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Milani JGPO, Milani M, Verboven K, Cipriano G, Hansen D. Exercise intensity prescription in cardiovascular rehabilitation: bridging the gap between best evidence and clinical practice. Front Cardiovasc Med 2024; 11:1380639. [PMID: 39257844 PMCID: PMC11383788 DOI: 10.3389/fcvm.2024.1380639] [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: 02/01/2024] [Accepted: 08/01/2024] [Indexed: 09/12/2024] Open
Abstract
Optimizing endurance exercise intensity prescription is crucial to maximize the clinical benefits and minimize complications for individuals at risk for or with cardiovascular disease (CVD). However, standardization remains incomplete due to variations in clinical guidelines. This review provides a practical and updated guide for health professionals on how to prescribe endurance exercise intensity for cardiovascular rehabilitation (CR) populations, addressing international guidelines, practical applicability across diverse clinical settings and resource availabilities. In the context of CR, cardiopulmonary exercise test (CPET) is considered the gold standard assessment, and prescription based on ventilatory thresholds (VTs) is the preferable methodology. In settings where this approach isn't accessible, which is frequently the case in low-resource environments, approximating VTs involves combining objective assessments-ideally, exercise tests without gas exchange analyses, but at least alternative functional tests like the 6-minute walk test-with subjective methods for adjusting prescriptions, such as Borg's ratings of perceived exertion and the Talk Test. Therefore, enhancing exercise intensity prescription and offering personalized physical activity guidance to patients at risk for or with CVD rely on aligning workouts with individual physiological changes. A tailored prescription promotes a consistent and impactful exercise routine for enhancing health outcomes, considering patient preferences and motivations. Consequently, the selection and implementation of the best possible approach should consider available resources, with an ongoing emphasis on strategies to improve the delivery quality of exercise training in the context of FITT-VP prescription model (frequency, intensity, time, type, volume, and progression).
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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, 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, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kenneth Verboven
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Biomedical Research Institute (BIOMED), Hasselt, Belgium
| | - Gerson Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, 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
- Faculty of Medicine and Life Sciences, Biomedical Research Institute (BIOMED), Hasselt, Belgium
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Contreras-Briceño F, Cancino J, Espinosa-Ramírez M, Fernández G, Johnson V, Hurtado DE. Estimation of ventilatory thresholds during exercise using respiratory wearable sensors. NPJ Digit Med 2024; 7:198. [PMID: 39060511 PMCID: PMC11282229 DOI: 10.1038/s41746-024-01191-9] [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: 11/01/2023] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Ventilatory thresholds (VTs) are key physiological parameters used to evaluate physical performance and determine aerobic and anaerobic transitions during exercise. Current assessment of these parameters requires ergospirometry, limiting evaluation to laboratory or clinical settings. In this work, we introduce a wearable respiratory system that continuously tracks breathing during exercise and estimates VTs during ramp tests. We validate the respiratory rate and VTs predictions in 17 healthy adults using ergospirometry analysis. In addition, we use the wearable system to evaluate VTs in 107 recreational athletes during ramp tests outside the laboratory and show that the mean population values agree with physiological variables traditionally used to exercise prescription. We envision that respiratory wearables can be useful in determining aerobic and anaerobic parameters with promising applications in health telemonitoring and human performance.
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Affiliation(s)
- Felipe Contreras-Briceño
- Laboratory of Exercise Physiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Cancino
- Laboratory of Exercise Physiology & Metabolism, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Maximiliano Espinosa-Ramírez
- Laboratory of Exercise Physiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Daniel E Hurtado
- IC Innovations SpA, Santiago, Chile.
- Department of Structural and Geotechnical Engineering, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine, and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Inglis EC, Iannetta D, Rasica L, Mackie MZ, Keir DA, Macinnis MJ, Murias JM. Heavy-, Severe-, and Extreme-, but Not Moderate-Intensity Exercise Increase V̇o 2max and Thresholds after 6 wk of Training. Med Sci Sports Exerc 2024; 56:1307-1316. [PMID: 38376995 DOI: 10.1249/mss.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION This study assessed the effect of individualized, domain-based exercise intensity prescription on changes in maximal oxygen uptake (V̇O 2max ) and submaximal thresholds. METHODS Eighty-four young healthy participants (42 females, 42 males) were randomly assigned to six age, sex, and V̇O 2max -matched groups (14 participants each). Groups performed continuous cycling in the 1) moderate (MOD), 2) lower heavy (HVY1), and 3) upper heavy-intensity (HVY2) domain; interval cycling in the form of 4) high-intensity interval training (HIIT) in the severe-intensity domain, or 5) sprint-interval training (SIT) in the extreme-intensity domain; or no exercise for 6) control (CON). All training groups, except SIT, were work-matched. Training participants completed three sessions per week for 6 wk with physiological evaluations performed at PRE, MID, and POST intervention. RESULTS Compared with the change in V̇O 2max (∆V̇O 2max ) in CON (0.1 ± 1.2 mL·kg -1 ·min -1 ), all training groups, except MOD (1.8 ± 2.7 mL·kg -1 ·min -1 ), demonstrated a significant increase ( P < 0.05). HIIT produced the highest increase (6.2 ± 2.8 mL·kg -1 ·min -1 ) followed by HVY2 (5.4 ± 2.3 mL·kg -1 ·min -1 ), SIT (4.7 ± 2.3 mL·kg -1 ·min -1 ), and HVY1 (3.3 ± 2.4 mL·kg -1 ·min -1 ), respectively. The ΔPO at the estimated lactate threshold ( θLT ) was similar across HVY1, HVY2, HIIT, and SIT, which were all greater than CON ( P < 0.05). The ΔV̇O 2 and ΔPO at θLT for MOD was not different from CON ( P > 0.05). HIIT produced the highest ΔPO at maximal metabolic steady state, which was greater than CON, MOD, and SIT ( P < 0.05). CONCLUSIONS This study demonstrated that i) exercise intensity is a key component determining changes in V̇O 2max and submaximal thresholds and ii) exercise intensity domain-based prescription allows for a homogenous metabolic stimulus across individuals.
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Affiliation(s)
| | - Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Letizia Rasica
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Mary Z Mackie
- Faculty of Kinesiology, University of Calgary, Calgary, AB, CANADA
| | - Daniel A Keir
- School of Kinesiology, Western University, London, ON, CANADA
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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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Keltz RR, Hartley T, Huitema AA, McKelvie RS, Suskin NG, Keir DA. Do Clinical Exercise Tests Permit Exercise Threshold Identification in Patients Referred to Cardiac Rehabilitation? Can J Cardiol 2023; 39:1701-1711. [PMID: 37517474 DOI: 10.1016/j.cjca.2023.07.029] [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: 04/28/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND To evaluate the feasibility of "threshold-based" aerobic exercise prescription in cardiovascular disease, we aimed to quantify the proportion of patients whose clinical cardiopulmonary exercise test (CPET) permit identification of estimated lactate threshold (θLT) and respiratory compensation point (RCP) and to characterize the variability at which these thresholds occur. METHODS Breath-by-breath CPET data of 1102 patients (65 ± 12 years) referred to cardiac rehabilitation were analyzed to identify peak O2 uptake (V˙O2peak; mL·min-1 and mL·kg-1·min-1) and θLT and RCP (reported as V˙O2, %V˙O2peak, and %peak heart rate [%HRpeak]). Patients were grouped by the presence or absence of thresholds: group 0: neither θLT nor RCP; group 1: θLT only; and group 2: both θLT and RCP. RESULTS Mean V˙O2peak was 1523 ± 627 mL·min-1 (range: 315-3789 mL·min-1) or 18.0 ± 6.5 mL·kg-1·min-1 (5.2-46.5 mL·kg-1·min-1) and HRpeak was 123 ± 24 beats per minute (bpm) (52 bpm-207 bpm). There were 556 patients (50%) in group 0, 196 (18%) in group 1, and 350 (32%) in group 2. In group 1, mean θLT was 1240 ± 410 mL·min-1 (580-2560 mL·min-1), 75% ± 8%V˙O2peak (52%-92%V˙O2peak), or 84% ± 6%HRpeak (64%-96%HRpeak). In group 2, θLT was 1390 ± 360 mL·min-1 (640-2430 mL·min-1), 70% ± 8%V˙O2peak (41%-88%V˙O2peak), or 78% ± 7%HRpeak (52%-96%HRpeak), and RCP was 1680 ± 440 mL·min-1 (730-3090 mL·min-1), 84% ± 7%V˙O2peak (54%-99%V˙O2peak), or 87% ± 6%HRpeak (59%-99%HRpeak). Compared with group 1, θLT in group 2 occurred at a higher V˙O2 but lower %V˙O2peak and %HRpeak (P < 0.05). CONCLUSIONS Only 32% of CPETs exhibited both θLT and RCP despite flexibility in protocol options. Commonly used step-based protocols are suboptimal for "threshold-based" exercise prescription.
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Affiliation(s)
- Randi R Keltz
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Tim Hartley
- Lawson Health Research Institute, London, Ontario, Canada; Cardiac Rehabilitation and Secondary Prevention Program, St Joseph's Health Care, London, Ontario, Canada
| | - Ashlay A Huitema
- Cardiac Rehabilitation and Secondary Prevention Program, St Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Robert S McKelvie
- Cardiac Rehabilitation and Secondary Prevention Program, St Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Neville G Suskin
- Lawson Health Research Institute, London, Ontario, Canada; Cardiac Rehabilitation and Secondary Prevention Program, St Joseph's Health Care, London, Ontario, Canada; Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Daniel A Keir
- School of Kinesiology, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Toronto General Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
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D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol 2023; 46:1015-1020. [PMID: 37503665 PMCID: PMC10540010 DOI: 10.1002/clc.24112] [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: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Gian L. Ragazzoni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Alex Boncompagni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
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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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Iannetta D, Marinari G, Murias JM. Can the heart rate response at the respiratory compensation point be used to retrieve the maximal metabolic steady state? J Sports Sci 2023; 41:1025-1032. [PMID: 37722819 DOI: 10.1080/02640414.2023.2259206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023]
Abstract
The metabolic rate (VO2) at the maximal metabolic steady state (MMSS) is generally not different from the VO2 at the respiratory compensation point (RCP). Based on this, it is often assumed that the heart rate (HR) at RCP would also be similar to that at MMSS. The study aims to compare the HR at RCP with that at MMSS. Seventeen individuals completed a ramp-incremental test, a series of severe-intensity trials to estimate critical power and two-to-three 30-min trials to confirm MMSS. The HR at RCP was retrieved by linear interpolation of the ramp-VO2/HR relationship and compared to the HR at MMSS recorded at 10, 15, 20, 25 and 30 min. The HR at RCP was 166 ± 12 bpm. The HR during MMSS at the timepoints of interest was 168 ± 8, 171 ± 8, 175 ± 9, 177 ± 9 and 178 ± 10 bpm. The HR at RCP was not different from the HR at MMSS at 10 min (P > 0.05) but lower at subsequent timepoints (P < 0.05) with this difference becoming progressively larger. For all timepoints, limits of agreement were large (~30 bpm). Given these differences and the variability at the individual level, the HR at RCP cannot be used to control the metabolic stimulus of endurance exercise.
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Affiliation(s)
- Danilo Iannetta
- Department of Internal Medicine, University of Utah, Salt Lake City, USA
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Birnbaumer P, Dostal T, Cipryan L, Hofmann P. Pattern of the heart rate performance curve in maximal graded treadmill running from 1100 healthy 18-65 Years old men and women: the 4HAIE study. Front Physiol 2023; 14:1178913. [PMID: 37324398 PMCID: PMC10264846 DOI: 10.3389/fphys.2023.1178913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: The heart rate performance curve (HRPC) in maximal incremental cycle ergometer exercise demonstrated three different patterns such as downward, linear or inverse versions. The downward pattern was found to be the most common and therefore termed regular. These patterns were shown to differently influence exercise prescription, but no data are available for running. This study investigated the deflection of the HRPC in maximal graded treadmill tests (GXT) of the 4HAIE study. Methods: Additional to maximal values, the first and second ventilatory thresholds as well as the degree and the direction of the HRPC deflection (kHR) were determined from 1,100 individuals (489 women) GXTs. HRPC deflection was categorized as downward (kHR < -0.1), linear (-0.1 ≤ kHR ≤ 0.1) or inverse (kHR > 0.1) curves. Four (even split) age- and two (median split) performance-groups were used to investigate the effects of age and performance on the distribution of regular (= downward deflection) and non-regular (= linear or inverse course) HR curves for male and female subjects. Results: Men (age: 36.8 ± 11.9 years, BMI: 25.0 ± 3.3 kg m-2, VO2max: 46.4 ± 9.4 mL min-1. kg-1) and women (age: 36.2 ± 11.9 years, BMI: 23.3 ± 3.7 kg m-2, VO2max: 37.4 ± 7.8 mL min-1. kg-1) presented 556/449 (91/92%) downward deflecting, 10/8 (2/2%) linear and 45/32 (7/6%) inverse HRPC´s. Chi-squared analysis revealed a significantly higher number of non-regular HRPC´s in the low-performance group and with increasing age. Binary logistic regression revealed that the odds ratio (OR) to show a non-regular HRPC is significantly affected by maximum performance (OR = 0.840, 95% CI = 0.754-0.936, p = 0.002) and age (OR = 1.042, 95% CI = 1.020-1.064, p < 0.001) but not sex. Discussion: As in cycle ergometer exercise, three different patterns for the HRPC were identified from the maximal graded treadmill exercise with the highest frequency of regular downward deflecting curves. Older subjects and subjects with a lower performance level had a higher probability to show a non-regular linear or inverted curve which needs to be considered for exercise prescription.
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Affiliation(s)
- Philipp Birnbaumer
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Tomas Dostal
- Department of Human Movement Studies & Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Lukas Cipryan
- Department of Human Movement Studies & Human Motion Diagnostic Centre, The University of Ostrava, Ostrava, Czech Republic
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
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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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11
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Iannetta D, Rouleau CR, Chirico D, Fontana FY, Hauer T, Wilton SB, Aggarwal S, Austford LD, Arena R, Murias JM. An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program. Int J Cardiol 2023; 379:104-110. [PMID: 36934989 DOI: 10.1016/j.ijcard.2023.03.036] [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: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. METHODS A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. RESULTS At pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. CONCLUSIONS Along with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.
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Affiliation(s)
- Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Codie R Rouleau
- Department of Psychology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Daniele Chirico
- Faculty of Kinesiology, University of Calgary, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Federico Y Fontana
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Trina Hauer
- TotalCardiology™ Rehabilitation, Calgary, Canada; TotalCardiology™ Research Network, Calgary, Canada
| | - Stephen B Wilton
- TotalCardiology™ Research Network, Calgary, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Canada
| | - Sandeep Aggarwal
- TotalCardiology™ Research Network, Calgary, Canada; Department of Cardiac Science, University of Calgary, Calgary, Canada
| | | | - Ross Arena
- TotalCardiology™ Research Network, Calgary, Canada; Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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12
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Marinus N, Van Hoornweder S, Aarts M, Vanbilsen J, Hansen D, Meesen R. The influence of a single transcranial direct current stimulation session on physical fitness in healthy subjects: a systematic review. Exp Brain Res 2023; 241:31-47. [PMID: 36357590 PMCID: PMC9648891 DOI: 10.1007/s00221-022-06494-5] [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: 07/21/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
Physical fitness is of indisputable importance for both health, and sports. Currently, the brain is being increasingly recognized as a contributor to physical fitness. Hereby, transcranial direct current stimulation (tDCS), as an ergogenic aid, has gained scientific interest. The current PRISMA-adherent review aimed to examine the effect of tDCS on the three core components of physical fitness: muscle strength, -endurance and cardiopulmonary endurance. Randomized controlled- or cross-over trials evaluating the effect of a single tDCS session (vs. sham) in healthy individuals were included. Hereby, a wide array of tDCS-related factors (e.g., tDCS montage and dose) was taken into account. Thirty-five studies (540 participants) were included. Between-study heterogeneity in factors such as age, activity level, tDCS protocol, and outcome measures was large. The capacity of tDCS to improve physical fitness varied substantially across studies. Nevertheless, muscle endurance was most susceptible to improvements following anodal tDCS (AtDCS), with 69% of studies (n = 11) investigating this core component of physical fitness reporting positive effects. The primary motor cortex and dorsolateral prefrontal cortex were targeted the most, with positive results being reported on muscle and cardiopulmonary endurance. Finally, online tDCS seemed most beneficial, and no clear relationship between tDCS and dose-related parameters seemed present. These findings can contribute to optimizing tDCS interventions during the rehabilitation of patients with a variety of (chronic) diseases such as cardiovascular disease. Therefore, future studies should focus on further unraveling the potential of AtDCS on physical fitness and, more specifically, muscle endurance in both healthy subjects and patients suffering from (chronic) diseases. This study was registered in Prospero with the registration number CRD42021258529. "To enable PROSPERO to focus on COVID-19 registrations during the 2020 pandemic, this registration record was automatically published exactly as submitted. The PROSPERO team has not checked eligibility".
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Affiliation(s)
- Nastasia Marinus
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium. .,Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.
| | - Sybren Van Hoornweder
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Marthe Aarts
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Jessie Vanbilsen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Dominique Hansen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium.,Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Raf Meesen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium.,Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
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13
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Chua MT, Sim A, Burns SF. Acute and Chronic Effects of Blood Flow Restricted High-Intensity Interval Training: A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:122. [PMID: 36178530 PMCID: PMC9525532 DOI: 10.1186/s40798-022-00506-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
Background The implementation of blood flow restriction (BFR) during exercise is becoming an increasingly useful adjunct method in both athletic and rehabilitative settings. Advantages in pairing BFR with training can be observed in two scenarios: (1) training at lower absolute intensities (e.g. walking) elicits adaptations akin to high-intensity sessions (e.g. running intervals); (2) when performing exercise at moderate to high intensities, higher physiological stimulus may be attained, leading to larger improvements in aerobic, anaerobic, and muscular parameters. The former has been well documented in recent systematic reviews, but consensus on BFR (concomitant or post-exercise) combined with high-intensity interval training (HIIT) protocols is not well established. Therefore, this systematic review evaluates the acute and chronic effects of BFR + HIIT. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. A systematic search on 1 February 2022, was conducted on four key databases: ScienceDirect, PubMed, Scopus and SPORTDiscus. Quality of each individual study was assessed using the Physiotherapy Evidence Database (PEDro) scale. Extraction of data from included studies was conducted using an adapted version of the 'Population, Intervention, Comparison, Outcome' (PICO) framework. Results A total of 208 articles were identified, 18 of which met inclusion criteria. Of the 18 BFR + HIIT studies (244 subjects), 1 reported both acute and chronic effects, 5 examined acute responses and 12 investigated chronic effects. Acutely, BFR challenges the metabolic processes (vascular and oxygenation responses) during high-intensity repeated sprint exercise—which accelerates central and peripheral neuromuscular fatigue mechanisms resulting in performance impairments. Analysis of the literature exploring the chronic effects of BFR + HIIT suggests that BFR does provide an additive physiological training stimulus to HIIT protocols, especially for measured aerobic, muscular, and, to some extent, anaerobic parameters. Conclusion Presently, it appears that the addition of BFR into HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance. However due to large variability in permutations of BFR + HIIT methodologies, it is necessary for future research to explore and recommend standardised BFR guidelines for each HIIT exercise type.
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14
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Kominami K, Akino M. Prolonged mean response time in older adults with cardiovascular risk compared to healthy older adults. BMC Sports Sci Med Rehabil 2022; 14:173. [PMID: 36151572 PMCID: PMC9503204 DOI: 10.1186/s13102-022-00565-4] [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: 05/10/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND During incremental exercise (Inc-Ex), the mean response time (MRT) of oxygen uptake (V̇O2) represents the time delay before changes in muscle V̇O2 reflect at the mouth level. MRT calculation by linear regression or monoexponential (τ') fitting of V̇O2 data are known to be highly variable, and a combination of incremental and constant load exercise (CL-Ex) is more reproducible. METHODS We evaluated MRT in older adults using linear regression and combination methods. We recruited 20 healthy adults (male: 9, 69.4 ± 6.8 years) and 10 cardiovascular risk subjects (male: 8, 73.0 ± 8.8 years). On day 1, they performed Inc-Ex using a 10W/min ramp protocol, for determination of the ventilatory anaerobic threshold (VAT) using the V-slope method. On day 2, they performed Inc-Ex to VAT exercise intensity and CL-Ex for 25min total. The MRT was calculated from the CL-Ex V̇O2 average and the time at equivalent V̇O2 in the Inc-Ex. We also assessed the amount of physical activity using the International Physical Activity Questionnaire short form (IPAQ-SF). RESULTS The MRT of healthy participants and those at cardiovascular risk were 49.2 ± 36.3 vs. 83.6 ± 45.4s (p = 0.033). Total physical activity in the IPAQ-SF was inversely correlated with MRT. CONCLUSION The MRT was significantly prolonged in cardiovascular risk participants compared to healthy participants, possibly related to the amount of daily physical activity. Individual MRT may be useful for adjustment of exercise intensity, but this should also be based on daily physical activity and individual condition during exercise.
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Affiliation(s)
- Kazuyuki Kominami
- Department of Rehabilitation, Sanseikai Kitano Hospital, 6-30, 1-chome, Kitano1-jyo, Kiyota-ku, 004–0861 Sapporo, Hokkaido Japan
| | - Masatoshi Akino
- Department of Rehabilitation, Sapporo Kiyota Orthopedic Hospital, 1-50, 4-chome, Kiyota1-jyo, Kiyota-ku, 004-0841 Sapporo, Hokkaido Japan
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15
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Kirton MJ, Burnley MT, Ramos JS, Weatherwax R, Dalleck LC. The Effects of Standardised versus Individualised Aerobic Exercise Prescription on Fitness-Fatness Index in Sedentary Adults: A Randomised Controlled Trial. J Sports Sci Med 2022; 21:347-355. [PMID: 36157386 PMCID: PMC9459763 DOI: 10.52082/jssm.2022.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/10/2022] [Indexed: 06/16/2023]
Abstract
A poor Fitness Fatness Index (FFI) is associated with type 2 diabetes incidence, other chronic conditions (Alzheimer's, cancer, and cardiovascular disease) and all-cause mortality. Recent investigations have proposed that an individualised exercise prescription based on ventilatory thresholds is more effective than a standardised prescription in improving cardiorespiratory fitness (CRF), a key mediator of FFI. Thus, the aim of the current study was to determine the effectiveness of individualised versus standardised exercise prescription on FFI in sedentary adults. Thirty-eight sedentary individuals were randomised to 12-weeks of: (1) individualised exercise training using ventilatory thresholds (n = 19) or (2) standardised exercise training using a percentage of heart rate reserve (n = 19). A convenience sample was also recruited as a control group (n=8). Participants completed CRF exercise training three days per week, for 12-weeks on a motorised treadmill. FFI was calculated as CRF in metabolic equivalents (METs), divided by fatness determined by waist to height ratio (WtHR). A graded exercise test was used to measure CRF, and anthropometric measures (height and waist circumference) were assessed to ascertain WtHR. There was a difference in FFI change between study groups, whilst controlling for baseline FFI, F (2, 42) = 19.382 p < .001, partial η2 = 0.480. The magnitude of FFI increase from baseline was significantly higher in the individualised (+15%) compared to the standardised (+10%) (p = 0.028) and control group (+4%) (p = <.001). The main finding of the present study is that individualised exercise prescription had the greatest effect on improving FFI in sedentary adults compared to a standardised prescription. Therefore, an individualised based exercise prescription should be considered a viable and practical method of improving FFI in sedentary adults.
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Affiliation(s)
- Michael J Kirton
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mitchel T Burnley
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Joyce S Ramos
- Caring Futures Institute, SHAPE Research Centre, Clinical Exercise Physiology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ryan Weatherwax
- University of Utah, Salt Lake City, Utah, United States of America
| | - Lance C Dalleck
- Western Colorado University, Gunnison, Colorado, United States of America
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16
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Brown DE, Sharma S, Jablonski JA, Weltman A. Neural network methods for diagnosing patient conditions from cardiopulmonary exercise testing data. BioData Min 2022; 15:16. [PMID: 35964102 PMCID: PMC9375280 DOI: 10.1186/s13040-022-00299-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiopulmonary exercise testing (CPET) provides a reliable and reproducible approach to measuring fitness in patients and diagnosing their health problems. However, the data from CPET consist of multiple time series that require training to interpret. Part of this training teaches the use of flow charts or nested decision trees to interpret the CPET results. This paper investigates the use of two machine learning techniques using neural networks to predict patient health conditions with CPET data in contrast to flow charts. The data for this investigation comes from a small sample of patients with known health problems and who had CPET results. The small size of the sample data also allows us to investigate the use and performance of deep learning neural networks on health care problems with limited amounts of labeled training and testing data. METHODS This paper compares the current standard for interpreting and classifying CPET data, flowcharts, to neural network techniques, autoencoders and convolutional neural networks (CNN). The study also investigated the performance of principal component analysis (PCA) with logistic regression to provide an additional baseline of comparison to the neural network techniques. RESULTS The patients in the sample had two primary diagnoses: heart failure and metabolic syndrome. All model-based testing was done with 5-fold cross-validation and metrics of precision, recall, F1 score, and accuracy. As a baseline for comparison to our models, the highest performing flow chart method achieved an accuracy of 77%. Both PCA regression and CNN achieved an average accuracy of 90% and outperformed the flow chart methods on all metrics. The autoencoder with logistic regression performed the best on each of the metrics and had an average accuracy of 94%. CONCLUSIONS This study suggests that machine learning and neural network techniques, in particular, can provide higher levels of accuracy with CPET data than traditional flowchart methods. Further, the CNN performed well with a small data set showing that these techniques can be designed to perform well on small data problems that are often found in health care and the life sciences. Further testing with larger data sets is needed to continue evaluating the use of machine learning to interpret CPET data.
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Affiliation(s)
- Donald E. Brown
- School of Data Science, University of Virginia, Charlottesville, VA USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA USA
| | - Suchetha Sharma
- School of Data Science, University of Virginia, Charlottesville, VA USA
| | - James A. Jablonski
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA USA
| | - Arthur Weltman
- Department of Kinesiology, University of Virginia, Charlottesville, VA USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA USA
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17
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Ribeiro GDS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol 2022; 360:39-43. [PMID: 35623479 DOI: 10.1016/j.ijcard.2022.05.041] [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: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) shows a four-fold greater risk of adverse events. This study aims to analyze the sensitivity and specificity of three EOV diagnostic definitions to predict adverse outcomes at a 2-year follow-up and to compare its EOV prevalence and relations with the patient's profile. METHODS Cardiopulmonary exercise tests from 233 heart failure patients were analyzed. Two blinded reviewers used a semiautomated software to identify EOV cases pattern according to the definitions of Ben-Dov, Corrà, and Leite. Data were grouped in EOV-positive or EOV-negative according to each definition. Baseline characteristics, EOV prevalence, relative risk, sensitivity, and specificity to predict 2-years of major adverse cardiovascular outcomes were analyzed. RESULTS The Corrà definition led to the best prediction of 2-year major cardiovascular adverse outcomes (HR 2.46 [1.16 to 5.25]; p = 0.019, AUC = 0.618; p = 0.007). EOV prevalence was 17.2%, 17.2%, and 9.4% applying Ben-Dov, Corrà, and Leite definition, respectively. The main clinical differences between EOV-positive and EOV-negative patients were: MECKI score and VE/VCO2 slope (all definitions), and BNP levels (Ben-Dov and Leite). BNP levels were correlated with amplitude (rho = 0.255; p = 0.033) and cycle length (rho = 0.388; p = 0.002). CONCLUSION Corrà definition was the only one that exhibited the capacity to predict major adverse cardiovascular outcomes at a 2-year follow-up. Regardless of its definition, EOV was more often prevalent in patients with a greater MECKI score and VE/VCO2 slope values.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, Brazil
| | | | - Dominique Hansen
- Hasselt University (UHASSELT), Faculty of Rehabilitation Sciences, BIOMED/REVAL, Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, Brazil.
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18
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D'Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med 2022; 56:bjsports-2021-105261. [PMID: 35680397 DOI: 10.1136/bjsports-2021-105261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
| | | | | | | | - Martin Halle
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
- DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
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Tran DL, Kamaladasa Y, Munoz PA, Kotchetkova I, D'Souza M, Celermajer DS, Maiorana A, Cordina R. Estimating exercise intensity using heart rate in adolescents and adults with congenital heart disease: Are established methods valid? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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20
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Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
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21
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Aleksova A, Janjusevic M, Gagno G, Pierri A, Padoan L, Fluca AL, Carriere C, Beltrami AP, Sinagra G. The Role of Exercise-Induced Molecular Processes and Vitamin D in Improving Cardiorespiratory Fitness and Cardiac Rehabilitation in Patients With Heart Failure. Front Physiol 2022; 12:794641. [PMID: 35087418 PMCID: PMC8787056 DOI: 10.3389/fphys.2021.794641] [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: 10/13/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Remarkably, unlike pathological hypertrophy, exercise leads to beneficial cardiac hypertrophy characterized by normal or enhanced contractile function. Exercise-based cardiac rehabilitation improves cardiorespiratory fitness and, as a consequence, ameliorates the quality of life of patients with HF. Particularly, multiple studies demonstrated the improvement in left ventricular ejection fraction (LVEF) among patients with HF due to the various processes in the myocardium triggered by exercise. Exercise stimulates IGF-1/PI3K/Akt pathway activation involved in muscle growth in both the myocardium and skeletal muscle by regulating protein synthesis and catabolism. Also, physical activity stimulates the activation of the mitogen-activated protein kinase (MAPK) pathway which regulates cellular proliferation, differentiation and apoptosis. In addition, emerging data pointed out the anti-inflammatory effects of exercises as well. Therefore, it is of utmost importance for clinicians to accurately evaluate the patient’s condition by performing a cardiopulmonary exercise test and/or a 6-min walking test. Portable devices with the possibility to measure exercise capacity proved to be very useful in this setting as well. The aim of this review is to gather together the molecular processes triggered by the exercise and available therapies in HF settings that could ameliorate heart performance, with a special focus on strategies such as exercise-based cardiac rehabilitation.
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Affiliation(s)
- Aneta Aleksova
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Milijana Janjusevic
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Giulia Gagno
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Alessandro Pierri
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Laura Padoan
- Cardiology and Cardiovascular Physiopathology, Azienda Ospedaliero-Universitaria S. Maria della Misericordia, Perugia, Italy
| | - Alessandra Lucia Fluca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Cosimo Carriere
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Antonio Paolo Beltrami
- Department of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), University of Udine, Udine, Italy.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy.,Department of Medical Surgical and Health Science, University of Trieste, Trieste, Italy
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22
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Vonbank K, Lehmann A, Bernitzky D, Gysan MR, Simon S, Krotka P, Zwick RH, Idzko M, Burtscher M. Comparison of heart rates at fixed percentages and the ventilatory thresholds in patients with interstitial lung disease. Scand J Med Sci Sports 2021; 32:754-764. [PMID: 34923682 PMCID: PMC9304263 DOI: 10.1111/sms.14117] [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: 06/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Heart rate (HR) responses to maximal exercise are commonly used for the prescription of training intensities in pulmonary rehabilitation. Those intensities are usually based on fixed percentages of peak HR (HRpeak), heart rate reserve (HRR), or peak work load (Wpeak), and rarely on HRs at the individual ventilatory thresholds (VT1 and VT2) derived from cardiopulmonary exercise testing (CPET). For patients suffering from interstitial lung disease (ILD), data on cardiorespiratory responses to CPET are scarce. Thus, the aim of this study was to record cardiorespiratory responses to CPET and to compare fixed HR percentages with HRs at VT1 and VT2 in ILD patients. A total of 120 subjects, 80 ILD patients and 40 healthy controls, underwent a symptom‐limited CPET. From the ILD patient, 32 suffered from idiopathic pulmonary fibrosis (IPF), 37 from connective tissue disease (CTD), and 11 from sarcoidosis. HRs at fixed percentages, that is, at 70%HRpeak, at 70%Wpeak, and at 60%HRR were significantly lower in the ILD patients compared with the control group (p‐values: 0.001, 0.044, and 0.011). Large percentages of HR values at 70%Wpeak and 60%HRR ranged between the HRs at VT1 and VT2 in ILD subgroups and controls as well. HRs at 70%HRpeak were lower than HRs at VT1 in 66% of the IPF patients, 54% of the CTD patients, and 55% of patients with sarcoidosis compared with 18% in the control group. Our findings demonstrate a considerable scattering of fixed HR percentages compared with HRs at the individual VTs derived from CPET in ILD patients. These findings may provide valuable information for the prescription of exercise intensity in pulmonary rehabilitation of ILD patients.
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Affiliation(s)
- Karin Vonbank
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Antje Lehmann
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Bernitzky
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Stefan Simon
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Pavla Krotka
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ralf-Harun Zwick
- ThermeWienMed, Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Burtscher
- Department of Sports Sciences, Medical Section, University of Innsbruck, Innsbruck, Austria
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23
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Calegari L, Moreira I, Falkowski A, Reolão JBC, Karsten M, Deresz LF. Agreement between heart rate at first ventilatory threshold on treadmill and at 6-min walk test in coronary artery disease patients on β-blockers treatment. J Exerc Rehabil 2021; 17:362-368. [PMID: 34805026 PMCID: PMC8566104 DOI: 10.12965/jer.2142488.244] [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: 08/16/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to verify the accuracy of the agreement between heart rate at the first ventilatory threshold (HRVT1) and heart rate at the end of the 6-min walk test (HR6MWT) in coronary artery disease (CAD) patients on β-blockers treatment. This was a cross-sectional study with stable CAD patients, which performed a cardiopulmonary exercise test (CPET) on a treadmill and a 6-min walk test (6MWT) on nonconsecutive days. The accuracy of agreement between HRVT1 and HR6MWT was evaluated by Bland–Altman analysis and Lin’s concordance correlation coefficient (rc), mean absolute percentage error (MAPE), and standard error of estimate (SEE). Seventeen stable CAD patients on β-blockers treatment (male, 64.7%; age, 61±10 years) were included in data analysis. The Bland–Altman analysis revealed a negative bias of −0.41±6.4 bpm (95% limits of agreements, −13 to 12.2 bpm) between HRVT1 and HR6MWT. There was acceptable agreement between HRVT1 and HR6MWT (rc=0.84; 95% confidence interval, 0.63 to 0.93; study power analysis=0.79). The MAPE of the HR6MWT was 5.1% and SEE was 6.6 bpm. The ratio HRVT1/HRpeak and HR6MWT/HRpeak from CPET were not significantly different (81%±5% vs. 81%±6%, P=0.85); respectively. There was a high correlation between HRVT1 and HR6MWT (r=0.85, P<0.0001). Finally, the results of the present study demonstrate that there was an acceptable agreement between HRVT1 and HR6MWT in CAD patients on β-blockers treatment and suggest that HR6MWT may be useful to prescribe and control aerobic exercise intensity in cardiac rehabilitation programs.
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Affiliation(s)
- Leonardo Calegari
- Physical Therapy Department, Faculdade Especializada da Área da Saúde do Rio Grande do Sul (FASURGS), Passo Fundo, RS, Brazil
| | - Igor Moreira
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | - Andrei Falkowski
- Physical Therapy Department, Universidade de Passo Fundo (UPF), Passo Fundo, RS, Brazil
| | | | - Marlus Karsten
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Graduate Program in Physical Therapy, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil.,Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Physical Education Department, Health Sciences Institute, Universidade Federal de Juiz de Fora, Governador Valadares, Brazil.,Post Graduation Program in Health Applied Sciences, Universidade Federal de Juiz de Fora, Campus Governador Valadares, MG, Brazil.,Research Group Ciência, Saúde e Desempenho Físico, Universidade Federal de Juiz de Fora, Campus Governador Valadares, MG, Brazil
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24
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Keir DA, Iannetta D, Mattioni Maturana F, Kowalchuk JM, Murias JM. Identification of Non-Invasive Exercise Thresholds: Methods, Strategies, and an Online App. Sports Med 2021; 52:237-255. [PMID: 34694596 DOI: 10.1007/s40279-021-01581-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
During incremental exercise, two thresholds may be identified from standard gas exchange and ventilatory measurements. The first signifies the onset of blood lactate accumulation (the lactate threshold, LT) and the second the onset of metabolic acidosis (the respiratory compensation point, RCP). The ability to explain why these thresholds occur and how they are identified, non-invasively, from pulmonary gas exchange and ventilatory variables is fundamental to the field of exercise physiology and requisite to the understanding of core concepts including exercise intensity, assessment, prescription, and performance. This review is intended as a unique and comprehensive theoretical and practical resource for instructors, clinicians, researchers, lab technicians, and students at both undergraduate and graduate levels to facilitate the teaching, comprehension, and proper non-invasive identification of exercise thresholds. Specific objectives are to: (1) explain the underlying physiology that produces the LT and RCP; (2) introduce the classic non-invasive measurements by which these thresholds are identified by connecting variable profiles to underlying physiological behaviour; (3) discuss common issues that can obscure threshold detection and strategies to identify and mitigate these challenges; and (4) introduce an online resource to facilitate learning and standard practices. Specific examples of exercise gas exchange and ventilatory data are provided throughout to illustrate these concepts and a novel online application tool designed specifically to identify the estimated LT (θLT) and RCP is introduced. This application is a unique platform for learners to practice skills on real exercise data and for anyone to analyze incremental exercise data for the purpose of identifying θLT and RCP.
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Affiliation(s)
- Daniel A Keir
- School of Kinesiology, The University of Western Ontario, AHB 3G18, 1151 Richmond Street, London, ON, N6A 3K7, Canada. .,Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada.
| | - Danilo Iannetta
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - John M Kowalchuk
- School of Kinesiology, The University of Western Ontario, AHB 3G18, 1151 Richmond Street, London, ON, N6A 3K7, Canada.,Department of Physiology and Pharmacology, The University of Western Ontario, London, ON, Canada
| | - Juan M Murias
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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25
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Kominami K, Nishijima H, Imahashi K, Katsuragawa T, Murakami M, Akino M. Gas exchange threshold to guide exercise training intensity of older individuals during cardiac rehabilitation. Medicine (Baltimore) 2021; 100:e27540. [PMID: 34678888 PMCID: PMC8542148 DOI: 10.1097/md.0000000000027540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 09/29/2021] [Indexed: 01/05/2023] Open
Abstract
The gas exchange threshold (GET), which is determined during incremental exercise (Inc-Ex) testing, is often considered a safe training intensity for cardiac rehabilitation. However, there are only a limited number of reports on the actual implementation of this method. We assessed the applicability of GET-guided exercise using a constant load exercise (CL-Ex) protocol.We recruited 20 healthy older individuals (healthy, age: 69.4 ± 6.8 years) and 10 patients with cardiovascular diseases or risk factors (patient, age: 73.0 ± 8.8 years). On day 1, we determined the GET during symptomatic maximal Inc-Ex. On day 2, CL-Ex at work rate (watt: W) where the GET manifested during Inc-Ex (therefore, not corrected for the known oxygen response delay) was maintained for 20 minute. Arterialized blood lactate (BLa) levels were also determined.Oxygen uptake reached a steady state in all participants, with a mean respiratory exchange ratio of < 1.0. The mean BLa at the GET during Inc-Ex was 1.51 ± .29 mmol·l-1 in the healthy group and 1.78 ± .42 mmol·L-1 in the patient group, which was about .5 mmol·L-1 above the resting level. During CL-Ex, BLa increased significantly over the value at the GET (Inc-Ex). However, it reached a steady-state level of 2.65 ± 1.56 (healthy) and 2.53 ± 0.95 (patient) mmol·L-1. The %peak oxygen uptake, %peak heart rate, and %heart rate reserve during CL-Ex were 58.8 ± 11.5, 71.8 ± 10.3, and 44.9 ± 17.4, respectively. All participants could complete CL-Ex with mean perceived exertion ratings (Borg/20) of 11.8 ± 1.3 (healthy) and 12.2 ± 1.3 (patient). These heart rate-related indices and exertion ratings were all within the recommended international guidelines for cardiac rehabilitation.CL-Ex at the GET appears to be the optimal exercise intensity for cardiac rehabilitation.
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Affiliation(s)
- Kazuyuki Kominami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Hirotaka Nishijima
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
- Department of Cardiovascular Medicine, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Keiko Imahashi
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Toko Katsuragawa
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Mitsuyo Murakami
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
| | - Masatoshi Akino
- Cardiac Rehabilitation Center, Sapporo Ryokuai Hospital, Sapporo, Japan
- Department of Cardiovascular Medicine, Sapporo Ryokuai Hospital, Sapporo, Japan
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26
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Fassora M, Calanca L, Jaques C, Mazzolai L, Kayser B, Lanzi S. Intensity-dependent effects of exercise therapy on walking performance and aerobic fitness in symptomatic patients with lower-extremity peripheral artery disease: A systematic review and meta-analysis. Vasc Med 2021; 27:158-170. [PMID: 34579581 PMCID: PMC9003762 DOI: 10.1177/1358863x211034577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We investigated how nonpain-based exercise therapy intensity (light-to-moderate or vigorous) affects improvements in walking performance and cardiorespiratory fitness of patients with symptomatic lower-extremity peripheral artery disease (PAD). We searched the Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases up to April 2021 and included randomized controlled trials reporting training therapies targeting exercise intensity (heart rate, oxygen consumption, or perceived exertion). The main outcomes were walking performance (pain-free [PFWD] and maximal [MWD] walking distance) and cardiorespiratory fitness (V̇O2peak). Secondary subanalyses examined the training modality (walking or other modalities) and the approach (high-intensity interval or moderate-intensity training). A total of 1132 patients were included. Light-to-moderate was superior to vigorous exercise intensity in improving MWD (223 m [95% CI 174 to 271], p < 0.00001; 153 m [95% CI 113 to 193], p < 0.00001; respectively) and PFWD (130 m [95% CI 87 to 173], p < 0.00001; 83 m [95% CI 61 to 104], p < 0.00001; respectively). When training modalities were considered, walking at a vigorous intensity (272 m [95% CI 207 to 337], p < 0.00001) showed the largest improvement in MWD compared to other exercise modalities. A larger increase in V̇O2peak was observed following vigorous (3.0 mL O2·kg-1·min-1 [95% CI 2.4 to 3.6], p < 0.00001) compared to light-to-moderate (1.1 mL O2·kg-1·min-1 [95% CI 0.4 to 1.7], p = 0.001) exercise intensity. These results indicate that vigorous was less effective than light-to-moderate intensity in improving walking performance, whereas it was more effective in improving V̇O2peak. When the training modalities were considered, walking at a vigorous intensity showed the greatest improvement in MWD. (PROSPERO Registration No.: CRD42020199469).
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Affiliation(s)
- Mattia Fassora
- Institute of Sport Sciences of the University of Lausanne, Switzerland
| | - Luca Calanca
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Cécile Jaques
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences of the University of Lausanne, Switzerland
| | - Stefano Lanzi
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Switzerland
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27
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Anselmi F, Cavigli L, Pagliaro A, Valente S, Valentini F, Cameli M, Focardi M, Mochi N, Dendale P, Hansen D, Bonifazi M, Halle M, D’Ascenzi F. The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects. Scand J Med Sci Sports 2021; 31:1796-1808. [PMID: 34170582 PMCID: PMC8456830 DOI: 10.1111/sms.14007] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT1 ) and second ventilatory thresholds (VT2 ) in cardiac patients, sedentary subjects, and athletes comparing VT1 and VT2 with EI defined by recommendations. METHODS We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO2 , peak heart rate (HR), and HR reserve were obtained at VT1 and VT2 and compared with the EI definition proposed by the recommendations. RESULTS VO2 at VT1 corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO2 values at VT2 corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively). CONCLUSIONS EI definition based on percentages of peak HR and peak VO2 may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.
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Affiliation(s)
- Francesca Anselmi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Antonio Pagliaro
- Clinical and Surgical Cardiology UnitCardio‐Thoracic and Vascular DepartmentUniversity Hospital of SienaSienaItaly
| | - Serafina Valente
- Clinical and Surgical Cardiology UnitCardio‐Thoracic and Vascular DepartmentUniversity Hospital of SienaSienaItaly
| | - Francesca Valentini
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Matteo Cameli
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Marta Focardi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
| | - Nicola Mochi
- Sports Medicine UnitUSL Toscana CentroFlorenceItaly
| | - Paul Dendale
- Heartcentre HasseltJessa HospitalHasselt UniversityHasseltBelgium
| | - Dominique Hansen
- REVAL‐Rehabilitation Research CenterBIOMEDFaculty of Rehabilitation SciencesHasselt UniversityHasseltBelgium
| | - Marco Bonifazi
- Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
| | - Martin Halle
- Department of Preventive Sports Medicine and Sports CardiologyTechnical University of MunichMunichGermany
| | - Flavio D’Ascenzi
- Department of Medical BiotechnologiesDivision of CardiologyUniversity of SienaSienaItaly
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPAUSA
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28
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Seo YG, Oh S, Park WH, Jang M, Kim HY, Chang SA, Park IK, Sung J. Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review. J Thorac Dis 2021; 13:4530-4540. [PMID: 34422379 PMCID: PMC8339761 DOI: 10.21037/jtd-20-3296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/12/2021] [Indexed: 01/21/2023]
Abstract
Background Exercise intensity in exercise training programs is an important determinant of program efficacy, such as improvement in exercise capacity and quality of life (QOL). It is not well known whether differently applied exercise intensities are efficacious when used in exercise-based cardiac rehabilitation programs for patients with pulmonary arterial hypertension (PAH). Methods Three databases (PubMed, EMBASE, and CINAHL) were searched with the following inclusion criteria: comparative study of exercise interventions for patients with pulmonary arterial hypertension. Three clinical specialists (a physician, nurse, and exercise physiologist) selected the included articles using the process of systematic review. Included articles were grouped according to aerobic exercise intensity: low, moderate-to-vigorous, and vigorous. The level of evidence for each study was rated using Sackett’s levels of evidence. Results Of 1,452 studies reviewed, 8 were included according to the inclusion criteria (3 randomized controlled trials (RCTs), 3 prospective studies, and 2 case series). Exercise capacity for a six-minute walk distance (mean: 57.7 m) and QOL improved in the above moderate intensity group, while the low intensity group did not show improvement after intervention. For termination criteria, data obtained from the reviewed articles were not sufficient to suggest any exercise intensity recommendations for patients with pulmonary arterial hypertension. Discussion The findings in this study suggest that at least moderate aerobic exercise intensity is needed to significantly improve six-minute walk distance and QOL in individuals diagnosed with World Health Organization Group 1 of pulmonary arterial hypertension. There is a need for prospective RCTs comparing different exercise intensities in this patient population.
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Affiliation(s)
- Yong-Gon Seo
- Division of Sports Medicine, Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Suki Oh
- Division of Sports Medicine, Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Won-Hah Park
- Division of Sports Medicine, Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Mija Jang
- Department of Nursing, Rehabilitation & Prevention Center, Cardiac Center, Heart Stroke & Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ho-Young Kim
- Cardiac Rehabilitation and Prevention Center, Heart Stroke & Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Imaging Center, Heart Stroke & Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - In-Kyung Park
- Division of Cardiology, Department of Internal Medicine, Rehabilitation & Prevention Center, Heart Stroke & Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jidong Sung
- Division of Cardiology, Department of Internal Medicine, Rehabilitation & Prevention Center, Heart Stroke & Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Gao Y, Feng B, Hu R, Zhang Y, Shi Y, Xu Y, Ma J. Differential Evaluating Effect on Exercise Capacity of Cardiopulmonary Exercise Testing and Treadmill Exercise Testing in Post-percutaneous Coronary Intervention Patients. Front Cardiovasc Med 2021; 8:682253. [PMID: 34395556 PMCID: PMC8355352 DOI: 10.3389/fcvm.2021.682253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Treadmill exercise testing (TET) is commonly used to measure exercise capacity. Studies have shown that cardiopulmonary exercise testing (CPET) is more accurate than TET and is, therefore, regarded as the "gold standard" for testing maximum exercise capacity and prescribing exercise plans. To date, no studies have reported the differences in exercise capacity after percutaneous coronary intervention (PCI) using the two methods or how to more accurately measure exercise capacity based on the results of TET. Aims: This study aims to measure maximum exercise capacity in post-PCI patients and to recommend exercise intensities that ensure safe levels of exercise. Methods: We enrolled 41 post-PCI patients who were admitted to the Cardiac Rehabilitation Clinic at the First Medical Center, the Chinese PLA General Hospital, from July 2015 to June 2016. They completed CPET and TET. The paired sample t-test was used to compare differences in measured exercise capacity, and multiple linear regression was applied to analyze the factors that affected the difference. Results: The mean maximum exercise capacity measured by TET was 8.89 ± 1.53 metabolic equivalents (METs), and that measured by CPET was 5.19 ± 1.23 METs. The difference between them was statistically significant (p = 0.000) according to the paired sample t-test. The difference averaged 40.15% ± 2.61% of the exercise capacity measured by TET multiple linear regression analysis showed that the difference negatively correlated with waist-hip ratio (WHR). Conclusion: For the purpose of formulating more accurate exercise prescription, the results of TET should be appropriately adjusted when applied to exercise capacity assessment. Clinical Trial Registration:http://www.chictr.org.cn/ number, ChiCTR2000031543.
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Affiliation(s)
- Yifan Gao
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Bin Feng
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Rong Hu
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - YingYue Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yajun Shi
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yong Xu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Ma
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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Birnbaumer P, Traninger H, Sattler MC, Borenich A, Hofmann P. Pattern of the Heart Rate Performance Curve in Subjects with Beta-Blocker Treatment and Healthy Controls. J Funct Morphol Kinesiol 2021; 6:jfmk6030061. [PMID: 34287331 PMCID: PMC8293437 DOI: 10.3390/jfmk6030061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022] Open
Abstract
(1): Heart rate performance curve (HRPC) in incremental exercise was shown to be not uniform, causing false intensity estimation applying percentages of maximal heart rate (HRmax). HRPC variations are mediated by β-adrenergic receptor sensitivity. The aim was to study age and sex dependent differences in HRPC patterns in adults with β-blocker treatment (BB) and healthy controls (C). (2): A total of 535 (102 female) BB individuals were matched 1:1 for age and sex (male 59 ± 11 yrs, female 61 ± 11 yrs) in C. From the maximum incremental cycle ergometer exercise a first and second heart rate (HR) threshold (Th1 and Th2) was determined. Based on the degree of the deflection (kHR), HRPCs were categorized as regular (downward deflection (kHR > 0.1)) and non-regular (upward deflection (kHR < 0.1), linear time course). (3): Logistic regression analysis revealed a higher odds ratio to present a non-regular curve in BB compared to C (females showed three times higher odds). The odds for non-regular HRPC in BB versus C decreased with older age (OR interaction = 0.97, CI = 0.94-0.99). Maximal and submaximal performance and HR variables were significantly lower in BB (p < 0.05). %HRmax was significantly lower in BB versus C at Th2 (male: 77.2 ± 7.3% vs. 80.8 ± 5.0%; female: 79.2 ± 5.1% vs. 84.0 ± 4.3%). %Pmax at Th2 was similar in BB and C. (4): The HRPC pattern in incremental cycle ergometer exercise is different in individuals receiving β-blocker treatment compared to healthy individuals. The effects were also dependent on age and sex. Relative HR values at Th2 varied substantially depending on treatment. Thus, the percentage of Pmax seems to be a stable and independent indicator for exercise intensity prescription.
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Affiliation(s)
- Philipp Birnbaumer
- Institute of Human Movement Science, Sport & Health, University of Graz, 8010 Graz, Austria; (P.B.); (M.C.S.)
| | - Heimo Traninger
- ZARG Centre for Outpatient Rehabilitation, 8021 Graz, Austria;
| | - Matteo C. Sattler
- Institute of Human Movement Science, Sport & Health, University of Graz, 8010 Graz, Austria; (P.B.); (M.C.S.)
| | - Andrea Borenich
- Department of Production and Operations Management, University of Graz, 8010 Graz, Austria;
| | - Peter Hofmann
- Institute of Human Movement Science, Sport & Health, University of Graz, 8010 Graz, Austria; (P.B.); (M.C.S.)
- Correspondence: ; Tel.: +43-316-380-3903
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31
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Giallauria F. Editorial to 'The effect of high-intensity interval training on exercise capacity in post-myocardial infarction patients: a systematic review and meta-analysis'. Eur J Prev Cardiol 2021; 29:473-474. [PMID: 34089586 DOI: 10.1093/eurjpc/zwab072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Francesco Giallauria
- Department of Translational Medical Sciences, "Federico II" University of Naples, Naples, Italy
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32
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Evaluating the Accuracy of Using Fixed Ranges of METs to Categorize Exertional Intensity in a Heterogeneous Group of Healthy Individuals: Implications for Cardiorespiratory Fitness and Health Outcomes. Sports Med 2021; 51:2411-2421. [PMID: 33900580 DOI: 10.1007/s40279-021-01476-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Appropriate quantification of exertional intensity remains elusive. OBJECTIVE To compare, in a large and heterogeneous cohort of healthy females and males, the commonly used intensity classification system (i.e., light, moderate, vigorous, near-maximal) based on fixed ranges of metabolic equivalents (METs) to an individualized schema based on the exercise intensity domains (i.e., moderate, heavy, severe). METHODS A heterogenous sample of 565 individuals (females 165; males 400; age range 18-83 years old) were included in the study. Individuals performed a ramp-incremental exercise test from which gas exchange threshold (GET), respiratory compensation point (RCP) and maximum oxygen uptake (VO2max) were determined to build the exercise intensity domain schema (moderate = METs ≤ GET; heavy = METs > GET but ≤ RCP; severe = METs > RCP) for each individual. Pearson's chi-square tests over contingency tables were used to evaluate frequency distribution within intensity domains at each MET value. A multi-level regression model was performed to identify predictors of the amplitude of the exercise intensity domains. RESULTS A critical discrepancy existed between the confines of the exercise intensity domains and the commonly used fixed MET classification system. Overall, the upper limit of the moderate-intensity domain ranged between 2 and 13 METs and of the heavy-intensity domain between 3 and 18 METs, whereas the severe-intensity domain included METs from 4 onward. CONCLUSIONS Findings show that the common practice of assigning fixed values of METs to relative categories of intensity risks misclassifications of the physiological stress imposed by exercise and physical activity. These misclassifications can lead to erroneous interpretations of the dose-response relationship of exercise and physical activity.
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Abstract
2020 es el año de la pandemia de COVID-19, durante la cual los pacientes con enfermedad cardiovascular o factores de riesgo han tenido mayor morbimortalidad. Por ello, la prevención cardiovascular y la rehabilitación cardiaca (RC) se hacen más imprescindibles que nunca. El tratamiento con fármacos protectores cardiovasculares y renales en diabetes es imparable y se actualiza en un nuevo algoritmo. El abandono del tabaco, control de la hipertensión, dislipemia, sedentarismo y obesidad se consideran prioritarios. La e-medicina se ha implementado como nunca en prevención; para llegar al máximo de pacientes, los programas de RC dejan de ser mayoritariamente presenciales para hacerse online y e-supervisados. La pandemia se convierte en una oportunidad para impulsar la prevención y la RC, más necesarias que nunca y para todos.
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Conti V, Corbi G, Polito MV, Ciccarelli M, Manzo V, Torsiello M, De Bellis E, D’Auria F, Vitulano G, Piscione F, Carrizzo A, Di Pietro P, Vecchione C, Ferrara N, Filippelli A. Sirt1 Activity in PBMCs as a Biomarker of Different Heart Failure Phenotypes. Biomolecules 2020; 10:biom10111590. [PMID: 33238655 PMCID: PMC7700185 DOI: 10.3390/biom10111590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
Heart Failure (HF) is a syndrome, which implies the existence of different phenotypes. The new categorization includes patients with preserved ejection fraction (HFpEF), mid-range EF (HFmrEF), and reduced EF (HFrEF) but the molecular mechanisms involved in these HF phenotypes have not yet been exhaustively investigated. Sirt1 plays a crucial role in biological processes strongly related to HF. This study aimed to evaluate whether Sirt1 activity was correlated with EF and other parameters in HFpEF, HFmrEF, and HFrEF. Seventy patients, HFpEF (n = 23), HFmrEF (n = 23) and HFrEF (n = 24), were enrolled at the Cardiology Unit of the University Hospital of Salerno. Sirt1 activity was measured in peripheral blood mononuclear cells (PBMCs). Angiotensin-Converting Enzyme 2 (ACE2) activity, Tumor Necrosis Factor-alpha (TNF-α) and Brain Natriuretic Peptide (BNP) levels were quantified in plasma. HFpEF showed lower Sirt1 and ACE2 activities than both HFmrEF and HFrEF (p < 0.0001), without difference compared to No HF controls. In HFmrEF and HFrEF a very strong correlation was found between Sirt1 activity and EF (r2 = 0.899 and r2 = 0.909, respectively), and between ACE2 activity and Sirt1 (r2 = 0.801 and r2 = 0.802, respectively). HFrEF showed the highest TNF-α levels without reaching statistical significance. Significant differences in BNP were found among the groups, with the highest levels in the HFrEF. Determining Sirt1 activity in PBMCs is useful to distinguish the HF patients’ phenotypes from each other, especially HFmrEF/HFrEF from HFpEF.
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Affiliation(s)
- Valeria Conti
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | - Maria Vincenza Polito
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Valentina Manzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Correspondence: ; Tel.: +39-089-672-424
| | - Martina Torsiello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Emanuela De Bellis
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Federica D’Auria
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Gennaro Vitulano
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Federico Piscione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Department of Vascular Physiopathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
- Department of Vascular Physiopathology, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy;
- Istituti Clinici Scientifici Maugeri SPA-Società Benefit, IRCCS, 82037 Telese Terme (BN), Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (V.C.); (M.V.P.); (M.C.); (M.T.); (E.D.B.); (F.D.); (G.V.); (F.P.); (A.C.); (P.D.P.); (C.V.); (A.F.)
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35
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Training intensity and improvements in exercise capacity in elderly patients undergoing European cardiac rehabilitation - the EU-CaRE multicenter cohort study. PLoS One 2020; 15:e0242503. [PMID: 33186408 PMCID: PMC7665625 DOI: 10.1371/journal.pone.0242503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/04/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Guidelines for exercise intensity prescription in Cardiac Rehabilitation (CR) are inconsistent and have recently been discussed controversially. We aimed (1) to compare training intensities between European CR centres and (2) to assess associations between training intensity and improvement in peak oxygen consumption ([Formula: see text]O2) in elderly CR patients. METHODS Peak [Formula: see text]O2, heart rate and work rate (WR) at the first and second ventilatory thresholds were measured at start of CR. Training heart rate was measured during three sessions spread over the CR. Multivariate models were used to compare training characteristics between centres and to assess the effect of training intensity on change in peak [Formula: see text]O2. RESULTS Training intensity was measured in 1011 out of 1633 EU-CaRE patients in 7 of 8 centers and the first and secondary ventilatory threshold were identified in 1166 and 817 patients, respectively. The first and second ventilatory threshold were found at 44% (SD 16%) and 78% (SD 9%) of peak WR and 78% (SD 9%) and 89% (SD 5%) of peak heart rate, respectively. Training intensity and session duration varied significantly between centres but change in peak [Formula: see text]O2 over CR did not. Training above the first individual threshold (β 0.62, 95% confidence interval [0.25-1.02]) and increase in training volume per hour (β 0.06, 95%CI [0.01-0.12]) were associated with a higher change in peak [Formula: see text]O2. CONCLUSION While training intensity and volume varied greatly amongst current European CR programs, changes in peak [Formula: see text]O2 were similar and the effect of training characteristics on these changes were small.
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Mitsiou G, Karatzanos E, Smilios I, Psarra K, Patsaki I, Douda HT, Ntalianis A, Nanas S, Tokmakidis SP. Exercise promotes endothelial progenitor cell mobilization in patients with chronic heart failure. Eur J Prev Cardiol 2020; 28:e24-e27. [PMID: 33624043 DOI: 10.1093/eurjpc/zwaa046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/28/2020] [Accepted: 08/08/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Georgios Mitsiou
- Clinical Ergophysiology and Exercise Physiology Laboratory, Department of Physical Education and Sport Science, Democritus University of Thrace, Panepistimioupoli, 69100 Komotini, Greece.,1st Critical Care Department, Evangelismos General Hospital, Department of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75 Athens, Greece
| | - Eleftherios Karatzanos
- 1st Critical Care Department, Evangelismos General Hospital, Department of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75 Athens, Greece
| | - Ilias Smilios
- Clinical Ergophysiology and Exercise Physiology Laboratory, Department of Physical Education and Sport Science, Democritus University of Thrace, Panepistimioupoli, 69100 Komotini, Greece
| | - Katherina Psarra
- Immunology and Histocompatibility Department, Evangelismos General Hospital, 45-47 Ypsilantou Str, 106 75 Athens, Greece
| | - Irini Patsaki
- 1st Critical Care Department, Evangelismos General Hospital, Department of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75 Athens, Greece
| | - Helen T Douda
- Clinical Ergophysiology and Exercise Physiology Laboratory, Department of Physical Education and Sport Science, Democritus University of Thrace, Panepistimioupoli, 69100 Komotini, Greece
| | - Argyrios Ntalianis
- Department of Clinical Therapeutics, University of Athens, Alexandra General Hospital, 80 Vassilissis Sofias Av., 115 28 Athens, Greece
| | - Serafeim Nanas
- 1st Critical Care Department, Evangelismos General Hospital, Department of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75 Athens, Greece
| | - Savvas P Tokmakidis
- Clinical Ergophysiology and Exercise Physiology Laboratory, Department of Physical Education and Sport Science, Democritus University of Thrace, Panepistimioupoli, 69100 Komotini, Greece.,1st Critical Care Department, Evangelismos General Hospital, Department of Medicine, National and Kapodistrian University of Athens, 45-47 Ypsilantou Str., 106 75 Athens, Greece
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Ibeggazene S, Moore C, Tsakirides C, Swainson M, Ispoglou T, Birch K. UK cardiac rehabilitation fit for purpose? A community-based observational cohort study. BMJ Open 2020; 10:e037980. [PMID: 33040006 PMCID: PMC7549464 DOI: 10.1136/bmjopen-2020-037980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/18/2020] [Accepted: 08/28/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables. DESIGN Observational cohort study. SETTING Outpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks. PARTICIPANTS Sixty patients (45 male/15 female 33-86 years) were recruited following referral to local outpatient CR. OUTCOME MEASURES The primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours. RESULTS The mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05). CONCLUSION Patients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.
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Affiliation(s)
- Saïd Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Chelsea Moore
- Department of Sport and Exercise Sciences, Wrexham Glyndwr University, Wrexham, Clwyd, UK
| | - Costas Tsakirides
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Michelle Swainson
- Lancaster University Lancaster Medical School, Lancaster, Lancashire, UK
| | - Theocharis Ispoglou
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Karen Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Gronwald T, Rogers B, Hoos O. Fractal Correlation Properties of Heart Rate Variability: A New Biomarker for Intensity Distribution in Endurance Exercise and Training Prescription? Front Physiol 2020; 11:550572. [PMID: 33071812 PMCID: PMC7531235 DOI: 10.3389/fphys.2020.550572] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022] Open
Abstract
Exercise and training prescription in endurance-type sports has a strong theoretical background with various practical applications based on threshold concepts. Given the challenges and pitfalls of determining individual training zones on the basis of subsystem indicators (e.g., blood lactate concentration, respiratory parameters), the question arises whether there are alternatives for intensity distribution demarcation. Considering that training in a low intensity zone substantially contributes to the performance outcome of endurance athletes and exceeding intensity targets based on a misleading aerobic threshold can lead to negative performance and recovery effects, it would be desirable to find a parameter that could be derived via non-invasive, low cost and commonly available wearable devices. In this regard, analytics conducted from non-linear dynamics of heart rate variability (HRV) have been adapted to gain further insights into the complex cardiovascular regulation during endurance-type exercise. Considering the reciprocal antagonistic behavior and the interaction of the sympathetic and parasympathetic branch of the autonomic nervous system from low to high exercise intensities, it may be promising to use an approach that utilizes information about the regulation quality of the organismic system to determine training-intensity distribution. Detrended fluctuation analysis of HRV and its short-term scaling exponent alpha1 (DFA-alpha1) seems suitable for applied sport-specific settings including exercise from low to high intensities. DFA-alpha1 may be taken as an indicator for exercise prescription and intensity distribution monitoring in endurance-type sports. The present perspective illustrates the potential of DFA-alpha1 for diagnostic and monitoring purposes as a “global” system parameter and proxy for organismic demands.
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Affiliation(s)
- Thomas Gronwald
- Department of Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Bruce Rogers
- Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, FL, United States
| | - Olaf Hoos
- Center for Sports and Physical Education, Julius Maximilians University of Würzburg, Würzburg, Germany
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Halasz G, Piepoli MF. Focus on exercise and sport cardiology. Eur J Prev Cardiol 2020; 27:1459-1462. [DOI: 10.1177/2047487320952601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Geza Halasz
- Heart Failure Unit, G da Saliceto Hospital, Italy
| | - Massimo F Piepoli
- Heart Failure Unit, G da Saliceto Hospital, Italy
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Italy
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Nichols S, McGregor G, Breckon J, Ingle L. Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure. Int J Sports Med 2020; 42:19-26. [PMID: 32650344 DOI: 10.1055/a-1198-5573] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cardiac rehabilitation is a package of lifestyle secondary prevention strategies designed for patients with coronary heart disease and chronic heart failure. A community-based cardiac rehabilitation programme provides patients with a structured exercise training intervention alongside educational support and psychological counselling. This review provides an update regarding the clinical benefits of community-based cardiac rehabilitation from a psycho-physiological perspective, and also focuses on the latest epidemiological evidence regarding potential survival benefits. Behaviour change is key to long-term adoption of a healthy and active lifestyle following a cardiac event. In order for lifestyle interventions such as structured exercise interventions to be adopted by patients, practitioners need to ensure that behaviour change programmes are mapped against patient's priorities and values, and adapted to their level of readiness and intention to engage with the target behaviour. We review the evidence regarding behaviour change strategies for cardiac patients and provide practitioners with the latest guidance. The 'dose' of exercise training delivered to patients attending exercise-based cardiac rehabilitation is an important consideration because an improvement in peak oxygen uptake requires an adequate physiological stimulus to invoke positive physiological adaptation. We conclude by critically reviewing the latest evidence regarding exercise dose for cardiac patients including the role of traditional and more contemporary training interventions including high intensity interval training.
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Affiliation(s)
- Simon Nichols
- Sheffield Hallam University Centre for Sports and Exercise Science, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Gordon McGregor
- University Hospital Coventry and Warwickshire National Health Service Trust, Coventry, Coventry University, United Kingdom of Great Britain and Northern Ireland
| | - Jeff Breckon
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, United Kingdom of Great Britain and Northern Ireland
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Cavigli L, Olivotto I, Fattirolli F, Mochi N, Favilli S, Mondillo S, Bonifazi M, D'Ascenzi F. Prescribing, dosing and titrating exercise in patients with hypertrophic cardiomyopathy for prevention of comorbidities: Ready for prime time. Eur J Prev Cardiol 2020; 28:1093-1099. [PMID: 33611579 DOI: 10.1177/2047487320928654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/02/2020] [Indexed: 01/09/2023]
Abstract
The benefits of physical activity are well established, leading to both cardiovascular and non-cardiovascular benefits, improving quality of life and reducing mortality. Despite such striking body of evidence, patients with hypertrophic cardiomyopathy are often discouraged by health professionals to practice physical activity and personalised exercise prescription is an exception rather than the rule. As a result, hypertrophic cardiomyopathy patients are on average less active and spend significantly less time at work or recreational physical activity than the general population. Exercise restriction derives from the evidence that vigorous exercise may occasionally trigger life-threatening arrhythmias and sudden cardiac death. However, while participation in competitive sports should be prudentially denied, hypertrophic cardiomyopathy patients can benefit from the positive effects of regular physical activity, aimed to reduce the risk of comorbidities and improve the quality of life. Based on this rationale, exercise should be prescribed and titrated just like a drug in hypertrophic cardiomyopathy patients, considering individual characteristics, symptoms, past medical history, objective individual response to exercise, previous training experience and stage of disease. Type, frequency, duration, and intensity should be defined on a personal basis. Yet exercise prescription in hypertrophic cardiomyopathy and its long-term effects represent major gaps in our current knowledge and require extensive research. We here review existing evidence regarding benefits and hazards of physical activity, with specific focus on viable modalities for tailored and safe exercise prescription in these patients, highlighting future developments and relevant research targets.
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Affiliation(s)
- Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.,Department of Medicine, University of Pittsburgh, USA
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Claes J, Buys R, Avila A, Cornelis N, Goetschalckx K, Cornelissen VA. Lifelong changes in physical activity behaviour through phase II cardiac rehabilitation? Still steps to take! Eur J Prev Cardiol 2020; 28:e17-e19. [PMID: 32484047 DOI: 10.1177/2047487320929451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Claes
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - R Buys
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - A Avila
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - N Cornelis
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - K Goetschalckx
- Department of Cardiovascular Sciences, KU Leuven, Belgium
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43
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Techniques de renforcement musculaire en réadaptation cardiaque. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX - PRATIQUE 2020; 2020:16-21. [PMID: 32562474 PMCID: PMC7243777 DOI: 10.1016/j.amcp.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
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45
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Davos CH. Do we have to reconsider the guidelines for exercise intensity determination in cardiovascular rehabilitation? Eur J Prev Cardiol 2019; 26:1918-1920. [PMID: 31446786 DOI: 10.1177/2047487319871870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
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