1
|
Sejersen C, Volianitis S, Secher NH. The athlete's heart: allometric considerations on published papers and relation to cardiovascular variables. Eur J Appl Physiol 2024; 124:1337-1346. [PMID: 38466432 DOI: 10.1007/s00421-024-05449-8] [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: 07/20/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
To evaluate the morphology of the "athlete's heart", left ventricular (LV) wall thickness (WT) and end-diastolic internal diameter (LVIDd) at rest were addressed in publications on skiers, rowers, swimmers, cyclists, runners, weightlifters (n = 927), and untrained controls (n = 173) and related to the acute and maximal cardiovascular response to their respective disciplines. Dimensions of the heart at rest and functional variables established during the various sport disciplines were scaled to body weight for comparison among athletes independent of body mass. The two measures of LV were related (r = 0.8; P = 0.04) across athletic disciplines. With allometric scaling to body weight, LVIDd was similar between weightlifters and controls but 7%-15% larger in the other athletic groups, while WT was 9%-24% enlarged in all athletes. The LVIDd was related to stroke volume, oxygen pulse, maximal oxygen uptake, cardiac output, and blood volume (r = ~ 0.9, P < 0.05), while there was no relationship between WT and these variables (P > 0.05). In conclusion, while cardiac enlargement is, in part, essential for the generation of the cardiac output and thus stroke volume needed for competitive endurance exercise, an enlarged WT seems important for the development of the wall tension required for establishing normal arterial pressure in the enlarged LVIDd.
Collapse
Affiliation(s)
- Casper Sejersen
- Department of Anaesthesia, Department of Clinical Medicine, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen Ø, Denmark.
| | - Stefanos Volianitis
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
| | - Niels H Secher
- Department of Anaesthesia, Department of Clinical Medicine, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
| |
Collapse
|
2
|
Husaini M, Emery MS. Cardiopulmonary Exercise Testing Interpretation in Athletes: What the Cardiologist Should Know. Card Electrophysiol Clin 2024; 16:71-80. [PMID: 38280815 DOI: 10.1016/j.ccep.2023.09.008] [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] [Indexed: 01/29/2024]
Abstract
The noninvasive assessment of oxygen consumption, carbon dioxide production, and ventilation during a cardiopulmonary exercise test (CPET) provides insight into the cardiovascular, pulmonary, and metabolic system's ability to respond to exercise. Exercise physiology has been shown to be distinct for competitive athletes and highly active persons (CAHAPs), thus creating more nuanced interpretations of CPET parameters. CPET in CAHAP is an important test that can be used for both diagnosis (provoking symptoms during a truly maximal test) and performance.
Collapse
Affiliation(s)
- Mustafa Husaini
- Department of Medicine, Division of Cardiovascular Medicine, Washington University School of Medicine, 4921 Parkview Place, Saint Louis, MO 63110, USA. https://twitter.com/husainim
| | - Michael S Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, Desk J2-4, Cleveland, OH 44195, USA.
| |
Collapse
|
3
|
Wang H, Wang J, Lyu L, Wei S, Zhang C. Numerical simulation on mass transfer in the bone lacunar-canalicular system under different gravity fields. Comput Methods Biomech Biomed Engin 2024; 27:478-488. [PMID: 36912751 DOI: 10.1080/10255842.2023.2187738] [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: 12/06/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
The bone lacunar-canalicular system (LCS) is a unique complex 3D microscopic tubular network structure within the osteon that contains interstitial fluid flow to ensure the efficient transport of signaling molecules, nutrients, and wastes to guarantee the normal physiological activities of bone tissue. The mass transfer laws in the LCS under microgravity and hypergravity are still unclear. In this paper, a multi-scale 3D osteon model was established to mimic the cortical osteon, and a finite element method was used to numerically analyze the mass transfer in the LCS under hypergravity, normal gravity and microgravity and combined with high-intensity exercise conditions. It was shown that hypergravity promoted mass transfer in the LCS to the deep lacunae, and the number of particles in lacunae increased more significantly from normal gravity to hypergravity the further away from the Haversian canal. The microgravity environment inhibited particles transport in the LCS to deep lacunae. Under normal gravity and microgravity, the number of particles in lacunae increased greatly when doing high-intensity exercise compared to stationary standing. This paper presents the first simulation of mass transfer within the LCS with different gravity fields combined with high-intensity exercise using the finite element method. The research suggested that hypergravity can greatly promote mass transfer in the LCS to deep lacunae, and microgravity strongly inhibited this mass transfer; high-intensity exercise increased the mass transfer rate in the LCS. This study provided a new strategy to combat and treat microgravity-induced osteoporosis.
Collapse
Affiliation(s)
- Hao Wang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Jiaming Wang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Linwei Lyu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Shuping Wei
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Chunqiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| |
Collapse
|
4
|
Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [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: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
Collapse
Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| |
Collapse
|
5
|
Pesova P, Jiravska Godula B, Jiravsky O, Jelinek L, Sovova M, Moravcova K, Ozana J, Gajdusek L, Miklik R, Sknouril L, Neuwirth R, Sovova E. Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort. J Cardiovasc Dev Dis 2023; 10:480. [PMID: 38132648 PMCID: PMC10743421 DOI: 10.3390/jcdd10120480] [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: 10/30/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.
Collapse
Affiliation(s)
- Petra Pesova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Bogna Jiravska Godula
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Otakar Jiravsky
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Libor Jelinek
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Marketa Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Katarina Moravcova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Jaromir Ozana
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| | - Libor Gajdusek
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Roman Miklik
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Libor Sknouril
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
| | - Radek Neuwirth
- Sports Cardiology Center, Nemocnice Agel Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic (R.N.)
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Eliska Sovova
- Faculty of Medicine, Palacky University, Krizkovskeho 511/8, 779 00 Olomouc, Czech Republic; (P.P.); (B.J.G.)
| |
Collapse
|
6
|
Nayor M, Gajjar P, Murthy VL, Miller P, Velagaleti RS, Larson MG, Vasan RS, Lewis GD, Mitchell GF, Shah RV. Blood Pressure Responses During Exercise: Physiological Correlates and Clinical Implications. Arterioscler Thromb Vasc Biol 2023; 43:163-173. [PMID: 36384270 PMCID: PMC9780190 DOI: 10.1161/atvbaha.122.318512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Abnormal blood pressure (BP) responses to exercise can predict adverse cardiovascular outcomes, but their optimal measurement and definitions are poorly understood. We combined frequently sampled BP during cardiopulmonary exercise testing with vascular stiffness assessment to parse cardiac and vascular components of exercise BP. METHODS Cardiopulmonary exercise testing with BP measured every two minutes and resting vascular tonometry were performed in 2858 Framingham Heart Study participants. Linear regression was used to analyze sex-specific exercise BP patterns as a function of arterial stiffness (carotid-femoral pulse wave velocity) and cardiac-peripheral performance (defined by peak O2 pulse). RESULTS Our sample was balanced by sex (52% women) with mean age 54±9 years and 47% with hypertension. We observed variability in carotid-femoral pulse wave velocity and peak O2 pulse across individuals with clinically defined exercise hypertension (peak systolic BP [SBP] in men ≥210 mm Hg; in women ≥190 mm Hg). Despite similar resting SBP and cardiometabolic profiles, individuals with higher peak O2 pulse displayed higher peak SBP (P≤0.017) alongside higher fitness levels (P<0.001), suggesting that high peak exercise SBP in the context of high peak O2 pulse may in fact be favorable. Although both higher (favorable) O2 pulse and higher (adverse) arterial stiffness were associated with greater peak SBP (P<0.0001 for both), the magnitude of association of carotid-femoral pulse wave velocity with peak SBP was higher in women (sex-carotid-femoral pulse wave velocity interaction P<0.0001). In sex-specific models, exercise SBP measures accounting for workload (eg, SBP during unloaded exercise, SBP at 75 watts, and SBP/workload slope) were directly associated with the adverse features of greater arterial stiffness and lower peak O2 pulse. CONCLUSIONS Higher peak exercise SBP reflects a complex trade-off between arterial stiffness and cardiac-peripheral performance that differs by sex. Studies of BP responses to exercise accounting for vascular and cardiac physiology may illuminate mechanisms of hypertension and clarify clinical interpretation of exercise BP.
Collapse
Affiliation(s)
- Matthew Nayor
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Preventive Medicine and Epidemiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
| | - Priya Gajjar
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Venkatesh L. Murthy
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor
| | - Patricia Miller
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Raghava S. Velagaleti
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- Cardiology Section, Department of Medicine, Boston VA Healthcare System, West Roxbury, Massachusetts
| | - Martin G. Larson
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Ramachandran S. Vasan
- Cardiovascular Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Preventive Medicine and Epidemiology Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Boston University’s and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, MA
- University of Texas School of Public Health San Antonio, and Departments of Medicine and Population Health Sciences, University of Texas Health Science Center, San Antonio, TX
- Department of Epidemiology, Boston University School of Public Health, and the Center for Computing and Data Sciences, Boston University, Boston, MA
| | - Gregory D. Lewis
- Cardiology Division and Pulmonary Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Ravi V. Shah
- Vanderbilt Translational and Clinical Research Center, Cardiology Division, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
7
|
Wang H, Gao L, Chen X, Zhang C. Study on mass transfer in the bone lacunar-canalicular system under different gravity fields. J Bone Miner Metab 2022; 40:940-950. [PMID: 36350408 DOI: 10.1007/s00774-022-01373-z] [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: 07/15/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The bone lacunar-canalicular system (LCS) is an important microstructural basis for signaling and material transport in bone tissue, guaranteeing normal physiological processes in tissues. Spaceflight astronauts and elderly osteoporosis are related to its function, so it is necessary to reveal the mass transfer laws in bone microstructure under different gravity fields to provide insight for effective clinical treatment. MATERIALS AND METHODS Using the natural LCS structure of bovine tibial cortical bone as the object, the mass transfer experiments on cortical bone were conducted by using sodium fluorescein tracer through different frequency pulsating pressure provided by dynamic perfusion loading device and different high G environments provided by high-speed centrifuge to analyze the mass transfer laws under different gravity fields and different pulsating pressures. RESULTS The fluorescence intensity of lacunae within the osteon was lower the farther away from the Haversian canal. As the gravity field magnitude increased, the fluorescence intensity within each lacuna enhanced, and the more distant the lacunae from the Haversian canal, the greater the fluorescence intensity enhancement. High-frequency pulsating pressure simulated high-intensity exercise in humans can improve mass transfer efficiency in the LCS. CONCLUSION High-intensity exercise may greatly increase solute molecules, nutrients, and signaling molecules in osteocytes and improve the activity of osteocytes. Hypergravity can enhance the transport of solute molecules, nutrients, and signaling molecules in the LCS, especially promoting mass transfer to deep layer lacunae. Conversely, mass transfer to deep layer lacunae may be inhibited under microgravity, causing bone loss and ultimately leading to osteoporosis.
Collapse
Affiliation(s)
- Hao Wang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, People's Republic of China
| | - Lilan Gao
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, People's Republic of China
| | - Xuyi Chen
- Characteristic Medical Center of People's Armed Police Forces, Institute of Brain Trauma and Neurological Diseases of the Armed Police Force, Tianjin, People's Republic of China.
| | - Chunqiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, People's Republic of China.
| |
Collapse
|
8
|
Hypertensive Response to Exercise in Athletes: Unremarkable Finding or Relevant Marker for Future Cardiovascular Complications? Int J Hypertens 2022; 2022:8476751. [DOI: 10.1155/2022/8476751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background. In the general population, hypertensive response to exercise (HRE) predicts new-onset resting hypertension or other cardiovascular diseases. Methods. PubMed was searched for English articles published between January 1st 2000 and April 30th 2020. Additional studies were identified via reference lists of included studies. 92 papers were selected for full text analysis, finally 30 studies were included. Results. The results from 5 follow-up studies suggested an association between HRE and the risk of developing hypertension, while 10 studies reported a link with adverse cardiovascular events in the general population. Another study showed an association between HRE and future hypertension in athletes after a follow-up of 7 years. HRE in athletes was associated with left ventricular hypertrophy in three studies. Two other studies showed a link between HRE and focal myocardial fibrosis in triathletes and myocardial injury, respectively. One study found lower Apoliprotein-1 serum levels in athletes with HRE leading to a higher risk for cardiovascular disease. Only in one study no association with cardiovascular dysfunction in athletes with HRE was found. Conclusions. Based on current evidence, HRE is not a normal finding in athletes. If detected, it should be interpreted as a risk factor for future cardiovascular complications. Future research should address the adequate follow-up and management of athletes with HRE.
Collapse
|
9
|
Stegmüller F, Dinter J, Ritzer B, Seth C, Stadler L, Esefeld K, Halle M. [Sports cardiology : Which sport can be recommended for heart diseases?]. Herz 2022; 47:564-574. [PMID: 36278977 PMCID: PMC9590382 DOI: 10.1007/s00059-022-05141-7] [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] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
Innerhalb der Kardiologie hat der Bereich der Sportkardiologie in den letzten 10 Jahren sukzessive an Bedeutung zugenommen. Dies liegt v. a. daran, dass sich das Spektrum der Fragestellungen zu körperlichem Training in der Prävention und Sekundärprävention jenseits der klassischen kardiovaskulären Rehabilitation erweitert hat. Dieses Spektrum betrifft v. a. Jugendliche und junge Erwachsene, die bei manifester kardialer Erkrankung weiterhin körperlich aktiv sein wollen und zum Teil Freizeit- und Leistungssport anstreben. Ergänzend wird der Kreis der Patient*innen mit kardialen Erkrankungen, die auch noch im höheren Alter sportliche Höchstleistungen anstreben und Beratung suchen, immer größer. In diesen Fällen geht es dann darum, auf der einen Seite ein körperliches Training als Therapiestrategie zu empfehlen, aber auf der anderen Seite auch das kardiovaskuläre System zu schützen. Empfehlungen zu körperlichem Training sollten deshalb auch individuelle Aspekte berücksichtigen. Zusätzlich wird im ambitionierten Freizeit- und Leistungssport die Empfehlung zur Freigabe von Wettkampfsport adressiert. So fragen Patient*innen nach Sport- und Trainingsempfehlungen bei kardiovaskulären Risikofaktoren wie arterieller Hypertonie, Pathologien der Koronararterien im Sinne des Fehlabgangs der Koronarien, Muskelbrücke oder koronarer Herzkrankheit, Kardiomyopathien, Myokarditis sowie Herzrhythmusstörungen und Herzklappenfehlern. In diesem Artikel werden diese Erkrankungen mit entsprechenden sportkardiologischen Spezifika diskutiert und jeweils Empfehlungen zu körperlichem Training und Wettkampfsport gegeben.
Collapse
Affiliation(s)
- Felix Stegmüller
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Jonas Dinter
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Barbara Ritzer
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Celina Seth
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Luis Stadler
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Katrin Esefeld
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Martin Halle
- Präventive Sportmedizin und Sportkardiologie/EAPC, Klinikum rechts der Isar, Technische Universität München, München, Deutschland. .,Klinikum rechts der Isar, Lehrstuhl für Präventive und Rehabilitative Sportmedizin, EAPC Centre for Sports Cardiology, Technische Universität München, Georg-Brauchle-Ring 56, 80992, München, Deutschland.
| |
Collapse
|
10
|
Husaini M, Emery MS. Cardiopulmonary Exercise Testing Interpretation in Athletes. Cardiol Clin 2022; 41:71-80. [DOI: 10.1016/j.ccl.2022.08.006] [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: 11/27/2022]
|
11
|
Watso JC, Romero SA, Moralez G, Huang M, Cramer MN, Johnson E, Crandall CG. Six months of unsupervised exercise training lowers blood pressure during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries. J Appl Physiol (1985) 2022; 133:742-754. [PMID: 35952345 PMCID: PMC9484988 DOI: 10.1152/japplphysiol.00181.2022] [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: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Exercise training reduces cardiovascular disease risk, partly due to arterial blood pressure (BP) lowering at rest and during fixed-load exercise. However, it is unclear whether exercise training can reduce BP at rest and during exercise in adults with well-healed burn injuries. Therefore, the purpose of this investigation was to test the hypothesis that 6 mo of unsupervised exercise training reduces BP at rest and during lower-body cycle ergometry in adults with well-healed burn injuries. Thirty-nine adults (28 with well-healed burn injuries and 11 controls) completed 6 mo of unsupervised, progressive exercise training including endurance, resistance, and high-intensity interval components. Before and after exercise training, we measured BP at rest, during fixed-load submaximal exercise (50 and 75 W), during fixed-intensity submaximal exercise (40% and 70% of V̇o2peak), and during maximal exercise on a lower-body cycle ergometer. We compared cardiovascular variables using two-way ANOVA (group × pre/postexercise training [repeated factor]). Adults with well-healed burn injuries had higher diastolic BP at rest (P = 0.04), which was unchanged by exercise training (P = 0.26). Exercise training reduced systolic, mean, and diastolic BP during fixed-load cycling exercise at 75 W in adults with well-healed burn injuries (P ≤ 0.03 for all), but not controls (P ≥ 0.67 for all). Exercise training also reduced mean and diastolic BP during exercise at 40% (P ≤ 0.02 for both), but not at 70% (P ≥ 0.18 for both), of V̇o2peak. These data suggest that a 6-mo unsupervised exercise training program lowers BP during moderate, but not vigorous, aerobic exercise in adults with well-healed burn injuries.NEW & NOTEWORTHY Adults with well-healed burn injuries have greater cardiovascular disease morbidity and all-cause mortality compared with nonburn-injured adults. We found that exercise training reduced blood pressure (BP) during fixed-load cycling at 75 W and during moderate, but not vigorous, intensity cycling exercise in adults with well-healed burn injuries. These data suggest that 6 mo of unsupervised exercise training provides some degree of cardioprotection by reducing BP responses during submaximal exercise in well-healed burn-injured adults.
Collapse
Affiliation(s)
- Joseph C Watso
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Nutrition & Integrative Physiology, Florida State University, Tallahassee, Florida
| | - Steven A Romero
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Physiology & Anatomy, University of North Texas Health Science Center, Fort Worth, Texas
| | - Gilbert Moralez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu Huang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
- Office of Science, Medicine, and Health, American Heart Association, Dallas, Texas
| | - Matthew N Cramer
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Elias Johnson
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
| | - Craig G Crandall
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas
- Department of Applied Clinical Research, School of Health Professions, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
12
|
Liu Z, Zhou C, Wang H, He Y. Blood pressure monitoring techniques in the natural state of multi-scenes: A review. Front Med (Lausanne) 2022; 9:851172. [PMID: 36091712 PMCID: PMC9462511 DOI: 10.3389/fmed.2022.851172] [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: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Blood pressure is one of the basic physiological parameters of human physiology. Frequent and repeated measurement of blood pressure along with recording of environmental or other physiological parameters when measuring blood pressure may reveal important cardiovascular risk factors that can predict occurrence of cardiovascular events. Currently, wearable non-invasive blood pressure measurement technology has attracted much research attention. Several different technical routes have been proposed to solve the challenge between portability or continuity of measurement methods and medical level accuracy of measurement results. The accuracy of blood pressure measurement technology based on auscultation and oscillography has been clinically verified, while majority of other technical routes are being explored at laboratory or multi-center clinical demonstration stage. Normally, Blood pressure measurement based on oscillographic method outside the hospital can only be measured at intervals. There is a need to develop techniques for frequent and high-precision blood pressure measurement under natural conditions outside the hospital. In this paper, we discussed the current status of blood pressure measurement technology and development trends of blood pressure measurement technology in different scenarios. We focuses on the key technical challenges and the latest advances in the study of miniaturization devices based on oscillographic method at wrist and PTT related method at finger positions as well as technology processes. This study is of great significance to the application of high frequency blood pressure measurement technology.
Collapse
Affiliation(s)
- Ziyi Liu
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Guangdong Transtek Medical Electronics Co., Ltd., Zhongshan, China
| | - Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Hongwei Wang
- Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Hongwei Wang,
| | - Yong He
- College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, China
- Yong He,
| |
Collapse
|
13
|
Heimark S, Eitzen I, Vianello I, Bøtker-Rasmussen KG, Mamen A, Hoel Rindal OM, Waldum-Grevbo B, Sandbakk Ø, Seeberg TM. Blood Pressure Response and Pulse Arrival Time During Exercise Testing in Well-Trained Individuals. Front Physiol 2022; 13:863855. [PMID: 35899026 PMCID: PMC9309297 DOI: 10.3389/fphys.2022.863855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r2 of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.
Collapse
Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Sondre Heimark,
| | - Ingrid Eitzen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Isabella Vianello
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Asgeir Mamen
- Kristiania University College, School of Health Sciences, Oslo, Norway
| | | | | | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine M. Seeberg
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| |
Collapse
|
14
|
Liu HY, Zhao CH, Zhang H, Wang W, Liu QJ. Simulation study on the effect of resistance exercise on the hydrodynamic microenvironment of osteocytes in microgravity. Comput Methods Biomech Biomed Engin 2022; 25:1757-1766. [PMID: 35170387 DOI: 10.1080/10255842.2022.2037130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Osteoporosis occurs in astronauts after long-term space flight owing to the lack of gravity. The mechanical microenvironment of osteocytes in load-bearing bone are changed during resistance exercise, which prevents massive bone loss in the human body. A cylindrical fluid-structure coupling finite element model for osteons with a two-stage pore structure (i.e., Haversian canal, lacunar-canalicular system) was established with the software COMSOL. In the Earth's gravity field and in microgravity, considering the effects of pulsating pressure of arterioles, a comparative study was performed on the changes in hydrodynamic microenvironment of osteocytes during human body high-intensity exercise at different frequencies (defined as causing bone to produce 3000 με) and the body is at rest. Positive and negative liquid pressure (with respect to one atmosphere pressure) alternately acted on osteocytes during human exercising, but only positive pressure acted on osteocytes during human resting. The variation range of liquid pressure acted on osteocytes during human exercising was significantly higher than that during resting. The liquid flow velocity around osteocytes during body exercise was about four orders of magnitude higher than that during resting. In microgravity, moderate physical exercise can obviously improve the hydrodynamic microenvironment of osteocytes in load-bearing bone, which could compensate for the lack of mechanical stimulation to osteocytes caused by the lack of gravity, thereby promoting the normal physiological function of osteocytes. To a certain extent, these results revealed the biomechanical mechanism by which exercise has an effect in fighting osteoporosis in astronauts.
Collapse
Affiliation(s)
- Hai-Ying Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, People's Republic of China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| | - Chao-Hui Zhao
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, People's Republic of China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| | - Hao Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, People's Republic of China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| | - Wei Wang
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
| | - Qing-Jian Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, People's Republic of China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education (Tianjin University of Technology), Tianjin, People's Republic of China
| |
Collapse
|
15
|
Wuestenfeld JC, Baersch F, Ruedrich P, Paech C, Wolfarth B. Blood pressure response to dynamic exercise testing in adolescent elite athletes, what is normal? Front Pediatr 2022; 10:974926. [PMID: 36340728 PMCID: PMC9635448 DOI: 10.3389/fped.2022.974926] [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: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In general, only few studies are dedicated to blood pressure behavior under physical stress in children and adolescents. Even less is published about the blood pressure behavior of young high-performance athletes on the ergometer. For this reason, we evaluated the blood pressure behavior under stress compared to non-athletes in a large collective (n = 739) of young high-performance athletes (age 10-20 years, mean 15.8 years, male 442, female 297) of different sports. A complete echocardiographic examination was available in all athletes. RESULT Regardless of gender, the young competitive athletes achieved significantly higher maximum blood pressure values than investastigated populations from previous studies. Based on the data obtained, blood pressure percentiles are now defined explicitly for junior athletes across sports as well as age- and gender-dependent, which did not exist in this form of normal values for the special clientele of young competitive athletes. The echocardiographic examinations demonstrated stress-induced cardiac adaptation adaptations in the majority of athletes, which thus correlate with the comparatively higher stress blood pressures compared to non-athletes. CONCLUSION For the first time, blood pressure percentiles for exercise tests on the ergometer for age groups and gender in high performance athletes are defined based on a comparatively large collective of young competitive athletes. Upper limits were determined, in particular for systolic blood pressure under stress, and categorized according to gender and age. Performance diagnosticians and physicians are now enabled to make a more accurate assessment of the corresponding blood pressure regulation of young athletes under exercise conditions.
Collapse
Affiliation(s)
- J C Wuestenfeld
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - F Baersch
- Faculty of Sports Science, Institut of Sports Medicine, University Leipzig, Leipzig, Germany
| | - P Ruedrich
- Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| | - C Paech
- Department for Pediatric Cardiology, University of Leipzig -Heart Center Leipzig, Leipzig, Germany
| | - B Wolfarth
- Department Sports Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Berlin, Germany.,Institute for Applied Training Science (IAT), Department of Sports Medicine, Leipzig, Germany
| |
Collapse
|
16
|
Petek BJ, Gustus SK, Churchill TW, Guseh JS, Loomer G, VanAtta C, Baggish AL, Wasfy MM. Sex-Based Differences in Peak Exercise Blood Pressure Indexed to Oxygen Consumption Among Competitive Athletes. Clin Ther 2021; 44:11-22.e3. [PMID: 34819243 DOI: 10.1016/j.clinthera.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/27/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Although exercise testing guidelines define cutoffs for an exaggerated exercise systolic blood pressure (SBP) response, SBPs above these cutoffs are not uncommon in athletes given their high exercise capacity. Alternately, guidelines also specify a normal SBP response that accounts for metabolic equivalents (METs; mean [SD] of 10 [2] mm Hg per MET or 3.5 mL/kg/min oxygen consumption [V˙o2]). SBP and V˙o2 increase less during exercise in females than males. It is not clear if sex-based differences in exercise V˙o2 are related to differences in SBP or if current recommendations for normal increase in SBP per MET produce reasonable estimates using measured METs (ie, V˙o2) in athletes. We therefore examined sex-based differences in exercise SBP indexed to V˙o2 in athletes with the goal of defining normative values for exercise SBP that account for fitness and sex. METHODS Using prospectively collected data from a single sports cardiology program, normotensive athlete patients were identified who had no relevant cardiopulmonary disease and had undergone cardiopulmonary exercise testing with cycle ergometry or treadmill. The relationship between ΔSBP (peak - rest) and ΔV˙o2 (peak - rest) was examined in the total cohort and compared between sexes. FINDINGS A total of 413 athletes (mean [SD] age, 35.5 [14] years; 38% female; mean [SD] peak V˙o2, 46.0 [10.2] mL/kg/min, 127% [27%] predicted) met the inclusion criteria. The ΔSBP correlated with unadjusted ΔV˙o2 (cycle: R2 = 0.18, treadmill: R2 = 0.12; P < 0.0001). Female athletes had lower mean (SD) peak SBP (cycle: 161 [15] vs 186 [24] mm Hg; treadmill: 165 [17] vs 180 [20] mm Hg; P < 0.05) than male athletes. Despite lower peak SBP, mean (SD) ΔSBP relative to unadjusted ΔV˙o2 was higher in female than male athletes (cycle: 25.6 [7.2] vs 21.1 [7.3] mm Hg/L/min; treadmill: 21.6 [7.2] vs 17.0 [6.2] mm Hg/L/min; P < 0.05). When V˙o2 was adjusted for body size and converted to METs, female and male athletes had similar mean (SD) ΔSBP /ΔMET (cycle: 6.0 [2.1] vs 5.8 [2.0] mm Hg/mL/kg/min; treadmill: 4.7 [1.8] vs 4.8 [1.7] mm Hg/mL/kg/min). IMPLICATIONS In this cohort of athletes without known cardiopulmonary disease, observed sex-based differences in peak exercise SBP were in part related to the differences in ΔV˙o2 between male and female athletes. Despite lower peak SBP, ΔSBP/unadjusted ΔV˙o2 was paradoxically higher in female athletes. Future work should define whether this finding reflects sex-based differences in the peripheral vascular response to exercise. In this athletic cohort, ΔSBP/ΔMET was similar between sexes and much lower than the ratio that has been proposed by guidelines to define a normal SBP response. Our observed ΔSBP/ΔMET, based on measured rather than estimated METs, provides a clinically useful estimate for normal peak SBP range in athletes.
Collapse
Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah K Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Garrett Loomer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Carolyn VanAtta
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
17
|
Abstract
Purpose of Review We reviewed most current medical literature in order to describe the epidemiology, clinical manifestation, outcome, and management of hypertension in athletes. Recent Findings An estimated quarter of the world’s population is suffering from hypertension and this prevalence is also reflected in athletes and in individuals involved in leisure time sport activities. Several studies found an inverse relationship between physical activity and blood pressure. Therefore, physical exercise is recommended to prevent, manage, and treat hypertension. On the other hand, the prevalence of hypertension may vary by sport and in some cases may even be higher in athletes competing in certain disciplines than in the general population. Hypertension is the most common medical condition in athletes and may raise concerns about its management and the individual’s eligibility for competitive sports. A thorough clinical evaluation should be performed to correctly diagnose or rule out hypertension in athletes, describe the individual’s risk profile, rule out secondary causes, and detect possible hypertension-mediated organ damage caused by hypertension at an early stage. Based on most recent clinical research and international consensus documents, we propose a diagnostic algorithm as well the non-pharmacological and pharmacological management of hypertension in athletes. Summary Although elevated blood pressure levels are less common in the active population, athletes are not protected from hypertension. A thorough diagnostic approach may help to identify individual at risk for adverse cardiovascular events and to address the optimal treatment as well as sport recommendations.
Collapse
Affiliation(s)
- Victor Schweiger
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Christine Attenhofer-Jost
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.,Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden Klinik im Park, Zurich, Switzerland
| |
Collapse
|
18
|
Schultz MG, La Gerche A, Sharman JE. Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing. Exerc Sport Sci Rev 2021; 50:25-30. [PMID: 34669623 DOI: 10.1249/jes.0000000000000276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We propose that for correct clinical interpretation of exaggerated exercise blood pressure (EEBP), both cardiorespiratory fitness and exercise workload must be considered. A key recommendation towards achieving the correct clinical interpretation of EEBP is that exercise BP should be measured during submaximal exercise with a fixed external workload.
Collapse
Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia Baker Institute, Melbourne, Australia
| | | | | |
Collapse
|
19
|
The association of elevated blood pressure during ischaemic exercise with sport performance in Master athletes with and without morbidity. Eur J Appl Physiol 2021; 122:211-221. [PMID: 34652528 PMCID: PMC8748359 DOI: 10.1007/s00421-021-04828-9] [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: 03/08/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022]
Abstract
Background An exaggerated exercise blood pressure (BP) is associated with a reduced exercise capacity. However, its connection to physical performance during competition is unknown. Aim To examine BP responses to ischaemic handgrip exercise in Master athletes (MA) with and without underlying morbidities and to assess their association with athletic performance during the World Master Track Cycling Championships 2019. Methods Forty-eight Master cyclists [age 59 ± 13yrs; weekly training volume 10.4 ± 4.1 h/week; handgrip maximum voluntary contraction (MVC) 46.3 ± 11.5 kg] divided into 2 matched groups (24 healthy MA and 24 MA with morbidity) and 10 healthy middle-aged non-athlete controls (age 48.3 ± 8.3 years; MVC 40.4 ± 14.8 kg) performed 5 min of forearm occlusion including 1 min handgrip isometric contraction (40%MVC) followed by 5 min recovery. Continuous beat-by-beat BP was recorded using finger plethysmography. Age-graded performance (AGP) was calculated to compare race performances among MA. Healthy Master cyclists were further grouped into middle-age (age 46.2 ± 6.4 years; N:12) and old-age (age 65.0 ± 7.7 years; N:12) for comparison with middle-aged non-athlete controls. Results Healthy and morbidity MA groups showed similar BP responses during forearm occlusion and AGP (90.1 ± 4.3% and 91.0 ± 5.3%, p > 0.05, respectively). Healthy and morbidity MA showed modest correlation between the BP rising slope for 40%MVC ischaemic exercise and AGP (r = 0.5, p < 0.05). MA showed accelerated SBP recovery after cessation of ischaemic handgrip exercise compared to healthy non-athlete controls. Conclusion Our findings associate long-term athletic training with improved BP recovery following ischaemic exercise regardless of age or reported morbidity. Exaggerated BP in Master cyclists during ischaemic exercise was associated with lower AGP during the World Master Cycling Championships. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-021-04828-9.
Collapse
|
20
|
Moore MN, Schultz MG, Hare JL, Marwick TH, Sharman JE. Improvement in functional capacity with spironolactone masks the treatment effect on exercise blood pressure. J Sci Med Sport 2021; 25:103-107. [PMID: 34690065 DOI: 10.1016/j.jsams.2021.09.008] [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: 03/14/2021] [Revised: 07/09/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES A hypertensive response to submaximal exercise is associated with cardiovascular disease but this relationship is influenced by functional capacity. Spironolactone improves functional capacity, which could mask treatment effects on exercise blood pressure. This study sought to examine this hypothesis. DESIGN Retrospective analysis of a randomized clinical trial. METHODS 102 participants (54 ± 9 years; 52% male) with a hypertensive response to maximal exercise (systolic BP ≥210 mm Hg men; ≥190 mm Hg women) were randomized to 3-month spironolactone 25 mg daily (n = 53) or placebo (n = 49). Submaximal exercise blood pressure was measured during low-intensity cycling (50, 60 or 70% age-predicted maximal heart rate). Functional capacity was measured as maximal oxygen capacity obtained during a maximal treadmill exercise test, and (resting) aortic stiffness by carotid-to-femoral pulse wave velocity. RESULTS Spironolactone improved submaximal exercise systolic blood pressure vs. placebo (-4 ± 16 vs. 2 ± 15 mm Hg, p = 0.045, Cohen's d = 0.42), and had a small (but non-statistically significant) improvement in functional capacity (0.64 ± 5.10 vs. -1.43 ± 5.04 ml/kg/min, p = 0.06, Cohen's d = 0.4). When treatment effects were expressed as the change in submaximal exercise systolic blood pressure relative to the change in functional capacity, a larger effect size was observed (-0.3 ± 1.1 vs. 0.3 ± 1.1 mm Hg/ml·kg·min-1, p = 0.01, Cohen's d = 0.58), but was not explained by improved aortic stiffness. CONCLUSIONS Spironolactone reduces submaximal exercise blood pressure, but this treatment effect may be hidden by improved functional capacity and a non-fixed workload. This highlights the most clinically relevant exercise blood pressure is at a low intensity and fixed workload where the influence of fitness on exercise blood pressure is removed, and the effects of therapy can be appreciated.
Collapse
Affiliation(s)
- Myles N Moore
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia
| | | | | | - James E Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia.
| |
Collapse
|
21
|
Petek BJ, Gustus SK, Wasfy MM. Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23. [DOI: 10.1007/s11936-021-00928-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
22
|
Bauer P, Kraushaar L, Dörr O, Nef H, Hamm CW, Most A. Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing. Eur J Appl Physiol 2021; 121:1859-1869. [PMID: 33709207 PMCID: PMC8192366 DOI: 10.1007/s00421-021-04656-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/05/2021] [Indexed: 12/28/2022]
Abstract
Purpose Sex differences in blood pressure (BP) regulation at rest have been attributed to differences in vascular function. Further, arterial stiffness predicts an exaggerated blood pressure response to exercise (BPR) in healthy young adults. However, the relationship of vascular function to the workload-indexed BPR and potential sex differences in athletes are unknown. Methods We examined 47 male (21.6 ± 1.7 years) and 25 female (21.1 ± 2 years) athletes in this single-center pilot study. We assessed vascular function at rest, including systolic blood pressure (SBP). Further, we determined the SBP/W slope, the SBP/MET slope, and the SBP/W ratio at peak exercise during cycling ergometry. Results Male athletes had a lower central diastolic blood pressure (57 ± 9.5 vs. 67 ± 9.5 mmHg, p < 0.001) but a higher central pulse pressure (37 ± 6.5 vs. 29 ± 4.7 mmHg, p < 0.001), maximum SBP (202 ± 20 vs. 177 ± 15 mmHg, p < 0.001), and ΔSBP (78 ± 19 vs. 58 ± 14 mmHg, p < 0.001) than females. Total vascular resistance (1293 ± 318 vs. 1218 ± 341 dyn*s/cm5, p = 0.369), pulse wave velocity (6.2 ± 0.85 vs. 5.9 ± 0.58 m/s, p = 0.079), BP at rest (125 ± 10/76 ± 7 vs. 120 ± 11/73.5 ± 8 mmHg, p > 0.05), and the SBP/MET slope (5.7 ± 1.8 vs. 5.1 ± 1.6 mmHg/MET, p = 0.158) were not different. The SBP/W slope (0.34 ± 0.12 vs. 0.53 ± 0.19 mmHg/W) and the peak SBP/W ratio (0.61 ± 0.12 vs. 0.95 ± 0.17 mmHg/W) were markedly lower in males than in females (p < 0.001). Conclusion Male athletes displayed a lower SBP/W slope and peak SBP/W ratio than females, whereas the SBP/MET slope was not different between the sexes. Vascular functional parameters were not able to predict the workload-indexed BPR in males and females.
Collapse
Affiliation(s)
- Pascal Bauer
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany.
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
- Department of Cardiology, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| |
Collapse
|
23
|
Richard NA, Hodges L, Koehle MS. Elevated peak systolic blood pressure in endurance-trained athletes: Physiology or pathology? Scand J Med Sci Sports 2021; 31:956-966. [PMID: 33382462 DOI: 10.1111/sms.13914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 01/21/2023]
Abstract
Blood pressure is a function of cardiac output and peripheral vascular resistance. During graded exercise testing (GXT), systolic blood pressure (SBP) is expected to increase gradually along with work rate, oxygen consumption, heart rate, and cardiac output. Individuals exposed to chronic endurance training attain a greater exercise SBP than in their untrained state and sedentary counterparts, but it is currently unknown what is considered a safe upper limit. This review discusses key studies examining blood pressure response in sedentary individuals and athletes. We highlight the physiological characteristics of highly fit individuals in terms of cardiovascular physiology and exercise blood pressure and review the state of the current literature regarding the safety of high SBP during exercise in this particular subgroup. Findings from this review indicate that a consensus on what is a normal SBP response to exercise in highly fit subjects and direct causation linking high GXT SBP to pathology is lacking. Consequently, applying GXT SBP guidelines developed for a "normal" population to endurance-trained individuals appears unsupported at this time. Lack of evidence for poor outcomes leads us to infer that elevated peak SBP in this subgroup could more likely reflect an adaptive response to training, rather than a pathological outcome. Future studies should track clinical outcomes of those achieving elevated SBP and develop athlete-specific guidelines.
Collapse
Affiliation(s)
| | - Lynette Hodges
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
24
|
Nakamura K, Fujiwara T, Hoshide S, Ishiyama Y, Taki M, Ozawa S, Kario K. Differences in exercise-induced blood pressure changes between young trained and untrained individuals. J Clin Hypertens (Greenwich) 2021; 23:843-848. [PMID: 33455054 PMCID: PMC8678678 DOI: 10.1111/jch.14177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/10/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
There are no studies assessing short‐term blood pressure (BP) changes induced by daily exercise load in young trained individuals. The authors enrolled 25 healthy, trained (mean age 19.7 ± 0.1 years, 36% female) and 26 healthy, untrained (mean age 20.4 ± 0.3 years, 50% female) individuals and measured BP after the Master two‐step test. Among them, 42 individuals underwent echocardiography after BP measurements to assess left ventricular mass index (LVMI). The baseline systolic BP (SBP) levels of trained and untrained individuals were 122.7 ± 2.9 versus 117.4 ± 1.5 mmHg, respectively (p = .016). Trained individuals showed a significant suppression of the SBP increase soon after exercise loads and lower SBP levels at 1, 2, and 3 min after exercise loads compared with untrained individuals. The peak SBP level over the study period was also significantly lower in trained individuals than in untrained individuals: 156.4 ± 3.3 versus 183.7 ± 5.2 mmHg (p < .001). Trained individuals showed significantly higher LVMI compared with untrained individuals: 129.4 versus 101.6 g/m2 (p < .001). These findings demonstrated that trained individuals showed significant suppression of short‐term BP variability in response to by daily exercise loads and prompt SBP recovery from acute exercise loads compared with untrained individuals. Our results would be useful to understand short‐term BPV and LV hypertrophy induced by adaptive responses of the heart to regular exercise loads.
Collapse
Affiliation(s)
- Kenji Nakamura
- Department of Healthcare Informatics, Faculty of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yusuke Ishiyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Mizuri Taki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Seiji Ozawa
- Department of Healthcare Informatics, Faculty of Health and Welfare, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| |
Collapse
|
25
|
Bauer P, Kraushaar L, Dörr O, Bauer T, Nef H, Hamm CW, Most A. Association of 25-hydroxy vitamin D level with the blood pressure response to a maximum exercise test among professional indoor athletes. Eur J Appl Physiol 2020; 120:1931-1941. [PMID: 32588193 PMCID: PMC7340632 DOI: 10.1007/s00421-020-04421-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
Purpose Low vitamin D levels have been associated with elevated blood pressure (BP) in the general population. However, whether there is an association of vitamin D insufficiency with BP changes during maximum exercise in athletes is currently unclear.
Methods A total of 120 male professional indoor athletes (age 26 ± 5 years) were examined. BP was measured at rest and during a graded cycling test. We assessed the BP response (BPR) during maximum exercise and the respective load. BP and BPR (peak-baseline BP) were analysed with respect to 25-OH vitamin D levels, with levels < 30 ng/mL defining vitamin D insufficiency.
Results 35 athletes were classified as being vitamin D insufficient. BP was not different between sufficient and insufficient vitamin D groups (122 ± 10/75 ± 7 vs. 120 ± 12/77 ± 9 mmHg). At maximum exercise, however, systolic BP (198 ± 17 vs. 189 ± 19, p = 0.026) and the pulse pressure (118 ± 18 vs. 109 ± 21 mmHg, p = 0.021) were higher in the sufficient group; the BPR was not different between groups (76 ± 20/5 ± 6 vs. 69 ± 22/3 ± 6 mmHg, p = 0.103). Athletes with sufficient levels had a higher maximum power output (3.99 ± 0.82 vs. 3.58 ± 0.78 W/kg, p = 0.015) and achieved higher workloads (367 ± 78 vs. 333 ± 80 W, p = 0.003). The workload-adjusted BPR (maximum systolic BP/MPO) was not different between athletes with sufficient and insufficient vitamin D levels (51 ± 10 vs. 56 ± 14 mmHg × kg/W, p = 0.079).
Conclusion Athletes with sufficient vitamin D achieved a higher maximum systolic BP and a higher maximum power output. The workload-adjusted BPR was not different between groups, which suggests that this finding reflects a better performance of athletes with sufficient vitamin D.
Collapse
Affiliation(s)
- Pascal Bauer
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany.
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| | - Timm Bauer
- Department of Cardiology and Intensive Care Medicine, Sana Clinic Offenbach, Offenbach, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany.,Department of Cardiology, Kerckhoff Clinic GmbH, Bad Nauheim, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, Justus- Liebig- University Giessen, Giessen, Germany
| |
Collapse
|
26
|
Bauer P, Kraushaar L, Dörr O, Nef H, Hamm CW, Most A. Workload-indexed blood pressure response to a maximum exercise test among professional indoor athletes. Eur J Prev Cardiol 2020; 28:1487-1494. [PMID: 33611510 DOI: 10.1177/2047487320922043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise testing is performed regularly in professional athletes. However, the blood pressure response (BPR) to exercise is rarely investigated in this cohort, and normative upper thresholds are lacking. Recently, a workload-indexed BPR (increase in systolic blood pressure per increase in metabolic equivalent of task (SBP/MET slope)) was evaluated in a general population and was compared with mortality. We sought to evaluate the SBP/MET slope in professional athletes and compare it with performance. DESIGN This was a cross-sectional study. METHODS A total of 142 male professional indoor athletes (age 26 ± 5 years) were examined. Blood pressure was measured at rest and during a standardized, graded cycle ergometer test. We assessed the BPR during exercise, the workload, and the metabolic equivalent of task (MET). Athletes were divided into groups according to their SBP/MET slope quartiles (I <4.3; II 4.3-6.2; III >6.2-9; IV >9 mmHg/MET) and compared regarding systolic BP (sBP) and workload achieved. RESULTS Athletes in group I (n = 42) had the lowest maximum sBP (180 ± 13 mmHg) but achieved the highest relative workload (4.2 ± 1 W/kg). With increasing SBP/MET slope, the maximum sBP increased (II (n = 56): 195 ± 15 mmHg; III (n = 44): 216 ± 16 mmHg) and the workload achieved decreased (II: 3.9 ± 0.7 W/kg; III: 3.3 ± 0.5 W/kg). The differences in sBP between these groups were significant (p < 0.001). None of the athletes were assigned to group IV (>9 mmHg/MET). CONCLUSION Athletes in the lowest SBP/MET slope quartile displayed the lowest maximum sBP but achieved a higher workload than athletes classified into the other SBP/MET slope groups. This simple, novel metric might help to distinguish a normal from an exaggerated BPR to exercise, to identify athletes at risk of developing hypertension.
Collapse
Affiliation(s)
- Pascal Bauer
- Department of Cardiology and Angiology, University Hospital Giessen, Germany
| | | | - Oliver Dörr
- Department of Cardiology and Angiology, University Hospital Giessen, Germany
| | - Holger Nef
- Department of Cardiology and Angiology, University Hospital Giessen, Germany
| | - Christian W Hamm
- Department of Cardiology and Angiology, University Hospital Giessen, Germany.,Department of Cardiology, Kerckhoff Clinic GmbH, Germany
| | - Astrid Most
- Department of Cardiology and Angiology, University Hospital Giessen, Germany
| |
Collapse
|
27
|
Werkman MS, Bongers BC, Blatter T, Takken T, Wittink H. Extended steep ramp test normative values for 19-24-year-old healthy active young adults. Eur J Appl Physiol 2019; 120:107-115. [PMID: 31705276 PMCID: PMC6969871 DOI: 10.1007/s00421-019-04255-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022]
Abstract
Purpose
To extend currently available sex and age-specific normative values in children and adolescents for the peak work rate (WRpeak) attained at the steep ramp test (SRT) to healthy active young adults. Methods Healthy male and female participants aged between 19 and 24 years were recruited. After screening and anthropometric measurements, participants performed a SRT on a cycle ergometer (increments of 25 W/10 s), monitoring and recording SRT-WRpeak, heart rate (HR), and blood pressure (BP) at rest and directly after peak exercise. Results Fifty-seven participants (31 males and 26 females; median age of 21.3 years) volunteered and were tested. Anthropometrics, resting BP and lung function were all within normal ranges. Ninety-three percent of the participants attained a peak HR (HRpeak) > 80% of predicted (mean HRpeak 87 ± 5% of predicted). No differences were found in resting and peak exercise variables between females and males, except for absolute SRT-WRpeak (350 W [Q1: 306; Q3: 371] and 487 W [Q1: 450; Q3: 517], respectively) and SRT-WRpeak normalized for body mass (relative SRT-WRpeak; 5.4 ± 0.5 and 6.2 ± 0.6 W/kg, respectively). Low-to-moderate correlations (ρ [0.02–0.71]) were observed between SRT-WRpeak and anthropometric variables for females and males separately. Extended reference curves (8–24-year-old subjects) for SRT performance show different trends between male and female subjects when modelled against age, body height, and body mass. Conclusions The present study provides sex-, age-, body height-, and body mass-related normative values (presented as reference centiles) for absolute and relative SRT performance throughout childhood and early adulthood. Electronic supplementary material The online version of this article (10.1007/s00421-019-04255-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M S Werkman
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands. .,Department of Physiotherapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - B C Bongers
- Department of Nutrition and Human Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - T Blatter
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - T Takken
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Child Development and Exercise Center, Utrecht, The Netherlands
| | - H Wittink
- Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| |
Collapse
|
28
|
Hedman K, Cauwenberghs N, Christle JW, Kuznetsova T, Haddad F, Myers J. Workload-indexed blood pressure response is superior to peak systolic blood pressure in predicting all-cause mortality. Eur J Prev Cardiol 2019; 27:978-987. [PMID: 31564136 DOI: 10.1177/2047487319877268] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS The association between peak systolic blood pressure (SBP) during exercise testing and outcome remains controversial, possibly due to the confounding effect of external workload (metabolic equivalents of task (METs)) on peak SBP as well as on survival. Indexing the increase in SBP to the increase in workload (SBP/MET-slope) could provide a more clinically relevant measure of the SBP response to exercise. We aimed to characterize the SBP/MET-slope in a large cohort referred for clinical exercise testing and to determine its relation to all-cause mortality. METHODS AND RESULTS Survival status for male Veterans who underwent a maximal treadmill exercise test between the years 1987 and 2007 were retrieved in 2018. We defined a subgroup of non-smoking 10-year survivors with fewer risk factors as a lower-risk reference group. Survival analyses for all-cause mortality were performed using Kaplan-Meier curves and Cox proportional hazard ratios (HRs (95% confidence interval)) adjusted for baseline age, test year, cardiovascular risk factors, medications and comorbidities. A total of 7542 subjects were followed over 18.4 (interquartile range 16.3) years. In lower-risk subjects (n = 709), the median (95th percentile) of the SBP/MET-slope was 4.9 (10.0) mmHg/MET. Lower peak SBP (<210 mmHg) and higher SBP/MET-slope (>10 mmHg/MET) were both associated with 20% higher mortality (adjusted HRs 1.20 (1.08-1.32) and 1.20 (1.10-1.31), respectively). In subjects with high fitness, a SBP/MET-slope > 6.2 mmHg/MET was associated with a 27% higher risk of mortality (adjusted HR 1.27 (1.12-1.45)). CONCLUSION In contrast to peak SBP, having a higher SBP/MET-slope was associated with increased risk of mortality. This simple, novel metric can be considered in clinical exercise testing reports.
Collapse
Affiliation(s)
- Kristofer Hedman
- Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nicholas Cauwenberghs
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.,Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Jeffrey W Christle
- Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Francois Haddad
- Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jonathan Myers
- Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, CA, USA.,Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| |
Collapse
|
29
|
Currie KD, Sasson Z, Goodman JM. Vascular-ventricular coupling during exercise is not affected by exaggerated blood pressures in endurance-trained athletes. J Appl Physiol (1985) 2019; 127:753-759. [DOI: 10.1152/japplphysiol.00108.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This study sought to examine whether cardiovascular performance during exercise, assessed using the vascular-ventricular coupling index (VVC), was affected by exaggerated blood pressure (EBP) responses in endurance-trained athletes. Subjects were middle-aged endurance-trained men and women. Blood pressure measurements and left ventricular echocardiography were performed in a semiupright position at rest and during steady-state cycling at workloads that elicited 100–110 beats/min ( stage 1) and 130–140 beats/min ( stage 2). These data were used to calculate effective arterial elastance index ( EaI), left ventricular end-systolic elastance index ( ELVI), and their ratio (VVC). Additional measurements of left ventricular volumes and function (i.e., stroke volume, cardiac output, and longitudinal strain) and indirect assessments of peripheral vascular function (i.e., total arterial compliance and peripheral vascular resistance) were examined. Fourteen subjects with EBP (EBP+, 50% men) and 14 sex-matched subjects without EBP (EBP−) participated, with results presented as EBP+ versus EBP−. EaI and ELVI increased from rest to exercise while VVC decreased, but only ELVI was different between groups at stage 1 [7.6 (1.8) vs. 6.4 (1.0) mmHg·ml−1·m−2, P = 0.045] and stage 2 [10.3 (1.6) vs. 8.0 (1.7) mmHg·ml−1·m−2, P < 0.001]. Additional comparisons revealed no group difference in the contribution of the Frank-Starling mechanism or left ventricular and peripheral vascular function during exercise. The cardiovascular adjustment to exercise in athletes with EBP is achieved through a matched increase in both EaI and ELVI, and the absence of between-group differences in left ventricular or peripheral vascular function suggests that other factors may contribute to the EBP response. NEW & NOTEWORTHY Cardiovascular performance during submaximal exercise, assessed using vascular-ventricular coupling, is unaffected by exaggerated blood pressure (EBP) responses in endurance-trained athletes. The underlying mechanisms of EBP in athletes remain unknown as changes in left ventricular and peripheral vascular function during exercise were similar in athletes with and without EBP.
Collapse
Affiliation(s)
- Katharine D. Currie
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
| | - Zion Sasson
- University Health Network and Mount Sinai Hospital Division of Cardiology, Toronto, Canada
| | - Jack M. Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- University Health Network and Mount Sinai Hospital Division of Cardiology, Toronto, Canada
| |
Collapse
|
30
|
Halle M, Esefeld K, Schindler M, Schunkert H. Exercise hypertension: Link to myocardial fibrosis in athletes? Eur J Prev Cardiol 2019; 27:89-93. [DOI: 10.1177/2047487319868795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Martin Halle
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Katrin Esefeld
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
| | - Michael Schindler
- Technical University Munich, School of Medicine, University Hospital ‘Klinikum rechts der Isar’, Department of Prevention, Rehabilitation and Sports Medicine, Germany
| | - Heribert Schunkert
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich Heart Alliance, Germany
- Technical University Munich, School of Medicine, German Heart Centre, Department of Cardiology, Germany
| |
Collapse
|
31
|
Tahir E, Scherz B, Starekova J, Muellerleile K, Fischer R, Schoennagel B, Warncke M, Stehning C, Cavus E, Bohnen S, Radunski UK, Blankenberg S, Simon P, Pressler A, Adam G, Patten M, Lund GK. Acute impact of an endurance race on cardiac function and biomarkers of myocardial injury in triathletes with and without myocardial fibrosis. Eur J Prev Cardiol 2019; 27:94-104. [PMID: 31242053 PMCID: PMC6923712 DOI: 10.1177/2047487319859975] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aim of this study was to investigate the occurrence of myocardial injury and cardiac dysfunction after an endurance race by biomarkers and cardiac magnetic resonance in triathletes with and without myocardial fibrosis. METHODS AND RESULTS Thirty asymptomatic male triathletes (45 ± 10 years) with over 10 training hours per week and 55 ± 8 ml/kg per minute maximal oxygen uptake during exercise testing were studied before (baseline) and 2.4 ± 1.1 hours post-race. Baseline cardiac magnetic resonance included cine, T1/T2, late gadolinium enhancement (LGE) and extracellular volume imaging. Post-race non-contrast cardiac magnetic resonance included cine and T1/T2 mapping. Non-ischaemic myocardial fibrosis was present in 10 triathletes (LGE+) whereas 20 had no fibrosis (LGE-). At baseline, LGE + triathletes had higher peak exercise systolic blood pressure with 222 ± 21 mmHg compared to LGE- triathletes (192 ± 30 mmHg, P < 0.01). Post-race troponin T and creatine kinase MB were similarly increased in both groups, but there was no change in T2 and T1 from baseline to post-race with 54 ± 3 ms versus 53 ± 3 ms (P = 0.797) and 989 ± 21 ms versus 989 ± 28 ms (P = 0.926), respectively. However, post-race left atrial ejection fraction was significantly lower in LGE + triathletes compared to LGE- triathletes (53 ± 6% vs. 59 ± 6%, P < 0.05). Furthermore, baseline atrial peak filling rates were lower in LGE - triathletes (121 ± 30 ml/s/m2) compared to LGE + triathletes (161 ± 34 ml/s/m2, P < 0.01). Post-race atrial peak filling rates increased in LGE- triathletes to 163 ± 46 ml/s/m2, P < 0.001), but not in LGE + triathletes (169 ± 50ml/s/m2, P = 0.747). CONCLUSION Despite post-race troponin T release, we did not find detectable myocardial oedema by cardiac magnetic resonance. However, the unfavourable blood pressure response during exercise testing seemed to be associated with post-race cardiac dysfunction, which could explain the occurrence of myocardial fibrosis in triathletes.
Collapse
Affiliation(s)
- Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Benedikt Scherz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Roland Fischer
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Germany.,UCSF, Benioff Children's Hospital Oakland, USA
| | - Björn Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | - Malte Warncke
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | | | - Ersin Cavus
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center, Germany
| | - Perikles Simon
- Department of Sports Medicine, Johannes Gutenberg University Mainz, Germany
| | - Axel Pressler
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Germany.,Center of Sports and Preventive Cardiology, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| | | | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Germany
| |
Collapse
|
32
|
|