physical Education, Exercise and Health, Lusófona University, 1749-024 Lisbon, Portugal
| | - Vitor Angarten
- CIPER, Exercise and Health Laboratory, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisbon, Portugal
| | - Xavier Melo
- CIPER, Exercise and Health Laboratory, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisbon, Portugal
- Egas Moniz Interdisciplinary Research Center (CiiEM), Egas Moniz School of Health, 2829-511 Almada, Portugal
| | - Rita Pinto
- Structural and Coronary Heart Disease Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculty of Medicine, University of Lisbon, 1649-004 Lisbon, Portugal
| | - Bo Fernhall
- College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125-3393, USA
| | - Helena Santa-Clara
- CIPER, Exercise and Health Laboratory, Faculdade de Motricidade Humana, Universidade de Lisboa, Cruz Quebrada, 1649-004 Lisbon, Portugal
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7
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(Home-based remote cardiovascular rehabilitation in a patient after coronary intervention during COVID-19 pandemic - a case study). COR ET VASA 2022. [DOI: 10.33678/cor.2021.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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Calegari L, Moreira I, Falkowski A, Reolão JBC, Karsten M, Deresz LF. Agreement between heart rate at first ventilatory threshold on treadmill and at 6-min walk test in coronary artery disease patients on β-blockers treatment. J Exerc Rehabil 2021; 17:362-368. [PMID: 34805026 PMCID: PMC8566104 DOI: 10.12965/jer.2142488.244] [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] [Received: 08/16/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to verify the accuracy of the agreement between heart rate at the first ventilatory threshold (HRVT1) and heart rate at the end of the 6-min walk test (HR6MWT) in coronary artery disease (CAD) patients on β-blockers treatment. This was a cross-sectional study with stable CAD patients, which performed a cardiopulmonary exercise test (CPET) on a treadmill and a 6-min walk test (6MWT) on nonconsecutive days. The accuracy of agreement between HRVT1 and HR6MWT was evaluated by Bland–Altman analysis and Lin’s concordance correlation coefficient (rc), mean absolute percentage error (MAPE), and standard error of estimate (SEE). Seventeen stable CAD patients on β-blockers treatment (male, 64.7%; age, 61±10 years) were included in data analysis. The Bland–Altman analysis revealed a negative bias of −0.41±6.4 bpm (95% limits of agreements, −13 to 12.2 bpm) between HRVT1 and HR6MWT. There was acceptable agreement between HRVT1 and HR6MWT (rc=0.84; 95% confidence interval, 0.63 to 0.93; study power analysis=0.79). The MAPE of the HR6MWT was 5.1% and SEE was 6.6 bpm. The ratio HRVT1/HRpeak and HR6MWT/HRpeak from CPET were not significantly different (81%±5% vs. 81%±6%, P=0.85); respectively. There was a high correlation between HRVT1 and HR6MWT (r=0.85, P<0.0001). Finally, the results of the present study demonstrate that there was an acceptable agreement between HRVT1 and HR6MWT in CAD patients on β-blockers treatment and suggest that HR6MWT may be useful to prescribe and control aerobic exercise intensity in cardiac rehabilitation programs.
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Affiliation(s)
- Leonardo Calegari
- Physical Therapy Department, Faculdade Especializada da Área da Saúde do Rio Grande do Sul (FASURGS), Passo Fundo, RS, Brazil
| | - Igor Moreira
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Andrei Falkowski
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | | | - Marlus Karsten
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Graduate Program in Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Physical Education Department, Health Sciences Institute, Universidade Federal de Juiz de Fora, Governador Valadares, Brazil.,Post Graduation Program in Health Applied Sciences, Universidade Federal de Juiz de Fora, Campus Governador Valadares, MG, Brazil.,Research Group Ciência, Saúde e Desempenho Físico, Universidade Federal de Juiz de Fora, Campus Governador Valadares, MG, Brazil
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10
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Taylor JL, Bonikowske AR, Olson TP. Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity. Front Cardiovasc Med 2021; 8:734278. [PMID: 34540924 PMCID: PMC8446279 DOI: 10.3389/fcvm.2021.734278] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/31/2021] [Indexed: 01/04/2023] Open
Abstract
Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO2peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.
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Affiliation(s)
- Jenna L Taylor
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Amanda R Bonikowske
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Thomas P Olson
- Division of Preventative Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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11
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Mallet RT, Burtscher J, Richalet JP, Millet GP, Burtscher M. Impact of High Altitude on Cardiovascular Health: Current Perspectives. Vasc Health Risk Manag 2021; 17:317-335. [PMID: 34135590 PMCID: PMC8197622 DOI: 10.2147/vhrm.s294121] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Globally, about 400 million people reside at terrestrial altitudes above 1500 m, and more than 100 million lowlanders visit mountainous areas above 2500 m annually. The interactions between the low barometric pressure and partial pressure of O2, climate, individual genetic, lifestyle and socio-economic factors, as well as adaptation and acclimatization processes at high elevations are extremely complex. It is challenging to decipher the effects of these myriad factors on the cardiovascular health in high altitude residents, and even more so in those ascending to high altitudes with or without preexisting diseases. This review aims to interpret epidemiological observations in high-altitude populations; present and discuss cardiovascular responses to acute and subacute high-altitude exposure in general and more specifically in people with preexisting cardiovascular diseases; the relations between cardiovascular pathologies and neurodegenerative diseases at altitude; the effects of high-altitude exercise; and the putative cardioprotective mechanisms of hypobaric hypoxia.
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Affiliation(s)
- Robert T Mallet
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Johannes Burtscher
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Jean-Paul Richalet
- Laboratoire Hypoxie & Poumon, UMR Inserm U1272, Université Sorbonne Paris Nord 13, Bobigny Cedex, F-93017, France
| | - Gregoire P Millet
- Department of Biomedical Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
- Institute of Sport Sciences, University of Lausanne, Lausanne, CH-1015, Switzerland
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, A-6020, Austria
- Austrian Society for Alpine and High-Altitude Medicine, Mieming, Austria
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Batalik L, Konecny V, Dosbaba F, Vlazna D, Brat K. Cardiac Rehabilitation Based on the Walking Test and Telerehabilitation Improved Cardiorespiratory Fitness in People Diagnosed with Coronary Heart Disease during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052241. [PMID: 33668304 PMCID: PMC7956401 DOI: 10.3390/ijerph18052241] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 02/07/2023]
Abstract
This study investigated an alternative home-based cardiac telerehabilitation model in consideration of the recommendations for the COVID-19 quarantine of people diagnosed with coronary heart disease (CHD). We hypothesized that using a 200 m fast walking test (200 mFWT) and telerehabilitation would create an effective alternative cardiac rehabilitation (CR) intervention that could improve cardiorespiratory fitness. Participants (n = 19, mean age 60.4 ± 9.6) of the 8-week intervention performed regular physical exercise at the target heart rate zone determined by calculations based on the 200 mFWT results. In our study, the participants were supervised using telerehabilitation. A total of 84% of participants completed the 8-week intervention. No adverse events were reported during telerehabilitation. The study participants noted a significant improvement (p < 0.001) in cardiorespiratory fitness expressed by an 8% reduction in the walking test time (Δ 8.8 ± 5.9 s). Home-based telerehabilitation based on 200 mFWT effectively increased the cardiorespiratory fitness in people with CHD with a low to moderate cardiovascular risk. This was a novel approach in CR during the COVID-19 pandemic. As research in this area is justified, this paper may serve as an alternative method of providing healthcare during the COVID-19 pandemic and as a basis for further upcoming randomized controlled trials.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (F.D.); (D.V.)
- Department of Public Health, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
- Correspondence:
| | - Vladimir Konecny
- Non-Government Health Facility, Cardiovascular Rehabilitation, 62500 Brno, Czech Republic;
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (F.D.); (D.V.)
| | - Daniela Vlazna
- Department of Rehabilitation, University Hospital Brno, 62500 Brno, Czech Republic; (F.D.); (D.V.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
| | - Kristian Brat
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic;
- Department of Respiratory Diseases, University Hospital Brno, 62500 Brno, Czech Republic
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Dolecińska D, Przywarska I, Podgórski T, Dylewicz P, Lewandowski J. Use of the six-minute walk test in exercise prescription in male patients after coronary artery bypass surgery. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2020; 17:183-188. [PMID: 33552181 PMCID: PMC7848618 DOI: 10.5114/kitp.2020.102340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION It is unclear whether it is possible to determine the training load on the basis of the 6-minute walk test (6-MWT) in patients after cardiac surgery with low tolerance of physical exercise. AIM Use of the 6-MWT to determine an individual initial training load in walking training on a treadmill in the early phase of cardiac rehabilitation in men after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Twenty-two men aged 54 to 74 years, up to 3 months after CABG surgery participated in walking training on a treadmill (12-15 sessions). Patients underwent the initial and final treadmill exercise stress test (TEST) and the 6-MWT. Based on 6-MWT results, the initial training load was prescribed. Before the 6-MWT and 3 minutes after its completion, lactate concentration was determined. RESULTS The 6-MWT distance increased from 420 ±80 m to 519 ±61 m (p < 0.001), and the energy expenditure from 4.4 ±1.4 MET to 6.3 ±1.3 MET (p < 0.001). There was a positive correlation between 6-MWT distance and energy expenditure in the TEST before rehabilitation (r = 0.60, p = 0.005), and after rehabilitation (r = 0.75, p < 0.001). A negative correlation was found between the baseline 6-MWT distance and distance increment in the final 6-MWT (r = -0.66, p = 0.002). The 6-MWT did not induce hyperlactatemia. CONCLUSIONS The 6-MWT can be used in exercise intensity prescription, especially for determining the individual initial training load, load progression, as well as its correction during follow-up tests.
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Affiliation(s)
- Dorota Dolecińska
- Department of Motor Organ Rehabilitation, Poznan University of Physical Education, Poznan, Poland
| | - Izabela Przywarska
- Department of Cardiological and Rheumatological Rehabilitation, Poznan University of Physical Education, Poznan, Poland
| | - Tomasz Podgórski
- Department of Physiology and Biochemistry, Poznan University of Physical Education, Poznan, Poland
| | - Piotr Dylewicz
- Institute of Health and Physical Education, Jan Amos Komenski State School of Higher Vocational Education, Leszno, Poland
| | - Jacek Lewandowski
- Department of Motor Organ Rehabilitation, Poznan University of Physical Education, Poznan, Poland
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Short-Term Exercise Progression of Cardiovascular Patients throughout Cardiac Rehabilitation: An Observational Study. J Clin Med 2020; 9:jcm9103160. [PMID: 33003544 PMCID: PMC7601310 DOI: 10.3390/jcm9103160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiac rehabilitation (CR) is a highly recommended secondary prevention measure for patients with diagnosed cardiovascular disease. Unfortunately, participation rates are low due to enrollment and adherence issues. As such, new CR delivery strategies are of interest, as to improve overall CR delivery. The goal of the study was to obtain a better understanding of the short-term progression of functional capacity throughout multidisciplinary CR, measured as the change in walking distance between baseline six-minute walking test (6MWT) and four consecutive follow-up tests. One-hundred-and-twenty-nine patients diagnosed with cardiovascular disease participated in the study, of which 89 patients who completed the whole study protocol were included in the statistical analysis. A one-way repeated measures ANOVA was conducted to determine whether there was a significant change in mean 6MWT distance (6MWD) throughout CR. A three-way-mixed ANOVA was performed to determine the influence of categorical variables on the progression in 6MWD between groups. Significant differences in mean 6MWD between consecutive measurements were observed. Two subgroups were identified based on the change in distance between baseline and end-of-study. Patients who increased most showed a linear progression. In the other group progression leveled off halfway through rehabilitation. Moreover, the improvement during the initial phase of CR seemed to be indicative for overall progression. The current study adds to the understanding of the short-term progression in exercise capacity of patients diagnosed with cardiovascular disease throughout a CR program. The results are not only of interest for CR in general, but could be particularly relevant in the setting of home-based CR.
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Validity of the Incremental Shuttle Walk Test to Assess Exercise Safety When Initiating Cardiac Rehabilitation in Low-Resource Settings. J Cardiopulm Rehabil Prev 2020; 39:E1-E7. [PMID: 31022005 DOI: 10.1097/hcr.0000000000000412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the validity of the Incremental Shuttle Walk Test (ISWT) for determining risk stratification in cardiac rehabilitation (CR). METHODS This is a cross-sectional study at a major CR center in a middle-income country. Clinically stable adult cardiac patients underwent an ISWT and an exercise test (ET), wore a pedometer for 7 d, and completed the Godin-Shepherd Leisure-Time Physical Activity Questionnaire. Metabolic equivalents of task (METs) achieved on the ISWT were calculated. RESULTS One hundred fifteen patients were evaluated. The mean ± standard deviation distance on the ISWT was 372.70 ± 128.52 m and METs were 5.03 ± 0.62. The correlation of ISWT distance with ET METs (7.57 ± 2.57), steps/d (4556.71 ± 3280.88), and self-reported exercise (13.08 ± 15.19) was rs = 0.61 (P < .001), rs = 0.37 (P < .001), and rs = 0.20 (P = .031), respectively. Distance on the ISWT accurately predicted METs from the ET (area under the receiver operating characteristic curve = 0.774). The ability to walk ≥410 m on the ISWT predicted, with a specificity of 81.5% and a sensitivity of 65.6%, a functional capacity of ≥7 METs on ET. CONCLUSION The ISWT is an alternative way to evaluate functional capacity in CR and can contribute to the process of identifying patients at low risk for a cardiac event during exercise at moderate intensity.
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De Cannière H, Smeets CJP, Schoutteten M, Varon C, Van Hoof C, Van Huffel S, Groenendaal W, Vandervoort P. Using Biosensors and Digital Biomarkers to Assess Response to Cardiac Rehabilitation: Observational Study. J Med Internet Res 2020; 22:e17326. [PMID: 32432552 PMCID: PMC7270861 DOI: 10.2196/17326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/06/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is known for its beneficial effects on functional capacity and is a key component within current cardiovascular disease management strategies. In addition, a larger increase in functional capacity is accompanied by better clinical outcomes. However, not all patients respond in a similar way to CR. Therefore, a patient-tailored approach to CR could open up the possibility to achieve an optimal increase in functional capacity in every patient. Before treatment can be optimized, the differences in response of patients in terms of cardiac adaptation to exercise should first be understood. In addition, digital biomarkers to steer CR need to be identified. OBJECTIVE The aim of the study was to investigate the difference in cardiac response between patients characterized by a clear improvement in functional capacity and patients showing only a minor improvement following CR therapy. METHODS A total of 129 patients in CR performed a 6-minute walking test (6MWT) at baseline and during four consecutive short-term follow-up tests while being equipped with a wearable electrocardiogram (ECG) device. The 6MWTs were used to evaluate functional capacity. Patients were divided into high- and low-response groups, based on the improvement in functional capacity during the CR program. Commonly used heart rate parameters and cardiac digital biomarkers representative of the heart rate behavior during the 6MWT and their evolution over time were investigated. RESULTS All participating patients improved in functional capacity throughout the CR program (P<.001). The heart rate parameters, which are commonly used in practice, evolved differently for both groups throughout CR. The peak heart rate (HRpeak) from patients in the high-response group increased significantly throughout CR, while no change was observed in the low-response group (F4,92=8.321, P<.001). Similar results were obtained for the recovery heart rate (HRrec) values, which increased significantly over time during every minute of recuperation, for the high-response group (HRrec1: P<.001, HRrec2: P<.001, HRrec3: P<.001, HRrec4: P<.001, and HRrec5: P=.02). The other digital biomarkers showed that the evolution of heart rate behavior during a standardized activity test differed throughout CR between both groups. These digital biomarkers, derived from the continuous measurements, contribute to more in-depth insight into the progression of patients' cardiac responses. CONCLUSIONS This study showed that when using wearable sensor technology, the differences in response of patients to CR can be characterized by means of commonly used heart rate parameters and digital biomarkers that are representative of cardiac response to exercise. These digital biomarkers, derived by innovative analysis techniques, allow for more in-depth insights into the cardiac response of cardiac patients during standardized activity. These results open up the possibility to optimized and more patient-tailored treatment strategies and to potentially improve CR outcome.
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Affiliation(s)
- Hélène De Cannière
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Christophe J P Smeets
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Holst Centre, imec the Netherlands, Eindhoven, Netherlands
| | - Melanie Schoutteten
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Carolina Varon
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- Circuits and Systems (CAS), Department of Microelectronics, Delft University of Technology (TU Delft), Delft, Netherlands
| | - Chris Van Hoof
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
- imec vzw Belgium, Leuven, Belgium
| | - Sabine Van Huffel
- Center for Dynamical Systems, Signal Processing and Data Analytics (STADIUS), Department of Electrical Engineering (ESAT), KU (Katholieke Universiteit) Leuven, Leuven, Belgium
| | | | - Pieter Vandervoort
- Mobile Health Unit, Limburg Clinical Research Center (LCRC), Faculty of Medicine and Life Sciences, Hasselt University (UHasselt), Diepenbeek, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Genk, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
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Davos CH. Do we have to reconsider the guidelines for exercise intensity determination in cardiovascular rehabilitation? Eur J Prev Cardiol 2019; 26:1918-1920. [PMID: 31446786 DOI: 10.1177/2047487319871870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
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Khushhal A, Nichols S, Carroll S, Abt G, Ingle L. Insufficient exercise intensity for clinical benefit? Monitoring and quantification of a community-based Phase III cardiac rehabilitation programme: A United Kingdom perspective. PLoS One 2019; 14:e0217654. [PMID: 31194759 PMCID: PMC6563987 DOI: 10.1371/journal.pone.0217654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background In recent years, criticism of the percentage range approach for individualised exercise prescription has intensified and we were concerned that sub-optimal exercise dose (especially intensity) may be in part responsible for the variability in the effectiveness of cardiac rehabilitation (CR) programmes in the United Kingdom (UK). The aim was to investigate the fidelity of a structured Phase III CR programme, by monitoring and quantifying exercise training intensity. Design Observational study. Methods The programme comprised 16 sessions over 8 weeks, where patients undertook an interval, circuit training approach within national guidelines for exercise prescription (40–70% heart rate reserve [HRR]). All patients wore an Apple Watch (Series 0 or 2, Watch OS2.0.1, Apple Inc., California, USA). We compared the mean % heart rate reserve (%HRR) achieved during the cardiovascular training component (%HRR-CV) of a circuit-based programme, with the %HRR during the active recovery phases (%HRR-AR) in a randomly selected cohort of patients attending standard CR. We then compared the mean %HRR-CV achieved with the minimal exercise intensity threshold during supervised exercise (40% HRR) recommended by national governing bodies. Results Thirty cardiac patients (83% male; mean age [SD] 67 [10] years; BMI 28.3 [4.6] kg∙m-2) were recruited. We captured 332 individual training sessions. The mean %HRR-CV and %HRR-AR were 37 (10) %, and 31 (13) %, respectively. There was weak evidence to support the alternative hypothesis of a difference between the %HRR-CV and 40% HRR. There was very strong evidence to accept the alternative hypothesis that the mean %HRR-AR was lower than the mean %HRR-CV, median standardised effect size 1.1 (95%CI: 0.563 to 1.669), with a moderate to large effect. Conclusion Mean exercise training intensity was below the lower limit of the minimal training intensity guidelines for a Phase III CR programme. These findings may be in part responsible for previous reports highlighting the significant variability in effectiveness of UK CR services and poor CRF improvements observed from several prior investigations.
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Affiliation(s)
- Alaa Khushhal
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Sean Carroll
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Grant Abt
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Kingston-upon-Hull, United Kingdom
- * E-mail:
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Morishita S, Tsubaki A, Hotta K, Fu JB, Fuji S. The benefit of exercise in patients who undergo allogeneic hematopoietic stem cell transplantation. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2019; 2:54-61. [PMID: 31131374 DOI: 10.4103/jisprm.jisprm_2_19] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (allo-HSCT) is increasingly used in the treatment of hematologic cancers such as leukemias, lymphomas, and myeloma, and for other hematologic disorders such as primary immunodeficiency, aplastic anemia, and myelodysplasia. Allo-HSCT entails a conditioning regimen of frequent high-dose chemotherapy in combination with total body irradiation, followed by infusion of donor-harvested bone marrow or peripheral blood stem cells. As an aggressive and demanding medical therapy that profoundly impacts patient quality of life (QOL), allo-HSCT is associated with numerous treatment-related physical, psychological, and psychosocial side effects. The procedure can result in decreased respiratory and balance function, skeletal muscle strength, and exercise capacity. Thus, as physical exercise has been shown to positively effect physical and psychosocial function and QOL in allo-HSCT patients, it is a recommended intervention for improving essential functions and offsetting lost exercise capacity after the procedure. Furthermore, recent evidence has shown that physical exercise can influence survival rate and mortality in allo-HSCT patients. This review provides an overview of the current research on the effectiveness of physical exercise for allo-HSCT patients.
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Affiliation(s)
- Shinichiro Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Kazuki Hotta
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Tel: +81-25-257-4300
| | - Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA, Tel: +1-713-745- 2327
| | - Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, Osaka, Japan, Tel: +81-6-6945-1900
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Grafe K, Bendick P, Burr M, Boura J, Franklin BA. Effects of Resistance Training on Vascular and Hemodynamic Responses in Patients With Coronary Artery Disease. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2018; 89:457-464. [PMID: 30300089 DOI: 10.1080/02701367.2018.1519385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study was to determine the impact of adjunctive resistance training (RT) in aerobically trained patients with coronary artery disease on systolic blood pressure (SBP), heart rate (HR), rating of perceived exertion (RPE; using the traditional 6-to-20 scale), and rate-pressure product (RPP) responses to lifting fixed submaximal workloads. Additionally, pretest and posttest RT measures of brachial artery reactivity were obtained. METHOD Fifteen patients with coronary artery disease (Mage = 66.1 ± 5.1 years) who were already performing regular aerobic exercise completed an adjunctive 12-week progressive RT program. Prior to and immediately after the training period, hemodynamic responses and RPE were obtained while participants performed one set of exercises including the bicep curl (BC), shoulder press (SP), and leg press (LP) at individually determined fixed submaximal loads, using ~ 60% to 80% of estimated maximal voluntary contraction. Vascular function was assessed by flow-mediated vasodilation (FMD) testing before and after training. RESULTS Attenuated hemodynamic and RPE responses for all variables were observed. Meaningful changes were attained for RPP ([HR × SBP] / 100) during BC (106 ± 27 mmHg × beats/min × 10-2 to 91 ± 22 mmHg × beats/min × 10-2, d = 0.6, p < .05) and SP (102 ± 24 mmHg × beats/min × 10-2 to 86 ± 17 mmHg × beats/min × 10-2, d = 0.8, p < .05). Rating of perceived exertion decreased significantly during all exercises (d ranging from 1.8 to 3.1, p < .05): BC (14.3 ± 2.6 to 9.7 ± 1.6), SP (13.9 ± 1.6 to 9.2 ± 1.5), and LP (14.3 ± 1.4 to 10.3 ± 1.6). Peak group FMD responses were 12.8% and 10.3% dilation at pretraining and posttraining, respectively (p > .05). Five of the 15 participants showed modest improvements in their posttraining time to achieve maximum dilation from a mean of 117 s to 81 s, although this change was not statistically significant (p > .05). CONCLUSION Among aerobically trained cardiac patients, a supplemental RT program resulted in decreased hemodynamic and RPE responses to lifting fixed submaximal workloads.
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Saini M, Kulandaivelan S, Devi P, Saini V. The talk test-A costless tool for exercise prescription in Indian cardiac rehabilitation. Indian Heart J 2018; 70 Suppl 3:S466-S470. [PMID: 30595308 PMCID: PMC6309710 DOI: 10.1016/j.ihj.2018.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022] Open
Abstract
Exercise-based cardiac rehabilitation (CR) plays a vital role in improving function and preventing mortality of cardiovascular disease (CVD) patients. Outpatient (Phase II and III) CR is almost nonexistent in India because of several reasons such as time, cost, distance, education level, scarcity of resources and so forth. Cardiologists or cardiac surgeons can directly advise patients and their family members to do an optimal dose of exercise in low-resource settings, that is, rural, low-income, or low-educated patients. Talk test is a no-cost, subjective tool for exercise prescription which is gaining popularity in CR because of its simplicity. This brief descriptive review covers history, administration, physiological mechanisms, reliability and validity, and safety among cardiac patients along with limitations of the ‘talk test’. This review also theoretically discusses how the talk test could be used in primary and secondary prevention of CVD. Finally, it advocates Indian CR team to use this simple validated tool as a self-monitoring tool of exercise intensity.
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Affiliation(s)
- Minaxi Saini
- Mother Teresa Saket College of Physiotherapy, Panchkula, Haryana, India
| | | | - Poovishnu Devi
- Krishna College of Physiotherapy, KIMDU, Karad, Maharashtra, India
| | - Vikram Saini
- Maharaja Agrasen Medical College, Agroha, Haryana, India
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Mourot L. Limitation of Maximal Heart Rate in Hypoxia: Mechanisms and Clinical Importance. Front Physiol 2018; 9:972. [PMID: 30083108 PMCID: PMC6064954 DOI: 10.3389/fphys.2018.00972] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022] Open
Abstract
The use of exercise intervention in hypoxia has grown in popularity amongst patients, with encouraging results compared to similar intervention in normoxia. The prescription of exercise for patients largely rely on heart rate recordings (percentage of maximal heart rate (HRmax) or heart rate reserve). It is known that HRmax decreases with high altitude and the duration of the stay (acclimatization). At an altitude typically chosen for training (2,000-3,500 m) conflicting results have been found. Whether or not this decrease exists or not is of importance since the results of previous studies assessing hypoxic training based on HR may be biased due to improper intensity. By pooling the results of 86 studies, this literature review emphasizes that HRmax decreases progressively with increasing hypoxia. The dose–response is roughly linear and starts at a low altitude, but with large inter-study variabilities. Sex or age does not seem to be a major contributor in the HRmax decline with altitude. Rather, it seems that the greater the reduction in arterial oxygen saturation, the greater the reduction in HRmax, due to an over activity of the parasympathetic nervous system. Only a few studies reported HRmax at sea/low level and altitude with patients. Altogether, due to very different experimental design, it is difficult to draw firm conclusions in these different clinical categories of people. Hence, forthcoming studies in specific groups of patients are required to properly evaluate (1) the HRmax change during acute hypoxia and the contributing factors, and (2) the physiological and clinical effects of exercise training in hypoxia with adequate prescription of exercise training intensity if based on heart rate.
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Affiliation(s)
- Laurent Mourot
- EA 3920 Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation Platform, University of Franche-Comté, Besançon, France.,Tomsk Polytechnic University, Tomsk, Russia
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