Sleep duration is associated with overnight changes in perceived fatigue in elite women soccer players

The current study aimed to describe sleep habits and analyze the associations between sleep indices, changes in perceived fatigue (Δ Fatigue) and external training load measures in women soccer players during a 7-day training camp. Sixteen elite women soccer players (age: 25.4 ± 3.6 years; mean ± SD) from the Portuguese Women's National Team participated in the study. Sleep indices (sleep duration and efficiency) were measured using a wrist-worn accelerometer. External training loads measures were measured using GPS devices. Players also reported perceived fatigue using a Likert scale (1 - very, very low to 7 - very, very high) before and immediately after sleep. Players' within-subject coefficient of variation for sleep duration was 5.6%, and 4.6% for sleep efficiency. Individually, 8 players (50%) slept less than 7 h per night throughout the training camp, and the same number of athletes had a sleep efficiency lower than 85%. Similar values (p<0.05) were measured for sleep duration and efficiency between training and match days. A moderate negative within-subjects correlation was found between Δ Fatigue and sleep duration (adjusted for pre-sleep fatigue) [r = -0.32; 95% Confidence Interval (-0.51 - -0.08); p = 0.04]. These findings reinforce the importance of sleep in the recovery process of elite women soccer players, showing that more sleep may help to attenuate fatigue.

Combined transcatheter aortic valve and tricuspid valve-in-valve implantation in a patient with a mitral mechanical prosthesis

Despite progressively uncommon in Western countries, rheumatic heart disease still portrays a significant global burden. In elderly or high-surgical risk patients, plurivalvular disease may require a complex percutaneous approach. Transcatheter aortic valve implantation (TAVI) in patients with previous monoleaflet mitral prosthesis is challenging due to interference between the aortic valve and the rigid mitral mechanical prosthesis "ring." Prior cases report the use of CoreValve or Edwards Sapien aortic valves in patients with adequate mitro-aortic distance. Performing a second major procedure, such as tricuspid valve-in-valve (TVIV), sequentially during a single percutaneous intervention, increases treatment complexity. An 83-year-old woman with rheumatic heart disease, with previous implantation of a Bjork-Shiley monoleaflet mitral prosthesis, and Carpentier-Edwards 29 tricuspid bioprosthesis presented with decompensated heart failure due to severe aortic stenosis and tricuspid bioprosthesis stenosis. After HeartTeam discussion, the patient was deemed as inoperable due to a prohibitive surgical risk. As an alternative, a TAVI (Navitor FlexNav) and a transcatheter TVIV replacement (Edwards Sapiens 3 Ultra) were discussed and proposed, with both techniques being performed sequentially in a single procedure. TAVI in a patient with a previous monoleaflet mitral mechanical prosthesis and TVIV may be a feasible approach in inoperable patients with plurivalvular disease.

An analysis of training load in highly trained female football players

This observational study aimed to analyze external training load in highly trained female football players, comparing starters and non-starters across various cycle lengths and training days.

METHOD

External training load [duration, total distance [TD], high-speed running distance [HSRD], sprint distance [SpD], and acceleration- and deceleration distance [AccDecdist] from 100 female football players (22.3 ± 3.7 years of age) in the Norwegian premier division were collected over two seasons using STATSports APEX. This resulted in a final dataset totaling 10498 observations after multiple imputation of missing data. Microcycle length was categorized based on the number of days between matches (2 to 7 days apart), while training days were categorized relative to match day (MD, MD+1, MD+2, MD-5, MD-4, MD-3, MD-2, MD-1). Linear mixed modeling was used to assess differences between days, and starters vs. non-starters.

RESULTS

In longer cycle lengths (5-7 days between matches), the middle of the week (usually MD-4 or MD-3) consistently exhibited the highest external training load (~21-79% of MD TD, MD HSRD, MD SpD, and MD AccDecdist); though, with the exception of duration (~108-120% of MD duration), it remained lower than MD. External training load was lowest on MD+2 and MD-1 (~1-37% of MD TD, MD HSRD, MD SpD, MD AccDecdist, and ~73-88% of MD peak speed). Non-starters displayed higher loads (~137-400% of starter TD, HSRD, SpD, AccDecdist) on MD+2 in cycles with 3 to 7 days between matches, with non-significant differences (~76-116%) on other training days.

CONCLUSION

Loading patterns resemble a pyramid or skewed pyramid during longer cycle lengths (5-7 days), with higher training loads towards the middle compared to the start and the end of the cycle. Non-starters displayed slightly higher loads on MD+2, with no significant load differentiation from MD-5 onwards.

A school-based physical activity intervention in primary school: effects on physical activity, sleep, aerobic fitness, and motor competence

Objective

The "Super Quinas" project evaluated the effectiveness of an intervention program to improve physical activity, aerobic fitness, sleep, and motor competence on children in primary school.

Methods

The experimental group (n = 19) enrolled in a 12-week intervention program (one more extra-curricular activity class of 60 min per week) compared to the CG (n = 19), all aged 9-10 years. Physical activity (PA) and sleep were measured by accelerometry, and aerobic fitness was measured by Children's Yo-Yo test (YYIR1C) during the 1st week (PRE), the 6th week (DUR), and the 12th week (POST) of the intervention program. Motor Competence in PRE and POST intervention was also assessed by the Motor Competence Assessment (MCA) instrument. Heart rate (HR, assessed using HR monitors), and enjoyment level were recorded during all intervention program classes. A linear mixed model analysis (i.e., within-subject analyses) was performed.

Results

Comparing the EG and CG in DUR and POST, the EG spent ~18 min and ~ 34 min more time in moderate to vigorous physical activity (MVPA) per day (p < 0.001); had ~44 min and ~ 203 min less sedentary time per day (p < 0.001); performed more 44 and 128 m in the Children's Yo-Yo test compared to CG (p < 0.001) and slept more 17 and 114 min per night (p < 0.001). In POST motor competence was significantly better (27%) in the EG compared to CG (p < 0.001). The %HRmax during the extra-curricular classes ranged between 65 and 81% (i.e., light to moderate intensities), and the enjoyment between fun and great fun.

Conclusion

Our findings suggest that adding one more extra-curricular activity class of 60 min per week for 12 weeks effectively increased the levels of physical activity, aerobic fitness, sleep duration, and motor competence in children aged 9-10 years.

The effect of menthol rinsing before intermittent exercise on physiological, physical, and thermo-behavioral responses of male football referees in hot and humid environment

Introduction

In the current experiment, we aimed to evaluate whether eliciting pre-exercise non-thermal cooling sensations would alter perceptual measures, and physical and physiological responses in football referees.

Methods

Nine highly trained male football referees undertook two 45-minute intermittent exercise protocols in hot and humid conditions (34.2 ± 0.6°C, 62.5 ± 1.0% relative humidity). In a randomized counterbalanced crossover design, 1 of 2 beverages were given before the warm-up: a 0.01% menthol solution or a placebo noncaloric solution. Physical performance was quantified as total distance covered in each of the three 15-minute exercise blocks. Core temperature, heart rate, thermal sensation and thermal comfort were measured at rest and after each exercise block.

Results

No changes were observed between trials and over time for distance covered. No main effect of mouth rinse was observed for core temperature and heart rate, but both increased over time in all conditions (P < 0.001). Thermal sensation and thermal comfort were significantly improved with menthol after mouth-rinsing (P < 0.05), but with no differences at any other time-point.

Discussion

These results indicate that non-thermal cooling oral stimuli provide immediate behavioral changes but may not influence physiological or physical responses in football referees, during intermittent exercise in hot and humid environments.

Clinical Trial Registration

www.clinicaltrials.gov, identifier NCT05632692.

Revisiting the 'Whys' and 'Hows' of the Warm-Up: Are We Asking the Right Questions?

The warm-up is considered beneficial for increasing body temperature, stimulating the neuromuscular system and overall preparing the athletes for the demands of training sessions and competitions. Even when warm-up-derived benefits are slight and transient, they may still benefit preparedness for subsequent efforts. However, sports training and competition performance are highly affected by contextual factors (e.g., how is the opponent acting?), and it is not always clear what should be the preferred warm-up modalities, structure and load for each athlete and context. Further, we propose that the warm-up can also be used as a pedagogical and training moment. The warm-up may serve several different (albeit complementary) goals (e.g., rising body temperature, neuromuscular activation, attentional focus) and be performed under a plethora of different structures, modalities, and loads. The current commentary highlights the warm-up period as an opportunity to teach or improve certain skills or physical capacities, and not only as a preparation for the subsequent efforts. Moreover, the (justified) call for individualized warm-ups would benefit from educating athletes about exploring different warm-up tasks and loads, providing a broad foundation for future individualization of the warm-up and for more active, engaged, and well-informed participation of the athletes in deciding their own warm-up practices.

Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve

AIM

Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve.

METHODS

We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed.

RESULTS

A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1-40.9%), with all-cause death in 35.1% (31.8-38.4%), stroke in 3.4% (1.3-3.4%), myocardial infarction in 1.0% (0.3-1.5%), and reintervention for valve degeneration in 1.1% (0.6-2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7-12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05).

CONCLUSIONS

Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.

Simulated Soccer Game Protocols: A Systematic Review on Validated Protocols That Represent the Demands of the Game

ABSTRACT

Brito, P, Costa, J, Figueiredo, P, and Brito, J. Simulated soccer game protocols: A systematic review on validated protocols that represent the demands of the game. J Strength Cond Res 38(1): 192-205, 2024-Several laboratory and field testing protocols have been developed attempting to simulate the activity pattern and physiological demands of soccer. In the present systematic review, we aimed to analyze and discuss the appropriateness, strengths, and limitations of soccer-specific simulated tests. A systematic review of the literature was conducted based on the PRISMA guidelines. Studies conducted in soccer, simulated soccer match tests, and validated simulation protocols performed on-the-field or on a treadmill were considered. No sex restriction was applied, and age >18 years (i.e., adults) was considered. At least 1 outcome measure (e.g., neuromuscular performance, external load, internal load, or psychometric state) of post-simulated-match test or protocol had to be reported. Within the 14 studies included, the average methodological quality of the included articles was 0.61 ± 0.09 (mean ± SD) of 1. Overall, 9 validated protocols were identified. In the protocols, only amateur, university, or semiprofessional soccer players were analyzed. Only one study evaluated female soccer players. None of the studies evaluated the effect on performance over the 2-3 days after the protocol. Accelerations and decelerations, and changes in direction typically present in a game have not been clearly described in any protocol. Future research should address this issue and validate soccer-specific protocols in women.

Effects of dietary supplements on athletic performance in elite soccer players: a systematic review

Dietary supplements are widely used among athletes, and soccer players are no exception. Nevertheless, evidence supporting the use of dietary supplements aiming to enhance performance in soccer is somewhat contradictory, scarce, or even nonexistent. Thus, the present study aimed to systematically review and synthesize the effects of dietary supplements on athletic performance (e.g. distance covered, sprinting, jump performance) in elite soccer players. Studies enrolling highly trained, elite, and world-class soccer players using dietary supplements were searched in MEDLINE/PubMed, Web of Science, Scopus, and EBSCO databases in June 2022. In total, 1043 studies were identified, and 18 met the eligibility criteria. The studies evaluated the impacts on athletic performance of several dietary supplements, including caffeine, creatine, protein, beverages with carbohydrates and electrolytes, tart cherry juice, nitrate-rich beetroot juice, sodium bicarbonate with minerals, yohimbine, and a proprietary nutraceutical blend. Caffeine supplementation in doses between 3 and 6 mg/kg of body mass may improve jump height and sprint ability, particularly in female players, but individual response to caffeine must be considered. Creatine may improve sprint, agility, and in female players, jump performance. Protein supplementation can improve sprint and jump performance between matches, especially if protein ingested from food is not up to recommendations. Beverages containing carbohydrates and electrolytes can be used as part of the strategies to achieve carbohydrate intake during training and match-days but used alone do not benefit athletic performance. Tart cherry juice might be useful for maintaining athletic performance after matches that produce higher force loss and exercise-induced muscle damage, although polyphenols from the diet might attenuate the effects of tart cherry supplementation. Nitrate-rich beetroot concentrate can attenuate performance decrease in the days following matches. Further investigation with sodium bicarbonate alone is necessary, as supplementation protocols with elite players included other substances. Finally, the available data does not support yohimbine supplementation or the use of Resurgex Plus® to improve athletic performance in elite soccer players. Still, more well-designed research with elite soccer players is needed to improve support and advice regarding the use of dietary supplements for athletic performance enhancement.

Menthol mouth rinsing and performance in elite football referees in the heat: A study protocol for a randomized crossover trial

Background

Within professional European competitions, matches can be played in extreme environmental temperatures, ranging from -5 °C to +30 °C in different countries. Furthermore, the World Cups are usually played in the summer months, when temperatures can exceed 35 °C, increasing physiological stress. Practical and cost-effective cooling strategies may be implemented to help players and referees to cope with exercising in the heat. No study has evaluated the effect of non-thermal internal cooling techniques regarding performance responses on elite football referees, so far. This study aims to analyse the effects of a menthol mouth rinse regarding physical, physiological, and perceptual performance in elite male football referees, during a 90-min football protocol in the heat.

Methods

At least thirteen male football referees will be recruited to perform two intermittent football protocols, separated by no less than 7 days. After passing the eligibility criteria, the participants will be randomly assigned to 1 of 2 beverages: (1) intervention - menthol solution 0.01% and (2) placebo - noncaloric berry-flavored solution, both at room temperature. The beverages will be given before warm-up (pre-cooling) and at the half-time (per-cooling). The trials will follow a randomized counterbalanced crossover design, single blinded, and will take place in indoor facilities, with Wet Bulb Globe Temperature (WBGT) > 30 °C, at the same time of the day to control for circadian variations.

Impact of the project

The results of this study are expected to determine whether mouth rinsing a menthol solution before and during a football exercise protocol performed in the heat will alter perceptual measures and help ease physiological strain and attenuate performance decrements in elite male football referees, comparing to a non-cooling strategy. Thus, we can be closer to defining nutritional strategies of internal cooling that may be an advantage for the performance of the football referees in the heat.

Trial registration

www.ClinicalTrials.gov NCT05632692 registered on 20 November 2022.

Predictive value of a positive stress single-photon emission computed tomography or stress cardiac magnetic resonance for ruling in obstructive coronary artery disease in a real-world setting

INTRODUCTION AND OBJECTIVES

Randomized controlled trials comparing stress cardiac magnetic resonance (CMR) and single-photon emission computed tomography (SPECT) suggest similar diagnostic accuracy for detecting obstructive coronary artery disease (CAD). There are few data on whether this remains true in routine clinical practice. The aim of this study was to assess clinical and angiographic characteristics of patients undergoing invasive coronary angiography (ICA) after stress CMR or SPECT, and to compare their positive predictive value with published results from the CE-MARC trial.

METHODS

In this retrospective tertiary-center analysis, we included 429 patients undergoing ICA after a positive stress CMR or positive SPECT performed within the previous 12 months. Obstructive CAD was defined as any coronary artery stenosis ≥50% in a vessel compatible with the ischemic territory on stress testing.

RESULTS

Of the total 429 patients, 356 (83%) were referred after a positive SPECT, and 73 (17%) after a positive stress CMR. Patients did not differ according to age, cardiovascular risk factors, previous revascularization or left ventricular dysfunction, but patients with SPECT were more frequently male (p=0.046). The prevalence of obstructive CAD was similar in patients with positive SPECT vs. positive stress CMR (76.1% vs. 80.8%, respectively, p=0.385). The positive predictive values of both techniques were similar to those reported in the CE-MARC trial.

CONCLUSION

In this tertiary center analysis, stress CMR and SPECT showed similar positive predictive values, comparable to those reported in the CE-MARC trial. This finding supports the emerging adoption of CMR in clinical practice for the diagnosis and management of CAD.

Epidemiology of Injuries in Elite Male Futsal Players

OBJECTIVE

This study aimed to describe and characterize injuries sustained by elite male futsal players in Portugal.

DESIGN

Prospective cohort study.

SETTING

Top-tier Portuguese league in the 2019 to 2020 season.

PARTICIPANTS

One hundred sixty-seven players from 9 elite/international-level (tier 4) futsal teams.

INDEPENDENT VARIABLES

The location, type, body side, body part, mechanism of injury, severity, occurrence, days lost, training, and match exposure were collected.

MAIN OUTCOME MEASURES

Injury incidence, prevalence, and burden.

RESULTS

The study was conducted during an 8-month season. A total of 133 injuries were recorded, and 92 (67.6%) players sustained injuries. The overall time-loss injury incidence was 4.5 injuries per 1000 hours of exposure. Injury incidence during matches was higher than during training sessions (25.9 vs 3.0 per 1000 hours of exposure, respectively). Average time loss was 9 days, and moderate injuries were the most frequent (44%), followed by mild injuries (24%). Injury burden was 73.8 days lost per 1000 hours of total player exposure. Sprains/ligament (29%) and muscle rupture/tear/strains (32%) were the most common injuries. The groin (19%), thigh (17%), knee (19%), and ankle (15%) were the most affected body areas. Noncontact injuries were the most reported mechanism (65%), and 24% were overuse injuries.

CONCLUSIONS

This study showed that elite/international-level (tier 4) male futsal players are more prone to noncontact injuries, primarily affecting the lower limbs. The incidence during match play increased by 9-fold compared with training sessions.

Using Deadlifts as a Postactivation Performance Enhancement Strategy in Warm-ups in Football

ABSTRACT

Abade, E, Brito, J, Gonçalves, B, Saura, L, Coutinho, D, and Sampaio, J. Using deadlifts as a postactivation performance enhancement strategy in warm-ups in football. J Strength Cond Res 37(9): 1821-1827, 2023-Postactivation performance enhancement activities may be relevant warm-up strategies aiming to improve subsequent physical performance. The purpose of the current study was to investigate the effects of adding barbell deadlift or hex-bar deadlift exercises to current warm-up routines on running and jumping performances in football players. Ten highly trained male football players participated in the study during the competitive phase of the season. All players performed 3 protocols in the same week: a standard warm-up that included players' regular routines and 2 other protocols with the addition of barbell or hex-bar deadlift, after the end of the warm-up (3 sets of 3 reps, progressing set by set from 60% to 85% repetition maximum). All protocols had the same time interval between pretest (immediately after the warm-up) and posttest (15 minutes after the warm-up). Vertical jumping (countermovement jump [CMJ]; Abalakov jump [AJ]) and running performances (505 test) were impaired 15 minutes after the standard warm-up (CMJ: -6.7 ± 4.2%; AJ: -8.1 ± 8.4%; and 505 time: 1.4 ± 2.5%). For warm-up with the addition of barbell deadlift, vertical jump increased by 4.3 ± 5.6% (Cohen's dunb : 0.23 [0.02-0.47]) and 505 time decreased by -5.9 ± 3.6% (Cohen's dunb : 0.97 [-1.68 to -0.43]). The warm-up with hex-bar deadlift led to trivial changes for CMJ and AJ, but 505 time decrease by -2.7 ± 2.6% (Cohen's dunb : -0.53 [-1.01 to -0.13]). The deadlift exercise can be added to warm-up routines to maintain or even enhance acute physical performance. However, coaches and practitioners should be aware that performance enhancements resultant from deadlift may vary according to individual physical profiles.

Perspectives and practices of nutritionists on dietary supplements for elite soccer teams: a cross-sectional survey study

Introduction and objectives

Dietary supplements are part of the nutritional strategies frequently applied in sports performance support. With growing research on this subject and high demand from athletes, nutritionists need to keep up to date with the latest evidence and utility of dietary supplements, particularly in real-world contexts. As information about the use of dietary supplements among elite soccer players is still scarce, this work aimed to know how nutritionists working with elite soccer teams perceive and use these substances in their daily practice.

Methods

A questionnaire previously used to describe nutritionists' beliefs and attitudes regarding the use of dietary supplements in a clinical context was adapted for this study. The online questionnaire was addressed to nutritionists working with elite soccer teams from six European Leagues and Brazil, between November 2022 and February 2023.

Results

Overall, the participants considered themselves well-trained (76.9%), knowledgeable (95.4%), and interested in dietary supplements (95.4%). The majority (70.8%) of the participants agreed or strongly agreed to recommend dietary supplements to soccer players. Personal usage of dietary supplements was associated with recommending supplements (p < 0.001), but no relationships were found with years of experience and academic level.

Discussion

Nutritionists working with elite soccer players consider the use of dietary supplements for performance-enhancement purposes and not only to compensate for nutritional deficits, which might contribute to their higher interest, training and perceived knowledge about this topic. Participants recognize players' interest in dietary supplements, and are mindful of the safety and efficacy of these products. The present study suggests that nutritionists working with elite soccer teams are among the highest prescribers of dietary supplements, although personal usage is lower than that of nutritionists working in a clinical context.

Effective playing time affects technical-tactical and physical parameters in football

Effective playing time has been debated as a topic of major concern in football. Thus, the current experimental study aimed to investigate the effects of effective playing time on technical-tactical and physical match parameters in football. One hundred and seventy-nine male highly trained football players (aged 27.9 ± 5.1 years) from twelve teams performed two different match-play conditions: 45 min of match-play without stopping the chronometer (T45), and 30 min of match-play by stopping the chronometer every time the ball was out-of-play (T30). T30 presented a significantly higher total time (49:30 vs. 45:00 min; p = <.001; ES = 0.76), effective playing time (28:70 vs. 26:80 min; p = <.001; ES = 0.62), and stopped time (20:60 vs. 18:20 min; p = 0.003; ES = 0.38) compared to T45. Total ball possession (54.4% vs. 45.6%; p = 0.002) and 1/3 ball possession (55.3% vs. 44.7%; p = 0.018) was higher in T30 condition when compared to T45. Regarding match external load, total distance covered (4,899 vs. 4,481 m; p = <.001; ES = 0.71), moderate-speed running (607 vs. 557 m; p = 0.002; ES = 0.26) and high-speed running (202 vs. 170 m; p = <.001; ES = 0.33), high-speed activities (284 vs. 245 m; p = 0.003; ES = 0.24), accelerations (27 vs. 24; p = <.001; ES = 0.32), and decelerations (31 vs. 28; p = 0.005; ES = 0.26) were higher in T30 compared to T45. In conclusion, these findings suggest that higher effective playing time may affect technical-tactical and physical parameters during football games.

Perspectives of eFootball Players and Staff Members Regarding the Effects of Esports on Health: A Qualitative Study

BACKGROUND

Recently, esports have been argued to impact esports players' health, particularly for those competing at higher levels. Esports are a relatively new phenomenon, and an inside perspective regarding esports players' needs and experiences is essential to promote adequate health support for this population. Thus, in this qualitative study, we explored the perspectives of elite esports players and staff members regarding the effects of esports participation on health. Ten semi-structured interviews were performed with members of the Portuguese FIFA (i.e. FIFA EA Sports^®) eFootball National team (i.e. five elite electronic football players, one world-class electronic football player, two national team coaches, and two members of the esports department). Data analysis was undertaken following the principles of thematic analysis.

RESULTS

We identified four major superordinate themes: health definition (1), factors of esports that impact mental (2) and mental health (3), and strategies to improve esports players' health (4). Esports-related factors such as gaming, competition, and performance were said to impact mental health, while equipment, facilities, and esports-related sitting time affect physical health. To minimise those risks, four main strategies were suggested: optimising and scheduling esports training, improving lifestyle habits with an emphasis on physical health, enhancing facilities and equipment, and improving health support, particularly with a mental health professional.

CONCLUSION

Esports players and staff members are concerned and aware of esports' mental and physical demands. Understanding what esports players need and perceive about their health, complemented with the view of staff members, and their proposed strategies for health promotion might help define and prioritise healthcare needs, which could help players and the broad esports community.

The Impact of Sleep Interventions on Athletic Performance: A Systematic Review

BACKGROUND

Sleep is essential for maximal performance in the athletic population. Despite that, the sport context has many factors that can negatively influence athletes' sleep and subsequent recovery.

OBJECTIVES

The purpose of this systematic review was to synthesize the most recent literature regarding sleep interventions aimed at improving sleep and subsequent performance in athletes.

METHODS

The present systematic review was conducted based on the PRISMA guidelines and the PICOS approach. The search was conducted in May 2022 using the electronic database PubMed, SPORTDiscus via EBSCOhost, and Web of Science. Once extracted, studies were included if they met the following criteria: (1) participants were athletes of individual or team sports; (2) implemented an intervention aimed at improving sleep; (3) measured at least one objective performance/recovery outcome; and (4) reported the relationship between sleep and performance.

RESULTS

The search returned 1584 records. Following the screening, a total of 25 studies met our inclusion criteria. All the included articles were intervention studies published between 2011 and 2021. The included studies implemented various sleep interventions, such as sleep hygiene, naps, sleep extension, light manipulation, cold water immersion, mindfulness, or a combination of two or more strategies. Sleep extension and naps were the most representative and most effective strategies to improve sleep and performance. Mindfulness and light manipulation demonstrated promising results, but more studies are needed to confirm these findings. Sleep hygiene, removing electronic devices at night, and cold water immersion had no effects on sleep and subsequent performance/recovery, but these results are based on a few studies only.

CONCLUSION

While acknowledging the limited amount of high-quality evidence reviewed, it appears that increasing sleep duration at night or through napping was the most effective interventions to improve physical and/or cognitive performance. Protocol Registration This protocol was registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on May 11, 2022, with the registration number INPLASY202250069.

Reliability of Maximal Strength and Peak Rate of Force Development in a Portable Nordic Hamstrings Exercise Device

The Nordic hamstring exercise (NHE) is a very popular exercise used to improve eccentric strength and prevent injuries. The aim of this investigation was to assess the reliability of a portable dynamometer that measures maximal strength (MS) and rate of force development (RFD) during the NHE. Seventeen physically active participants (34.8 ± 4.1 years; n = 2 women and n = 15 men) participated. Measurements occurred on two different days separated by 48-72 h. Test-retest reliability was calculated for bilateral MS and RFD. No significant test-retest differences were observed in NHE (test-retest [95% CI, confidence interval]) for MS [-19.2 N (-67.8; 29.4); p = 0.42] and RFD [-70.4 N·s^-1 (-178.4; 37.8); p = 0.19]. MS showed high reliability (intraclass correlation coefficient [ICC] [95% CI], =0.93 [0.80-0.97] and large within-subject correlation between test and retest [r = 0.88 (0.68; 0.95)]. RFD displayed good reliability [ICC = 0.76 (0.35; 0.91)] and moderate within-subject correlation between test and retest [r = 0.63 (0.22; 0.85)]. Bilateral MS and RFD displayed a coefficient of variation of 3.4% and 4.6%, respectively, between tests. The standard error of measurement and the minimal detectable change for MS was 44.6 arbitrary units (a.u.) and 123.6 a.u., and 104.6 a.u. and 290.0 a.u. for peak RFD. This study shows that MS and RFD can be measured for NHE using a portable dynamometer. However, not all exercises are suitable to apply to determine RFD, so caution must be taken when analyzing RFD during NHE.

How much does it cost to implement a community-based walking football programme for patients with type 2 diabetes?

Objectives

The current study analysed the implementation costs of a community-based walking football exercise programme for patients with type 2 diabetes.

Methods

The direct costs of a community-based walking football programme for middle-aged and older male patients with type 2 diabetes, designed and tested in Porto (Portugal), were calculated from the payer's perspective. One season of this programme consists of three sessions per week (60 min per session) for nine months (October to June). Cost calculations were based on two groups of 20 patients and included the sports infrastructure and equipment, human resources, pre-exercise clinical evaluation, medical equipment, technical training and other consumable costs. An economic depreciation of 1 year using the linear method for sports and electronic materials was considered. Cost analysis dated December 2021 and is expressed in international dollars ($).

Results

This programme was estimated to have a total implementation cost of $22 923.07; $2547.01/month; $573.08/patient; $106.13/session; $63.68/patient/month and $5.31/patient/session.

Conclusion

A community-based walking football programme for patients with type 2 diabetes is affordable and can be scaled up by local communities to promote physical activity and manage type 2 diabetes with the involvement of multiple stakeholders such as the football clubs, municipalities and primary healthcare units.

The Road to Becoming a World Champion in Futsal

PURPOSE

The aim of the current study was to report the training program and monitoring outcomes of the Portuguese national futsal team during the preparation and competition phases of the FIFA Futsal World Cup Lithuania 2021™. For that, the variations in training load and wellness were measured, as well as their relationship.

METHODS

The study followed a retrospective cohort design. For all field training sessions, the volume, exercise structure, and area of play were identified. Player load, session rating of perceived exertion (sRPE), and wellness were collected. Descriptive statistics and Kruskal-Wallis tests were used for comparison purposes. A visualization method was used for load and well-being.

RESULTS

No significant differences were observed in the number of training sessions, session duration, and player load between preparation and competitive periods. sRPE showed significantly higher values in preparation than in competition periods (P < .05, d = 0.86) and significant differences between weeks (P < .05, d = 1.08). Wellness showed a general statistical difference between periods (P < .001, d = 1.28) and weeks (P < .05, d = 1.17). The correlation analysis for the overall period revealed a general linear relationship within variables of training load and wellness (P < .001). Variations occurred for preparation and competition periods. The visualization method through quadrant plots allowed us to understand the adaptation of the team and the players over the specific period under analysis.

CONCLUSIONS

Through this study, it was possible to better understand the training program and monitoring strategies of a high-performance futsal team over a high-level tournament.

Is it Time to Consider Quaternary Injury Prevention in Sports?

Prevention has traditionally been categorized into three main areas: primary, secondary, and tertiary. In this Current Opinion, we present and discuss the concept of quaternary prevention in sports. Quaternary prevention aims to protect individuals from interventions that likely cause more harm than good, such as overdiagnosis, overtreatment, and overmedication. It includes preventing all types of harm associated with training and clinical interventions. Therefore, any sports injury prevention model or strategy should acknowledge the risks associated with training-related (i.e., overreaching and overuse) and clinical-related (i.e., overdiagnosis, over medicalization, and overtreatment) features. We propose a conceptual framework that integrates quaternary prevention into the contemporary injury prevention models in sports, taking into account that injury prevention is just one branch of the managerial, decision-making, and active hazard control process of risk management that athletes, coaches, and health and performance staff need to deal with. Therefore, we argue that integrating the concept of quaternary prevention into any form of prevention will significantly protect athletes from excessive, inappropriate, and ethically questionable interventions that may likely cause more harm than good.

Effects of walking football on adherence, safety, quality of life and physical fitness in patients with prostate cancer: Findings from the PROSTATA_MOVE randomized controlled trial

Aims

To analyze the feasibility and impact of a walking football (WF) program on quality of life (QoL), cardiorespiratory fitness (CRF), muscle strength, and balance program in men with prostate cancer under androgen deprivation therapy (ADT).

Methods

Fifty patients with prostate cancer (stages IIb-IVb) under ADT were randomized to a 16-week WF program plus usual care (n=25) or usual care control group (n=25). The WF program consisted of three 90-minute sessions per week. Recruitment, withdrawal, adherence, enjoyment rate, and safety of the intervention were recorded throughout the study. Cardiorespiratory fitness was assessed before and after the interventions, while handgrip strength, lower limb muscle strength, static balance, and QoL were assessed before, during (week 8), and after (week 16) the interventions. Adverse events during sessions were also recorded.

Results

The WF group showed high levels of adherence (81.6 ± 15.9%) and enjoyment rate (4.5 ± 0.5 out of 5 points). In the intention-to-treat analysis, the WF group showed an improvement in chair sit-to-stand (p=0.035) compared to the control group. Within-group comparisons showed that handgrip strength in the dominant upper limb (p=0.024), maximal isometric muscle strength in the non-dominant lower limb (p=0.006), and balance in the dominant limb (p=0.009) improved over time in the WF group but not in the usual care group. The results obtained from the per-protocol analysis indicate that CRF improved significantly in the WF group as compared to the control group (p=0.035). Within-group analysis revealed that CRF (p=0.036), muscle strength in dominant (p=0.006) and non-dominant (p=0.001) lower limbs, and balance in the non-dominant lower limb (p=0.023) improved after 16 weeks of WF, but not in the control group. One major traumatic injury (muscle tear) was reported with a complete recovery before the end of the intervention.

Conclusion

This study suggests that WF is feasible, safe, and enjoyable in patients with prostate cancer under hormonal therapy. Furthermore, patients who adhere to the WF program can expect cardiorespiratory fitness, muscle strength, and balance improvements.

Clinical trials registration

clinicaltrials.gov, identifier NCT04062162.

Comparing Sleep in Shared and Individual Rooms During Training Camps in Elite Youth Soccer Players: A Short Report

CONTEXT

Athletes' sleep is the most important recovery strategy and has received growing attention. However, athletes may experience sleep disruptions due to numerous factors, such as training and competition workloads, travel, changes in sleep-wake schedules, and sleeping environments. They often spend nights in unfamiliar hotels, and sharing a bed, room, or both with another person might affect sleep duration and quality.

OBJECTIVE

To analyze the effect of sleeping in shared (SRs) versus individual (IRs) rooms on objective and subjective sleep and on slow-wave-sleep-derived cardiac autonomic activity during an official training camp in elite youth soccer players. Training and match workloads were characterized.

DESIGN

Observational case study.

SETTING

Hotel accommodations.

PATIENTS OR OTHER PARTICIPANTS

Thirteen elite male youth soccer players.

RESULTS

Players slept longer in IRs than in SRs (+1:28 [95% CI = 1:18, 1:42] hours:minutes; P < .001). Sleep efficiency was higher in IRs than in SRs (+12% [95% CI = 10%, 15%]; P < .001), whereas sleep latency was shorter in IRs than in SRs (-3 [95% CI = -15, -4] minutes; P < .001). Subjective sleep quality was lower in IRs than in SRs (-2 [-3 to -2] arbitrary units; P < .001). No differences were found for slow-wave-sleep-derived cardiac autonomic activity or for training or match workloads between training camps.

CONCLUSIONS

During soccer training camps, sleep may be affected by whether the athlete is in an SR versus an IR.

Predicting obstructive coronary artery disease in heart failure with reduced ejection fraction: A practical clinical score

INTRODUCTION AND OBJECTIVES

Obstructive coronary artery disease (CAD) remains the most common etiology of heart failure with reduced ejection fraction (HFrEF). However, there is controversy whether invasive coronary angiography (ICA) should be used initially to exclude CAD in patients presenting with new-onset HFrEF of unknown etiology. Our study aimed to develop a clinical score to quantify the risk of obstructive CAD in these patients.

METHODS

We performed a cross-sectional observational study of 452 consecutive patients presenting with new-onset HFrEF of unknown etiology undergoing elective ICA in one academic center, between January 2005 and December 2019. Independent predictors for obstructive CAD were identified. A risk score was developed using multivariate logistic regression of designated variables. The accuracy and discriminative power of the predictive model were assessed.

RESULTS

A total of 109 patients (24.1%) presented obstructive CAD. Six independent predictors were identified and included in the score: male gender (2 points), diabetes (1 point), dyslipidemia (1 point), smoking (1 point), peripheral arterial disease (1 point), and regional wall motion abnormalities (3 points). Patients with a score ≤3 had less than 15% predicted probability of obstructive CAD. Our score showed good discriminative power (C-statistic 0.872; 95% CI 0.834-0.909: p<0.001) and calibration (p=0.333 from the goodness-of-fit test).

CONCLUSIONS

A simple clinical score showed the ability to predict the risk of obstructive CAD in patients presenting with new-onset HFrEF of unknown etiology and may guide the clinician in selecting the most appropriate diagnostic modality for the assessment of obstructive CAD.

The perception of injury risk and prevention among football players: A systematic review

Football is associated with a certain risk of injury, leading to short- and long-term health consequences. However, the perception of football players about injury risk and prevention strategies is poorly documented. The present article reviewed the literature about perceptions, beliefs, attitudes and knowledge toward injury risk and prevention strategies in football players. An electronic search was performed in PubMed, Scopus, Web of Science, and APA PsychINFO until July 2022. Studies were eligible if they included the perceptions, beliefs, attitudes, and knowledge about injury risk and prevention in football players from any competitive level. The risk of bias was assessed in included studies using the Joanna Briggs Institute critical appraisal checklist. A total of 14 studies were included. Most football players agreed that their risk of injury is high and prevention strategies are important, however they do not intend to use some of these strategies. The most frequent perceived injury risk factors were low muscle strength, lack of physical fitness, fatigue, excessive training and type and condition of surfaces. The most frequent perceived injury prevention factors were warm-up, workload monitoring and strength and conditioning training. It is essential to acknowledge perceived injury risk factors, as well as a better understanding of how coaching and medical departments' perceptions match with players' perceptions, and a modification in the perceptions of the several stakeholders at different levels of action.

Invasive assessment of aortic stenosis in contemporary practice

The authors review the current role of cardiac catheterization in the characterization of aortic stenosis, its main clinical applications, its pitfalls, and its additional value to the information provided by echocardiography. Discrepancies that may arise between these two modalities are discussed and further explained. Hemodynamic variables besides transvalvular pressure drop are described, and emphasis is given to an integrative approach to aortic stenosis assessment, that includes invasive and noninvasive evaluation.

Performance effects of internal pre- and per-cooling across different exercise and environmental conditions: A systematic review

Exercise in a hot and humid environment may endanger athlete's health and affect physical performance. This systematic review aimed to examine whether internal administration of ice, cold beverages or menthol solutions may be beneficial for physical performance when exercising in different environmental conditions and sports backgrounds. A systematic search was performed in PubMed, Web of Science, Scopus and SPORTDiscus databases, from inception to April 2022, to identify studies meeting the following inclusion criteria: healthy male and female physically active individuals or athletes (aged ≥18 years); an intervention consisting in the internal administration (i.e., ingestion or mouth rinse) of ice slush, ice slurry or crushed ice and/or cold beverages and/or menthol solutions before and/or during exercise; a randomized crossover design with a control or placebo condition; the report of at least one physical performance outcome; and to be written in English. Our search retrieved 2,714 articles in total; after selection, 43 studies were considered, including 472 participants, 408 men and 64 women, aged 18-42 years, with a VO2max ranging from 46.2 to 67.2 mL⋅kg-1⋅min-1. Average ambient temperature and relative humidity during the exercise tasks were 32.4 ± 3.5°C (ranging from 22°C to 38°C) and 50.8 ± 13.4% (varying from 20.0% to 80.0%), respectively. Across the 43 studies, 7 exclusively included a menthol solution mouth rinse, 30 exclusively involved ice slurry/ice slush/crushed ice/cold beverages intake, and 6 examined both the effect of thermal and non-thermal internal techniques in the same protocol. Rinsing a menthol solution (0.01%) improved physical performance during continuous endurance exercise in the heat. Conversely, the ingestion of ice or cold beverages did not seem to consistently increase performance, being more likely to improve performance in continuous endurance trials, especially when consumed during exercises. Co-administration of menthol with or within ice beverages seems to exert a synergistic effect by improving physical performance. Even in environmental conditions that are not extreme, internal cooling strategies may have an ergogenic effect. Further studies exploring both intermittent and outdoor exercise protocols, involving elite male and female athletes and performed under not extreme environmental conditions are warranted. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268197], identifier [CRD42021268197].

Peri-procedural, 30-day and 1 year-outcomes in chronic dialysis patients undergoing transcatheter aortic valve implantation

Background

Patients on chronic dialysis (CD) due to end-stage renal disease (ESRD) with symptomatic severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) were excluded from randomized clinical trials. Our study aimed to investigate the outcomes of patients with chronic dialysis who underwent TAVI.

Methods

Single center analysis on prospectively collected data of all consecutive patients who underwent TAVI between January 2011 and December 2020 according to baseline renal function: chronic dialysis group (CD) and control group (CTRL). Procedural, 30-day and 1-year outcomes were assessed. Outcomes were defined in accordance with the VARC-3 criteria.

Results

A total of 875 patients underwent TAVI during the study period, of whom 22 (2.5%) were on chronic dialysis. Patients on CD were younger (median age 80 years, [IQR 73–84] vs 84 years, [IQR 80–87]; p&lt;0.001), more likely to be men [365/863 (42.8%) vs 18/22 (81.8%); p&lt;0.001] and more likely to have peripheral vascular disease [41/853 (4.8%) vs 7/22 (31.8%); p=0.031] and lower body mass index (median 24.1 kg/m2, [IQR 21.5–26.5] vs 26.3 kg/m2, [IQR 23.7–29.3]). Short-term major or life-threatening bleeding were significantly higher in CD patients (odds ratio [95% confidential interval]: 3.67 [1.50–8.96], p 0.005). In contrast, no differences were found regarding rates of vascular complications requiring intervention (OR [95% CI]: 1.35 [0.31–5.90], p=0.662), permanent pacemaker implantation (OR [95% CI]: 0.87 [0.25–2.98], p=1.000) or stroke (OR [95% CI]: 1.51 [0.20–11.64], p=0.504). Importantly, dialysis patients had significantly higher rates of in-hospital, 30-day and 1-year mortality rates (13.6 vs 2.1%, p&lt;0.001; 18.9% vs 2.9, p&lt;0.001 and 26.4% vs 10.7%, p&lt;0.001, respectively). On multivariate analysis, after adjusting for age, gender, relevant co-morbidities, and procedure-related complications, CD remained independently associated with mortality at 1-year. Survival curves during follow up are presented in Figure 1.

Conclusions

Chronic dialysis patients submitted to TAVI had significantly higher rates of short-term life threatening and/or major bleeding, short-term and long-term mortality. Careful selection of patients who would benefit from TAVI among patients with ERDS requiring dialysis is necessary to prevent high rates of postprocedural complications and improve outcomes of this high-risk population.

Funding Acknowledgement

Type of funding sources: None.

Vascular closure device in TAVI with a dedicated endovascular plug-based device – experience from a high-volume tertiary center

Background

Vascular complications at the access site are important adverse events during transcatheter aortic valve implantation (TAVI). Effective, reproducible, and safe closure of large bore arteriotomies remains challenging as management strategies vary among centers and operators. MANTAÒ is a dedicated plug-based vascular closure device (VCD) recently approved for percutaneous access site closure. This study aimed to describe our experience and to determine the safety and effectiveness of MANTAÒ for large bore arteriotomies during transfemoral TAVI.

Methods

Single center retrospective analysis on prospectively collected data of all consecutive patients who underwent transfemoral TAVI from 2018 to 2020. The primary safety outcomes were access-related vascular injury and bleeding complications according to VARC-3 criteria. Technical success was defined as puncture closure obtained with MANTAÒ without the use of unplanned endovascular or surgical intervention. A secondary analysis according to center experience was performed.

Results

Of the 535 patients that underwent transfemoral TAVI during the study period (median age = 84 [IQR 80–87], 39.4% male; median EuroSCORE II of 3.89% [IQR 2.62–5.39]), MANTAÒ VCD was deployed in 320 (59.8%). Overall, 32 (10.0%) patients suffered an access-related vascular injury and 22 (6.6%) had a bleeding complication (Figure 1A). Technical success was achieved in most cases (n=298; 93.1%). 30-day mortality rate was 1.6% (n=5). Since the first deployment in mid-2018, the rates of MANTA-related complications decreased with increasing experience and a steep learning curve effect was noted (Figure 1B).

Conclusions

MANTAÒ was rapidly adopted as the default strategy for vascular access site closure after TAVI at our center. A relatively steep learning was observed, suggesting that few procedures are required to acquire device proficiency. In addition, our results suggest that MANTA Ò can effectively close large bore arteriotomies with a low risk of severe complications.

Funding Acknowledgement

Type of funding sources: None.

Contextual variables affect peak running performance in elite soccer players: A brief report

The current brief research report aimed to investigate the influence of contextual variables on peak running performance in male elite soccer players. We analyzed 29 matches of an elite soccer team during the Brazilian Serie A 2019. Twenty players were tracked using GPS units. Peak physical performance was determined using moving average running values with different time windows (1, 3, and 5-min periods). The variables analyzed were total distance covered, total distance covered in high-intensity running (≥19.8 km·h⁻¹), and the distance in accelerations (≥2 m·s⁻²) and decelerations ( ≤-2 m·s⁻²). Four contextual variables were considered: 1) positional status; 2) match location; 3) match outcome; and 4) match status. Central defenders showed a lower 1-min peak total distance in relation to all other positions (p = 0.001–0.03). Peak physical performance was higher in away matches for high-intensity running, acceleration, and deceleration (p = 0.01–0.03). In matches that ended in losses, peak values for high-intensity running and acceleration were higher compared to draws and wins (p = 0.01–0.04). Regarding the match status, higher values were observed in draws than wins and losses (p = 0.01). Peak running performance vary according to contextual variables of the match in male elite soccer players. Positional differences were found for peak periods, and physical performance was higher in away matches.

A New Portable Device to Reliably Measure Maximal Strength and Rate of Force Development of Hip Adduction and Abduction

ABSTRACT

Gonçalves, BM, Mesquita, RNO, Tavares, F, Brito, J, Correia, P, Santos, P, and Mil-Homens, P. A new portable device to reliably measure maximal strength and rate of force development of hip adduction and abduction. J Strength Cond Res 36(9): 2465-2471, 2022-Groin injuries are a major issue in sports involving kicking or quick changes of direction. Decreased hip adduction and abduction strength have been indicated as one of the main risk factors for groin injury. The methods currently available to measure hip adduction and abduction strength are reliable but highly dependent on the evaluator skills. Furthermore, several studies have reported the reliability of maximal strength (MVIC), but very few studies investigated the reliability of explosive strength (RFD), a parameter that has been previously shown to have a higher functional value. The aim of the current investigation was to assess the reliability of a user-independent portable dynamometer that concurrently measures MVIC and RFD. Twenty-five healthy young subjects performed maximal isometric hip adduction and abduction in both sitting and supine positions. Measurements occurred in 2 different days separated by 48-72 hours. Test-retest reliability was calculated for both MVIC and RFD. Both MVIC and RFD showed good relative reliability (intraclass correlation coefficient = 0.77-0.98) with no differences between positions or muscle actions. Measurement error was similar between positions for MVIC in both hip adduction and abduction. Measurements of RFD showed higher reliability using a time window of at least 0-100 milliseconds, and lower measurement error was observed in sitting for adduction and in supine for abduction. This study shows that portable dynamometry can be used to concurrently measure hip adduction and abduction maximal and explosive strength, with levels of reliability that are similar to previously described methods.

P02-12 The implementation cost of a walking football exercise program for patients with type 2 diabetes: a case study of SWEET-Football (Portugal)

Background

Economic analysis of health interventions is essential to the development and implementation of sustainable health policies, especially in noncommunicable diseases area. Type 2 diabetes (T2D) is one of the most relevant noncommunicable diseases globally. Regular physical activity is an established cornerstone of T2D control, with benefits in glycemic control, cardiovascular risk factors and quality of life. Thus, the current study aimed to assess the cost of a community-based physical activity intervention for patients with T2D.

Methods

We assessed the SWETT-Football program - a community-based walking football exercise program for middle-aged and older male patients with T2D. The program was tested in Portugal through a scientific project (NCT03810846) funded by FIFA (FIFA Research Scholarship 2018). One season of this program consists of three sessions per week (60 minutes per session) during nine months (October to June). For the calculations, we considered a total of 40 patients (two groups of 20). We calculated the direct costs of one season for the host institution: 216 hours of renting a sports hall and hiring human resources (a football coach and a nurse); cardiac stress tests and sports insurance for the participants; sports equipment (balls, cones, vests); vital signs monitoring equipment (blood pressure, heart rate and capillary blood glucose); logistical equipment (disposable and non-disposable); and technical training. In addition, we considered an economic depreciation of five years for sports and electronic materials. Cost analysis dated January 2022.

Results

One season of this program for 40 patients with T2D was estimated to have a total implementation cost of 11,026.51€: 1,225.17€/month; 275.66€/patient; 51.05€/session; 30.63€/patient/month; and 2.55€/patient/session.

Conclusions

A community-based walking football program for patients with T2D has an affordable cost and is feasible for large-scale implementation by local communities with the involvement of football clubs, municipalities and primary health care units, promoting physical activity and contributing to T2D control.

Economic evaluation of physical activity interventions for type 2 diabetes management: a systematic review

Background

Economic evaluation of physical activity interventions has become an important area for policymaking considering the high costs attributable to physical inactivity. However, the evidence for such interventions targeting type 2 diabetes control is scarce. Therefore, the present study aimed to synthesize economic evaluation studies of physical activity interventions for type 2 diabetes management.

Methods

A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement (PROSPERO reference number CRD42021231021). An electronic search was performed in PubMed, Web of Science, Cochrane Library and NHS Economic Evaluation Database. Studies were eligible if they included: adults with type 2 diabetes; any physical activity intervention in the community settings; an experimental or quasi-experimental design; and a parameter of economic evaluation [cost analysis of interventions, cost-effectiveness analysis (including cost-utility analysis) and cost-benefit analysis] as an outcome.

Results

Ten studies were included in this review: seven were randomized controlled trials and three were quasi-experimental studies. All studies included direct costs, and four also included indirect costs. Four studies demonstrated that physical activity interventions were cost-saving, six studies showed cost-effectiveness, and two studies reported cost-utility. The estimates varied considerably across the studies with different analytical and methodological approaches.

Conclusion

Overall, this systematic review found that physical activity interventions are a worth investment for type 2 diabetes management. However, comparability across interventions was limited due to heterogeneity in interventions type, design and delivery, which may explain the differences in the economic measures.

Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors

BACKGROUND

Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours.

METHODS

A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables.

RESULTS

A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001).

CONCLUSIONS

The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

Training in women soccer players: A systematic review on training load monitoring

Objective

The present systematic review aimed to provide an overview of training load (TL), along with their responses, monitoring during training sessions in highly trained and elite adult women soccer players.

Data source

Electronic databases searches (PubMed, Scopus, Web of Science and Ebsco) for relevant studies published in peer-reviewed journals were conducted, and eligibility criteria were based on the PICOS model in accordance with PRISMA guidelines.

Study selection

Studies were considered as follows: (a) highly trained and elite adult (>18 years) women's soccer players; (b) continuous (minimum 1-week duration) TL monitoring in the context of the team routine; (c) TL collected from entire training session. Methodological qualitative assessments and risk of bias criteria were used for judging the studies.

Data extraction

A total of 1,163 studies were identified, and 16 were included. The selected studies were fully screened to extract the population characteristics; the number of players; a type of study design; region where the study was performed; the main findings.

Data synthesis

Accumulated external TL (ETL) during the pre-season was positively correlated to enhanced adaptations in intermittent exercise capacity. Daily ETL was negatively correlated to next-day self-reported fatigue and muscle soreness. Daily internal TL (ITL) was negatively correlated to post-session sleep duration and sleep efficiency. One study showed that higher accumulated player load and total distance were associated with injury.

Conclusion

Information about TL during training sessions in women soccer players is very sparse, and it is currently very difficult to consider evidence-based practices for training sessions in highly trained and elite adult women soccer players. Moreover, the dose-response relationships between TL and training outcome (e.g., fatigue, training adaptations and injuries) need to be further explored to understand the optimal training stimulus to enhance performance outcomes while preserving player health.

SAECG - advances in Brugada stratification

Funding Acknowledgements

Type of funding sources: None.

Introduction

Brugada syndrome (BrS) is a relevant cause of sudden cardiac death (SCD) in young adults. Several risk factors have been identified, but clinical decision making remains extremely challenging, particularly in asymptomatic patients.

Purpose

To explore the usefulness of the non-invasive assessment of late potentials (LPs) based signal-averaged ECG (SAECG) for risk stratification in BrS.

Methods

Prospective single-center study of patients with BrS included from 2003 to 2021. LPs were evaluated by SA-ECG with determination of the total filtered QRS duration (fQRS), root mean square voltage of the 40ms terminal portion of the QRS (RMS40) and duration of the low amplitude electric potential component of the terminal portion of the QRS (LAS40) in conventional and modified right precordial leads.

The primary endpoint was the occurrence of malignant arrhythmic events (MAEs), defined as a composite of SCD or appropriate shocks. Uni- and multivariate Cox regression survival analyses were used to identify significant prognostic predictors considering the clinical, genetic, and electrocardiographic characteristics as well as the tercile distribution of the SAECG parameters. A risk score was computed incorporating the significant LPs variables and its usefulness for prognostic stratification was explored using Kaplan Meier survival analysis.

Results

Our cohort consisted of 117 patients (mean age: 47±13 years, 33% male), including 75 (65%) with type 1 spontaneous pattern and 92 (79%) asymptomatic individuals. Symptoms at presentation included syncope in 16 pts (14%) and polymorphic VT/cardiac arrest in 4 (3.4%).

During a median follow-up of 4.1±0.3 years, 8 pts (6.8%) suffered MAEs: 3 (2.6%) with SCD and 5 (4.3%) with appropriate shocks.

The risk of events differed in relation to the several SAECG parameters (Table 1), increasing linearly with the fQRS duration determined either in the conventional (HR 1.03, 95% CI 1.01-1.06, p=0.008) or modified leads (HR: 1.03, 95% CI 1.01- 1.05, p=0.003). The SAECG score incorporated as risk markers a fQRS ≥113ms and a RMS40 &lt;13 μV. Patients with both risk markers presented a 7-fold increased risk (HR 7.17, 95% CI 1.29-40, p = 0.025), independently of the baseline symptomatic status and ECG pattern.

Conclusion

This study shows that the non-invasive assessment of LPs based on SAECG is useful for prognostic stratification of BrS. It was possible to identify a subset of patients presenting a high risk of events who may deserve individualized preventive strategies.

Non-ischemic cardiomyopathy: what predicts survival and ICD shocks after ventricular tachycardia ablation?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with non-ischemic cardiomyopathy (NICM) present an increased morbidity and mortality from sustained monomorphic ventricular tachycardia (VT). Implantable cardiac defibrillators effectively terminate VT, but ablation is usually required to prevent recurrences and appropriate shocks. Although several risk factors have been pointed out, clear prognostic predictors need to be established and addressed.

Purpose

To evaluate risk factors associated with all-cause mortality and ICD shocks in NICM pts submitted to VT ablation.

Methods

Prospective, observational, single-centre study of pts with NICM submitted to VT ablation using high density mapping tools.The primary outcome was all-cause death or VT recurrence terminated with appropriate ICD shock during long-term follow up. Kaplan-Meier analysis was used to estimate the long-term event-free survival. Uni and multivariate Cox regression analyses were used to determine relevant prognostic predictors.

Results

A total of 27 consecutive pts with NICM were referred for a first-ever VT ablation procedure between June 2015 and June 2021 (males: 93%; mean age: 61±12 years). The mean left ventricular ejection fraction (LVEF) was 35±12% and 70% of pts had NYHA class I or II.

During a mean follow-up of 29 ± 19 months, VT recurrences requiring ICD shocks occurred in 25.9% of pts. VT ablation success and the risk of ICD shocks were not associated with any of the clinical characteristics. Long-term all-cause mortality was 37%. In univariate analysis, LVEF &lt;30%, NT-proBNP, NYHA classification III-IV, chronic kidney disease (CKD), ICD for secondary prevention and prior VT ablation (p=0.08) were associated with reduced survival. On multivariate analysis, CKD was identified as the strongest independent survival predictor (HR 6.9; CI95%: 1.5-23-2, p=0.010)

Conclusions

In pts with NIDM, VT ablation may be successful even in pts with advanced heart disease. However, long-term survival will depend mostly on the stage of disease progression and is strongly associated with the clinical markers of end-stage heart failure. Therefore, a timely referral is crucial to derive the best clinical benefit from VT ablation in this population.

Epicardial mapping as first intention approach for structural ventricular tachycardia ablation

Funding Acknowledgements

Type of funding sources: None.

Introduction

In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool.

Purpose

To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation.

Methods

Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed.

Results

First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8±12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocardis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy. Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevenon). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications. In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases. In 3 pts radiofrequency (RF) applicaons were not performed at epicardium, as no abnormal electrograms were locally detected, and an addional endocardial approach was prosecuted. The mean overall procedure and fluoroscopic time were 123 and 28min, respectively, with a mean RF application me of 51min. After the procedure 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred. During a mean follow-up of 2.8±1.8 years, only 3pts (17%) had VT recurrence; 5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation.

Conclusion

In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings,and presents a safety profile.

Additional features in Brugada Syndrome stratification: frequent PVC and QRS duration

Funding Acknowledgements

Type of funding sources: None.

Introduction

Brugada syndrome (BrS) is a channelopathy with high prevalence of malignant arrhythmic events. The risk stratification in patients (pts) with Brugada electrocardiographic (ECG) pattern is of major importance, to prevent sudden cardiac death (SCD). A higher risk is evidenced in spontaneous type 1 pattern when compared with induced type-1 pattern, as so other electrocardiographic features have been explored aiming to detect additional prognostic factors.

Purpose

To evaluate the association of QRS duration and frequent premature ventricular contractions (PVC) with malignant arrhythmic events.

Methods

Prospective single-center study of consecutive pts with BrS, with spontaneous or induced type 1 pattern included from 2003 to 2021. All pts were enrolled in a protocol including annual non-invasive assessment with ECG and 24-hours Holter monitoring. Primary endpoints were defined as SCD or appropriate shocks in the context of ventricular tachycardia or fibrillation (VT/FV) during follow-up. Cox regression and Kaplan-Meier survival analyses were used to determine the association between the baseline ECG and Holter characteristics and the long-term risk of arrhythmic events.

Results

A total of 117 pts was included, 75 (65%) with a spontaneous type 1 pattern and 44 (33%) with an induced type 1 pattern. The mean age was 47±13years and 38 (32.5%) were male.

During a median follow-up of 4.1±0.3 years, the primary endpoint occurred in 8 (6.8%) pts, with sudden cardiac death in 3 (2.6%) and appropriate shocks due to VT/FV in 5 (4.3%). Pts who suffered arrhythmic events had presented at the study inclusion higher QRS duration (124±18 vs. 108±16ms, p= 0.014) and more frequent PVCs on 24-hour Holter (169±297 vs. 29±198; p = 0.001) - Figure 1. Indeed, the presence of QRS ≥119ms was associated with a 7-fold higher risk (HR: 7.250, 95% CI 1.619-32.461, p = 0.010) and the presence of more than 6 PVC on 24-hour Holter was also associated with a 5-fold higher risk of malignant arrhythmic events (HR 5.376, 95% 1.186-24.260, p = 0.029).

Conclusion

QRS duration and frequent PVC may established themselves as additional risk factors. In our cohort, they were both predictors of arrhythmic events during follow-up and thus can further complement BrS risk stratification.

Apical versus septal pacing - can we chose the localization of ventricular lead in order to prevent upgrade to cardiac resynchronization therapy?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Right ventricular apical pacing (RVAp) may be deleterious to ventricular function and hemodynamics due to pacing induced dyssynchrony. In the last decades, some studies showed that RVAp has been associated with heart failure, deterioration of left ventricular function and high mortality. Some patients (pts) may need, during the follow up (FUP), an upgrade to cardiac resynchronizaon therapy (CRT). New techniques have emerged such as RV lead implantation in the high septum or outflow RV tract (RVOT) and, more recently, His bundle/LB pacing.

Purpose

To compare the need for upgrade to CRT in patients with RVAp versus septal/RVOT pacing.

Methods

Retrospective single-center study of consecutive pts that implanted pacemakers in a tertiary center between January 1995 and December 2020. We collected data regarding pacing indication, RV pacing site (apex versus septum/RVOT) and need for an upgrade to CRT during follow up (FUP).

Our primary endpoint was upgrade to CRT during the FU period. In the model, the impact of localization of the implanted lead on the survival free from upgrade was estimated assuming a neutral effect on mortality. Statistical analysis was performed using T-student test and logistic regression.

Results

We included 8761 pts, 60.2% (n=5275) were male, with a mean age of 76.5±10.7 years. The main indications for pacemaker implantation were (1) complete atrioventricular (AV) block (2239, 25.6%), (2) sick sinus syndrome (2211, 25.2%), (3) atrial fibrillation with AV block or bradycardia with significant pauses (17.4%) and (4) Mobitz II 2nd degree AV block (1467, 16.7%).

RVAp was performed in 1746 (20%) patients and RVOT/septal pacing in 6933 patients (80%; RVOT in 657 (9,5%)). During FUP, 26 (1,5%) RVAp pts and 52 (0,8%) RVOT/septal pacing pts underwent upgrade to CRT, in a total of 78 pts (CRT-P in 54 patients and CRT-D in 24 patients).

We observed that patients with RVAp had twice the risk of CRT upgrade during FUP (OR: 2,0 (IC 95% 1,25-3,21), p=0,004) when compared to patients with RVOT/septal pacing.

Conclusions

Patients with RVAp presented a 2-fold higher risk for upgrade to CRT when compared to patients with RVOT/septal pacing in our center. This retrospective analysis shows that lead implantation in the septum/RVOT should be preferred instead of the apex to reduce pacing induced dyssynchrony and need for CRT upgrade.

Electrocardiography: an usefull tool for prediction of the diagnosis and severity of pulmonary embolism

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pulmonary embolism (PE) is associated with morbidity and mortality. Immediate recognition of this condition is critical to commencement of early and appropriate therapy which could be lifesaving. Particularly in patients with suspected PE in which computed tomography pulmonary angiography (CTPA) is not promptly available or is contra-indicated, an electrocardiographic (ECG) score could serve as a ubiquitously available test to raise suspicion of PE. This study aimed to evaluate the diagnostic value of an ECG score for PE diagnosis.

Methods

Retrospective study of consecutive patients who performed CTPA in Emergency Department due to PE suspicion. All ECG were scored according to the previous published Daniel’s ECG score, by an investigator blinded for the CTPA result.

Results

The most common ECG findings in patients with PE were incomplete right-brand bock (48%), T wave inversion in DIII (48%), sinus tachycardia (41%) and Q wave in DII (31%). The S1Q3T3 sign was documented in 20% of patients.

The ECG score was significantly higher in patients with PE compared to those without PE (5.06 vs 3.70, p=0.005). ECG score showed moderate accuracy to detect PE (AUC: 0.60; 95%CI: 0.53-0.67; p=0.004), but it is of a particular value because of very high specificity: an ECG score &gt; 12 identified PE with a specificity of 96% (95% CI 91.93 – 98.38).

The ECG score significantly increased the diagnostic accuracy of the diagnostic algorithm based on pretest clinical probability evaluated by Wells score combined with D-Dimer measurement (Wells & DD). In comparison to patients in which clinical pretest probability combined with D-dimer measurement considers PE excluded (Wells & ECG -), PE was 6.3 times more frequent in patients with Wells & DD +/ECG- (95% 2.7- 14.5) and 14.6 times more prevalent in the ones with Wells & DD +/ECG+ (95%CI: 4.1-51.3; p&lt;0.001) – Figure 1.

Conclusion

In patients with clininal suspition of PE, na ECG score (Daniel’s score) &gt;12 predicts PE with 96% specificity and could be used to increase the suspicion and define therapeutic strategy in patients in whom CTPA could not be immediately performed or is contra-indicated.

Is it possible to predict mortality and recurrence of VT afterablation? PAINESD risk score applicability vs new predictors

Funding Acknowledgements

Type of funding sources: None.

Introduction

Catheter ablation (CA) prevents ventricular tachycardia (VT) recurrences in patients (pts) with structural heart disease (SHD), and might have a favorable outcome, but is associated with severe short-term complications. Identification of pts at high risk of periprocedural acute haemodynamic decompensation has important implications at procedural planning.

The PAINESD risk score is a promising tool to predict VT ablation procedure-related mortality.

Aim

To evaluate the accuracy of the PAINESD risk score to predict short-term mortality after structural VT ablation and to compare it with other conventional clinical predictors.

Methods

Prospective, observational, single-centre study of consecutive pts with SHD (ischemic or nonischemic), referred for VT-CA. High-density substrate maps were collected, through endocardial, epicardial or combined endo-epicardial approaches according to clinical data and operator preference. The primary endpoint was 30-day mortality or hemodynamic decompensation. Univariate Cox regression analysis was used to identify relevant clinical predictors and to compare them with the PAINESD risk score. Multivariable Cox proportional hazards regression models were used to estimate predictors of 30-day mortality.

Results

A total of 102 pts with SHD referred for VT ablation were evaluated(mean age: 67±11 years, 94% male, 78.4% in NYHA class I-II; mean LVEF was 34±11%). The baseline PAINESD risk score was 12.39±5.8, 19.6% at low risk, 36.3% at intermediate risk and 27.5% at high risk of adverse events. Overall 30-day mortality was 4.9%. The PAINESD did not predict 30-days mortality or hemodynamic decompensation (p= 0.93). Indeed, a non- significant trend to higher short and long-term mortality was noticed in high-risk score pts – Figure 1. On univariate analysis age&gt;65 years (p=0.019), LVEF &lt;35% (p=0.049), body mass index&lt;28kg/m2 (p=0.019), CKD (p=0.001) and previous VT ablation (p=0.022) were prognostic predictors. On multivariate analysis, only LVEF&lt;35% (HR2.225; CI95% 1.004-4-774,p=0.038) and CKD (HR 3.35; CI95%: 1.31-8.51, p=0.011) were independent predictors of short-term prognosis.

Conclusions

In our population, LVEF&lt;35% and CKD were the strongest predictors of short-term mortality. PAINESD risk score was not accurate in predicting adverse events. New score systems must be derived for prognostic stratification in this population, incorporating the reduction on the actual short-term event rates after VT ablation.

Upgrade pacemaker to CRT: predictors and the importance of LVEF

Funding Acknowledgements

Type of funding sources: None.

Introduction

Nowadays 10-15% of CRT implantaon is upgrading from paents (pts) with pacemaker (PMK) who develop reduced LVEF and worsening symptoms from HF. There are few retrospecve studies showing some predictors of pts with single or dual chamber PMK that may need upgrade to CRT, but it is not completely established which pts may benefit the most.

Purpose

To identify predictors at follow-up of upgrading pacemaker to CRT in a population with pacemaker implantation.

Methods

Single center case-control study of pts that performed upgrading to CRT-pacemaker (CRT-P) in our hospital. We excluded pts that performed upgrade to CRT-D. We compare to a PMK populaon matched to age at implantaon and cause of PMK implantaon. Demographic, clinic and electrocardiographic (ECG) data were considered at baseline. Echocardiographic evaluation was performed before pacemaker/CRT upgrading implantaon and at follow-up. Predictors of upgrading were evaluated by the Cox regression. Prognosc impact of LVEF was evaluated as upgrading to CRT-P by Kaplan-Meier curves.

Results

We included 71 pts that performed CRT-P upgrade (mean age 77±10; 49,6% male, mean LVEF before PMK 54.9±9.2%) and 71 pts with pacemaker implantaon (mean age 78 ± 11; 50,4% male; mean LVEF 60.9±7.2%). The clinical characteriscs, ECG and echocardiographic were similar between pacemaker and CRT-P-upgrade, except atrial fibrillaon being more prevalent in PMK group (57.5% vs 42.5% p=0.039). Mortality was not different duringfollow-up between the two groups. In univariate analysis, QRS duraon (PMK: 115ms vs upgrade CRT-P: 132 ms, p=0.038), LVEF (PMK: 60.9% vs upgrade CRT-P: 54.9%, p=0.002) and LV end-diastolic diameter (LVEDD) (PMK: 48.9.4 ± 6.6mm vs upgrade CRT-P: 56.4 ± 6.6mm, p=0.001), LV end-sistolic diameter (LVESD) (PMK: 29.5 ± 6.5mm vs upgrade CRT-P: 37.9 ± 9 mm, p=0.006) were associate to upgrading to CRT. In our population, the unique independent predictor was lower LVEF(Long Rank 6.108, p=0.013) – Figure 1. The best LVEF cut- off to predict upgradingto CRT was 55% (AUC 0.954, sensitivity 64%, specificity 84%) – Figure 2.

Conclusion

In our populaon of CRT upgrading pts, a broad QRS duraon, lower LVEF and a higher LVEDD and LVESD were associated to upgrade to CTR-P. We try to establish a new value for LVEF that could lead to upgradingto CRT-P, and maybe the classical cut-off of 50% should be reviewed.

Cardiac Optimal Point: Identifying high risk patients for an optimal approach

Funding Acknowledgements

Type of funding sources: None.

Introduction

In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values &gt; 30 conveyed worse prognosis.

Purpose

To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term.

Methods

Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview.

Results

A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%).

A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p&lt;0.001, r= 0.450) and on follow-up CPET (p= 0.39, r= 0.303).

COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP&gt;30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size).

Conclusion

COP values &gt; 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.

Shorter cardiac rehabilitation programs: taking time is taking effectiveness?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP.

Objective

To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program.

Methods

Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation.

Results

A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities.

After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112).

Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157).

Conclusion

Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.

Very acute benefits on physical performance in elderly patients who undergone TAVI

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve implantation (TAVI) emerged as a safe and efficient procedure in patients with high or prohibitive surgical risk or in older patients. The prevalence of severe aortic stenosis is growing up, given de aging of population. These patients are much often frailty and experience low levels of physical activity and functional capacity as a result of their aortic valve disease and comorbidities. When untreated severe aortic stenosis has a poor prognosis so it is of utmost importance to restore the normal hemodynamic condition and consequently to improve functional capacity.

Aim

To assess the acute benefits (in 1 moth) of TAVI on functional capacity and physical performance.

Methods

Single center prospective study of patients submitted to TAVi between April 2021 and September 2021. Patients were evaluated at baseline (before TAVI) and one month after the procedure. To assess physical activity and functional capacity it was used the International Physical Activity Questionnaire (IPAQ) and the short physical performance battery (SPPB) which is a group of measures that combines the results of the gait speed (two timed trials of a 4-m walk – fastest recorded), chair stand (time to raise for a chair 5 times) and balance tests (ability to stand for 10 seconds with feet in 3 different positions). Additionally, patients were submitted to handgrip strength test. Paired sample t-test and Wilcoxon test were used to statistical analysis.

Results

We included 20 patients, with a mean age of 85±5,86 years, 40% (8) male. 19 patients undergone TAVI due severe native aortic stenosis and 1 due to bioprosthetic aortic valve dysfunction. The vascular access site was transfemoral in 19 patients and transapical in 1 patient.

No patient had vigorous physical activity either before or after TAVI, but the daily sitting time was lower after the procedure (mean time: 634 versus 570 minutes), however not statistically significant. Regarding the results of SPPB patients experience improvements in balance (p=0,035) and chair stand (time to raise for a chair 5 times: 19,04 versus 17,05 seconds), p=0,01.

Patients tended to be faster in 4m velocity test, however with no statistical difference (8,49 versus 6,6 seconds). No statistical differences were also observed in handgrip strength test.

Conclusion

In an elderly population, TAVI appears to have an early and beneficial effect (in 1 moth) on some domains oh physical activity and functional capacity.

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown.

Purpose

Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic.

Methods

A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session.

A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021).

Results

A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction.

There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period.

When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001).

Conclusion

In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.