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Spencer L, Wright L, Foulkes SJ, Rowe SJ, Dillon HT, Climie R, Bigaran A, Janssens K, Mitchell A, Wallace I, Lindqvist A, Burnham L, Prior DL, Howden EJ, La Gerche A. Characterizing the influence of cardiorespiratory fitness on left atrial size and function in the general population. Am J Physiol Heart Circ Physiol 2024; 326:H1269-H1278. [PMID: 38457351 DOI: 10.1152/ajpheart.00422.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/10/2024]
Abstract
Increased left atrial (LA) size and reduced LA function have been associated with heart failure and atrial fibrillation (AF) in at-risk populations. However, atrial remodeling has also been associated with exercise training and the relationship between fitness, LA size, and function has not been defined across the fitness spectrum. In a cross-sectional study of 559 ostensibly healthy participants, comprising 304 males (mean age, 46 ± 20 yr) and 255 females (mean age, 47 ± 15 yr), we sought to define the relationship between cardiorespiratory fitness (CRF), LA size, and function. We also aimed to interrogate sex differences in atrial factors influencing CRF. Echocardiographic measures included biplane measures of LA volumes indexed to body surface area (LAVi) and atrial deformation using two-dimensional speckle tracking. CRF was measured as peak oxygen consumption (V̇o2peak) during cardiopulmonary exercise testing (CPET). Using multivariable regression, age, sex, weight, and LAVi (P < 0.001 for all) predicted V̇o2peak (P < 0.001, R2 = 0.66 for combined model). After accounting for these variables, heart rate reserve added strength to the model (P < 0.001, R2 = 0.74) but LA strain parameters did not predict V̇o2peak. These findings add important nuance to the perception that LA size is a marker of cardiac pathology. LA size should be considered in the context of fitness, and it is likely that the adverse prognostic associations of increased LA size may be confined to those with LA enlargement and low fitness.NEW & NOTEWORTHY Left atrial (LA) structure better predicts cardiorespiratory fitness (CRF) than LA function. LA function adds little statistical value to predictive models of peak oxygen uptake (V̇o2peak) in healthy individuals, suggesting limited discriminatory for CRF once LA size is factored. In the wider population of ostensibly healthy individuals, the association between increased LA volume and higher CRF provides an important counter to the association between atrial enlargement and heart failure symptoms in those with cardiac pathology.
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Affiliation(s)
- Luke Spencer
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Stephanie J Rowe
- St Vincent's Institute, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Kristel Janssens
- St Vincent's Institute, Fitzroy, Victoria, Australia
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Amy Mitchell
- St Vincent's Institute, Fitzroy, Victoria, Australia
| | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Lauren Burnham
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David L Prior
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Erin J Howden
- University of Melbourne, Parkville, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Victor Chang Cardiac Research Centre, Darlinghurst, New South Wales, Australia
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Skow RJ, Foulkes SJ, Seres P, Freer MA, Mathieu ED, Raj SR, Thompson RB, Haykowsky MH, Richer L. Effect of lower body negative pressure on cardiac and cerebral function in postural orthostatic tachycardia syndrome: A pilot MRI assessment. Physiol Rep 2024; 12:e15979. [PMID: 38490814 PMCID: PMC10942852 DOI: 10.14814/phy2.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) is characterized by an excessive heart rate (HR) response upon standing and symptoms indicative of inadequate cerebral perfusion. We tested the hypothesis that during lower body negative pressure (LBNP), individuals with POTS would have larger decreases in cardiac and cerebrovascular function measured using magnetic resonance (MR) imaging. Eleven patients with POTS and 10 healthy controls were studied at rest and during 20 min of -25 mmHg LBNP. Biventricular volumes, stroke volume (SV), cardiac output (Qc), and HR were determined by cardiac MR. Cerebral oxygen uptake (VO2 ) in the superior sagittal sinus was calculated from cerebral blood flow (CBF; MR phase contrast), venous O2 saturation (SvO2 ; susceptometry-based oximetry), and arterial O2 saturation (pulse oximeter). Regional cerebral perfusion was determined using arterial spin labelling. HR increased in response to LBNP (p < 0.001) with no group differences (HC: +9 ± 8 bpm; POTS: +13 ± 11 bpm; p = 0.35). Biventricular volumes, SV, and Qc decreased during LBNP (p < 0.001). CBF and SvO2 decreased with LBNP (p = 0.01 and 0.03, respectively) but not cerebral VO2 (effect of LBNP: p = 0.28; HC: -0.2 ± 3.7 mL/min; POTS: +1.1 ± 2.0 mL/min; p = 0.33 between groups). Regional cerebral perfusion decreased during LBNP (p < 0.001) but was not different between groups. These data suggest patients with POTS have preserved cardiac and cerebrovascular function.
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Affiliation(s)
- Rachel J. Skow
- Integrated Cardiovascular Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Health SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Stephen J. Foulkes
- Integrated Cardiovascular Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Health SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Peter Seres
- Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonAlbertaCanada
| | - Meghan A. Freer
- Women and Children's Health Research InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Eric D. Mathieu
- Women and Children's Health Research InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Satish R. Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Richard B. Thompson
- Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonAlbertaCanada
- Department of Biomedical EngineeringUniversity of AlbertaEdmontonAlbertaCanada
| | - Mark H. Haykowsky
- Integrated Cardiovascular Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Health SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Lawrence Richer
- Women and Children's Health Research InstituteUniversity of AlbertaEdmontonAlbertaCanada
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
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Foulkes SJ, Haykowsky MJ, Li T, Wang J, Kennedy M, Kirkham AA, Thompson RB, Paterson DI, La Gerche A, Pituskin E. Determinants of Impaired Peak Oxygen Uptake in Breast Cancer Survivors: JACC: CardioOncology Primer. JACC CardioOncol 2024; 6:33-37. [PMID: 38510287 PMCID: PMC10950426 DOI: 10.1016/j.jaccao.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 03/22/2024] Open
Abstract
•Exercise intolerance is common among breast cancer survivors.•Exercise intolerance in breast cancer survivors is related to cardiac, vascular, and skeletal muscle impairments.•Holistic rehabilitation or pharmacological therapies are needed to address these impairments.
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Affiliation(s)
- Stephen J. Foulkes
- College of Health Sciences, University of Alberta, Edmonton, Ontario, Canada
- Heart, Exercise and Research Trials Lab, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia
| | - Mark J. Haykowsky
- College of Health Sciences, University of Alberta, Edmonton, Ontario, Canada
| | - Todd Li
- College of Health Sciences, University of Alberta, Edmonton, Ontario, Canada
| | - Jing Wang
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Megan Kennedy
- University of Alberta Library, University of Alberta, Edmonton, Alberta, Canada
| | - Amy A. Kirkham
- Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Richard B. Thompson
- College of Health Sciences, University of Alberta, Edmonton, Ontario, Canada
| | - D. Ian Paterson
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andre La Gerche
- Heart, Exercise and Research Trials Lab, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia
- Cardiology Department, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Edith Pituskin
- College of Health Sciences, University of Alberta, Edmonton, Ontario, Canada
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Foulkes SJ, Howden EJ, Pituskin E, Thompson RB, La Gerche A, Haykowsky MJ. A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors. J Cardiopulm Rehabil Prev 2024; 44:5-14. [PMID: 38032257 DOI: 10.1097/hcr.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy. REVIEW METHODS A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy. SUMMARY Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.
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Affiliation(s)
- Stephen J Foulkes
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada (Drs Foulkes, Pituskin, and Haykowsky); Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (Drs Foulkes, Howden, La Gerche, and Haykowsky); Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia (Drs Foulkes, Howden, and La Gerche); College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Thompson); National Centre for Sports Cardiology, Fitzroy, Victoria, Australia (Dr La Gerche); and Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (Dr La Gerche)
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Foulkes SJ, Hewitt D, Peters A, Schmidt T, Reiss N, Riess K, Paterson S, La Gerche A, Haykowsky MJ. Effect of Exercise Training on Peak Aerobic Power After Heart Transplantation: A Brief Review. Can J Cardiol 2023; 39:S368-S374. [PMID: 37480990 DOI: 10.1016/j.cjca.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023] Open
Abstract
Heart transplantation (HTP) is a life-saving therapy for selected individuals with end-stage refractory heart failure. Despite improvements in quality of life and survival, HTP recipients' peak aerobic power (peak VO2) remains up to 50% lower than age-matched healthy control subjects owing to abnormal cardiovascular and skeletal muscle function. Currently, little is known regarding the effect of exercise training (ET) to improve peak VO2 after HTP. This brief review aims to summarise existing evidence regarding the role of ET on peak VO2 and its determinants, highlights the upper limits of endurance performance in highly trained HTP athletes, and identifies areas for future HTP exercise rehabilitation research.
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Affiliation(s)
- Stephen J Foulkes
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia
| | - Dean Hewitt
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany; Institute for Cardiology and Sports Medicine, German Sports University Cologne, Cologne, Germany
| | - Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Ken Riess
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Northern Alberta Institute of Technology, Edmonton, Alberta, Canada
| | - Sarah Paterson
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Australia
| | - Mark J Haykowsky
- College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Rowe SJ, Paratz ED, Foulkes SJ, Janssens K, Spencer LW, Fahy L, D'Ambrosio P, Haykowsky MJ, La Gerche A. Understanding Exercise Capacity: From Elite Athlete to HFpEF. Can J Cardiol 2023; 39:S323-S334. [PMID: 37574129 DOI: 10.1016/j.cjca.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023] Open
Abstract
Exercise capacity is a spectrum that reflects an individual's functional capacity and the dynamic nature of cardiac remodelling along with respiratory and skeletal muscle systems. The relationship of increasing physical activity, increased cardiac mass and volumes, and improved cardiorespiratory fitness (CRF) is well established in the endurance athlete. However, less emphasis has been placed on the other end of the spectrum, which includes individuals with a more sedentary lifestyle and small hearts who are at increased risk of functional disability and poor clinical outcomes. Reduced CRF is an independent predictor of all-cause mortality and cardiovascular events determined by multiple inter-related exogenous and endogenous factors. In this review, we explore the relationship of physical activity, cardiac remodelling, and CRF across the exercise spectrum, emphasising the critical role of cardiac size in determining exercise capacity. In contrast to the large compliant left ventricle of the endurance athlete, an individual with a lifetime of physical inactivity is likely to have a small, stiff heart with reduced cardiac reserve. We propose that this might contribute to the development of heart failure with preserved ejection fraction in certain individuals, and is key to understanding the link between low CRF and increased risk of heart failure.
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Affiliation(s)
- Stephanie J Rowe
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen J Foulkes
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Melbourne, Australia; Exercise and Nutrition Research Program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Luke W Spencer
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Louise Fahy
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Paolo D'Ambrosio
- Baker Heart and Diabetes Institute, Melbourne, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia; Cardiology Department, Royal Melbourne Hospital, Parkville, Australia
| | - Mark J Haykowsky
- Baker Heart and Diabetes Institute, Melbourne, Australia; Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Department of Cardiometabolic Health, The University of Melbourne, Parkville, Victoria, Australia
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Pituskin E, Foulkes SJ, Cox-Kennett N, Driga A, Dimitry R, Thompson RB, Kirkham A, Prado C, Gyenes G, Haykowsky MJ. Cardio-oncology and Cancer Rehabilitation: Is an Integrated Approach Possible? Can J Cardiol 2023; 39:S315-S322. [PMID: 37758015 DOI: 10.1016/j.cjca.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
With significant improvements in the understanding of cancer biology, improved detection, and the use of novel adjuvant therapies, each year more Canadians are surviving a cancer diagnosis. Despite their effectiveness these therapies often result in short- and long-term deleterious effects to major organ systems, particularly cardiovascular. Cardio-oncology is an emerging field of study with the aim to improve cardiovascular health across the oncology disease spectrum. International guidelines distinguish "cardio-oncology" rehabilitation from "cancer" rehabilitation, but how this is navigated is currently unknown. How such care should be assessed and integrated acutely or in the longer term remains unknown. Accordingly, the aim of this article is to consider the cancer patient's needs beyond the scope of cardio-oncology rehabilitation to holistically integrate cancer rehabilitation across the disease trajectory.
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Affiliation(s)
- Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephen J Foulkes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy Driga
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | - Rebecca Dimitry
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | | | - Amy Kirkham
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada
| | - Carla Prado
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Gabor Gyenes
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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La Gerche A, Foulkes SJ, Haykowsky MJ. Reply: Heart Failure With Preserved Ejection Fraction: Exercise Deficiency or Ventricular Maladaptation to Metabolic Demands? JACC Cardiovasc Imaging 2023; 16:1236-1237. [PMID: 37673478 DOI: 10.1016/j.jcmg.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 09/08/2023]
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Foulkes SJ, Howden EJ, Dillon HT, Janssens K, Beaudry R, Mitchell AM, Lindqvist A, Wallace I, Wright L, Costello BT, Claessen G, Haykowsky MJ, La Gerche A. Too Little of a Good Thing: Strong Associations Between Cardiac Size and Fitness Among Women. JACC Cardiovasc Imaging 2023; 16:768-778. [PMID: 36881424 DOI: 10.1016/j.jcmg.2022.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) is associated with functional impairment and cardiac events, particularly heart failure (HF). However, the factors predisposing women to low CRF and HF remain unclear. OBJECTIVES This study sought to evaluate the association between CRF and measures of ventricular size and function and to examine the potential mechanism linking these factors. METHODS A total of 185 healthy women aged >30 years (51 ± 9 years) underwent assessment of CRF (peak volume of oxygen uptake [Vo2peak]) and biventricular volumes at rest and during exercise by using cardiac magnetic resonance (CMR). The relationships among Vo2peak, cardiac volumes, and echocardiographic measures of systolic and diastolic function were assessed using linear regression. The effect of cardiac size on cardiac reserve (change in cardiac function during exercise) was assessed by comparing quartiles of resting left ventricular end-diastolic volume (LVEDV). RESULTS Vo2peak was strongly associated with resting measures of LVEDV and right ventricular end-diastolic volume (R2 = 0.58-0.63; P < 0.0001), but weakly associated with measures of resting left ventricular (LV) systolic and diastolic function (R2 = 0.01-0.06; P < 0.05). Increasing LVEDV quartiles were positively associated with cardiac reserve, with the smallest quartile showing the smallest reduction in LV end-systolic volume (quartile [Q]1: -4 mL vs Q4: -12 mL), smallest augmentation in LV stroke volume (Q1: +11 mL vs Q4: +20 mL) and cardiac output (Q1: +6.6 L/min vs Q4: +10.3 L/min) during exercise (interaction P < 0.001 for all). CONCLUSIONS A small ventricle is strongly associated with low CRF because of the combined effect of a smaller resting stroke volume and an attenuated capacity to increase with exercise. The prognostic implications of low CRF in midlife highlight the need for further longitudinal studies to determine whether women with small ventricles are predisposed to functional impairment, exertional intolerance, and HF later in life.
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Affiliation(s)
- Stephen J Foulkes
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Hayley T Dillon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Kristel Janssens
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Rhys Beaudry
- Faculty of Medicine and Dentistry, College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Amy M Mitchell
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Imogen Wallace
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Leah Wright
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Benedict T Costello
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Guido Claessen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - Mark J Haykowsky
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - André La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
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10
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Foulkes SJ, Howden EJ, Haykowsky MJ, Antill Y, Salim A, Nightingale SS, Loi S, Claus P, Janssens K, Mitchell AM, Wright L, Costello BT, Lindqvist A, Burnham L, Wallace I, Daly RM, Fraser SF, La Gerche A. Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BREXIT Study. Circulation 2023; 147:532-545. [PMID: 36342348 DOI: 10.1161/circulationaha.122.062814] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breast cancer survivors treated with anthracycline-based chemotherapy (AC) have increased risk of functional limitation and cardiac dysfunction. We conducted a 12-month randomized controlled trial in 104 patients with early-stage breast cancer scheduled for AC to determine whether 12 months of exercise training (ExT) could attenuate functional disability (primary end point), improve cardiorespiratory fitness (VO2peak), and prevent cardiac dysfunction. METHODS Women 40 to 75 years of age with stage I to III breast cancer scheduled for AC were randomized to 3 to 4 days per week aerobic and resistance ExT for 12 months (n=52) or usual care (UC; n=52). Functional measures were performed at baseline, at 4 weeks after AC (4 months), and at 12 months, comprising: (1) cardiopulmonary exercise testing to quantify VO2peak and functional disability (VO2peak ≤18.0 mL·kg-1·min-1); (2) cardiac reserve (response from rest to peak exercise), quantified with exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output, and stroke volume; (3) standard-of-care echocardiography-derived resting left ventricular ejection fraction and global longitudinal strain; and (4) biochemistry (troponin and BNP [B-type natriuretic peptide]). RESULTS Among 104 participants randomized, greater study attrition was observed among UC participants (P=0.031), with 93 women assessed at 4 months (ExT, n=49; UC, n=44) and 87 women assessed at 12 months (ExT, n=49; UC, n=38). ExT attenuated functional disability at 4 months (odds ratio, 0.32 [95% CI, 0.11-0.94]; P=0.03) but not at 12 months (odds ratio, 0.27 [95% CI, 0.06-1.12]; P=0.07). In a per-protocol analysis, functional disability was prevented entirely at 12 months among participants adherent to ExT (ExT, 0% versus UC, 20%; P=0.005). Compared with UC at 12 months, ExT was associated with a net 3.5-mL·kg-1·min-1 improvement in VO2peak that coincided with greater cardiac output, stroke volume, and left and right ventricular ejection fraction reserve (P<0.001 for all). There was no effect of ExT on resting measures of left ventricular function. Postchemotherapy troponin increased less in ExT than in UC (8-fold versus 16-fold increase; P=0.002). There were no changes in BNP in either group. CONCLUSIONS In women with early-stage breast cancer undergoing AC, 12 months of ExT did not attenuate functional disability, but provided large, clinically meaningful benefits on VO2peak and cardiac reserve. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12617001408370.
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Affiliation(s)
- Stephen J Foulkes
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.).,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Erin J Howden
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Mark J Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.)
| | - Yoland Antill
- Cabrini Health, Melbourne, VIC, Australia (Y.A.).,Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, VIC, Australia (Y.A.)
| | - Agus Salim
- Epidemiology (A.S.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health (A.S.), University of Melbourne, Parkville, VIC, Australia.,School of Mathematics and Statistics (A.S.), University of Melbourne, Parkville, VIC, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (S.S.N., S.L.)
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium (P.C.)
| | - Kristel Janssens
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Amy M Mitchell
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Leah Wright
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ben T Costello
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Lauren Burnham
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Imogen Wallace
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - André La Gerche
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia (A.L.G.)
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11
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Foulkes SJ, Claessen G, Howden EJ, Daly RM, Fraser SF, Haykowsky MJ, La Gerche A. A Walnut Heart Phenotype Is Associated With Reduced Cardiovascular Reserve In Breast Cancer Survivors. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760120.76553.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Via JD, Owen PJ, Daly RM, Mundell NL, Livingston PM, Rantalainen T, Foulkes SJ, Millar JL, Murphy DG, Fraser SF. Musculoskeletal Responses to Exercise plus Nutrition in Men with Prostate Cancer on Androgen Deprivation: A 12-month RCT. Med Sci Sports Exerc 2021; 53:2054-2065. [PMID: 33867499 DOI: 10.1249/mss.0000000000002682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Androgen deprivation therapy (ADT) for prostate cancer (PCa) has multiple adverse effects on musculoskeletal health. This 12-month randomised controlled trial aimed to assess the effects of multi-component exercise training combined with whey protein, calcium and vitamin D supplementation on bone mineral density (BMD), structure and strength, body composition, muscle strength and physical function in ADT-treated men. METHODS Seventy ADT-treated men were randomised to exercise plus supplementation (Ex+Suppl; n=34) or usual care (Control; n=36). Ex+Suppl involved thrice weekly progressive resistance training plus weight-bearing impact exercise with daily multi-nutrient supplementation. Primary outcomes were DXA hip and spine areal BMD. Secondary outcomes included: tibia and radius pQCT volumetric BMD, bone structure and strength; DXA body composition; pQCT muscle and fat cross-sectional area and muscle density; muscle strength and physical function. RESULTS Sixty men (86%) completed the study. Mean exercise and supplement adherence were 56% and 77%, respectively. There were no effects of the intervention on bone or body composition outcomes. Ex+Suppl improved leg muscle strength (net difference [95% CI] 14.5% [-0.2, 29.2], P=0.007) and dynamic mobility (four-square-step test time, -9.3% [-17.3, -1.3], P=0.014) relative to controls. Per-protocol analysis of adherent participants (≥66% exercise, ≥80% supplement) showed Ex+Suppl preserved femoral neck aBMD (1.9% [0.1, 3.8], P=0.026) and improved total body lean mass (1.0 kg [-0.23, 2.22], P=0.044) relative to controls. CONCLUSION Exercise training combined with multi-nutrient supplementation had limited effect on ameliorating the adverse musculoskeletal consequences of ADT, likely related to the modest intervention adherence.
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Affiliation(s)
- Jack Dalla Via
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia Deakin University, Faculty of Health, Geelong, Victoria, Australia Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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13
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Foulkes SJ, Howden EJ, Antill Y, Loi S, Salim A, Haykowsky MJ, Daly RM, Fraser SF, La Gerche A. Exercise as a diagnostic and therapeutic tool for preventing cardiovascular morbidity in breast cancer patients- the BReast cancer EXercise InTervention (BREXIT) trial protocol. BMC Cancer 2020; 20:655. [PMID: 32664946 PMCID: PMC7362469 DOI: 10.1186/s12885-020-07123-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Anthracycline chemotherapy (AC) is an efficacious (neo) adjuvant treatment for early-stage breast cancer (BCa), but is associated with an increased risk of cardiac dysfunction and functional disability. Observations suggest that regular exercise may be a useful therapy for the prevention of cardiovascular morbidity but it is yet to be interrogated in a large randomised trial. The primary aims of this study are to: 1) determine if 12-months of ET commenced at the onset of AC can reduce the proportion of BCa patients with functional disability (peak VO2, < 18 ml/kg/min), and 2) compare current standard-of-care for detecting cardiac dysfunction (resting left-ventricular ejection fraction assessed from 3-dimensional echocardiography) to measures of cardiac reserve (peak exercise cardiac output assessed from exercise cardiac magnetic resonance imaging) for predicting the development of functional disability 12-months following AC. Secondary aims are to assess the effects of ET on VO2peak, left ventricular morphology, vascular stiffness, cardiac biomarkers, body composition, bone mineral density, muscle strength, physical function, habitual physical activity, cognitive function, and multidimensional quality of life. METHODS One hundred women with early-stage BCa (40-75 years) scheduled for AC will be randomized to 12-months of structured exercise training (n = 50) or a usual care control group (n = 50). Participants will be assessed at baseline, 4-weeks following completion of AC (4-months) and at 12-months for all measures. DISCUSSION Women diagnosed with early-stage BCa have increased cardiac mortality. More sensitive strategies for diagnosing and preventing AC-induced cardiovascular impairment are critical for reducing cardiovascular morbidity and improving long-term health outcomes in BCa survivors. TRIAL REGISTRATION Australia & New Zealand Clinical Trials Registry (ANZCTR), ID: 12617001408370 . Registered on 5th of October 2017.
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Affiliation(s)
- Stephen J Foulkes
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Erin J Howden
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Yoland Antill
- Melbourne Cancer Care, Cabrini Health, Brighton, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Sherene Loi
- Translational Breast Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Agus Salim
- Department of Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Melbourne School of Populatoin and Global Health; School of Mathematics and Statistics, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark J Haykowsky
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Robin M Daly
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Steve F Fraser
- Institute of Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Andre La Gerche
- Sports Cardiology Lab, Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
- National Centre for Sports Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia.
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Foulkes SJ, Ramsden G, Antill Y, Loi S, Haykowsky MJ, Daly RM, Fraser SF, Howden EJ, La Gerche A. Effect Of Exercise Training During Anthracycline Chemotherapy For Breast Cancer On Skeletal Muscle Composition, Strength And Physical Function. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671692.64314.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Foulkes S, Foulkes SJ, Fraser S, Howden EJ, Bigran A, Selig S, Daly R, Janssens K, Antill Y, Loi S, La Gerche A. P644Changes in cardiopulmonary fitness and cardiac reserve 12-months following anthracycline-based chemotherapy with or without concurrent exercise training. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Foulkes
- Baker IDI Heart and Diabetes Institute, Sports Cardiology, Melbourne, Australia
| | - S J Foulkes
- Deakin University, Institute of Physical Activity and Nutrition, Melbourne, Australia
| | - S Fraser
- Deakin University, Institute of Physical Activity and Nutrition, Melbourne, Australia
| | - E J Howden
- Baker IDI Heart and Diabetes Institute, Sports Cardiology, Melbourne, Australia
| | - A Bigran
- Baker IDI Heart and Diabetes Institute, Sports Cardiology, Melbourne, Australia
| | - S Selig
- Deakin University, Institute of Physical Activity and Nutrition, Melbourne, Australia
| | - R Daly
- Deakin University, Institute of Physical Activity and Nutrition, Melbourne, Australia
| | - K Janssens
- Baker IDI Heart and Diabetes Institute, Sports Cardiology, Melbourne, Australia
| | - Y Antill
- Cabrini Hospital, Medical Oncology, Melbourne, Australia
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A La Gerche
- Baker IDI Heart and Diabetes Institute, Sports Cardiology, Melbourne, Australia
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Foulkes SJ, Daly RM, Fraser SF. The clinical importance of quantifying body fat distribution during androgen deprivation therapy for prostate cancer. Endocr Relat Cancer 2017; 24:R35-R48. [PMID: 28062546 DOI: 10.1530/erc-16-0505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 01/06/2017] [Indexed: 12/13/2022]
Abstract
Androgen deprivation therapy (ADT) is now considered a mainstay in the treatment of metastatic and locally advanced prostate cancer (PCa). Despite well-established benefits of ADT in relation to overall survival, this treatment has been associated with a number of adverse effects, particularly with regard to key cardiometabolic risk factors including the development of insulin resistance, dyslipidemia and increases in total and regional fat mass. In non-ADT populations, increased levels of visceral adipose tissue (VAT) are thought to be a key mediator of the increased cardiometabolic risk associated with weight gain, but this has received limited attention in men treated with ADT. VAT is best assessed using tools such as computed tomography or magnetic resonance imaging; however, these tools are not readily accessible for the majority of researchers or clinicians. Recent advances allow for a method of estimating VAT using a whole-body dual-energy X-ray absorptiometry (DXA) scan that shows promise as a practical tool for researchers to evaluate changes in body fat distribution during ADT. The aim of this narrative review is to (1) review the available evidence with regard to the relationship between ADT and cardiometabolic risk; (2) discuss the role of body fat distribution on cardiometabolic risk in non-ADT populations, with a particular emphasis on the importance of visceral adiposity; (3) examine the potential influence of ADT on body fat distribution and visceral adiposity and (4) provide an overview of current tools used to measure changes in body fat distribution in men treated with ADT, highlighting the potential utility of a recently developed DXA-derived measure of VAT.
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Affiliation(s)
- Stephen J Foulkes
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Robin M Daly
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Steve F Fraser
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Abstract
Faeces or rectal swabs from 1527 subjects were examined for the presence of intestinal spirochaetes by anaerobic culture on blood agar incorporating spectinomycin (400 mg/l). Twenty three specimens (1.5%) were positive, and only one of these came from a patient with diarrhoea. All positive specimens came from either Asians or known homosexuals. Comparative tests showed a close phenotypic similarity between the human isolates and non-pathogenic porcine intestinal spirochaetes. These organisms differ from Brachyspira aalborgi, a spirochaete isolated from subjects with histologically confirmed intestinal spirochaetosis.
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Swann RA, Foulkes SJ, Holmes B, Young JB, Mitchell RG, Reeders ST. "Agrobacterium yellow group" and Pseudomonas paucimobilis causing peritonitis in patients receiving continuous ambulatory peritoneal dialysis. J Clin Pathol 1985; 38:1293-9. [PMID: 4066989 PMCID: PMC499430 DOI: 10.1136/jcp.38.11.1293] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Five cases of peritonitis occurred during continuous ambulatory peritoneal dialysis in which unusual yellow pigmented Gram negative bacteria were isolated in pure culture. Four of these isolates were identified as the so called "Agrobacterium yellow group." The remaining isolate was identified as Pseudomonas paucimobilis, an organism closely related to the Agrobacterium yellow group.
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Foulkes SJ, Deighton R, Feeney AR, Mohanty KC, Freeman CW. Comparison of direct immunofluorescence and cell culture for detecting Chlamydia trachomatis. Genitourin Med 1985; 61:255-7. [PMID: 3894214 PMCID: PMC1011824 DOI: 10.1136/sti.61.4.255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Conventional cell culture methods were compared with a direct immunofluorescence test (MicroTrak, Syva UK, Maidenhead, Berkshire) to detect Chlamydia trachomatis in 137 patients (126 women, 11 men) attending a sexually transmitted diseases (STD) clinic. Results obtained by the two tests agreed in 87.6% of cases. Of 34 positive specimens, 17 were detected by culture and fluorescence, 15 by fluorescence only, and two by culture only. The excess of specimens that were negative on culture but positive on fluorescence might be accounted for by delays in culture (up to 18 hours). The MicroTrak test appears to be of value in peripheral hospitals that have to rely on transporting specimens to larger centres for culture.
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Young JB, Ahmed-Jushuf IH, Brownjohn AM, Parsons FM, Foulkes SJ, Evans EG. Opportunistic peritonitis in continuous ambulatory peritoneal dialysis. Clin Nephrol 1984; 22:268-9. [PMID: 6518678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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