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Margolis G, Cohen O, Roguin A. Vigorous physical activity and atrial fibrillation in healthy individuals: What is the correct approach? Clin Cardiol 2024; 47:e24237. [PMID: 38440948 PMCID: PMC10913085 DOI: 10.1002/clc.24237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Sport activity compared to sedentary life is associated with improved wellbeing and risk reduction in many different health conditions including atrial fibrillation (AF). Vigorous physical activity is associated with increased AF risk. We describe four individuals, who regularly perform endurance sport activity and developed AF. We discuss the changes occurring in the heart of endurance athletes and the possible etiology for AF, as well as currently available treatment options in this seemingly healthy population. Although the etiology of AF in the general population differs from the one in the usually younger endurance sport activity population, the treatment options are similar. There are several factors unique to those involved in vigorous physical activity that can influence their management. Despite a lack of evidence, endurance athletes with AF have traditionally been advised to "de-training," to reduce both the amount and intensity of exercise. Some of the current offered treatment options (beta-blockers, class III antiarrhythmic) have a varied range of adverse effect, hindering them unattractive for these individuals. Depending on risk stratification tools, anticoagulation may be indicated. Some suggest an intermittent dosing therapy, while others recommend following current guidelines. AF ablation is recommended in exercising individuals with recurrent, symptomatic AF and/or in those who do not want drug therapy, given its impact on athletic performance, AF treatment decisions should be individualized for those engaging vigorous physical activity, while considering the potential risks, the urgency of returning to training, and the will and expectations of the patient.
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Affiliation(s)
- Gilad Margolis
- Hillel Yaffe Medical CenterCardiology DepartmentHaderaIsrael
- Ruth and Bruc Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
| | - Oshri Cohen
- Hillel Yaffe Medical CenterCardiology DepartmentHaderaIsrael
- Ruth and Bruc Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
| | - Ariel Roguin
- Hillel Yaffe Medical CenterCardiology DepartmentHaderaIsrael
- Ruth and Bruc Rappaport Faculty of MedicineTechnion Israel Institute of TechnologyHaifaIsrael
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2
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities. Pediatrics 2023; 151:190446. [PMID: 36622098 DOI: 10.1542/peds.2022-060643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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3
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Prevalence of Elevated Blood Pressure and Risk Factors for Hypertension in College Athletes. Clin J Sport Med 2022; 32:e74-e82. [PMID: 34184859 DOI: 10.1097/jsm.0000000000000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the prevalence and risk factors for hypertension (HTN) in college athletes using the new (≥130/80 mm Hg) versus prior (≥140/90 mm Hg) US hypertension guidelines. DESIGN Retrospective cohort study. SETTING Eleven Pacific-12 Conference institutions. PARTICIPANTS Of the 8602 athletes enrolled in the primary study, 4977 (57.9%) met inclusion criteria. Athletes were included in the study if age <30 and blood pressure (BP), baseline demographics (age, weight, height, sex, and race), and primary sport were available. INDEPENDENT VARIABLES Age, sex, race, height, weight, body mass index, and primary sport. MAIN OUTCOME MEASURES Elevated BP of ≥130/80 mm Hg and/or ≥140/90 mm Hg. RESULTS Normal BP (<130/80) was present in 3214 (64.6%) athletes and 1763 (35.4%) had BP ≥ 130/80, including 460 (9.2%) with BP ≥ 140/90. Male athletes had a higher prevalence of BP ≥ 130/80 (46.7% vs 21.5%; P < 0.001) and BP ≥ 140/90 (14.2% vs 3.1%; P < 0.001) compared to female athletes. Independent risk factors from multivariate analyses for BP ≥ 130/80 included: older age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.00-1.11, P = 0.04), male sex (OR = 1.97, 95% CI 1.65-2.35, P < 0.001), heavier weight (OR = 1.03, 95% CI 1.02-1.03, P < 0.001), and baseball as the primary sport (OR = 1.47, 95% CI 1.14-1.90, P < 0.01). Independent risk factors for BP ≥ 140/90 mm Hg included: male sex (OR = 3.54, 95% CI 2.55-4.97, P < 0.001) and heavier weight (OR = 1.03, 95% CI 1.02-1.04, P < 0.001). CONCLUSIONS In a large, diverse cohort of matriculating college athletes from multiple institutions, over one-third presented with elevated BP ≥ 130/80 mm Hg, which was more common in older male athletes with larger body size and baseball players.
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Baker-Smith CM, Pietris N, Jinadu L. Recommendations for exercise and screening for safe athletic participation in hypertensive youth. Pediatr Nephrol 2020; 35:743-752. [PMID: 31025109 DOI: 10.1007/s00467-019-04258-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 01/19/2023]
Abstract
Physical activity is an important component of ideal cardiovascular health. Current guidelines recommend that youth with hypertension participate in competitive sports once hypertensive target organ effects and risks have been assessed and that children with hypertension receive treatment to lower BP below stage 2 thresholds (e.g., < 140/90 mmHg or < 95th percentile + 12 mmHg) before participating in competitive sports. Despite these recommendations, pediatricians and pediatric subspecialists continue to struggle with how best to counsel their patients regarding appropriate forms of physical activity, the impact of exercise on blood pressure, and how best to screen for cardiovascular conditions that place youth at risk for sudden cardiac death. This review provides a summary of our current knowledge regarding the safety and utility of exercise in the management of high blood pressure in youth. We review determinants of blood pressure during exercise, the impact of blood pressure on cardiovascular health and structure, mechanisms for assessing cardiometabolic fitness (e.g., exercise stress test), contraindications to athletic participation, and how best to plan for athletic participation among hypertensive youth. Greater knowledge in these areas may offer clarity to providers faced with the challenge of prescribing exercise recommendations for hypertensive youth.
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Affiliation(s)
- Carissa M Baker-Smith
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Nicholas Pietris
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Laide Jinadu
- Department of Pediatrics, Valley Children's Medical Center, Madera, CA, USA
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Achkasov E, Bondarev S, Smirnov V, Waśkiewicz Z, Rosemann T, Nikolaidis PT, Knechtle B. Atrial Fibrillation in Athletes-Features of Development, Current Approaches to the Treatment, and Prevention of Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4890. [PMID: 31817190 PMCID: PMC6950061 DOI: 10.3390/ijerph16244890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022]
Abstract
Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmias. This review article highlights the problem of the development of atrial fibrillation in individuals engaged in physical activity and sports. Predisposing factors, causes, and development mechanisms of atrial fibrillation in athletes from the perspective of the authors are described. Methods of treatment, as well as prevention of thromboembolic complications, are discussed. Directions for further studies of this problem and prevention of complications are proposed.
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Affiliation(s)
- Evgeny Achkasov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
| | - Sergey Bondarev
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
| | - Victor Smirnov
- Department of Hospital Therapy, Saint-Petersburg State Pediatric Medical University Ministry of Health of Russia, Saint Petersburg 194100, Russia;
| | - Zbigniew Waśkiewicz
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia; (E.A.); (S.B.); (Z.W.)
- Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland;
| | | | - Beat Knechtle
- Exercise Physiology Laboratory, 18450 Nikaia, Greece;
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
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Berkowitz JN, Skinner AC, Lohr JA. Carrying the Weight: Athletics and Obesity in High School Football Players. Clin Pediatr (Phila) 2019; 58:1409-1414. [PMID: 31142142 DOI: 10.1177/0009922819850495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article determines the prevalence of obesity among high school football players nationwide and compares obesity between position groups of football players and across team sports. We calculate body mass index (BMI) for 391 212 males participating in baseball, basketball, football, lacrosse, and soccer, then stratify BMI into commonly accepted categories and subdivide football players by position played, comparing BMI across position groups and sports. A total of 47.4% of high school football players are healthy weight (BMI = 18.5-24.9 kg/m2), 18.0% have obesity (BMI = 30-34.9 kg/m2: 12.4%) or class 2 obesity (BMI >34.9 kg/m2: 5.6%). Among linemen, 14.8% are healthy weight, 14.6% have class 2 obesity, and another 29.3% have obesity. Among non-linemen, the combined prevalence of obesity and class 2 obesity is 2.7%, comparable to other team sports. Obesity is common among high school football players, more so than among other high school athletes. Obesity and class 2 obesity are only common among linemen.
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Affiliation(s)
| | | | - Jacob A Lohr
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Krysztofiak H, Młyńczak M, Małek ŁA, Folga A, Braksator W. Left ventricular mass is underestimated in overweight children because of incorrect body size variable chosen for normalization. PLoS One 2019; 14:e0217637. [PMID: 31141818 PMCID: PMC6541472 DOI: 10.1371/journal.pone.0217637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 05/15/2019] [Indexed: 01/20/2023] Open
Abstract
Background Left ventricular mass normalization for body size is recommended, but a question remains: what is the best body size variable for this normalization—body surface area, height or lean body mass computed based on a predictive equation? Since body surface area and computed lean body mass are derivatives of body mass, normalizing for them may result in underestimation of left ventricular mass in overweight children. The aim of this study is to indicate which of the body size variables normalize left ventricular mass without underestimating it in overweight children. Methods Left ventricular mass assessed by echocardiography, height and body mass were collected for 464 healthy boys, 5–18 years old. Lean body mass and body surface area were calculated. Left ventricular mass z-scores computed based on reference data, developed for height, body surface area and lean body mass, were compared between overweight and non-overweight children. The next step was a comparison of paired samples of expected left ventricular mass, estimated for each normalizing variable based on two allometric equations—the first developed for overweight children, the second for children of normal body mass. Results The mean of left ventricular mass z-scores is higher in overweight children compared to non-overweight children for normative data based on height (0.36 vs. 0.00) and lower for normative data based on body surface area (-0.64 vs. 0.00). Left ventricular mass estimated normalizing for height, based on the equation for overweight children, is higher in overweight children (128.12 vs. 118.40); however, masses estimated normalizing for body surface area and lean body mass, based on equations for overweight children, are lower in overweight children (109.71 vs. 122.08 and 118.46 vs. 120.56, respectively). Conclusion Normalization for body surface area and for computed lean body mass, but not for height, underestimates left ventricular mass in overweight children.
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Affiliation(s)
- Hubert Krysztofiak
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- National Centre for Sports Medicine, Warsaw, Poland
- * E-mail:
| | - Marcel Młyńczak
- Warsaw University of Technology, Faculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw Poland
| | - Łukasz A. Małek
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | | | - Wojciech Braksator
- Department of Sports Cardiology and Noninvasive Cardiovascular Imaging, 2nd Medical Faculty, Medical University of Warsaw, Warsaw, Poland
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Chu L, Timmons BW. Nutritional Considerations for Sport Participation in Children and Adolescents With Obesity. Am J Lifestyle Med 2019; 13:129-137. [PMID: 30800016 PMCID: PMC6378498 DOI: 10.1177/1559827617751684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a high prevalence of children with obesity who are participating in sports. Appropriate nutritional considerations are important to optimize health and training adaptations. This review focuses on macronutrient recommendations and their effect on weight management and/or benefits for athletic training for children ages 5 to 18 years. Equal distribution of protein intake throughout the day (~25-30 g/meal) and during postexercise recovery is recommended. Special attention should be given to increasing protein intake during breakfast because it is often the meal with the least protein intake. Both postexercise recommendations for protein (~0.3 g/kg of body weight) and carbohydrate (~1.0-1.2 g/kg/h) were not determined in children with obesity, and require future verification. Individual carbohydrate needs of training to meet fuel costs are recommended, but ~200 to 500 g/day of carbohydrate may be required depending on a child's level of sport participation and competition. Fat intake should follow general recommendations to meet the accepted macronutrient distribution range in children (25% to 35%) and reduce saturated fat intake. No evidence suggests that additional dietary fat modifications would improve training adaptations in children. Longitudinal studies are required to further our understanding of age and sex effects and confirm the appropriate quantity of macronutrients for active children with obesity.
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Affiliation(s)
- Lisa Chu
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Brian W. Timmons
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Georgiev AM, Krajnović D, Kotur-Stevuljević J, Ignjatović S, Marinković V. Undiagnosed Hyperglycaemia and Hypertension as Indicators of the Various Risk Factors of Future Cardiovascular Disease Among Population of Serbian Students. J Med Biochem 2018; 37:289-298. [PMID: 30598625 PMCID: PMC6298463 DOI: 10.1515/jomb-2017-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/29/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A number of risk behaviours, such as smoking, overweight, excessive alcohol intake, insufficient physical activity, excessive and frequent intake of salt, reduced fruit and vegetable intake, increased fat intake, which constitute living habits of an individual can influence the occurrence of hypertension and hyperglycaemia. The changing of these lifestyles can reduce the risk of developing prehypertension and prediabetes. METHODS The survey was conducted at student's campuses. The respondents were subjected to the height, weight, blood glucose and blood pressure. Respondents filled in previously created questionnaire that was approved by the Ethics Committee for Biomedical Research Faculty of Pharmacy, University of Belgrade. RESULTS The percentage of respondents with a glucose value above the reference value was 14.6% (n=19), 2.4% (n=3) had values greater than 7 mmol/L without being diagnosed with diabetes, and accordingly, 2.4% (n=3) had elevated HbA1c values (above 42 mmol/mol or 6.0%). The percentage of respondents with elevated systolic and diastolic blood pressure was 14.9% and 7.4% respectively. Regarding calculated risk scores, they showed parallel increase with increas-ing of BMI (HPS), systolic and diastolic pressure (OHS), and glucose concentration (OPS). CONCLUSIONS When analysing all the factors that could cause the later development of diabetes, which is associated with hypertension as well, it is observed that the student population is very much exposed to those factors. The results of this study cannot be representative for the general population of students, but they can provide recommendations for further research.
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Affiliation(s)
- Andrijana Milošević Georgiev
- University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
- Center for the Study of Bioethics, Belgrade, Serbia
| | - Dušanka Krajnović
- University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
- Center for the Study of Bioethics, Belgrade, Serbia
| | | | - Svetlana Ignjatović
- University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
- Clinical Center of Serbia, Belgrade, Serbia
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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11
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Georgeson A, Lebenthal M, Catania R, Georgeson S. Obesity and elevated blood pressure in suburban student athletes. BMJ Open Sport Exerc Med 2017; 3:e000276. [PMID: 29177075 PMCID: PMC5687525 DOI: 10.1136/bmjsem-2017-000276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/20/2023] Open
Abstract
Objective To assess the prevalence of obesity and elevated blood pressure in a suburban population of middle school and high school student athletes and examine the differences from the previously published populations. Study design The Student Athlete Cardiac Evaluation Registry Study is a single-centre, community hospital-based registry study, that provided free annual preparticipation physical examinations (PPE) from 2009 to 2017. The PPE on the 906 athletes included a history, a physical examination and body metrics including height, weight and blood pressure. The blood pressure was measured with an automated blood pressure cuff and, if elevated, was remeasured using a manual blood pressure cuff with aneroid manometer. The data from the PPE were collected and analysed for prevalence of obesity, overweight and elevated blood pressure measurements. Results The prevalence of obesity was 11%, and 19% of participants were overweight. Many of the athletes had an elevated blood pressure (15%). There was a significant association (P<0.001) between weight and elevated blood pressure. Among athletes with elevated blood pressure, 50% were either obese or overweight. Conclusions There was a similar prevalence of overweight athletes in our study compared with previously published populations, but there were a lower proportion of obese athletes, which may be explained by differences in demographics. Despite the differences in study populations and the lower rate of obesity, the proportion of athletes with elevated blood pressure in our study was similar to prior populations. Weight issues and elevated blood pressure affect athletes across a range of different populations.
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Affiliation(s)
- Andrew Georgeson
- Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Mark Lebenthal
- Department of Cardiology, Robert Wood Johnson University Hospital Somerset, Somerville, New Jersey, USA
| | - Raymond Catania
- Department of Cardiology, Robert Wood Johnson University Hospital Somerset, Somerville, New Jersey, USA
| | - Steven Georgeson
- Department of Cardiology, Robert Wood Johnson University Hospital Somerset, Somerville, New Jersey, USA
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12
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Yong J, Lin D, Tan XR. Primary prevention of cardiovascular disease in older adults in China. World J Clin Cases 2017; 5:349-359. [PMID: 29026833 PMCID: PMC5618113 DOI: 10.12998/wjcc.v5.i9.349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/22/2017] [Accepted: 06/13/2017] [Indexed: 02/05/2023] Open
Abstract
Over the past two decades, the percentage of Chinese who is 60 years or older has increased from 5.2% in 1995 to 10.5% in 2015. Approximately 16% of the population in China was 60 years old and above in 2015. Since 1990, cardiovascular disease (CVD) has been the leading cause of death in China. Cardiovascular medications of older adults are usually more complicated than younger age groups due to polypharmacy, the presence of comorbidities and more susceptible to treatment-related adverse outcomes. Therefore, effective primary prevention of CVD for older adults is important in sustaining the health of older adults and reducing the burden of the healthcare system. Proper management of CVD-related risk factors, such as hypertension, dyslipidemia, diabetes and obesity, can remarkably reduce risks of CVDs in older Chinese. These risk factors can be modified by managing blood pressure, glucose and lipids via lifestyle modifications or receiving medications. Smoking cessation, healthy diets, strict alcohol intake and moderate physical exercise are examples of recommended lifestyle changes for remarkably recovering health conditions of older adults who have hypertension, dyslipidemia, obesity, diabetes or complications. Treatment prescriptions of older adults, in general, are recommended to be individualized and to be initiated at a low dose. The future directions for better primary CVD prevention in older adults include establishing guidelines for primary prevention of CVD for different older adults and further research on better management strategies of CVD risks for elderly Chinese.
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Affiliation(s)
- Jian Yong
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Dong Lin
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Xue-Rui Tan
- First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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13
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Kropa J, Close J, Shipon D, Hufnagel E, Terry C, Oliver J, Johnson B. High Prevalence of Obesity and High Blood Pressure in Urban Student-Athletes. J Pediatr 2016; 178:194-199. [PMID: 27544309 DOI: 10.1016/j.jpeds.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/24/2016] [Accepted: 07/06/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the prevalence of obesity and hypertension-level blood pressures in an urban, athletic adolescent population using preparticipation physical evaluation (PPE) data. STUDY DESIGN The Athlete Health Organization provides free preparticipation physical evaluations to Philadelphia student-athletes via an annual mass-screening event. From 2009 to 2012, Athlete Health Organization personnel performed PPEs on more than 2700 middle school and high school athletes. The PPE included biometric information, a history, and a physical examination. Medical volunteers measured blood pressures using a manual blood pressure cuff with an aneroid manometer. The data from each PPE were collected and analyzed for prevalence of obesity, overweight, and hypertension-level blood pressure readings. RESULTS A large percentage of student-athletes were found to be overweight (20%) or obese (24.0%). Many of these athletes also had stage 1 or 2 level blood pressure readings (14.8%), a finding which strongly correlated with elevated body mass index (P < .00001). CONCLUSIONS The cardiovascular health of this urban adolescent athletic population is a major concern because their rates of obesity and elevated blood pressure place them at increased risk of cardiovascular complications later in life despite their participation in school athletics.
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Affiliation(s)
- Jill Kropa
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
| | - Jeremy Close
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA; Athlete Health Organization, Philadelphia, PA
| | - David Shipon
- Athlete Health Organization, Philadelphia, PA; The Heart Center of Philadelphia, Jefferson, Philadelphia, PA
| | - Erich Hufnagel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Jeffrey Oliver
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Johnson
- Public Health Program, Thomas Jefferson University, Philadelphia, PA
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Abstract
Hypertension continues to be the most common cardiovascular disorder in the USA and worldwide. While generally considered a disorder of aging individuals, hypertension is more prevalent in athletes and the active population than is generally appreciated. The timely detection, diagnosis, and appropriate treatment of hypertension in athletes must focus on both adequately managing the disorder and ensuring safe participation in sport while not compromising exercise capacity. This publication focuses on appropriately diagnosing hypertension, treating hypertension in the athletic population, and suggesting follow-up and participation guidelines for athletes.
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Affiliation(s)
- Kevin T Schleich
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - M Kyle Smoot
- Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael E Ernst
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA. .,Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA.
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med 2016; 51:153-167. [PMID: 27660369 DOI: 10.1136/bjsports-2016-096781] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karl B Fields
- Department of Family Medicine, University of North Carolina, Greensboro, North Carolina, USA
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
| | - David E Price
- Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Robert J Dimeff
- Departments of Orthopedic Surgery, Family and Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David T Bernhardt
- Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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