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Bar-On O, Goldberg O, Stafler P, Levine H, Jacobi E, Shmueli E, Rothschild B, Prais D, Mei-Zahav M. Wearing face masks while climbing stairs influences respiratory physiology. J Breath Res 2024; 18:036002. [PMID: 38631331 DOI: 10.1088/1752-7163/ad3fde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/17/2024] [Indexed: 04/19/2024]
Abstract
During the COVID-19 pandemic wearing face masks was mandatory. Nowadays, face masks are still encouraged indoors, especially in hospitals. People climbing stairs with masks describe unpredictable dyspnea. In this study, healthy adults climbed 5 floors with and without a mask. Various cardio-respiratory parameters were measured, including O2-saturation (O2-Sat) and end-tidal CO2(EtCO2), at baseline and on the top floor. Subjective indexes, such as Borg's scale, were evaluated. Thirty-two volunteers (16 males), median age 39 years (IQR 32.5-43), median BMI = 23.6 (IQR 21.5-25.1), with good fitness levels, participated. Comparing baseline to end-activity, median (IQR): O2-Sat change was -1.0% (-2-0) without mask, versus -3.0% (-4-0) with mask,p= 0.003; EtCO2+ 7.0 (+3.3-+9) without mask, versus +8.0 (+6-+12) with mask,p= 0.0001. Hypercarbia was seen in 5 (15.6%) participants without mask, median = 48 mmHg (IQR 47.5-51), and in 11 (34%) participants with mask, median = 50 mmHg (IQR 47-54),p< 0.001. Desaturation (O2-Sat < 95%) was seen in 5 (15.6%) participants without mask, median = 94% (IQR 93%-94%), and in 10 (31%) participants with mask, median = 91.5% (IQR 90%-93%),p= 0.06. Regression analysis demonstrated that only male sex was significantly associated with abnormal EtCO2(OR = 26.4, 95% CI = 1.9-366.4,p= 0.005). Ascent duration increased from median (IQR) of 94 s (86-100) without mask to 98 s (89-107) with mask,p< 0.001. Borg's scale of perceived exertion (range 0-10) increased from median (IQR) of 3.0 (2.5-3.87) without mask to 4.0 (3.0-4.37) with mask,p< 0.001. To conclude, during routine daily activities, such as stair-climbing, face masks cause dyspnea, and have measurable influences on ventilation, including true desaturation and hypercapnia, especially in males.
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Affiliation(s)
- Ophir Bar-On
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Goldberg
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Pulmonary Service, Kaplan Medical Center (affiliated with the Faculty of Medicine, Hebrew University, Jerusalem, Israel), Rehovot, Israel
| | - Patrick Stafler
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagit Levine
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Jacobi
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Einat Shmueli
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Rothschild
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dario Prais
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Ghosal AM, Chandrasekaran B. Stair-climbing interventions on cardio-metabolic outcomes in adults: A scoping review. J Taibah Univ Med Sci 2024; 19:136-150. [PMID: 38021217 PMCID: PMC10656261 DOI: 10.1016/j.jtumed.2023.10.003] [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: 05/05/2023] [Revised: 07/30/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Physical inactivity is linked with high chronic disease risk; however, only a fraction of the global population meets the recommendations for physical activity. Stair-climbing is a simple and accessible form of physical activity that has been shown to improve cardio-metabolic outcomes in adults. The present scoping review explores the physiological and therapeutic effects of stair-climbing interventions on adult cardio-metabolic disease risk factors. Methods This scoping review followed the reporting guidelines of the Arksey & O'Malley framework, which collates evidence in stages. The research question was framed as "What are the effects of stair climbing on cardio-metabolic outcomes in adults?". Eligible articles were identified through an extensive search of four electronic databases, and data from 24 research studies were charted and organized. Results Stair climbing improves aerobic capacity (8-33 ml kg/min) and serum biomarkers by ≈9-15 %. A minimum of 4-8 weeks are necessary to alter cardiometabolic risk. Regular stair climbing can improve cardio-metabolic risk indicators, including body composition, blood pressure, cholesterol levels, and insulin sensitivity. The research regarding inflammatory and musculoskeletal changes with stair climbing bouts is still in its infancy. Conclusion Stair climbing interventions are a no-cost and feasible form of physical activity for improving cardiometabolic disease risk in adults.
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Affiliation(s)
- Anang M. Ghosal
- Department of Exercise and Sport Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Baskaran Chandrasekaran
- Department of Exercise and Sport Sciences, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Raisi A, Boonpor J, Breheny M, Vasquez J, Matus C, Diaz-Martinez X, Pell JP, Ho FK, Celis-Morales C. Association of Stair Use With Risk of Major Chronic Diseases. Am J Prev Med 2024; 66:324-332. [PMID: 37813170 DOI: 10.1016/j.amepre.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Physical inactivity is associated with a higher risk of chronic diseases. Regular stair use can contribute to increasing physical activity in the population. This study aimed to investigate the association between flights of stairs used daily at home and all-cause mortality and cause-specific incidence and mortality. METHODS Of the 502,628 UK Biobank participants recruited between 2007 and 2010, 442,027 (mean age, 56±8 years) had available data and were included in the analyses conducted in 2023. Participants were categorized on the basis of flights of stairs climbed daily (1-5, 6-10, 11-15, >15). The disease-specific outcomes were cardiovascular disease, respiratory disease, cancer, type 2 diabetes, and all-cause dementia. Cox proportional hazard models, adjusted for sociodemographic, lifestyle, and health-related confounding factors, were used to analyze the associations between stair use frequency and health outcomes. RESULTS Participants were followed up for a median of 10.9 years. Climbing stairs >15 times per day was associated with a lower risk of 8 of the 9 outcomes analyzed than not using stairs. The magnitude of association ranged from 3% (95% CI=0.94, 0.99) lower risk for all-cause cancer to 51% (95% CI=0.39, 0.60) lower risk of chronic obstructive pulmonary disease. Findings were similar for mortality outcomes, with the hazard ratios ranging from 0.82 (95% CI=0.77, 0.87) for all-cause cancer to 0.46 (95% CI=0.23, 0.92) for chronic obstructive pulmonary disease mortality. CONCLUSIONS Stair use was associated with a lower risk of all-cause mortality and cause-specific incidence and mortality independent of confounding factors, including adiposity and multimorbidity.
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Affiliation(s)
- Andrea Raisi
- Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Jirapitcha Boonpor
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom; Faculty of Public Health, Chalermphrakiat Sakon Nakhon Province Campus, Kasetsart University, Sakon Nakhon, Thailand
| | - Megan Breheny
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Jaime Vasquez
- Laboratorio de Rendimiento Humano, Unidad de Investigación en Educación, Actividad Física y Salud. Universidad Católica del Maule. Talca, Chile
| | - Carlos Matus
- Department of Sports Sciences and Physical Conditioning, Faculty of Education, Universidad Católica de La Santísima Concepción, Concepción, Chile
| | - Ximena Diaz-Martinez
- Quality of Life Group in different populations, Department of Education Sciences, University of Bío-Bío, Chillan, Chile
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Carlos Celis-Morales
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom; Laboratorio de Rendimiento Humano, Unidad de Investigación en Educación, Actividad Física y Salud. Universidad Católica del Maule. Talca, Chile.
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Arafa A, Yasui Y, Kato Y, Matsumoto C, Kokubo Y. The association between stair climbing and modifiable cardiovascular disease risk factors: the Suita Study. Environ Health Prev Med 2024; 29:26. [PMID: 38710616 PMCID: PMC11111291 DOI: 10.1265/ehpm.23-00323] [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: 11/15/2023] [Accepted: 03/30/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Stair climbing is a readily available form of physical activity with potential cardiovascular benefits. This study aimed to investigate the association between stair climbing and numerous modifiable cardiovascular disease (CVD) risk factors. METHODS In this cross-sectional study, we used data from 7282 Japanese people (30-84 years) residing in Suita City, Osaka. CVD risk factors and stair climbing frequency were assessed during the Suita Study health examination. Logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for CVD risk factors across stair climbing frequencies. RESULTS After adjustment for age, sex, lifestyle, and medical conditions, stair climbing >60% of the time, compared to <20% of the time, was inversely associated with obesity, smoking, physical inactivity, and stress: ORs (95% CIs) = 0.63 (0.53, 0.75), 0.81 (0.69, 0.96), 0.48 (0.41, 0.55), and 0.67 (0.58, 0.78), respectively (p-trends < 0.05). CONCLUSION Stair climbing was inversely associated with obesity, smoking, physical inactivity, and stress; suggesting a potential role for cardiovascular disease prevention.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Yuka Yasui
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Graduate School of Human Life and Science, Doshisha Women’s College of Liberal Arts, Kyoto, Japan
| | - Yuka Kato
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chisa Matsumoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiology, Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
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Roever L, Biondi-Zoccai G, Vassiliou V. One step every day keeps atherosclerosis away? Atherosclerosis 2023; 386:117336. [PMID: 37866978 DOI: 10.1016/j.atherosclerosis.2023.117336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon.
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Vassilios Vassiliou
- Norwich Medical School, University of East Anglia, and Norfolk and Norwich Hospital, Norwich, UK
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Song Z, Wan L, Wang W, Li Y, Zhao Y, Zhuang Z, Dong X, Xiao W, Huang N, Xu M, Clarke R, Qi L, Huang T. Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study. Atherosclerosis 2023; 386:117300. [PMID: 37813749 DOI: 10.1016/j.atherosclerosis.2023.117300] [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: 06/16/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND AIMS The associations between intensity of stair climbing and atherosclerotic cardiovascular disease (ASCVD) and how these vary by underlying disease susceptibility are not fully understood. We aim to evaluate the intensity of stair climbing and risk of ASCVD types and whether these vary with the presence of ASCVD risk factors. METHODS This prospective study used data of 458,860 adult participants from the UK Biobank. Information about stair climbing, sociodemographic, and lifestyle factors was collected at baseline and a resurvey 5 years after baseline. ASCVD was defined as coronary artery disease (CAD), ischemic stroke (IS), or acute complications. Associations between flights of stair climbing and ASCVD were examined as hazard ratios (HRs) from Cox proportional hazards models. The modification role of disease susceptibility on such associations was assessed by analyses stratified by levels of genetic risk score (GRS), 10-year risks of ASCVD, and self-reported family history of ASCVD. RESULTS During a median of 12.5 years of follow-up, 39,043 ASCVD, 30,718 CAD, and 10,521 IS cases were recorded. Compared with the reference group (reported climbing stairs 0 times/day at baseline), the multivariable-adjusted HRs for ASCVD were 0.97 (95% CI, 0.93-1.01), 0.84 (0.82-0.87), 0.78 (0.75-0.81), 0.77 (0.73-0.80) and 0.81 (0.77-0.85) for stair climbing of 1-5, 6-10, 11-15, 16-20 and ≥21 times/day, respectively. Comparable results were obtained for CAD and IS. When stratified by different disease susceptibility based on the GRS for CAD/IS, 10-year risk, and family history of ASCVD, the protection association of stair climbing was attenuated by increasing levels of disease susceptibility. Furthermore, compared with people who reported no stair climbing (<5 times/d) at two examinations, those who climbed stairs at baseline and then stopped at resurvey experienced a 32% higher risk of ASCVD (HR 1.32, 95% CI:1.06-1.65). CONCLUSIONS Climbing more than five flights of stairs (approx 50 steps) daily was associated with a lower risk of ASCVD types independent of disease susceptibility. Participants who stopped stair climbing between baseline and resurvey had a higher risk of ASCVD compared with those who never climbed stairs.
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Affiliation(s)
- Zimin Song
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Li Wan
- The School of Health Humanities, Peking University, Beijing, 100191, China
| | - Wenxiu Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Yueying Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Yimin Zhao
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Zhenhuang Zhuang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Xue Dong
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Wendi Xiao
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Ninghao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Ming Xu
- Department of Cardiology, Institute of Vascular Medicine, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Peking University Third Hospital, Beijing, 100191, China; State Key Laboratory of Natural and Biomimetic Drugs, Peking University, Beijing, 100191, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China; Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, 100191, China.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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8
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Nogueira-Ferreira R, Santos I, Ferreira R, Fontoura D, Sousa-Mendes C, Falcão-Pires I, Lourenço A, Leite-Moreira A, Duarte IF, Moreira-Gonçalves D. Exercise training impacts skeletal muscle remodelling induced by metabolic syndrome in ZSF1 rats through metabolism regulation. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166709. [PMID: 37030522 DOI: 10.1016/j.bbadis.2023.166709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/10/2023]
Abstract
Metabolic syndrome (MetS), characterized by a set of conditions that include obesity, hypertension, and dyslipidemia, is associated with increased cardiovascular risk. Exercise training (EX) has been reported to improve MetS management, although the underlying metabolic adaptations that drive its benefits remain poorly understood. This work aims to characterize the molecular changes induced by EX in skeletal muscle in MetS, focusing on gastrocnemius metabolic remodelling. 1H NMR metabolomics and molecular assays were employed to assess the metabolic profile of skeletal muscle tissue from lean male ZSF1 rats (CTL), obese sedentary male ZSF1 rats (MetS-SED), and obese male ZF1 rats submitted to 4 weeks of treadmill EX (5 days/week, 60 min/day, 15 m/min) (MetS-EX). EX did not counteract the significant increase of body weight and circulating lipid profile, but had an anti-inflammatory effect and improved exercise capacity. The decreased gastrocnemius mass observed in MetS was paralleled with glycogen degradation into small glucose oligosaccharides, with the release of glucose-1-phosphate, and an increase in glucose-6-phosphate and glucose levels. Moreover, sedentary MetS animals' muscle exhibited lower AMPK expression levels and higher amino acids' metabolism such as glutamine and glutamate, compared to lean animals. In contrast, the EX group showed changes suggesting an increase in fatty acid oxidation and oxidative phosphorylation. Additionally, EX mitigated MetS-induced fiber atrophy and fibrosis in the gastrocnemius muscle. EX had a positive effect on gastrocnemius metabolism by enhancing oxidative metabolism and, consequently, reducing susceptibility to fatigue. These findings reinforce the importance of prescribing EX programs to patients with MetS.
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Affiliation(s)
- Rita Nogueira-Ferreira
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal.
| | - Inês Santos
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Rita Ferreira
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Dulce Fontoura
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Cláudia Sousa-Mendes
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - André Lourenço
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- UnIC@RISE, Department of Surgery and Physiology, Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Cardiothoracic Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Iola F Duarte
- CICECO-Aveiro Institute of Materials, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Daniel Moreira-Gonçalves
- CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
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Wu Y, Luo M, Tan X, Chen L. Stair climbing, genetic predisposition, and the risk of incident type 2 diabetes: A large population-based prospective cohort study. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:158-166. [PMID: 36243314 PMCID: PMC10105025 DOI: 10.1016/j.jshs.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/18/2022] [Accepted: 07/22/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation. However, few studies have examined the long-term association between stair climbing and the incidence of type 2 diabetes (T2D). We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D. METHODS We included 451,699 adults (mean age = 56.3 ± 8.1 years, mean ± SD; 55.2% females) without T2D at baseline in the UK Biobank and followed up to March 31, 2021. Stair climbing information was collected through the touchscreen questionnaire. Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms. RESULTS During a median follow up of 12.1 years, 14,896 T2D cases were documented. Compared with participants who reported no stair climbing, those who climbed stairs regularly had a lower risk of incident T2D (10-50 steps/day: hazard ratio (HR) = 0.95, 95% confidence interval (95%CI): 0.89-1.00; 60-100 steps/day: HR = 0.92, 95%CI: 0.87-0.98; 110-150 steps/day: HR = 0.86, 95%CI: 0.80-0.91; >150 steps/day: HR = 0.93, 95%CI: 0.87-0.99, p for trend = 0.0007). We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk (p for interaction = 0.0004), where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk. CONCLUSION A higher number of stairs climbed at home was associated with lower T2D incidence risk, especially among individuals with a low genetic predisposition to T2D. These findings highlight that stair climbing, as incidental physical activity, offers a simple and low-cost complement to public health interventions for T2D prevention.
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Affiliation(s)
- Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Department of Clinical Nutrition, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mengyun Luo
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, NSW 2006, Australia; Charles Perkins Centre, the University of Sydney, New South Wales, NSW 2006, Australia; School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Xiao Tan
- Department of Medical Sciences, Uppsala University, Uppsala 78185, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm 17165, Sweden
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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11
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Arafa A, Kashima R, Kokubo Y. Stair climbing and the incidence of atherosclerotic cardiovascular disease: a population-based prospective cohort study. Environ Health Prev Med 2023; 28:60. [PMID: 37899207 PMCID: PMC10613554 DOI: 10.1265/ehpm.23-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/11/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Stair climbing is a readily available form of physical activity with potential cardioprotective merits. Herein, we investigated the association between stair climbing and atherosclerotic cardiovascular disease (ASCVD) incidence among Japanese people. METHODS This prospective cohort study used data from 7,282 participants, aged 30-84 years, registered in the Suita Study and free from stroke and ischemic heart disease (IHD). Standard approaches were used to detect incident ASCVD events, including cerebral infarction and IHD, during follow-up. Stair climbing was assessed using a baseline questionnaire. We applied the Cox regression to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of incident ASCVD for climbing stairs in 20-39%, 40-59%, and ≥60% compared to <20% of the time. We adjusted the regression models for age, sex, body mass index, smoking, alcohol consumption, physical activity, hypertension, diabetes, atrial fibrillation, lipid profile, chronic kidney disease, and history of cardiac murmur or valvular diseases. RESULTS A total of 536 new ASCVD events were detected within a median follow-up period of 16.6 years. In the age- and sex-adjusted model, stair climbing 20-39%, 40-59%, and ≥60% of the time was associated with lower ASCVD incidence: HRs (95% CIs) = 0.72 (0.56, 0.92), 0.86 (0.68, 1.08), and 0.78 (0.61, 0.99), respectively (p-trend = 0.020). The corresponding associations were attenuated after adjusting for lifestyle and clinical factors: HRs (95% CIs) = 0.74 (0.58, 0.95), 0.90 (0.71, 1.13), and 0.89 (0.69, 1.13), respectively (p-trend = 0.152). CONCLUSION Frequent stair climbing was associated with lower ASCVD incidence; however, this association was partly explained by lifestyle and clinical factors of participants.
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Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Rena Kashima
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Pathophysiology and Therapeutics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
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12
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Mat Azmi ISM, Wallis GA, White MJ, Puig-Ribera A, Eves FF. Desk based prompts to replace workplace sitting with stair climbing; a pilot study of acceptability, effects on behaviour and disease risk factors. BMC Public Health 2022; 22:1985. [PMID: 36316656 PMCID: PMC9620615 DOI: 10.1186/s12889-022-14393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Prolonged sitting is associated with increased risk of obesity, type 2 diabetes and cardiovascular disease. Occupational sitting accounts for up to 50 h/week for employees. This pilot study assessed the acceptability of stair climbing as an interruption to sitting throughout working hours, and provided preliminary data of the effects on glucose and lipid profiles. Methods A quasi-experimental design was conducted involving 16 sedentary office workers (five females and 11 males) for intervention (n = 8) and control groups (n = 8) with mean age of 36.38 (5.58). For the eight-week intervention, a continuous four-floor stair climb and descent was performed eight times/day spread evenly over the working day. A prompt to climb was presented on the participant’s computer eight times/day. Participants in the experimental group recorded daily floors climbed and steps (measured using pedometers) in a weekly log sheet. Blood samples were collected pre and post intervention to test effects on fasting glucose and 2 h plasma glucose, triglycerides, and total (TC), LDL and HDL cholesterol. Experimental participants were interviewed at the end of the study. The Wilcoxon signed rank test was used to compare the median changes (pre-post) of the dependent variables. Results On average, the experimental group climbed 121 floors/week when prompted. There were significant reductions in fasting blood glucose, TC and LDL, as well as the derived measures of ‘bad’ cholesterol and the TC/HDL ratio in the experimental group. Post-experimental interviews indicated that the interruption to sitting was well tolerated. Conclusion Prompted stair climbing activity had impacts on health outcomes and was found acceptable to employees at work. Trial registration Ethics for this study was approved by Science, Technology, Engineering and Mathematics Ethical Review Committee, University of Birmingham with ethics reference number ERN_15_0491. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14393-1.
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Affiliation(s)
- Intan Suhana Munira Mat Azmi
- grid.6572.60000 0004 1936 7486School of Sports, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK ,grid.449643.80000 0000 9358 3479Community Medicine Unit, Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Medical Campus, Jalan Sultan Mahmud, 20400 Kuala Terengganu, Terengganu Malaysia
| | - Gareth A. Wallis
- grid.6572.60000 0004 1936 7486School of Sports, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Mike J. White
- grid.6572.60000 0004 1936 7486School of Sports, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Puig-Ribera
- grid.440820.aCentre for Health and Social Care Research, Department of Physical Activity Sciences, Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
| | - Frank F. Eves
- grid.6572.60000 0004 1936 7486School of Sports, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK ,grid.440820.aCentre for Health and Social Care Research, Department of Physical Activity Sciences, Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain
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13
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Moore JM, Vinoskey C, Salmons H, Hooshmand S, Kressler J. Sex differences in the acute effect of stair-climbing on postprandial blood glucose levels: A randomized controlled trial. Metabol Open 2022; 15:100200. [PMID: 35898575 PMCID: PMC9309661 DOI: 10.1016/j.metop.2022.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 11/19/2022] Open
Abstract
Single, short stair climbing and descending (SCD) bouts of low to moderate intensity effectively lower postprandial blood glucose but previous reports have found conflicting results on interactions by sex during exercise. We hypothesize that SCD at a self-selected intensity will be equally effective at lowering postprandial blood glucose in males and females. Methods and Results: Thirty subjects (age: 23.8 (3.0) years) performed 0, 1, 3, and 10 min of SCD following consumption of a mixed meal. SCD was performed at a self-selected comfortable pace and all bouts ended at minute 28. Postprandial blood glucose was measured every 15 min for 1 h and analyzed as glucose over time, area under the curve (AUC), and incremental AUC (iAUC) using mixed-design ANOVAs with repeated measures. Although there was no interaction between sex and condition or time (p = .129 to .541) for glucose over time, AUC, or iAUC, there was a main effect for sex for glucose over time (p = .004) and AUC (p = .006), but not iAUC (p = .125). Females had higher blood glucose throughout each trial (22% (13 to 31%), p = .004) but both males' and females’ postprandial blood glucose was lowered following 10 min of SCD relative to the seated control condition. Conclusions: Males and females benefited equally from single, short SCD bouts of low to moderate intensity despite females having higher blood glucose at all time points. Previous findings of sex differences in the attenuating effect of exercise on postprandial blood glucose are likely due to the use of absolute workloads leading to varying relative intensities. SCD at a self-selected, comfortable pace for 3 min reduced postmeal blood glucose. Men and women benefit equally from SCD postprandial glucose attenuations. Previous sex differences were likely due to unequal relative intensity of exercise.
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Affiliation(s)
- Jeff M. Moore
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA
- Corresponding author. School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA.
| | - Cameron Vinoskey
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Hannah Salmons
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Shirin Hooshmand
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
| | - Jochen Kressler
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, 92182, USA
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14
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Arafa A, Kokubo Y, Shimamoto K, Kashima R, Watanabe E, Sakai Y, Li J, Teramoto M, Sheerah HA, Kusano K. Stair climbing and incident atrial fibrillation: a prospective cohort study. Environ Health Prev Med 2022; 27:10. [PMID: 35288490 PMCID: PMC9093618 DOI: 10.1265/ehpm.21-00021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Ahmed Arafa
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Rena Kashima
- Public Health Division, Ibaraki Public Health Center, Osaka Prefectural Government
| | - Emi Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Yukie Sakai
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Jiaqi Li
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Masayuki Teramoto
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Haytham A. Sheerah
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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15
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Aidar FJ, Paz ÂDA, Gama DDM, de Souza RF, Vieira Souza LM, dos Santos JL, Almeida-Neto PF, Marçal AC, Neves EB, Moreira OC, Garrido ND, Cabral BGAT, Clemente FM, Reis VM, Nikolaidis PT, Knechtle B. Evaluation of the Post-Training Hypotensor Effect in Paralympic and Conventional Powerlifting. J Funct Morphol Kinesiol 2021; 6:92. [PMID: 34842735 PMCID: PMC8629010 DOI: 10.3390/jfmk6040092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/29/2023] Open
Abstract
High blood pressure (HBP) has been associated with several complications and causes of death. The objective of the study was to analyze the hemodynamic responses in Paralympic bench press powerlifting (PP) and conventional powerlifting (CP) before and after training and up to 60 minutes (min) after training. Ten PP and 10 CP athletes performed five sets of five repetition maximal bench press exercises, and we evaluated systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP, respectively), heart rate (HR), heart pressure product (HPP), and myocardial oxygen volume (MVO2). The SBP increased after training (p < 0.001), and there were differences in the post training and 30, 40, and 60 min later (p = 0.021), between 10 and 40 min after training (p = 0.031, η2p = 0.570), and between CP and PP (p =0.028, η2p = 0.570). In the MBP, there were differences between before and after (p = 0.016) and 40 min later (p = 0.040, η2p = 0.309). In the HR, there was a difference between before and after, and 5 and 10 min later (p = 0.002), and between after and 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.767). In HPP and MVO2, there were differences between before and after (p = 0.006), and between after and 5, 10, 20, 30, 40, 50, and 60 min later (p < 0.001, η2p = 0.816). In CP and PP, there is no risk of hemodynamic overload to athletes, considering the results of the HPP, and training promotes a moderate hypotensive effect, with blood pressure adaptation after and 60 min after exercise.
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Affiliation(s)
- Felipe J. Aidar
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GPEPS), Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil; (F.J.A.); (L.M.V.S.); (J.L.d.S.); (A.C.M.)
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
| | - Ângelo de Almeida Paz
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
| | - Dihogo de Matos Gama
- Cardiovascular & Physiology of Exercise Laboratory, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Raphael Fabricio de Souza
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
| | - Lúcio Marques Vieira Souza
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GPEPS), Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil; (F.J.A.); (L.M.V.S.); (J.L.d.S.); (A.C.M.)
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Physical Education Course, State University of Minas Gerais (UEMG), Divinopolis 37900-106, MG, Brazil
| | - Jymmys Lopes dos Santos
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GPEPS), Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil; (F.J.A.); (L.M.V.S.); (J.L.d.S.); (A.C.M.)
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
| | - Paulo Francisco Almeida-Neto
- Department of Physical Education, Federal University of Rio Grande do Norte (UFRN), Natal 59078-970, RN, Brazil; (P.F.A.-N.); (B.G.A.T.C.)
| | - Anderson Carlos Marçal
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GPEPS), Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil; (F.J.A.); (L.M.V.S.); (J.L.d.S.); (A.C.M.)
- Program of Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
| | - Eduardo Borba Neves
- Graduate Program of Biomedical Engineering, Federal Technological University of Paraná (PPGEB/UTFPR), Curitiba 80230-901, PR, Brazil;
| | - Osvaldo Costa Moreira
- Institute of Biological Sciences and Health, Federal University of Viçosa, Campus Florestal, Viçosa 35690-000, MG, Brazil;
| | - Nuno Domingos Garrido
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5001-801 Vila Real, Portugal; (N.D.G.); (V.M.R.)
| | | | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5001-801 Vila Real, Portugal; (N.D.G.); (V.M.R.)
| | | | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9001 St. Gallen, Switzerland
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