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Ozemek C, Hardwick J, Bonikowske A, Christle J, German C, Reddy S, Arena R, Faghy M. How to interpret a cardiorespiratory fitness assessment - Key measures that provide the best picture of health, disease status and prognosis. Prog Cardiovasc Dis 2024; 83:23-28. [PMID: 38417770 DOI: 10.1016/j.pcad.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Graded exercise testing is a widely accepted tool for revealing cardiac ischemia and/or arrhythmias in clinical settings. Cardiopulmonary exercise testing (CPET) measures expired gases during a graded exercise test making it a versatile tool that helps reveal underlying physiologic abnormalities that are in many cases only present with exertion. It also characterizes one's health status and clinical trajectory, informs the therapeutic plan, evaluates the efficacy of therapy, and provides submaximal and maximal information that can be used to tailor an exercise intervention. Practitioners can also modify the mode and protocol to allow individuals of all ages, fitness levels, and most disease states to perform a CPET. When used to its full potential, CPET can be a key tool used to optimize care in primary and secondary prevention settings.
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Affiliation(s)
- Cemal Ozemek
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA.
| | - Joel Hardwick
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Amanda Bonikowske
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey Christle
- Division of Cardiovascular Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Satyajit Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Mark Faghy
- Human Sciences Research Centre, College of Science and Engineering, University of Derby, UK
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2
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Jenkins DG, Devin JL, Weston KL, Jenkins JG, Skinner TL. Benefits beyond cardiometabolic health: the potential of frequent high intensity 'exercise snacks' to improve outcomes for those living with and beyond cancer. J Physiol 2023; 601:4691-4697. [PMID: 37732418 DOI: 10.1113/jp284985] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
High intensity interval training (HIIT) has been shown to consistently elicit rapid and significant adaptations in a number of physiological systems, across many different healthy and clinical populations. In addition, there is increasing interest in how some acute, yet transient responses to high intensity exercise potentially reduce the risks of particular diseases. Recent work has shown that discrete, brief bouts of high intensity exercise (termed 'exercise snacks') can improve glucose control and vascular health and thus counter the negative cardiometabolic consequences of prolonged, uninterrupted periods of inactivity. In this brief review, we advance the case, using evidence available from pre-clinical studies in the exercise oncology literature, that brief, frequently completed bouts of high intensity exercise embedded within an individual's overall daily and weekly physical activity schedule, may transiently impact the tumour microenvironment and improve the health outcomes for those who have been diagnosed and treated for cancer.
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Affiliation(s)
- David G Jenkins
- University of the Sunshine Coast, Maroochydore, Australia
- Applied Sports Science Technology and Medicine Research Centre, Swansea University, Swansea, UK
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
| | - James L Devin
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Kathryn L Weston
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Joseph G Jenkins
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Australia
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3
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Bryde R, Martinez MW, Emery MS. Exercise recommendations for patients with hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2023; 80:53-59. [PMID: 37201741 DOI: 10.1016/j.pcad.2023.05.004] [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: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA; Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Michael S Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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4
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Birnbaumer P, Dostal T, Cipryan L, Hofmann P. Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18-65 Years old men and women: the 4HAIE study. Front Physiol 2023; 14:1178913. [PMID: 37324398 PMCID: PMC10264846 DOI: 10.3389/fphys.2023.1178913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: The heart rate performance curve (HRPC) in maximal incremental cycle ergometer exercise demonstrated three different patterns such as downward, linear or inverse versions. The downward pattern was found to be the most common and therefore termed regular. These patterns were shown to differently influence exercise prescription, but no data are available for running. This study investigated the deflection of the HRPC in maximal graded treadmill tests (GXT) of the 4HAIE study. Methods: Additional to maximal values, the first and second ventilatory thresholds as well as the degree and the direction of the HRPC deflection (kHR) were determined from 1,100 individuals (489 women) GXTs. HRPC deflection was categorized as downward (kHR < -0.1), linear (-0.1 ≤ kHR ≤ 0.1) or inverse (kHR > 0.1) curves. Four (even split) age- and two (median split) performance-groups were used to investigate the effects of age and performance on the distribution of regular (= downward deflection) and non-regular (= linear or inverse course) HR curves for male and female subjects. Results: Men (age: 36.8 ± 11.9 years, BMI: 25.0 ± 3.3 kg m-2, VO2max: 46.4 ± 9.4 mL min-1. kg-1) and women (age: 36.2 ± 11.9 years, BMI: 23.3 ± 3.7 kg m-2, VO2max: 37.4 ± 7.8 mL min-1. kg-1) presented 556/449 (91/92%) downward deflecting, 10/8 (2/2%) linear and 45/32 (7/6%) inverse HRPC´s. Chi-squared analysis revealed a significantly higher number of non-regular HRPC´s in the low-performance group and with increasing age. Binary logistic regression revealed that the odds ratio (OR) to show a non-regular HRPC is significantly affected by maximum performance (OR = 0.840, 95% CI = 0.754-0.936, p = 0.002) and age (OR = 1.042, 95% CI = 1.020-1.064, p < 0.001) but not sex. Discussion: As in cycle ergometer exercise, three different patterns for the HRPC were identified from the maximal graded treadmill exercise with the highest frequency of regular downward deflecting curves. Older subjects and subjects with a lower performance level had a higher probability to show a non-regular linear or inverted curve which needs to be considered for exercise prescription.
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Affiliation(s)
- Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Tomas Dostal
- Department of Human Movement Studies & Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Lukas Cipryan
- Department of Human Movement Studies & Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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5
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Kuwamizu R, Yamazaki Y, Aoike N, Ochi G, Suwabe K, Soya H. Pupil-linked arousal with very light exercise: pattern of pupil dilation during graded exercise. J Physiol Sci 2022; 72:23. [DOI: 10.1186/s12576-022-00849-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022]
Abstract
AbstractAlthough it has been hypothesized that moderate to vigorous exercise immediately modulates cognition via ascending arousal system activation, such activation during very-light to light exercise has remained uncertain. Here, we aimed to uncover the exact exercise intensity necessary for ascending arousal system activation using pupillometry. The pupil diameter, psychological arousal, and ventilation during graded exercise of 26 young males were analyzed based on %$${\dot{V}}_{{\text{O}}_{\text{2peak}}}$$
V
˙
O
2peak
. Pupils dilated with very-light exercise compared to rest, stabilized, and then drastically increased again with moderate exercise and above. Pupil dilation with very-light exercise was positively correlated with increases in psychological arousal. Thus, we have shown that there are two phases of pupil dilation during graded exercise: one with very-light exercise coinciding with psychological arousal response, and the other with moderate exercise or above similar to the ventilation increase pattern. This unique pupil dilation pattern provides physiological evidence of ascending arousal system activation with very-light exercise.
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6
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Gustus S, Moulson N, Churchill TW, Guseh JS, Petek BJ, VanAtta C, Baggish AL, Wasfy MM. Impact of the COVID-19 pandemic on perceived cardiorespiratory fitness in athlete patients. PM R 2022; 14:561-568. [PMID: 35238166 PMCID: PMC9088663 DOI: 10.1002/pmrj.12800] [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: 11/18/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022]
Abstract
Introduction Cardiorespiratory fitness (CRF), as one of the most potent prognostic factors in medicine, is followed longitudinally to guide clinical management. Coronavirus disease 2019 (COVID‐19) pandemic‐related changes in lifestyle stand to influence CRF. Objective To assess the influence of the pandemic on perceived CRF in athlete patients and evaluate how perceived CRF change was related to demographics, pre‐pandemic measured CRF, and current physical activity (PA). Design Prospective cohort study, utilizing electronic survey. Setting Tertiary care sports cardiology clinical practice. Participants Adult athlete patients without COVID‐19 with pre‐pandemic measured CRF using cardiopulmonary exercise testing. Interventions Not applicable. Main Outcome Measures Perceived change in CRF since pandemic onset; association between perceived CRF change and demographics, PA, health status, and pre‐pandemic measured CRF assessed via analysis of variance (ANOVA). Results Among 62 participants (male: 71%, 50.1 ± 12.1 years old), 40% (25/62) reported no change and 32% (20/62) reported an increase in perceived CRF since pandemic onset. Among the 27% (17/62) who reported a decrease in perceived CRF, in most (12/17), this was characterized as only mild. Demographics and pre‐pandemic measured CRF did not differ across groups of perceived CRF change. Participants with a moderate or greater decrease in perceived CRF regarded their overall health (via Euro Quality of Life Visual Analogue Scale) as worse than other groups (ANOVA, p = .001). Although total PA was similar across groups, those who had improvement in perceived CRF reported higher levels of moderate intensity PA (ANOVA, p = .008). Conclusions The majority of participants perceived that they had maintained or improved CRF over the pandemic. Findings from this study suggest that a reduction in perceived CRF from pre‐pandemic values in athletic patients in clinical practice may not result from population‐wide pandemic changes in lifestyle. Worse health status and lower levels of moderate intensity PA were associated with perceived reduction in CRF over the pandemic in athlete patients.
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Affiliation(s)
- Sarah Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Carolyn VanAtta
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
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Gati S, Sharma S. Exercise prescription in individuals with hypertrophic cardiomyopathy: what clinicians need to know. Heart 2022; 108:1930-1937. [PMID: 35197306 DOI: 10.1136/heartjnl-2021-319861] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/01/2022] [Indexed: 01/02/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequently cited cause of exercise-related sudden cardiac death (SCD) in young individuals and has claimed the lives of some high-profile athletes. The circumstantial link between exercise and SCD from HCM has resulted in conservative exercise recommendations which focus on activities that should be avoided rather than the minimal amount of physical activity required to reap the multiple rewards of exercise. Consequently, most patients with HCM are confined to a sedentary lifestyle through fear of SCD, with accruing risk factors such as obesity and low cardiorespiratory fitness that confer a worse prognosis. Recent exercise programmes in asymptomatic and symptomatic individuals with HCM have shown that mild and moderate exercise is safe and accompanied by increased functional capacity and improved quality of life. Population studies also reveal that individuals with HCM in the higher quartiles of self-reported physical activity have lower total cardiovascular mortality compared with those in the lower quartiles. The impact of vigorous exercise on the natural history of HCM is unknown, although current experience suggests that affected adults with mild morphology and absence of high-risk factors may partake in such activity without adverse events. This review highlights the evidence base that has resulted in a paradigm shift in the approach to exercise in HCM and liberalised recent international exercise guidelines in HCM. Practical tips for prescribing exercise in symptomatic patients and relevant precautions are provided to aid clinicians when recommending exercise as part of the management plan for all patients with HCM.
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Affiliation(s)
- Sabiha Gati
- Cardiovascular Medicine, Imperial College London, London, UK .,Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK.,St George's University Hospital NHS Foundation Trust, London, UK
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8
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Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M, Focardi M, Mochi N, Dendale P, Hansen D, Bonifazi M, Halle M, D'Ascenzi F. The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects. Scand J Med Sci Sports 2021; 31:1796-1808. [PMID: 34170582 PMCID: PMC8456830 DOI: 10.1111/sms.14007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1 ) and second ventilatory thresholds (VT2 ) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations. METHODS We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2 , peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations. RESULTS VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively). CONCLUSIONS EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.
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Affiliation(s)
- Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Clinical and Surgical Cardiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena, Siena, Italy
| | - Serafina Valente
- Clinical and Surgical Cardiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Siena, Siena, Italy
| | - Francesca Valentini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicola Mochi
- Sports Medicine Unit, USL Toscana Centro, Florence, Italy
| | - Paul Dendale
- Heartcentre Hasselt, Jessa Hospital, Hasselt University, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Munich, Germany
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.,Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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9
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Bayonas-Ruiz A, Muñoz-Franco FM, Ferrer V, Pérez-Caballero C, Sabater-Molina M, Tomé-Esteban MT, Bonacasa B. Cardiopulmonary Exercise Test in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10112312. [PMID: 34070695 PMCID: PMC8198116 DOI: 10.3390/jcm10112312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with chronic diseases frequently adapt their lifestyles to their functional limitations. Functional capacity in Hypertrophic Cardiomyopathy (HCM) can be assessed by stress testing. We aim to review and analyze the available data from the literature on the value of Cardiopulmonary Exercise Test (CPET) in HCM. Objective measurements from CPET are used for evaluation of patient response to traditional and new developing therapeutic measurements. METHODS A systematic review of the literature was conducted in PubMed, Web of Science and Cochrane in Mar-20. The original search yielded 2628 results. One hundred and two full texts were read after the first screening, of which, 69 were included for qualitative synthesis. Relevant variables to be included in the review were set and 17 were selected, including comorbidities, body mass index (BMI), cardiac-related symptoms, echocardiographic variables, medications and outcomes. RESULTS Study sample consisted of 69 research articles, including 11,672 patients (48 ± 14 years old, 65.9%/34.1% men/women). Treadmill was the most common instrument employed (n = 37 studies), followed by upright cycle-ergometer (n = 16 studies). Mean maximal oxygen consumption (VO2max) was 22.3 ± 3.8 mL·kg-1·min-1. The highest average values were observed in supine and upright cycle-ergometer (25.3 ± 6.5 and 24.8 ± 9.1 mL·kg-1·min-1; respectively). Oxygen consumption in the anaerobic threshold (ATVO2) was reported in 18 publications. Left ventricular outflow tract gradient (LVOT) > 30 mmHg was present at baseline in 31.4% of cases. It increased to 49% during exercise. Proportion of abnormal blood pressure response (ABPRE) was higher in severe (>20 mm) vs. mild hypertrophy groups (17.9% vs. 13.6%, p < 0.001). Mean VO2max was not significantly different between severe vs. milder hypertrophy, or for obstructive vs. non-obstructive groups. Occurrence of arrhythmias during functional assessment was higher among younger adults (5.42% vs. 1.69% in older adults, p < 0.001). Twenty-three publications (9145 patients) evaluated the prognostic value of exercise capacity. There were 8.5% total deaths, 6.7% cardiovascular deaths, 3.0% sudden cardiac deaths (SCD), 1.2% heart failure death, 0.6% resuscitated cardiac arrests, 1.1% transplants, 2.6% implantable cardioverter defibrillator (ICD) therapies and 1.2 strokes (mean follow-up: 3.81 ± 2.77 years). VO2max, ATVO2, METs, % of age-gender predicted VO2max, % of age-gender predicted METs, ABPRE and ventricular arrhythmias were significantly associated with major outcomes individually. Mean VO2max was reduced in patients who reached the combined cardiovascular death outcome compared to those who survived (-6.20 mL·kg-1·min-1; CI 95%: -7.95, -4.46; p < 0.01). CONCLUSIONS CPET is a valuable tool and can safely perform for assessment of physical functional capacity in patients with HCM. VO2max is the most common performance measurement evaluated in functional studies, showing higher values in those based on cycle-ergometer compared to treadmill. Subgroup analysis shows that exercise intolerance seems to be more related to age, medication and comorbidities than HCM phenotype itself. Lower VO2max is consistently seen in HCM patients at major cardiovascular risk.
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Affiliation(s)
- Adrián Bayonas-Ruiz
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
| | | | - Vicente Ferrer
- Physiotherapy Department, Faculty of Medicine, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - Carlos Pérez-Caballero
- Sports Activities Service, Campus of Espinardo, University of Murcia, 30100 Murcia, Spain
| | - María Sabater-Molina
- Inherited Cardiopathies Unit, Virgen de la Arrixaca University Hospital, El Palmar, 30120 Murcia, Spain
| | - María Teresa Tomé-Esteban
- Cardiovascular Clinical Academic Group, Inherited Cardiovascular Disease Unit, St George's Hospital NHS Foundation Trust, St George's University of London, London SW17 0QT, UK
| | - Bárbara Bonacasa
- Human Physiology Area, Faculty of Sport Sciences, University of Murcia, Santiago de la Ribera-San Javier, 30720 Murcia, Spain
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10
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Koracevic G, Micic S, Stojanovic M. By discontinuing beta-blockers before an exercise test we may precipitate a rebound phenomenon. Curr Vasc Pharmacol 2021; 19:624-633. [PMID: 33653252 DOI: 10.2174/1570161119666210302152322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/25/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a need to analyse the current approach to beta-blocker (BB) use in relation to exercise-based stress tests. OBJECTIVE We compared various guidelines regarding recommending abrupt vs gradual discontinuation of BB prior to exercise tests. We also analyse the shortcomings of the currently recommended approach and suggest a new approach to avoid BB rebound. METHODS A narrative review is used to analyse this topic due to lack of valid randomized clinical trials. RESULTS Omitting the BB therapy prior to exercise-based test has been recommended in guidelines for many years. Although reasonable, this approach has potential disadvantages since sudden BB withdrawal may induce a rebound phenomenon, which is, also, acknowledged in several guidelines. CONCLUSIONS We observed inconsistency among relevant guidelines; there is no homogenous approach regarding BB use before exercise tests. Most guidelines recommend BB withdrawal for a couple of days before the test; they do not advise BB dose tapering. This approach is not standardised and raises the risk of BB rebound phenomenon both before and during the test. Therefore, we suggest using the half the prescribed BB dose at the usual time of administration (in the morning, prior to the exercise test).
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis. Serbia
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11
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Cavigli L, Olivotto I, Fattirolli F, Mochi N, Favilli S, Mondillo S, Bonifazi M, D'Ascenzi F. Prescribing, dosing and titrating exercise in patients with hypertrophic cardiomyopathy for prevention of comorbidities: Ready for prime time. Eur J Prev Cardiol 2020; 28:1093-1099. [PMID: 33611579 DOI: 10.1177/2047487320928654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/02/2020] [Indexed: 01/09/2023]
Abstract
The benefits of physical activity are well established, leading to both cardiovascular and non-cardiovascular benefits, improving quality of life and reducing mortality. Despite such striking body of evidence, patients with hypertrophic cardiomyopathy are often discouraged by health professionals to practice physical activity and personalised exercise prescription is an exception rather than the rule. As a result, hypertrophic cardiomyopathy patients are on average less active and spend significantly less time at work or recreational physical activity than the general population. Exercise restriction derives from the evidence that vigorous exercise may occasionally trigger life-threatening arrhythmias and sudden cardiac death. However, while participation in competitive sports should be prudentially denied, hypertrophic cardiomyopathy patients can benefit from the positive effects of regular physical activity, aimed to reduce the risk of comorbidities and improve the quality of life. Based on this rationale, exercise should be prescribed and titrated just like a drug in hypertrophic cardiomyopathy patients, considering individual characteristics, symptoms, past medical history, objective individual response to exercise, previous training experience and stage of disease. Type, frequency, duration, and intensity should be defined on a personal basis. Yet exercise prescription in hypertrophic cardiomyopathy and its long-term effects represent major gaps in our current knowledge and require extensive research. We here review existing evidence regarding benefits and hazards of physical activity, with specific focus on viable modalities for tailored and safe exercise prescription in these patients, highlighting future developments and relevant research targets.
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Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.,Department of Medicine, University of Pittsburgh, USA
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12
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Kruk J, Kotarska K, Aboul-Enein BH. Physical exercise and catecholamines response: benefits and health risk: possible mechanisms. Free Radic Res 2020; 54:105-125. [PMID: 32020819 DOI: 10.1080/10715762.2020.1726343] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Beneficial effect of regular moderate physical exercise (PE) and negative effect of severe exercise and/or overtraining as an activator of the sympathetic nervous system (SNS) have been shown in numerous aspects of human health, including reduced risk of cardiovascular disease, neurological disease, depression, and some types of cancer. Moderate-to-vigorous PE stimulates the SNS activation, releasing catecholamines (CATs) adrenaline, noradrenaline, dopamine that play an important regulatory and modulatory actions by affecting metabolic processes and the immune system. Summary of the dispersed literature in this area and explanation of the biological mechanisms operating between PE-CATs and the immune system would lead to a better understanding of the beneficial and negative effects of PE on health. This overview aimed to: demonstrate representative literature findings on the exercise released CATs levels, major functions performed by these hormones, their interactions with the immune system and their effects on carbohydrate and lipid metabolism. Also, mechanisms of cytotoxic free radicals and reactive oxygen species (ROS) generation during CATs oxidation, and molecular mechanisms of CATs response to exercise are discussed to demonstrate positive and negative on human health effects. Owing to the large body of the subject literature, we present a representative cross-section of the published studies in this area. The results show a significant role of CATs in carbohydrate and lipid metabolism, immunity and as generators of ROS, depending on PE intensity and duration. Further investigation of the PE-CATs relationship should validate CATs levels to optimize safe intensity and duration of exercise and individualize their prescription, considering CATs to be applied as markers for a dose of exercise. Also, a better understanding of the biological mechanisms is also needed.
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Affiliation(s)
- Joanna Kruk
- Faculty of Physical Culture and Health, University of Szczecin, Szczecin, Poland
| | - Katarzyna Kotarska
- Faculty of Physical Culture and Health, University of Szczecin, Szczecin, Poland
| | - Basil H Aboul-Enein
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
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Spector S, Debi R, Shin J. Big heart, no longer a big problem: using catecholamine‐based quantifications may be an effective means to prescribe exercise to non‐obstructive hypertrophic cardiomyopathy patients. J Physiol 2019; 597:2329-2330. [DOI: 10.1113/jp277970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Steven Spector
- Department of BiologyYork University Toronto Ontario M3J 1P3 Canada
| | - Ryan Debi
- Department of BiologyYork University Toronto Ontario M3J 1P3 Canada
| | - Jin Shin
- Department of BiologyYork University Toronto Ontario M3J 1P3 Canada
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14
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Joyner MJ. Hypertrophic cardiomyopathy and exercise: a need for more information. J Physiol 2019; 597:1225-1226. [DOI: 10.1113/jp277538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael J. Joyner
- Department of Anesthesiology & Perioperative MedicineMayo Clinic Rochester MN 55905 USA
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15
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Vecchiarelli E, Bentley RF. Exercising caution: is there a role for exercise testing in the hypertrophic cardiomyopathy population? J Physiol 2019; 597:1789-1790. [PMID: 30807651 DOI: 10.1113/jp277778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Emily Vecchiarelli
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Robert F Bentley
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
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