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Gomes-Neto M, Durães AR, Conceição LSR, Saquetto MB, Alves IG, Smart NA, Carvalho VO. Effects of Different Exercise Interventions on Cardiorespiratory Fitness, as Measured by Peak Oxygen Consumption in Patients with Coronary Heart Disease: An Overview of Systematic Reviews. Sports Med 2024:10.1007/s40279-024-02053-w. [PMID: 39037575 DOI: 10.1007/s40279-024-02053-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Exercise is an important component of rehabilitation care for people with coronary heart disease (CHD). OBJECTIVES The aim of this study was to critically analyze and summarize the existing evidence from published systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) that have evaluated the effects of different types of exercise interventions on cardiorespiratory fitness, as measured by peak oxygen consumption in people with CHD. METHODS Electronic databases (Cochrane Library, Medline/PubMed, EMBASE, and PEDro) were searched for SRs of exercise interventions of people with CHD. Two reviewers assessed the quality of SRs using the AMSTAR-2 tool and evaluated the strength of evidence quality with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system for relevant outcome measures. Mean difference (MD) and 95% confidence intervals (CIs) were calculated. RESULTS Thirty-one SRs (with 125 RCTs) met the study criteria, including 33,608 patients. Compared with usual care, continuous aerobic exercise produced an improvement in peak oxygen consumption, MD of 3.8 mL kg-1 min-1 (95% CI: 3.204.4, I2 = 67%); high-intensity interval training, MD 6.1 mL kg-1 min-1 (95% CI: 0.4-11.8, I2 = 97%); resistance training, MD of 2.1 mL kg-1 min-1 (95% CI: 0.98-3.2, I2 = 60%); combined aerobic and resistance training, MD of 3.0 mL kg-1 min-1 (95% CI: 2.5-3.4, I2 = 0%); and water-based exercise, MD of 4.4 mL kg-1 min-1 (95% CI, 2.1-6.7; I2 = 2%). CONCLUSION Exercise interventions improve peak oxygen consumption in people with CHD. However, there was moderate to very-low certainty for the evidence found.
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Affiliation(s)
- Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil.
- Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, BA, Brazil.
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil.
- Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil.
- Physiotherapy Department, Multidisciplinary Institute for Rehabilitation and Health, Federal University of Bahia (UFBA), Rua Padre Feijó, nº 312 (Casas 47 e 49), Bairro Canela, Salvador, BA, 40.110-170, Brazil.
| | | | - Lino Sérgio Rocha Conceição
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil
| | - Michelli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, BA, Brazil
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil
- Postgraduate Program in Medicine and Health, UFBA, Salvador, BA, Brazil
| | | | - Neil A Smart
- School of Science and Technology in the Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW, 2351, Australia
| | - Vitor Oliveira Carvalho
- Department of Physical Therapy, Federal University of Sergipe (Universidade Federal de Sergipe-UFS), Postgraduate Program in Health Science, Aracaju, SE, Brazil
- Physiotherapy Research Group, UFBA, Salvador, BA, Brazil
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Chair SY, Cheng HY, Lo SWS, Sit JWH, Wong EML, Leung KC, Wang Q, Choi KC, Leung TSY. Effectiveness of a home-based music-paced physical activity programme on exercise-related outcomes after cardiac rehabilitation: a randomized controlled trial. Eur J Cardiovasc Nurs 2024; 23:510-520. [PMID: 38165270 DOI: 10.1093/eurjcn/zvad115] [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: 05/30/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
AIMS A randomized controlled trial was conducted to examine the effects of a home-based music-paced physical activity programme guided by Information-Motivation-Strategy (IMS) model and Self-determination theory on exercise-related outcomes for patients with coronary heart disease (CHD) after cardiac rehabilitation (CR). METHODS AND RESULTS A total of 130 patients with CHD from a regional CR centre in Hong Kong were recruited and randomly allocated into intervention (n = 65) or control groups (n = 65). The intervention group received theory-guided practical sessions on performing prescribed home-based physical activity with individualized synchronized music, and follow-up telephone calls. The primary outcome was exercise capacity. Secondary outcomes included exercise self-efficacy, physical activity level, and exercise self-determination. Data were collected at baseline, 3 months, and 6 months after study entry. The generalized estimating equations model was used to assess the intervention effects. Patients with CHD in the intervention group demonstrated significantly greater improvements in exercise capacity at 3 months [β = 35.68, 95% confidence interval (CI) 2.69-68.68, P = 0.034] and significantly improved exercise self-efficacy at 6 months (β = 3.72, 95% CI 0.11-7.32, P = 0.043) when compared with the control group. However, no significant group differences were found in physical activity level and exercise self-determination. CONCLUSION The study findings provide evidence on an innovation on improving the exercise capacity and exercise self-efficacy of patients with CHD. The music-paced physical activity guided by the IMS model and Self-determination theory requires further investigation on its long-term effects in future studies. CLINICAL TRIAL REGISTRATION ChiCTR-IOR-17011015.
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Affiliation(s)
- Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Sally Wai Sze Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Janet Wing Hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | | | - Kai Chi Leung
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong SAR, China
| | - Qun Wang
- School of Nursing, Shenzhen University, Shenzhen, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Thomas Sui Yuen Leung
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong SAR, China
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Garcia-Tabar I, Ruiz-Rios M, Martinez-Labari C, Maldonado-Martin S, Murias JM, Gorostiaga EM. Reassembling the Field-based Applicability of the Lactate Threshold for Old Age. Int J Sports Med 2024. [PMID: 38959953 DOI: 10.1055/a-2328-3845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
This study aimed to investigate the applicability of the Lactate Threshold (LT) to predict maximal oxygen uptake (˙VO2max) and demarcate the boundary between the moderate- to heavy-intensity domain (HRm-h) in old age in comparison to the most utilized methods. A cross-sectional validation study was conducted. Participants aged 61 to 77 performed a familiarization procedure, an incremental maximal exercise treadmill test (CPX) for ˙VO2max determination, the Six-minute Walk Test (6MWT), and a discontinuous incremental field test for LT determination. Lower (P<0.01) internal effort was required for LT testing (76±8%HRmax) compared to 6MWT (92±9%HRmax). The application of the 6MWT reference equations overestimated ˙VO2max by 10-23%. LTs better estimated the ˙VO2max (r ≈0.90, SEE: ≈3.0] compared to the 6MWT (r=0.68, SEE=5.5). HRm-h determined by the CPX differed (20%; P=0.001) from that obtained by LT. HRm-h stratification indicated participants fall into the very light to the vigorous intensity domains. LT testing is more submaximal than the 6MWT, and is a valuable tool to estimate the ˙VO2max in older male adults. Implementation of LT testing in physical activity programs might help improving the quality of aerobic exercise training in older men.
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Affiliation(s)
- Ibai Garcia-Tabar
- Department of Physical Education and Sport, Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain, Vitoria-Gasteiz, Spain
- Studies, Research and Sports Medicine Centre (CEIMD), Government of Navarre, Pamplona, Spain, Pamplona, Spain
- Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Physical Activity, Exercise, and Health group. Vitoria-Gasteiz, Basque Country, Spain, Vitoria-Gasteiz, Spain
| | - Maitane Ruiz-Rios
- Department of Physical Education and Sport, Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain, Vitoria-Gasteiz, Spain
- Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Physical Activity, Exercise, and Health group. Vitoria-Gasteiz, Basque Country, Spain, Vitoria-Gasteiz, Spain
| | - Cristina Martinez-Labari
- Studies, Research and Sports Medicine Centre (CEIMD), Government of Navarre, Pamplona, Spain, Pamplona, Spain
| | - Sara Maldonado-Martin
- Department of Physical Education and Sport, Society Sports and Physical Exercise Research Group (GIKAFIT), Department of Physical Education and Sport, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain, Vitoria-Gasteiz, Spain
- Physical Activity, Exercise, and Health group, Bioaraba Health Research Institute, Physical Activity, Exercise, and Health group. Vitoria-Gasteiz, Basque Country, Spain, Vitoria-Gasteiz, Spain
| | - Juan Manuel Murias
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| | - Esteban M Gorostiaga
- Studies, Research and Sports Medicine Centre (CEIMD), Government of Navarre, Pamplona, Spain, Pamplona, Spain
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Huber SK, Manser P, de Bruin ED. PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example. Front Sports Act Living 2024; 6:1397949. [PMID: 38915297 PMCID: PMC11194322 DOI: 10.3389/fspor.2024.1397949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/26/2024] Open
Abstract
Background Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
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Affiliation(s)
- Simone K. Huber
- Physiotherapy and Occupational Therapy Research Centre, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Patrick Manser
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Mitropoulos A, Anifanti M, Koukouvou G, Ntovoli A, Alexandris K, Kouidi E. Exploring the effects of real-time online cardiac telerehabilitation using wearable devices compared to gym-based cardiac exercise in people with a recent myocardial infarction: a randomised controlled trial. Front Cardiovasc Med 2024; 11:1410616. [PMID: 38903965 PMCID: PMC11188591 DOI: 10.3389/fcvm.2024.1410616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Background Exercise-based cardiac rehabilitation (CR) is a non-pharmacological multidisciplinary programme for individuals after myocardial infarction (MI) that offers multiple health benefits. One of the greatest barriers to CR participation is the travel distance to the rehabilitation centre. Remotely monitored CR appears to be at least as effective in improving cardiovascular risk factors and exercise capacity as traditional centre-based CR. Nevertheless, the efficacy of remotely monitored CR in individuals with a recent MI has yet to be examined. Methods A total of 30 individuals (8 women, 22 men) after a recent (i.e., <4 weeks) MI were randomly allocated into two groups (online home-based and gym-based groups). Both groups underwent a 26-week CR programme three times per week. All patients performed baseline and 24-week follow-up measurements where peak oxygen uptake (VO2peak), mean daily steps, distance, and calories were assessed. Results The online group showed an improvement in mean daily steps (p < 0.05) and mean daily distance (p < 0.05) at 24 weeks compared to the gym-based group. The paired-sample t-test showed that all the assessed variables were statistically (p < 0.001) improved for both groups at 24 weeks. Pearson's r demonstrated positive correlations between VO2peak and mean daily distance (r = 0.375), and negative correlations between VO2peak and muscle (r = -0.523) and fat masses (r = -0.460). There were no exercise-induced adverse events during the study. Conclusion Our findings might indicate that a real-time online supervised CR exercise programme using wearable technology to monitor the haemodynamic responses in post-MI patients is equally effective as a gym-based exercise programme.
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Affiliation(s)
- A. Mitropoulos
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Lifestyle, Exercise and Nutritional Improvement (LENI) Research Group, Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | - M. Anifanti
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G. Koukouvou
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A. Ntovoli
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Physical Education, Sports Sciences Frederick University, Nicosia, Cyprus
| | - K. Alexandris
- Laboratory of Management of Sports Recreation and Tourism, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E. Kouidi
- Laboratory of Sport Medicine, Department of Physical Education and Sport Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Piaggi G, Paneroni M, Maestri R, Salvioni E, Corrà U, Caporotondi A, Scalvini S, Agostoni P, La Rovere MT. Estimating maximum work rate during cardiopulmonary exercise testing from the six-minute walk distance in patients with heart failure. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200247. [PMID: 38496329 PMCID: PMC10943044 DOI: 10.1016/j.ijcrp.2024.200247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
Background Exercise is recommended for patients with chronic heart failure (CHF) and its intensity is usually set as a percentage of the maximal work rate (MWR) during cardiopulmonary exercise testing (CPX) or a symptom-limited incremental test (SLIT). As these tests are not always available in cardiac rehabilitation due to logistic/cost constraints, we aimed to develop a predictive model to estimate MWR at CPX (estMWR@CPX) in CHF patients using anthropometric and clinical measures and the 6-min walk test (6 MWT), the most widely used exercise field test. Methods This is a multicentre cross-sectional retrospective study in a cardiac rehabilitation setting. Six hundred patients with HF in New York Heart Association (NYHA) functional class I-III underwent both CPX and 6 MWT and, through multivariable linear regression analysis, we defined several predictive models to define estMWR@CPX. Results The best model included 6 MWT, sex, age, weight, NYHA class, left ventricular ejection fraction (LVEF), smoking status and chronic obstructive pulmonary disease COPD (adjusted R2 = 0.55; 95% LoA -39 to 33 W). When LVEF was excluded as a predictor, the resulting model performed only slightly worse (adjusted R2 = 0.54; 95% LoA -42 to 34 W). Only in 34% of cases was the percentage difference between estMWR@CPX and real MWR@CPX <10% in absolute value. EstMWR@CPX tended to overestimate low values and underestimate high values of true MWR@CPX. Conclusions Our results showed a lack of accuracy in the predictive model evaluated; therefore, for an accurate prescription of cycle-ergometer exercise training, it is necessary to assess MWR by CPX or SLIT.
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Affiliation(s)
- Giancarlo Piaggi
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory and Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Cardio-Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Biomedical Engineering of the Institute of Montescano, Pavia, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Cardiac Rehabilitation of the Institute of Veruno, Novara, Italy
| | - Angelo Caporotondi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Montescano, Pavia, Italy
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Wernhart S, Michel L, Carpinteiro A, Luedike P, Rassaf T. (Non)-Exertional Variables of Cardiopulmonary Exercise Testing in Heart Failure with and Without Cardiac Amyloidosis. Curr Heart Fail Rep 2024; 21:224-237. [PMID: 38635117 PMCID: PMC11090960 DOI: 10.1007/s11897-024-00661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE OF REVIEW Cardiac amyloidosis (CA) constitutes an important etiology of heart failure with preserved ejection fraction (HFpEF) or heart failure with mildly reduced ejection fraction (HFmrEF). Since patients with CA show early exhaustion, we aimed to investigate whether non-exertional variables of cardiopulmonary exercise testing (CPET) provide additional information in comparison to traditional peak oxygen consumption (VO2peak). RECENT FINDINGS We retrospectively investigated CPET variables of patients with HFpEF and HFmrEF with (n = 21) and without (n = 21, HF) CA at comparable age and ejection fraction. Exertional and non-exertional CPET variables as well as laboratory and echocardiographic markers were analyzed. The primary outcome was the difference in CPET variables between groups. The secondary outcome was rehospitalization in patients with CA during a follow-up of 24 months. Correlations between CPET, NTproBNP, and echocardiographic variables were calculated to detect patterns of discrimination between the groups. HF patients with CA were inferior to controls in most exertional and non-exertional CPET variables. Patients with CA were hospitalized more often (p = 0.002), and rehospitalization was associated with VE/VCO2 (p = 0.019), peak oxygen pulse (p = 0.042), the oxygen equivalent at the first ventilatory threshold (p = 0.003), circulatory (p = 0.024), and ventilatory power (p < .001), but not VO2peak (p = 0.127). Higher performance was correlated with lower E/e' and NTproBNP as well as higher resting heart rate and stroke volume in CA. Patients with CA displayed worse non-exertional CPET performance compared to non-CA HF patients, which was associated with rehospitalization. Differences between correlations of resting echocardiography and CPET variables between groups emphasize different properties of exercise physiology despite comparable ejection fraction.
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Affiliation(s)
- Simon Wernhart
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Lars Michel
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alexander Carpinteiro
- Clinic for Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Joaquim A, Amarelo A, Antunes P, Garcia C, Leão I, Vilela E, Teixeira M, Duarte B, Vieira M, Afreixo V, Capela A, Viamonte S, Costa H, Helguero LA, Alves A. Effects of a Physical Exercise Program on Quality of Life and Physical Fitness of Breast Cancer Survivors: the MAMA_MOVE Gaia After Treatment Trial. PSYCHOL HEALTH MED 2024; 29:964-987. [PMID: 37644639 DOI: 10.1080/13548506.2023.2240074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.
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Affiliation(s)
- Ana Joaquim
- Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Anabela Amarelo
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Pedro Antunes
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Beira Interior, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Catarina Garcia
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Inês Leão
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Eduardo Vilela
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Madalena Teixeira
- Cardiology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Bárbara Duarte
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Micael Vieira
- Solinca Classic, SA, SC Fitness, SA, Lisbon, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
| | - Vera Afreixo
- Department of Mathematics; University of Aveiro, Center for Research & Development in Mathematics and Applications (CIDMA), University of Aveiro
| | - Andreia Capela
- Medical Oncology Department; Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Sofia Viamonte
- Department of Medical Sciences, University of Aveiro Centro de Reabilitação Do Norte, Centro Hospitalar Vila Nova de Gaia/Espinho, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO), Portugal
| | - Horácio Costa
- Department of Plastic Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Department of Medical Sciences, University of Aveiro, Portugal
| | - Luisa A Helguero
- Department of Medical Sciences, University of Aveiro, Institute of Biomedicine of Aveiro (IBIMED), University of Aveiro, Aveiro, Portugal
| | - Alberto Alves
- Research Center in Sport Sciences, Health, and Human Development (CIDESD), University of Maia, ONCOMOVE® - Associação de Investigação de Cuidados de Suporte Em Oncologia (AICSO)
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9
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Minardi S, Sciarra L, Robles AG, Scara A, Sciarra F, De Masi De Luca G, Romano S. Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation. Front Pharmacol 2024; 15:1384213. [PMID: 38803430 PMCID: PMC11129016 DOI: 10.3389/fphar.2024.1384213] [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: 02/08/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.
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Affiliation(s)
- Simona Minardi
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Antonio Gianluca Robles
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, L. Bonomo Hospital, Andria, Italy
| | - Antonio Scara
- Department of Cardiology, San Carlo di Nancy-GVM, Rome, Italy
| | | | - Gabriele De Masi De Luca
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Cardiology, Card. G. Panico Hospital, Tricase, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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10
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Buckley JP, Terada T, Lion A, Reed JL. Is breathing frequency a potential means for monitoring exercise intensity in people with atrial fibrillation and coronary heart disease when heart rate is mitigated? Eur J Appl Physiol 2024:10.1007/s00421-024-05487-2. [PMID: 38703192 DOI: 10.1007/s00421-024-05487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Moderate-intensity aerobic exercise is safe and beneficial in atrial fibrillation (AF) and coronary heart disease (CHD). Irregular or rapid heart rates (HR) in AF and other heart conditions create a challenge to using HR to monitor exercise intensity. The purpose of this study was to assess the potential of breathing frequency (BF) to monitor exercise intensity in people with AF and CHD without AF. METHODS This observational study included 30 AF participants (19 Male, 70.7 ± 8.7 yrs) and 67 non-AF CHD participants (38 Male, 56.9 ± 11.4 yrs). All performed an incremental maximal exercise test with pulmonary gas exchange. RESULTS Peak aerobic power in AF ( V ˙ O2peak; 17.8 ± 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p < .001). BF responses in AF and CHD were similar (BF peak: AF 34.6 ± 5.4 and CHD 36.5 ± 5.0 breaths.min-1; p = .106); at the 1st ventilatory threshold (BF@VT-1: AF 23.2 ± 4.6; CHD 22.4 ± 4.6 breaths.min-1; p = .240). % V ˙ O2peak at VT-1 were similar in AF and CHD (AF: 59%; CHD: 57%; p = .656). CONCLUSION With the use of wearable technologies on the rise, that now include BF, this first study provides an encouraging potential for BF to be used in AF and CHD. As the supporting data are based on incremental ramp protocol results, further research is required to assess BF validity to manage exercise intensity during longer bouts of exercise.
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Affiliation(s)
- John P Buckley
- School of Allied Health Professions, Keele University, Staffordshire, ST5 5BG, UK.
| | - Tasuku Terada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Anna Lion
- Rehabilitation Technologies Network+, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Jennifer L Reed
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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11
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Meng Y, Zhang T, Ge X, Zheng Q, Feng T. Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study. BMC Cardiovasc Disord 2024; 24:232. [PMID: 38684960 PMCID: PMC11059695 DOI: 10.1186/s12872-024-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical activity (PA) is essential and effective for chronic heart failure (CHF) patients. A greater understanding of the longitudinal change in PA and its influencing factors during the postdischarge transition period may help create interventions for improving PA. The aims of this study were (1) to compare the change in PA, (2) to examine the influencing factors of PA change, and (3) to verify the mediating pathways between influencing factors and PA during the postdischarge transition period in CHF patients. METHODS A total of 209 CHF patients were recruited using a longitudinal study design. The Chinese version of the International Physical Activity Questionnaire (IPAQ), Patient-reported Outcome Measure for CHF (CHF-PRO), and the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart) were used to assess PA, CHF-related symptoms, and kinesiophobia. The IPAQ score was calculated (1) at admission, (2) two weeks after discharge, (3) two months after discharge, and (4) three months after discharge. Two additional questionnaires were collected during admission. Generalized estimating equation (GEE) models were fitted to identify variables associated with PA over time. We followed the STROBE checklist for reporting the study. RESULTS The PA scores at the four follow-up visits were 1039.50 (346.50-1953.00) (baseline/T1), 630.00 (1.00-1260.00) (T2), 693.00 (1-1323.00) (T3) and 693.00 (160.88-1386.00) (T4). The PA of CHF patients decreased unevenly, with the lowest level occurring two weeks after discharge, and gradually improving at two and three months after discharge. CHF-related symptoms and kinesiophobia were significantly associated with changes in PA over time. Compared with before hospitalization, an increase in CHF-related symptoms at two weeks and two months after discharge was significantly associated with decreased PA. According to our path analysis, CHF-related symptoms were positively and directly associated with kinesiophobia, and kinesiophobia was negatively and directly related to PA. Moreover, CHF-related symptoms are indirectly related to PA through kinesiophobia. CONCLUSION PA changed during the postdischarge transition period and was associated with CHF-related symptoms and kinesiophobia in CHF patients. Reducing CHF-related symptoms helps improve kinesiophobia in CHF patients. In addition, the reduction in CHF-related symptoms led to an increase in PA through the improvement of kinesiophobia. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry (11/10/2022 ChiCTR2200064561 retrospectively registered).
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Affiliation(s)
- Yingtong Meng
- Cardiology Department II ward I, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Tingting Zhang
- Cardiology Department II ward I, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Xiaohua Ge
- Department of Nursing, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China.
| | - Qingru Zheng
- Department of Intensive Care Medicine, The Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, People's Republic of China
| | - Tienan Feng
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
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12
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Panassollo TRB, Lord S, Rashid U, Taylor D, Mawston G. The effect of chronotropic incompetence on physiologic responses during progressive exercise in people with Parkinson's disease. Eur J Appl Physiol 2024:10.1007/s00421-024-05492-5. [PMID: 38683403 DOI: 10.1007/s00421-024-05492-5] [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: 06/30/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Heart rate (HR) response is likely to vary in people with Parkinson's disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription. METHODS Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO2), and changes in HR responses (HR/WR slope) to an increase in exercise demand. RESULTS CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively). CONCLUSION Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.
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Affiliation(s)
| | - Sue Lord
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, 6 Harrison Road, Mount Wellington, 1060, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Grant Mawston
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
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13
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Milani JGPO, Milani M, Machado FVC, Wilhelm M, Marcin T, D'Ascenzi F, Cavigli L, Keytsman C, Falter M, Bonnechere B, Meesen R, Braga F, Cipriano GFB, Cornelissen V, Verboven K, Junior GC, Hansen D. Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation. Eur J Prev Cardiol 2024:zwae149. [PMID: 38636093 DOI: 10.1093/eurjpc/zwae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
AIMS To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains. METHODS Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). RESULTS HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines. CONCLUSION Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.
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Affiliation(s)
- Juliana Goulart Prata Oliveira Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - Mauricio Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Felipe Vilaça Cavallari Machado
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thimo Marcin
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bruno Bonnechere
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, University of Hasselt, Diepenbeek, Belgium
- Centre of expertise in Care Innovation, Department of PXL - Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Raf Meesen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Braga
- Laboratório de Performance Humana, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Graziella França Bernardelli Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Programme, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Kenneth Verboven
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Gerson Cipriano Junior
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Dominique Hansen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
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14
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Do J, Lim WT, Kim DY, Ko EJ, Ko MH, Kim GW, Kim JH, Kim S, Kim H. Effects of high-intensity interval robot-assisted gait training on cardiopulmonary function and walking ability in chronic stroke survivors: A multicenter single-blind randomized controlled trial. J Back Musculoskelet Rehabil 2024:BMR230385. [PMID: 38788059 DOI: 10.3233/bmr-230385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. OBJECTIVE To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. METHODS A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RESULTS RAGT significantly improved VO2max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. CONCLUSION RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation.
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Affiliation(s)
- Junghwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Taek Lim
- Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Korea
| | - Dae Yul Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine of Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea
| | - Geon Woo Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - SooBin Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwal Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Stephan H, Klophaus N, Wehmeier UF, Tomschi F, Hilberg T. Calculation of Oxygen Uptake during Ambulatory Cardiac Rehabilitation. J Clin Med 2024; 13:2235. [PMID: 38673508 PMCID: PMC11050814 DOI: 10.3390/jcm13082235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cardiopulmonary exercise testing is not used routinely. The goal of this study was to determine whether accurate estimates of VO2 values can be made at the beginning and at the end of a rehabilitation program. Methods: A total of 91 cardiac rehabilitation patients were included. Each participant had to complete cardiopulmonary exercise testing at the beginning and at the end of a rehabilitation program. Measured VO2 values were compared with estimates based on three different equations. Results: Analyses of the means of the differences in the peak values showed very good agreement between the results obtained with the FRIEND equation or those obtained with a combination of rules of thumb and the results of the measurements. This agreement was confirmed with the ICCs and with the standard errors of the measurements. The ACSM equation performed worse. The same tendency was seen when considering the VO2 values at percentage-derived work rates. Conclusions: The FRIEND equation and the more easily applicable combination of rules of thumb are suitable for estimating the peak VO2 and the VO2 at a percentage-derived work rate in cardiac patients both at the beginning and at the end of a cardiac rehabilitation program.
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Affiliation(s)
| | | | | | | | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Moritzstraße 14, 42117 Wuppertal, Germany
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16
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Marinus N, Cornelissen V, Meesen R, Coninx K, Hansen D. Are exercise prescriptions for patients with cardiovascular disease, made by physiotherapists, in agreement with European recommendations? Eur J Cardiovasc Nurs 2024; 23:230-240. [PMID: 37439451 DOI: 10.1093/eurjcn/zvad065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
AIMS Physiotherapists often treat patients with (elevated risk for) cardiovascular disease (CVD), and should thus be able to provide evidence-based exercise advice to these patients. This study, therefore, aims to examine whether exercise prescriptions by physiotherapists to patients with CVD are in accordance with European recommendations. METHODS AND RESULTS This prospective observational survey included forty-seven Belgian physiotherapists. The participants agreed to prescribe exercise intensity, frequency, session duration, program duration, and exercise type (endurance or strength training) for the same three patient cases. Exercise prescriptions were compared between physiotherapists and relations with their characteristics were studied. The agreement between physiotherapists' exercise prescriptions and those from European recommendations ('agreement score': based on a maximal score of 60/per case) was assessed. A wide inter-clinician variability was noticed for all exercise modalities, leading to a large variance for total peak-effort training minutes (from 461 up to 9000 over the three cases). The exercise frequency was prescribed fully out of range of the recommendations and the prescription of additional exercise modes was generally flawed. Exercise intensity and program duration were prescribed partially correct. The addition of strength exercises and session duration was prescribed correctly. This led to physiotherapist agreement scores of 25.3 ± 9.6, 23.2 ± 9.9, and 27.1 ± 10.6 (all out of 60), for cases one, two, and three, respectively. A greater agreement score was found in younger colleagues and those holding a Ph.D. CONCLUSION Exercise prescriptions for CVD patients vary widely among physiotherapists and often disagree with European recommendations. REGISTRATION ClinicalTrials.gov NCT05449652.
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Affiliation(s)
- Nastasia Marinus
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, 3000 Leuven, Belgium
| | - Raf Meesen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
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Dores H, Mendes M, Abreu A, Durazzo A, Rodrigues C, Vilela E, Cunha G, Gomes Pereira J, Bento L, Moreno L, Dinis P, Amorim S, Clemente S, Santos M. Cardiopulmonary exercise testing in clinical practice: Principles, applications, and basic interpretation. Rev Port Cardiol 2024:S0870-2551(24)00078-7. [PMID: 38583860 DOI: 10.1016/j.repc.2024.01.005] [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: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024] Open
Abstract
Cardiopulmonary exercise testing (CPET) provides a noninvasive and integrated assessment of the response of the respiratory, cardiovascular, and musculoskeletal systems to exercise. This information improves the diagnosis, risk stratification, and therapeutic management of several clinical conditions. Additionally, CPET is the gold standard test for cardiorespiratory fitness quantification and exercise prescription, both in patients with cardiopulmonary disease undergoing cardiac or pulmonary rehabilitation programs and in healthy individuals, such as high-level athletes. In this setting, the relevance of practical knowledge about this exam is useful and of interest to several medical specialties other than cardiology. However, despite its multiple established advantages, CPET remains underused. This article aims to increase awareness of the value of CPET in clinical practice and to inform clinicians about its main indications, applications, and basic interpretation.
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Affiliation(s)
- Hélder Dores
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal; CHRC, NOVA Medical School, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
| | - Miguel Mendes
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Abreu
- Cardiovascular Rehabilitation Center, Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, CHULN/Faculdade de Medicina da Universidade de Lisboa, FMUL/CRECUL, Lisbon, Portugal; Ergometry Department, Department of Cardiology, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Saúde Ambiental, ISAMB, FMUL/Laboratório Associado Terra, Lisbon, Portugal; Instituto de Medicina Preventiva e Saúde Pública, IMPSP, FMUL, Lisbon, Portugal; Instituto de Medicina Nuclear, IMN, FMUL, Lisbon, Portugal; Cardiovascular Center, Universidade de Lisboa, CCUL, Centro Académico de Medicina da Universidade de Lisboa, CAML, Lisbon, Portugal
| | - Anaí Durazzo
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Cidália Rodrigues
- Department of Pulmonology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo Vilela
- Department of Cardiology, Unidade Local de Saúde Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Gonçalo Cunha
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - José Gomes Pereira
- Faculdade de Motricidade Humana, Universidade de Lisboa, Oeiras, Portugal; Comité Olímpico de Portugal, Lisbon, Portugal; Desporsano - Sports Clinic, Lisbon, Portugal
| | | | - Luís Moreno
- Regimento de Comandos, Exército Português, Belas, Portugal; Hospital CUF Tejo, Lisbon, Portugal
| | - Paulo Dinis
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centro de Saúde Militar de Coimbra, Exército Português, Coimbra, Portugal
| | - Sandra Amorim
- Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Susana Clemente
- Department of Pulmonology, Hospital da Luz, Lisbon, Portugal; Department of Pulmonology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Mário Santos
- Department of Cardiology, Pulmonary Vascular Disease Unit, Centro Hospitalar Universitário de Santo António, Porto, Portugal; CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Porto, Portugal; Department of Immuno-Physiology and Pharmacology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, Universidade do Porto, Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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Gomes-Neto M, Durães AR, Conceição LSR, Saquetto MB, Alves IG, Smart NA, Carvalho VO. Some types of exercise interventions are more effective than others in people with coronary heart disease: systematic review and network meta-analysis. J Physiother 2024; 70:106-114. [PMID: 38503676 DOI: 10.1016/j.jphys.2024.02.018] [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: 04/18/2023] [Revised: 05/22/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
QUESTION What are the effects of different types of exercise treatments on oxygen consumption, quality of life and mortality in people with coronary heart disease? DESIGN Systematic review with network meta-analysis of randomised controlled trials. PARTICIPANTS Adults with coronary heart disease. INTERVENTION Exercise interventions including aerobic (continuous or high-intensity interval) training, resistance training, respiratory muscle exercises, water-based exercises, yoga, Tai chi, Qigong exercises and a combination of different types of exercise. OUTCOME MEASURES Oxygen consumption, quality of life and mortality. RESULTS This review included 178 randomised controlled trials with 19,143 participants. Several exercise interventions improved peak oxygen consumption (mL/kg/min): high-intensity interval training (MD 4.5, 95% CI 3.7 to 5.4); combined water-based exercises and moderate-intensity continuous training (MD 3.7, 95% CI 1.3 to 6.0); combined aerobic and resistance exercise (MD 3.4, 95% CI 2.5 to 4.3); water-based exercises (MD 3.4, 95% CI 0.6 to 6.2); combined respiratory muscle training and aerobic exercise (MD 3.2, 95% CI 0.6 to 5.8); Tai chi (MD 3.0, 95% CI 1.0 to 5.0); moderate-intensity continuous training (MD 3.0, 95% CI 2.3 to 3.6); high-intensity continuous training (MD 2.7, 95% CI 1.6 to 3.8); and resistance training (MD 2.2, 95% CI 0.6 to 3.7). Quality of life was improved by yoga (SMD 1.5, 95% CI 0.5 to 2.4), combined aerobic and resistance exercise (SMD 1.2, 95% CI 0.6 to 1.7), moderate-intensity continuous training (SMD 1.1, 95% CI 0.6 to 1.6) and high-intensity interval training (SMD 0.9, 95% CI 0.1 to 1.6). All-cause mortality was reduced by continuous aerobic exercise (RR 0.67, 95% CI 0.53 to 0.86) and combined aerobic and resistance exercise (RR 0.58, 95% CI 0.36 to 0.94). Continuous aerobic exercise also reduced cardiovascular mortality (RR 0.56, 95% CI 0.42 to 0.74). CONCLUSION People with coronary heart disease may use a range of exercise modalities to improve oxygen consumption, quality of life and mortality. REGISTRATION PROSPERO CRD42022344545.
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Affiliation(s)
- Mansueto Gomes-Neto
- Postgraduate Program in Health Science, Federal University of Sergipe, Aracaju, Brazil; Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
| | - Andre Rodrigues Durães
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | | | | | - Iura Gonzalez Alves
- Department of Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Neil A Smart
- Department of Exercise and Sports Science, University of New England, Armidale, Australia
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Alves da Cruz M, Laurino M, Christofaro D, Ghisi G, Vanderlei L. Long-term effects of virtual reality-based therapy in cardiovascular rehabilitation: A longitudinal study. Physiother Theory Pract 2024; 40:727-735. [PMID: 36567613 DOI: 10.1080/09593985.2022.2160222] [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: 09/10/2021] [Revised: 10/12/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In Cardiovascular Rehabilitation (CR), patient adherence to the maintenance phase is a major challenge. Virtual reality-based therapy (VRBT) promotes acute hemodynamic and autonomic repercussions similar to traditional rehabilitation and can increase patient adherence to the program. However, it is unknown whether the combination of VRBT to a traditional CR manages to maintain or even improve clinical and autonomic variables in long term. OBJECTIVE To analyze whether VRBT combination in a traditional CR can maintain or improve clinical and autonomic variables in cardiac patients in the maintenance phase of these programs. METHODS Twenty-six volunteers (62.04 ± 12.22 years) were evaluated, who underwent an initial assessment and two other assessments (in the sixth and 12th week) of the following outcomes: systolic and diastolic blood pressure, respiratory rate, pulse saturation of oxygen, heart rate, perceived exertion, and cardiac autonomic modulation, using linear and non-linear heart rate variability methods. RESULTS Except for the apparent lack of clinical significance observed in Shannon Entropy, LF (nu), and HF (nu), the combination of VRBT as routine in a traditional program did not cause significant changes in the analyzed variables. CONCLUSION combination of VRBT was able to maintain the chronic hemodynamic and autonomic repercussions caused by traditional CR.
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Affiliation(s)
- Mayara Alves da Cruz
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Pres. Prudente 19060-900, Brazil
| | - Maria Laurino
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Pres. Prudente 19060-900, Brazil
| | - Diego Christofaro
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Pres. Prudente 19060-900, Brazil
| | - Gabriela Ghisi
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON M4G2V7, Canada
| | - Luiz Vanderlei
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, Pres. Prudente 19060-900, Brazil
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Moncion K, Rodrigues L, Wiley E, Noguchi KS, Negm A, Richardson J, MacDonald MJ, Roig M, Tang A. Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis. Br J Sports Med 2024; 58:392-400. [PMID: 38413134 DOI: 10.1136/bjsports-2023-107956] [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] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O2peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023. ELIGIBILITY CRITERIA Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke. ANALYSES Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed. RESULTS There were 28 studies (n=1298) included in the NMA for V̇O2peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O2peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O2peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care. CONCLUSION This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ahmed Negm
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Jane MacDonald
- Department of Kinesiology, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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21
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Sempere-Ruiz N, Sarabia JM, Baladzhaeva S, Moya-Ramón M. Reliability and validity of a non-linear index of heart rate variability to determine intensity thresholds. Front Physiol 2024; 15:1329360. [PMID: 38375458 PMCID: PMC10875128 DOI: 10.3389/fphys.2024.1329360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Exercise intensity distribution is crucial for exercise individualization, prescription, and monitoring. As traditional methods to determine intensity thresholds present limitations, heart rate variability (HRV) using DFA a1 has been proposed as a biomarker for exercise intensity distribution. This index has been associated with ventilatory and lactate thresholds in previous literature. This study aims to assess DFA a1's reliability and validity in determining intensity thresholds during an incremental cycling test in untrained healthy adults. Sixteen volunteers (13 males and 3 females) performed two identical incremental cycling stage tests at least 1 week apart. First and second ventilatory thresholds, lactate thresholds, and HRV thresholds (DFA a1 values of 0.75 and 0.5 for HRVT1 and HRVT2, respectively) were determined in heart rate (HR), relative oxygen uptake (VO2rel), and power output (PO) values for both tests. We used intraclass correlation coefficient (ICC), change in mean, and typical error for the reliability analysis, and paired t-tests, correlation coefficients, ICC, and Bland-Altman analysis to assess the agreement between methods. Regarding reliability, HRV thresholds showed the best ICCs when measured in PO (HRVT1: ICC = .87; HRVT2: ICC = .97), comparable to ventilatory and lactate methods. HRVT1 showed the strongest agreement with LA 2.5 in PO (p = 0.09, r = .93, ICC = .93, bias = 9.9 ± 21.1), while HRVT2 reported it with VT2 in PO (p = 0.367, r = .92, ICC = .92, bias = 5.3 ± 21.9). DFA a1 method using 0.75 and 0.5 values is reliable and valid to determine HRV thresholds in this population, especially in PO values.
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Affiliation(s)
- Noemí Sempere-Ruiz
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Manuel Sarabia
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sabina Baladzhaeva
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Manuel Moya-Ramón
- Department of Sport Sciences, Sport Research Centre, Miguel Hernandez University, Elche, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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22
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Košuta D, Novaković M, Božič Mijovski M, Jug B. Acute effects of high intensity interval training versus moderate intensity continuous training on haemostasis in patients with coronary artery disease. Sci Rep 2024; 14:1963. [PMID: 38263210 PMCID: PMC10806221 DOI: 10.1038/s41598-024-52521-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024] Open
Abstract
Exercise training is associated with an acute net increase in coagulation, which may increase the risk of atherothrombosis in coronary artery disease (CAD) patients. We sought to compare the acute haemostatic effects of a bout of moderate-intensity continuous (MICT) and high-intensity interval training (HIIT) in patients with CAD. Patients after a recent myocardial infarction were randomized into a HIIT or MICT session of exercise training on a stationary bike. Blood was sampled at baseline, after the exercise bout and after a one-hour resting period. We measured overall haemostatic potential (OHP), overall coagulation potential (OCP), fibrinogen, D-dimer and von Willebrand factor (vWF) and calculated overall fibrinolytic potential (OFP). Linear mixed models for repeated measures were constructed to assess the treatment effect. A total of 117 patients were included. OCP, OHP, fibrinogen, D-dimer and vWF significantly increased after exercise and returned to baseline after a one-hour rest, OFP decreased after exercise and returned to baseline levels after a one-hour rest. Linear mixed models showed a significant difference between HIIT and MICT in fibrinogen (p 0.043) and D-dimer (p 0.042). Our study has shown that an exercise bout is associated with a transient procoagulant state in patients with CAD, with similar exercise-induced haemostatic changes for HIIT and MICT.
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Affiliation(s)
- Daniel Košuta
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia.
| | - Marko Novaković
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia
| | - Mojca Božič Mijovski
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška Cesta 7, 1000, Ljubljana, Slovenia
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23
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Brouwers RWM, Scherrenberg M, Kemps HMC, Dendale P, Snoek JA. Cardiac telerehabilitation: current status and future perspectives. Neth Heart J 2024; 32:31-37. [PMID: 38085505 PMCID: PMC10781917 DOI: 10.1007/s12471-023-01833-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 01/04/2024] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede participation in CR and to improve the effectiveness of CR, cardiac telerehabilitation (CTR) has emerged as a cost-effective alternative to traditional, centre-based CR. Although the body of evidence for the feasibility and effectiveness of CTR is large and still growing, real-life implementations are scarce, which may be due to insufficient knowledge about CTR interventions and due to the challenges its implementation comes with. Up to now, mainly exercise-related core components of CR and e‑coaching have been investigated in the setting of CTR. Translation of research findings to clinical practice may be hampered by methodological limitations present in most CTR studies, being selection bias of participants, lack of long-term follow-up, heterogeneity of studied interventions and the lack of robust outcome measures. Besides conducting highly needed implementation studies for CTR interventions, their implementation could be facilitated by the development of guideline-based, multidisciplinary and personalised CTR programmes and widespread reimbursement for CTR.
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Affiliation(s)
- Rutger W M Brouwers
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands.
- Heart Centre, Catharina Hospital, Eindhoven, The Netherlands.
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hareld M C Kemps
- Department of Cardiology, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Johan A Snoek
- Isala Heart Centre, Zwolle, The Netherlands
- Sports Medicine Department, Isala, Zwolle, The Netherlands
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Miyasato RS, Felix AJ, Andrade-Lima A, Silva Júnior NDD, Ritti-Dias RM, Wolosker N, Cornelissen V, Goessler KF, Forjaz CLDM. Physiological responses during walking in men and women with intermittent claudication. EINSTEIN-SAO PAULO 2023; 21:eAO0120. [PMID: 38126545 DOI: 10.31744/einstein_journal/2023ao0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/16/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Miyasato et al. show that peak oxygen consumption, walking economy, anaerobic threshold, and cardiovascular responses (heart rate, blood pressure, and rate pressure product) during walking were similar between men and women with peripheral artery disease and intermittent claudication. There were no differences in the physiological responses to walking between men and women with intermittent claudication. Sex per se is not a factor that demands changes in walking prescription for patients with intermittent claudication. OBJECTIVE Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. METHODS Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. RESULTS There were no significant differences between men and women (VO2peak: 15.0±4.8 versus 13.9±2.9mL∙kg-1∙min-1, p=0.38; walking economy: 9.6±2.7 versus 8.4±1.6mL∙kg-1∙min-1, p=0.09; anaerobic threshold: 10.5±3.2 versus 10.5±2.2mL∙kg-1∙min-1, p=0.98; rate pressure product at 1st stage: 13,465± 2,910 versus 14,445±4,379bpm∙mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673±3,100 versus 16,390±5,870bpm∙mmHg, p=0.08 and rate pressure product at peak exercise: 21,253±6,141 versus 21,923±7,414bpm∙mmHg, p=0.76, respectively). CONCLUSION Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.
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Affiliation(s)
- Roberto Sanches Miyasato
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alex Jesus Felix
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Aluísio Andrade-Lima
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
- Postgraduate Program in Physical Education, Universidade Federal de Sergipe, São Cristóvão, SE, Brazil
| | - Natan Daniel da Silva Júnior
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Nelson Wolosker
- Vascular Unit, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | - Claúdia Lúcia de Moraes Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, SP, Brazil
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Røysland IØ, Ueland VI, Larsen AI. Reassured on a background of vulnerability - people with microvascular angina 12 months after high-intensity physical exercise program. Int J Qual Stud Health Well-being 2023; 18:2162452. [PMID: 36578152 PMCID: PMC9809340 DOI: 10.1080/17482631.2022.2162452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Physical activity is recommended for patients with coronary microvascular dysfunction, however, avoided due to fear about the heart. The aim is to achieve an understanding of the meaning of physical activity one year after participating in a high-intensity exercise training program. METHOD Twelve people were interviewed using a phenomenological hermeneutic approach. RESULTS Four themes were formulated and revealed that one year after participating in high-intensity exercise training participants had an awareness of the meaning of the project, their chest pain and daily life: Being reassured, Daily life's impact on chest pain and continuing doing high-intensity exercise training, A strengthened body and mind, Being part of a group of people with similar problems.Comprehensive understanding was formulated as "Being reassured according being physically active in a background of vulnerability". CONCLUSION This study indicates that by going through the high-intensity exercise training program the person regains more unity with the lived body and an unfolding life. A person-centred approach is suggested including an underlying dimension of vulnerability. A lifeworld led care means meeting the patient in their way of relating to the world bodily and existentially. Taking this understanding into consideration will advance the requirements for establishing person-centred care.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway,CONTACT Ingrid Ølfarnes Røysland Department of Health Studies, Faculty of Health Sciences, University of Stavanger, StavangerN-4036, Norway
| | - Venke Irene Ueland
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Ruiz-Rios M, Lekue A, Pinedo-López J, Tous-Espelosin M, Arratibel-Imaz I, García-Tabar I, Maldonado-Martin S. Supervised multicomponent exercise as an adjuvant program for people with unilateral and/or bilateral chronic vestibular hypofunction: EXERVEST study protocol. Contemp Clin Trials Commun 2023; 36:101213. [PMID: 37868660 PMCID: PMC10589776 DOI: 10.1016/j.conctc.2023.101213] [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: 05/04/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
Background Unilateral and bilateral peripheral vestibular hypofunction (UVH and BVH) often complains of dizziness, gaze, and balance disturbances. There is a lack of evidence on exercise intervention in UVH and BVH patients. To investigate the effect of an eight-week supervised multicomponent exercise program in people suffering from UVH or BVH in comparison with a control group doing conventional vestibular rehabilitation at home. Methods This longitudinal, controlled, randomized, prospective, single-blinded, two-arm, parallel intervention study will include 66 adults (≥18 years old) with chronic UVH or BVH. Participants will be randomly assigned to an exercise intervention group or an attention control group. Participants will be assessed at baseline, after a two-month intervention period, and after a six-month follow-up. The primary variable will be the balance, measured by the dynamic posturography sensory organization test and the Modified Dynamic Gait Index test. Secondary outcome variables will include cardiorespiratory fitness (peak cardiopulmonary exercise test), body composition (bioimpedance and anthropometric variables), physical activity level and sleep quality (accelerometry), health-related quality of life (Dizziness Handicap Inventory questionnaire), emotional state (Beck Depression and Anxiety Inventory questionnaires), and blood pressure monitoring. Discussion This study will try to answer whether in people with UVH/BVH, an adjuvant program of multicomponent exercise will help the prognosis of this population. Trial registration ClinicalTrials.gov, identifier [NCT05192564]. Verification date: April 2023.
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Affiliation(s)
- Maitane Ruiz-Rios
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
- Bioaraba Health Research Institute, Physical Activity, Exercise, and Health Group, Vitoria-Gasteiz, Basque Country, Spain
| | - Asier Lekue
- Department of Otolaryngology, Araba University Hospital, OSIARABA, Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
| | - Jon Pinedo-López
- Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
| | - Mikel Tous-Espelosin
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
- Bioaraba Health Research Institute, Physical Activity, Exercise, and Health Group, Vitoria-Gasteiz, Basque Country, Spain
| | - Iñaki Arratibel-Imaz
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
- Bioaraba Health Research Institute, Physical Activity, Exercise, and Health Group, Vitoria-Gasteiz, Basque Country, Spain
| | - Ibai García-Tabar
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
- Bioaraba Health Research Institute, Physical Activity, Exercise, and Health Group, Vitoria-Gasteiz, Basque Country, Spain
| | - Sara Maldonado-Martin
- GIzartea, Kirola eta Ariketa Fisikoa Ikerkuntza Taldea (GIKAFIT), Society, Sports, and Exercise Research Group, Department of Physical Education and Sport, Faculty of Education and Sport-Physical Activity and Sport Sciences Section, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Araba/Álava, Basque Country, Spain
- Bioaraba Health Research Institute, Physical Activity, Exercise, and Health Group, Vitoria-Gasteiz, Basque Country, Spain
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Spence C, Khoo N, Mackie A, Conway J, Rowland S, Foshaug R, Boulanger P, Spence JC, Stickland MK, Khoury M. Exploring the Promise of Telemedicine Exercise Interventions in Children and Adolescents With Congenital Heart Disease. Can J Cardiol 2023; 39:S346-S358. [PMID: 37657493 DOI: 10.1016/j.cjca.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/03/2023] Open
Abstract
Youth with congenital heart disease (CHD) have reduced exercise capacity via various physical and psychosocial mechanisms. In addition to limited physiologic exercise capacity, these patients experience lower levels of physical activity, physical activity self-efficacy, health-related quality of life, and endothelial function. The study of exercise interventions and cardiac rehabilitation programs in pediatric CHD populations remains limited, particularly home-based interventions that incorporate real-time physiologic monitoring. Home-based interventions provide improved access and convenience to patients. This is principally important for patients from geographically disperse regions who receive their care at centralized subspecialty centres, as is the case for Canadian pediatric cardiac care. These programs, however, have traditionally not permitted the supervision of safety, technique, and adherence that are afforded by hospital/facility-based programs. As such, telemedicine is an important evolving area that combines the benefits of traditional home and facility-based cardiac rehabilitation. An additional key area lacking study surrounds the types of exercise interventions in youth with CHD. To date, interventions have often centred around moderate-intensity continuous exercise. High-intensity interval training might offer superior cardiorespiratory advantages but remains understudied in the CHD population. In this review, we highlight the existing evidence basis for exercise interventions in youth with CHD, explore the promise of incorporating telemedicine home-based solutions, and highlight key knowledge gaps. To address identified knowledge gaps, we are undertaking a 12-week randomized crossover trial of a home-based telemedicine high-intensity interval training intervention in youth with repaired moderate-severe CHD using a video game-linked cycle ergometer (known as the MedBIKE; https://spaces.facsci.ualberta.ca/ahci/projects/medical-projects/remote-rehab-bike-projects).
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Affiliation(s)
- Christopher Spence
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Nee Khoo
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Mackie
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samira Rowland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Boulanger
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - John C Spence
- Sedentary Living Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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Puri SN, Lalwani L. A Comparison Between Cardiac Telerehabilitation Program and Outpatient Hospital-Based Cardiac Rehabilitation Program for Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Review. Cureus 2023; 15:e48488. [PMID: 38073989 PMCID: PMC10704402 DOI: 10.7759/cureus.48488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/08/2023] [Indexed: 06/09/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent and possibly fatal cardiovascular ailment, and it is treated surgically by coronary artery bypass grafting (CABG). The coronary arteries, which supply the heart with oxygen and nutrients, are the most commonly affected. Even though CABG is a frequently employed procedure to restore cardiac blood flow, prolonged rehabilitation is necessary for long-term success. For patients with heart disease, cardiac rehabilitation (CR) involves a comprehensive therapeutic approach. It consists of risk mitigation, regular exercise, health education, and efficient stress management. Information and communication technology is used in telerehabilitation (TR), a rehabilitation service that offers a flexible choice that improves self-management. This study examined novel approaches and effective intervention elements while comparing cardiac TR with center-based programs in terms of risk factor management, patient commitment, and satisfaction.
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Affiliation(s)
- Saurabh N Puri
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
| | - Lajwanti Lalwani
- Department of Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education And Research (DU), Wardha, IND
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Zhang J, Tam WWS, Hounsri K, Kusuyama J, Wu VX. Effectiveness of Combined Aerobic and Resistance Exercise on Cognition, Metabolic Health, Physical Function, and Health-related Quality of Life in Middle-aged and Older Adults With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023:S0003-9993(23)00591-9. [PMID: 37875170 DOI: 10.1016/j.apmr.2023.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/02/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of combined aerobic and resistance exercise on cognition, metabolic health, physical function, and health-related quality of life (HRQoL) in middle-aged and older adults with type 2 diabetes mellitus (T2DM). DATA SOURCE AND STUDY SELECTION Systematic search of CINAHL, Cochrane, EMBASE, Scopus, PubMed, ProQuest Dissertation and Thesis, PsycINFO, Web of Science databases, and gray literature from Google Scholar. Pertinent randomized controlled trials (RCTs) were selected. The Protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023387336). DATA EXTRACTION The risk of bias was evaluated using the Cochrane Risk of Bias tool by 2 reviewers independently. Outcome data were extracted in a fixed-effect model if heterogeneity test were not significant and I2≤50%; otherwise, the random-effects model was used. DATA SYNTHESIS Sixteen studies with 2426 participants were included in this review. Combined aerobic and resistance exercise had significant positive effects on cognition (SMD=0.34, 95% CI: 0.13 to 0.55), metabolic health on HbA1c (SMD=-0.35, 95% CI: -0.48 to -0.22) and lipid profile (total cholesterol SMD=-0.20, 95% CI: -0.34 to -0.07; low-density lipoprotein SMD=-0.19, 95% CI: -0.33 to -0.05; high-density lipoprotein SMD=0.25, 95% CI: 0.12 to 0.39; and triglycerides SMD=-0.18, 95% CI: -0.31 to -0.04), physical function on aerobic oxygen uptake (SMD=0.58, 95% CI: 0.21 to 0.95) and body mass index (MD=-1.33, 95% CI: -1.84 to -0.82), and physical HRQoL (MD=4.17, 95% CI: 0.86 to 7.48). Our results showed that clinically important effects on cognition may occur in combining the low-moderate intensity of aerobic exercise and progressive intensity of resistance training, the total duration of the exercise needs to be at least 135 minutes per week, among which, resistance training should be at least 60 minutes. CONCLUSION Combined aerobic and resistance exercise effectively improves cognition, ameliorates metabolic health, enhances physical function, and increases physical HRQoL in middle-aged and older adults with T2DM. More RCTs and longitudinal follow-ups are required to provide future evidence of structured combined aerobic and resistance exercise on other domains of cognition.
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Affiliation(s)
- Jinghua Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Kanokwan Hounsri
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Joji Kusuyama
- Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore; NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore.
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Rizvi MR, Sharma A, Malki A, Sami W. Enhancing Cardiovascular Health and Functional Recovery in Stroke Survivors: A Randomized Controlled Trial of Stroke-Specific and Cardiac Rehabilitation Protocols for Optimized Rehabilitation. J Clin Med 2023; 12:6589. [PMID: 37892727 PMCID: PMC10607659 DOI: 10.3390/jcm12206589] [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: 09/23/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Stroke is a major contributor to disability and mortality globally. It leads to physical impairments, including weakness and cardiovascular deconditioning, posing significant challenges to stroke survivors' quality of life. Exercise-based cardiac rehabilitation has shown promise as a rehabilitation strategy. This study aims to assess and compare the impacts of stroke-specific rehabilitation and individualized cardiac rehabilitation exercises on various health parameters in stroke patients. METHODS A randomized controlled trial was conducted, involving 38 stroke patients aged 40-75 years. Group A received stroke-specific rehabilitation, which consisted of a combination of range of motion exercises, strength training for the paralyzed side, balance and coordination training, gait training, functional mobility exercises, neuromuscular reeducation, and breathing exercises. This program was conducted five days per week for 12 weeks. Group B received individually designed cardiac rehabilitation exercises, in addition to stroke-specific rehabilitation. They engaged in this exercise for at least 30-45 min per day, four days per week, and incorporated two days of resistive training over a 12-week period. Baseline and post-intervention assessments included measures of cardiac autonomic function, balance (Berg Balance Scale), mobility (Timed Up and Go Test), cardiovascular fitness indicators, respiratory parameters, exercise efficiency, and perceived exertion. RESULTS Group B receiving individualized cardio rehab showed significant improvements in balance and mobility compared to Group A receiving conventional stroke-specific rehab. Moreover, Group B exhibited enhanced cardiovascular fitness, respiratory performance, exercise efficiency, and autonomic function post-intervention. Notably, Group A displayed no significant improvements in these parameters. CONCLUSIONS Individualized cardiac rehabilitation exercises demonstrated favorable outcomes in improving certain health parameters, highlighting the potential benefits of individualized rehabilitation strategies for stroke patients.
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Affiliation(s)
- Moattar Raza Rizvi
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad 121001, India; (M.R.R.); (A.S.)
| | - Ankita Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad 121001, India; (M.R.R.); (A.S.)
| | - Ahmed Malki
- Department of Biomedical Sciences, College of Health Sciences, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Waqas Sami
- Department of Pre-Clinical Affairs, College of Nursing, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
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Gaskill SE, Skinner JS, Quindry J. Ventilatory Threshold Related to V̇O 2 reserve, Heart Rate Reserve, and Rating of Perceived Exertion in a Large Varied Sample. Med Sci Sports Exerc 2023; 55:1876-1885. [PMID: 37202881 PMCID: PMC10524184 DOI: 10.1249/mss.0000000000003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE ACSM guidelines state that aerobic exercise intensity should be 30%/40% to 89% V̇O 2 reserve (V̇O 2 R) or heart rate reserve (HRR). Determining the proper intensity within this range is the "art" of exercise prescription, often relying on rating of perceived exertion (RPE) as the adjunctive intensity modulator. Current guidelines do not consider the use of ventilatory threshold (VT) due to the need for specialized equipment and methodological issues. The purpose of this investigation was to evaluate VT related to V̇O 2peak , V̇O 2 R, HRR, and RPE across the full spectrum of very low to very high V̇O 2peak values. METHODS Eight hundred and sixty-three records of exercise tests were retrospectively examined. Data were stratified for V̇O 2peak , activity level, age, test modality, and sex. RESULTS When stratified for V̇O 2peak , V̇O 2 at VT (V̇O 2 vt) had a lower mean value of ~14 mL·kg -1 ·min -1 in the lowest fit, rose gradually until median V̇O 2peak , and rose steeply thereafter. When graphed relative to V̇O 2peak , V̇O 2 vt as a percentage of V̇O 2 R (VT%V̇O 2 R) resembled a U-shaped curve, with a nadir ~43% V̇O 2 R at V̇O 2peak ~40 mL·kg -1 ·min -1 . Average VT%V̇O 2 R increased to ~75% in groups with the lowest or highest V̇O 2peak . There was a large variance in the value of VT at all V̇O 2peak levels. Mean RPE at VT was 12.5 ± 0.93, regardless of V̇O 2peak . CONCLUSIONS Given the relationship of VT as the transition from moderate- to higher-intensity exercise, these data may help the understanding of aerobic exercise prescription in persons across the spectrum of V̇O 2peak values.
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Affiliation(s)
- Steven E. Gaskill
- University of Montana, Integrative Physiology and Athletic Training, Missoula, MT
| | | | - John Quindry
- University of Montana, Integrative Physiology and Athletic Training, Missoula, MT
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Carl DL, Whitesel D, Meyrose C, Westover J, Khoury J, Gerson M, Kissela B, Dunning K, Boyne P. A 3-minute recumbent stepper test in chronic stroke. PM R 2023; 15:1258-1265. [PMID: 36580538 PMCID: PMC10307922 DOI: 10.1002/pmrj.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Persons with stroke often have difficulty achieving target heart rate (HR) during graded exercise testing (GXT), which is known to limit test sensitivity for detecting clinically relevant cardiac conditions. A novel Recumbent Stepper 3-minute (RS 3Min) "all out" test may increase sensitivity of stress testing after stroke. OBJECTIVE To determine the feasibility of adding the RS 3Min test after GXT among persons after stroke. DESIGN A within-participant, nonrandomized, repeated measures design. SETTING Rehabilitation research laboratory and cardiovascular stress laboratory PARTICIPANTS: Fifteen participants with chronic stroke (56.7 ± 9.6 years; 6.4 ± 4.3 years post stroke; 8 male). INTERVENTIONS All participants randomly completed (1) a symptom-limited treadmill GXT and (2) a symptom-limited RS GXT followed by RS 3Min critical power test. MAIN OUTCOME MEASURES HR, ratings of perceived exertion, oxygen consumption, respiratory exchange ratio, and power output measured continuously during each test. Blood pressure measured every 2 minutes and or immediately post exercise. P value set at p < .05 from omnibus test for a significant difference among protocols. RESULTS The RS 3Min test had a significantly higher rate of achieving target HR compared to the RS GXT (9/14 vs 4/14, p = .02) and was not significantly different from the treadmill GXT (9/14 vs 5/14, p = .09). Minimum power output during the RS 3Min was significantly higher than peak power output during the RS GXT (110 ± 41 W vs. 84 ± 22 W, p = .02) with 12/15 participants reaching a VO2 plateau. CONCLUSIONS Although additional studies with randomized designs are needed, a novel RS 3Min "all out" test appears to be a promising method for enhancing test sensitivity in cardiovascular screening after stroke, while providing a potentially valid measure of critical power.
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Affiliation(s)
- Daniel L Carl
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Colleen Meyrose
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jennifer Westover
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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Røysland IØ. Moving from one state to another among patients experiencing unexplained chest pain during physical activity: A secondary qualitative analysis by Meleis transition theory. Scand J Caring Sci 2023; 37:851-861. [PMID: 36808758 DOI: 10.1111/scs.13153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/20/2022] [Accepted: 01/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Unexplained chest pain is a common condition in medical settings. Nurses usually coordinate the rehabilitation of patients. Physical activity is recommended; however, it is one of the major avoidance behaviours in patients with coronary heart disease. There is a need for a deeper understanding of the transition that patients with unexplained chest pain undergo during physical activity. AIM To develop deeper understanding about experiences of transition in patients with unexplained chest pain during physical activity. DESIGN Secondary qualitative analysis of data from three exploratory studies. METHOD Meleis et al.'s transition theory was used as a framework for the secondary analysis. FINDINGS The transition was complex and multidimensional. The participants experienced personal processes of change toward health within the illness, corresponding to indicators of healthy transitions. CONCLUSION The process can be identified as a transition from an uncertain and often sick role to a healthy role. Knowledge regarding transition promotes a person-centred approach in which patients' perspectives are included. Nurses and other health professionals can better direct and plan the caring and rehabilitation of patients with unexplained chest pain by deepening their knowledge of the transition process based on physical activity.
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Affiliation(s)
- Ingrid Ølfarnes Røysland
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Bok D, Gulin J, Škegro D, Šalaj S, Foster C. Comparison of anaerobic speed reserve and maximal aerobic speed methods to prescribe short format high-intensity interval training. Scand J Med Sci Sports 2023; 33:1638-1647. [PMID: 37246423 DOI: 10.1111/sms.14411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
The purpose of the study was to compare the degree of intersubject variability in the cardiorespiratory, metabolic, and perceptual responses to high-intensity interval training (HIIT) prescribed based on the relative anaerobic speed reserve (ASR) or maximal aerobic speed (MAS) and to identify the optimal % ASR for execution of such HIIT. Seventeen male physical education students (age: 23.6 ± 1.1 years, height: 180.2 ± 5.9, body mass: 78.3 ± 8.1 kg; % body fat: 14.3 ± 2.7%) volunteered to execute three randomly scheduled 10-min HIIT exercises at 110% vVO2max , Δ15% ASR, or Δ25% ASR. Analysis of variance for repeated measures and the least significant difference post-hoc test were used to compare the physiological responses and the mean of individual residuals between the training sessions. The coefficients of variation (CV) of time spent ≥90% of maximal oxygen uptake (VO2max ) and maximal heart rate (HRmax ), peak VO2 , mean VO2 , peak HR, mean HR, blood lactate [La], and rating of perceived exertion (RPE) were 48.7%, 35.9%, 9.3%, 7%, 3.5%, 4.8%, 32%, and 16.9% during 110% vVO2max , 47.2%, 31%, 7.5%, 6.7%, 3.9%, 4.6%, 24.2%, and 14.6% during Δ15% ASR, and 48.1%, 31.5%, 7.6%, 8.4%, 3.6%, 4.1%, 20.2%, and 3.4% during Δ25% ASR session, respectively. Only the residuals in RPE were significantly (p < 0.001) higher in 110% vVO2max and Δ15% ASR in comparison to Δ25% ASR. Time spent ≥90% HRmax /VO2max was maximized during Δ15% ASR session, albeit this was not significantly different from other sessions. The ASR-based method leads to reduced CVs of physiological and perceptual responses during 10-min HIIT; however, only reductions in [La] and RPE may be considered practically meaningful. Practitioners can use vVO2max for prescription of 10-min HIIT session comprised of 15-s work and passive recovery intervals.
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Affiliation(s)
- Daniel Bok
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Jere Gulin
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Dario Škegro
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Sanja Šalaj
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Carl Foster
- Department of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, USA
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Spence CM, Foshaug R, Rowland S, Krysler A, Conway J, Urschel S, West L, Stickland M, Boulanger P, Spence JC, Khoury M. Evaluating a Telemedicine Video Game-Linked High-Intensity Interval Training Exercise Programme in Paediatric Heart Transplant Recipients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:198-205. [PMID: 37969861 PMCID: PMC10642108 DOI: 10.1016/j.cjcpc.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 11/17/2023]
Abstract
Paediatric heart transplant recipients (HTRs) have reduced exercise capacity, physical activity (PA), health-related quality of life (HRQoL), and self-efficacy towards PA. Exercise interventions have demonstrated improvements in exercise capacity and functional status in adult HTRs, with a specific emerging interest in the role of high-intensity interval training (HIIT). Studies of exercise interventions in paediatric HTRs have been limited and nonrandomized to date. HIIT has not yet been evaluated in paediatric HTRs. We thus seek to evaluate the safety and feasibility of a randomized crossover trial of a 12-week, home-based, video game-linked HIIT intervention using a cycle ergometer with telemedicine and remote physiological monitoring capabilities (MedBIKE) in paediatric HTRs. The secondary objective is to evaluate the impact of the intervention on (1) exercise capacity, (2) PA, (3) HRQoL and self-efficacy towards PA, and (4) sustained changes in secondary outcomes at 6 and 12 months after intervention. After a baseline assessment of the secondary outcomes, participants will be randomized to receive the MedBIKE intervention (12 weeks, 36 sessions) or usual care. After the intervention and a repeated assessment, all participants will cross over. Follow-up assessments will be administered at 6 and 12 months after the MedBIKE intervention. We anticipate that the MedBIKE intervention will be feasible and safely yield sustained improvements in exercise capacity, PA, HRQoL, and self-efficacy towards PA in paediatric HTRs. This study will serve as the foundation for a larger, multicentre randomized crossover trial and will help inform exercise rehabilitation programmes for paediatric HTRs.
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Affiliation(s)
- Christopher M. Spence
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samira Rowland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Krysler
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Lori West
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Pierre Boulanger
- Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - John C. Spence
- Sedentary Living Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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36
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Milani JGPO, Milani M, Cipriano GFB, Hansen D, Cipriano Junior G. Exercise intensity domains determined by heart rate at the ventilatory thresholds in patients with cardiovascular disease: new insights and comparisons to cardiovascular rehabilitation prescription recommendations. BMJ Open Sport Exerc Med 2023; 9:e001601. [PMID: 37533593 PMCID: PMC10391816 DOI: 10.1136/bmjsem-2023-001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods. Methods A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE). Results Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r2 of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%-19.3%). Conclusion The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable.
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Affiliation(s)
| | - Mauricio Milani
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
| | - Graziella França Bernardelli Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
- Rehabilitation Sciences Programme, University of Brasilia, Brasilia, Brazil
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Gerson Cipriano Junior
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
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37
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Dharmavaram N, Esmaeeli A, Jacobson K, Brailovsky Y, Raza F. Cardiopulmonary Exercise Testing, Rehabilitation, and Exercise Training in Postpulmonary Embolism. Interv Cardiol Clin 2023; 12:349-365. [PMID: 37290839 DOI: 10.1016/j.iccl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Long-term exercise intolerance and functional limitations are common after an episode of acute pulmonary embolism (PE), despite 3 to 6 months of anticoagulation. These persistent symptoms are reported in more than half of the patients with acute PE and are referred as "post-PE syndrome." Although these functional limitations can occur from persistent pulmonary vascular occlusion or pulmonary vascular remodeling, significant deconditioning can be a major contributing factor. Herein, the authors review the role of exercise testing to elucidate the mechanisms of exercise limitations to guide next steps in management and exercise training for musculoskeletal deconditioning.
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Affiliation(s)
- Naga Dharmavaram
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Amir Esmaeeli
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Kurt Jacobson
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA
| | - Yevgeniy Brailovsky
- Division of Cardiology, Department of Medicine, Jefferson Heart Institute-Sidney Kimmel School of Medicine, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Farhan Raza
- Division of Cardiology, Department of Medicine, University of Wisconsin-Madison, Hospitals and Clinics, 600 Highland Avenue CSC-E5/582B, Madison, WI 53792, USA.
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Saeki H, Kuramoto M, Iida Y, Yasumura K, Arita Y, Ogasawara N. Effect of Constant vs. Variable Moderate-Intensity Load on Peak Oxygen Uptake in Outpatient Cardiac Rehabilitation. Circ Rep 2023; 5:167-176. [PMID: 37180472 PMCID: PMC10166670 DOI: 10.1253/circrep.cr-23-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 04/04/2023] Open
Abstract
Background: In outpatient center-based cardiac rehabilitation (O-CBCR), moderate-intensity continuous training (MICT) based on the anaerobic threshold (AT) determined by cardiopulmonary exercise stress testing is recommended. However, it is unclear whether differences in exercise intensity within the MICT domain affect peak oxygen uptake (%peakV̇O2). Methods and Results: We retrospectively evaluated patients who underwent O-CBCR at Japan Community Healthcare Organization Osaka Hospital. Those treated with the constant-load method were designated as Group A (n=38), whereas those treated with the variable-load method were designated as Group B (n=48). Although the change in exercise intensity was significantly greater in Group B by approximately 4.5 W, the change in %peakV̇O2 was not significantly different between groups. Group A had a significantly longer exercise time than Group B (by approximately 4-5 min). No deaths or hospitalizations occurred in either group. The percentage of episodes with exercise cessation was similar between the 2 groups, but the percentage of episodes with load reduction was significantly higher in Group B, mostly because of the increased heart rate. Conclusions: In supervised MICT based on AT, the variable-load method increased exercise intensity more than the constant-load method without severe complications, but did not improve %peakV̇O2.
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Affiliation(s)
- Hajime Saeki
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Miho Kuramoto
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoshinori Iida
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Kaori Yasumura
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
| | - Yoh Arita
- Japan Community Healthcare Organization Osaka Hospital Osaka Japan
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Meng J, Geng Q, Jin S, Teng X, Xiao L, Wu Y, Tian D. Exercise protects vascular function by countering senescent cells in older adults. Front Physiol 2023; 14:1138162. [PMID: 37089434 PMCID: PMC10118010 DOI: 10.3389/fphys.2023.1138162] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Blood vessels are key conduits for the transport of blood and circulating factors. Abnormalities in blood vessels promote cardiovascular disease (CVD), which has become the most common disease as human lifespans extend. Aging itself is not pathogenic; however, the decline of physiological and biological function owing to aging has been linked to CVD. Although aging is a complex phenomenon that has not been comprehensively investigated, there is accumulating evidence that cellular senescence aggravates various pathological changes associated with aging. Emerging evidence shows that approaches that suppress or eliminate cellular senescence preserve vascular function in aging-related CVD. However, most pharmacological therapies for treating age-related CVD are inefficient. Therefore, effective approaches to treat CVD are urgently required. The benefits of exercise for the cardiovascular system have been well documented in basic research and clinical studies; however, the mechanisms and optimal frequency of exercise for promoting cardiovascular health remain unknown. Accordingly, in this review, we have discussed the changes in senescent endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) that occur in the progress of CVD and the roles of physical activity in CVD prevention and treatment.
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Affiliation(s)
- Jinqi Meng
- Department of Sports, Hebei Medical University, Shijiazhuang, China
| | - Qi Geng
- Hebei Key Lab of Laboratory Animal Science, Hebei Medical University, Shijiazhuang, China
| | - Sheng Jin
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Xu Teng
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Lin Xiao
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Yuming Wu
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
| | - Danyang Tian
- Department of Physiology, Hebei Medical University, Shijiazhuang, China
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Meyler S, Bottoms L, Wellsted D, Muniz‐Pumares D. Variability in exercise tolerance and physiological responses to exercise prescribed relative to physiological thresholds and to maximum oxygen uptake. Exp Physiol 2023; 108:581-594. [PMID: 36710454 PMCID: PMC10103872 DOI: 10.1113/ep090878] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/22/2022] [Indexed: 01/31/2023]
Abstract
NEW FINDINGS What is the central question of this study? Does prescribing exercise intensity using physiological thresholds create a more homogeneous exercise stimulus than using traditional intensity anchors? What is the main finding and its importance? Prescribing exercise using physiological thresholds, notably critical power, reduced the variability in exercise tolerance and acute metabolic responses. At higher intensities, approaching or exceeding the transition from heavy to severe intensity exercise, the imprecision of using fixed %V ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ as an intensity anchor becomes amplified. ABSTRACT The objective of this study was to determine whether the variability in exercise tolerance and physiological responses is lower when exercise is prescribed relative to physiological thresholds (THR) compared to traditional intensity anchors (TRAD). Ten individuals completed a series of maximal exercise tests and a series of moderate (MOD), heavy (HVY) and severe intensity (HIIT) exercise bouts prescribed using THR intensity anchors (critical power and gas exchange threshold) and TRAD intensity anchors (maximum oxygen uptake;V ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ ). There were no differences in exercise tolerance or acute response variability between MODTHR and MODTRAD . All individuals completed HVYTHR but only 30% completed HVYTRAD . Compared to HVYTHR , where work rates were all below critical power, work rates in HVYTRAD exceeded critical power in 70% of individuals. There was, however, no difference in acute response variability between HVYTHR and HVYTRAD . All individuals completed HIITTHR but only 20% completed HIITTRAD . The variability in peak (F = 0.274) and average (F = 0.318) blood lactate responses was lower in HIITTHR compared to HIITTRAD . The variability in W' depletion (the finite work capacity above critical power) after the final interval bout was lower in HIITTHR compared to HIITTRAD (F = 0.305). Using physiological thresholds to prescribe exercise intensity reduced the heterogeneity in exercise tolerance and physiological responses to exercise spanning the boundary between the heavy and severe intensity domains. To increase the precision of exercise intensity prescription, it is recommended that, where possible, physiological thresholds are used in place ofV ̇ O 2 max ${\dot V_{{{\rm{O}}_{\rm{2}}}{\rm{max}}}}$ .
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Affiliation(s)
- Samuel Meyler
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
| | - Lindsay Bottoms
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
| | - David Wellsted
- School of Life and Medical SciencesUniversity of HertfordshireHatfieldUK
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Harris MP, Zeng S, Zhu Z, Lira VA, Yu L, Hodgson-Zingman DM, Zingman LV. Myokine Musclin Is Critical for Exercise-Induced Cardiac Conditioning. Int J Mol Sci 2023; 24:6525. [PMID: 37047496 PMCID: PMC10095193 DOI: 10.3390/ijms24076525] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
This study investigates the role and mechanisms by which the myokine musclin promotes exercise-induced cardiac conditioning. Exercise is one of the most powerful triggers of cardiac conditioning with proven benefits for healthy and diseased hearts. There is an emerging understanding that muscles produce and secrete myokines, which mediate local and systemic "crosstalk" to promote exercise tolerance and overall health, including cardiac conditioning. The myokine musclin, highly conserved across animal species, has been shown to be upregulated in response to physical activity. However, musclin effects on exercise-induced cardiac conditioning are not established. Following completion of a treadmill exercise protocol, wild type (WT) mice and mice with disruption of the musclin-encoding gene, Ostn, had their hearts extracted and exposed to an ex vivo ischemia-reperfusion protocol or biochemical studies. Disruption of musclin signaling abolished the ability of exercise to mitigate cardiac ischemic injury. This impaired cardioprotection was associated with reduced mitochondrial content and function linked to blunted cyclic guanosine monophosphate (cGMP) signaling. Genetic deletion of musclin reduced the nuclear abundance of protein kinase G (PKGI) and cyclic adenosine monophosphate (cAMP) response element binding (CREB), resulting in suppression of the master regulator of mitochondrial biogenesis, peroxisome proliferator-activated receptor γ coactivator 1α (PGC1α), and its downstream targets in response to physical activity. Synthetic musclin peptide pharmacokinetic parameters were defined and used to calculate the infusion rate necessary to maintain its plasma level comparable to that observed after exercise. This infusion was found to reproduce the cardioprotective benefits of exercise in sedentary WT and Ostn-KO mice. Musclin is essential for exercise-induced cardiac protection. Boosting musclin signaling might serve as a novel therapeutic strategy for cardioprotection.
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Affiliation(s)
- Matthew P. Harris
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
| | - Shemin Zeng
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
- Veterans Affairs Medical Center, Iowa City, IA 52246, USA
| | - Zhiyong Zhu
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
- Veterans Affairs Medical Center, Iowa City, IA 52246, USA
| | - Vitor A. Lira
- Department of Health and Human Physiology, Fraternal Order of Eagles Diabetes Center, Pappajohn Biomedical Institute, University of Iowa, Iowa City, IA 52242, USA
| | - Liping Yu
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
- NMR Core Facility and Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Denice M. Hodgson-Zingman
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
| | - Leonid V. Zingman
- Department of Internal Medicine, Fraternal Order of Eagles Diabetes Center, Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA 52242, USA
- Veterans Affairs Medical Center, Iowa City, IA 52246, USA
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Rodriguez-Arietaleanizbeaskoa M, Mojas Ereño E, Arietaleanizbeaskoa MS, Grandes G, Rodríguez Sánchez A, Urquijo V, Hernando Alday I, Dublang M, Angulo-Garay G, Cacicedo J. Protocol for the SEHNeCa randomised clinical trial assesing Supervised Exercise for Head and Neck Cancer patients. BMC Cancer 2023; 23:271. [PMID: 36964485 PMCID: PMC10037879 DOI: 10.1186/s12885-023-10718-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of an innovative supervised exercise programme to mitigate the loss of lean body mass, functional capacity and quality of life in people with head and neck cancer, as well as to identify the optimal moment to apply it, before or after radiotherapy treatment, compared with the prescription of a physical activity plan carried out autonomously. METHODS Patients with squamous cell carcinoma of the head and neck (n = 144), treated with radiotherapy, will be randomly assigned to one of 3 comparison groups: pre-radiotherapy supervised exercise, post-radiotherapy supervised exercise and autonomous exercise, stratifying by human papillomavirus infection and previous surgery. The exercise programme will be carried out in 36 sessions over 12 weeks, combining moderate and high intensity strength and aerobic exercises. The main outcome variable is the change in lean body mass at 6 months measured by bioimpedance, while secondary variables are functional capacity, symptoms, quality of life and adverse effects. Longitudinal generalised mixed models will be used for the analyses of the repeated measurements at 3, 6, and 12 months after baseline. CONCLUSIONS The pilot study supports the feasibility and safety of the project. However, as the programme progressed, attendance at the sessions decreased. Strategies will be necessary for increasing attendance, as well as involving the patient in their recovery and other incentives. Follow-up after treatment to assess acute/late toxicity will enable us to know the response to both the exercise programme and its adherence. TRIAL REGISTRATION NCT04658706 Date and version identifier: March 1, 2023. Version 1.1.
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Affiliation(s)
- M Rodriguez-Arietaleanizbeaskoa
- Comprehensive Care Group for Patients With Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain.
| | - E Mojas Ereño
- AFD Salud. Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, Bizkaia, 48007, Spain
| | - M S Arietaleanizbeaskoa
- Comprehensive Care Group for Patients With Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - G Grandes
- Primary Care Research Unit - Bizkaia, Basque Health Service (Osakidetza), General Directorate, Vitoria-Gasteiz, Spain
| | - A Rodríguez Sánchez
- Basurto Radiation Oncology Department, Avenida Montevideo 18, 48013, Bilbao, Bizkaia, Spain
| | - V Urquijo
- Cruces Endocrinology Department, Plaza de Cruces S/N, 48903, Barakaldo, Bizkaia, Spain
| | - I Hernando Alday
- Basurto Endocrinology Department, Avenida Montevideo 18, 48013, Bilbao, Bizkaia, Spain
| | - M Dublang
- Galdakao Endocrinology Department, Barrio Labeaga, 48960, Galdakao, Bizkaia, Spain
| | - G Angulo-Garay
- AFD Salud. Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, Bizkaia, 48007, Spain
| | - J Cacicedo
- Department of Radiation Oncology, Group for Radiology and Physical Medicine in Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, 48903, Spain
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Festa RR, Monsalves-Álvarez M, Cancino J, Jannas-Vela S. Prescription of High-intensity Aerobic Interval Training Based on Oxygen Uptake Kinetics. Int J Sports Med 2023; 44:159-168. [PMID: 35995143 DOI: 10.1055/a-1929-0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endurance training results in diverse adaptations that lead to increased performance and health benefits. A commonly measured training response is the analysis of oxygen uptake kinetics, representing the demand of a determined load (speed/work) on the cardiovascular, respiratory, and metabolic systems, providing useful information for the prescription of constant load or interval-type aerobic exercise. There is evidence that during high-intensity aerobic exercise some interventions prescribe brief interval times (<1-min), which may lead to a dissociation between the load prescribed and the oxygen uptake demanded, potentially affecting training outcomes. Therefore, this review explored the time to achieve a close association between the speed/work prescribed and the oxygen uptake demanded after the onset of high-intensity aerobic exercise. The evidence assessed revealed that at least 80% of the oxygen uptake amplitude is reached when phase II of oxygen uptake kinetics is completed (1 to 2 minutes after the onset of exercise, depending on the training status). We propose that the minimum work-time during high-intensity aerobic interval training sessions should be at least 1 minute for athletes and 2 minutes for non-athletes. This suggestion could be used by coaches, physical trainers, clinicians and sports or health scientists for the prescription of high-intensity aerobic interval training.
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Affiliation(s)
- Raúl Ricardo Festa
- Laboratorio de Fisiología del Ejercicio y Metabolismo, Escuela de Kinesiología, Universidad Finis Terrae, Santiago, Chile
| | | | - Jorge Cancino
- Laboratorio de Fisiología del Ejercicio y Metabolismo, Escuela de Kinesiología, Universidad Finis Terrae, Santiago, Chile
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Sorace P, LaFontaine T, Batrakoulis A. Left Ventricular Assist Device. ACSM'S HEALTH & FITNESS JOURNAL 2023. [DOI: 10.1249/fit.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Bjarnason-Wehrens B, Schmidt T, Schwaab B. [Cardiopulmonary exercise testing for exercise prescription in cardiac rehabilitation]. Herzschrittmacherther Elektrophysiol 2023; 34:26-32. [PMID: 36720723 DOI: 10.1007/s00399-022-00921-4] [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: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 02/02/2023]
Abstract
Aerobic endurance training is a core component of exercise training (ET) during cardiac rehabilitation (CR). Improvements of cardiopulmonary performance and symptom-free exercise capacity that can be achieved by ET during CR are essential for patient's prognosis and quality of life. Before initiating exercise training in CR, a detailed risk stratification including incremental exercise testing is required in order to ensure safe and effective exercise training conditions. Cardiopulmonary exercise testing (CPX) with measurement of respiratory gases is considered the gold standard of cardiopulmonary performance diagnostics. The oxygen uptake measured at the highest exercise intensity achieved (peakVO2) has strong prognostic implications in primary and secondary prevention of cardiovascular diseases, respectively. The use of CPX with measurement of peakVO2 and determination of ventilatory thresholds (VT) enables a reliable determination of the individual cardiopulmonary performance (peakVO2) and also the aerobic exercise capacity. In addition, CPX is a valuable tool to detect increments in exercise capacity that were achieved by ET during CR. The measurement of peakVO2 and the determination of ventilatory thresholds are basic parameters for an individually tailored exercise prescription. In addition, the targeted control of aerobic endurance training on the basis of CPX parameters increases the effectiveness and safety of the exercise program during CR. In this article, recommendations for an individual exercise prescription, based on the results of CPX, are given for patients with coronary heart disease (CHD), heart failure, as well as for patients with CHD and concomitant type 2 diabetes mellitus.
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Affiliation(s)
- Birna Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.
| | - Thomas Schmidt
- Institut für Kreislaufforschung und Sportmedizin, Abt. Präventive und rehabilitative Sport- und Leistungsmedizin, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland.,Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Deutschland
| | - Bernhard Schwaab
- Rehabilitationskrankenhaus für Kardiologie, Angiologie und Diabetes, Curschmann Klinik, Timmendorfer Strand, Deutschland.,Medizinische Fakultät, Universität zu Lübeck, Lübeck, Deutschland
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Torres-Nunes L, da Costa-Borges PP, Paineiras-Domingos LL, Bachur JA, Coelho-Oliveira AC, da Cunha de Sá-Caputo D, Bernardo-Filho M. Effects of the Whole-Body Vibration Exercise on Sleep Disorders, Body Temperature, Body Composition, Tone, and Clinical Parameters in a Child with Down Syndrome Who Underwent Total Atrioventricular Septal Defect Surgery: A Case-Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020213. [PMID: 36832342 PMCID: PMC9955036 DOI: 10.3390/children10020213] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The health and developmental issues of people with Down syndrome (DS) are complex and are associated with many medical, psychological, and social problems from childhood through into adulthood. DS children have an increased risk of multiorgan comorbidities, including congenital heart disease. Atrioventricular septal defect (AVSD) is a congenital heart malformation that often occurs in DS people. AIM Physical activity and exercise are recommended for patients with cardiovascular disease and are considered to be the gold standard of cardiac rehabilitation. Whole-body vibration exercise (WBVE) is considered a form of exercises. The aim of this case report is to show the effects of WBVE on sleep disturbances, body temperature, body composition, tone, and clinical parameters in a child with DS with corrected total AVSD. The subject is a 10-year-old girl, with free-type DS, who underwent surgery to correct a total AVSD at 6 months. She underwent periodic cardiological monitoring and was released to perform any type of physical exercise, including WBVE. WBVE improved sleep quality and body composition. CONCLUSION WBVE leads to physiological effects that benefit the DS child.
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Affiliation(s)
- Luiza Torres-Nunes
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Program of Postgraduate Degree in Clinical and Experimental Pathophysiology, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
- Correspondence: (L.T.-N.); (L.L.P.-D.); Tel.: +55-21-99813570 (L.T.-N.)
| | - Patrícia Prado da Costa-Borges
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
| | - Laisa Liane Paineiras-Domingos
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Department of Physiotherapy, Multidisciplinary Institute of Rehabilitation and Health, Federal University of Bahia, Salvador 40110-909, Brazil
- Correspondence: (L.T.-N.); (L.L.P.-D.); Tel.: +55-21-99813570 (L.T.-N.)
| | | | - Ana Carolina Coelho-Oliveira
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Program of Postgraduate Degree in Clinical and Experimental Pathophysiology, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
| | - Danúbia da Cunha de Sá-Caputo
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
- Program of Postgraduate Degree in Clinical and Experimental Pathophysiology, State University of Rio de Janeiro, Rio de Janeiro 20550-170, Brazil
| | - Mario Bernardo-Filho
- Laboratory of Mechanical Vibrations and Integrative Practices, Department of Biophysics and Biometrics, Roberto Alcântara Gomes Institute of Biology and Piquet Carneiro University Polyclinic, State University of Rio de Janeiro, Rio de Janeiro 20950-003, Brazil
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Gentil P, Silva LRBE, Antunes DE, Carneiro LB, de Lira CAB, Batista G, de Oliveira JCM, Cardoso JS, Souza DC, Rebelo ACS. The effects of three different low-volume aerobic training protocols on cardiometabolic parameters of type 2 diabetes patients: A randomized clinical trial. Front Endocrinol (Lausanne) 2023; 14:985404. [PMID: 36755928 PMCID: PMC9900112 DOI: 10.3389/fendo.2023.985404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Objective To compare the effects of different aerobic training protocols on cardiometabolic variables in patients with type 2 diabetes mellitus (T2DM). Methods This study was a parallel clinical trial. Fifty-two men and women with T2DM (>40 years) were randomly allocated into three groups, and 44 (22 males/22 females) were included in the final analysis. Exercise intensity was based on the speed corresponding to the maximum oxygen consumption (v V ˙ O2max). Moderate intensity continuous training (MICT) involved 14 minutes at 70% of v V ˙ O2max; short interval high-intensity interval training (S-HIIT) consisted of 20 bouts of 30 seconds at 100% of V˙O2max with 30 seconds passive recovery; long interval high-intensity training (L-HIIT) consisted of 5 bouts of 2 minutes at 100% of v V ˙ O2max with 2 minutes passive recovery. Training protocols were performed on a motorized treadmill two times per week for eight weeks. Glycated hemoglobin (Hb1Ac), total cholesterol, triglycerides, resting systolic blood pressure (SBP), resting diastolic blood pressure (DBP), resting heart rate (resting HR) and maximum oxygen consumption (V˙O2max) were measured before and after the exercise intervention. The study was registered on the Brazilian clinical trial records (ID: RBR45 4RJGC3). Results There was a significant difference between groups for changes on V ˙ O2max. Greater increases on V ˙ O2max were achieved for L-HIIT (p = 0.04) and S-HIIT (p = 0.01) in comparison to MICT group, with no significant difference between L-HIIT and S-HIIT (p = 0.9). Regarding comparison within groups, there were significant reductions on HbA1c and triglycerides levels only for L-HIIT (p< 0.05). V ˙ O2max significantly increased for both L-HIIT (MD = 3.2 ± 1.7 ml/kg/min, p< 0.001) and S-HIIT (MD = 3.4 ± 1.7, p< 0.001). There was a significant reduction on resting SBP for L-HIIT group (MD = -12.07 ± 15.3 mmHg, p< 0.01), but not for S-HIIT and MICT. There were no significant changes from pre- to post-training on fasting glycemia, total cholesterol, HDL, LDL, resting HR and resting DBP for any group (p > 0.05). Conclusion Low-volume HIIT promoted greater improvements in cardiorespiratory capacity in comparison with low-volume MICT, independent of the protocols used. There were no other differences between groups. All protocols improved at least one of the variables analyzed; however, the most evident benefits were after the high-intensity protocols, especially L-HIIT.
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Affiliation(s)
- Paulo Gentil
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
- Hypertension League, Federal University of Goiás, Goiânia, Brazil
- Instituto VIDA, Brasilia, Brazil
| | - Lucas Raphael Bento e Silva
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil
| | | | | | - Claudio Andre Barbosa de Lira
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
| | - Gislene Batista
- Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Ana Cristina Silva Rebelo
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Hospital das Clínicas, Federal University of Goiás, Goiânia, Brazil
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Impact of a COmprehensive cardiac REhabilitation framework among high cardiovascular risk cancer survivors: Protocol for the CORE trial. Int J Cardiol 2023; 371:384-390. [PMID: 36216089 DOI: 10.1016/j.ijcard.2022.09.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/30/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cancer survivors are challenging patients, as they often present increased cardiovascular risk. In this background, cardio-oncology rehabilitation frameworks for specific cancer patients have been proposed. However, optimal program designs, as well as their overall safety and efficacy in different subsets of patients, are not fully ascertained. DESIGN Single-center, pragmatic, prospective, randomized controlled trial performed in Portugal aiming to evaluate the impact of a center-based cardiac rehabilitation program, consisting of exercise training, nutritional counselling, psychosocial management and lifestyle behavior change, compared to community-based exercise training, in cancer survivors. METHODS Adult cancer survivors (N = 80) exposed to cardiotoxic cancer treatment and/or with previous cardiovascular disease will be randomized (1:1) to receive either an eight-week cardiac rehabilitation program or community-based exercise training. Primary endpoint is cardiorespiratory fitness; secondary endpoints are physical activity, psychosocial parameters, blood pressure, body composition, lipids and inflammatory parameters. Physical function, quality of life, fatigue, health literacy, and feasibility will be assessed; a cost-effectiveness evaluation will also be performed. Between-group differences at baseline and in the change from baseline to the end of the study will be tested with unpaired t-tests or Mann-Whitney U test. Paired t-tests or Wilcoxon signed-rank test will be performed for within-group comparisons. CONCLUSION This trial will address the overall impact of a contemporary cardiac rehabilitation program framework in cancer survivors, as compared to a community-based exercise training. Given the higher cardiovascular risk in several groups of cancer patients, our results could provide novel insights into optimized preventive strategies in this complex patient population.
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Li S, Chen X, Jiao H, Li Y, Pan G, Yitao X. The Effect of High-Intensity Interval Training on Exercise Capacity in Patients with Coronary Artery Disease: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2023; 2023:7630594. [PMID: 37050938 PMCID: PMC10085654 DOI: 10.1155/2023/7630594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 04/14/2023] Open
Abstract
Background The optimal exercise prescription for coronary artery disease (CAD) remains under debate. The aim of our meta-analysis is to investigate the efficacy of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) of coronary artery disease patients. Methods Electronic databases were searched from their inception date until October 23, 2021, and the articles include randomized controlled trials. The mean differences and 95% confidence intervals were calculated, and heterogeneity was assessed using the I 2 test. Results The study standards were met by seventeen studies. The pooled studies included 902 patients. HIIT resulted in improvement in peak oxygen uptake (1.50 ml/kg/min, 95% confidence interval: 0.48 to 2.53, n = 853 patients, and low quality evidence) compared with MICT. There was no discernible difference between the individuals in the HIIT group and the MICT group in terms of systolic/diastolic blood pressure or peak/resting heart rate. Conclusion This systematic review and meta-analysis reported the superiority of HIIT versus MICT in enhancing peak oxygen uptake in CAD patients.
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Affiliation(s)
- Siyi Li
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiankun Chen
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm 17177, Sweden
| | - Huachen Jiao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Yan Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Guanghui Pan
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Xue Yitao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
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Zupkauskiene J, Lauceviciene I, Ryliskyte L, Navickas P, Kizlaitis R, Laucevicius A. Ambulatory and successive home-based heart rate targeted aerobic training improves arterial parameters: a follow-up study in people with metabolic syndrome. Ann Med 2023; 55:2250363. [PMID: 37625386 PMCID: PMC10461504 DOI: 10.1080/07853890.2023.2250363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/26/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Studies demonstrated that outpatient aerobic exercise programs (aEP) can significantly decrease aortic stiffness in people with metabolic syndrome (MetS). There is some limited data that remotely supervised home-based aEP can also improve arterial stiffness in this population. We aimed to evaluate the changes in the arterial wall parameters after the 2-month ambulatory supervised aEP followed by the 6-month home-based aEP with and without targeting of heart rate (HR) by electrocardiogram (ECG) in people with MetS. METHODS In this prospective study (ClinicalTrials.gov identifier: NCT05592704) 132 MetS subjects (mean age 52.44 ± 6.26 years, 54.55% female) were evaluated. At first, all subjects participated in the 2-month ambulatory supervised aEP, which consisted of 40 individual aerobic training sessions on a cycle ergometer 5 times/week for 40 min and received the recommendations for home-based training. Then the study (n = 66) and the control (n = 66) groups participated in the 6-month home-based aEP, but only the study group subjects targeted their HR using ECG monitor connected to the smartphone during workouts. Arterial stiffness parameters and carotid artery intima-media thickness (cIMT) were evaluated in all participants at baseline and after 8 months. RESULTS After 8 months, carotid-femoral pulse wave velocity (c-f PWV) significantly reduced in both groups (-12.22% in the study group vs. -7.85% in the control group, all p < .001) without a significant between-group difference (p = 0.144). A significant improvement of carotid-radial pulse wave velocity (c-r PWV) was observed only in the study group (-11.37%, p < .001, d = -0.671) with significant between-group difference (p < .001). The reduction of c-r PWV after 8 months of aEP occurred when c-r PWV at baseline was in the 2nd quartile (>7.90 m/s). A significant decrease of 3.32% in cIMT was present only in the study group (p = .032, d = -0.288). CONCLUSIONS The combination of 2-month ambulatory supervised aEP and successive 6-month home-based aEP targeted by HR monitoring using ECG improved arterial properties in MetS subjects more than the same combination without HR targeting, leading to the greater reduction of c-r PWV and cIMT.
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Affiliation(s)
- Jurate Zupkauskiene
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania
| | - Ieva Lauceviciene
- Department of Rehabilitation, Physical and Sports Medicine, Vilnius University, Vilnius, Lithuania
| | - Ligita Ryliskyte
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania
| | - Petras Navickas
- Clinic of Cardiac and Vascular Diseases, Vilnius University, Vilnius, Lithuania
- State Research Institute Center for Innovative Medicine, Vilnius, Lithuania
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