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Bilberg A, Mannerkorpi K, Borjesson M, Svedlund S, Sivertsson J, Klingberg E, Bjersing J. High-intensity interval training improves cardiovascular and physical health in patients with rheumatoid arthritis: a multicentre randomised controlled trial. Br J Sports Med 2024:bjsports-2024-108369. [PMID: 39179363 DOI: 10.1136/bjsports-2024-108369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) have substantially elevated risk for cardiovascular diseases, and low cardiorespiratory fitness (VO2max) is a major mediator. The aim of this assessor-blinded, two-armed multicentre randomised controlled trial was to evaluate the effects of high-intensity interval training (HIIT) and strength exercise on cardiovascular health, physical fitness and overall health in patients with RA. METHODS In total, 87 patients (86% female; aged 20-60 years) were randomly assigned to an intervention group (IG) or a control group (CG). The IG performed HIIT and strength exercise for 12 weeks. The CG was instructed to be physically active on a moderately intensive level, ≥150 min/week. Primary outcome was change in VO2max. Secondary outcomes were changes in anthropometry measures, muscle strength, overall health (Visual Analogue Scale (VAS)-Global), Patient Global Impression of Change (PGIC), pain and disease activity (Disease Activity Score in 28 joints (DAS28)). RESULTS There was a significant mean group difference of change on VO2max (3.71 mL/kg/min; 95% CI 2.16, 5.25) in favour of the IG. Significant mean group differences of change were also seen for O2-pulse (1.38; 95% CI 0.85 to 1.91), waist circumference (-2.6; 95% CI -5.09 to -0.18), 1-minute sit-to-stand (5.0; 95% CI 3.35 to 6.72), handgrip strength (28.5; 95% CI 3.80 to 52.8), overall health (-14.7; 95% CI -23.8 to -5.50) and PGIC (p<0.0001) in favour of the IG. No significant mean group differences of change were found for pain (-4.0; 95% CI -13.07 to 5.06), DAS28 (-0.25; 95% CI -0.60 to 0.10) and erythrocyte sedimentation rate (-0.64; 95% CI -3.23 to 1.90). CONCLUSION Supervised HIIT and strength exercise improved cardiovascular health, physical fitness and overall health without a deterioration in pain and disease activity and should be considered in patients with well-controlled RA. TRIAL REGISTRATION NUMBER NCT05768165.
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Affiliation(s)
- Annelie Bilberg
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Physiotherapy, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Occupational and Physiotherapy, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Physiotherapy, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Mats Borjesson
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Center for Lifestyle Intervention, Department of MGAÖ, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Sara Svedlund
- Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Jenny Sivertsson
- Department of Physiotherapy, Uddevalla Hospital, Uddevalla, Sweden
| | - Eva Klingberg
- Institute of Medicine, Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Jan Bjersing
- Institute of Medicine, Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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John K, Kathuria S, Peel J, Page J, Aitkenhead R, Felstead A, Heffernan SM, Jeffries O, Tallent J, Waldron M. Caffeine ingestion compromises thermoregulation and does not improve cycling time to exhaustion in the heat amongst males. Eur J Appl Physiol 2024; 124:2489-2502. [PMID: 38568259 PMCID: PMC11322244 DOI: 10.1007/s00421-024-05460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/04/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Caffeine is a commonly used ergogenic aid for endurance events; however, its efficacy and safety have been questioned in hot environmental conditions. The aim of this study was to investigate the effects of acute caffeine supplementation on cycling time to exhaustion and thermoregulation in the heat. METHODS In a double-blind, randomised, cross-over trial, 12 healthy caffeine-habituated and unacclimatised males cycled to exhaustion in the heat (35 °C, 40% RH) at an intensity associated with the thermoneutral gas exchange threshold, on two separate occasions, 60 min after ingesting caffeine (5 mg/kg) or placebo (5 mg/kg). RESULTS There was no effect of caffeine supplementation on cycling time to exhaustion (TTE) (caffeine; 28.5 ± 8.3 min vs. placebo; 29.9 ± 8.8 min, P = 0.251). Caffeine increased pulmonary oxygen uptake by 7.4% (P = 0.003), heat production by 7.9% (P = 0.004), whole-body sweat rate (WBSR) by 21% (P = 0.008), evaporative heat transfer by 16.5% (P = 0.006) and decreased estimated skin blood flow by 14.1% (P < 0.001) compared to placebo. Core temperature was higher by 0.6% (P = 0.013) but thermal comfort decreased by - 18.3% (P = 0.040), in the caffeine condition, with no changes in rate of perceived exertion (P > 0.05). CONCLUSION The greater heat production and storage, as indicated by a sustained increase in core temperature, corroborate previous research showing a thermogenic effect of caffeine ingestion. When exercising at the pre-determined gas exchange threshold in the heat, 5 mg/kg of caffeine did not provide a performance benefit and increased the thermal strain of participants.
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Affiliation(s)
- Kevin John
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Sayyam Kathuria
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Jenny Peel
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Joe Page
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Robyn Aitkenhead
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Aimee Felstead
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Shane M Heffernan
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK
| | - Owen Jeffries
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Jamie Tallent
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Colchester, UK
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Mark Waldron
- Applied Sports Science Technology and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Bay Campus, Swansea University, Swansea, Wales, SA1 8EN, UK.
- Welsh Institute of Performance Science, Swansea University, Swansea, UK.
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Down, QLD, Australia.
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Sejersen C, Volianitis S, Secher NH. The athlete's heart: allometric considerations on published papers and relation to cardiovascular variables. Eur J Appl Physiol 2024; 124:1337-1346. [PMID: 38466432 DOI: 10.1007/s00421-024-05449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
To evaluate the morphology of the "athlete's heart", left ventricular (LV) wall thickness (WT) and end-diastolic internal diameter (LVIDd) at rest were addressed in publications on skiers, rowers, swimmers, cyclists, runners, weightlifters (n = 927), and untrained controls (n = 173) and related to the acute and maximal cardiovascular response to their respective disciplines. Dimensions of the heart at rest and functional variables established during the various sport disciplines were scaled to body weight for comparison among athletes independent of body mass. The two measures of LV were related (r = 0.8; P = 0.04) across athletic disciplines. With allometric scaling to body weight, LVIDd was similar between weightlifters and controls but 7%-15% larger in the other athletic groups, while WT was 9%-24% enlarged in all athletes. The LVIDd was related to stroke volume, oxygen pulse, maximal oxygen uptake, cardiac output, and blood volume (r = ~ 0.9, P < 0.05), while there was no relationship between WT and these variables (P > 0.05). In conclusion, while cardiac enlargement is, in part, essential for the generation of the cardiac output and thus stroke volume needed for competitive endurance exercise, an enlarged WT seems important for the development of the wall tension required for establishing normal arterial pressure in the enlarged LVIDd.
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Affiliation(s)
- Casper Sejersen
- Department of Anaesthesia, Department of Clinical Medicine, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark.
- The August Krogh Section for Human Physiology, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen Ø, Denmark.
| | - Stefanos Volianitis
- Department of Physical Education, College of Education, Qatar University, Doha, Qatar
| | - Niels H Secher
- Department of Anaesthesia, Department of Clinical Medicine, University of Copenhagen, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark
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Kaminsky LA, Myers J, Brubaker PH, Franklin BA, Bonikowske AR, German C, Arena R. 2023 update: The importance of cardiorespiratory fitness in the United States. Prog Cardiovasc Dis 2024; 83:3-9. [PMID: 38360462 DOI: 10.1016/j.pcad.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
The American Heart Association issued a Policy Statement in 2013 that characterized the importance of cardiorespiratory fitness (CRF) as an essential marker of health outcomes and specifically the need for increased assessment of CRF. This statement summarized the evidence demonstrating that CRF is "one of the most important correlates of overall health status and a potent predictor of an individual's future risk of cardiovascular disease." Subsequently, this Policy Statement led to the development of a National Registry for CRF (Fitness Registry and the Importance of Exercise: A National Data Base [FRIEND]) which established normative reference values for CRF for adults in the United States (US). This review provides an overview of the progress made in the past decade to further our understanding of the importance of CRF, specifically related to prevention and for clinical populations. Additionally, this review overviews the evolvement and additional uses of FRIEND and summarizes a hierarchy of assessment methods for CRF. In summary, continued efforts are needed to expand the representation of data from across the US, and to include data from pediatric populations, to further develop the CRF Reference Standards for the US as well as further develop Global CRF Reference Standards.
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Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, United States of America; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, United States of America
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, United States of America
| | - Barry A Franklin
- Corewell Health East, William Beaumont University Hospital, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, Royal Oak, MI, United States of America
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
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Wakeham DJ, Ivey E, Saland SA, Lewis JS, Palmer D, Morris M, Bleich JL, Weyand PG, Brazile TL, Hearon CM, Sarma S, MacNamara JP, Hieda M, Levine BD. Effects of Synchronizing Foot Strike and Cardiac Phase on Exercise Hemodynamics in Patients With Cardiac Resynchronization Therapy: A Within-Subjects Pilot Study to Fine-Tune Cardio-Locomotor Coupling for Heart Failure. Circulation 2023; 148:2008-2016. [PMID: 37830218 PMCID: PMC11032184 DOI: 10.1161/circulationaha.123.066170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Despite advances in medical and cardiac resynchronization therapy (CRT), individuals with chronic congestive heart failure (CHF) have persistent symptoms, including exercise intolerance. Optimizing cardio-locomotor coupling may increase stroke volume and skeletal muscle perfusion as previously shown in healthy runners. Therefore, we tested the hypothesis that exercise stroke volume and cardiac output would be higher during fixed-paced walking when steps were synchronized with the diastolic compared with systolic portion of the cardiac cycle in patients with CHF and CRT. METHODS Ten participants (58±17 years of age; 40% female) with CHF and previously implanted CRT pacemakers completed 5-minute bouts of walking on a treadmill (range, 1.5-3 mph). Participants were randomly assigned to first walking to an auditory tone to synchronize their foot strike to either the systolic (0% or 100±15% of the R-R interval) or diastolic phase (45±15% of the R-R interval) of their cardiac cycle and underwent assessments of oxygen uptake (V̇o2; indirect calorimetry) and cardiac output (acetylene rebreathing). Data were compared through paired-samples t tests. RESULTS V̇o2 was similar between conditions (diastolic 1.02±0.44 versus systolic 1.05±0.42 L/min; P=0.299). Compared with systolic walking, stroke volume (diastolic 80±28 versus systolic 74±26 mL; P=0.003) and cardiac output (8.3±3.5 versus 7.9±3.4 L/min; P=0.004) were higher during diastolic walking; heart rate (paced) was not different between conditions. Mean arterial pressure was significantly lower during diastolic walking (85±12 versus 98±20 mm Hg; P=0.007). CONCLUSIONS In patients with CHF who have received CRT, diastolic stepping increases stroke volume and oxygen delivery and decreases afterload. We speculate that, if added to pacemakers, this cardio-locomotor coupling technology may maximize CRT efficiency and increase exercise participation and quality of life in patients with CHF.
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Affiliation(s)
- Denis J Wakeham
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Erika Ivey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Sophie A Saland
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Joshua S Lewis
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Dean Palmer
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Margot Morris
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | | | - Peter G Weyand
- Locomotor Performance Laboratory, Department of Applied Physiology & Wellness, Southern Methodist University, Dallas, TX (P.G.W.)
| | - Tiffany L Brazile
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Christopher M Hearon
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Satyam Sarma
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - James P MacNamara
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Michinari Hieda
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
| | - Benjamin D Levine
- University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)
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Zhanpeng F, Yan J, Fengrong Z, Sijie T. Estimation of peak oxygen pulse from body mass, resting heart rate, age, gender and systolic blood pressure in Chinese adults aged 20-39. Heliyon 2023; 9:e21912. [PMID: 38027988 PMCID: PMC10663905 DOI: 10.1016/j.heliyon.2023.e21912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Peak oxygen pulse (O2Ppeak) can reflect the condition of cardiovascular function and provide supplementary information for maximal oxygen uptake, but its direct measurement requires the precise instruments under the guidance of professionals, and the subjects should strive to the state of exhaustion. Objectives The aim of the present cross-sectional study was to establish a prediction equation to estimate O2Ppeak of Chinese adults aged 20-39, from routine measures of anthropometry and cardiovascular function. Methods 252 adults (20-39 years old) were recruited and randomly allocated to the validation group (n = 226) and the cross-validation group (n = 26). To be included in the study, subjects were required to be healthy, none-professional sports experience (healthy individuals who are not athletes or have had experience as athletes), and no medication taken recently. Subjects with cardiovascular diseases, lung disease and musculoskeletal diseases were excluded. The subjects' anthropometric and cardiovascular variables were measured and each subject performed a maximal exercise test on an electromagnetic cycle ergometer. Results The O2Ppeak estimated equation was developed using multiple linear regression models, O2Ppeak = 30.394 + 0.083 x body mass (kg) - 0.090 x resting heart rate (bpm) - 0.157 x age (years) - 2.710 x gender (1 = male, 2 = female) - 0.035 x systolic blood pressure (mmHg). The equation had the coefficient of determination (R2) = 0.804 and the standard error of estimate (SEE) = 1.619 ml/beat. An ANOVA and Akaike's information criterion (AIC) were tested. Bland-Altman graphs were plotted to examine the distribution of bias. Cross-validation estimated O2Ppeak and directly measured O2Ppeak did not show significant difference while had a strong positive correlation (r = 0.89, p < 0.001). Conclusions The established equation has high effectiveness and reliability to predict O2Ppeak of adults aged 20-39.
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Affiliation(s)
- Feng Zhanpeng
- Tianjin Institute of Physical Education Sports and Health College, Tianjin University of Sport, Tianjin, China
| | - Jiang Yan
- College of Physical Science, Tianjin Normal University, Tianjin, China
| | - Zhou Fengrong
- Sports Department, Tianjin College of Media & Arts, Tianjin, China
| | - Tan Sijie
- Tianjin Institute of Physical Education Sports and Health College, Tianjin University of Sport, Tianjin, China
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Mapelli M, Cattadori G, Salvioni E, Mattavelli I, Pestrin E, Attanasio U, Magrì D, Palermo P, Agostoni P. "Under the Bridge": Looking for Ischemia in a Patient with Intramyocardial Coronary Artery Course-The Role of the Cardiopulmonary Exercise Test. J Clin Med 2023; 12:5764. [PMID: 37685831 PMCID: PMC10488515 DOI: 10.3390/jcm12175764] [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: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Many variables obtained during cardiopulmonary exercise test (CPET), including O2 uptake (VO2) versus heart rate (HR, O2-pulse) and work rate (VO2/Watt), provide quantitative patterns of responses to exercise when left ventricular dysfunction is an effect of myocardial ischemia (MI). Therefore, CPET offers a unique approach to evaluate exercise-induced MI in the presence of fixed or dynamic coronary arteries stenosis. In this paper, we examined the case of a 74-year-old patient presenting with an ischemic CPET and a normal stress cardiac magnetic resonance (CMR) with dipyridamole. A coronary angiography demonstrated the presence of myocardial bridging (MB), a well-known congenital coronary anomaly that is able to generate MI during exercise (but not in provocative testing using coronary artery vasodilators, such as dipyridamole). Despite the good diagnostic accuracy of the imaging methods (i.e., stress CMR) in MI detection, this case shows that exercise should be the method of choice in elicit ischemia in specific cases, like MB.
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Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (M.M.); (E.S.); (I.M.); (P.P.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
| | | | - Elisabetta Salvioni
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (M.M.); (E.S.); (I.M.); (P.P.); (P.A.)
| | - Irene Mattavelli
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (M.M.); (E.S.); (I.M.); (P.P.); (P.A.)
| | - Emanuele Pestrin
- Unità Clinico Operativa di Clinica Medica, Università degli Studi di Trieste, Piazzale Europa, 1, 34127 Trieste, Italy;
| | - Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Corso Umberto I 40, 80138 Naples, Italy;
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine, University “La Sapienza”, Piazzale Aldo Moro 5, 00185 Rome, Italy;
| | - Pietro Palermo
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (M.M.); (E.S.); (I.M.); (P.P.); (P.A.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (M.M.); (E.S.); (I.M.); (P.P.); (P.A.)
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
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Dos Santos PB, Simões RP, Goulart CL, Arêas GPT, Marinho RS, Camargo PF, Roscani MG, Arbex RF, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study. Sci Rep 2022; 12:1592. [PMID: 35102201 PMCID: PMC8803920 DOI: 10.1038/s41598-022-05503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The [Formula: see text]E/[Formula: see text]CO2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of [Formula: see text]E (OUES) was calculated using the following equation: [Formula: see text]O2 = a log [Formula: see text]E + b, with the constant 'a' referring to the rate of increase of [Formula: see text]O2. Circulatory power (CP) was obtained through the product of peak [Formula: see text]O2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the [Formula: see text]E/[Formula: see text]CO2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ([Formula: see text]O2), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak [Formula: see text]O2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p < 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak [Formula: see text]O2 (r: 0.52; p < 0.001), and FEV1 and WR (r: 0.62; p < 0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups. The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
- Sciences of Motricity Institute, Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | | | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Patrícia F Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Claudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil.
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9
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Chowdhury SM, Graham EM, Taylor CL, Savage A, McHugh KE, Gaydos S, Nutting AC, Zile MR, Atz AM. Diastolic Dysfunction With Preserved Ejection Fraction After the Fontan Procedure. J Am Heart Assoc 2022; 11:e024095. [PMID: 35023347 PMCID: PMC9238510 DOI: 10.1161/jaha.121.024095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023]
Abstract
Background Heart failure phenotyping in single-ventricle Fontan patients is challenging, particularly in patients with normal ejection fraction (EF). The objective of this study was to identify Fontan patients with abnormal diastolic function, who are high risk for heart failure with preserved ejection fraction (HFpEF), and characterize their cardiac mechanics, exercise function, and functional health status. Methods and Results Data were obtained from the Pediatric Heart Network Fontan Cross-sectional Study database. EF was considered abnormal if <50%. Diastolic function was defined as abnormal if the diastolic pressure:volume quotient (lateral E:e'/end-diastolic volume) was >90th percentile (≥0.26 mL-1). Patients were divided into: controls=normal EF and diastolic function; systolic dysfunction (SD) = abnormal EF with normal diastolic function; diastolic dysfunction (DD) = normal EF with abnormal diastolic pressure:volume quotient. Exercise function was quantified as percent predicted peak VO2. Physical Functioning Summary Score (FSS) was reported from the Child Health Questionnaire. A total of 239 patients were included, 177 (74%) control, 36 (15%) SD, and 26 (11%) DD. Median age was 12.2 (5.4) years. Arterial elastance, a measure of arterial stiffness, was higher in DD (3.6±1.1 mm Hg/mL) compared with controls (2.5±0.8 mm Hg/mL), P<0.01. DD patients had lower predicted peak VO2 compared with controls (52% [20] versus 67% [23], P<0.01). Physical FSS was lower in DD (45±13) and SD (44±13) compared with controls (50±7), P<0.01. Conclusions Fontan patients with abnormal diastolic function and normal EF have decreased exercise tolerance, decreased functional health status, and elevated arterial stiffness. Identification of patients at high risk for HFpEF is feasible and should be considered when evaluating Fontan patients.
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Affiliation(s)
- Shahryar M. Chowdhury
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Eric M. Graham
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Carolyn L. Taylor
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Andrew Savage
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Kimberly E. McHugh
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Stephanie Gaydos
- Division of CardiologyDepartment of MedicineMedical University of South CarolinaCharlestonSC
| | - Arni C. Nutting
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Michael R. Zile
- Division of CardiologyDepartment of MedicineMedical University of South CarolinaCharlestonSC
| | - Andrew M. Atz
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
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10
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Dun Y, Hammer SM, Smith JR, MacGillivray MC, Simmons BS, Squires RW, Liu S, Olson TP. Cardiorespiratory Responses During High-Intensity Interval Training Prescribed by Rating of Perceived Exertion in Patients After Myocardial Infarction Enrolled in Early Outpatient Cardiac Rehabilitation. Front Cardiovasc Med 2022; 8:772815. [PMID: 35071350 PMCID: PMC8767110 DOI: 10.3389/fcvm.2021.772815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to determine the cardiorespiratory responses during, and adaptations to, high-intensity interval training (HIIT) prescribed using ratings of perceived exertion (RPE) in patients after myocardial infarction (MI) during early outpatient cardiac rehabilitation (CR). Methods: We prospectively recruited 29 MI patients after percutaneous coronary intervention who began CR within 2 weeks after hospital discharge. Eleven patients (seven men; four women; age: 61 ± 11 yrs) who completed ≥24 supervised HIIT sessions with metabolic gas exchange measured during HIIT once weekly for 8 weeks and performed pre- and post- CR cardiopulmonary exercise tests were included in the study. Each HIIT session consisted of 5–8 high-intensity intervals [HIIs, 1-min RPE 14–17 (Borg 6–20 scale)] and low-intensity intervals (LIIs, 4-min RPE < 12). Metabolic gas exchange, heart rate (HR), and blood pressure during HIIT were measured. Results: The mean oxygen uptake (V˙O2) during HIIs across 88 sessions of HIITs [91 (14)% of V˙O2peak, median (interquartile range, IQR)] was significantly higher than the lower limit of target V˙O2 zone (75% of V˙O2peak) recommended for the HII (p < 0.001). Exercise intensity during RPE-prescribed HIITs, determined as %V˙O2peak, was highly repeatable with intra-class correlations of 0.95 (95% CI 0.86– 0.99, p < 0.001). For cardiorespiratory adaptations from the first to the last session of HIIT, treadmill speed, treadmill grade, treadmill power, V˙O2HII, %V˙O2peak, and VE during HIIs were increased (all p < 0.05), while no difference was found for HR, %HRpeak and systolic blood pressure (all p > 0.05). V˙O2peak increased by an average of 9% from pre-CR to post-CR. No adverse events occurred. Conclusion: Our results demonstrate that HIIT can be effectively prescribed using RPE in MI patients during early outpatient CR. Participation in RPE-prescribed HIIT increases exercise workload and V˙O2 during exercise training without increased perception of effort or excessive increases in heart rate or blood pressure.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Shane M. Hammer
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Joshua R. Smith
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Mary C. MacGillivray
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin S. Simmons
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ray W. Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Thomas P. Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Thomas P. Olson
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11
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Petek BJ, Churchill TW, Sawalla Guseh J, Loomer G, Gustus SK, Lewis GD, Weiner RB, Baggish AL, Wasfy MM. Utility of the oxygen pulse in the diagnosis of obstructive coronary artery disease in physically fit patients. Physiol Rep 2021; 9:e15105. [PMID: 34767313 PMCID: PMC8587175 DOI: 10.14814/phy2.15105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiopulmonary exercise testing (CPET) guidelines recommend analysis of the oxygen (O2 ) pulse for a late exercise plateau in evaluation for obstructive coronary artery disease (OCAD). However, whether this O2 pulse trajectory is within the range of normal has been debated, and the diagnostic performance of the O2 pulse for OCAD in physically fit individuals, in whom V ˙ O 2 may be more likely to plateau, has not been evaluated. Using prospectively collected data from a sports cardiology program, patients were identified who were free of other cardiac disease and underwent clinically-indicated CPET within 90 days of invasive or computed tomography coronary angiography. The diagnostic performance of quantitative O2 pulse metrics (late exercise slope, proportional change in slope during late exercise) and qualitative assessment for O2 pulse plateau to predict OCAD was assessed. Among 104 patients (age:56 ± 12 years, 30% female, peak V ˙ O 2 119 ± 34% predicted), the diagnostic performance for OCAD (n = 24,23%) was poor for both quantitative and qualitative metrics reflecting an O2 pulse plateau (late exercise slope: AUC = 0.55, sensitivity = 68%, specificity = 41%; proportional change in slope: AUC = 0.55, sensitivity = 91%, specificity = 18%; visual plateau/decline: AUC = 0.51, sensitivity = 33%, specificity = 67%). When O2 pulse parameters were added to the electrocardiogram, the change in AUC was minimal (-0.01 to +0.02, p ≥ 0.05). Those patients without OCAD with a plateau or decline in O2 pulse were fitter than those with linear augmentation (peak V ˙ O 2 133 ± 31% vs. 114 ± 36% predicted, p < 0.05) and had a longer exercise ramp time (9.5 ± 3.2 vs. 8.0 ± 2.5 min, p < 0.05). Overall, a plateau in O2 pulse was not a useful predictor of OCAD in a physically fit population, indicating that the O2 pulse should be integrated with other CPET parameters and may reflect a physiologic limitation of stroke volume and/or O2 extraction during intense exercise.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J Sawalla Guseh
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Garrett Loomer
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah K Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Frazão M, Werlang LA, Azevedo C, Kunz A, Peltz M. Metabolic, ventilatory and cardiovascular responses to FES-cycling: A comparison to NMES and passive cycling. Technol Health Care 2021; 30:909-918. [PMID: 34744034 DOI: 10.3233/thc-213220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cyclergometry with functional electrical stimulation (FES-cycling) is a feasible method for rehabilitation. The concept is to promote exercise induced by depolarization of the motoneuron and muscular contraction. OBJECTIVE To measure acute physiological responses to FES-cycling. METHODS Retrospective study of data from ten healthy volunteers who performed FES-cycling, passive cycling and neuromuscular electrical stimulation (NMES) alone. Metabolic, ventilatory and cardiovascular parameters were analyzed. RESULTS Oxygen uptake enhanced 97 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. Energy expenditure enhanced 102 ± 15% during FES-cycling, with medium effect size compared to NMES and large effect size compared to passive cycling. Minute ventilation enhanced 115 ± 26% during FES-cycling, with small effect size compared to NMES and medium effect size compared to passive cycling. Cardiac output enhanced 21 ± 4% during FES-cycling, with medium effect size compared to NMES and passive cycling. Arterial - mixed venous oxygen content difference enhanced 60 ± 8% during FES-cycling, with a medium effect size compared to NMES and large effect size compared to passive cycling. CONCLUSIONS FES-cycling enhances metabolic, ventilatory and cardiovascular demands and the physiological responses are higher than NMES and passive cycling.
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Affiliation(s)
- Murillo Frazão
- Lauro Wanderley Hospital, Federal University of Paraíba, João Pessoa, PB, Brazil.,CLINAR Exercise Physiology, João Pessoa, PB, Brazil
| | | | - Cássio Azevedo
- INBRAMED Brazilian Medical Equipment Industry, Porto Alegre, RS, Brazil
| | - Adelar Kunz
- INBRAMED Brazilian Medical Equipment Industry, Porto Alegre, RS, Brazil
| | - Maikel Peltz
- INBRAMED Brazilian Medical Equipment Industry, Porto Alegre, RS, Brazil
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13
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Niederseer D, Walser R, Schmied C, Dela F, Gräni C, Bohm P, Müller E, Niebauer J. Effects of a 12-Week Recreational Skiing Program on Cardio-Pulmonary Fitness in the Elderly: Results from the Salzburg Skiing in the Elderly Study (SASES). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111378. [PMID: 34769896 PMCID: PMC8583387 DOI: 10.3390/ijerph182111378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate whether recreational alpine skiing in the elderly can improve cardio-pulmonary fitness. DESIGN Randomized controlled study with pre-post repeated measurements. METHODS A total of 48 elderly participants (60-76 years) were randomly assigned to either participate in a 12-week guided recreational skiing program (intervention group, IG, average of 28.5 ± 2.6 skiing days) or to continue a sedentary ski-free lifestyle (control group, CG). Cardio-pulmonary exercise testing (CPET) and pulmonary function testing were performed in both groups before (PRE) and after (POST) the intervention/control period to compare parameters PRE vs. POST CPET. RESULTS At baseline, IG and CG did not differ significantly with respect to CPET and pulmonary function parameters. At POST, several measures of maximal exercise capacity and breathing economy were significantly improved in IG as compared to CG: maximal oxygen capacity (IG: 33.8 ± 7.9; CG: 28.7 ± 5.9 mL/min/kg; p = 0.030), maximal carbon dioxide production (IG: 36.2 ± 7.7; CG: 31.8 ± 6.5 mL/min/kg; p = 0.05), maximal oxygen pulse (IG: 16.8 ± 4.2; CG: 13.2 ± 4 mL/heart beat; p = 0.010), maximal minute ventilation (IG: 96.8 ± 17.8; CG: 81.3 ± 21.9 l/min; p = 0.025), and maximal metabolic equivalent of task (METs, IG: 9.65 ± 2.26; CG: 8.19 ± 1.68 METs; p = 0.029). Except for oxygen pulse, these significant changes could also be observed at the anaerobic threshold. Maximal heart rate and pulmonary function parameters remained essentially unchanged. CONCLUSION Regular recreational skiing improves cardio-pulmonary fitness along with breathing economy and thus can contribute to a heart-healthy lifestyle for the elderly.
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Affiliation(s)
- David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: +41-(0)44-253-94-71; Fax: +41-(0)44-255-44-01
| | - Roman Walser
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Christian Schmied
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Flemming Dela
- Department of Geriatrics, Bispebjerg-Frederiksberg University Hospital, DK-2400NV Copenhagen, Denmark;
- Xlab, Department of Biomedicine, University of Copenhagen, DK-2200N Copenhagen, Denmark
| | - Christoph Gräni
- Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland;
| | - Philipp Bohm
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.W.); (C.S.); (P.B.)
| | - Erich Müller
- Department of Sport Science and Kinesiology, University of Salzburg, 5020 Salzburg, Austria;
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
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14
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Kounalakis SN, Keramidas ME, Eiken O, Mekjavic IB. Exercise temperature regulation following a 35-day horizontal bedrest. Exp Physiol 2021; 106:1498-1507. [PMID: 33938053 DOI: 10.1113/ep089539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/28/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does a 35-day horizontal bedrest impair thermoeffector responses during whole-body submaximal exercise performed in temperate conditions? What is the main finding and its importance? Cardiovascular and muscular deconditioning ensuing from prolonged recumbency seems to augment, at least to a degree, exercise-induced increase in body core temperature, most likely due to an impairment in non-evaporative heat loss. The response is a function of the absolute exercise intensity imposed. ABSTRACT We examined the effects of a 35-day horizontal bedrest on thermoregulation during whole-body exercise. Fifteen healthy men were randomly assigned to either a bedrest (BR; n = 10) or a control (CON; n = 5) group. Prior to bedrest, both groups performed 40-min constant-load upright cycling at 30% of their peak workload (Wpeak ; PRE). One and 2 days after bedrest, the BR group performed, in a randomised counterbalanced order, two 40-min trials at 30% of (i) the pre-bedrest Wpeak (i.e., at a fixed absolute intensity; POST-A) and (ii) the post-bedrest Wpeak (i.e., at a fixed relative intensity; POST-R). The CON group conducted only the POST-A trial, at the same time intervals. During the trials, rectal (Trec ) and skin ( T ¯ sk ) temperatures, and the forehead sweating rate (SwR) were monitored. In the CON group, no differences were observed between the trials. Bedrest potentiated moderately the Trec elevation during the latter part of POST-A (∼0.10°C; P ≤ 0.05), but not of POST-R (∼0.04°C; P = 0.11). In both post-bedrest trials, T ¯ sk was attenuated by ∼1.5-2.0°C throughout (P < 0.01), whereas the forehead SwR was not modulated. Trec and T ¯ sk were similar in POST-A and POST-R, yet the forehead SwR was more dependent on the relative workload imposed (P = 0.04). The present findings therefore suggest that the cardiovascular and muscular deconditioning ensuing from a 35-day bedrest may aggravate the exercise-induced increase in body core temperature when working at a given absolute intensity, most likely due to an impairment in non-evaporative heat loss.
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Affiliation(s)
- Stylianos N Kounalakis
- Department of Physical & Cultural Education, Evelpidon Hellenic Army Academy, Vari, Greece
| | - Michail E Keramidas
- Division of Environmental Physiology, KTH Royal Institute of Technology, Swedish Aerospace Physiology Center, Stockholm, Sweden
| | - Ola Eiken
- Division of Environmental Physiology, KTH Royal Institute of Technology, Swedish Aerospace Physiology Center, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Jamova 39, Ljubljana, SI-1000, Slovenia.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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15
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Petek BJ, Gustus SK, Wasfy MM. Cardiopulmonary Exercise Testing in Athletes: Expect the Unexpected. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23. [DOI: 10.1007/s11936-021-00928-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Waldron M, Papavasileiou G, Jeffries O, Nevola V, Heffernan S M, Kilduff L, Tallent J. Concurrent adaptations in maximal aerobic capacity, heat tolerance, microvascular blood flow and oxygen extraction following heat acclimation and ischemic preconditioning. J Therm Biol 2020; 93:102724. [PMID: 33077136 DOI: 10.1016/j.jtherbio.2020.102724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Abstract
We investigated the effects of: 1) Ischemic pre-conditioning (IPC) plus a concurrent five-day heat acclimation + IPC (IPC + HA), 2) five-day HA with sham IPC (HA), or 3) control (CON) on thermoneutral measurements of endurance performance, resting measures of skeletal muscle oxygenation and blood flow. Twenty-nine participants were randomly allocated to three groups, which included: 1) five-days of repeated leg occlusion (4 x 5-min) IPC at limb occlusive pressure, plus fixed-intensity (55% V˙ O2max) cycling HA at ~36 °C/40% humidity; 2) HA plus sham IPC (20 mmHg) or 3) or CON (thermoneutral 55% V˙ O2max plus sham IPC). In IPC + HA and HA, there were increases in maximal oxygen consumption (O2max) (7.8% and 5.4%, respectively; P < 0.05), ventilatory threshold (VT) (5.6% and 2.4%, respectively, P < 0.05), delta efficiency (DE) (2.0% and 1.4%, respectively; P < 0.05) and maximum oxygen pulse (O2pulse-Max) (7.0% and 6.9%, respectively; P < 0.05) during an exhaustive incremental test. There were no changes for CON (P > 0.05). Changes (P < 0.05) in resting core temperature (TC), muscle oxygen consumption (m V˙ O2), and limb blood flow (LBF) were also found pre-to-post intervention among the HA and IPC + HA groups, but not in CON (P > 0.05). Five-days of either HA or IPC + HA can enhance markers of endurance performance in cooler environments, alongside improved muscle oxygen extraction, blood flow, exercising muscle efficiency and O2 pulse at higher intensities, thus suggesting the occurrence of peripheral adaptation. Both HA and IPC + HA enhance the adaptation of endurance capacity, which might partly relate to peripheral changes.
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Affiliation(s)
- M Waldron
- A-STEM Centre, College of Engineering, Swansea University, Swansea, UK; School of Science and Technology, University of New England, NSW, Australia; Welsh Institute of Performance Science, Swansea University, Swansea, UK.
| | - G Papavasileiou
- Sport, Health and Applied Sciences, St Mary's University, London, UK
| | - O Jeffries
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - V Nevola
- A-STEM Centre, College of Engineering, Swansea University, Swansea, UK; Defence Science and Technology Laboratory (Dstl), Fareham, Hampshire, UK
| | - M Heffernan S
- A-STEM Centre, College of Engineering, Swansea University, Swansea, UK
| | - L Kilduff
- A-STEM Centre, College of Engineering, Swansea University, Swansea, UK; Welsh Institute of Performance Science, Swansea University, Swansea, UK
| | - J Tallent
- Sport, Health and Applied Sciences, St Mary's University, London, UK
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17
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Nesti L, Pugliese NR, Sciuto P, Natali A. Type 2 diabetes and reduced exercise tolerance: a review of the literature through an integrated physiology approach. Cardiovasc Diabetol 2020; 19:134. [PMID: 32891175 PMCID: PMC7487838 DOI: 10.1186/s12933-020-01109-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/29/2020] [Indexed: 12/14/2022] Open
Abstract
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) is well established. Early in the course of the diabetic disease, some degree of impaired exercise capacity (a powerful marker of health status with prognostic value) can be frequently highlighted in otherwise asymptomatic T2DM subjects. However, the literature is quite heterogeneous, and the underlying pathophysiologic mechanisms are far from clear. Imaging-cardiopulmonary exercise testing (CPET) is a non-invasive, provocative test providing a multi-variable assessment of pulmonary, cardiovascular, muscular, and cellular oxidative systems during exercise, capable of offering unique integrated pathophysiological information. With this review we aimed at defying the cardiorespiratory alterations revealed through imaging-CPET that appear specific of T2DM subjects without overt cardiovascular or pulmonary disease. In synthesis, there is compelling evidence indicating a reduction of peak workload, peak oxygen assumption, oxygen pulse, as well as ventilatory efficiency. On the contrary, evidence remains inconclusive about reduced peripheral oxygen extraction, impaired heart rate adjustment, and lower anaerobic threshold, compared to non-diabetic subjects. Based on the multiparametric evaluation provided by imaging-CPET, a dissection and a hierarchy of the underlying mechanisms can be obtained. Here we propose four possible integrated pathophysiological mechanisms, namely myocardiogenic, myogenic, vasculogenic and neurogenic. While each hypothesis alone can potentially explain the majority of the CPET alterations observed, seemingly different combinations exist in any given subject. Finally, a discussion on the effects -and on the physiological mechanisms-of physical activity and exercise training on oxygen uptake in T2DM subjects is also offered. The understanding of the early alterations in the cardiopulmonary response that are specific of T2DM would allow the early identification of those at a higher risk of developing HF and possibly help to understand the pathophysiological link between T2DM and HF.
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Affiliation(s)
- Lorenzo Nesti
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy. .,Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Nicola Riccardo Pugliese
- Cardiopulmonary Test Lab, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Paolo Sciuto
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition and Atherosclerosis Lab, Dietologia Universitaria, Pisa, Italy
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18
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Auclair A, Harvey J, Leclerc J, Piché ME, O'Connor K, Nadreau É, Pettigrew M, Haykowsky MJ, Marceau S, Biertho L, Hould FS, Lebel S, Biron S, Julien F, Bouvet L, Lescelleur O, Poirier P. Determinants of Cardiorespiratory Fitness After Bariatric Surgery: Insights From a Randomised Controlled Trial of a Supervised Training Program. Can J Cardiol 2020; 37:251-259. [PMID: 32738206 DOI: 10.1016/j.cjca.2020.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Severely obese patients have decreased cardiorespiratory fitness (CRF) and poor functional capacity. Bariatric surgery-induced weight loss improves CRF, but the determinants of this improvement are not well known. We aimed to assess the determinants of CRF before and after bariatric surgery and the impact of an exercise training program on CRF after bariatric surgery. METHODS Fifty-eight severely obese patients (46.1 ± 6.1 kg/m2, 78% women) were randomly assigned to either an exercise group (n = 39) or usual care (n = 19). Exercise training was conducted from the 3rd to the 6th months after surgery. Anthropometric measurements, abdominal and mid-thigh computed tomographic scans, resting echocardiography, and maximal cardiopulmonary exercise testing was performed before bariatric surgery and 3 and 6 months after surgery. RESULTS Weight, fat mass, and fat-free mass were reduced significantly at 3 and 6 months, without any additive impact of exercise training in the exercise group. From 3 to 6 months, peak aerobic power (V̇O2peak) increased significantly (P < 0.0001) in both groups but more importantly in the exercise group (exercise group: from 18.6 ± 4.2 to 23.2 ± 5.7 mL/kg/min; control group: from 17.4 ± 2.3 to 19.7 ± 2.4 mL/kg/min; P value, group × time = 0.01). In the exercise group, determinants of absolute V̇O2peak (L/min) were peak exercise ventilation, oxygen pulse, and heart rate reserve (r2 = 0.92; P < 0.0001), whereas determinants of V̇O2peak indexed to body mass (mL/kg/min) were peak exercise ventilation and early-to-late filling velocity ratio (r2 = 0.70; P < 0.0001). CONCLUSIONS A 12-week supervised training program has an additive benefit on cardiorespiratory fitness for patients who undergo bariatric surgery.
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Affiliation(s)
- Audrey Auclair
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jacinthe Leclerc
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada; Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Marie-Eve Piché
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Kim O'Connor
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Éric Nadreau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Myriam Pettigrew
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Marceau
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Laurent Biertho
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Frédéric-Simon Hould
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Stéfane Lebel
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Simon Biron
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - François Julien
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Léonie Bouvet
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Odette Lescelleur
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
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19
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Spee RF, Niemeijer VM, Thijssen CGE, Hoogeveen A, Wijn PFF, Doevendans PA, Kemps HMC. The utility of the oxygen pulse recovery as a marker of the cardiac output response to exercise in patients with chronic heart failure. Clin Physiol Funct Imaging 2020; 40:328-335. [PMID: 32378304 DOI: 10.1111/cpf.12639] [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: 01/18/2019] [Revised: 01/31/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of chronic heart failure (CHF). The recovery of the oxygen pulse (OP) is a non-invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central haemodynamic response to exercise remains to be determined. We hypothesized that an impaired OP recovery is associated with a reduced CO response to exercise in CHF patients. METHODS Sixty one CHF patients performed cardiopulmonary exercise test with simultaneous measurement of CO. Impaired OP recovery was defined as an overshoot during the first minute of recovery or OP at 1-min recovery as a percentage of peak OP (OPRR ). RESULTS An OP overshoot was observed in 9% (n = 5) of patients. In these patients, peak CO and VO2 were significantly lower (peak CO 7.9 ± 0.8 versus 11.2 ± 4.3 L/min and peak VO2 14.1 ± 4.7 versus 19.6 ± 5.8 ml min-1 kg-1 ). Mean relative recovery of OP was 78 ± 20%. Slow OP recovery (negative OPRR ) was seen in 13% (n = 8). Peak CO and VO2 were significantly lower in the negative OPRR group (11 ± 4 versus 8 ± 0.7 L/min and 19.7 ± 5.9 versus 14.6 ± 3.7 ml kg min-1 ). There was a significant relation between OPRR and stroke volume (SV) RR (r = .57), as well as between OPRR and a-v O2 diff RR (rs = .4). CONCLUSION An impaired OP recovery is associated with a reduced CO response to exercise and worse functional status. Therefore, the OP recovery can be used to grade the severity of CHF.
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Affiliation(s)
- Ruud F Spee
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Victor M Niemeijer
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
| | | | - Adwin Hoogeveen
- Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands
| | - Pieter F F Wijn
- Department of Applied Physics, University of Technology, Eindhoven, The Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center, Utrecht, The Netherlands.,ICIN, Netherlands Heart Institute, Utrecht, The Netherlands
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
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20
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Accalai E, Vignati C, Salvioni E, Pezzuto B, Contini M, Cadeddu C, Meloni L, Agostoni P. Non-invasive estimation of stroke volume during exercise from oxygen in heart failure patients. Eur J Prev Cardiol 2020; 28:280-286. [PMID: 33611434 DOI: 10.1177/2047487320920755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
AIMS In heart failure, oxygen uptake and cardiac output measurements at peak and during exercise are important in defining heart failure severity and prognosis. Several cardiopulmonary exercise test-derived parameters have been proposed to estimate stroke volume during exercise, including the oxygen pulse (oxygen uptake/heart rate). Data comparing measured stroke volume and the oxygen pulse or stroke volume estimates from the oxygen pulse at different stages of exercise in a sizeable population of healthy individuals and heart failure patients are lacking. METHODS We analysed 1007 subjects, including 500 healthy and 507 heart failure patients, who underwent cardiopulmonary exercise testing with stroke volume determination by the inert gas rebreathing technique. Stroke volume measurements were made at rest, submaximal (∼50% of exercise) and peak exercise. At each stage of exercise, stroke volume estimates were obtained considering measured haemoglobin at rest, predicted exercise-induced haemoconcentration and peripheral oxygen extraction according to heart failure severity. RESULTS A strong relationship between oxygen pulse and measured stroke volume was observed in healthy and heart failure subjects at submaximal (R2 = 0.6437 and R2 = 0.6723, respectively), and peak exercise (R2 = 0.6614 and R2 = 0.5662) but not at rest. In healthy and heart failure subjects, agreement between estimated and measured stroke volume was observed at submaximal (-3 ± 37 and -11 ± 72 ml, respectively) and peak exercise (1 ± 31 and 6 ± 29 ml, respectively) but not at rest. CONCLUSION In heart failure patients, stroke volume estimation and oxygen pulse during exercise represent stroke volume, albeit with a relevant individual data dispersion so that both can be used for population studies but cannot be reliably applied to a single subject. Accordingly, whenever needed stroke volume must be measured directly.
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Affiliation(s)
- Emanuele Accalai
- Università degli studi di Cagliari, UOC di Cardiologia-UTIC, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy
| | | | | | | | | | - Luigi Meloni
- Università degli studi di Cagliari, UOC di Cardiologia-UTIC, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Italy
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21
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Nytrøen K, Rolid K, Andreassen AK, Yardley M, Gude E, Dahle DO, Bjørkelund E, Relbo Authen A, Grov I, Philip Wigh J, Have Dall C, Gustafsson F, Karason K, Gullestad L. Effect of High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia. Circulation 2020; 139:2198-2211. [PMID: 30773030 DOI: 10.1161/circulationaha.118.036747] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is no consensus on how, when, or at what intensity exercise should be performed after heart transplantation (HTx). We have recently shown that high-intensity interval training (HIT) is safe, well tolerated, and efficacious in the maintenance state after HTx, but studies have not investigated HIT effects in the de novo HTx state. We hypothesized that HIT could be introduced early after HTx and that it could lead to clinically meaningful increases in exercise capacity and health-related quality of life. METHODS This multicenter, prospective, randomized, controlled trial included 81 patients a mean of 11 weeks (range, 7-16 weeks) after an HTx. Patients were randomized 1:1 to 9 months of either HIT (4×4-minute intervals at 85%-95% of peak effort) or moderate-intensity continuous training (60%-80% of peak effort). The primary outcome was the effect of HIT versus moderate-intensity continuous training on the change in aerobic exercise capacity, assessed as the peak oxygen consumption (Vo2peak). Secondary outcomes included tolerability, safety, adverse events, isokinetic muscular strength, body composition, health-related quality of life, left ventricular function, hemodynamics, endothelial function, and biomarkers. RESULTS From baseline to follow-up, 96% of patients completed the study. There were no serious exercise-related adverse events. The population comprised 73% men, and the mean±SD age was 49±13 years. At the 1-year follow-up, the HIT group demonstrated greater improvements than the moderate-intensity continuous training group; the groups showed significantly different changes in the Vo2peak (mean difference between groups, 1.8 mL·kg-1·min-1), the anaerobic threshold (0.28 L/min), the peak expiratory flow (11%), and the extensor muscle exercise capacity (464 J). The 1.8-mL·kg-1·min-1 difference was equal to ≈0.5 metabolic equivalents, which is regarded as clinically meaningful and relevant. Health-related quality of life was similar between the groups, as indicated by results from the Short Form-36 (version 2), Hospital Anxiety and Depression Scale, and a visual analog scale. CONCLUSIONS We demonstrated that HIT was a safe, efficient exercise method in de novo HTx recipients. HIT, compared with moderate-intensity continuous training, resulted in a clinically significantly greater change in exercise capacity based on the Vo2peak values (25% versus 15%), anaerobic threshold, peak expiratory flow, and muscular exercise capacity. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier NCT01796379.
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Affiliation(s)
- Kari Nytrøen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Katrine Rolid
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Norwegian Health Association, Oslo, Norway (K.R., M.Y.).,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Arne Kristian Andreassen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway
| | - Marianne Yardley
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,Norwegian Health Association, Oslo, Norway (K.R., M.Y.)
| | - Einar Gude
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
| | - Dag Olav Dahle
- Transplantation Medicine (D.O.D.), Oslo University Hospital Rikshospitalet, Norway
| | - Elisabeth Bjørkelund
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Anne Relbo Authen
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Ingelin Grov
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway
| | - Julia Philip Wigh
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden (J.P.W., K.K.)
| | - Christian Have Dall
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (C.H.D.).,University of Copenhagen, Denmark (C.H.D., F.G.)
| | - Finn Gustafsson
- University of Copenhagen, Denmark (C.H.D., F.G.).,Rigshospitalet, Copenhagen, Denmark (F.G.)
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden (J.P.W., K.K.)
| | - Lars Gullestad
- Departments of Cardiology (K.N., K.R., A.K.A., M.Y., E.G., E.B., A.R.A., I.G., L.G.), Oslo University Hospital Rikshospitalet, Norway.,Institute of Clinical Medicine, Faculty of Medicine (K.N., K.R., A.K.A., M.Y., L.G.), University of Oslo, Norway.,KG Jebsen Center for Cardiac Research (K.N., K.R., E.G., L.G.), University of Oslo, Norway.,Center for Heart Failure Research, Oslo University Hospital, Norway (K.N., K.R., E.G., L.G.)
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22
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Peak oxygen pulse responses during maximal cardiopulmonary exercise testing: Reference standards from FRIEND (Fitness Registry and the Importance of Exercise: an International Database). Int J Cardiol 2020; 301:180-182. [DOI: 10.1016/j.ijcard.2019.11.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/19/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
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Bernardi M, Guerra E, Rodio A, Dante D, Castellano V, Peluso I, Schena F, Bhambhani Y. Assessment of Exercise Stroke Volume and Its Prediction From Oxygen Pulse in Paralympic Athletes With Locomotor Impairments: Cardiac Long-Term Adaptations Are Possible. Front Physiol 2020; 10:1451. [PMID: 32218739 PMCID: PMC7079670 DOI: 10.3389/fphys.2019.01451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
The determinants of cardiac output (CO) during exercise, i.e., stroke volume (SV) and heart rate (HR), could differ in Paralympic athletes (PAthl) with spinal cord injury (SCI) with respect to PAthl with locomotor impairments caused by different health conditions (HCs). The purposes of the present study were the comparisons of two groups of PAthl, one with SCI and the other with either amputation (AMP) or post poliomyelitis syndrome (PM), assessing the (1) peak cardiorespiratory responses and determinants (SV and HR) of CO during maximal and submaximal arm cranking exercise (ACE), respectively; (2) correlations between peak oxygen uptake (VO2peak) and the highest SV obtained during submaximal exercise; and (3) correlations between oxygen pulse (O2 pulse, ratio between VO2 and HR) and both SV and O2 arterio-venous difference [(a-v)O2diff]. Each athlete (19 PAthl with SCI, 9 with AMP, and 5 with PM) completed a continuous incremental cardiopulmonary ACE test to volitional fatigue to assess peak responses. In a different session, CO was indirectly measured through carbon dioxide (CO2) rebreathing method at sub-maximal exercise intensities approximating 30, 50, and 70% of the VO2peak. There were no significant differences between the PAthl groups in age, anthropometry, and VO2peak. However, peak HR was significantly lower, and peak O2 pulse was significantly higher in PAthl with AMP/PM compared to those with SCI. During sub-maximal exercise, PAthl with AMP/PM displayed significantly higher SV values (154.8 ± 17.60 ml) than PAthl with SCI (117.1 ± 24.66 ml). SV correlated significantly with VO2peak in both PAthl with SCI (R 2 = 0.796) and AMP/PM (R 2 = 0.824). O2 pulse correlated significantly with SV in both PAthl with SCI (R 2 = 0.888) and AMP/PM (R 2 = 0.932) and in the overall sample (R 2 = 0.896). No significant correlations were observed between O2 pulse and (a-v)O2diff. It was concluded that in PAthl with different HCs: (1) significant differences, as a consequence of the different HC, exist in the determinants of CO at maximal and submaximal ACE; (2) SV is a significant determinant of VO2peak, suggesting cardiac adaptations possible also in PAthl with SCI; and (3) SV can be predicted from O2 pulse measurements during submaximal exercise in both groups of PAthl.
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Affiliation(s)
- Marco Bernardi
- Department of Physiology and Pharmacology, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy.,Italian Paralympic Committee, Rome, Italy
| | - Emanuele Guerra
- Sports Medicine Service, Local Health Unit of Modena, Modena, Italy
| | - Angelo Rodio
- Department of Human, Social and Health Sciences, University of Cassino, Cassino, Italy
| | - Donatella Dante
- Department of Physiology and Pharmacology, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Ilaria Peluso
- Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Yagesh Bhambhani
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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24
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Birkett ST, Nichols S, Sawrey R, Gleadall-Siddall D, McGregor G, Ingle L. The effects of low-volume high-intensity interval training and circuit training on maximal oxygen uptake. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00552-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Wolff CA, Konopka AR, Suer MK, Trappe TA, Kaminsky LA, Harber MP. Increased cardiorespiratory fitness and skeletal muscle size following single-leg knee extension exercise training. J Sports Med Phys Fitness 2019; 59:934-940. [DOI: 10.23736/s0022-4707.18.08590-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Shortened Recovery Period Between Firefighting Work Bouts Increases Cardiac Response Disproportionately With Metabolic Rate. J Occup Environ Med 2019; 61:e217-e225. [DOI: 10.1097/jom.0000000000001579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Clark A, De La Rosa AB, DeRevere JL, Astorino TA. Effects of various interval training regimes on changes in maximal oxygen uptake, body composition, and muscular strength in sedentary women with obesity. Eur J Appl Physiol 2019; 119:879-888. [PMID: 30643959 DOI: 10.1007/s00421-019-04077-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE We determined the effects of two high-intensity interval training (HIIT) regimens [the traditional (TRAD) and periodized (PER)] on changes in maximal oxygen uptake (VO2max), body composition, and muscular strength in sedentary, obese women. METHODS Seventeen women (age and BMI = 37.5 ± 10.5 year and 39.1 ± 4.3 kg/m2) were randomized into a 6 week regime of TRAD or PER which consisted of three sessions per week, two in the laboratory, and one on their own. Pre- and post-training, VO2max, body composition, and muscular strength of the knee extensors (KE) and flexors (KF) were assessed via ramp cycling to exhaustion, air displacement plethysmography, and isokinetic dynamometry, respectively. RESULTS VO2max was increased by 4-5% in response to training (p = 0.045) with no group-by-time interaction (p = 0.79). Body mass, fat mass, and waist-to-hip ratio were unaltered (p > 0.05) in response to training, yet there was a significant change in percent body fat (p = 0.03), percent fat-free mass (p = 0.03), and absolute fat-free mass (p = 0.03) in TRAD but not PER. No change occurred in KE (p = 0.36) or KF torque (p = 0.75) in response to training and there was no group-by-time interaction (p > 0.05). CONCLUSIONS Low-volume HIIT improved VO2max and body composition but did not modify muscular strength, which suggests that obese women desiring to increase strength should initiate more intense HIIT or partake in formal resistance training.
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Affiliation(s)
- Amy Clark
- Department of Kinesiology, California State University, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Annie B De La Rosa
- Department of Kinesiology, California State University, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Jamie L DeRevere
- Department of Kinesiology, California State University, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Todd A Astorino
- Department of Kinesiology, California State University, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA.
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VAN DE Sande DAJP, Schoots T, Hoogsteen J, Doevendans PA, Kemps HMC. O2 Pulse Patterns in Male Master Athletes with Normal and Abnormal Exercise Tests. Med Sci Sports Exerc 2019; 51:12-18. [PMID: 30157105 DOI: 10.1249/mss.0000000000001772] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The clinical relevance of abnormal exercise testing (ET) results (at least 0.1 mV ST segment depression measured during exercise or recovery in three consecutive beats) in athletes without obstructive coronary artery disease (CAD) is not well understood. It is unknown whether this phenomenon reflects a physiological adaptation to sport or a truly ischemic response and a concomitant attenuated stroke volume (SV) response. The aim of this study was to investigate if athletes with abnormal ET results without obstructive CAD showed signs of an attenuated SV response using cardiopulmonary ET parameters. METHODS A total of 78 male master athletes with abnormal ET results without obstructive CAD underwent cardiopulmonary ET. ΔO2 pulse/Δwork rate (WR), ΔV˙O2/ΔWR, and Δheart rate (HR)/ΔWR were assessed and compared with data from 78 male master athletes with normal ET results, matched for age, sports characteristics, and exercise capacity. RESULTS The ΔO2 pulse/ΔWR ratio beyond anaerobic threshold in athletes with abnormal ET results was lower than that in athletes with normal ET results (0.73 ± 0.41 vs 1.12 ± 0.54, respectively, P < 0.001). The ΔV˙O2/ΔWR ratio was also lower in athletes with abnormal ET results (0.9 ± 0.2 vs 1.0 ± 0.3, respectively, P = 0.041). Furthermore, these athletes showed a greater increase in HR in the last 2 min of exercise (ΔHR/ΔWR ratio: 1.19 ± 0.5 vs 0.80 ± 0.6, P < 0.001). CONCLUSION Athletes with abnormal ET results without obstructive CAD showed an attenuated O2 pulse slope, decreased ΔV˙O2/ΔWR ratio, and increased ΔHR/ΔWR ratio beyond anaerobic threshold when compared with athletes with a normal ET result. These results support the hypothesis that at least a part of the athletes with an abnormal ET in absence of obstructive CAD have an attenuated SV response at high-intensity exercise.
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Affiliation(s)
| | - Thijs Schoots
- Department of Cardiology, Máxima Medical Center, Veldhoven, THE NETHERLANDS
| | - Jan Hoogsteen
- Department of Cardiology, Máxima Medical Center, Veldhoven, THE NETHERLANDS
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, THE NETHERLANDS
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, THE NETHERLANDS
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Guio de Prada V, Ortega JF, Ramirez-Jimenez M, Morales-Palomo F, Pallares JG, Mora-Rodriguez R. Training intensity relative to ventilatory thresholds determines cardiorespiratory fitness improvements in sedentary adults with obesity. Eur J Sport Sci 2018; 19:549-556. [PMID: 30381027 DOI: 10.1080/17461391.2018.1540659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of the present study was to study if training intensity relative to ventilatory thresholds (VTs) determines the improvements in cardiorespiratory fitness (CRF) in middle-aged sedentary individuals with obesity. Before and after 16-weeks of HIIT (43-min alternating bouts at 70/90% of HRMAX), oxygen consumption ( V˙ O2) and heart rate (HR) at ventilatory threshold 1 ( V˙ O2VT1, HRVT1), ventilatory threshold 2 ( V˙ O2VT2, HRVT2) and at maximal effort ( V˙ O2MAX, HRMAX) were assessed during a graded cycle-ergometer exercise test. Retrospectively, participants were divided into two groups based on whether training intensities were under (UNDER; n = 39) or over (OVER; n = 37) VT1 and VT2. At baseline, age, body composition, V˙ O2VT1, V˙ O2VT2, and HRMAX were similar in both groups. However, V˙ O2MAX was higher in OVER (P = 0.033), whereas HRVT1 and HRVT2 were higher in UNDER (P < 0.05). V˙ O2MAX (9.0%) and HRMAX (2.2%) improved similarly in both groups. V˙ O2VT1 and V˙ O2VT2 improved with training in both groups (P < 0.001) but the improvement was larger in OVER versus UNDER in V˙ O2VT1 (P = 0.013) and tended to be higher in V˙ O2VT2 (P = 0.068). HRVT1 increased only in OVER (P < 0.001), whereas HRVT2 did not change in any group (P = 0.248). A 16-week programme of HIIT improves V˙ O2MAX similarly in individuals training at intensities over or under their VTs. However, individuals training over their VTs showed a larger improvements in V˙ O2VT1 expanding exercise workloads fuelled by oxidative metabolism.
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Affiliation(s)
| | - Juan Fernando Ortega
- b Exercise Physiology Lab at Toledo , University of Castilla-La Mancha , Toledo , Spain
| | | | - Felix Morales-Palomo
- b Exercise Physiology Lab at Toledo , University of Castilla-La Mancha , Toledo , Spain
| | - Jesús G Pallares
- c Human Performance and Sports Science , University of Murcia , San Javier , Spain
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Gries KJ, Raue U, Perkins RK, Lavin KM, Overstreet BS, D'Acquisto LJ, Graham B, Finch WH, Kaminsky LA, Trappe TA, Trappe S. Cardiovascular and skeletal muscle health with lifelong exercise. J Appl Physiol (1985) 2018; 125:1636-1645. [PMID: 30161005 DOI: 10.1152/japplphysiol.00174.2018] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to examine the effects of aerobic lifelong exercise (LLE) on maximum oxygen consumption (V̇o2max) and skeletal muscle metabolic fitness in trained women ( n = 7, 72 ± 2 yr) and men ( n = 21, 74 ± 1 yr) and compare them to old, healthy nonexercisers (OH; women: n = 10, 75 ± 1 yr; men: n = 10, 75 ± 1 yr) and young exercisers (YE; women: n = 10, 25 ± 1 yr; men: n = 10, 25 ± 1 yr). LLE men were further subdivided based on intensity of lifelong exercise and competitive status into performance (LLE-P, n = 14) and fitness (LLE-F, n = 7). On average, LLE exercised 5 day/wk for 7 h/wk over the past 52 ± 1 yr. Each subject performed a maximal cycle test to assess V̇o2max and had a vastus lateralis muscle biopsy to examine capillarization and metabolic enzymes [citrate synthase, β-hydroxyacyl-CoA dehydrogenase (β-HAD), and glycogen phosphorylase]. V̇o2max had a hierarchical pattern (YE > LLE > OH, P < 0.05) for women (44 ± 2 > 26 ± 2 > 18 ± 1 ml·kg-1·min-1) and men (53 ± 3 > 34 ± 1 > 22 ± 1 ml·kg-1·min-1) and was greater ( P < 0.05) in LLE-P (38 ± 1 ml·kg-1·min-1) than LLE-F (27 ± 2 ml·kg-1·min-1). LLE men regardless of intensity and women had similar capillarization and aerobic enzyme activity (citrate synthase and β-HAD) as YE, which were 20%-90% greater ( P < 0.05) than OH. In summary, these data show a substantial V̇o2max benefit with LLE that tracked similarly between the sexes, with further enhancement in performance-trained men. For skeletal muscle, 50+ years of aerobic exercise fully preserved capillarization and aerobic enzymes, regardless of intensity. These data suggest that skeletal muscle metabolic fitness may be easier to maintain with lifelong aerobic exercise than more central aspects of the cardiovascular system. NEW & NOTEWORTHY Lifelong exercise (LLE) is a relatively new and evolving area of study with information especially limited in women and individuals with varying exercise intensity habits. These data show a substantial maximal oxygen consumption benefit with LLE that tracked similarly between the sexes. Our findings contribute to the very limited skeletal muscle biopsy data from LLE women (>70 yr), and similar to men, revealed a preserved metabolic phenotype comparable to young exercisers.
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Affiliation(s)
- Kevin J Gries
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Ulrika Raue
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Ryan K Perkins
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Kaleen M Lavin
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | | | | | - Bruce Graham
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - W Holmes Finch
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | | | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana
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Astorino TA, deRevere J, Anderson T, Kellogg E, Holstrom P, Ring S, Ghaseb N. Change in VO 2max and time trial performance in response to high-intensity interval training prescribed using ventilatory threshold. Eur J Appl Physiol 2018; 118:1811-1820. [PMID: 29923111 DOI: 10.1007/s00421-018-3910-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/05/2018] [Indexed: 12/19/2022]
Abstract
Completion of high-intensity interval training (HIIT) leads to significant increases in maximal oxygen uptake (VO2max) and oxidative capacity. However, individual responses to HIIT have been identified as approximately 20-40% of individuals show no change in VO2max, which may be due to the relatively homogeneous approach to implementing HIIT. PURPOSE This study tested the effects of HIIT prescribed using ventilatory threshold (VT) on changes in VO2max and cycling performance. METHODS Fourteen active men and women (age and VO2max = 27 ± 8 year and 38 ± 4 mL/kg/min) underwent nine sessions of HIIT, and 14 additional men and women (age and VO2max = 22 ± 3 year and 40 ± 5 mL/kg/min) served as controls. Training was performed on a cycle ergometer at a work rate equal to 130%VT and consisted of eight to ten 1 min bouts interspersed with 75 s of recovery. At baseline and post-testing, they completed progressive cycling to exhaustion to determine VO2max, and on a separate day, a 5 mile cycling time trial. RESULTS Compared to the control group, HIIT led to significant increases in VO2max (6%, p = 0.007), cycling performance (2.5%, p = 0.003), and absolute VT (9 W, p = 0.005). However, only 57% of participants revealed meaningful increases in VO2max and cycling performance in response to training, and two showed no change in either outcome. CONCLUSIONS A greater volume of HIIT may be needed to maximize the training response for all individuals.
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Affiliation(s)
- Todd A Astorino
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA.
| | - Jamie deRevere
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
- Department of Physical Education and Human Performance, Central Connecticut State University, New Britain, CT, USA
| | - Theodore Anderson
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
- Department of Kinesiology, California State University-Sacramento, Sacramento, USA
| | - Erin Kellogg
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Patrick Holstrom
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Sebastian Ring
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
| | - Nicholas Ghaseb
- Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA
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Kim DD, Lang DJ, Procyshyn RM, Woodward ML, Kaufman K, White RF, Honer WG, Warburton DER. Reduced cardiovascular fitness associated with exposure to clozapine in individuals with chronic schizophrenia. Psychiatry Res 2018; 262:28-33. [PMID: 29407565 DOI: 10.1016/j.psychres.2018.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/21/2017] [Accepted: 01/12/2018] [Indexed: 01/07/2023]
Abstract
Studies show that individuals with schizophrenia have impaired cardiovascular fitness (i.e., low peak aerobic power (VO2peak)). It is speculated that antipsychotics with adverse cardiovascular and metabolic profiles, in particular clozapine, have a significant impact on VO2peak. In this cross-sectional study, we examined whether exposure to clozapine was associated with further reduced VO2peak compared with non-clozapine antipsychotics. Thirty participants with chronic schizophrenia or schizoaffective disorder were divided into clozapine and non-clozapine groups. Mean daily doses of antipsychotics were standardized to chlorpromazine equivalents and haloperidol equivalents for antagonism of alpha1- and alpha2-adrenergic receptors. Participants completed an incremental-to-maximal symptom-limited exercise test on a cycle ergometer for the assessment of VO2peak. The clozapine group demonstrated significantly lower VO2peak than the non-clozapine group. Haloperidol equivalents for alpha-adrenergic receptor antagonism, but not chlorpromazine equivalents, demonstrated significant inverse associations with VO2peak. The clozapine group had a significantly higher amount of antagonistic activity at alpha-adrenergic receptors than the non-clozapine group. In conclusion, exposure to clozapine was associated with further reduced cardiovascular fitness, which may be explained by the drug's greater antagonistic activity at alpha-adrenergic receptors. Cardiovascular fitness needs to be promoted in individuals treated with antipsychotics, particularly clozapine, to prevent the risk of cardiovascular disease and mortality.
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Affiliation(s)
- David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L Woodward
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai Kaufman
- Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada
| | - Randall F White
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Darren E R Warburton
- Cardiovascular Physiology and Rehabilitation Laboratory, Physical Activity Promotion and Chronic Disease Prevention Unit, University of British Columbia, Vancouver, BC, Canada; Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Laukkanen JA, Araújo CGS, Kurl S, Khan H, Jae SY, Guazzi M, Kunutsor SK. Relative peak exercise oxygen pulse is related to sudden cardiac death, cardiovascular and all-cause mortality in middle-aged men. Eur J Prev Cardiol 2018; 25:772-782. [DOI: 10.1177/2047487318761679] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Preliminary evidence suggests that peak exercise oxygen pulse – peak oxygen uptake/heart rate-, a variable obtained during maximal cardiopulmonary exercise testing and a surrogate of stroke volume, is a predictor of mortality. We aimed to assess the associations of peak exercise oxygen pulse with sudden cardiac death, fatal coronary heart disease and cardiovascular disease and all-cause mortality. Design A prospective study. Methods Peak exercise oxygen pulse was assessed in a maximal cycling test at baseline in 2227 middle-aged men of the Kuopio Ischaemic Heart Disease cohort study using expired gas variables and electrocardiograms. Relative peak exercise oxygen pulse was obtained by dividing the absolute value by body weight. Results During a median follow-up of 26.1 years 1097 subjects died; there were 220 sudden cardiac deaths, 336 fatal coronary heart diseases and 505 fatal cardiovascular diseases. Relative peak exercise oxygen pulse (mean 19.5 (4.1) mL per beat/kg/102) was approximately linearly associated with each outcome. Comparing extreme quartiles of relative peak exercise oxygen pulse, hazard ratios (95% confidence intervals) for sudden cardiac death, fatal coronary heart disease and cardiovascular disease, and all-cause mortality on adjustment for cardiovascular risk factors were 0.55 (0.36–0.83), 0.58 (0.42–0.81), 0.60 (0.46–0.79) and 0.59 (0.49–0.70), respectively ( P < 0.001 for all). The hazard ratios were unchanged on further adjustment for C-reactive protein and the use of beta-blockers. The addition of relative peak exercise oxygen pulse to a cardiovascular disease mortality risk prediction model significantly improved risk discrimination (C-index change 0.0112; P = 0.030). Conclusion Relative peak exercise oxygen pulse measured during maximal exercise was linearly and inversely associated with fatal cardiovascular and all-cause mortality events in middle-aged men. In addition, relative peak exercise oxygen pulse provided significant improvement in cardiovascular disease mortality risk assessment beyond conventional risk factors.
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Affiliation(s)
- Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
- Department of Internal Medicine, Central Finland Health Care District, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
| | | | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Hassan Khan
- Department of Medicine, Emory University, USA
| | - Sae Y Jae
- Department of Sport Science, University of Seoul, Republic of Korea
| | - Marco Guazzi
- Department of Biomedical Sciences, Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Univrsity of Milan, Milan, Italy
| | - Setor K Kunutsor
- School of Clinical Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, UK
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Van Iterson EH, Olson TP, Borlaug BA, Johnson BD, Snyder EM. Comparisons of Noninvasive Methods Used to Assess Exercise Stroke Volume in Heart Failure with Preserved Ejection Fraction. Med Sci Sports Exerc 2018; 49:1758-1768. [PMID: 28471812 DOI: 10.1249/mss.0000000000001308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) plays an important role in properly phenotyping signs and symptoms of heart failure with preserved ejection fraction (HFpEF). The prognostic value of CPET is strengthened when accompanied by cardiac hemodynamic measurements. Although recognized as the "gold" standard, cardiac catheterization is impractical for routine CPET. Thus, advancing the scientific/methodologic understanding of noninvasive techniques for exercise cardiac hemodynamic assessment is clinically impactful in HFpEF. This study tested the concurrent validity of noninvasive acetylene gas (C2H2) uptake, echocardiography (ECHO), and oxygen pulse (O2pulse) for measuring/predicting exercise stroke volume (SV) in HFpEF. METHODS Eighteen white HFpEF and 18 age-/sex-matched healthy controls participated in upright CPET (ages, 69 ± 9 yr vs 63 ± 9 yr). At rest, 20 W, and peak exercise, SV was measured at steady-state via C2H2 rebreathe (SVACET) and ECHO (SVECHO), whereas O2pulse was derived (=V˙O2/HR). RESULTS Resting relationships between SVACET and SVECHO, SVECHO and O2pulse, or SVACET and O2pulse were significant in HFpEF (R = 0.30, 0.36, 0.67), but not controls (R = 0.07, 0.01, 0.09), respectively. Resting relationships persisted to 20 W in HFpEF (R = 0.70, 0.53, 0.70) and controls (R = 0.05, 0.07, 0.21), respectively. Peak exercise relationships were significant in HFpEF (R = 0.62, 0.24, 0.64), but only for SVACET versus O2pulse in controls (R = 0.07, 0.04, 0.33), respectively. Standardized standard error of estimate between techniques was strongest in HFpEF at 20 W: SVACET versus SVECHO = 0.57 ± 0.22; SVECHO versus O2pulse = 0.71 ± 0.28; SVACET versus O2pulse = 0.56 ± 0.22. CONCLUSIONS Constituting a clinically impactful step towards construct validation testing, these data suggest SVACET, SVECHO, and O2pulse demonstrate moderate-to-strong concurrent validity for measuring/predicting exercise SV in HFpEF.
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Affiliation(s)
- Erik H Van Iterson
- 1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; and 2Department of Kinesiology, University of Minnesota, Minneapolis, MN
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Exercise testing in heart failure: a contemporary discussion in an era of novel diagnostic techniques and biomarkers. Curr Opin Cardiol 2017; 33:217-224. [PMID: 29227300 DOI: 10.1097/hco.0000000000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to highlight recent advances in the field of exercise testing for patients with heart failure. RECENT FINDINGS The importance of assessment of cardiorespiratory fitness (CRF) and exercise testing in heart failure is highlighted in the consensus recommendation of the American Heart Association. Contemporary studies have validated the independent and incremental strength of CRF metrics in patients with heart failure and coronary artery disease. The use of respiratory gas analysis and imaging or hemodynamics during physical exercise is feasible and results in high prognostic utility across the continuum of heart failure. Understanding how CRF metrics complement existing and novel biomarkers and risk scores is an emerging subject of scientific inquiry. SUMMARY In the current era of personalized medicine, integrating CRF, imaging and circulating biomarkers will allow us to further develop individualized strategies for improving outcome in patients with heart failure.
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Abstract
BACKGROUND Studies that have evaluated cardiopulmonary responses to exercise within the first few months of bariatric surgery have utilized cycle ergometry. However, walking is the most commonly reported mode of both pre- and post-operative PA. The divergent cardiopulmonary responses and metabolic costs of weight-bearing (walking) and non-weight-bearing (cycling) exercises warrant examination of the effects of bariatric surgery on cardiopulmonary responses during walking. METHODS Nine women completed a maximal cardiopulmonary exercise test on a treadmill 2 weeks before and 3 months after gastric bypass surgery (GBS). Heart rate (HR), oxygen uptake (VO2), oxygen pulse (O2-p), and time to fatigue were compared before and after surgery and between the GBS group and a comparison group of 12 normal-weight (NW) women who completed the same exercise testing protocol. RESULTS Time to fatigue increased by ~140 s following GBS (p = 0.018). No other parameter improved during maximal exercise from pre- to post-surgery. Body weight- and fat-free mass-corrected VO2 and O2-p at peak exercise differed between the GBS and NW groups before surgery, while only weight-corrected values were different following surgery. These differences disappeared after controlling for body fat percentage. CONCLUSION We have demonstrated that weight loss alone was not sufficient to improve select cardiopulmonary fitness measures during treadmill walking in obese females 3 months after GBS. However, we did observe a significant overall improvement in exercise capacity as the GBS group was able to exercise longer, presumably due to significant reductions in body mass and a subsequent reduced metabolic cost of walking.
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Keramidas ME, Mekjavic IB, Eiken O. LunHab: interactive effects of a 10 day sustained exposure to hypoxia and bedrest on aerobic exercise capacity in male lowlanders. Exp Physiol 2017; 102:694-710. [DOI: 10.1113/ep086167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/20/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Michail E. Keramidas
- Department of Environmental Physiology; Swedish Aerospace Physiology Center; School of Technology and Health; Royal Institute of Technology; Stockholm Sweden
| | - Igor B. Mekjavic
- Department of Automation; Biocybernetics and Robotics; Jozef Stefan Institute; Ljubljana Slovenia
- Department of Biomedical Physiology and Kinesiology; Simon Fraser University; Burnaby BC Canada
| | - Ola Eiken
- Department of Environmental Physiology; Swedish Aerospace Physiology Center; School of Technology and Health; Royal Institute of Technology; Stockholm Sweden
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Leprêtre P, Lopes P, Koralzstein J, Billat V. Heavy cycling exercise at fixed heart rate prevent the decline of stroke volume and delay time to exhaustion in trained adolescents. Sci Sports 2017. [DOI: 10.1016/j.scispo.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LEE CHIALUN, HSU WEICHIEH, CHENG CHINGFENG. Physiological Adaptations to Sprint Interval Training with Matched Exercise Volume. Med Sci Sports Exerc 2017; 49:86-95. [DOI: 10.1249/mss.0000000000001083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Muscat KM, Kotrach HG, Wilkinson-Maitland CA, Schaeffer MR, Mendonca CT, Jensen D. Physiological and perceptual responses to incremental exercise testing in healthy men: effect of exercise test modality. Appl Physiol Nutr Metab 2015; 40:1199-209. [DOI: 10.1139/apnm-2015-0179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a randomized cross-over study of 15 healthy men aged 20–30 years, we compared physiological and perceptual responses during treadmill and cycle exercise test protocols matched for increments in work rate — the source of increased locomotor muscle metabolic and contractile demands. The rates of O2 consumption and CO2 production were higher at the peak of treadmill versus cycle testing (p ≤ 0.05). Nevertheless, work rate, minute ventilation, tidal volume (VT), breathing frequency (fR), inspiratory capacity (IC), inspiratory reserve volume (IRV), tidal esophageal (Pes,tidal) and transdiaphragmatic pressure swings (Pdi,tidal), peak expiratory gastric pressures (Pga,peak), the root mean square of the diaphragm electromyogram (EMGdi,rms) expressed as a percentage of maximum EMGdi,rms (EMGdi,rms%max), and dyspnea ratings were similar at the peak of treadmill versus cycle testing (p > 0.05). Ratings of leg discomfort were higher at the peak of cycle versus treadmill exercise (p ≤ 0.05), even though peak O2 consumption was lower during cycling. Oxygen consumption, CO2 production, minute ventilation, fR, Pes,tidal, Pdi,tidal and Pga,peak were higher (p ≤ 0.05), while VT, IC, IRV, EMGdi,rms%max, and ratings of dyspnea and leg discomfort were similar (p > 0.05) at all or most submaximal work rates during treadmill versus cycle exercise. Our findings highlight important differences (and similarities) in physiological and perceptual responses at maximal and submaximal work rates during incremental treadmill and cycle exercise testing protocols. The lack of effect of exercise test modality on peak work rate advocates for the use of this readily available parameter to optimize training intensity determination, regardless of exercise training mode.
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Affiliation(s)
- Kristina M. Muscat
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Houssam G. Kotrach
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Courtney A. Wilkinson-Maitland
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Michele R. Schaeffer
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Cassandra T. Mendonca
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montréal, QC H2W 1S4, Canada
- Respiratory Epidemiology and Clinical Research Unit, Montréal Chest Institute, McGill University Health Centre, Montréal, QC H4A 3J1, Canada
- Research Centre for Physical Activity and Health, McGill University, Montréal, QC H2W 1S4, Canada
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Edvardsen E, Anderssen SA, Borchsenius F, Skjønsberg OH. Reduction in cardiorespiratory fitness after lung resection is not related to the number of lung segments removed. BMJ Open Sport Exerc Med 2015; 1:e000032. [PMID: 27900127 PMCID: PMC5117018 DOI: 10.1136/bmjsem-2015-000032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 12/25/2022] Open
Abstract
Aim To evaluate the effect of lung cancer surgery on cardiorespiratory fitness (CRF), and to assess the agreement between the predicted postoperative (ppo) V̇O2peak and actually measured postoperative peak oxygen uptake (V̇O2peak). Methods Before and 4–6 weeks after lung cancer surgery, 70 patients (35 women) underwent measurements of pulmonary function and CRF via a cardiopulmonary exercise test. In addition, the 23 non-exercising patients underwent measurements after 6 months. The ppo V̇O2peak calculated from the number of functional segments removed was compared with the actually measured postoperative values of V̇O2peak for accuracy and precision. Results After surgery, the V̇O2peak decreased from 23.9±5.8 to 19.2±5.5 mL/kg/min (−19.6±15.7%) (p<0.001). The breathing reserve increased by 5% (p=0.001); the oxygen saturation remained unchanged (p=0.30); the oxygen pulse decreased by −1.9 mL/beat (p<0.001); the haemoglobin concentration decreased by 0.7 g/dL (p=0.001). The oxygen pulse was the strongest predictor for change in V̇O2peak; adjusted linear squared: r2=0.77. Six months after surgery, the V̇O2peak remained unchanged (−3±15%, p=0.27). The ppo V̇O2peak (mL/kg/min) was 18.6±5.4, and the actually measured V̇O2peak was 19.2±5.5 (p=0.24). However, the limits of agreement were large (CI −7.4 to 8.2). The segment method miscalculated the ppo V̇O2peak by more than ±10 and ±20% in 54% and 25% of the patients, respectively. Conclusions The reduction in V̇O2peak and lack of improvement 6 months after lung cancer surgery cannot be explained by the loss of functional lung tissue. Predicting postoperative V̇O2peak based on the amount of lung tissue removed is not recommendable due to poor precision. Trial registration number NCT01748981.
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Affiliation(s)
- Elisabeth Edvardsen
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Sigmund A Anderssen
- Department of Sports Medicine , Norwegian School of Sport Sciences , Oslo , Norway
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Role of obesity on cerebral hemodynamics and cardiorespiratory responses in healthy men during repetitive incremental lifting. Eur J Appl Physiol 2015; 115:1905-17. [DOI: 10.1007/s00421-015-3171-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/07/2015] [Indexed: 01/08/2023]
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Rønnestad BR, Hansen J, Thyli V, Bakken TA, Sandbakk Ø. 5-week block periodization increases aerobic power in elite cross-country skiers. Scand J Med Sci Sports 2015; 26:140-6. [DOI: 10.1111/sms.12418] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 12/11/2022]
Affiliation(s)
- B. R. Rønnestad
- Section for Sport Science; Lillehammer University College; Lillehammer Norway
| | - J. Hansen
- Section for Sport Science; Lillehammer University College; Lillehammer Norway
| | - V. Thyli
- Section for Sport Science; Lillehammer University College; Lillehammer Norway
| | - T. A. Bakken
- Section for Sport Science; Lillehammer University College; Lillehammer Norway
| | - Ø. Sandbakk
- Center for Elite Sports Research; Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
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Reducing the volume of sprint interval training does not diminish maximal and submaximal performance gains in healthy men. Eur J Appl Physiol 2014; 114:2427-36. [PMID: 25091854 DOI: 10.1007/s00421-014-2960-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/16/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE The present study examined the effect of reducing sprint interval training (SIT) work-interval duration on increases in maximal and submaximal performance. METHODS Subjects (n = 36) were assigned to one of three training groups: endurance training (ET; 60 min per session for weeks 1-2, increasing to 75 min per session for weeks 3-4), or sprint interval training consisting of either repeated 30 (SIT 30) or 15 (SIT 15) second all-out intervals (starting with 4 bouts per session for weeks 1-2, increasing to 6 intervals per session for weeks 3-4). Training consisted of cycling 3 times per week for 4 weeks. RESULTS While there was a significant main effect of training on VO₂peak such that VO₂peak was elevated post-training, no significant difference was observed in the improvements observed between groups (ET ~13%, SIT 30-4%, SIT 15-8%). A significant main effect of training was observed such that lactate threshold and critical power were higher during post-testing across all groups (p < 0.05). There was a main effect of training (p < 0.05) on Wingate peak power with no differences observed between groups at post-training. CONCLUSIONS Together, these results indicate that reducing SIT work-interval duration from 30 to 15 s had no impact on training-induced increases in aerobic or anaerobic power, or on increases in lactate threshold (absolute) and critical power.
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Maranhao Neto GA, Oliveira RB, Myers JN, Farinatti PTV. Prediction of peak oxygen pulse (O2Ppeak) without exercise testing in older adults. Arch Gerontol Geriatr 2014; 59:562-7. [PMID: 25085231 DOI: 10.1016/j.archger.2014.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/27/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Peak oxygen pulse has been considered a surrogate of cardiovascular function and an independent predictor of all cause mortality. However, O2P(peak) depends on maximal volitional effort which may limit its utility in older subjects. The aim of this study was to develop a model to estimate O2P(peak) without exercise in an elderly sample. This cross-sectional study enrolled 67 community-dwelling older adults (69.4±7.1 years; 41 men) for the non-exercise model development and 30 community-dwelling older adults (67.7±6.4 years; n=30; 17 men) for cross-validation. The non-exercise model was derived through hierarchical regression model and cross-validated by means of PRESS statistics and comparison against an independent sample. Classification accuracy of the model for tertiles of estimated and actual O2P(peak) was tested by gamma (γ) nonparametric correlation. The following prediction equation was generated: -3.416+0.137 × weight (kg)+1.226 × Veterans Specific Activity Questionnaire (VSAQ) (metabolic equivalents, METs)+1.987 × gender (0=women, 1=men)-2.045 × β-Blockers use (0=no, 1=yes)-0.044 × resting heart rate (HR) (R(2)=0.83; standard error of estimate (SEE)=1.68 mL beat(-1)). Correlation in cross-validation group was 0.80 (P<0.001). A high probability was observed for the model to rank the values in the same tertile in validation and cross-validation groups (γ=0.98; γ=0.92, respectively, P<0.05). In conclusion, O2P(peak) can be estimated with reasonable precision without exercise testing, providing an alternative for elder subjects not capable to perform maximal effort.
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Affiliation(s)
| | | | | | - Paulo T V Farinatti
- Salgado de Oliveira University, Niteroi, RJ, Brazil; Rio de Janeiro State University, RJ, Brazil.
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Stasiule L, Capkauskiene S, Vizbaraite D, Stasiulis A. Deep mineral water accelerates recovery after dehydrating aerobic exercise: a randomized, double-blind, placebo-controlled crossover study. J Int Soc Sports Nutr 2014; 11:34. [PMID: 25002835 PMCID: PMC4083353 DOI: 10.1186/1550-2783-11-34] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/20/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The effect of deep mineral water (DMW) with moderate mineralization on the recovery of physical performance after prolonged dehydrating aerobic exercise in the heat was studied in nine healthy, physically active (VO2max = 45.8 ± 8.4 mL kg(-1) min(-1)) women aged 24.0 ± 3.7 years. METHODS We conducted a randomized, double-blind, placebo-controlled crossover human study to evaluate the effect of ingestion of natural mineral water extracted from a depth of 689 m on recovery from prolonged fatiguing aerobic running conducted at 30°C. RESULTS Mean body weight decreased by 2.6-2.8% following dehydrating exercise. VO2max was 9% higher after 4 h of recovery after rehydrating with DMW compared with plain water. Leg muscle power recovered better during the slow phase of recovery and was significantly higher after 48 h of recovery after rehydrating with DMW compared with plain water. CONCLUSIONS DMW with moderate mineralization was more effective in inducing recovery of aerobic capacity and leg muscle power compared with plain water following prolonged dehydrating aerobic running exercise.
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Bruzas V, Stasiulis A, Cepulenas A, Mockus P, Statkeviciene B, Subacius V. Aerobic capacity is correlated with the ranking of boxers. Percept Mot Skills 2014; 119:50-8. [PMID: 25153738 DOI: 10.2466/30.29.pms.119c12z9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal was to assess the aerobic capacity of boxers and its relation with sport mastery. Participants were 12 boxers from the Lithuanian national team (VO₂max - 58.03 ± 3.00 ml/kg/min) of different weight classes. Their sport mastery ranking was established according to their achieved results during the last years of participation in amateur boxing contests. In a graduated treadmill running test, the boxers' aerobic capacity indices were established. Running speed at first and second ventilatory thresholds, VO₂max, and maximal oxygen pulse had moderate to strong correlations with the boxers' sport mastery ranking. Aerobic capacity is an important fitness component of boxers in all weight categories. Special attention should be paid to development of cardiac capacity in the boxers' training processes, as with aerobic power and anaerobic threshold training.
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Affiliation(s)
- Vidas Bruzas
- 1 Lithuanian Sports University, Kaunas, Lithuania
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Shi HZ, Li YZ, Tang ZZ, Zhong CF, Fan QC, Gao JY, Liu JL, Mi T, Zhao S, Li YH. Impact of 60 days of 6° head down bed rest on cardiopulmonary function, and the effects of Taikong Yangxin Prescription as a countermeasure. Chin J Integr Med 2014; 20:654-60. [PMID: 24810476 DOI: 10.1007/s11655-014-1345-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study the changes in cardiopulmonary function induced by mid/long-term simulated microgravity with 6° head down bed rest (HDBR), and the effects of Taikong Yangxin Prescription (, TYP) as a countermeasure. METHODS Fourteen healthy male volunteers were randomly divided into a control group and a Chinese medicine (CM) group (7 in each group) by a random digital table based on their body weight. Both groups underwent 6° HDBR for 60 days. Subjects in the CM group received daily TYP pills and subjects in the control group received daily placebo pills. Cardiac systolic and pumping functions were measured by echocardiography before HDBR; on days 20, 42, and 57 of HDBR; and on day 3 of recovery after HDBR (R+3). Cardiopulmonary functional reserve and exercise capacity were evaluated before HDBR, on day 29, and on day R+3 by exercise testing. RESULTS The heart rate (HR) increased gradually during HDBR. The HR was significantly higher on day 57 than before HDBR in the control group (P<0.05), but did not increase significantly in the CM group. The stroke volume/stroke volume index, ejection fraction, and left ventricular fractional shortening tended to decrease over time in the control group, but not in the CM group. These parameters were significantly higher in the CM group than in the control group on day 42 (P<0.05 or <0.01). Exercise testing showed that maximum O2 consumption (VO2max), metabolic equivalents, relative O2 consumption (VO2), O2 pulse, and exercise duration were significantly lower on day 29 than before HDBR in the control group, but not in the CM group. CONCLUSIONS Sixty days of 6° HDBR induced a reduction in cardiac systolic and pumping functions, and reduced cardiopulmonary functional reserve and exercise capacity. Administration of TYP significantly improved cardiac systolic and pumping functions, and maintained cardiopulmonary functional reserve and exercise capacity.
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Affiliation(s)
- Hong-zhi Shi
- State Key Laboratory of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, 100094, China
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Kim CH, Cha YM, Shen WK, Maccarter DJ, Taylor BJ, Johnson BD. Effects of atrioventricular and interventricular delays on gas exchange during exercise in patients with heart failure. J Heart Lung Transplant 2014; 33:397-403. [PMID: 24594137 DOI: 10.1016/j.healun.2014.01.855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/22/2013] [Accepted: 01/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been an important treatment for heart failure. However, it is controversial as to whether an individualized approach to altering AV and VV timing intervals would improve outcomes. Changes in respiratory patterns and gas exchange are dynamic and may be influenced by timing delays. Light exercise enhances the heart and lung interactions. Thus, in this study we investigated changes in non-invasive gas exchange by altering AV and VV timing intervals during light exercise. METHODS Patients (n = 20, age 66 ± 9 years) performed two walking tests post-implantation. The protocol evaluated AV delays (100, 120, 140, 160 and 180 milliseconds), followed by VV delays (0, -20 and -40 milliseconds) while gas exchange was assessed. RESULTS There was no consistent group pattern of change in gas exchange variables across AV and VV delays (p > 0.05). However, there were modest changes in these variables on an individual basis with variations in VE/VCO2 averaging 10%; O2 pulse 11% and PETCO2 5% across AV delays, and 4%, 8% and 2%, respectively, across VV delays. Delays that resulted in the most improved gas exchange differed from nominal in 17 of 20 subjects. CONCLUSION Gas exchange measures can be improved by optimization of AV and VV delays and thus could be used to individualize the approach to CRT optimization.
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Affiliation(s)
- Chul-Ho Kim
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Win-Kuang Shen
- Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona
| | | | - Bryan J Taylor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Taylor BJ, Olson TP, Chul-Ho-Kim, Maccarter D, Johnson BD. Use of noninvasive gas exchange to track pulmonary vascular responses to exercise in heart failure. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2013; 7:53-60. [PMID: 24093002 PMCID: PMC3785385 DOI: 10.4137/ccrpm.s12178] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We determined whether a non-invasive gas exchange based estimate of pulmonary vascular (PV) capacitance [PVCAP = stroke volume (SV) × pulmonary arterial pressure (Ppa)] (GXCAP) tracked the PV response to exercise in heart-failure (HF) patients. Pulmonary wedge pressure (Ppw), Ppa, PV resistance (PVR), and gas exchange were measured simultaneously during cycle exercise in 42 HF patients undergoing right-heart catheterization. During exercise, PETCO2 and VE/VCO2 were related to each other (r = −0.93, P < 0.01) and similarly related to mean Ppa (mPpa) (r = −0.39 and 0.36; P < 0.05); PETCO2 was subsequently used as a metric of mPpa. Oxygen pulse (O2 pulse) tracked the SV response to exercise (r = 0.91, P < 0.01). Thus, GXCAP was calculated as O2 pulse × PETCO2. During exercise, invasively determined PVCAP and non-invasive GXCAP were related (r = 0.86, P < 0.01), and GXCAP correlated with mPpa and PVR (r = −0.46 and −0.54; P < 0.01). In conclusion, noninvasive gas exchange measures may represent a simple way to track the PV response to exercise in HF.
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Affiliation(s)
- Bryan J Taylor
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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