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Monti R, Mariani F, Mastricci R, Nifosì FM, Palmieri V, Manes Gravina E, Capriati M, Rendeli C. Spina bifida and cardiorespiratory profile: the impact of leisure sport activities on physical fitness. Childs Nerv Syst 2024; 40:205-211. [PMID: 37688616 PMCID: PMC10761380 DOI: 10.1007/s00381-023-06152-3] [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: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE The aim of the present study is to evaluate a population of young patients affected by Spina Bifida (SB) to describe their cardiorespiratory function and bone mineral density profile, analyzing any differences between people performing and those who do not perform sports activity. The study also aimed to rule out possible congenital heart disease associated with spina bifida, considering the common origin of certain cardiac structures with those found to be altered in SB patients. METHODS Thirty-four young patients, aged between 12 and 22 years, diagnosed with spinal dysraphism (SD), have been clinically described and, in order to evaluate their physical fitness, functional capacity and bone mass, almost all of them underwent a complete cardiorespiratory assessment, including electrocardiogram (ECG), echocardiogram, Cardiopulmonary Exercise Test (CPET), body composition analysis using bioimpedance analysis (BIA) and Dual Energy X-ray Absorptiometry (DEXA), as well as the estimation of bone mineral density (BMD) with Computerized Bone Mineralometry (CBM). RESULTS Collected data demonstrated that only 35% of the subjects practiced physical activity during the week. BMI and percentage FM values were pathological in at least 50% of the population. On cardiological investigations (ECG and echocardiogram), no significant alterations were found. In all patients who performed CPET (79.4%), pathological values of the main functional capacity parameters were revealed, especially peak oxygen consumption (VO2 peak), even when corrected for BCM or FFM estimated at BIA and DEXA, respectively. In the CBM analysis, out of 27 patients in whom the femoral T-score was evaluated, a condition of osteopenia was revealed in 40.7% of the patients (11/27) and osteoporosis in 18.5% (5/27); out of 27 patients in whom the lumbar T-score was evaluated, 37% of the patients showed osteopenia (10/27) and 29.6% osteoporosis (8/27). When the comparison between exercising and non-exercising patients was performed, the only statistically significant difference that emerged was the median lumbar T-score value, which appeared lower in the group not performing physical activity (p = 0,009). CONCLUSIONS The extensive cardiorespiratory evaluation, including CPET, of our cohort of spina bifida patients showed altered values of the main parameters related to cardiorespiratory fitness and is the only study in the literature that analysed bone mineralization values in physically active and sedentary spina bifida patients and demonstrated a statistically significant difference. Furthermore, it is the only study to date that investigated the possible association of congenital heart diseases with SD, without demonstrating the existence of pathological conditions.
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Affiliation(s)
- Riccardo Monti
- Sports Medicine and Functional Re-Education Centre, Department of Ageing, Orthopaedic and Rheumatological Sciences, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy.
| | - Francesco Mariani
- Department of Women's and Children's Health Sciences and Public Health, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Rosanna Mastricci
- Department of Women's and Children's Health Sciences and Public Health, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Francesco Maria Nifosì
- Sports Medicine and Functional Re-Education Centre, Department of Ageing, Orthopaedic and Rheumatological Sciences, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine and Functional Re-Education Centre, Department of Ageing, Orthopaedic and Rheumatological Sciences, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Ester Manes Gravina
- Cognitive-Functional Unit, Department of Ageing, Orthopaedic and Rheumatological Sciences, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Margherita Capriati
- Spina Bifida and Malformative Uropathies Centre, Department of Women's and Children's Health Sciences and Public Health, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
| | - Claudia Rendeli
- Spina Bifida and Malformative Uropathies Centre, Department of Women's and Children's Health Sciences and Public Health, "Agostino Gemelli" University Polyclinic Foundation - IRCCS, Rome, Italy
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Dos Santos Ribeiro G, Beltrame T, Fernando Deresz L, Hansen D, Agostoni P, Karsten M. Software development to standardize the clinical diagnosis of exercise oscillatory ventilation in heart failure. J Clin Monit Comput 2023; 37:1247-1253. [PMID: 36735189 DOI: 10.1007/s10877-023-00976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Exercise oscillatory ventilation (EOV) is characterized by periodic oscillations of minute ventilation during cardiopulmonary exercise testing (CPET). Despite its prognostic value in chronic heart failure (HF), its diagnosis is complex due to technical limitations. An easier and more accurate way of EOV identification can contribute to a better approach and clinical diagnosis. This study aims to describe a software development to standardize the EOV diagnosis from CPET's raw data in heart failure patients and test its reliability (intra- and inter-rater). METHODS The software was developed in the "drag-and-drop" G-language using LabVIEW®. Five EOV definitions (Ben-Dov, Corrà, Kremser, Leite, and Sun definitions), two alternative approaches, one smoothing technique, and some basic statistics were incorporated into the interface to visualize four charts of the ventilatory response. EOV identification was based on a set of criteria verified from the interaction between amplitude, cycle length, and oscillation time. Two raters analyzed the datasets. In addition, repeated measurements were verified after six months using about 25% of the initial data. Cohen's kappa coefficient (κ) was used to investigate the reliability. RESULTS Overall, 391 tests were analyzed in duplicate (inter-rater reliability) and 100 tests were randomized for new analysis (intra-rater reliability). High inter-rater (κ > 0.80) and intra-rater (κ > 0.80) reliability of the five EOV diagnoses were observed. CONCLUSION The present study proposes novel semi-automated software to detect EOV in HF, with high inter and intra-rater agreements. The software project and its tutorial are freely available for download.
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Affiliation(s)
- Gustavo Dos Santos Ribeiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Thomas Beltrame
- Samsung R&D Institute Brazil - SRBR, Universidade Federal de São Carlos (UFSCAR), Campinas, SP, Brazil
| | - Luís Fernando Deresz
- Departamento de Educação Física, Universidade Federal de Juiz de Fora (UFJF), Governador Valadares, MG, Brazil
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences, Hasselt University (UHASSELT), BIOMED/REVAL, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences of Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Marlus Karsten
- Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
- Departamento de Fisioterapia, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
- Programa de Pós-Graduação em Fisioterapia, UDESC, Florianópolis, SC, Brazil
- Centro de Ciências da Saúde e do Esporte, UDESC, Rua Pascoal Simone 358, CEP 88080-350, Florianópolis, SC, Brazil
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Stussman B, Calco B, Norato G, Gavin A, Chigurupati S, Nath A, Walitt B. A Mixed Methods System for the Assessment of Post Exertional Malaise in Encephalomyelitis/Chronic Fatigue Syndrome. medRxiv 2023:2023.04.24.23288821. [PMID: 37205352 PMCID: PMC10187342 DOI: 10.1101/2023.04.24.23288821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background A central feature of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is post exertional malaise (PEM), which is an acute worsening of symptoms after a physical, emotional and/or mental exertion. PEM is also a feature of Long COVID. Dynamic measures of PEM have historically included scaled questionnaires which have not been validated in ME/CFS. To enhance our understanding of PEM and how best to measure it, we conducted semi-structured qualitative interviews (QIs) at the same intervals as Visual Analog Scale (VAS) measures after a Cardiopulmonary Exercise Test (CPET). Methods Ten ME/CFS and nine healthy volunteers participated in a CPET. For each participant, PEM symptom VAS (7 symptoms) and semi-structured QIs were administered at six timepoints over 72 hours before and after a single CPET. QI data were used to plot the severity of PEM at each time point and identify the self-described most bothersome symptom for each patient. QI data were used to determine the symptom trajectory and peak of PEM. Performance of QI and VAS data were compared to each other using Spearman correlations. Results QIs documented that each ME/CFS volunteer had a unique PEM experience, with differences noted in the onset, severity, trajectory over time, and most bothersome symptom. No healthy volunteers experienced PEM. Scaled QI data were able to identify PEM peaks and trajectories, even when VAS scales were unable to do so due to known ceiling and floor effects. QI and VAS fatigue data corresponded well prior to exercise (baseline, r=0.7) but poorly at peak PEM (r=0.28) and with the change from baseline to peak (r=0.20). When the most bothersome symptom identified from QIs was used, these correlations improved (r=.0.77, 0.42. and 0.54 respectively) and reduced the observed VAS scale ceiling and floor effects. Conclusion QIs were able to capture changes in PEM severity and symptom quality over time in all the ME/CFS volunteers, even when VAS scales failed to do so. Information collected from QIs also improved the performance of VAS. Measurement of PEM can be improved by using a quantitative-qualitative mixed model approach.
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Affiliation(s)
- Barbara Stussman
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Brice Calco
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Gina Norato
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Angelique Gavin
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Snigdha Chigurupati
- George Washington School of Medicine and Health Sciences, Washington D.C., United States
| | - Avindra Nath
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Brian Walitt
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, United States
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Hortegal RA, Hossri C, Giolo L, Cancellier R, Gun C, Assef J, Moriya HT, Franchini KG, Feres F, Meneghelo R. Mechanical dispersion is a superior echocardiographic feature to predict exercise capacity in preclinical and overt heart failure with preserved ejection fraction. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-02830-0. [PMID: 36997835 DOI: 10.1007/s10554-023-02830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Heart Failure with Preserved Ejection Fraction (HFpEF) is a syndrome characterized by different degrees of exercise intolerance, which leads to poor quality of life and prognosis. Recently, the European score (HFA-PEFF) was proposed to standardize the diagnosis of HFpEF. Even though Global Longitudinal Strain (GLS) is a component of HFA-PEFF, the role of other strain parameters, such as Mechanical Dispersion (MD), has yet to be studied. In this study, we aimed to compare MD and other features from the HFA-PEFF according to their association with exercise capacity in an outpatient population of subjects at risk or suspected HFpEF. METHODS This is a single-center cross-sectional study performed in an outpatient population of 144 subjects with a median age of 57 years, 58% females, referred to the Echocardiography and Cardiopulmonary Exercise Test to investigate HFpEF. RESULTS MD had a higher correlation to Peak VO2 (r=-0.43) when compared to GLS (r=-0.26), MD presented a significant correlation to Ventilatory Anaerobic Threshold (VAT) (r=-0.20; p = 0.04), while GLS showed no correlation (r=-0.14; p = 0.15). Neither MD nor GLS showed a correlation with the time to recover VO2 after exercise (T1/2). In Receiver Operator Characteristic (ROC) analysis, MD presented superior performance to GLS to predict Peak VO2 (AUC: 0.77 vs. 0.62), VAT (AUC: 0.61 vs. 0.57), and T1/2 (AUC: 0.64 vs. 0.57). Adding MD to HFA-PEFF improved the model performance (AUC from 0.77 to 0.81). CONCLUSION MD presented a higher association with Peak VO2 when compared to GLS and most features from the HFA-PEFF. Adding MD to the HFA-PEFF improved the model performance.
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Affiliation(s)
- Renato A Hortegal
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil.
| | - Carlos Hossri
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Luiz Giolo
- Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
| | - Renato Cancellier
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Carlos Gun
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Jorge Assef
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Henrique T Moriya
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
- Biomedical Engineering Laboratory, University of Sao Paulo, São Paulo, Brazil
| | - Kleber G Franchini
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
- Brazilian National Laboratory for Biosciences, Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, São Paulo, Brazil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Romeu Meneghelo
- Instituto Dante Pazzanese de Cardiologia, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
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van Voorthuizen EL, van Helvoort HAC, Peters JB, van den Heuvel MM, van den Borst B. Persistent Exertional Dyspnea and Perceived Exercise Intolerance After Mild COVID-19: A Critical Role for Breathing Dysregulation? Phys Ther 2022; 102:6651031. [PMID: 35900016 PMCID: PMC9384552 DOI: 10.1093/ptj/pzac105] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/19/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE After mild COVID-19, a subgroup of patients reported post-acute-phase sequelae of COVID-19 (PASC) in which exertional dyspnea and perceived exercise intolerance were common. Underlying pathophysiological mechanisms remain incompletely understood. The purpose of this study was to examine outcomes from cardiopulmonary exercise testing (CPET) in these patients. METHODS In this observational study, participants were patients who were referred for the analysis of PASC after mild COVID-19 and in whom CPET was performed after standard clinical workup turned out unremarkable. Cardiocirculatory, ventilatory, and metabolic responses to and breathing patterns during exercise at physiological limits were analyzed. RESULTS Twenty-one patients (76% women; mean age = 40 years) who reported severe disability in physical functioning underwent CPET at 32 weeks (interquartile range = 22-52) after COVID-19. Mean peak O2 uptake was 99% of predicted with normal anaerobic thresholds. No cardiovascular or gas exchange abnormalities were detected. Twenty of the 21 patients (95%) demonstrated breathing dysregulation (ventilatory inefficiency [29%], abnormal course of breathing frequency and tidal volume [57%], absent increase of end-tidal Pco2 [57%], and abnormal resting blood gases [67%]). CONCLUSION Breathing dysregulation may explain exertional dyspnea and perceived exercise intolerance in patients with PASC after mild COVID-19 and can be present in the absence of deconditioning. This finding warrants further study on the levels of neural control of breathing and muscle function, and simultaneously provides a potential treatment opportunity. IMPACT This study contributes to the understanding of persistent exertional dyspnea and perceived exercise intolerance following mild COVID-19, which is vital for the development of effective rehabilitation strategies.
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Affiliation(s)
| | | | - Jeanette B Peters
- Department of Pulmonary Diseases, Radboud University Medical Center Nijmegen, the Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center Nijmegen, the Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center Nijmegen, the Netherlands
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Jeong D, Oh YM, Lee SW, Lee SD, Lee JS. Comparison of Predicted Exercise Capacity Equations in Adult Korean Subjects. J Korean Med Sci 2022; 37:e113. [PMID: 35411731 PMCID: PMC9001184 DOI: 10.3346/jkms.2022.37.e113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Maximal oxygen uptake (VO₂ max) is a useful index to assess exercise capacity. However, there is no reference value for Koreans. This study aimed to compare actual VO₂ max and predicted VO₂ max using exercise capacity equations in Korean subjects. METHODS This retrospective study enrolled 383 patients who underwent cardiopulmonary exercise test (CPET) with incremental maximal cycle ergometer test at Asan Medical Center from January 2020 to May 2021. Stage 1 and 2 lung cancer patients with normal lung function and healthy persons of 50 subjects who had maximal CPET were analyzed. RESULTS The subjects were aged 65 ± 13 years and predominantly male (74%). CPET results were as follows: absolute VO₂ max, 1.2 ± 0.3 L/min; body weight referenced VO₂ max, 20 ± 3.9 mL/kg/min; peak work rate, 94 ± 24 watts; peak heart rate, 142 ± 21 bpm; peak O2 pulse, 10 ± 3 mL/beat; minute ventilation, 59 ± 14 L/min; peak respiratory rate, 34 ± 6 breaths per minute; and peak breathing reserve, 41 ± 18%. There was significant discordance between the measured and predicted absolute VO₂ max using the Jones, Hansen, and Wasserman prediction equations developed for Caucasian population (P < 0.001). Agreement using Bland-Altman test between true and predicted absolute VO₂ max was the best in Chinese equation (-0.03, 2SD = 0.55) compared to Jones (0.42, 2SD = 1.07), Hansen (0.44, 2SD = 0.86), and Wasserman (0.42, 2SD = 0.86) equations. CONCLUSION The reference value and prediction equation from studies including primarily Caucasians may not be appropriate for Koreans. Since the mean difference is the lowest in Chinese equation, the Chinese equation might be used for the Korean adult population.
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Affiliation(s)
- Daehyun Jeong
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Won Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Do Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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West M, Bates A, Grimmett C, Allen C, Green R, Hawkins L, Moyses H, Leggett S, Z H Levett D, Rickard S, Varkonyi-Sepp J, Williams F, Wootton S, Hayes M, P W Grocott M, Jack S. The Wessex Fit-4-Cancer Surgery Trial (WesFit): a protocol for a factorial-design, pragmatic randomised-controlled trial investigating the effects of a multi-modal prehabilitation programme in patients undergoing elective major intra-cavity cancer surgery. F1000Res 2021; 10:952. [PMID: 36247802 PMCID: PMC9490280 DOI: 10.12688/f1000research.55324.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 07/20/2022] [Indexed: 07/21/2023] Open
Abstract
Background: Surgical resection remains the primary curative treatment for intra-cavity cancer. Low physical fitness and psychological factors such as depression are predictive of post-operative morbidity, mortality and length of hospital stay. Prolonged post-operative morbidity is associated with persistently elevated risk of premature death. We aim to investigate whether a structured, responsive exercise training programme, a psychological support programme or combined exercise and psychological support, delivered between treatment decision and major intra-cavity surgery for cancer, can reduce length of hospital stay, compared with standard care. Methods: WesFit is a pragmatic , 2x2 factorial-design, multi-centre, randomised-controlled trial, with planned recruitment of N=1560. Participants will be randomised to one of four groups. Group 1 (control) will receive usual pre-operative care, Group 2 (exercise) patients will undergo 2/3 aerobic, high-intensity interval training sessions per week supervised by personal trainers. Group 3 (psychological support) patients are offered 1 session per week at a local cancer support centre. Group 4 will receive both exercise and psychological support. All patients undergo baseline and pre-operative cardiopulmonary exercise testing, complete self-report questionnaires and will be followed up at 30 days, 12 weeks and 12 months post-operatively. Primary outcome is post-operative length-of-stay. Secondary outcomes include disability-adjusted survival at 1-year postoperatively, post-operative morbidity, and health-related quality of life. Exploratory investigations include objectively measured changes in physical fitness assessed by cardiopulmonary exercise test, disease-free and overall mortality at 1-year postoperatively, longer-term physical activity behaviour change, pre-operative radiological tumour regression, pathological tumour regression, pre and post-operative body composition analysis, health economics analysis and nutritional characterisation and its relationship to post-operative outcome. Conclusions: The WesFit trial will be a randomised controlled study investigating whether a high-intensity exercise training programme +/- psychological intervention results in improvements in clinical and patient reported outcomes in patients undergoing major inter-cavity resection of cancer. ClinicalTrials.gov registration: NCT03509428 (26/04/2018).
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Affiliation(s)
- Malcolm West
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Andrew Bates
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, SO22 1BJ, UK
| | - Cait Allen
- Wessex Cancer Trust, Registered charity 1110216, Chandlers Ford, SO53 2GG, UK
| | - Richard Green
- Anaesthetic Department (Royal Bournemouth Site), University Hospitals Dorset, Bournmouth, BH77DW, UK
| | - Lesley Hawkins
- Critical Care/Anaesthesia and Perioperative Medicine Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Helen Moyses
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Samantha Leggett
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Denny Z H Levett
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Sally Rickard
- Wessex Cancer Alliance, Oakley Road, Southampton, SO16 4GX, UK
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Fran Williams
- Wessex Cancer Alliance, Oakley Road, Southampton, SO16 4GX, UK
| | - Stephen Wootton
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Matthew Hayes
- Wessex Cancer Alliance, Oakley Road, Southampton, SO16 4GX, UK
| | - Micheal P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Sandy Jack
- School of Clinical and Experimental Science, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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8
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De Lorenzo A, da Silva CL, Souza FCC, Serra S, Marino P, Sl Lima R. Clinical, scintigraphic, and angiographic predictors of oxygen pulse abnormality in patients undergoing cardiopulmonary exercise testing. Clin Cardiol 2017; 40:914-918. [PMID: 28679027 DOI: 10.1002/clc.22747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/25/2017] [Accepted: 05/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The oxygen (O2 ) pulse curve obtained at cardiopulmonary exercise testing provides information on cardiorespiratory fitness and the presence of cardiovascular disease. O2 pulse abnormalities have been attributed to myocardial ischemia, among other conditions, but the predictors of abnormal O2 pulse curves are not completely known. HYPOTHESIS Perfusion abnormalities detected by myocardial perfusion scintigraphy (MPS) may be associated with abnormal O2 pulse curves. METHODS Forty patients with normal left ventricular function underwent cardiopulmonary exercise testing with radiotracer injection at peak exercise, followed by MPS. The O2 pulse curves were classified as (A) normal; (B) probably normal (normal slope with lower peak value); (C) probably abnormal (flat, with low peak value); or (D) definitely abnormal (descending slope), and analyzed as A/B vs C/D. Coronary artery disease (CAD) was defined as >50% stenosis. MPS perfusion scores were calculated (summed rest score [SRS], indicating myocardial fibrosis; summed difference score, indicating ischemia). RESULTS Comparing patients with A/B vs C/D curves, the latter were more frequently female and had higher SRS. The prevalence of ischemic MPS, of any CAD, or multivessel CAD was not significantly different among patients with A/B or C/D curve patterns. On logistic regression, female sex, body mass index, and the SRS were significantly associated with C/D curves. CONCLUSIONS Female sex, increasing body mass index, and myocardial fibrosis were significant predictors of abnormal O2 pulse curves. Myocardial ischemia and the presence and extent of CAD were not associated with the abnormal patterns of the O2 pulse curve.
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Affiliation(s)
- Andrea De Lorenzo
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
| | - Carlito Lessa da Silva
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
| | - Fernando Cesar Castro Souza
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
| | - Salvador Serra
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
| | - Pablo Marino
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
| | - Ronaldo Sl Lima
- Federal University of Rio de Janeiro, National Institute of Cardiology, Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, Brazil
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Bonadei I, Sciatti E, Vizzardi E, Berlendis M, Bozzola G, Metra M. Coronary Artery Disease and High Altitude: Unresolved Issues. Res Cardiovasc Med 2016; 5:e32645. [PMID: 27800458 PMCID: PMC5075388 DOI: 10.5812/cardiovascmed.32645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/05/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ivano Bonadei
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Edoardo Sciatti
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Corresponding author: Edoardo Sciatti, Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39-0303995536, Fax: +39-0303995013, E-mail:
| | - Enrico Vizzardi
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marialma Berlendis
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Pneumology Unit, Cardio-Thoracic Department, Spedali Civili od Brescia, Brescia, Italy
| | - Giordano Bozzola
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Pneumology Unit, Cardio-Thoracic Department, Spedali Civili od Brescia, Brescia, Italy
| | - Marco Metra
- Section of Cardiovascular Disease, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Samos F, Fuenmayor G, Hossri C, Elias P, Ponce L, Souza R, Jatene I. Exercise Capacity Long-Term after Arterial Switch Operation for Transposition of the Great Arteries. CONGENIT HEART DIS 2015; 11:155-9. [PMID: 26556777 DOI: 10.1111/chd.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/30/2022]
Abstract
UNLABELLED Transposition of the great arteries (TGA) is a congenital heart defect successfully corrected through arterial switch operation (ASO). Although this technique had significant impact in improving survival, little is known about the functional capacity of the operated patients long-term after surgery. OBJECTIVE The aim of this study was to compare the functional capacity of children with TGA long-term after ASO with that of healthy children. DESIGN Retrospective study. PATIENTS All patients that performed cardiopulmonary exercise test (CPET) were included in the study. As a control group, healthy children in evaluation for physical activity that performed CPET during the same period were also enrolled. RESULTS Thirty-one TGA patients (19 male) were compared with 29 age-matched controls (21 male). Maximum oxygen consumption was higher in the control group (45.47 ± 8.05 vs. 40.52 ± 7.19, P = .017), although within normal limits in both groups (above 90% of predicted value). The heart rate behavior during exercise was different in both groups, with a mean chronotropic index significantly lower in the TGA group (63% ± 14 vs. 81% ± 12, P < .001). CONCLUSIONS Our results showed that exercise capacity long-term after ASO in TGA is well preserved although lower than in healthy children what might be explained by the presence of chronotropic incompetence in the TGA group.
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Affiliation(s)
- Flávia Samos
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil
| | | | - Carlos Hossri
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil
| | - Patrícia Elias
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil
| | - Leandro Ponce
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil
| | - Rogério Souza
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil.,Pulmonary Department, Heart Institute, University of Sao Paulo Medical School
| | - Ieda Jatene
- Heart Hospital, Sirio Sanatorium Association, São Paulo, Brazil
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