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Noda T, Kamiya K, Hamazaki N, Yamashita M, Miki T, Nozaki K, Uchida S, Ueno K, Maekawa E, Terada T, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. Screening for sarcopenia with SARC-F in older patients hospitalized with cardiovascular disease. Eur J Cardiovasc Nurs 2024; 23:675-684. [PMID: 38315615 DOI: 10.1093/eurjcn/zvae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
AIMS SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity values to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score. METHODS AND RESULTS This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in the SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Area under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g. walking speed, leg strength, and 6 min walking distance) of each SARC-F score. A total of 1066 participants (63.8% male; median age: 76 years) were included. Sarcopenia was present in 401 patients. A SARC-F cut-off ≥2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (AUCs = 0.658; 95% confidence interval: 0.625-0.691). When the patients had low scores (1-3), every 1 point increase in the SARC-F score was associated with lower physical functions such as lower muscle strength and shorter walking distance (all P < 0.001). CONCLUSION A SARC-F cut-off ≥2 was optimal for screening sarcopenia, and even a low SARC-F score is useful in detecting sarcopenia and low physical function at an early stage in patients with CVD.
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Affiliation(s)
- Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street Ottawa, Ontario K1Y 4W7, Canada
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Division of Research, ARCE Inc., 4-2-1F Sakae-cho, Minami-ku, Sagamihara 252-0306, Japan
| | - Takashi Miki
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
| | - Tasuku Terada
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street Ottawa, Ontario K1Y 4W7, Canada
- School of Life Sciences, Physiology, Metabolism & Nutrition Research Group, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street Ottawa, Ontario K1Y 4W7, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Montpetit Hall 125 University, Room 240, Ottawa, Ontario K1N 6N5, Canada
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0373, Japan
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0375, Japan
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Shakuta S, Noda T, Kamiya K, Hamazaki N, Nozaki K, Yamashita M, Uchida S, Ueno K, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Clinical Impact of Improvement in Sarcopenia through Cardiac Rehabilitation in Patients with Heart Failure. J Am Med Dir Assoc 2024; 25:514-520.e2. [PMID: 38182121 DOI: 10.1016/j.jamda.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Sarcopenia in patients with heart failure (HF) is associated with poor prognosis. Cardiac rehabilitation (CR) decreases the incidence of adverse events in patients with HF. However, the clinical implications of improving sarcopenia status through CR remain unclear. This study investigated the relationship between the changes in sarcopenia status in patients with HF undergoing outpatient CR and the risk of mortality and adverse events. DESIGN This was a retrospective cohort study of patients hospitalized at the Kitasato University Hospital Cardiovascular Center for the treatment of HF between January 2007 and December 2020. SETTING AND PARTICIPANTS Patients with HF whose sarcopenia status was assessed at hospital discharge and following at least 3 months of outpatient CR were included. Based on the sarcopenia status, all patients were divided into 3 groups: patients without sarcopenia at discharge (ie, robust), patients with sarcopenia at discharge but no sarcopenia following CR (ie, improved), and patients with sarcopenia at discharge and following CR (ie, unimproved). METHODS Cox regression analysis was used to examine the risk of all-cause death associated with the 3 sarcopenia status groups. RESULTS Of 546 patients with HF (median age: 70 years; male: 63.6%), 377 (69.0%), 54 (9.9%), and 115 (21.1%) were classified as robust, improved, and unimproved, respectively. Multivariate Cox regression analysis showed that the unimproved group had a significantly greater risk of all-cause death when compared to the robust group [hazard ratio (HR) 2.603, 95% CI 1.375-4.930, P = .004], but it did not differ from the improved group (HR 1.403, 95% CI 0.598-3.293, P = .43). CONCLUSIONS AND IMPLICATIONS No improvement in sarcopenia status in patients with HF undergoing outpatient CR was associated with a higher risk of all-cause death. Sarcopenia may be an important target to improve the prognosis of patients with HF.
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Affiliation(s)
- Saki Shakuta
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Division of Research, ARCE Inc, Sagamihara, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Research fellow, Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Raisi A, Bernardi E, Myers J, Piva T, Zerbini V, Masotti S, Menegatti E, Caruso L, Mazzoni G, Grazzi G, Mandini S. Change in Peak Oxygen Uptake Predicted by the Moderate 1-km Treadmill Walking Test After Walking Training in Outpatients With Cardiovascular Disease. J Cardiopulm Rehabil Prev 2024; 44:131-136. [PMID: 37616588 DOI: 10.1097/hcr.0000000000000812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE The purpose of this study was to determine the ability of the moderate 1-km treadmill walking test (1km-TWT) to predict changes in peak oxygen uptake (V˙O 2peak ) in patients with stable cardiovascular disease (CVD) during an exercise-based secondary prevention program. METHODS Sixty-four male outpatients with stable CVD (age 64 [41-85] yr) performed the 1km-TWT before and after an 8-wk walking training program. Patient V˙O 2peak was estimated using a sex-specific equation including age, body mass index, 1km-TWT performance time, and heart rate (V˙O 2peakEST ). Forty-one patients completed a maximal cardiopulmonary treadmill test (CPX) for direct V˙O 2peak determination (V˙O 2peakMEAS ). The training prescription consisted of moderate-to-high intensity supervised walking for 30-40 min/session, and an additional 2-4 times/wk of unsupervised home moderate walking sessions between 20-60 min at the end of the program. The walking intensity was based on the results of the 1km-TWT. RESULTS Patients participated in an average of 14 of the 16 supervised sessions. An overall significant improvement in V˙O 2peakMEAS and weekly recreational physical activity levels were observed. No differences were observed between V˙O 2peakMEAS and V˙O 2peakEST . Compared with CPX results, the 1km-TWT underestimated the V˙O 2peak increase after the exercise intervention (mean difference -0.3 mL/kg/min, P > .05). CONCLUSIONS The 1km-TWT provides a reasonably accurate and simple tool to predict changes in V˙O 2peak due to moderate walking training in male outpatients with CVD. These findings contribute to the growing body of evidence supporting the use of the 1km-TWT for exercise testing and training purposes in the context of cardiac rehabilitation/secondary prevention programs.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy (Messrs Raisi and Piva, Drs Bernardi, Masotti, Mazzoni, Grazzi, and Mandini and Ms Zerbini), Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, the United States (Drs Myers and Grazzi); Division of Cardiology, VA Palo Alto, California, the United States, and Stanford University School of Medicine, Stanford, California, the United States (Dr Myers); Department of Environmental Sciences and Prevention, University of Ferrara, Ferrara, Italy (Drs Menegatti and Caruso); and Public Health Department, AUSL Ferrara, Ferrara, Italy (Drs Mazzoni and Grazzi)
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Liao CD, Huang SW, Chen HC, Huang YY, Liou TH, Lin CL. Effects of Protein Supplementation Combined with Resistance Exercise Training on Walking Speed Recovery in Older Adults with Knee Osteoarthritis and Sarcopenia. Nutrients 2023; 15:nu15071552. [PMID: 37049391 PMCID: PMC10096553 DOI: 10.3390/nu15071552] [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: 03/03/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Knee osteoarthritis (KOA) is closely associated with sarcopenia, sharing the common characteristics of muscle weakness and low physical performance. Resistance exercise training (RET), protein supplementation (PS), and PS+RET have promise as treatments for both sarcopenia and KOA. However, whether PS+RET exerts any effect on time to recovery to normal walking speed (WS) in older adults with sarcopenia and KOA remains unclear. This study investigated the treatment efficiency of PS+RET on WS recovery among individuals with KOA and sarcopenia. A total of 108 older adults aged ≥ 60 years who had a diagnosis of radiographic KOA and sarcopenia were enrolled in this prospective cohort study. Sarcopenia was defined on the basis of the cutoff values of the appendicular skeletal muscle mass index for Asian people and a slow WS less than 1.0 m/s. The patients were equally distributed to three groups: PS+RET, RET alone, and usual care. The weekly assessment was performed during a 12-week intervention and a subsequent 36-week follow-up period. A cutoff of 1.0 m/s was used to identify successful recovery to normal WS. Kaplan-Meier analysis was performed to measure the survival time to normal WS among the study groups. Multivariate Cox proportional-hazards regression (CPHR) models were established to calculate the hazard ratios (HRs) of successful WS recovery and determine its potential moderators. After the 3-month intervention, PS+RET as well as RET obtained greater changes in WS by an adjusted mean difference of 0.18 m/s (p < 0.0001) and 0.08 (p < 0.05) m/s, respectively, compared to usual care. Kaplan-Meier analysis results showed both RET and PS+RET interventions yielded high probabilities of achieving normal WS over the 12-month follow-up period. Multivariate CPHR results revealed that PS+RET (adjusted HR = 5.48; p < 0.001), as well as RET (adjusted HR = 2.21; p < 0.05), independently exerted significant effects on WS recovery. PS+RET may accelerate normal WS recovery by approximately 3 months compared with RET. Sex and initial WS may influence the treatment efficiency. For patients with KOA who suffer sarcopenia, 12-week RET alone exerts significant effects on WS recovery, whereas additional PS further augments the treatment effects of RET by speeding up the recovery time of WS toward a level ≥ 1.0 m/s, which facilitates the patients to diminish the disease severity or even free from sarcopenia.
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Affiliation(s)
- Chun-De Liao
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110301, Taiwan
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Yu-Yun Huang
- Department of Pediatrics, New York University Langone Medical Center, New York City, NY 10016, USA
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Mazzoni G, Raisi A, Myers J, Arena R, Kaminsky L, Zerbini V, Lordi R, Chiaranda G, Mandini S, Sella G, Tonet E, Campo G, Grazzi G. Promotion and maintenance of physically active lifestyle in older outpatients 2 years after acute coronary syndrome. Aging Clin Exp Res 2022; 34:1065-1072. [PMID: 34997543 DOI: 10.1007/s40520-021-02044-1] [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: 10/14/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
AIMS To examine long-term changes in lifestyle and exercise capacity of older patients hospitalized for acute coronary syndrome (ACS) involved in an innovative centre- and home-based exercise-based secondary prevention program. METHODS A sample of 118 patients with ACS (age 76 [72-80] years) was analysed. Long-term changes in self-reported weekly leisure-time physical activity (wLTPA), walking speed (WS), and estimated cardiorespiratory fitness (eCRF, VO2peak, mL/kg/min) were the outcome variables. The program consisted of seven individual on-site sessions including motivational interviewing to reach exercise goals. Exercise prescription was based on the results of a standardized moderate and perceptually regulated treadmill walk to estimate VO2peak. wLTPA, WS, and eCRF were assessed at 1 (baseline), 2, 3, 4, 6, 12, and 24 months after discharge. RESULTS 87, 76, and 70 patients completed follow-up at 6, 12, and 24 months, respectively. wLTPA significantly increased during the follow-up period (median METs/H/week 2.5, 11.2, 12.0, and 13.4 at baseline, 6, 12, and 24 months, respectively; P < 0.0001). At baseline, 18% of the sample met the current international guidelines for physical activity, while 75%, 70%, and 76% of them met the recommended values at 6-, 12-, and 24-month follow-up sessions, respectively. These results were associated with increasing median WS (2.9 ± 1.0, 4.3 ± 1.2, 4.5 ± 1.1, 4.5 ± 1.2 km/h, respectively, P < 0.0001), and VO2peak (16.5, 21.4, 21.1, 21.3 mL/kg/min, respectively, P < 0.0001). CONCLUSIONS This early, individualized exercise intervention improved long-term adherence to a physically active lifestyle, walking capacity, and eCRF in older patients after ACS. Larger studies are needed to confirm short- and long-term clinical benefits of this intervention.
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Affiliation(s)
- Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy.
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, Palo Alto, CA, USA
- Stanford University School of Medicine, Stanford, CA, USA
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leonard Kaminsky
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN, USA
| | - Valentina Zerbini
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | - Rosario Lordi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Public Health Department, AUSL Piacenza, Piacenza, Italy
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
| | | | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, via Gramicia 35, 44121, Ferrara, Italy
- Public Health Department, AUSL Ferrara, Ferrara, Italy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
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Maintenance of Exercise Habit and Its Impact on Cardiovascular Risk Factors in Previously Sedentary People: A 7-Year Follow-Up. J Aging Phys Act 2022; 30:1038-1046. [PMID: 35461189 DOI: 10.1123/japa.2021-0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
The aim of the study was to assess whether the level of physical activity in daily life in previously sedentary adults had been sustained 7 years beyond a 1-year supervised walking program. One hundred ten participants (63 females, 57.5 ± 8.4 years; 47 males, 66.4 ± 7.9 years) were recalled and assessed for physical activity in daily life, weight, body mass index, blood pressure, and walking speed. Fifty-nine percentage of the participants measured met and exceeded the World Health Organization physical activity guidelines (Group 1), while 41% did not (Group 2). In both groups, we observed a significant decrease of weight (72.0 ± 14.0 kg vs. 69.7 ± 14.0 kg in Group 1; 77.4 ± 19.5 kg vs. 75.4 ± 18.6 kg in Group 2) and body mass index (25.9 ± 3.7 vs. 25.1 ± 3.9 in Group 1; 27.9 ± 5.6 vs. 27.2 ± 5.4 in Group 2). Group 1 showed a significant increase in walking speed (5.8 ± 0.7 km/hr vs. 6.2 ± 0.8 km/hr), while systolic pressure did not change from the baseline. In Group 2, systolic pressure significantly increased (131.3 ± 13.5 mmHg vs. 138.0 ± 15.5 mmHg), while walking speed did not change. A guided walking program seems to have been effective in educating sedentary people to remain physically active over time.
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Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-Arginine is the substrate used by nitric oxide (NO) synthase (NOS) to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-Arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy 1 bottle containing 1.66 g of L-arginine or 1 bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT) and were assessed their Borg modified 0-10 rating of perceived exertion (BRPE) before starting and at the end of the treatment. Seventy-five patients receiving L-Arginine, and thirty-five receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-Arginine group compared to both baseline and placebo (p<0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR, independently of age, sex, baseline functional capacity, and comorbid conditions. Significance Statement This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent from age, sex, comorbid conditions, and baseline functional capacity.
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Mazzoni G, Myers J, Sassone B, Pasanisi G, Mandini S, Raisi A, Pizzolato M, Franchi M, Caruso L, Missiroli L, Chiaranda G, Grazzi G. A moderate 200-m walk test estimates peak oxygen uptake in elderly outpatients with cardiovascular disease. J Sports Med Phys Fitness 2020; 60:786-793. [PMID: 32438791 DOI: 10.23736/s0022-4707.20.10387-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A moderate 1-km treadmill walk test (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak) in outpatients with cardiovascular disease (CVD). The results obtained by the 1k-TWT predict survival and hospitalization in men and women with CVD. We aimed to examine whether shorter versions of the full 1k-TWT equally assess VO2peak in outpatients with CVD. METHODS One hundred eighteen outpatients with CVD, aged 70±9 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, heart rate, time to walk 100-m, 200-m, 300-m, and 400-m, and the full 1000-m, were entered into equations to estimate VO2peak. RESULTS The minimal distance providing similar VO2peak results of the full 1k-TWT was 200-m: 23.0±5.3 mL/kg/min and 23.0±5.5 mL/kg/min, respectively. The concordance correlation coefficient between the two was 0.97 (95%CI 0.96 to 0.98, P<0.0001). The slope and the intercept of the relationship between the values obtained by the 200-m and the full 1k-TWT were not different from the line of identity. Bland-Altman analysis did not show systematic or proportional error. CONCLUSIONS A moderate 200-m treadmill-walk is a reliable method for estimating VO2peak in elderly outpatients with CVD. A 200-m walk enables quick and easy cardiorespiratory fitness assessment, with low costs and low burden for health professionals and patients. These findings have practical implications for the transition of patients from clinically-based programs to fitness facilities or self-guided exercise programs.
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Affiliation(s)
- Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Department of Public Health, AUSL Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto Health Case System, Palo Alto, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - Biagio Sassone
- Division of Cardiology, Department of Medicine, AUSL Ferrara, Ferrara, Italy
| | - Giovanni Pasanisi
- Division of Cardiology, Department of Medicine, AUSL Ferrara, Ferrara, Italy
| | - Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy - .,Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Andrea Raisi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Matteo Pizzolato
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Michele Franchi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Loretta Missiroli
- Unit of Bibliometric and Dataset, Research Office, University of Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Ferrara, Ferrara, Italy.,Department of Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Department of Public Health, AUSL Ferrara, Ferrara, Italy
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9
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Chiaranda G, Myers J, Arena R, Kaminsky L, Sassone B, Pasanisi G, Mandini S, Pizzolato M, Franchi M, Napoli N, Guerzoni F, Caruso L, Mazzoni G, Grazzi G. Improved percent-predicted peak VO2 is associated with lower risk of hospitalization in patients with coronary heart disease. Analysis from the FRIEND registry. Int J Cardiol 2020; 310:138-144. [DOI: 10.1016/j.ijcard.2020.02.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/22/2020] [Accepted: 02/21/2020] [Indexed: 12/25/2022]
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10
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Mandini S, Conconi F, Mori E, Grazzi G, Mazzoni G. Guided walking is more effective than suggested walking in reducing the blood pressure of hypertensive sedentary subjects and in modifying their lifestyle. SPORT SCIENCES FOR HEALTH 2020. [DOI: 10.1007/s11332-020-00620-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Aida K, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Usefulness of the Simplified Frailty Scale in Predicting Risk of Readmission or Mortality in Elderly Patients Hospitalized with Cardiovascular Disease. Int Heart J 2020; 61:571-578. [PMID: 32418965 DOI: 10.1536/ihj.19-557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The simplified frailty scale is a simple frailty assessment tool modified from Fried's phenotypic frailty criteria, which is easy to administer in hospitalized patients. The applicability of the simplified frailty scale to indicate prognosis in elderly hospitalized patients with cardiovascular disease (CVD) was examined.This cohort study was performed in 895 admitted patients ≥ 65 years (interquartile range, 71.0-81.0, 541 men) with CVD. Patients were classified as robust, prefrail, or frail based on the five components of the simplified frailty scale: weakness, slowness, exhaustion, low activity, and weight loss. The primary endpoint was the composite outcome of all-cause mortality and unplanned readmission for CVD.Patients positive for greater numbers of frailty components showed higher risk of all-cause mortality or unplanned CVD-related readmission (P for trend < 0.001). Classification as both frail (adjusted HR: 3.27, 95% confidence interval [CI]: 1.49-7.21, P = 0.003) and prefrail (adjusted HR: 2.19, 95% CI: 1.00-4.79, P = 0.049) independently predicted the composite endpoint compared with robust after adjusting for potential confounding factors. The inclusion of prefrail, frail, and number of components of frailty increased both continuous net reclassification improvement (0.113, P = 0.049; 0.426, P < 0.001; and 0.321, P < 0.001) and integrated discrimination improvement (0.007, P = 0.037; 0.009, P = 0.038; and 0.018, P = 0.002) for the composite endpoint.Higher scores on the simplified frailty scale were associated with increased risk of mortality or readmission in elderly patients hospitalized for CVD.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | | | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital
| | | | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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12
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Mandini S, Conconi F, Mori E, Caruso L, Grazzi G, Mazzoni G. Guided walking reduces blood pressure in hypertensive sedentary subjects including those with resistant hypertension. J Hum Hypertens 2020; 35:226-231. [PMID: 32152454 DOI: 10.1038/s41371-020-0324-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/27/2020] [Accepted: 02/27/2020] [Indexed: 11/09/2022]
Abstract
Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P < 0.0001) of systolic pressure was observed in both groups. The decrease was significantly higher (P < 0.0001) in the subjects under therapy. The decrease of systolic pressure was directly proportional to baseline values. Diastolic blood pressure decreased significantly in both groups. In conclusion, habitual walking may lead to clinically significant reductions of blood pressure in therapy resistant hypertensive subjects.
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Affiliation(s)
- Simona Mandini
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.
| | - Francesco Conconi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Elisa Mori
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Lorenzo Caruso
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy
| | - Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL, Ferrara, Italy
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL, Ferrara, Italy
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13
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Campo G, Tonet E, Chiaranda G, Sella G, Maietti E, Bugani G, Vitali F, Serenelli M, Mazzoni G, Ruggiero R, Villani G, Biscaglia S, Pavasini R, Rubboli A, Campana R, Caglioni S, Volpato S, Myers J, Grazzi G. Exercise intervention improves quality of life in older adults after myocardial infarction: randomised clinical trial. Heart 2020; 106:1658-1664. [PMID: 32144189 DOI: 10.1136/heartjnl-2019-316349] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To establish the benefits of an early, tailored and low-cost exercise intervention in older patients hospitalised for acute coronary syndrome (ACS). METHODS The study was a multicentre, randomised assessment of an exercise intervention in patients with ACS ≥70 years with reduced physical performance (as defined by the short physical performance battery (SPPB), value 4-9). The exercise intervention included four supervised sessions (1, 2, 3, 4 months after discharge) and home-based exercises. The control group attended a health education programme only. The outcomes were the 6-month and 1-year effects on physical performance, daily activities, anxiety/depression and quality of life. Finally, 1-year occurrence of adverse events was recorded. RESULTS Overall, 235 patients with ACS (median age 76 (73-81) years) were randomised 1 month after ACS. Exercise and control groups were well balanced. Exercise intervention improved 6-month and 1-year grip strength and gait speed. Exercise intervention was associated with a better quality of life (as measured by EuroQol-visual analogue scale at 6 months 80 (70-90) vs 70 (50-80) points, p<0.001 and at 1 year 75 (70-87) vs 65 (50-80) points, p<0.001) and with a reduced perception of anxiety and/or depression (6 months: 21% vs 42%, p=0.001; 1 year 32% vs 47%, p=0.03). The occurrence of cardiac death and hospitalisation for cardiac cause was lower in the intervention group (7.5% vs 17%, p=0.04). CONCLUSIONS The proposed early, tailored, low-cost exercise intervention improves mobility, daily activities, quality of life and outcomes in older patients with ACS. Larger studies are needed to confirm the clinical benefit. TRIAL REGISTRATION NUMBER NCT03021044.
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Affiliation(s)
- Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Piacenza, and Sport Medicine Service, Piacenza, Italy
| | | | - Elisa Maietti
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Francesco Vitali
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Gianni Mazzoni
- Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
| | - Rossella Ruggiero
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Giovanni Villani
- Cardiology Unit, Ospedale S, Giovanni da Saliceto, Piacenza, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Andrea Rubboli
- Sports Medicine Center, AUSL Ravenna, Ravenna, Italy.,Division of Cardiology, S. Maria Delle Croci Hospital, Ravenna, Italy
| | - Roberta Campana
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Serena Caglioni
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Jonathan Myers
- School of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiology, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Giovanni Grazzi
- Public Health Department, Azienda USL di Ferrara, Ferrara, Italy.,Center of Sport and Exercise Sciences, University of Ferrara, Ferrara, Italy
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14
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Grazzi G, Myers J, Arena R, Kaminsky L, Mazzoni G, Chiaranda G. Reply to commentary on: Prediction of VO 2peak by an endurance test and prognostic value of the FRIEND equation. Eur J Prev Cardiol 2019; 27:2054-2056. [PMID: 31787025 DOI: 10.1177/2047487319892121] [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: 11/15/2022]
Affiliation(s)
- Giovanni Grazzi
- Center for Exercise Science and Sport, University of Ferrara, Italy.,Public Health Department, AUSL Ferrara, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, USA.,Stanford University School of Medicine, USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago, USA
| | - Leonard Kaminsky
- Clinical Exercise Physiology Laboratory, Ball State University, USA
| | - Gianni Mazzoni
- Center for Exercise Science and Sport, University of Ferrara, Italy.,Public Health Department, AUSL Ferrara, Italy
| | - Giorgio Chiaranda
- Public Health Department, AUSL Piacenza, Italy.,General Directorship for Public Health and Integration Policy, Italy
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15
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Nakamura T, Kamiya K, Matsunaga A, Hamazaki N, Matsuzawa R, Nozaki K, Yamashita M, Maekawa E, Noda C, Yamaoka-Tojo M, Ako J. Impact of Gait Speed on the Obesity Paradox in Older Patients With Cardiovascular Disease. Am J Med 2019; 132:1458-1465.e1. [PMID: 31356768 DOI: 10.1016/j.amjmed.2019.06.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this study was to determine whether gait speed affects the obesity paradox in older patients with cardiovascular disease. METHODS The study population consisted of 2224 patients ≥60 years old with cardiovascular disease admitted to hospital between May 1, 2006, and January 31, 2018. Body mass index (BMI) and gait speed before hospital discharge were determined, and patients were divided into two groups: slow and preserved gait speed (≤0.8 and >0.8 m/s, respectively), according to the algorithm for sarcopenia diagnosis. The slow and preserved gait speed groups were also further subdivided according to BMI: <18.5 kg/m2, 18.5-24.9 kg/m2, and BMI ≥25.0 kg/m2. The study endpoint was all-cause mortality. RESULTS The study population (male: 66.7%) had a mean age of 73.1 ± 7.6 years. Over a median follow-up period of 1.69 years (interquartile range 0.67-3.67 years), 283 patients died. Higher BMI was associated with favorable prognosis in the group with preserved gait speed but not in the group with slow gait speed after adjusting for other prognostic factors. Adding BMI to the clinical model significantly increased the area under the receiver operating characteristic curve in the group with preserved gait speed (0.744 vs 0.726, P = 0.028) but not in the group with slow gait speed (0.716 vs 0.716, P = 0.789). CONCLUSIONS Higher BMI was consistently associated with favorable prognosis in patients with cardiovascular disease and preserved gait speed but not in those with slow gait speed. These findings indicated that physical frailty influences the obesity paradox in older patients with cardiovascular disease.
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Affiliation(s)
- Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University Sagamihara, Japan.
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University Sagamihara, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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16
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Mikkelsen N, Cadarso-Suárez C, Lado-Baleato O, Díaz-Louzao C, Gil CP, Reeh J, Rasmusen H, Prescott E. Improvement in VO2peak predicts readmissions for cardiovascular disease and mortality in patients undergoing cardiac rehabilitation. Eur J Prev Cardiol 2019; 27:811-819. [DOI: 10.1177/2047487319887835] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Improvement in exercise capacity is a main goal of cardiac rehabilitation but the effects are often lost at long-term follow-up and thus also the benefits on prognosis. We assessed whether improvement in VO2peak during a cardiac rehabilitation programme predicts long-term prognosis. Methods and results We performed a retrospective analysis of 1561 cardiac patients completing cardiac rehabilitation in 2011–2017 in Copenhagen. Mean age was 63.6 (11) years, 74% were male and 84% had coronary artery disease, 6% chronic heart failure and 10% heart valve replacement. The association between baseline VO2peak and improvement after cardiac rehabilitation and being readmitted for cardiovascular disease and/or all-cause mortality was assessed with three different analyses: Cox regression for the combined outcome, for all-cause mortality and a multi-state model. During a median follow-up of 2.3 years, 167 readmissions for cardiovascular disease and 77 deaths occurred. In adjusted Cox regression there was a non-linear decreasing risk of the combined outcome with higher baseline VO2peak and with improvement of VO2peak after cardiac rehabilitation. A similar linear association was seen for all-cause mortality. Applying the multi-state model, baseline VO2peak and change in VO2peak were associated with risk of a cardiovascular disease readmission and with all-cause mortality but not with mortality in those having an intermediate readmission for cardiovascular disease. Conclusion VO2peak as well as change in VO2peak were highly predictive of future risk of readmissions for cardiovascular disease and all-cause mortality. The predictive value did not extend beyond the next admission for a cardiovascular event.
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Affiliation(s)
- Nicolai Mikkelsen
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Carmen Cadarso-Suárez
- Unit of Biostatistics, Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Spain
| | - Oscar Lado-Baleato
- Unit of Biostatistics, Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Spain
| | - Carla Díaz-Louzao
- Unit of Biostatistics, Department of Statistics, Mathematical Analysis, and Optimization, Universidade de Santiago de Compostela, Spain
| | - Carlos P Gil
- Cardiology and Coronary Care Department Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Jacob Reeh
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Hanne Rasmusen
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Eva Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Denmark
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17
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Afilalo J, Sharma A, Zhang S, Brennan JM, Edwards FH, Mack MJ, McClurken JB, Cleveland JC, Smith PK, Shahian DM, Peterson ED, Alexander KP. Gait Speed and 1-Year Mortality Following Cardiac Surgery: A Landmark Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database. J Am Heart Assoc 2019; 7:e010139. [PMID: 30571598 PMCID: PMC6405557 DOI: 10.1161/jaha.118.010139] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background In older adults undergoing cardiac surgery, prediction of downstream risk is critical. Our objective was to determine the association of 5‐m gait speed with 1‐year mortality and repeat hospitalization following cardiac surgery. Methods and Results In this prospective cohort of patients undergoing cardiac surgery at centers participating in the Society of Thoracic Surgeons Database with gait speed recorded, we examined all‐cause mortality using a landmark analysis at 0 to 30, 30 to 365, and >365 days, as well as repeat hospitalization. The cohort consisted of 8287 patients (median age, 74 years; 32% females). At 1 year, survival was 90% in the slow (<0.83 m/s), 95% in the middle (0.83–1.00 m/s), and 97% in the fast (>1.00 m/s) gait speed tertiles, and risk of hospitalization was 45%, 33%, and 27%, respectively (both P<0.0001). After adjustment, gait speed remained predictive of mortality (hazard ratio, 2.16 per 0.1‐m/s decrease in gait speed; 95% confidence interval, 1.59–2.93) and rehospitalization (hazard ratio, 1.71 per 0.1‐m/s decrease in gait speed; 95% confidence interval, 1.45–2.0). In a landmark analysis, the effect of slow gait speed on mortality was most marked from 30 to 365 days after surgery, where each decline in 0.1 m/s of gait speed conferred a 2‐fold increased risk of mortality. Conclusions Gait speed is a simple tool to screen for frailty and identify older adults at risk for adverse events in the early and midterm postoperative periods.
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Affiliation(s)
- Jonathan Afilalo
- 1 Division of Cardiology & Centre for Clinical Epidemiology Jewish General Hospital McGill University Montreal Quebec Canada
| | - Abhinav Sharma
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Shuaiqi Zhang
- 2 Duke Centre for Clinical Research Institute Durham NC
| | - J Matthew Brennan
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Fred H Edwards
- 5 Division of Cardiac Surgery University of Florida Jacksonville FL
| | - Michael J Mack
- 6 Division of Cardiac Surgery The Heart Hospital Baylor Plano Plano TX
| | - James B McClurken
- 7 Cardiothoracic Surgery Reif Cardiovascular Institute, Doylestown Hospital Doylestown PA
| | | | - Peter K Smith
- 4 Divisions of Cardiac Surgery Duke University Medical Center Durham NC
| | - David M Shahian
- 9 Department of Surgery Massachusetts General Hospital Boston MA
| | - Eric D Peterson
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
| | - Karen P Alexander
- 2 Duke Centre for Clinical Research Institute Durham NC.,3 Divisions of Cardiology Duke University Medical Center Durham NC
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18
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Burch AE, D'Souza B, Gimbel JR, Rohrer U, Masuda T, Sears S, Scherr D. Physical activity is reduced prior to ventricular arrhythmias in patients with a wearable cardioverter defibrillator. Clin Cardiol 2019; 43:60-65. [PMID: 31710766 PMCID: PMC6954377 DOI: 10.1002/clc.23288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The utility of accelerometer-based activity data to identify patients at risk of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) has not previously been investigated. The aim of the current study was to determine whether physical activity is associated with manifesting spontaneous sustained VT/VF requiring emergent defibrillation in patients with an ejection fraction of ≤35%. METHODS Patients consecutively prescribed a wearable cardioverter defibrillator (WCD) from April 2015 to May 2018 were included. Shock data and 4 weeks of physical activity data, beginning with the first week of WCD wear, were analyzed. RESULTS Based on the ROC curve outcome generated from 4057 patients, average daily step count during the first week accurately predicted those patients with sustained VT/VF compared to those without (shocked (n = 81) vs nonshocked (n = 3976) area under the curve, c-index = 0.71, 95% CI = 0.65-0.77, P < .001). An average cutoff of 3637 daily steps during week 1 separated the groups. Patients who averaged fewer than 3637 steps per day during the first week of WCD use were 4.3 times more likely to experience a shock than those who walked more than 3637 steps per day (OR = 4.29, 95% CI = 2.58-7.15, P < .001). DISCUSSION Average daily step counts are lower in WCD patients who manifest spontaneous VT/VF. Whether these findings represent a causal or correlational relationship, future studies to encourage a minimum daily step count in high-risk patients may impact the incidence of sustained VT/VF.
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Affiliation(s)
- Ashley E Burch
- East Carolina Heart Institute, Greenville, North Carolina
| | | | | | - Ursula Rohrer
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | | | - Samuel Sears
- East Carolina University, Greenville, North Carolina
| | - Daniel Scherr
- Department of Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
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19
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Chiaranda G, Myers J, Arena R, Kaminsky L, Sassone B, Pasanisi G, Mandini S, Mazzoni G, Grazzi G. Prognostic comparison of the FRIEND and Wasserman/Hansen peak VO2 equations applied to a submaximal walking test in outpatients with cardiovascular disease. Eur J Prev Cardiol 2019; 28:287-292. [PMID: 33891689 DOI: 10.1177/2047487319871728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/03/2019] [Indexed: 12/24/2022]
Abstract
AIMS The aim of this study was to determine the ability to predict all-cause mortality using established per cent-predicted (%PRED) equations for peak oxygen consumption (VO2peak) estimated by a submaximal walk test in outpatients with cardiovascular disease. METHODS Male patients (N = 1491) aged 62 ± 10 years at baseline underwent a moderate and perceptually regulated (11-13 on the 6-20 Borg scale) 1-km treadmill-walking test to estimate VO2peak. %PRED was derived from the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND) and the Wasserman/Hansen equations. RESULTS There were 215 deaths during a median 9.4-year follow-up. The FRIEND prediction equation provided better prognostic information with receiver operating curve analysis showing significantly different areas under the curve (0.72 and 0.69 for the FRIEND and the Wasserman/Hansen equations respectively, p = 0.001). Overall mortality rate was higher across decreasing tertiles of %PRED using FRIEND, with 26%, 11% and 5% for the least fit, intermediate and high fit tertiles, respectively (p for trend < 0.0001). Compared with the least fit tertile, the adjusted hazard ratios for the second and third tertiles were 0.54 (95% confidence interval 0.34-0.87, p = 0.01) and 0.45 (95% confidence interval 0.25-0.81, p = 0.008), respectively. Each 1% increase in %PRED conferred a 3% improvement in survival (p = 0.0004). CONCLUSION Low %PRED VO2peak in cardiac outpatients determined by the FRIEND equation was associated with a high mortality rate independent of traditional cardiovascular risk factors and clinical history. The FRIEND equation may provide a suitable normal standard when applied to clinically stable outpatients with cardiovascular disease.
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Affiliation(s)
- Giorgio Chiaranda
- Public Health Department, AUSL Piacenza, Italy.,General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Jonathan Myers
- Division of Cardiology, VA Palo Alto, USA.,Stanford University School of Medicine, USA
| | - Ross Arena
- Department of Physical Therapy, University of Illinois at Chicago, USA
| | - Leonard Kaminsky
- Clinical Exercise Physiology Laboratory, Ball State University, Muncie, USA
| | - Biagio Sassone
- Department of Emergency, Division of Cardiology, AUSL Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Emergency, Division of Cardiology, AUSL Ferrara, Italy
| | - Simona Mandini
- Centre for Exercise Science and Sport, University of Ferrara, Italy.,Public Health Department, AUSL Ferrara, Italy
| | - Gianni Mazzoni
- Centre for Exercise Science and Sport, University of Ferrara, Italy.,Public Health Department, AUSL Ferrara, Italy
| | - Giovanni Grazzi
- Centre for Exercise Science and Sport, University of Ferrara, Italy.,Public Health Department, AUSL Ferrara, Italy
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Nakamura T, Yamashita M, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. Short-Term Change in Gait Speed and Clinical Outcomes in Older Patients With Acute Heart Failure. Circ J 2019; 83:1860-1867. [PMID: 31281168 DOI: 10.1253/circj.cj-19-0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Evidence for the prognostic value of gait speed is largely based on a single measure at baseline, so we investigated the prognostic significance of change in gait speed in hospitalized older acute heart failure (AHF) patients.Methods and Results:This retrospective study was performed in a cohort of 388 AHF patients ≥60 years old (mean age: 74.8±7.8 years, 228 men). Routine geriatric assessment included gait speed measurement at baseline and at discharge. The primary outcome of this study was all-cause death. Gait speed increased from 0.74±0.25 m/s to 0.98±0.27 m/s after 13.5±11.0 days. Older age, shorter height and lower hemoglobin level at admission, prior HF admission, and higher baseline gait speed were independently associated with lesser improvement in gait speed. A total of 80 patients died and 137 patients were readmitted for HF over a mean follow-up period of 2.1±1.9 years. In multivariate analyses, change in gait speed showed inverse associations with all-cause death (hazard ratio [HR] per 0.1 m/s increase: 0.83; 95% confidence interval [CI]: 0.73 to 0.95; P=0.006) and with risk of readmission for HF (HR: 0.91; 95% CI: 0.83 to 0.99; P=0.036). CONCLUSIONS Short-term improvement in gait speed during hospitalization was associated with reduced risks of death and readmission for HF in older patients with AHF.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation, Nagoya University Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Nobuaki Hamazaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University.,Department of Rehabilitation, Kitasato University Hospital
| | | | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital
| | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | - Takashi Masuda
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University
| | - Junya Ako
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kitasato University.,Department of Cardiovascular Medicine, Kitasato University School of Medicine
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Ögmundsdottir Michelsen H, Nilsson M, Scherstén F, Sjölin I, Schiopu A, Leosdottir M. Tailored nurse-led cardiac rehabilitation after myocardial infarction results in better risk factor control at one year compared to traditional care: a retrospective observational study. BMC Cardiovasc Disord 2018; 18:167. [PMID: 30111283 PMCID: PMC6094912 DOI: 10.1186/s12872-018-0907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 08/09/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation improves prognosis after an acute myocardial infarction (AMI), however, the optimal method of implementation is unknown. The aim of the study was to evaluate the effect of individually-tailored, nurse-led cardiac rehabilitation on patient outcomes. METHOD This single-centre retrospective observational study included 217 patients (62 ± 9 years, 73% men). All patients attended cardiac rehabilitation including at least two follow-up consultations with a nurse. Patients receiving traditional care (n = 105) had a routine cardiologist consultation, while for those receiving tailored care (n = 112) their need for a cardiologist consultation was individually evaluated by the nurses. Regression analysis was used to analyse risk factor control and hospital readmissions at one year. RESULTS Patients in the tailored group achieved better control of total cholesterol (- 0.1 vs + 0.4 mmol/L change between baseline (time of index event) and 12-14-month follow-up, (p = 0.01), LDL cholesterol (- 0.1 vs + 0.2 mmol/L, p = 0.02) and systolic blood pressure (- 2.1 vs + 4.3 mmHg, p = 0.01). Active smokers, at baseline, were more often smoke-free at one-year in the tailored group [OR 0.32 (0.1-1.0), p = 0.05]. There was a no significant difference in re-admissions during the first year of follow-up. In the tailored group 60% of the patients had a cardiologist consultation compared to 98% in the traditional group (p < 0.001). The number of nurse visits was the same in both groups, while the number of telephone contacts was 38% higher in the tailored group (p = 0.02). CONCLUSION A tailored, nurse-led cardiac rehabilitation programme can improve risk factor management in post-AMI patients.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Marie Nilsson
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Fredrik Scherstén
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
| | - Ingela Sjölin
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Alexandru Schiopu
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Margret Leosdottir
- Department of Coronary Disease, Skåne University Hospital, Inga Marie Nilsson gata 47, Malmö, Sweden
- Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Box 117, SE-221 00 Lund, Sweden
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22
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Peak oxygen uptake estimation from a moderate 500-m treadmill walk in older women with cardiovascular disease. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0483-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Tonet E, Maietti E, Chiaranda G, Vitali F, Serenelli M, Bugani G, Mazzoni G, Ruggiero R, Myers J, Villani GQ, Corvi U, Pasanisi G, Biscaglia S, Pavasini R, Lucchi GR, Sella G, Ferrari R, Volpato S, Campo G, Grazzi G. Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of a randomized clinical trial. BMC Cardiovasc Disord 2018; 18:98. [PMID: 29783928 PMCID: PMC5963011 DOI: 10.1186/s12872-018-0839-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/11/2018] [Indexed: 01/06/2023] Open
Abstract
Background Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4–9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance. Trial registration Clinicaltrials.gov, identifier NCT03021044, first posted January, 13th 2017. Electronic supplementary material The online version of this article (10.1186/s12872-018-0839-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Elisa Maietti
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Giorgio Chiaranda
- Department of Public Health, AUSL Piacenza, and Sport Medicine Service, Piacenza, Italy
| | - Francesco Vitali
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Giulia Bugani
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Gianni Mazzoni
- Center of Biomedical Studies applied to Sport, Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
| | - Rossella Ruggiero
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Jonathan Myers
- VA Palo Alto Health Care System, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Ursula Corvi
- Cardiology Unit, Ospedale S, Giovanni da Saliceto, Piacenza, Italy
| | - Giovanni Pasanisi
- Department of Medicine, Division of Cardiology, "Delta" Hospital AUSL Ferrara, Ferrara, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | - Rita Pavasini
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy
| | | | | | - Roberto Ferrari
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Cona FE, Italy. .,Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy.
| | - Giovanni Grazzi
- Center of Biomedical Studies applied to Sport, Public Health Department, Azienda USL di Ferrara, Ferrara, Italy
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Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichinosawa Y, Harada M, Nakamura T, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Masuda T, Ako J. SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease. JCSM CLINICAL REPORTS 2018. [DOI: 10.17987/jcsm-cr.v3i1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A simple and inexpensive sarcopenia screening tool would be beneficial in clinical practice. This study was performed to determine whether SARC-F questionnaire can be used to identify physical limitations and poor prognosis in elderly cardiovascular disease (CVD) patients.Methods The study population consisted of 257 Japanese patients ≥65 years old admitted to our hospital for CVD. Prior to discharge from hospital, SARC-F, handgrip strength, usual gait speed, short physical performance battery score, and 6-minute walking distance were measured in all patients. The patients were divided into two groups according to SARC-F score: SARC-F <4 and SARC-F ≥4. The study endpoint was the first occurrence of all-cause emergency readmission or all-cause mortality.Results The prevalence rate of SARC-F ≥4 was 26.8%, and increased with age and number of comorbidities. Even after adjusting for covariates, physical function was significantly poorer and the risks of physical function measurements below the critical cut-off values were higher in the SARC-F ≥4 group compared to the SARC-F <4 group. Sixty (23.3%) patients were readmitted and 17 (6.6%) died over a median follow-up period of 11 months (interquartile range: 6–13 months). SARC-F score was a significant predictor of adverse events after discharge. Patients with SARC-F ≥4 showed higher event risk than those with SARC-F <4 (adjusted hazard ratio: 1.78; 95% confidence interval: 1.03–3.07; P = 0.040).Conclusions SARC-F questionnaire is useful to identify patients at high risk of physical limitations and to predict post-discharge outcomes in elderly CVD patients.
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25
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Mazzoni G, Sassone B, Pasanisi G, Myers J, Mandini S, Volpato S, Conconi F, Chiaranda G, Grazzi G. A moderate 500-m treadmill walk for estimating peak oxygen uptake in men with NYHA class I-II heart failure and reduced left ventricular ejection fraction. BMC Cardiovasc Disord 2018; 18:67. [PMID: 29661150 PMCID: PMC5902976 DOI: 10.1186/s12872-018-0801-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO2peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO2peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF). Methods Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11–13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO2peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF. Results Directly measured and estimated VO2peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P < 0.0001). The slope and the intercept coincided with the line of identity (Passing and Bablock analysis, P = 0.50). Residuals were normally distributed, and the examination of the Bland-Altman analysis do not show systematic or proportional error. Conclusions A moderate and self-regulated 500-m treadmill-walking test is a valid tool for VO2peak estimation in patients with HFrEF. These findings may have practical implications in the context of transitioning from clinically based programs to fitness facilities or self-guided exercise programs in adults and elderly men with HFrEF. Electronic supplementary material The online version of this article (10.1186/s12872-018-0801-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gianni Mazzoni
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy
| | - Biagio Sassone
- Department of Medicine, Division of Cardiology, Cento Hospital, AUSL Ferrara, Ferrara, Italy
| | - Giovanni Pasanisi
- Department of Medicine, Division of Cardiology, "Delta" Hospital, AUSL Ferrara, Ferrara, Italy
| | - Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University School of Medicine, Stanford, CA, USA
| | - Simona Mandini
- Center of Biomedical Studies Applied to Sport, University of Ferrara, via Gramicia 35 -, 44123, Ferrara, Italy.
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesco Conconi
- Center of Biomedical Studies Applied to Sport, University of Ferrara, via Gramicia 35 -, 44123, Ferrara, Italy
| | - Giorgio Chiaranda
- General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Grazzi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Public Health Department, AUSL Ferrara, Ferrara, Italy
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Grazzi G, Mazzoni G, Myers J, Codecà L, Pasanisi G, Mandini S, Piepoli M, Volpato S, Conconi F, Chiaranda G. Determining the best percent-predicted equation for estimated VO 2 peak by a 1-km moderate perceptually-regulated treadmill walk to predict mortality in outpatients with cardiovascular disease. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nogic J, Thein PM, Cameron J, Mirzaee S, Ihdayhid A, Nasis A. The utility of personal activity trackers (Fitbit Charge 2) on exercise capacity in patients post acute coronary syndrome [UP-STEP ACS Trial]: a randomised controlled trial protocol. BMC Cardiovasc Disord 2017; 17:303. [PMID: 29284402 PMCID: PMC5747185 DOI: 10.1186/s12872-017-0726-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/04/2017] [Indexed: 01/22/2023] Open
Abstract
Background The benefits of physical activity and cardiovascular rehabilitation on the reduction of cardiovascular risk are well documented. Despite this, significant barriers and challenges remain in optimizing patient risk factors post acute coronary syndromes (ACS) and ensuring patient compliance. Consumer wearable personal activity trackers represent a cost effective and readily available technology that may aid in this endeavour. Methods UP-STEP ACS is a prospective single-blinded, two-arm, parallel, randomized control trial with an aim to enrol 200 patients all undertaking cardiac rehabilitation. It will assess the affect that personal activity monitors have on change in exercise capacity in patients post acute coronary syndromes primarily measured by a six-minute walk test (6MWT). Secondary end points will be the improvement in other cardiovascular risk factors, namely; blood lipid and glucose levels, weight, waist circumference, along with mood, quality of life and cardiac rehabilitation adherence. Patients will be randomized to either receive a personal activity tracker or standard post hospital care during their index event. After the 8- week intervention period, patients will return for a clinical review and repeat of baseline assessments including the 6MWT. Discussion The utility and impact on exercise capacity of personal activity trackers in patient’s post-acute coronary syndrome has not been assessed. This study aims to add to the scientific evidence emerging regarding the clinical utility and validity of these devices in different patient population groups. If proven to be of benefit, these devices represent a cost effective, easily accessible technology that could aid in the reduction of cardiovascular events. Trial registration The trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). The registration number is ACTRN12617000312347 (28/02/2017).
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Affiliation(s)
- Jason Nogic
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia.
| | - Paul Min Thein
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - James Cameron
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Sam Mirzaee
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Abdul Ihdayhid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
| | - Arthur Nasis
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, 246 Clayton Road, Clayton, Melbourne, VIC, 3168, Australia
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Heart rate recovery of individuals undergoing cardiac rehabilitation after acute coronary syndrome. Ann Phys Rehabil Med 2017; 61:65-71. [PMID: 29223653 DOI: 10.1016/j.rehab.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND An efficient cardiac rehabilitation programme (CRP) can improve the functional ability of patients after acute coronary syndrome (ACS). OBJECTIVE To examine the effect of a CRP on parasympathetic reactivation and heart rate recovery (HRR) measured after a 6-min walk test (6MWT), and correlation with 6MWT distance and well-being after ACS. METHODS Eleven normoweight patients after ACS (BMI<25kg/m2; 10 males; mean [SD] age 61 [9] years) underwent an 8-week CRP. Before (pre-) and at weeks 4 (W4) and 8 (W8) during the CRP, they performed a 6MWT on a treadmill, followed by 10-min of seated passive recovery, with HRR and HR variability (HRV) recordings. HRR was measured at 1, 3, 5 and 10min after the 6MWT (HRR1, HRR3, HRR5, HRR10), then modelized by a mono-exponential function. Time-domain (square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals [RMSSD]) and frequency-domain (with high- and low-frequency band powers) were used to analyse HRV. Participants completed a mental and physical well-being questionnaire at pre- and W8. Exhaustion after tests was assessed by the Borg scale. Pearson correlation was used to assess correlations. RESULTS HRR3, HRR5 and HRR10 increased by 37%, 36% and 28%, respectively, between pre- and W8 (P<0.05), and were positively correlated with change in 6MWT distance (r=0.58, 0.66 and 0.76; P<0.05). Percentage change in HRR3 was positively correlated with change in well-being (r=0.70; P=0.01). Parasympathic reactivation (RMSSD) was improved only during the first 30sec of recovery (P=0.04). CONCLUSION Among patients undergoing a CRP after ACS, increased HRR after a 6MWT, especially at 3min, was positively correlated with 6MWT distance and improved well-being. HRR raw data seem more sensitive than post-exercise HRV analysis for monitoring functional and autonomic improvement after ACS.
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Mandini S, Collini G, Grazzi G, Lavezzi E, Mazzoni G, Conconi F. Reduction in risk factors for cardiovascular diseases and long-lasting walking habit in sedentary male and female subjects following 1 year of guided walking. SPORT SCIENCES FOR HEALTH 2017. [DOI: 10.1007/s11332-017-0412-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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A moderate 1-km treadmill walk predicts mortality in men with mid-range left ventricular dysfunction. Eur J Prev Cardiol 2017; 24:1670-1672. [DOI: 10.1177/2047487317722434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bravo-Escobar R, González-Represas A, Gómez-González AM, Montiel-Trujillo A, Aguilar-Jimenez R, Carrasco-Ruíz R, Salinas-Sánchez P. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial. BMC Cardiovasc Disord 2017; 17:66. [PMID: 28219338 PMCID: PMC5319164 DOI: 10.1186/s12872-017-0499-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk. METHODS A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life. RESULTS No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme. CONCLUSIONS The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life. TRIAL REGISTRATION Retrospectively registered NCT02796404 (May 23, 2016).
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Affiliation(s)
- Raquel Bravo-Escobar
- Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España.
| | - Alicia González-Represas
- Facultad de Fisioterapia, Departamento de Biología Funcional y Ciencias de la Salud, Universidad de Vigo, Campus A Xunqueira s/n, 36005, Pontevedra, España.
| | - Adela María Gómez-González
- Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España
| | - Angel Montiel-Trujillo
- Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España.,Servicio de Cardiología, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España
| | - Rafael Aguilar-Jimenez
- Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España
| | - Rosa Carrasco-Ruíz
- Unidad de Rehabilitación Cardiaca, Hospital universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, 29010, Málaga, España
| | - Pablo Salinas-Sánchez
- Facultad de Medicina, Departamento de Anatomía Humana, Medicina legal e Historia de la Ciencia, University of Málaga, Campus de Teatinos s/n, 29010, Malaga, España
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Matata BM, Williamson SA. A Review of Interventions to Improve Enrolment and Adherence to Cardiac Rehabilitation Among Patients Aged 65 Years or Above. Curr Cardiol Rev 2017; 13:252-262. [PMID: 28699488 PMCID: PMC5730958 DOI: 10.2174/1574884712666170710094842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This review provides an overview and quality assessment of existing interventions, assessing the intervention types that are most effective at increasing enrolment and adherence to cardiac rehabilitation in older patients aged ≥65 years Methods: The review of the literature was performed using electronic databases to search for randomised controlled trials that aimed to increase enrolment and/or adherence to cardiac rehabilitation in older patients aged ≥65 years. The main key words were cardiac rehabilitation, enrolment, adherence and older patients. Studies were included if; (1) the intervention targeted improving enrolment and/or adherence to at least one of the following components of the cardiac rehabilitation programme: exercise, education or maintaining lifestyle changes; (2) assess the effectiveness of an intervention on increasing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (3) include measures for assessing enrolment and/or adherence to a cardiac rehabilitation programme or any of its components; (4) the study included patients with a mean age of ≥65 years who were deemed eligible to participate in a cardiac rehabilitation programme. Included studies could be published in any language and there were no date restrictions for included studies. Studies focusing on pharmaceutical adherence were not included for the purpose of this review. RESULTS Seven studies were included, with four investigating enrolment (1944 participants) and three assessing adherence to intervention programmes (410 participants). Three studies (1919 participants) reported higher enrolment to cardiac rehabilitation in the intervention group. Two studies that reported increases in enrolment to cardiac rehabilitation were deemed to have an unclear or high risk of bias. All three studies (410 participants) reported better adherence to cardiac rehabilitation in the intervention group when compared to the control group. Two studies that reported better completion of cardiac rehabilitation were deemed to have an unclear or high risk of bias. No formal meta-analysis was conducted due to the observed multiple heterogeneity among outcome measures, the low number of included studies and variability in study designs. CONCLUSION This review found only weak evidence to suggest that interventions can increase enrolment or adherence to cardiac rehabilitation programmes for patients aged ≥65 years, therefore no practice recommendations could be made and further high-quality research is needed in this population group.
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Affiliation(s)
- Bashir M. Matata
- Liverpool Heart & Chest Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
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