1
|
Milani JGPO, Milani M, Machado FVC, Wilhelm M, Marcin T, D'Ascenzi F, Cavigli L, Keytsman C, Falter M, Bonnechere B, Meesen R, Braga F, Cipriano GFB, Cornelissen V, Verboven K, Junior GC, Hansen D. Accurate Prediction Equations for Ventilatory Thresholds in Cardiometabolic Disease When Gas Exchange Analysis is Unavailable: Development and Validation. Eur J Prev Cardiol 2024:zwae149. [PMID: 38636093 DOI: 10.1093/eurjpc/zwae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/08/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
AIMS To develop and validate equations predicting heart rate (HR) at the first and second ventilatory thresholds (VTs) and an optimized range-adjusted prescription for patients with cardiometabolic disease (CMD). To compare their performance against guideline-based exercise intensity domains. METHODS Cross-sectional study involving 2,868 CMD patients from nine countries. HR predictive equations for first and second VTs (VT1, VT2) were developed using multivariate linear regression with 975 cycle-ergometer cardiopulmonary exercise tests (CPET). 'Adjusted' percentages of peak HR (%HRpeak) and HR reserve (%HRR) were derived from this group. External validation with 1,893 CPET (cycle-ergometer or treadmill) assessed accuracy, agreement, and reliability against guideline-based %HRpeak and %HRR prescriptions using mean absolute percentage error (MAPE), Bland-Altman analyses, intraclass correlation coefficients (ICC). RESULTS HR predictive equations (R²: 0.77 VT1, 0.88 VT2) and adjusted %HRR (VT1: 42%, VT2: 77%) were developed. External validation demonstrated superiority over widely used guideline-directed intensity domains for %HRpeak and %HRR. The new methods showed consistent performance across both VTs with lower MAPE (VT1: 7.1%, VT2: 5.0%), 'good' ICC for VT1 (0.81, 0.82) and 'excellent' for VT2 (0.93). Guideline-based exercise intensity domains had higher MAPE (VT1: 6.8%-21.3%, VT2: 5.1%-16.7%), 'poor' to 'good' ICC for VT1, and 'poor' to 'excellent' for VT2, indicating inconsistencies related to specific VTs across guidelines. CONCLUSION Developed and validated HR predictive equations and the optimized %HRR for CMD patients for determining VT1 and VT2 outperformed the guideline-based exercise intensity domains and showed ergometer interchangeability. They offer a superior alternative for prescribing moderate intensity exercise when CPET is unavailable.
Collapse
Affiliation(s)
- Juliana Goulart Prata Oliveira Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
| | - Mauricio Milani
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Felipe Vilaça Cavallari Machado
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thimo Marcin
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bruno Bonnechere
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, University of Hasselt, Diepenbeek, Belgium
- Centre of expertise in Care Innovation, Department of PXL - Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Raf Meesen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Braga
- Laboratório de Performance Humana, Rio de Janeiro, Brazil
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Graziella França Bernardelli Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Rehabilitation Sciences Programme, University of Brasilia (UnB), Brasilia, DF, Brazil
| | | | - Kenneth Verboven
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| | - Gerson Cipriano Junior
- Graduate Programme in Health Sciences and Technologies, University of Brasilia (UnB), Brasilia, DF, Brazil
- Graduate Program in Human Movement and Rehabilitation of Evangelical (PPGMHR), UniEVANGÉLICA, Anápolis, Brazil
| | - Dominique Hansen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt, Belgium
| |
Collapse
|
2
|
Marinus N, Cornelissen V, Meesen R, Coninx K, Hansen D. Are exercise prescriptions for patients with cardiovascular disease, made by physiotherapists, in agreement with European recommendations? Eur J Cardiovasc Nurs 2024; 23:230-240. [PMID: 37439451 DOI: 10.1093/eurjcn/zvad065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
AIMS Physiotherapists often treat patients with (elevated risk for) cardiovascular disease (CVD), and should thus be able to provide evidence-based exercise advice to these patients. This study, therefore, aims to examine whether exercise prescriptions by physiotherapists to patients with CVD are in accordance with European recommendations. METHODS AND RESULTS This prospective observational survey included forty-seven Belgian physiotherapists. The participants agreed to prescribe exercise intensity, frequency, session duration, program duration, and exercise type (endurance or strength training) for the same three patient cases. Exercise prescriptions were compared between physiotherapists and relations with their characteristics were studied. The agreement between physiotherapists' exercise prescriptions and those from European recommendations ('agreement score': based on a maximal score of 60/per case) was assessed. A wide inter-clinician variability was noticed for all exercise modalities, leading to a large variance for total peak-effort training minutes (from 461 up to 9000 over the three cases). The exercise frequency was prescribed fully out of range of the recommendations and the prescription of additional exercise modes was generally flawed. Exercise intensity and program duration were prescribed partially correct. The addition of strength exercises and session duration was prescribed correctly. This led to physiotherapist agreement scores of 25.3 ± 9.6, 23.2 ± 9.9, and 27.1 ± 10.6 (all out of 60), for cases one, two, and three, respectively. A greater agreement score was found in younger colleagues and those holding a Ph.D. CONCLUSION Exercise prescriptions for CVD patients vary widely among physiotherapists and often disagree with European recommendations. REGISTRATION ClinicalTrials.gov NCT05449652.
Collapse
Affiliation(s)
- Nastasia Marinus
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, 3000 Leuven, Belgium
| | - Raf Meesen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| |
Collapse
|
3
|
Machado FVC, Loyola WS, Prado CM, Hansen D. Optimizing sarcopenia screening in older patients with cardiovascular disease: insights and cut-off considerations. Eur J Cardiovasc Nurs 2024:zvae040. [PMID: 38574247 DOI: 10.1093/eurjcn/zvae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Felipe V C Machado
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Walter Sepúlveda Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, Echaurren 140, Santiago, Chile
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Dominique Hansen
- Rehabilitation Research Center (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| |
Collapse
|
4
|
Marques-Sule E, Hansen D, Almenar L, Deka P, Sentandreu-Mañó T, López-Vilella R, Klompstra L, Machado FVC. What motivates heart transplantation patients to exercise and engage in physical activity? A network analysis. Eur J Cardiovasc Nurs 2024; 23:137-144. [PMID: 37200456 DOI: 10.1093/eurjcn/zvad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
AIMS After heart transplantation (HTx), increments in physical activity (PA) are strongly recommended. However, participation rates in exercise-based cardiac rehabilitation and engagement in PA are insufficient in many patients. Hence, this study aimed to explore the central factors and the interconnections among distinct types of motivation to exercise, PA, sedentary time, psychosomatic, diet, and activity limitation characteristics in post-HTx patients. METHODS AND RESULTS This is a cross-sectional study involving 133 post-HTx patients (79 men, mean age 57 ± 13 years, mean time from transplantation 55 ± 42 months) recruited from an outpatient clinic in Spain. The patients were asked to fill in questionnaires measuring self-reported PA, motivation to exercise, kinesiophobia, musculoskeletal pain, quality of sleep, depression, functional capacity, frailty, sarcopenia risk, and diet quality. Two network structures were estimated: one network including PA and one network including sedentary time as nodes. The relative importance of each node in the network structures was determined using centrality analyses. According to the strength centrality index, functional capacity and identified regulation (subtypes of motivation to exercise) are the two most central nodes of the network (strength: z-score = 1.35-1.51). Strong and direct connections emerged between frailty and PA and between sarcopenia risk and sedentary time. CONCLUSION Functional capacity and autonomous motivation to exercise are the most promising targets of interventions to improve PA levels and sedentary time in post-HTx patients. Furthermore, frailty and sarcopenia risk were found to mediate the effects of several other factors on PA and sedentary time.
Collapse
Affiliation(s)
- Elena Marques-Sule
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Spain
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590 Agoralaan, Diepenbeek, Belgium
| | - Luis Almenar
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Pallav Deka
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Östergötland, Sweden
| | - Felipe V C Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590 Agoralaan, Diepenbeek, Belgium
| |
Collapse
|
5
|
Gojevic T, Gelade K, Da Silva NT, Tulleneers B, Mullens W, Hansen D. Effects of low vs. moderate intense resistance exercise training combined with endurance exercise training in patients with heart failure: a randomized clinical trial†. Eur J Prev Cardiol 2024; 31:e9-e12. [PMID: 37555298 DOI: 10.1093/eurjpc/zwad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/16/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Tin Gojevic
- REVAL/BIOMED-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Hasselt, Belgium
| | - Kristof Gelade
- Department of Cardiology, Hospital East-Limburg, Algemeen secretariaat cardiologie ZOL Genk, campus Sint-Jan Genk, ZOL Genk, Genk, Belgium
| | - Natalia Turri Da Silva
- REVAL/BIOMED-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Hasselt, Belgium
| | - Bart Tulleneers
- Department of Cardiology, Hospital East-Limburg, Algemeen secretariaat cardiologie ZOL Genk, campus Sint-Jan Genk, ZOL Genk, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Hospital East-Limburg, Algemeen secretariaat cardiologie ZOL Genk, campus Sint-Jan Genk, ZOL Genk, Genk, Belgium
| | - Dominique Hansen
- REVAL/BIOMED-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Hasselt, Belgium
| |
Collapse
|
6
|
Kambič T, Hansen D, Harber MP. Resistance Training in Cardiac Rehabilitation: PAST, PRESENT, AND FUTURE. J Cardiopulm Rehabil Prev 2024; 44:79-82. [PMID: 38407806 DOI: 10.1097/hcr.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Tim Kambič
- Department of Medical Sciences in Sport, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia (Dr Kambič); Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium (Dr Hansen); BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Diepenbeek, Belgium (Dr Hansen); and Clinical Exercise Physiology Program, Human Performance Laboratory, Ball State University, Muncie, Indiana (Dr Harber)
| | | | | |
Collapse
|
7
|
Kambič T, Hansen D, Eijsvogels TMH. High-load resistance training in cardiac rehabilitation: is it time to debunk old clinical dogmas for a better clinical tomorrow? Eur J Prev Cardiol 2024:zwae079. [PMID: 38394775 DOI: 10.1093/eurjpc/zwae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Tim Kambič
- Department of Medical Sciences in Sport, Faculty of Sport, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- REVAL (Rehabilitation Research Centre)/BIOMED, Hasselt University, 3590 Diepenbeek, Belgium
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Exercise Physiology Research Group, Radboud University Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Tsampasian V, Bäck M, Bernardi M, Cavarretta E, Dębski M, Gati S, Hansen D, Kränkel N, Koskinas K, Niebauer J, Spadafora L, Frias Vargas M, Biondi-Zoccai G, Vassiliou VS. Cardiovascular disease as part of Long COVID: A systematic review. Eur J Prev Cardiol 2024:zwae070. [PMID: 38381595 DOI: 10.1093/eurjpc/zwae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Long COVID syndrome has had a major impact on million patients' lives worldwide. The cardiovascular system is an important aspect of this multifaceted disease that may manifest in many ways. We have hereby performed a narrative review in order to identify the extent of the cardiovascular manifestations of the Long COVID syndrome. METHODS AND RESULTS An in-depth systematic search of the literature has been conducted for this narrative review. The systematic search of PubMed and Cochrane databases yielded 3,993, of which 629 underwent full text screening. A total of 78 studies were included in the final qualitative synthesis and data evaluation. The pathophysiology of the cardiovascular sequelae of Long COVID syndrome and the cardiac manifestations and complications of Long COVID syndrome are critically evaluated. In addition, potential cardiovascular risk factors are assessed, and preventive methods and treatment options are examined in this review. CONCLUSIONS This systematic review poignantly summarises the evidence from the available literature regarding the cardiovascular manifestations of Long COVID syndrome and reviews potential mechanistic pathways, diagnostic approaches, preventive measures and treatment options.
Collapse
Affiliation(s)
| | - Maria Bäck
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Maciej Dębski
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sabiha Gati
- Royal Brompton Hospital, UK and Imperial College London, UK
| | | | - Nicolle Kränkel
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Campus Benjamin-Franklin (CBF), Charité University Medicine Berlin, 12203 Berlin, Germany
| | - Konstantinos Koskinas
- Department of Cardiology, Bern University Hospital - INSELSPITAL, University of Bern, Switzerland
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Manuel Frias Vargas
- Department of Medicine, Faculty of Medicine, Complutense University of Madrid, Spain
- San Andres Primary Care Health Centre, Madrid, Spain
| | - Giuseppe Biondi-Zoccai
- Mediterranea Cardiocentro, Naples, Italy
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Vassilios S Vassiliou
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Cardiology, Norfolk and Norwich University Hospital, UK
| |
Collapse
|
9
|
D’Haese S, Claes L, de Laat I, Van Campenhout S, Deluyker D, Heeren E, Haesen S, Lambrichts I, Wouters K, Schalkwijk CG, Hansen D, Eijnde BO, Bito V. Moderate-Intensity and High-Intensity Interval Exercise Training Offer Equal Cardioprotection, with Different Mechanisms, during the Development of Type 2 Diabetes in Rats. Nutrients 2024; 16:431. [PMID: 38337716 PMCID: PMC10856993 DOI: 10.3390/nu16030431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Endurance exercise training is a promising cardioprotective strategy in type 2 diabetes mellitus (T2DM), but the impact of its intensity is not clear. We aimed to investigate whether and how isocaloric moderate-intensity exercise training (MIT) and high-intensity interval exercise training (HIIT) could prevent the adverse cardiac remodeling and dysfunction that develop T2DM in rats. Male rats received a Western diet (WD) to induce T2DM and underwent a sedentary lifestyle (n = 7), MIT (n = 7) or HIIT (n = 8). Insulin resistance was defined as the HOMA-IR value. Cardiac function was assessed with left ventricular (LV) echocardiography and invasive hemodynamics. A qPCR and histology of LV tissue unraveled underlying mechanisms. We found that MIT and HIIT halted T2DM development compared to in sedentary WD rats (p < 0.05). Both interventions prevented increases in LV end-systolic pressure, wall thickness and interstitial collagen content (p < 0.05). In LV tissue, HIIT tended to upregulate the gene expression of an ROS-generating enzyme (NOX4), while both modalities increased proinflammatory macrophage markers and cytokines (CD86, TNF-α, IL-1β; p < 0.05). HIIT promoted antioxidant and dicarbonyl defense systems (SOD2, glyoxalase 1; p < 0.05) whereas MIT elevated anti-inflammatory macrophage marker expression (CD206, CD163; p < 0.01). We conclude that both MIT and HIIT limit WD-induced T2DM with diastolic dysfunction and pathological LV hypertrophy, possibly using different adaptive mechanisms.
Collapse
Affiliation(s)
- Sarah D’Haese
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Lisa Claes
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Iris de Laat
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Sven Van Campenhout
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Dorien Deluyker
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Ellen Heeren
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Sibren Haesen
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Ivo Lambrichts
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| | - Kristiaan Wouters
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Casper G. Schalkwijk
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands; (K.W.); (C.G.S.)
| | - Dominique Hansen
- UHasselt, Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Centre, Agoralaan, 3590 Diepenbeek, Belgium;
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - BO Eijnde
- SMRc-Sports Medicine Research Center, BIOMED-Biomedical Research Institute, Faculty of Medicine & Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium;
- Division of Sport Science, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Virginie Bito
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.); (D.D.); (E.H.); (S.H.); (I.L.)
| |
Collapse
|
10
|
Hansen D, Coninx K, Beckers P, Cornelissen V, Kouidi E, Neunhauserer D, Niebauer J, Spruit MA, Takken T, Dendale P. Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease: why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network†. Eur J Prev Cardiol 2023; 30:1986-1995. [PMID: 37458001 DOI: 10.1093/eurjpc/zwad232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
In Europe alone, on a yearly basis, millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynamic moderate-intensity resistance exercise 2 days/week). However, recent evidence shows that this one size does not fit all and that individual adjustments should be made according to the patient's underlying disease(s), risk profile, and individual needs, to maximize the clinical benefits of exercise. In this paper, we (i) argue that this general exercise prescription simply provided to all patients with CVD, or elevated risk for CVD, is insufficient for optimal CVD prevention, and (ii) show that clinicians and healthcare professionals perform heterogeneously when asked to adjust exercise characteristics (e.g. intensity, volume, and type) according to the patient's condition, thereby leading to suboptimal CVD risk factor control. Since exercise training is a class 1A intervention in the primary and secondary prevention of CVD, the awareness of the need to improve exercise prescription has to be raised among clinicians and healthcare professionals if optimized prevention of CVD is ambitioned.
Collapse
Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Karin Coninx
- UHasselt, Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Beckers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp Hasselt, Belgium
| | - Véronique Cornelissen
- Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Neunhauserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Rehab-Center Salzburg, Ludwig Boltzmann Institute for digital Health and Prevention, Salzburg, Austria
| | - Martijn A Spruit
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| |
Collapse
|
11
|
Hansen D, Marinus N, Cornelissen V, Ramakers W, Coninx K. Exercise prescription by physiotherapists to patients with cardiovascular disease is in greater agreement with European recommendations after using the EXPERT training tool. Med Educ Online 2023; 28:2182660. [PMID: 36853878 PMCID: PMC9980021 DOI: 10.1080/10872981.2023.2182660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement. AIM To assess whether exercise prescriptions by physiotherapists to patients with CVD are better in agreement with European (ESC/EAPC) recommendations when the EXPERT (EXercise Prescription in Everyday practice & Rehabilitative Training) Training tool is used for digital educational training. DESIGN In a prospective non-randomized intervention study. METHODS Twenty-three belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a one-month digital training by using the EXPERT Training tool and completed 31 ± 13 training cases. The EXPERT tool is a training and decision support system that automatically generates a (personalised) exercise prescription according to the patient's characteristics, thus integrating the exercise prescriptions for different CVDs and risk factors, all based on ESC/EAPC recommendations. Thereafter, the same three patient cases as at entry of study were filled out again, with re-assessment of level of agreement with ESC/EAPC recommendations. RESULTS After using the EXPERT Training tool, the physiotherapists prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p < 0.05). In cases 1, 2 and 3, the agreement score increased from 29 ± 9 (out of 60), 28 ± 9, and 34 ± 7 to 41 ± 9, 41 ± 10, and 45 ± 8, respectively (p < 0.001). Hence, the total agreement score increased from 91 ± 17 (out of 180) to 127 ± 19 (p < 0.001, +44 ± 32%). A lower starting agreement score and younger age correlated with a greater improvement in total agreement score (p < 0.05). CONCLUSIONS Exercise prescriptions to patients with CVD, generated by physiotherapists, are significantly better in agreement with European recommendations when the EXPERT Training tool is used, indicating its educational potential.
Collapse
Affiliation(s)
- Dominique Hansen
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Nastasia Marinus
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, Leuven, Belgium
| | - Wim Ramakers
- Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| | - Karin Coninx
- Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
12
|
Daniels K, Lemmens R, Knippenberg E, Marinus N, Vonck S, Baerts J, Bergs J, Spooren A, Hansen D, Bonnechère B. Promoting physical activity and a healthy active lifestyle in community-dwelling older adults: a design thinking approach for the development of a mobile health application. Front Public Health 2023; 11:1280941. [PMID: 38106904 PMCID: PMC10724027 DOI: 10.3389/fpubh.2023.1280941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background Physical activity (PA) has wide-ranging, and well documented benefits for older adults, encompassing physical, cognitive, and mental well-being. The World Health Organization advocates for a minimum of 150-300 min of moderate intensity PA per week, supplemented by muscle-strengthening exercises. However, the rates of PA among older adults remain a concern. While portable technologies hold promises in promoting PA, sustaining long-term engagement continues to be a challenge. Objective The aims of this study are to identify barriers and facilitators to PA in older adults, to develop an mHealth app promoting PA and an active healthy lifestyle in collaboration with community-dwelling older adults guided by the design thinking process, and to test it. Methods A co-creative process was used, employing design thinking. Interviews were conducted to understand the needs of the target population and identify the problem of insufficient PA. Two cocreation sessions involving older adults and experts were conducted to generate innovative ideas. Participants were selected based on age (≥65 years), no severe illness, Dutch language proficiency, and active participation ability. Results were qualitatively analyzed and coded. Finally a prototype was developed and tested. Results Interviews with older adults highlighted diverse perceptions of PA but unanimous agreement on its importance. They recognized health benefits such as improved mobility, balance, and reduced fall risk, while emphasizing the social and mental aspects. Barriers included poor health, time constraints, weather conditions and fear of falling. Cocreation sessions identified key topics: perception of a healthy lifestyle, coping strategies, mHealth App features, screen visualization, and tailored notifications, which led to the development of a mobile app promoting PA and an active lifestyle. The app was stepwise prototyped. Conclusion This study emphasizes the importance of promoting PA among older adults through a collaborative design thinking approach. However, the implementation of mHealth apps faces obstacles due to the digital divide, necessitating personalized solutions to bridge the gap. Moreover, it calls for further research to investigate the long-term impact of such interventions and explore behavior change patterns in this population.
Collapse
Affiliation(s)
- Kim Daniels
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ryanne Lemmens
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Els Knippenberg
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Nastasia Marinus
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Sharona Vonck
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
| | - Jan Baerts
- Department of Digital, PXL University College of Applied Sciences and Arts, Hasselt, Belgium
| | - Jochen Bergs
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- THINK3 Simulation & Innovation Lab, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Annemie Spooren
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bruno Bonnechère
- Department of PXL – Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
13
|
Hansen D, Beckers P, Neunhäuserer D, Bjarnason-Wehrens B, Piepoli MF, Rauch B, Völler H, Corrà U, Garcia-Porrero E, Schmid JP, Lamotte M, Doherty P, Reibis R, Niebauer J, Dendale P, Davos CH, Kouidi E, Spruit MA, Vanhees L, Cornelissen V, Edelmann F, Barna O, Stettler C, Tonoli C, Greco E, Pedretti R, Abreu A, Ambrosetti M, Braga SS, Bussotti M, Faggiano P, Takken T, Vigorito C, Schwaab B, Coninx K. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 2023; 53:2013-2037. [PMID: 37648876 DOI: 10.1007/s40279-023-01909-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.
Collapse
Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium.
| | - Paul Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium
| | - Daniel Neunhäuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy
| | | | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | | | - Rona Reibis
- Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martijn A Spruit
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Luc Vanhees
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland
| | - Cajsa Tonoli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Ana Abreu
- Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy
| | | | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy
| | - Bernhard Schwaab
- Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany
| | - Karin Coninx
- UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium
| |
Collapse
|
14
|
Amanzonwé ER, Kossi O, Noukpo SI, Adoukonou T, Hansen D, Triccas LT, Feys P. Physiotherapy practices in acute and sub-acute stroke in a low resource country: A prospective observational study in Benin. J Stroke Cerebrovasc Dis 2023; 32:107353. [PMID: 37713747 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/04/2023] [Accepted: 09/09/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Physiotherapy is highly recommended for early recovery from stroke. This study aimed to document physiotherapy practices for people with acute and early sub-acute stroke in Benin. METHODS In this prospective observational study, physiotherapists working with acute stroke people documented the content of their treatment from six hospitals in Benin during the first session, at 2-week, and 1-month post-stroke with a standardized physiotherapy documentation form. We used the motricity index (MI) and trunk control test (TCT) to assess impairments, and the 10-meter walk test (10mWT), functional independence measure (FIM), walking, stair climbing, and dressing upper body subscales were used for activity limitations. RESULTS Fifteen physiotherapists (60 % male, mean±SD age=31.3±5.8 years) recorded treatment sessions for 77 stroke participants (53.2 % male, mean±SD age=57.7±12.5 years). Physiotherapists focused on conventional physiotherapy approaches, including musculoskeletal (67 % of pre-functional activity time) and neuromuscular (53 % of sitting activity time) interventions. A significant difference was found between the therapy time delivered for people with mild, moderate, and severe stroke (p < 0.001). The MI (p= 0.033) and TCT (p= 0.002) measures showed significant improvement at 2-week and 1-month (p< 0.001) post-stroke, while 10mWT, FIM walking, stair climbing, and dressing upper body items significantly increased at 1-month (p< 0.001) but not at 2-week post-stroke. CONCLUSION Physiotherapists working with acute stroke patients in Benin mainly use conventional neuromuscular and musculoskeletal interventions. In contrast, aerobic exercises were rarely employed regardless of stroke severity. Furthermore, our findings showed that the volume of physiotherapy sessions varied by stroke severity.
Collapse
Affiliation(s)
- Elogni Renaud Amanzonwé
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | - Oyéné Kossi
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin; ENATSE, National School of Public Health and Epidemiology, Université de Parakou, Parakou, Benin.
| | - Sènadé Inès Noukpo
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin
| | - Thierry Adoukonou
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin; ENATSE, National School of Public Health and Epidemiology, Université de Parakou, Parakou, Benin
| | - Dominique Hansen
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Lisa Tedesco Triccas
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| | - Peter Feys
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium
| |
Collapse
|
15
|
Hanssen H, Moholdt T, Bahls M, Biffi A, Siegrist M, Lewandowski AJ, Biondi-Zoccai G, Cavarretta E, Kokkvoll A, Løchen ML, Maestrini V, Pinto RS, Palermi S, Thivel D, Wojcik M, Hansen D, Van Craenenbroeck EM, Weghuber D, Kraenkel N, Tiberi M. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur J Prev Cardiol 2023; 30:1462-1472. [PMID: 37491406 DOI: 10.1093/eurjpc/zwad152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
Collapse
Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald, University of Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Palermi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicolle Kraenkel
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care, Campus Benjamin-Franklin (CBF), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Friede Springer- Cardiovascular Prevention Center @ Charité, Charite- Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
| |
Collapse
|
16
|
Dos Santos Ribeiro G, Beltrame T, Fernando Deresz L, Hansen D, Agostoni P, Karsten M. Software development to standardize the clinical diagnosis of exercise oscillatory ventilation in heart failure. J Clin Monit Comput 2023; 37:1247-1253. [PMID: 36735189 DOI: 10.1007/s10877-023-00976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET's raw data in heart failure patients and test its reliability (intra- and inter-rater). METHODS The software was developed in the "drag-and-drop" G-language using LabVIEW®. Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen's kappa coefficient (κ) was used to investigate the reliability. RESULTS Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed. CONCLUSION The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.
Collapse
Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thomas Beltrame
- Samsung R&D Institute Brazil - SRBR, Universidade Federal de São Carlos (UFSCAR), Campinas, SP, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, MG, Brazil
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences, Hasselt University (UHASSELT), BIOMED/REVAL, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
- Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, SC, Brazil
- Centro de Ciências da Saúde e do Esporte, UDESC, Rua Pascoal Simone 358, CEP 88080-350, Florianópolis, SC, Brazil
| |
Collapse
|
17
|
D’Haese S, Verboven M, Evens L, Deluyker D, Lambrichts I, Eijnde BO, Hansen D, Bito V. Moderate- and High-Intensity Endurance Training Alleviate Diabetes-Induced Cardiac Dysfunction in Rats. Nutrients 2023; 15:3950. [PMID: 37764732 PMCID: PMC10535416 DOI: 10.3390/nu15183950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Exercise training is an encouraging approach to treat cardiac dysfunction in type 2 diabetes (T2DM), but the impact of its intensity is not understood. We aim to investigate whether and, if so, how moderate-intensity training (MIT) and high-intensity interval training (HIIT) alleviate adverse cardiac remodeling and dysfunction in rats with T2DM. Male rats received standard chow (n = 10) or Western diet (WD) to induce T2DM. Hereafter, WD rats were subjected to a 12-week sedentary lifestyle (n = 8), running MIT (n = 7) or HIIT (n = 7). Insulin resistance and glucose tolerance were assessed during the oral glucose tolerance test. Plasma advanced glycation end-products (AGEs) were evaluated. Echocardiography and hemodynamic measurements evaluated cardiac function. Underlying cardiac mechanisms were investigated by histology, western blot and colorimetry. We found that MIT and HIIT lowered insulin resistance and blood glucose levels compared to sedentary WD rats. MIT decreased harmful plasma AGE levels. In the heart, MIT and HIIT lowered end-diastolic pressure, left ventricular wall thickness and interstitial collagen deposition. Cardiac citrate synthase activity, mitochondrial oxidative capacity marker, raised after both exercise training modalities. We conclude that MIT and HIIT are effective in alleviating diastolic dysfunction and pathological cardiac remodeling in T2DM, by lowering fibrosis and optimizing mitochondrial capacity.
Collapse
Affiliation(s)
- Sarah D’Haese
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - Maxim Verboven
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
| | - Lize Evens
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
| | - Dorien Deluyker
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
| | - Ivo Lambrichts
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
| | - BO Eijnde
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
- UHasselt, SMRC Sports Medical Research Center, Agoralaan, 3590 Diepenbeek, Belgium
- Division of Sport Science, Faculty of Medicine & Health Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
| | - Dominique Hansen
- UHasselt, REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Agoralaan, 3590 Diepenbeek, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Virginie Bito
- UHasselt, Cardio & Organ Systems (COST), Biomedical Research Institute, Agoralaan, 3590 Diepenbeek, Belgium; (S.D.)
| |
Collapse
|
18
|
Verdicchio C, Freene N, Hollings M, Maiorana A, Briffa T, Gallagher R, Hendriks JM, Abell B, Brown A, Colquhoun D, Howden E, Hansen D, Reading S, Redfern J. A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement. Heart Lung Circ 2023; 32:1035-1048. [PMID: 37516652 DOI: 10.1016/j.hlc.2023.06.854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 07/31/2023]
Abstract
Patients with cardiovascular disease benefit from cardiac rehabilitation, which includes structured exercise and physical activity as core components. This position statement provides pragmatic, evidence-based guidance for the assessment and prescription of exercise and physical activity for cardiac rehabilitation clinicians, recognising the latest international guidelines, scientific evidence and the increasing use of technology and virtual delivery methods. The patient-centred assessment and prescription of aerobic exercise, resistance exercise and physical activity have been addressed, including progression and safety considerations.
Collapse
Affiliation(s)
- Christian Verdicchio
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Heart Rhythm Disorders, University of Adelaide, SAHMRI and Royal Adelaide Hospital, Adelaide, SA, Australia.
| | - Nicole Freene
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, ACT, Australia; Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Maiorana
- Allied Health Department, Fiona Stanley Hospital, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide, SAHMRI and Royal Adelaide Hospital, Adelaide, SA, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - Alex Brown
- Telethon Kids Institute, Australian National University, Canberra, ACT, Australia
| | - David Colquhoun
- Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia; Faculty of Medicine, Wesley Medical Centre, Brisbane, Qld, Australia
| | - Erin Howden
- Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Vic, Australia
| | - Dominique Hansen
- UHasselt, REVAL/BIOMED (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Stacey Reading
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
19
|
Van der Stede T, Spaas J, de Jager S, De Brandt J, Hansen C, Stautemas J, Vercammen B, De Baere S, Croubels S, Van Assche CH, Pastor BC, Vandenbosch M, Van Thienen R, Verboven K, Hansen D, Bové T, Lapauw B, Van Praet C, Decaestecker K, Vanaudenaerde B, Eijnde BO, Gliemann L, Hellsten Y, Derave W. Extensive profiling of histidine-containing dipeptides reveals species- and tissue-specific distribution and metabolism in mice, rats, and humans. Acta Physiol (Oxf) 2023; 239:e14020. [PMID: 37485756 DOI: 10.1111/apha.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/26/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
AIM Histidine-containing dipeptides (HCDs) are pleiotropic homeostatic molecules with potent antioxidative and carbonyl quenching properties linked to various inflammatory, metabolic, and neurological diseases, as well as exercise performance. However, the distribution and metabolism of HCDs across tissues and species are still unclear. METHODS Using a sensitive UHPLC-MS/MS approach and an optimized quantification method, we performed a systematic and extensive profiling of HCDs in the mouse, rat, and human body (in n = 26, n = 25, and n = 19 tissues, respectively). RESULTS Our data show that tissue HCD levels are uniquely produced by carnosine synthase (CARNS1), an enzyme that was preferentially expressed by fast-twitch skeletal muscle fibres and brain oligodendrocytes. Cardiac HCD levels are remarkably low compared to other excitable tissues. Carnosine is unstable in human plasma, but is preferentially transported within red blood cells in humans but not rodents. The low abundant carnosine analogue N-acetylcarnosine is the most stable plasma HCD, and is enriched in human skeletal muscles. Here, N-acetylcarnosine is continuously secreted into the circulation, which is further induced by acute exercise in a myokine-like fashion. CONCLUSION Collectively, we provide a novel basis to unravel tissue-specific, paracrine, and endocrine roles of HCDs in human health and disease.
Collapse
Affiliation(s)
- Thibaux Van der Stede
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Jan Spaas
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- University MS Center (UMSC) Hasselt, Pelt, Belgium
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Sarah de Jager
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Jana De Brandt
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Camilla Hansen
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Jan Stautemas
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Bjarne Vercammen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Siegrid De Baere
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, Ghent, Belgium
| | - Siska Croubels
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, Ghent, Belgium
| | - Charles-Henri Van Assche
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Berta Cillero Pastor
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Michiel Vandenbosch
- The Maastricht MultiModal Molecular Imaging (M4I) institute, Maastricht University, Maastricht, The Netherlands
| | - Ruud Van Thienen
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Kenneth Verboven
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Dominique Hansen
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital Hasselt, Hasselt, Belgium
| | - Thierry Bové
- Department of Cardiac Surgery, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Charles Van Praet
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Karel Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Bart Vanaudenaerde
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Bert O Eijnde
- University MS Center (UMSC) Hasselt, Pelt, Belgium
- SMRC Sports Medical Research Center, BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Division of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Lasse Gliemann
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports, Copenhagen University, Copenhagen, Denmark
| | - Wim Derave
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
20
|
Milani JGPO, Milani M, Cipriano GFB, Hansen D, Cipriano Junior G. Exercise intensity domains determined by heart rate at the ventilatory thresholds in patients with cardiovascular disease: new insights and comparisons to cardiovascular rehabilitation prescription recommendations. BMJ Open Sport Exerc Med 2023; 9:e001601. [PMID: 37533593 PMCID: PMC10391816 DOI: 10.1136/bmjsem-2023-001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives To compare the elicited exercise responses at ventilatory thresholds (VTs: VT1 and VT2) identified by cardiopulmonary exercise testing (CPET) in patients with cardiovascular disease (CVD) with the guideline-directed exercise intensity domains; to propose equations to predict heart rate (HR) at VTs; and to compare the accuracy of prescription methods. Methods A cross-sectional study was performed with 972 maximal treadmill CPET on patients with CVD. First, VTs were identified and compared with guideline-directed exercise intensity domains. Second, multivariate linear regression analyses were performed to generate prediction equations for HR at VTs. Finally, the accuracy of prescription methods was assessed by the mean absolute percentage error (MAPE). Results Significant dispersions of individual responses were found for VTs, with the same relative intensity of exercise corresponding to different guideline-directed exercise intensity domains. A mathematical error inherent to methods based on percentages of peak effort was identified, which may help to explain the dispersions. Tailored multivariable equations yielded r2 of 0.726 for VT1 and 0.901 for VT2. MAPE for the novel VT1 equation was 6.0%, lower than that for guideline-based prescription methods (9.5 to 23.8%). MAPE for the novel VT2 equation was 4.3%, lower than guideline-based methods (5.8%-19.3%). Conclusion The guideline-based exercise intensity domains for cardiovascular rehabilitation revealed inconsistencies and heterogeneity, which limits the currently used methods. New multivariable equations for patients with CVD were developed and demonstrated better accuracy, indicating that this methodology may be a valid alternative when CPET is unavailable.
Collapse
Affiliation(s)
| | - Mauricio Milani
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
| | - Graziella França Bernardelli Cipriano
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
- Rehabilitation Sciences Programme, University of Brasilia, Brasilia, Brazil
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Gerson Cipriano Junior
- Graduate Programme in Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
| |
Collapse
|
21
|
De Bosscher R, Dausin C, Claus P, Bogaert J, Dymarkowski S, Goetschalckx K, Ghekiere O, Van De Heyning CM, Van Herck P, Paelinck B, Addouli HE, La Gerche A, Herbots L, Willems R, Heidbuchel H, Claessen G, Claeys M, Hespel P, Dresselaers T, Miljoen H, Belmans A, Favere K, Vermeulen D, Witvrouwen I, Hansen D, Eijnde BO, Thijs D, Vanvoorden P, Van Soest S. Lifelong endurance exercise and its relation with coronary atherosclerosis. Eur Heart J 2023; 44:2388-2399. [PMID: 36881712 PMCID: PMC10327878 DOI: 10.1093/eurheartj/ehad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS The impact of long-term endurance sport participation (on top of a healthy lifestyle) on coronary atherosclerosis and acute cardiac events remains controversial. METHODS AND RESULTS The Master@Heart study is a well-balanced prospective observational cohort study. Overall, 191 lifelong master endurance athletes, 191 late-onset athletes (endurance sports initiation after 30 years of age), and 176 healthy non-athletes, all male with a low cardiovascular risk profile, were included. Peak oxygen uptake quantified fitness. The primary endpoint was the prevalence of coronary plaques (calcified, mixed, and non-calcified) on computed tomography coronary angiography. Analyses were corrected for multiple cardiovascular risk factors. The median age was 55 (50-60) years in all groups. Lifelong and late-onset athletes had higher peak oxygen uptake than non-athletes [159 (143-177) vs. 155 (138-169) vs. 122 (108-138) % predicted]. Lifelong endurance sports was associated with having ≥1 coronary plaque [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.17-2.94], ≥ 1 proximal plaque (OR 1.96, 95% CI 1.24-3.11), ≥ 1 calcified plaques (OR 1.58, 95% CI 1.01-2.49), ≥ 1 calcified proximal plaque (OR 2.07, 95% CI 1.28-3.35), ≥ 1 non-calcified plaque (OR 1.95, 95% CI 1.12-3.40), ≥ 1 non-calcified proximal plaque (OR 2.80, 95% CI 1.39-5.65), and ≥1 mixed plaque (OR 1.78, 95% CI 1.06-2.99) as compared to a healthy non-athletic lifestyle. CONCLUSION Lifelong endurance sport participation is not associated with a more favourable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile. Longitudinal research is needed to reconcile these findings with the risk of cardiovascular events at the higher end of the endurance exercise spectrum.
Collapse
Affiliation(s)
- Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Christophe Dausin
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Bogaert
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Steven Dymarkowski
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kaatje Goetschalckx
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Olivier Ghekiere
- Division of Radiology, Jessa Ziekenhuis, Stadsomvaat 11, 3500 Hasselt, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Caroline M Van De Heyning
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul Van Herck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Bernard Paelinck
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Haroun El Addouli
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - André La Gerche
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Lieven Herbots
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hein Heidbuchel
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- Department of Cardiology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
- Division of Cardiology, Hartcentrum, Jessa Ziekenhuis, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Division of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Peter Hespel
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium
| | - Tom Dresselaers
- Division of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Hielko Miljoen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kasper Favere
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dorien Vermeulen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Isabel Witvrouwen
- Division of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Cardiovascular Research, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Dominique Hansen
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Bert Op’t Eijnde
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
- REVAL/BIOMED, Hasselt University, Agoralaan Gebouw C, 3590 Diepenbeek, Belgium
| | - Daisy Thijs
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Peter Vanvoorden
- Department of Medicine and Life Sciences, University of Hasselt, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Sofie Van Soest
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
22
|
De Wilde C, Bekhuis Y, Kuznetsova T, Claes J, Claessen G, Coninx K, Decorte E, De Smedt D, Hansen D, Lannoo M, Van Craenenbroeck EM, Verhaeghe N, Cornelissen VA. Personalized remotely guided preventive exercise therapy for a healthy heart (PRIORITY): protocol for an assessor-blinded, multicenter randomized controlled trial. Front Cardiovasc Med 2023; 10:1194693. [PMID: 37456813 PMCID: PMC10339344 DOI: 10.3389/fcvm.2023.1194693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Aims A key treatment for patients with varying stages of heart failure with preserved ejection fraction (HFpEF) is exercise. Yet, despite a Class 1A recommendation, only one-third of patients exercise sufficiently. A huge treatment gap exists between guidelines and clinical practice. PRIORITY aims to establish the feasibility, clinical effectiveness and cost-effectiveness of a hybrid centre and home-based personalized exercise and physical activity intervention for patients along the HFpEF continuum. Methods An assessor-blinded, multicenter randomized controlled trial will be conducted among 312 patients along the HFpEF continuum. Participants will be randomized (1:1) to the PRIORITY intervention or a comparator group receiving only a written exercise prescription. Participants in the PRIORITY group will receive 18 supervised centre-based exercise sessions during one year, supplemented with a remotely guided home-based physical activity program. Outcomes will be assessed at baseline, 4 months, one and two years. The primary outcome is the peak oxygen uptake (pVO2) at 1-year. Secondary outcomes include physical activity, other physical fitness parameters, cardiovascular health, echocardiographic parameters, health-related quality of life and costs at 1-year FU. Machine learning algorithms will analyse big data on physical activity collected during the 1-year intervention to develop models that can predict physical activity uptake and adherence as well as changes in fitness and health. A cost-utility analysis will be performed to evaluate the cost-effectiveness of the PRIORITY intervention compared to the control condition. Discussion We anticipate that participants in the supervised home-based exercise intervention group will have a greater increase in pVO2 compared to those receiving a written exercise prescription. Trial registration number This trial is registered at ClinicalTrials.gov (NCT04745013) and is currently in the recruitment stage.
Collapse
Affiliation(s)
- Camille De Wilde
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Youri Bekhuis
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
- REVAL—Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Karin Coninx
- HCI And eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elise Decorte
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research, Ghent University, Ghent, Belgium
| | - Dominique Hansen
- REVAL—Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Matthias Lannoo
- Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Emeline M. Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research, Ghent University, Ghent, Belgium
- Department of Public Health, Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Véronique A. Cornelissen
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
23
|
Kaihara T, Hansen D, Sankaran S, Scherrenberg M, Falter M, Xu L, Coninx K, Dendale P. Do we need to rethink the determination of exercise-related energy expenditure in cardiac telerehabilitation interventions? J Telemed Telecare 2023:1357633X231166159. [PMID: 37013407 DOI: 10.1177/1357633x231166159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The American College of Sports Medicine determined the energy consumption of daily activities and sports. Cardiac telerehabilitation (CTR) requires knowing how much energy people consume in daily life outside of cardiac rehabilitation activities. Therefore, we have investigated if the estimated values are valid in CTR. Data from two studies were incorporated. The first study measured ventilatory threshold (VT)1, VT2, and peak exercise on cardiopulmonary exercise testing (CPET) collected from 272 cardiac (risk) patients and compared them to the estimated oxygen consumption (VO2) at low-to-moderate-intense exercise (3-6 metabolic equivalents [METs]). Next, a patient-tailored application was developed to support CTR using these estimated values, and the intervention (the second study) was conducted with 24 coronary artery disease patients using this application during a CTR intervention. In the first study, VO2 at VT1, VT2 and peak exercise corresponded to 3.2 [2.8, 3.8], 4.3 [3.8, 5.3], and 5.4 [4.5, 6.2] METs, which are significantly different from the estimated VO2 at low-to-moderate-intense exercise, especially lower in older, obese, female, and post-myocardial infarction/heart failure patients. These VO2 varied considerably between patients. The telerehabilitation study did not show significant progress in peak VO2, but using the application's estimated target, 97.2% of the patients achieved their weekly target, which is a significant overestimate. The estimated and observed exercise-related energy expenditures by CPET were significantly different, resulting in an overestimation of the exercise done by the patients at home. The results can have a significant impact on the quantification of exercise dose during (tele)rehabilitation programs.
Collapse
Affiliation(s)
- Toshiki Kaihara
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Sciences, Human-Computer Interaction and eHealth, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, UHasselt, Diepenbeek, Belgium
| | - Supraja Sankaran
- Faculty of Sciences, Human-Computer Interaction and eHealth, UHasselt, Diepenbeek, Belgium
- Department of Communication and Cognition, 7899Tilburg University, Tilburg, The Netherlands
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, UAntwerp, Antwerp, Belgium
| | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Linqi Xu
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- School of Nursing, Jilin University, Changchun, PR China
| | - Karin Coninx
- Faculty of Sciences, Human-Computer Interaction and eHealth, UHasselt, Diepenbeek, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| |
Collapse
|
24
|
Madin JS, Baird AH, Connolly SR, Dornelas MA, Álvarez-Noriega M, McWilliam MJ, Barbosa M, Blowes SA, Cetina-Heredia P, Christie AP, Cumbo VR, Diaz M, Emms MA, Graham E, Hansen D, Hisano M, Howells E, Kuo CY, Palmer C, Hong JTC, Zhi En Teo T, Woods R. Six years of demography data for 11 reef coral species. Ecology 2023; 104:e4017. [PMID: 36882893 DOI: 10.1002/ecy.4017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 03/09/2023]
Abstract
Scleractinian corals are colonial animals with a range of life history strategies, making up diverse species assemblages that define coral reefs. We tagged and tracked approximately 30 colonies from each of 11 species during seven trips spanning six years (2009-2015) in order to measure their vital rates and competitive interactions on the reef crest at Trimodal Reef, Lizard Island, Australia. Pairs of species were chosen from five growth forms where one species of the pair was locally rare (R) and the other common (C). The sampled growth forms were massive [Goniastrea pectinata (R) and G. retiformis (C)], digitate [Acropora humilis (R) and A. cf. digitifera (C)], corymbose [A. millepora (R) and A. nasuta (C)], tabular [A. cytherea (R) and A. hyacinthus (C)] and arborescent [A. robusta (R) and A. intermedia (C)]. An extra corymbose species with intermediate abundance, A. spathulata was included when it became apparent that A. millepora was too rare on the reef crest, making the 11 species in total. The tagged colonies were visited each year in the weeks prior to spawning. During visits, two or more observers each took 2-3 photographs of each tagged colony from directly above and on the horizontal plane with a scale plate to track planar area. Dead or missing colonies were recorded and new colonies tagged in order to maintain approximately 30 colonies per species throughout the six years of the study. In addition to tracking tagged corals, 30 fragments were collected from neighboring untagged colonies of each species for counting numbers of eggs per polyp (fecundity); and fragments of untagged colonies were brought into the laboratory where spawned eggs were collected for biomass and energy measurements. We also conducted surveys at the study site to generate size structure data for each species in several of the years. Each tagged colony photograph was digitized by at least two people. Therefore, we could examine sources of error in planar area for both photographers and outliners. Competitive interactions were recorded for a subset of species by measuring the margins of tagged colony outlines interacting with neighboring corals. The study was abruptly ended by Tropical Cyclone Nathan (Category 4) that killed all but nine of the over 300 tagged colonies in early 2015. Nonetheless, these data will be of use to other researchers interested in coral demography and coexistence, functional ecology, and parametrizing population, community and ecosystem models. The data set is not copyright restricted, and users should cite this paper when using the data.
Collapse
Affiliation(s)
- Joshua S Madin
- Hawai'i Institute of Marine Biology, University of Hawai'i at Manoa, Kaneohe, HI, USA
| | - Andrew H Baird
- ARC Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, QLD, Australia
| | | | - Maria A Dornelas
- Centre for Biological Diversity, Scottish Oceans Institute, University of St Andrews, St Andrews, UK.,Faculdade de Ciencias da Universidade de Lisboa, Portugal
| | - Mariana Álvarez-Noriega
- ARC Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, QLD, Australia
| | - Michael J McWilliam
- Hawai'i Institute of Marine Biology, University of Hawai'i at Manoa, Kaneohe, HI, USA
| | - Miguel Barbosa
- Centre for Biological Diversity, Scottish Oceans Institute, University of St Andrews, St Andrews, UK.,CESAM, Department of Biology, University of Aveiro, Aveiro, Portugal
| | - Shane A Blowes
- German Centre for Integrative Biodiversity Research (iDiv), Halle-Jena-Leipzig, Germany.,Martin Luther University Halle-Wittenberg, Institute of Computer Science, Halle (Saale), Germany
| | - Paulina Cetina-Heredia
- Laboratorio de Ingeniería y Procesos Costeros, Instituto de Ingeniería, Universidad Nacional Autónoma de, México.,Laboratorio Nacional de Resiliencia Costera (LANRESC), Laboratorios Nacionales CONACYT, México
| | | | - Vivian R Cumbo
- Department of Biological Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Marcela Diaz
- Department of Biological Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Madeleine A Emms
- Institute of Genetics and Biophysics 'A. Buzzati-Traverso', National Research Council (CNR), Naples, Italy
| | - Erin Graham
- College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - Dominique Hansen
- College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - Mizue Hisano
- ARC Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, QLD, Australia
| | - Emily Howells
- National Marine Science Centre, Southern Cross University, Coffs Harbour, Australia
| | - Chao-Yang Kuo
- Biodiversity Research Center, Academia Sinica, 128 Academia Road, Sec. 2, Nankang, Taipei, Taiwan
| | - Caroline Palmer
- School of Biological and Marine Sciences, Plymouth, Devon, UK
| | - James Tan Chun Hong
- Research and Education on Environment for Future Sustainability (REEFS) Research Interest Group, Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | - Theophilus Zhi En Teo
- College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - Rachel Woods
- Department of Biological Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| |
Collapse
|
25
|
Franssen WMA, Keytsman C, Marinus N, Verboven K, Eijnde BO, van Ryckeghem L, Dendale P, Zeevaert R, Massa G, Hansen D. Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance. J Sport Health Sci 2023; 12:194-201. [PMID: 33529767 PMCID: PMC10105027 DOI: 10.1016/j.jshs.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/18/2020] [Accepted: 12/08/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing, which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular events. It is unknown whether cardiac chronotropic incompetence (CI) during maximal exercise is already present in obese adolescents and, if so, how that relates to cardiometabolic health. METHODS Sixty-nine obese adolescents (body mass index standard deviation score = 2.23 ± 0.32, age = 14.1 ± 1.2 years; mean ± SD) and 29 lean adolescents (body mass index standard deviation score = -0.16 ± 0.84, age = 14.0 ± 1.5 years) performed a maximal cardiopulmonary exercise testing from which indicators for peak performance were determined. The resting heart rate and peak heart rate were used to calculate the maximal chronotropic response index. Biochemistry (lipid profile, glycemic control, inflammation, and leptin) was studied in fasted blood samples and during an oral glucose tolerance test within obese adolescents. Regression analyses were applied to examine associations between the presence of CI and blood or exercise capacity parameters, respectively, within obese adolescents. RESULTS CI was prevalent in 32 out of 69 obese adolescents (46%) and 3 out of 29 lean adolescents (10%). C-reactive protein was significantly higher in obese adolescents with CI compared to obese adolescents without CI (p = 0.012). Furthermore, peak oxygen uptake and peak cycling power output were significantly reduced (p < 0.05) in obese adolescents with CI vs. obese adolescents without CI. The chronotropic index was independently related to blood total cholesterol (standardized coefficient β = -0.332; p = 0.012) and C-reactive protein concentration (standardized coefficient β = -0.269; p = 0.039). CONCLUSION CI is more common in the current cohort of obese adolescents, and is related to systemic inflammation and exercise intolerance.
Collapse
Affiliation(s)
- Wouter M A Franssen
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium.
| | - Charly Keytsman
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
| | - Nastasia Marinus
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium
| | - Kenneth Verboven
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
| | - Bert O Eijnde
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium; ADLON Sports Medical Center, Hasselt 3500, Belgium
| | - Lisa van Ryckeghem
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
| | - Paul Dendale
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt 3500, Belgium
| | - Renate Zeevaert
- Department of Pediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt 3500, Belgium
| | - Guy Massa
- Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium; Department of Pediatric Endocrinology and Diabetology, Jessa Hospital, Hasselt 3500, Belgium
| | - Dominique Hansen
- Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt 3500, Belgium
| |
Collapse
|
26
|
Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
Collapse
Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
| |
Collapse
|
27
|
Gojevic T, Van Ryckeghem L, Jogani S, Frederix I, Bakelants E, Petit T, Stroobants S, Dendale P, Bito V, Herbots L, Hansen D, Verwerft J. Pulmonary hypertension during exercise underlies unexplained exertional dyspnoea in patients with Type 2 diabetes. Eur J Prev Cardiol 2023; 30:37-45. [PMID: 35881689 DOI: 10.1093/eurjpc/zwac153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023]
Abstract
AIMS To compare the cardiac function and pulmonary vascular function during exercise between dyspnoeic and non-dyspnoeic patients with Type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Forty-seven T2DM patients with unexplained dyspnoea and 50 asymptomatic T2DM patients underwent exercise echocardiography combined with ergospirometry. Left ventricular (LV) function [stroke volume, cardiac output (CO), LV ejection fraction, systolic annular velocity (s')], estimated LV filling pressures (E/e'), mean pulmonary arterial pressures (mPAPs) and mPAP/COslope were assessed at rest, low- and high-intensity exercise with colloid contrast. Groups had similar patient characteristics, glycemic control, stroke volume, CO, LV ejection fraction, and E/e' (P > 0.05). The dyspnoeic group had significantly lower systolic LV reserve at peak exercise (s') (P = 0.021) with a significant interaction effect (P < 0.001). The dyspnoeic group also had significantly higher mPAP and mPAP/CO at rest and exercise (P < 0.001) with significant interaction for mPAP (P < 0.009) and insignificant for mPAP/CO (P = 0.385). There was no significant difference in mPAP/COslope between groups (P = 0.706). However, about 61% of dyspnoeic vs. 30% of non-dyspnoeic group had mPAP/COslope > 3 (P = 0.009). The mPAP/COslope negatively predicted V̇O2peak in dyspneic group (β = -1.86, 95% CI: -2.75, -0.98; multivariate model R2:0.54). CONCLUSION Pulmonary hypertension and less LV systolic reserve detected by exercise echocardiography with colloid contrast underlie unexplained exertional dyspnoea and reduced exercise capacity in T2DM.
Collapse
Affiliation(s)
- Tin Gojevic
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | - Lisa Van Ryckeghem
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | | | - Ines Frederix
- Department of Cardiology, Zuyderland MC, 6419 PC Heerlen, The Netherlands
- Faculty of Medicine and Health Sciences, Antwerp University, 2610 WILRIJK (Antwerpen), Belgium
| | - Elise Bakelants
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Department of Cardiology, Geneva University Hospital, 1205 Genève, Switzerland
| | - Thibault Petit
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | | | - Paul Dendale
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Virginie Bito
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | - Lieven Herbots
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Dominique Hansen
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Jan Verwerft
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| |
Collapse
|
28
|
Jardim IDSC, Milani M, Castro I, Hansen D, Karsten M, Cahalin LP, Cipriano GFB, Cipriano G. Impact of COVID-19's on Cardiovascular Rehabilitation Programs in Brazil: An Online Survey-Based Cross-Sectional Study. Arq Bras Cardiol 2023; 120:e20220135. [PMID: 36921154 PMCID: PMC9973047 DOI: 10.36660/abc.20220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/16/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had an impact on cardiovascular rehabilitation (CR) programs in Brazil. OBJECTIVES To describe the characteristics of CR programs in Brazil, the impacts of the first epidemiological wave of COVID-19 (first 60 days) on the programs and present the initiatives used to overcome the impacts. METHOD This cross-sectional and retrospective study utilized a specific online survey. Participants were coordinators of CR programs. Variables were presented by Brazilian geographic region and as the following categories: demographic, clinical and operational characteristics. The significance level for statistical analysis was set at 5%. RESULTS Fifty-nine CR programs were responsible for 5,349 patients, of which only 1,817 were post-acute cardiovascular events, which corresponded to 1.99% of hospitalized patients in the month prior to the survey (n=91,231). The greatest impact was the suspension of on-site activities, which occurred similarly in areas with the highest and the lowest rates of COVID-19 in the period. Forty-five programs (75%) were shortly interrupted, while three (5%) were ended. All 42 programs that already used remote rehabilitation strategies noticed a substantial increase in activities, based primarily on the use of media and video calling. Only three (5%) considered safe to see patients during the first 60 days. CONCLUSIONS There was a reduction in the number of CR programs with the COVID-19 pandemic. Telerehabilitation activities increased during the first two months of the COVID-19 pandemic, but this was not enough to overcome the reduction in CR program activities across Brazil.
Collapse
Affiliation(s)
- Iara de Sousa Cezário Jardim
- Programa de Pós Graduação em Ciências da Reabilitação (PPGCR), Universidade de Brasília (UNB), Brasília, DF - Brasil
| | - Mauricio Milani
- Fitcordis, Brasília, DF - Brasil.,Programa de Pós Graduação em Ciências e Tecnologias em Saúde (PPGCTS), Universidade de Brasília (UNB), Brasília, DF - Brasil
| | - Isac Castro
- Universidade de São Paulo, São Paulo, SP - Brasil
| | | | - Marlus Karsten
- Programa de Pós-graduação em Fisioterapia (PPGFT), Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | | | - Gerson Cipriano
- Programa de Pós Graduação em Ciências da Reabilitação (PPGCR), Universidade de Brasília (UNB), Brasília, DF - Brasil
| |
Collapse
|
29
|
Marinus N, Van Hoornweder S, Aarts M, Vanbilsen J, Hansen D, Meesen R. The influence of a single transcranial direct current stimulation session on physical fitness in healthy subjects: a systematic review. Exp Brain Res 2023; 241:31-47. [PMID: 36357590 PMCID: PMC9648891 DOI: 10.1007/s00221-022-06494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022]
Abstract
Physical fitness is of indisputable importance for both health, and sports. Currently, the brain is being increasingly recognized as a contributor to physical fitness. Hereby, transcranial direct current stimulation (tDCS), as an ergogenic aid, has gained scientific interest. The current PRISMA-adherent review aimed to examine the effect of tDCS on the three core components of physical fitness: muscle strength, -endurance and cardiopulmonary endurance. Randomized controlled- or cross-over trials evaluating the effect of a single tDCS session (vs. sham) in healthy individuals were included. Hereby, a wide array of tDCS-related factors (e.g., tDCS montage and dose) was taken into account. Thirty-five studies (540 participants) were included. Between-study heterogeneity in factors such as age, activity level, tDCS protocol, and outcome measures was large. The capacity of tDCS to improve physical fitness varied substantially across studies. Nevertheless, muscle endurance was most susceptible to improvements following anodal tDCS (AtDCS), with 69% of studies (n = 11) investigating this core component of physical fitness reporting positive effects. The primary motor cortex and dorsolateral prefrontal cortex were targeted the most, with positive results being reported on muscle and cardiopulmonary endurance. Finally, online tDCS seemed most beneficial, and no clear relationship between tDCS and dose-related parameters seemed present. These findings can contribute to optimizing tDCS interventions during the rehabilitation of patients with a variety of (chronic) diseases such as cardiovascular disease. Therefore, future studies should focus on further unraveling the potential of AtDCS on physical fitness and, more specifically, muscle endurance in both healthy subjects and patients suffering from (chronic) diseases. This study was registered in Prospero with the registration number CRD42021258529. "To enable PROSPERO to focus on COVID-19 registrations during the 2020 pandemic, this registration record was automatically published exactly as submitted. The PROSPERO team has not checked eligibility".
Collapse
Affiliation(s)
- Nastasia Marinus
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium. .,Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.
| | - Sybren Van Hoornweder
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Marthe Aarts
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Jessie Vanbilsen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium
| | - Dominique Hansen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium.,Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Raf Meesen
- Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan Building A 3590, Diepenbeek, Belgium.,Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
| |
Collapse
|
30
|
Amanzonwé ER, Tedesco Triccas L, Codjo L, Hansen D, Feys P, Kossi O. Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke. S Afr J Physiother 2023; 79:1846. [PMID: 36873960 PMCID: PMC9982519 DOI: 10.4102/sajp.v79i1.1846] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Objectives Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. Method PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Conclusion Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. Clinical implications A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.
Collapse
Affiliation(s)
- Elogni R Amanzonwé
- Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lisa Tedesco Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Léopold Codjo
- Department of Cardiology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Dominique Hansen
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Oyéné Kossi
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin.,ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| |
Collapse
|
31
|
Gevaert AB, Wood N, Boen JRA, Davos CH, Hansen D, Hanssen H, Krenning G, Moholdt T, Osto E, Paneni F, Pedretti RFE, Plösch T, Simonenko M, Bowen TS. Epigenetics in the primary and secondary prevention of cardiovascular disease: influence of exercise and nutrition. Eur J Prev Cardiol 2022; 29:2183-2199. [PMID: 35989414 DOI: 10.1093/eurjpc/zwac179] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
Increasing evidence links changes in epigenetic systems, such as DNA methylation, histone modification, and non-coding RNA expression, to the occurrence of cardiovascular disease (CVD). These epigenetic modifications can change genetic function under influence of exogenous stimuli and can be transferred to next generations, providing a potential mechanism for inheritance of behavioural intervention effects. The benefits of exercise and nutritional interventions in the primary and secondary prevention of CVD are well established, but the mechanisms are not completely understood. In this review, we describe the acute and chronic epigenetic effects of physical activity and dietary changes. We propose exercise and nutrition as potential triggers of epigenetic signals, promoting the reshaping of transcriptional programmes with effects on CVD phenotypes. Finally, we highlight recent developments in epigenetic therapeutics with implications for primary and secondary CVD prevention.
Collapse
Affiliation(s)
- Andreas B Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, Antwerp 2610, Belgium.,Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Nathanael Wood
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| | - Jente R A Boen
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken D.T.228, Universiteitsplein 1, Antwerp 2610, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Dominique Hansen
- Department of Cardiology, Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium.,BIOMED-REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Sports and Exercise Medicine, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Guido Krenning
- Laboratory for Cardiovascular Regenerative Medicine, Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian Institute of Science and Technology (NTNU), Trondheim, Norway.,Department of Women's Health, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Elena Osto
- Institute of Clinical Chemistry, University and University Hospital Zurich, Zurich, Switzerland.,University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Laboratory of Translational Nutrition Biology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Francesco Paneni
- University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Milan, Italy
| | - Torsten Plösch
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Perinatal Neurobiology, Department of Human Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - T Scott Bowen
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds LS2 9JT, UK
| |
Collapse
|
32
|
Goulart Prata Oliveira Milani J, Milani M, Cipriano GFB, Hansen D, Cipriano Junior G. Exercise intensity domains determined by heart rate at ventilatory threshold: a comparison of the guideline-directed exercise intensity domains for cardiovascular rehabilitation prescription. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Appropriate exercise prescription for cardiovascular diseases patients is a keystone for efficient and safe cardiovascular rehabilitation (CR). Exercise intensity prescribed according to the first and second ventilatory threshold (VT1 and VT2), identified by cardiopulmonary exercise testing (CPET), is considered the gold-standard method. However, because CPET is often not available, percentages of peak heart rate (%HRpeak) or heart rate reserve (%HRR), according to heart rate (HR) response during a conventional exercise test, are very commonly used.
Purpose
To compare the HR at VT1 and VT2 identified by CPET with the recommended exercise intensity prescription domains according to the Brazilian, American, and European CR guidelines/recommendations.
Methods
This retrospective cohort study assessed 1,465 treadmill CPETs from adult patients with stable cardiovascular diseases. Inclusion criteria were available VT1 and VT2 identification, sinus rhythm during exercise, and had reached maximal effort (respiratory exchange rate ≥1.10). HR at VT1 and VT2 were compared with the exercise intensity prescription domains recommended by Brazilian CR Guideline 2020, European Position Statement 2022, and the American College of Sports Medicine Guideline 2017, according to the obtained %HRpeak and %HRR.
Results
After applying the inclusions criteria, a sample of 972 CPETs were included (mean age 57.7±12.0 years, 80.8% males, 81.4% with coronary artery disease, and 26.6% with heart failure). VT1 and VT2 were identified, respectively, at 68.8% (63.8, 74.7) and 89.1 (85.8, 92.2) of the peak HR, and 39.0 (32.9, 45.8) and 78.0 (71.6, 84.5) of the HR reserve, indicating a greater heterogeneity of the latter (Figure 1). We found substantial heterogeneity between the measured %HRpeak and %HRR correspondent to the VT1 and VT2 and the estimated HR exercise intensity domains by compared international recommendations (Figure 2).
Conclusion
The disparities among currently established guideline-directed exercise domains limits the clinical validity of the use of %HRR and %HRpeak, and further strengthens the importance of performing CPET for an accurate exercise intensity prescription in CR. In the absence of CPET, HR values identified in our study at VT1 and VT2 could be used for guiding moderate-intensity exercise prescription for CVD patients, and the suggested range would be 69 to 89% of %HRpeak or 40 to 78% of %HRR. Current established exercise domains limits should be revised to improve HR-based prescription efficiency and safety.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPq).
Collapse
Affiliation(s)
| | - M Milani
- Fitcordis Exercise Medicine Clinic , Brasilia , Brazil
| | - G F B Cipriano
- University of Brasilia, Health Sciences and Technologies Graduate Program , Brasilia , Brazil
| | - D Hansen
- Hasselt University , Hasselt , Belgium
| | - G Cipriano Junior
- University of Brasilia, Health Sciences and Technologies Graduate Program , Brasilia , Brazil
| |
Collapse
|
33
|
Gojevic T, Turri Da Silva N, Gelade K, Jacobs G, Pirlotte R, Tulleneers B, Duchateau A, Mullens W, Hansen D. Effects of adding high- vs low-intensity resistance training to endurance training in patients with heart failure: preliminary results of a randomized controlled trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In current ESC/EAPC guidelines, adding resistance training to endurance training is advised for patients with heart failure (HF), but the optimal intensity of the resistance training is unknown (40–80% of 1RM is advised).
Purpose
To investigate the effects of high- vs low-intensity resistance training as an adjunct to endurance training on: aerobic capacity (primary outcome), walking capacity, muscle strength and quality of life in patients with HF.
Methods
Forty patients with HF were consecutively recruited in the cardiac rehabilitation center of the Hospital East-Limburg in Belgium. Patients were block-randomized (by age and sex) by an independent researcher to receive maximally 45 supervised sessions (3x/week) of high-intense (HI: 3 exercises, 3x12 repetitions, 55–70%1RM) or low-intense resistance training (LI: 3 exercises, 3x22 repetitions, 35–40%1RM) as an adjunct to endurance training (30 min/session; 50–75% VO2max). The aerobic capacity (VO2max) was measured by a blinded assessor with a ramp cardiopulmonary cycling test (+5–30W/min). Walking distance was assessed with a 6-minute walk test (6MWT), maximal strength with 1RM (leg-press, pull-down and dip), and quality of life with the Minnesota questionnaire. An unpaired t-test, Mann-Whitney U test or ANCOVA were used for between-group analysis, and paired t-test or Wilcox sign-rank test for the within-group analysis.
Results
Both groups had similar baseline characteristics and training adherence (HI vs LI; 20 vs 20 subjects; Age: 62±9 vs 59±13 years; Sex: 76% vs 79%male; BMI: 27±58 vs 29±4 kg/m2; LVEF: 35±10 vs 38±6%; Adherence: 33±10 vs 36±10 sessions; p>0.05). There were no adverse events. Both groups had significant within-group improvements in aerobic and walking capacity (VO2max: LI (n=20) vs HI (n=19), p≤0.010; 6MWT distance: p≤0.007) (Figure 1), but these improvements did not differ between groups (VO2max: p=0.855; 6MWT distance: p=0.854). The LI group improved significantly more in muscle strength than the HI group (dip and leg-press: p<0.001). Although the LI group significantly improved in the quality of life (Minnesota score reduction: p=0.028), the quality of life did not differ between groups (Minnesota score: p=0.756).
Conclusions
Both low-and high-intense resistance training are similarly beneficial for improving aerobic and walking capacity in patients with HF. Surprisingly, low-intense resistance training seems superior to high-intense training in improving muscle strength.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University
Collapse
Affiliation(s)
- T Gojevic
- Hasselt University, REVAL – Rehabilitation Research Centre, Faculty of Rehabilitation Sciences , Hasselt , Belgium
| | - N Turri Da Silva
- Hasselt University, REVAL – Rehabilitation Research Centre, Faculty of Rehabilitation Sciences , Hasselt , Belgium
| | - K Gelade
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - G Jacobs
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - R Pirlotte
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - B Tulleneers
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - A Duchateau
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - W Mullens
- Hospital Oost-Limburg (ZOL), Cardiovascular Rehabilitation Center , Genk , Belgium
| | - D Hansen
- Hasselt University, REVAL – Rehabilitation Research Centre, Faculty of Rehabilitation Sciences , Hasselt , Belgium
| |
Collapse
|
34
|
Landler N, Olsen FJ, Bro S, Feldt-Rasmussen B, Hansen D, Kamper AL, Christoffersen C, Ballegaard ELF, Soerensen IMH, Bjergfelt SS, Seidelin E, Biering-Soerensen T. Early diastolic strain rate and its associations with estimated glomerular filtration rate and albuminuria. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The ratio of early diastolic inflow to early diastolic strain rate, E/e'sr, is a novel echocardiographic measure, which has been shown to correlate better with left ventricular (LV) filling pressures than the conventionally used measure, E/e' (1). Additionally, E/e'sr has demonstrated prognostic value in various patient populations (2). Patients with chronic kidney disease (CKD) suffer frequently of diastolic dysfunction and elevated filling pressures (3). We wanted to investigate, how E/e'sr associates with two central measures of kidney function: estimated glomerular filtration rate, eGFR, and urine albumin creatinine ratio, UACR.
Methods
We enrolled a cohort of 825 ambulatory patients with CKD at the Departments of Nephrology of two university hospitals. Participants were examined with echocardiography including tissue doppler imaging. Two-dimensional speckle strain analysis was performed in all three apical standard projections. LV mass index (LVMI), E/e' and global longitudinal strain (GLS) were determined according to guidelines (4,5). Global early diastolic strain rate, e'sr, was calculated as the average of all 18 segments and indexed to early transmittal inflow velocity in order to calculate E/e'sr. Multivariable linear regression models were used to investigate associations between e'sr, E/e'sr, E/e' and kidney parameters. Models were adjusted for eGFR, UACR, LV ejection fraction (LVEF), age, sex, ever smoker, diabetes, hypertension, systolic and diastolic blood pressure (BP), heart rate and body mass index (BMI). We performed sensitivity analysis by excluding patients with known coronary artery disease (CAD) and heart failure (HF).
Results
Seventy-six patients had no measures of E/e'sr available leaving 749 for analysis. Excluding patients with CAD and/or HF (n=88) left 661 patients. For clinical and echocardiographic variables, see table. Patients with lower e'sr were older, had higher blood pressure and lower LVEF and GLS. E'sr was independently associated with eGFR and decreased 0.014 s–1 (95% CI 0.006 to 0.022, p=0.002) pr. 10 mL/min/1.73 m2 decrement of eGFR. Similarly, E/e'sr increased 1.1% (95% CI 0.2% to 19.2%) pr. 10 mL/min/1.73 m2 decrement of eGFR indicating rise in LV filling pressures. Contrary, E/e' was not independently associated with eGFR (p=0.5). Sensitivity analysis did not change the results significantly. None of the three measures were independently associated with UACR. Cubic restricted splines of e'sr, E/e'sr, E/e' over eGFR (figure) showed a non-linear relationship between E/e'sr and eGFR with accelerated increase at eGFR below 40 ml/min/1.73 m2.
Conclusion and perspectives
In patients with CKD, deformation-based e'sr and E/e'sr are independently associated with eGFR, but not with UACR. Repeated measurements and longitudinal follow-up of the cohort will provide information on the prognostic performance of these novel measures compared with conventional measures of LV filling pressure.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Capital Region of Denmark
Collapse
Affiliation(s)
- N Landler
- Gentofte University Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory , Copenhagen , Denmark
| | - F J Olsen
- Gentofte University Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory , Copenhagen , Denmark
| | - S Bro
- Rigshospitalet - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - B Feldt-Rasmussen
- Rigshospitalet - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - D Hansen
- Herlev-Gentofte Hospital - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - A L Kamper
- Herlev-Gentofte Hospital - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - C Christoffersen
- Rigshospitalet - Copenhagen University Hospital, Department of Clinical Biochemistry , Copenhagen , Denmark
| | - E L F Ballegaard
- Rigshospitalet - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - I M H Soerensen
- Rigshospitalet - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - S S Bjergfelt
- Rigshospitalet - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - E Seidelin
- Herlev-Gentofte Hospital - Copenhagen University Hospital, Department of Nephrology , Copenhagen , Denmark
| | - T Biering-Soerensen
- Gentofte University Hospital, Cardiovascular Non-Invasive Imaging Research Laboratory , Copenhagen , Denmark
| |
Collapse
|
35
|
Ambrosetti M, Hansen D. Exercise training for cardiovascular patients: Push me across the threshold! International Journal of Cardiology Cardiovascular Risk and Prevention 2022; 14:200133. [PMID: 36060287 PMCID: PMC9434398 DOI: 10.1016/j.ijcrp.2022.200133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
- Corresponding author. Cardiovascular Rehabilitation Unit, ASST Crema, Rivolta D'Adda Hospital Viale Monte Grappa 15, 26027, Rivolta D'Adda, CR, Italy.
| | - Dominique Hansen
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| |
Collapse
|
36
|
Teng J, Martini J, Funk T, Connor J, Cook E, Hansen D, Paller A. LB941 Importance of six-month dosing with QTORIN rapamycin to achieve maximal effect in patients with pachyonychia congenita. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Ribeiro GDS, Deresz LF, Salvioni E, Hansen D, Agostoni P, Karsten M. Sensitivity and specificity of different exercise oscillatory ventilation definitions to predict 2-year major adverse cardiovascular outcomes in chronic heart failure patients. Int J Cardiol 2022; 360:39-43. [PMID: 35623479 DOI: 10.1016/j.ijcard.2022.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) shows a four-fold greater risk of adverse events. This study aims to analyze the sensitivity and specificity of three EOV diagnostic definitions to predict adverse outcomes at a 2-year follow-up and to compare its EOV prevalence and relations with the patient's profile. METHODS Cardiopulmonary exercise tests from 233 heart failure patients were analyzed. Two blinded reviewers used a semiautomated software to identify EOV cases pattern according to the definitions of Ben-Dov, Corrà, and Leite. Data were grouped in EOV-positive or EOV-negative according to each definition. Baseline characteristics, EOV prevalence, relative risk, sensitivity, and specificity to predict 2-years of major adverse cardiovascular outcomes were analyzed. RESULTS The Corrà definition led to the best prediction of 2-year major cardiovascular adverse outcomes (HR 2.46 [1.16 to 5.25]; p = 0.019, AUC = 0.618; p = 0.007). EOV prevalence was 17.2%, 17.2%, and 9.4% applying Ben-Dov, Corrà, and Leite definition, respectively. The main clinical differences between EOV-positive and EOV-negative patients were: MECKI score and VE/VCO2 slope (all definitions), and BNP levels (Ben-Dov and Leite). BNP levels were correlated with amplitude (rho = 0.255; p = 0.033) and cycle length (rho = 0.388; p = 0.002). CONCLUSION Corrà definition was the only one that exhibited the capacity to predict major adverse cardiovascular outcomes at a 2-year follow-up. Regardless of its definition, EOV was more often prevalent in patients with a greater MECKI score and VE/VCO2 slope values.
Collapse
Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, Brazil
| | | | - Dominique Hansen
- Hasselt University (UHASSELT), Faculty of Rehabilitation Sciences, BIOMED/REVAL, Hasselt, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil; Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, Brazil.
| |
Collapse
|
38
|
D'Ascenzi F, Cavigli L, Pagliaro A, Focardi M, Valente S, Cameli M, Mandoli GE, Mueller S, Dendale P, Piepoli M, Wilhelm M, Halle M, Bonifazi M, Hansen D. Clinician approach to cardiopulmonary exercise testing for exercise prescription in patients at risk of and with cardiovascular disease. Br J Sports Med 2022; 56:bjsports-2021-105261. [PMID: 35680397 DOI: 10.1136/bjsports-2021-105261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a powerful medicine and critical component of the management plan for patients at risk for or diagnosed with CVD. A tailored approach based on the patient's personal and clinical characteristics represents a cornerstone for the benefits of exercise prescription. In this regard, the use of cardiopulmonary exercise testing is well-established for risk stratification, quantification of cardiorespiratory fitness and ventilatory thresholds for a tailored, personalised exercise prescription. The aim of this paper is to provide a practical guidance to clinicians on how to use data from cardiopulmonary exercise testing towards personalised exercise prescriptions for patients at risk of or with CVD.
Collapse
Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Antonio Pagliaro
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Stephan Mueller
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
| | | | | | | | - Martin Halle
- Department of Prevention and Sports Medicine, Technical University of Munich, Munchen, Germany
- DZHK (German Center for Cardiovascular Research), Munich, Germany
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | | |
Collapse
|
39
|
Scherrenberg M, Bonneux C, Yousif Mahmood D, Hansen D, Dendale P, Coninx K. A Mobile Application to Perform the Six-Minute Walk Test (6MWT) at Home: A Random Walk in the Park Is as Accurate as a Standardized 6MWT. Sensors 2022; 22:s22114277. [PMID: 35684898 PMCID: PMC9185289 DOI: 10.3390/s22114277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023]
Abstract
The six-minute walk test (6MWT) provides an objective measurement of a person’s functional exercise capacity. In this study, we developed a smartphone application that allows cardiac patients to do a self-administered 6MWT at home on a random trajectory. In a prospective study with 102 cardiovascular disease patients, we aimed to identify the optimal circumstances to perform a smartphone-measured 6MWT, i.e., the best algorithm and the best position to wear the smartphone during the test. Furthermore, we investigated if a random walk is as accurate as a standardized 6MWT. When considering both the reliability and accuracy of the distance walked, the best circumstances to perform a standardized smartphone-measured 6MWT are wearing the smartphone in a strap around the patient’s arm and using an algorithm that relies on the processed step count data acquired from Google Fit. Furthermore, we demonstrated that a smartphone-measured walk along a random trajectory is as accurate to determine a cardiac patient’s functional exercise capacity as a standardized (smartphone-measured) 6MWT. We conclude this paper by presenting how our 6MWT application can be used in a home setting to remotely follow up on cardiac patients’ functional exercise capacity.
Collapse
Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (D.H.); (P.D.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Faculty of Medicine, Antwerp University, 2000 Antwerp, Belgium
| | - Cindel Bonneux
- HCI and eHealth, Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (C.B.); (D.Y.M.)
| | - Deeman Yousif Mahmood
- HCI and eHealth, Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (C.B.); (D.Y.M.)
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (D.H.); (P.D.)
- BIOMED-REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (M.S.); (D.H.); (P.D.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- HCI and eHealth, Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (C.B.); (D.Y.M.)
- Correspondence:
| |
Collapse
|
40
|
Goswami N, Hansen D, Gumze G, Brix B, Schmid-Zalaudek K, Fredriksen PM. Health and Academic Performance With Happy Children: A Controlled Longitudinal Study Based on the HOPP Project. Front Cardiovasc Med 2022; 9:820827. [PMID: 35722126 PMCID: PMC9203822 DOI: 10.3389/fcvm.2022.820827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Overweight/obesity in children and adolescents, largely arising due to increased food intake and reduced physical activity, is a major health concern. Physical activity (PA) integrated into learning has been shown to not only lead to improved health outcomes and wellbeing but also positively affect academic performance. The Health and Academic Performance with Happy Children (HAPHC) project aims at enhancing health and academic performance in elementary school children via implementation of a daily unit of Physical Activity Across the Curriculum (PAAC), which is carried out within the school setting. In this project, PA as an integrated part of learning will be evaluated and the learning material adapted for a large scale implementation across several European countries. Methods In three European countries (Austria, Slovenia, and Belgium), 12 primary schools in total will be recruited to act as either intervention or control school in a large intervention study, which applies the PAAC pedagogy during lectures. It is estimated that, at least 3,000+ children across the three countries will be recruited in this study. All teachers of intervention schools will receive training and materials/teaching equipment that will allow them to integrate a daily PA unit of 45 min over 3 years across the curriculum. In response to the daily PA intervention, the following primary outcomes will be assessed: changes in health related physiological factors, academic achievement, psycho-social aspects and wellbeing. Impact of Project The HAPHC project aims at promoting public health by increasing PA at an early age within the school setting and therewith preventing the increasing risk of non-communicable diseases across Europe. HAPHC project aims to develop knowledge and materials, which will ensure that the PAAC can be scalable to other European countries. Trial Registration Number ClinicalTrials.gov, identifier: NCT04956003.
Collapse
Affiliation(s)
- Nandu Goswami
- Physiology Division, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
- Health Sciences, Alma Mater Europaea, Maribor, Slovenia
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Dominique Hansen
- REVAL/BIOMED, Faculty of Rehabilitation Sciences, Hasselt/Heart Centre Hasselt, Jessa Hospital, Hasselt University, Hasselt, Belgium
- *Correspondence: Dominique Hansen
| | - Goran Gumze
- Health Sciences, Alma Mater Europaea ECM, Maribor, Slovenia
| | - Bianca Brix
- Physiology Division, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Karin Schmid-Zalaudek
- Physiology Division, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | - Per Morten Fredriksen
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Hamar, Norway
- School of Health Sciences, Kristiania University College, Oslo, Norway
| |
Collapse
|
41
|
Hansen D, Bressendorff I, Nordholm A, Møller AS, Klausen T, Jørgensen N. Circadian rhythm of markers of bone turnover in patients with chronic kidney disease. Bone Rep 2022; 16:101593. [PMID: 35663376 PMCID: PMC9157017 DOI: 10.1016/j.bonr.2022.101593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 11/15/2022] Open
Abstract
Patients with chronic kidney disease (CKD) have a high risk of bone fractures. A circadian rhythmicity in turnover and mineralization of bone appears to be of importance for bone health. In CKD disturbances in the circadian rhythm of various functions has been demonstrated and indeed the circadian rhythm in the mineral metabolism is disturbed. The aim of the present study was to compare the circadian rhythm of bone turnover markers in ten patients with CKD to ten healthy controls. Bone turnover markers (C-terminal telopeptide of type I collagen, tartrate-resistant acid phosphatase 5b, N-terminal propeptide of type I procollagen, bone alkaline phosphatase and osteocalcin) were measured every third hour for 24 h. All bone turnover markers displayed a significant circadian rhythm in both groups and there were no significant differences in the rhythmicity between the two groups (no group*time interaction). As expected, due to the reduced renal clearance, the overall level of C-terminal telopeptide of type I collagen and osteocalcin was higher in CKD compared to the healthy controls. The present study suggests that disturbances in the circadian rhythm of bone turnover do not explain the metabolic bone disease and increased risk of fractures in CKD.
Collapse
Affiliation(s)
- D. Hansen
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - I. Bressendorff
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - A. Nordholm
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Astrid Sand Møller
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - T.W. Klausen
- Department of Hematology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - N.R. Jørgensen
- Institute of Clinical Medicine, University of Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet Glostrup, Copenhagen, Denmark
| |
Collapse
|
42
|
De Wilde C, Bekhuis Y, Claessen G, Kuznetsova T, Cauwenberghs N, Hansen D, Gojevic T, Vancraenenbroeck E, Michielsen M, Decorte E, Claes J, Cornelissen V. Personalized remotely guided preventive exercise therapy for a healthy heart: protocol and design of the PRIORITY study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation – Flanders (FWO)
Introduction
Approximately half of the heart failure population has heart failure with preserved ejection fraction (HFpEF), a chronic disease starting with cardiovascular risk factors such as hypertension, diabetes and obesity (stage A) which can further emerge in a structural heart disease without (stage B) or with (stage C) signs or symptoms. Structured exercise therapy is recommended as a Class IA intervention in national and international guidelines and, as such, should be offered to all patients. Yet, in current practice, exercise therapy is often only offered within a secondary prevention program. At present, there exists no comprehensive preventive care program that includes structured exercise for patients in the early stages of heart failure, when cardiovascular risk factors are present, but cardiac remodeling and dysfunction might still be reversible or even preventable.
Purpose
PRIORITY aims to investigate the use of remotely guided exercise therapy as a preventive clinical and cost-effective treatment in the HFpEF continuum. This includes both prevention of progression of asymptomatic diastolic dysfunction towards symptomatic HFpEF (= primary prevention) and delaying progression of symptomatic HFpEF (= secondary prevention).
Methods
A randomized controlled multicenter trial will be conducted in 450 patients (men and women, aged 35-80 years) with heart failure (n = 180 stage A, 180 stage B, 90 stage C). Participants are being recruited from 3 different hospitals and the general population during a 16-month period which started in September 2021. Patients will be randomized (1:1) to usual care or to the PRIORITY exercise intervention (i.e. a combination of supervised with remotely guided home-based training sessions). Training prescription is based on the EXPERT tool and includes person-tailored endurance and dynamic strength training. During one year, participants will receive 18 supervised exercise sessions supplemented with a structured progressive home-based exercise program. Outcomes will be assessed at baseline, 4 months, one and two-years. Primary outcome is the proportion of patients with a clinically relevant improvement in peak oxygen uptake at one-year. Secondary outcomes include vascular health, muscle metabolism, change in electrocardiographic parameters and physical fitness parameters (muscle strength, body composition). Further, big data of physical activity collected during the trial will be used to develop models using machine-learning algorithms which can predict physical activity uptake and changes in fitness to facilitate the creation of more personalized interventions and better tailored exercise prescription.
Conclusion
We anticipate that the PRIORITY study will contribute to better prevention of heart failure thanks to an early easily accessible person-tailored exercise intervention.
Collapse
Affiliation(s)
| | - Y Bekhuis
- University of Leuven, Leuven, Belgium
| | | | | | | | - D Hansen
- Hasselt University, Hasselt, Belgium
| | - T Gojevic
- Hasselt University, Hasselt, Belgium
| | | | | | - E Decorte
- University of Leuven, Leuven, Belgium
| | - J Claes
- University of Leuven, Leuven, Belgium
| | | |
Collapse
|
43
|
Gojevic T, Turri Da Silva N, Gelade K, Jacobs G, Pirlotte R, Tulleneers B, Kissembeek B, Duchateau A, Mullens W, Hansen D. Effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure: preliminary results from a randomized clinical trial. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Hasselt University
Background
Adding resistance training on top of endurance training is recommended in the rehabilitation of patients with heart failure. However, it is unknown which intensity of resistance training should be preferred.
Purpose
To compare the effects of the addition of high- vs. low-intensity resistance training on top of endurance training in patients with heart failure.
Methods
Nineteen patients with heart failure were block randomized (by gender and sex) in a combined high-intensity resistance and endurance group (HIG; n=8, age=61±12y, 7 males, LVEF=38±10%) vs. combined low-intensity resistance and endurance group (LIG; n=9, age=68±21y, 8 males, LVEF=38±13%). Patients trained 3x/week for 45 sessions. The resistance exercises were volume-matched between groups and consisted of three sets of leg press, pull down and dip exercises, separated by 30s of rest, done at 55-70% 1RM in HIG vs. 35-40% 1RM in LIG. Both groups did moderate-intense endurance training on a bicycle, cross-trainer, treadmill and arm ergometer for 30 min per training. Maximal oxygen consumption was evaluated with an incremental cardiopulmonary cycling test and muscle strength by 1-RM testing, while quality of life was assessed with the Minnesota questionnaire, and walking distance by a 6-minute walking test. Mann-Whitney U test was used for analyzing differences between groups in all variables and Wilcoxon signed-rank test for evaluating pre-post difference of the entire sample. P values <0,05 (2-tailed) were considered statistically significant.
Results
Training adherence was similar in both groups (LIG vs HIG: 41±6 vs 37±9 sessions, p=0,370; Table 1). Overall, the intervention improved maximal oxygen consumption, walking capacity and muscle strength (p<0,05), but the between-group changes in maximal oxygen consumption (LIG vs HIG: 3±2 vs 3±4 ml/kg/min, p=0,963), quality of life (LIG vs HIG: -8±23 vs -1±5 points, p=0,931) and muscle strength (LIG vs HIG: Dip 34±34 vs 18±20kg, p=0,481; Leg press, 66±87 vs 47±53kg, p=0,486; Pull down, 9±6 vs 9±7kg, p=0,574) were similar.
Conclusion
Adding either high- or low-intensity resistance training on top of endurance training seems equally effective for improving aerobic capacity and walking performance in patients with heart failure. The study is ongoing.
Collapse
Affiliation(s)
- T Gojevic
- Hasselt University, Hasselt, Belgium
| | | | - K Gelade
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | - G Jacobs
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | - R Pirlotte
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | | | | | | | - W Mullens
- Hospital Oost-Limburg (ZOL), Genk, Belgium
| | - D Hansen
- Hasselt University, Hasselt, Belgium
| |
Collapse
|
44
|
Karsten M, Ribeiro GS, Deresz LF, Salvioni E, Silveira LS, Hansen D, Agostoni P. Would be the minute ventilation variability an alternative to the dichotomous diagnosis of exercise oscillatory ventilation? Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAPES and FAPERGS.
Background
Exercise oscillatory ventilation (EOV) is an abnormal ventilatory phenomenon observed in chronic heart failure (HF) patients usually defined as EOV-positive or EOV-negative based on a dichotomous diagnosis. Minute ventilation variability (vVE) can quantify the presence of these oscillations and assist the prognosis of patients.
Purpose
To analyse the sensitivity and specificity of vVE to predict 2-year all-causes of death in HF patients.
Methods
Data from 233 cardiopulmonary exercise tests from HF patients performed between 2011 and 2014 at an Italian heart centre were analysed. The vVE was defined by the standard deviation (SD) of VE normalized by the number of respiratory cycles (SD/n) during the exercise tests. The cut-off to predict 2-year mortality was determined by the receiver-operating characteristic (ROC) curve.
Results
Thirty-five deaths were registered at 2-years. The ROC curve indicated ≤ 54.9 as the better cut-off for vVE (32 deaths were registered in follow-up; Figure 1). The relative risk was 3.9 (1.3 to 12.4) with a hazard ratio of 2.7 (1.3 to 5.6) for 2-year mortality.
Conclusion
The vVE appears to be a sensitive alternative to quantify EOV and stratify high-risk cases from 2-year all-cause mortality.
Collapse
Affiliation(s)
- M Karsten
- Santa Catarina State University, Florianopolis, Brazil
| | - GS Ribeiro
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - LF Deresz
- Federal University of Juiz de Fora, Physical Education, Juiz De Fora, Brazil
| | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - LS Silveira
- Santa Catarina State University, Florianopolis, Brazil
| | - D Hansen
- Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
| |
Collapse
|
45
|
Michielsen M, Gojevic T, De Craemer M, Claessen G, Cornelissen V, Hansen D. Prevention of heart failure in type 2 diabetes by exercise intervention: protocol and design of the PROTECTION study. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): research Foundation - Flanders (FWO)
Introduction
Cardiac dysfunction is highly prevalent in patients with type 2 diabetes mellitus (T2DM), leading to increased risk of cardiac morbidity and premature death. Previous research underscored the high prevalence of a disturbed global longitudinal strain (GLS), a marker to predict this cardiac dysfunction, in both symptomatic and asymptomatic T2DM patients. Exercise-based therapy is recommended in the management of patients with type 2 diabetes. However, it remains unclear i) which type of exercise therapy to have the biggest effect on GLS and ii) which factors modify the effect of exercise therapy on GLS.
Purpose
The PROTECTION study will i) investigate the impact of exercise volume and intensity on GLS to optimize exercise prescription in T2DM and will ii) assess which patient-specific factors influence the change in GLS and physical fitness as a result of exercise intervention in T2DM.
Methods and analyses
The PROTECTION study is composed of two work packages (WP). In WP 1, 100 T2DM adults (50% male, aged 30-75 years) will be randomized to a usual care group or one of the three supervised exercise intervention groups (see Table 1) for a duration of 26 weeks. Outcome measures will be performed at baseline, 13, 26 and 52 weeks of follow-up. The primary outcomes are GLS and cardiac dimensions. Secondary outcomes include health-related physical fitness, blood biomarkers and physical activity behavior. Data will be analyzed by two-way ANOVA repeated measures. A two-tailed P-value <0.05 will be considered statistically significant.
Parallel with the randomized controlled trial, a longitudinal intervention study (WP2) involving 107 adults (50% male, aged 30-75 years) with T2DM will be conducted. All participants will engage in a supervised intervention for 26 weeks, including a high volume of moderate intense physical activity (see Table 1). The main objective of this work package is to define determinants of change in GLS during an exercise intervention. Moreover, the interaction between diet-exercise, habitual physical activity-exercise and phenotype-exercise on change in GLS will be studied in great detail. Patient-specific data will be analyzed by multivariate regression analysis. A two-tailed P-value <0.05 will be considered statistically significant.
Conclusion
It is anticipated that the PROTECTION study will contribute to a better understanding on i) which exercise characteristics are preferred to maximally improve GLS in T2DM and on ii) the determinants of the responsiveness of GLS and physical fitness to exercise in T2DM.
Collapse
Affiliation(s)
| | - T Gojevic
- Hasselt University, Hasselt, Belgium
| | | | | | | | - D Hansen
- Hasselt University, Hasselt, Belgium
| |
Collapse
|
46
|
Ribeiro GS, Deresz LF, Salvioni E, Silveira LS, Hansen D, Agostoni P, Karsten M. Brain natriuretic peptide levels are associated with cycle length average and are different between Ben-Dov and Corra exercise oscillatory ventilation definitions in heart failure patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CAPES e FAPERGS.
Background
The brain natriuretic peptide (BNP) is a marker of ventricular dysfunction related to severity and prognosis in heart failure patients. Exercise oscillatory ventilation (EOV) is a phenomenon in the ventilatory pattern associated with a worse prognosis in heart failure patients. EOV diagnosis is defined by the interaction among amplitude, cycle length, and the total time of the oscillations. Ben-Dov and Corrà definitions are used to identify EOV-positive cases by different criteria, which may stratify EOV patients with distinct clinical characteristics.
Purpose
To assess the BPN levels in heart failure patients and to test BNP level correlation with amplitude, cycle length, and total oscillation time according to Ben-Dov and Corrà definitions.
Methods
Data from 242 cardiopulmonary exercise tests (CPETs) performed between 2011 and 2014 at an Italian heart centre were screened for EOV identification. CPETs were done in a cycle-ergometer with gas exchange analysed breath-by-breath. EOV cases were identified according to the definitions of Ben-Dov and Corrà. Mann-Whitney test was applied to compare BPN levels between the EOV-positive and negative in each definition and between EOV-positive from Ben-Dov and Corrà definitions. Spearman coefficient (rs) evaluated the association between amplitude and length average of the oscillatory cycle, percentage of total oscillation time, and BNP levels in each EOV definition. The BNP levels from EOV-positive identified by Corrà or Ben-Dov definition alone, and from patients who have met the criteria of both definitions were compared by the Kruskal-Wallis test.
Results
Sixty-seven patients were identified as EOV-positive. From them, 19 were identified exclusively by the Ben-Dov and 26 by Corrà. Twenty-two met the criteria for both definitions. Overall, no difference in EOV prevalence between Ben-Dov and Corrà definitions was found (20.4 vs 24.2%, p = 0.482). EOV-positive identified by the Ben-Dov definition have higher BNP levels than EOV-negative (p < 0.01) and the EOV-positive by Corrà definition (p = 0.025) (Table 1). Spearman correlation showed association just between BNP levels and cycle length average from EOV-positive by the Ben-Dov (rs = 0.566; p < 0.001) and by Corrà (rs = 0.339; p = 0.011) (Figure 1). When analysed by exclusive criteria identification, the BNP levels were higher in EOV-positive identified by Ben-Dov than Corrà (737 [562 to 1,178] vs 276 [221 to 603] pg/mL; p = 0.009). BNP levels in the EOV-positive identified by both definitions (475 [347 to 852] pg/mL) were not different from those identified by the Ben-Dov and Corrà definitions alone.
Conclusion
EOV-positive identified by the Ben-Dov have higher BNP levels than EOV-negative and the EOV-positive identified by Corrà, alone or not. BNP levels also are associated with the cycle length average, with a higher correlation for the Ben-Dov EOV-positive.
Collapse
Affiliation(s)
- GS Ribeiro
- Federal University of Health Sciences of Porto Alegre, Graduate Program in Rehabilitation Sciences, Porto Alegre, Brazil
| | - LF Deresz
- Federal University of Juiz de Fora, Physical Education, Juiz De Fora, Brazil
| | - E Salvioni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - LS Silveira
- Santa Catarina State University, Florianopolis, Brazil
| | - D Hansen
- Hasselt University, Faculty of Rehabilitation Sciences, Hasselt, Belgium
| | - P Agostoni
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - M Karsten
- Santa Catarina State University, Florianopolis, Brazil
| |
Collapse
|
47
|
Marinus N, Vigorito C, Giallauria F, Dendale P, Meesen R, Bokken K, Haenen L, Jansegers T, Vandenheuvel Y, Scherrenberg M, Spildooren J, Hansen D. Frailty Test Battery Development including Physical, Socio-Psychological and Cognitive Domains for Cardiovascular Disease Patients: A Preliminary Study. J Clin Med 2022; 11:jcm11071926. [PMID: 35407534 PMCID: PMC9014815 DOI: 10.3390/jcm11071926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/23/2023] Open
Abstract
Frailty is an age-related decline in physical, socio-psychological and cognitive function that results in extreme vulnerability to stressors. Therefore, this study aimed to elucidate which tests have to be selected to detect frailty in a comprehensive and feasible manner in cardiovascular disease (CVD) patients based on multivariate regression and sensitivity/specificity analyses. Patients (n = 133, mean age 78 ± 7 years) hospitalised for coronary revascularisation or heart failure (HF) were examined using the Fried and Vigorito criteria, together with some additional measurements. Moreover, to examine the association of frailty with 6-month clinical outcomes, hospitalisations and mortality up to 6 months after the initial hospital admission were examined. Some level of frailty was detected in 44% of the patients according to the Vigorito criteria and in 65% of the patients according to the Fried criteria. Frailty could best be detected by a score based on: sex, Mini Nutritional Assessment (MNA), Katz scale, timed up-and-go test (TUG), handgrip strength, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and total number of medications. Frailty and specific markers of frailty were significantly associated with mortality and six-month hospitalisations. We thus can conclude that, in patients with CVD, sex, MNA, Katz scale, TUG, handgrip strength, MMSE, GDS-15 and total number of medications play a key role in detecting frailty, assessed by a new time- and cost-efficient test battery.
Collapse
Affiliation(s)
- Nastasia Marinus
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Correspondence: ; Tel.: +32-(0)11-269203
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (C.V.); (F.G.)
- Faculty of Science and Technology, University of New England, Armidale, NSW 2350, Australia
| | - Paul Dendale
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Raf Meesen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Kevin Bokken
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Laura Haenen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Thomas Jansegers
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Yenthe Vandenheuvel
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Martijn Scherrenberg
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Joke Spildooren
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (R.M.); (K.B.); (L.H.); (T.J.); (Y.V.); (J.S.); (D.H.)
- BIOMED-Biomedical Research Center, Hasselt University, 3590 Diepenbeek, Belgium; (P.D.); (M.S.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| |
Collapse
|
48
|
Hansen D, Abreu A, Ambrosetti M, Cornelissen V, Gevaert A, Kemps H, Laukkanen JA, Pedretti R, Simonenko M, Wilhelm M, Davos CH, Doehner W, Iliou MC, Kränkel N, Völler H, Piepoli M. Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2022; 29:230-245. [PMID: 34077542 DOI: 10.1093/eurjpc/zwab007] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
Collapse
Affiliation(s)
- Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590 Hasselt, Belgium
| | - Ana Abreu
- Cardiology Department, Hospital Universitário de Santa Maria/Centro Académico de Medicina de Lisboa (CAML), Exercise and Cardiovascular Rehabilitation Laboratory, Centro Cardiovascular da Universidade de Lisboa (CCUL), Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiac Rehabilitation Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Veronique Cornelissen
- Research Unit of Cardiovascular Exercise Physiology, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
| | - Andreas Gevaert
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Sesto San Giovanni, Milano, Italy
| | - Roberto Pedretti
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Maria Simonenko
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Constantinos H Davos
- BCRT-Berlin Institute of Health Center for Regenerative Therapies, Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, Partner Site Berlin, Germany
| | - Wolfram Doehner
- Cardiac Rehabilitation and Secondary Prevention Department, Corentin Celton Hospital, Assistance Publique Hopitaux de Paris Centre Université de Paris, Paris, France
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
| | - Marie-Christine Iliou
- Charité - University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Nicolle Kränkel
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin D-1220, Germany
- Klinik am See, Rehabilitation Centers for Internal Medicine, Berlin, Germany
| | - Heinz Völler
- Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Massimo Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| |
Collapse
|
49
|
Scherrenberg M, Marinus N, Giallauria F, Falter M, Kemps H, Wilhelm M, Prescott E, Vigorito C, De Kluiver E, Cipriano G, Dendale P, Hansen D. The need for long-term personalized management of frail CVD patients by rehabilitation and telemonitoring: a framework. Trends Cardiovasc Med 2022:S1050-1738(22)00023-8. [PMID: 35121082 DOI: 10.1016/j.tcm.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022]
Abstract
Due to advances in cardiovascular medicine and preventive cardiology, patients benefit from a better prognosis, even in case of significant disease burden such as acute and chronic coronary syndromes, advanced valvular heart disease and chronic heart failure. These advances have allowed CVD patients to increase their life expectancy, but on the other hand also experience aging-related syndromes such as frailty. Despite being underrecognized, frailty is a critical, common, and co-existent condition among older CVD patients, leading to exercise intolerance and compromised adherence to cardiovascular rehabilitation. Moreover, frail patients need a different approach for CR and are at very high risk for adverse events, but yet are underrepresented in conventional CR. Fortunately, recent advances have been made in technology, allowing remote monitoring, coaching and supervision of CVD patients in secondary prevention programs with promising benefits. Similarly, we hypothesized that such programs should also be implemented to treat frailty in CVD patients. However, considering frail patients' particular needs and challenges, telerehabilitation interventions should thus be appropriately adapted. Our purpose is to provide, for the first time and based on expert opinions, a framework of how such a cardiac telerehabilitation program could be developed and implemented to manage a prevention and rehabilitation program for CVD patients with frailty.
Collapse
Affiliation(s)
- Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine and Health Sciences, Antwerp University, Belgium
| | - Nastasia Marinus
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium
| | | | - Maarten Falter
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Faculty of Medicine, Department of Cardiology, KULeuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Center, The Netherlands; Department of Industrial Design, Technical University Eindhoven, The Netherlands
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, NW, Denmark
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University of Naples
| | | | | | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL, Hasselt, Belgium.
| |
Collapse
|
50
|
Van Ryckeghem L, Keytsman C, De Brandt J, Verboven K, Verbaanderd E, Marinus N, Franssen WMA, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D. Impact of continuous vs. interval training on oxygen extraction and cardiac function during exercise in type 2 diabetes mellitus. Eur J Appl Physiol 2022; 122:875-887. [PMID: 35038022 DOI: 10.1007/s00421-022-04884-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Exercise training improves exercise capacity in type 2 diabetes mellitus (T2DM). It remains to be elucidated whether such improvements result from cardiac or peripheral muscular adaptations, and whether these are intensity dependent. METHODS 27 patients with T2DM [without known cardiovascular disease (CVD)] were randomized to high-intensity interval training (HIIT, n = 15) or moderate-intensity endurance training (MIT, n = 12) for 24 weeks (3 sessions/week). Exercise echocardiography was applied to investigate cardiac output (CO) and oxygen (O2) extraction during exercise, while exercise capacity [([Formula: see text] (mL/kg/min)] was examined via cardiopulmonary exercise testing at baseline and after 12 and 24 weeks of exercise training, respectively. Changes in glycaemic control (HbA1c and glucose tolerance), lipid profile and body composition were also evaluated. RESULTS 19 patients completed 24 weeks of HIIT (n = 10, 66 ± 11 years) or MIT (n = 9, 61 ± 5 years). HIIT and MIT similarly improved glucose tolerance (pTime = 0.001, pInteraction > 0.05), [Formula: see text] (mL/kg/min) (pTime = 0.001, pInteraction > 0.05), and exercise performance (Wpeak) (pTime < 0.001, pInteraction > 0.05). O2 extraction increased to a greater extent after 24 weeks of MIT (56.5%, p1 = 0.009, pTime = 0.001, pInteraction = 0.007). CO and left ventricular longitudinal strain (LS) during exercise remained unchanged (pTime > 0.05). A reduction in HbA1c was correlated with absolute changes in LS after 12 weeks of MIT (r = - 0.792, p = 0.019, LS at rest) or HIIT (r = - 0.782, p = 0.038, LS at peak exercise). CONCLUSION In patients with well-controlled T2DM, MIT and HIIT improved exercise capacity, mainly resulting from increments in O2 extraction capacity, rather than changes in cardiac output. In particular, MIT seemed highly effective to generate these peripheral adaptations. TRIAL REGISTRATION NCT03299790, initially released 09/12/2017.
Collapse
Affiliation(s)
- Lisa Van Ryckeghem
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium. .,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Charly Keytsman
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jana De Brandt
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kenneth Verboven
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elvire Verbaanderd
- Physical Activity, Sport and Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wouter M A Franssen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ines Frederix
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Elise Bakelants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Thibault Petit
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Siddharth Jogani
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Sarah Stroobants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Paul Dendale
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Virginie Bito
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Verwerft
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| |
Collapse
|