Athlete's Heart Assessed by Sit-Up Strength Exercises in Military Men and Women: The CHIEF Heart Study

Association between physical activity and cardiovascular parameters in 7-year-old children: a Chinese cross-sectional study

INTRODUCTION

Physical activity (PA) is believed to play an important part in many aspects during childhood and adolescence, especially cardiorespiratory fitness and cardiometabolic health. However, whether different levels of PA in daily life influence the structure or function of heart in school-aged children remains unknown. We aimed to investigate the association between PA and cardiovascular parameters in 7-year-old children.

METHODS

Follow-up data from the Shanghai Prenatal Cohort Study and the Shanghai Birth Cohort was analyzed. Perinatal information including both maternal and offspring datum was recorded. A refined questionnaire was used to evaluate the frequency and duration of children's PA levels. Blood pressure, echocardiography, and anthropometry assessment were conducted during the follow-up of 7-year-old children.

RESULTS

Overall, high PA level was associated with higher left ventricle posterior wall thickness in diastole (LVPWd, β coefficient: 0.36, 95% CI: 0.12, 0.61), higher left ventricle mass index (LVMI, β = 0.28, 95% CI: 0.07, 0.48), mitral E/a ratio (β = 0.47, 95% CI: 0.22, 0.71) and slower heart rate (β = -0.32, 95% CI: -0.57, -0.07), compared to low PA level. Medium PA level was associated with lower diastolic blood pressure (DBP, β = -0.18, 95% CI: -0.35, -0.01). In subgroup analysis, increased relative wall thickness (RWT) was found in high PA level boys (β = 0.36, 95% CI: 0.05, 0.67), and systolic blood pressure (SBP) showed a significant decrease in high PA level girls (β = -0.42, 95% CI: -0.78, -0.06).

CONCLUSIONS

This study suggested non-athlete children having higher PA level were associated with thicker left ventricle (LV) walls and better LV diastolic function, as well as slower heart rate and DBP at the age of 7. Furthermore, disparity in the association between PA level with morphological heart patterns and blood pressure existed in different sex category.

Inverse Association between Exercising Blood Pressure Response and Left Ventricular Chamber Size and Mass in Women Who Habitually Resistance Train

Exercise is a major modifiable lifestyle factor that leads to temporarily increased systolic blood pressure (SBP), which is thought to influence left ventricular mass normalized to body surface area (LVM/BSA). This relationship has never been studied in women who habitually perform resistance exercise.

PURPOSE

To determine if a direct correlation exists between the SBP response to resistance exercise (change from rest; eSBP) and LVM/BSA in young healthy women who habitually resistance train.

METHODS

Leg extension resistance exercise was performed while continuously monitoring blood pressure using finger plethysmography. LVM was estimated using echocardiography. Data are shown as mean ± SD.

RESULTS

Thirty-one women participated (age 23 ± 3 years, height 164 ± 7 cm, body mass 63.7 ± 10.3 kg). Resting SBP (110 ± 8 mmHg, r = 0.355, p = 0.049) was shown to be directly correlated to LVM/BSA (72.0 ± 28.4 g/m2). Conversely, eSBP (30.8 ± 14.6 ∆mmHg, r = -0.437, p = 0.014) was inversely related to LVM/BSA. eSBP was not correlated to interventricular septum width (0.88 ± 0.12 cm, r = -0.137, p = 0.463) or posterior wall thickness (0.91 ± 0.15 cm, r = -0.084, p = 0.654). eSBP was inversely related to left ventricle internal diameter during diastole (LVIDd) (4.25 ± 0.33 cm, r = -0.411, p = 0.021).

CONCLUSION

Counter to the hypothesis, these data suggest an inverse association between eSBP during resistance exercise and LVM/BSA in healthy young women who resistance train. This relationship is due to a smaller LVIDd with greater eSBP.

Mean power output for muscular endurance exercises and maximal oxygen uptake in military young adults

The American Heart Association recommends a cardiopulmonary exercise test (CPET) and some alternative exercise tests to evaluate maximal oxygen uptake (VO2 max) of youth. Power output has shown a high correlation with VO2 max on a CPET. However, the correlations between mean power output (MPO) for muscular endurance exercises and VO2 max measured from a CPET are not established in young adults. Forty-five volunteers, with an average age of 29.93 ± 7.05 years, from a sample of 1120 military personnel in Taiwan who attended a 2-minute pushup test and a 2-minute sit-up test were included in the current study. These volunteers subsequently underwent a CPET using the Bruce protocol to assess VO2 max. According to the physics rule, MPO (watts) for the muscular endurance test was defined as a product of moving distance and force: [1/5 × body height (m) × numbers performed × body mass (kg) × gravity (9.8 m/s2)]. Pearson correlation analyses were performed. For the 2-min pushups, the correlations (r) between pushup numbers and VO2 max with and without body mass adjustment were 0.541 (P < .01) and 0.188 (P = .21), respectively, while the correlation (r) between MPO and VO2 max with and without body mass adjustment were 0.410 and 0.557 (both P < .01), respectively. For the 2-minute sit-ups, the correlations (r) between sit-up numbers and VO2 max with and without body mass adjustment were 0.529 (P < .01) and 0.291 (P = .052), respectively, while the correlations (r) between MPO and VO2 max with and without body mass adjustment were 0.318 (P = .03) and 0.705 (P < .01), respectively. In military young adults, MPO for both the 2-minute sit-up and the 2-minute pushup tests could be used as alternative field-based methods to estimate VO2 max.

Mitral valve prolapse and physical performance in Asian military males: The CHIEF Heart study

The impact of mitral valve prolapse (MVP) and mitral regurgitation (MR) on physical performance has not been examined. Of 1,808 physically fit Asian military males, we compared the physical fitness between 62 subjects with MVP (MVP(+)) and 1,311 age- and anthropometrics-matched controls from the 1,746 participants without MVP (MVP(-)). MVP and MR grade were defined based on the American Society of Echocardiography criteria. Aerobic endurance capacity was evaluated by a 3000-m run and muscular endurance capacity was separately evaluated by 2-min sit-ups and 2-min push-ups. Analysis of covariance was used to determine the difference between groups. As compared to the MVP(-), the MVP(+) completed the 3000-m run test faster (839.2 ± 65.3 sec vs. 866.6 ± 86.8 sec, p = 0.019), but did fewer push-ups (41.3 ± 3.92 vs. 48.0 ± 10.1, p = 0.02) and similar sit-ups within 2 min. Of the MVP(+), those with any MR (trivial, mild or moderate) completed the 3000-m run test faster than those without MR (830.6 ± 61.7 sec vs. 877.2 ± 61.7 sec, p = 0.02). Our findings suggest that in physically active Asian military males, the MVP(+) may have greater aerobic endurance capacity but lower muscular endurance capacity than the MVP(-). The presence of MR may play a role for the MVP(+) to have greater aerobic endurance capacity.

Electrocardiographic and echocardiographic predictors of greater carotid intima-media thickness in tactical athletes: The CHIEF atherosclerosis study

OBJECTIVE

Both electrocardiographic and echocardiographic left ventricular hypertrophy (LVH) have been reported with an association with greater carotid intima-media thickness (cIMT), a marker of subclinical atherosclerosis in patients with hypertension, while the associations are unclear in physically fit young adults.

METHODS

A total of 1822 Taiwanese military personnel, aged 18-40 years, received an annual health examination including electrocardiography (ECG) and echocardiography in 2018-2020. Left carotid bulb cIMT was measured by high-resolution ultrasonography. Multiple logistic regression analysis with adjustments for age, sex, smoking, alcohol consumption, body mass index, mean blood pressure, and physical fitness was used to determine the associations between echocardiographic and ECG parameters and the highest quintile of cIMT (≥0.8 mm).

RESULTS

Cornell-based LVH, Myers et al.-based RVH and heart rate ≥75/min were associated with cIMT ≥0.8 mm [odds ratios (ORs) and 95% confidence intervals: 1.54 (1.01, 2.35), 1.66 (1.18, 2.33), and 1.39 (1.06, 1.83), respectively], while echocardiographic LVH defined as ≥46.0 g/m^2.7 for men and ≥38.0 g/m^2.7 for women was inversely associated with cIMT ≥0.8 mm [OR: 0.45 (0.24, 0.86)].

CONCLUSION

In tactical athletes of military, the associations of ECG and echocardiographic LVH with cIMT were in opposite directions. Higher physical fitness may cause cardiac muscle hypertrophy and reduce the atherosclerosis severity, possibly leading to the paradoxical echocardiographic finding. This study suggests that ECG-based LVH remains a good marker of subclinical atherosclerosis in our military population.

Muscular Strength and Carotid Intima-Media Thickness in Physically Fit Young Adults: The CHIEF Atherosclerosis Study

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may differ by sex and has not been clarified in young adults. Methods and Results: A total of 1021 Taiwanese military personnel, aged 18−40 years, participated in annual health examinations in 2018−2020. MusS was separately assessed by 2-min push-up and 2-min sit-up numbers. Subclinical atherosclerosis was measured by the left carotid bulb intima−media thickness (cIMT) using high-resolution ultrasonography. Multiple linear regression with adjustments for age, sex, alcohol intake, cigarette smoking, anthropometric indices, blood pressure, and lipid profiles was utilized to determine the correlation between MusS and cIMT. Both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.089 and −0.072, respectively; both p-values < 0.05). In men, both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.076 and −0.086, respectively; both p-values < 0.05), while in women, 2-min push-up numbers but not 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.204 and −0.01; p = 0.03 and 0.99, respectively). Conclusions: Among young adults, there was an inverse association between MusS and cIMT, emphasizing the beneficial impact of MusS on the regression of atherosclerosis. The study also revealed a sex difference and suggested that training of the upper arm muscles may be an effective preventive measure for young women to reduce the risk of early cardiovascular diseases.

Electrocardiographic and cardiometabolic risk markers of left ventricular diastolic dysfunction in physically active adults: CHIEF heart study

Aim

This study was aimed to investigate the association of cardiometabolic and ECG markers with left ventricular diastolic dysfunction (LVDD) in physically active Asian young adults, which has not been clarified in prior studies.

Methods and results

A total of 2,019 men aged 18–43 years were included from the military in Taiwan. All the subjects underwent anthropometric, hemodynamic, and blood metabolic marker measurements. Physical fitness was investigated by time for a 3,000-m run. LVDD was defined by presence of either one of the three echocardiographic criteria: (1) mitral inflow E/A ratio < 0.8 with a peak E velocity of > 50 cm/s, (2) tissue Doppler lateral mitral annulus e′ <10 cm/s, and (3) E/e′ ratio > 14. Multiple logistic regressions with adjustments for age, physical fitness, and pulse rate were conducted to determine the association of cardiometabolic and ECG markers with LVDD. The prevalence of LVDD was estimated to be 4.16% (N = 84). Of the cardiometabolic markers, central obesity, defined as waist circumference ≥ 90 cm, was the only independent marker of LVDD [odds ratio (OR) and 95% confidence interval: 2.97 (1.63–5.41)]. There were no association for hypertension, prediabetes, and dyslipidemia. Of the ECG markers, left atrial enlargement and incomplete right bundle branch block/intraventricular conduction delay were the independent ECG markers of LVDD [OR: 2.98 (1.28–6.94) and 1.94 (1.09–3.47), respectively]. There was borderline association for Cornell-based left ventricular hypertrophy and inferior T wave inversion [OR: 1.94 (0.97–3.63) and 2.44 (0.98–6.08), respectively].

Conclusion

In the physically active Asian young male adults, central obesity and some ECG markers for left heart abnormalities were useful to identify LVDD.

Sex-specific cardiometabolic risk markers of left ventricular mass in physically active young adults: the CHIEF heart study

Greater physical fitness may lead to greater left ventricular mass (LVM) and reduce the effect of cardiometabolic risk factors on LVM. However, the cardiometabolic biomarkers associations for LVM have not been clarified in physically active young adults. This study included 2019 men and 253 women, aged 18-43 years, from the military in Taiwan. All participants underwent anthropometric and blood metabolic markers measurements, and completed a 3000-m run test for assessing fitness. LVM was calculated on the basis of an echocardiography. Multiple linear regression was used to determine the sex-specific associations between cardiometabolic risk markers and LVM indexed for the body height (g/m^2.7). In men, age, systolic blood pressure (SBP), 3000-m running time, serum triglycerides, serum uric acid and waist circumference (WC) were correlated with LVM index (β = 0.07, 0.10, - 0.01, 0.01, 0.24 and 0.24, respectively; all p-values < 0.05). The correlations were not significant for fasting plasma glucose, total cholesterol and high-density lipoprotein cholesterol (HDL-C). In women, SBP, HDL-C and WC were correlated with LVM index in the univariate analysis (β = 0.07, - 0.05 and 0.32, respectively; all p-values < 0.05), whereas the correlation was only significant for WC in the multiple linear regression analysis (β = 0.20; p-value < 0.001). In physically active adults, the associations of cardiometabolic risk markers with LVM might vary by sex. Better endurance exercise performance associated with greater LVM was noted only in men, while greater WC was the only metabolic risk marker for greater LVM in both men and women.