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Pubblicazioni recenti - cardiopulmonary exercise
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Veterans with Gulf War Illness exhibit distinct respiratory patterns during maximal cardiopulmonary exercise.
PLoS One2019 ;14(11):e0224833. doi: 10.1371/journal.pone.0224833.
Lindheimer Jacob B, Cook Dane B, Klein-Adams Jacquelyn C, Qian Wei, Hill Helene Z, Lange Gudrun, Ndirangu Duncan S, Wylie Glenn R, Falvo Michael J,
Abstract
INTRODUCTION:
The components of minute ventilation, respiratory frequency and tidal volume, appear differentially regulated and thereby afford unique insight into the ventilatory response to exercise. However, respiratory frequency and tidal volume are infrequently reported, and have not previously been considered among military veterans with Gulf War Illness. Our purpose was to evaluate respiratory frequency and tidal volume in response to a maximal cardiopulmonary exercise test in individuals with and without Gulf War Illness.
MATERIALS AND METHODS:
20 cases with Gulf War Illness and 14 controls participated in this study and performed maximal cardiopulmonary exercise test on a cycle ergometer. Ventilatory variables (minute ventilation, respiratory frequency and tidal volume) were obtained and normalized to peak exercise capacity. Using mixed-design analysis of variance models, with group and time as factors, we analyzed exercise ventilatory patterns for the entire sample and for 11 subjects from each group matched for race, age, sex, and height.
RESULTS:
Despite similar minute ventilation (p = 0.57, ?2p = 0.01), tidal volume was greater (p = 0.02, ?2p = 0.16) and respiratory frequency was lower (p = 0.004, ?2p = 0.24) in Veterans with Gulf War Illness than controls. The findings for respiratory frequency remained significant in the matched subgroup (p = 0.004, ?2p = 0.35).
CONCLUSION:
In our sample, veterans with Gulf War Illness adopt a unique exercise ventilatory pattern characterized by reduced respiratory frequency, despite similar ventilation relative to controls. Although the mechanism(s) by which this pattern is achieved remains unresolved, our findings suggest that the components of ventilation should be considered when evaluating clinical conditions with unexplained exertional symptoms.
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Pedometer Feedback Interventions Increase Daily Physical Activity in Phase III Cardiac Rehabilitation Participants.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000472.
Ozemek Cemal, Strath Scott J, Riggin Katrina, Harber Matthew P, Imboden Mary T, Kaminsky Leonard A,
Abstract
PURPOSE:
To determine the effects of individually tailored interventions designed to increase physical activity (PA) in cardiac patients.
METHODS:
A total of 99 (77 men and 22 women, 61.5 ± 10.7 yr) patients entering a phase III cardiac rehabilitation program completed a 12-wk PA intervention. Patients were randomized to usual care (UC, time-based recommendation), pedometer feedback (PF), newsletter-based motivational messaging (MM), or PF + MM. Both PF groups were given a goal of increasing steps/d by 10% of individual baseline value each week. If the goal for the week was not reached, the same goal was used for the next week. Physical activity was assessed for 7 d before beginning and after completing the program. The change in steps/d, moderate to vigorous intensity PA minutes, and sedentary time were compared among intervention groups.
RESULTS:
Average change in steps/d was found to be significantly greater (P < .01) in the PF (2957 ± 3185) and the PF + MM (3150 ± 3007) compared with UC (264 ± 2065) and MM (718 ± 2415) groups. No group experienced changes in moderate to vigorous intensity PA time and only the PF intervention group decreased sedentary time (baseline 470.2 ± 77.1 to postintervention 447.8 ± 74.9 min/d, P = .01).
CONCLUSION:
The findings from this study demonstrate that using PF was superior to the usual time-based PA recommendations and to newsletter-based MM in patients starting a phase III CR program. Cardiac rehabilitation programs are encouraged to implement PA feedback with individualized PA goals in order to support the increase in PA.
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Type 2 Diabetes Mellitus, Glycated Hemoglobin Levels, and Cardiopulmonary Exercise Capacity in Patients With Ischemic Heart Disease.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000451.
Uribe-Heredia Giovanna, Arroyo-Espliguero Ramón, Viana-Llamas María Carmen, Piccone-Saponara Luis Guillermo, Álvaro-Fernández Henar, García-Magallón Belén, Torán-Martínez Claudio, Silva-Obregón Alberto, Izquierdo-Alonso José Luis,
Abstract
PURPOSE:
Diabetes mellitus (DM) is associated with long-term cardiovascular complications, including ischemic heart disease (IHD). Nonetheless, DM may directly impair myocardial and lung structure and function. The aim of this study was to assess the impact of type 2 DM (T2DM) and glycemic control on cardiopulmonary exercise capacity in patients with IHD.
METHODS:
The study involved a cross-sectional analysis of 91 consecutive patients (57 ± 10 yr, 90% men) who underwent a cardiopulmonary exercise test at the beginning of an exercise-based standard phase-II cardiac rehabilitation program, 2 to 3 mo after an acute coronary syndrome. Association of T2DM with cardiopulmonary exercise test parameters was assessed using multiple linear regression analysis controlling for prespecified potential confounders.
RESULTS:
There were 26 (29%) diabetic subjects among IHD patients included in the study. After adjustment, T2DM was an independent predictor of a reduced peak oxygen uptake (VO2peak) (P = .005), a reduced pulse O2 trajectory (P = .001), a steeper minute ventilation to carbon dioxide output (VE/VCO2) slope (P = .046), and an increased dead space-to-tidal volume ratio (VD/VT) at peak exercise (P = .049). Glycated hemoglobin (HbA1c) levels were significantly associated with a reduced forced expiratory volume in the first second of expiration (FEV1) (P = .013), VE (P = .001), and VT (P = .007). VO2peak (P trend < .001), VO2 at anaerobic threshold (P trend < .001), and pulse O2 trajectory (P trend < .001) decreased among HbA1c tertiles.
CONCLUSIONS:
Patients with IHD and a previous diagnosis of T2DM had a reduced aerobic capacity and a ventilation-perfusion mismatch compared with nondiabetic patients. Poor glycemic control in men further deteriorates aerobic capacity probably due to ventilatory inefficiency.
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Diagnostic Validity of Cardiopulmonary Exercise Testing for Screening Pulmonary Hypertension in Patients With Chronic Obstructive Pulmonary Disease.
J Cardiopulm Rehabil Prev2019 Nov;():. doi: 10.1097/HCR.0000000000000456.
Kader Mohamed Nabhan, Moiz Jamal Ali, Bhati Pooja, Ali Mir Shad, Talwar Deepak,
Abstract
PURPOSE:
To determine diagnostic validity of cardiopulmonary exercise testing (CPX) parameters for detecting pulmonary hypertension (PH) in patients with chronic obstructive pulmonary disease (COPD) and to investigate association between CPX parameters and indices of PH.
METHODS:
This cross-sectional study enrolled 48 moderate to very severe COPD patients in whom PH was confirmed by echocardiography. Symptom-limited CPX was performed using an incremental exercise protocol. Relevant CPX parameters were derived and were tested for their diagnostic ability for diagnosing PH. Logistic regression was applied to examine the effect of various clinical covariates on the diagnostic ability of exercise test variables for detecting PH.
RESULTS:
Of the 48 patients, 29 were diagnosed with PH and 19 were negative for PH based on echocardiographic testing. CPX measures including peak oxygen uptake (% predicted VO2peak, VO2peak [mL/min], VO2/kg), oxygen pulse (VO2/HR % predicted, VO2/HR mL/beat), and peak minute ventilation (VEpeak [L/m]) were inversely correlated with mean pulmonary arterial pressure (mPAP). Peak VO2/HR and VO2peak were found to be significant predictors of PH in univariate analysis. VO2peak (%), VO2/HR (mL/beat), and desaturation (%) were identified as independent predictors of PH adjusted for age, forced expiratory volume in 1 sec (%), and forced vital capacity (L).
CONCLUSION:
The present study validates the use of CPX parameters such as VO2peak and VO2/HR as a diagnostic tool for correctly identifying PH in COPD patients. Therefore, CPX may be used as an adjunct to echocardiographic measurement of PH where there is unavailability of equipment and expertise.
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Knowledge of cardiopulmonary resuscitation among Greek physiotherapists.
Monaldi Arch Chest Dis2019 Nov;89(3):. doi: 10.4081/monaldi.2019.1124.
Pepera Garyfallia, Xanthos ?fstratios, Lilios Andreas, Xanthos Theodoros,
Abstract
High quality cardiopulmonary resuscitation (CPR) is crucial for influencing survival from cardiac arrest. Healthcare professionals are expected to know how to perform CPR as they may encounter emergency situations during their work. Physiotherapists, who use exercise as a therapeutic approach, should have good knowledge and skills in CPR not only to cope with possible adverse cardiac events during exercise but also because a widespread CPR application and early defibrillation can greatly reduce mortality due to heart attack. The aim of this study is to investigate knowledge of Greek physiotherapists in European Resuscitation Council guidelines for resuscitation. A secondary aim of this study was to assess and compare the knowledge score between those with and without previous training and/or lower self-confidence in CPR skills. Three hundred and fifty Greek physiotherapists who were working in hospitals and rehabilitation centres (face-to-face and e-mail contact) were randomly selected to complete an anonymous questionnaire containing demographic questions, CPR experience questions, and ten theoretical knowledge questions, based on European Resuscitation Council guidelines for resuscitation. The response ratio was 63% (n=220 physiotherapists). Respondents' total mean score for the theoretic knowledge questions was 4.1±2 (range 1-10); 21.4% of the respondents had participated in a CPR course, while only 0.9% had previous experience in CPR performance. The group of respondents who had attended a CPR course had a significantly higher score in CPR knowledge questions and higher confidence score (p<0.01). Moreover, the physiotherapists who attended refresher courses in CPR in the workplace scored significantly higher (p<0.01). Our results indicate that Greek physiotherapists have knowledge gaps in the European Resuscitation Council guidelines for resuscitation. The percentage of Greek physiotherapists who had CPR certification and recertification was low, thus the CPR training should be mandatory for all working physiotherapists.
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HFPEF Score for the Prediction of Exercise Intolerance and Abnormal Hemodynamics in Japanese?- Evaluation by Exercise Stress Echocardiography Combined With Cardiopulmonary Exercise Testing.
Circ J2019 Nov;():. doi: 10.1253/circj.CJ-19-0699.
Takahari Kosuke, Hidaka Takayuki, Ueda Yusuke, Izumi Kanako, Harada Yu, Susawa Hitoshi, Kinoshita Mirai, Itakura Kiho, Utsunomiya Hiroto, Kihara Yasuki,
Abstract
BACKGROUND:
Both the HFPEF-score and nomogram-score, which consist of simple clinical parameters, can assist in diagnosing "early" heart failure with preserved ejection fraction (HFpEF) and only exertional dyspnea, but their these usefulness in Japanese remains unclear. We sought to investigate the correlation between these scores and exercise response, including the peak oxygen uptake (V?O), the pulmonary artery systolic pressure (PASP), the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') and stroke volume (SV) using exercise stress echocardiography (ESE) combined with cardiopulmonary exercise testing (CPET).Methods?and?Results:In this single-center, retrospective cross-sectional study the HFPEF-score and nomogram-score were calculated in a total of 139 patients who underwent ESE combined with CPET. The scores correlated with peak V?O(r=-0.48, r=-0.44), PASP (r=0.23, r=0.29) and SV (r=-0.32, r=-0.19) at peak exercise. The nomogram-score correlated with E/e' (r=0.24). The prevalence of exercise intolerance (percent predicted peak V?O<75% and <50%) increased as the HFPEF-score increased and reached 88.9% and 22.2% among the patients with high HFPEF-score (6-9 points).
CONCLUSIONS:
The HFPEF-score may be useful as the initial step to diagnosing 'early' HFpEF. The nomogram-score may be more useful in Japanese because of its more universal association with exercise response than the HFPEF-score.
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Successful catheter ablation improves exercise tolerance in persistent atrial fibrillation patients, especially those with reduced ventricular contraction, preserved atrial function, or a high CHADS score.
J Cardiol2019 Nov;():. doi: S0914-5087(19)30330-2.
Katayama Hisashi, Shibata Atsushi, Doi Atsushi, Ishikawa Hirotoshi, Tamura Shota, Yamaguchi Yumi, Matsuo Masanori, Yoshiyama Tomotaka, Tatsumi Hiroaki, Iwata Shinichi, Ehara Shoichi, Izumiya Yasuhiro, Yoshiyama Minoru,
Abstract
BACKGROUND:
It has been reported that rhythm control for persistent atrial fibrillation (per-AF) patients by catheter ablation improves their exercise tolerance, subjective symptoms, and quality of life (QoL). However, clinical factors that can predict future improvement of exercise capacity after successful catheter ablation in per-AF patients are unclear.
METHODS:
This study consisted of 62 patients (mean age 65.6?±?8.7 years, 77% males) with per-AF who underwent catheter ablation from June 2017 to May 2018. All patients were subjected to extended pulmonary vein isolation. Exercise tolerance was evaluated using a symptom-limited cardiopulmonary exercise test before and 3 months after catheter ablation. Primary endpoints were QoL measurements using an original questionnaire and functional assessments performed at 3 months.
RESULTS:
The questionnaire revealed significant improvement in QoL after catheter ablation (minimal metabolic equivalents occurring symptoms: from 5.48?±?1.14 to 5.64?±?1.06; p?=?0.01). Endurance exercise characteristics improved significantly after catheter ablation, demonstrated by a shift in anaerobic threshold (from 13.3?±?3.0 to 15.2?±?3.3?ml/kg/min; p?
CONCLUSIONS:
Catheter ablation for per-AF patients improves QoL and exercise tolerance. The effect was especially remarkable in patients with reduced ventricular function, those who had a preserved atrial function, or those at high risk of thromboembolism.
Copyright © 2019. Published by Elsevier Ltd.
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Appropriate coronary revascularization can be accomplished if myocardial perfusion is quantified by positron emission tomography prior to treatment decision.
J Nucl Cardiol2019 Nov;():. doi: 10.1007/s12350-019-01938-y.
Akil Shahnaz, Hedeer Fredrik, Oddstig Jenny, Olsson Thomas, Jögi Jonas, Erlinge David, Carlsson Marcus, Arheden Hĺkan, Hindorf Cecilia, Engblom Henrik,
Abstract
BACKGROUND:
Many patients undergo percutaneous coronary intervention (PCI) without the use of non-invasive stress testing prior to treatment. The aim of this study was to determine the potential added value of guiding revascularization by quantitative assessment of myocardial perfusion prior to intervention.
METHODS AND RESULTS:
Thirty-three patients (10 females) with suspected or established CAD who had been referred for a clinical coronary angiography (CA) with possibility for PCI were included. Adenosine stress and rest N-NH PET, cardiac magnetic resonance (CMR), and cardiopulmonary exercise test were performed 4?±?3 weeks before and 5?±?1 months after CA. The angiographer was blinded to the PET and CMR results. Myocardial flow reserve (MFR)
CONCLUSION:
Assessment of quantitative myocardial perfusion prior to revascularization could lead to more appropriate use of CA when managing patients with stable CAD.
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Cardiorespiratory fitness and right ventricular mechanics in uncomplicated diabetic patients: Is there any relationship?
Acta Diabetol2019 Nov;():. doi: 10.1007/s00592-019-01449-9.
Vukomanovic Vladan, Suzic-Lazic Jelena, Celic Vera, Cuspidi Cesare, Skokic Dusan, Esposito Antonio, Grassi Guido, Tadic Marijana,
Abstract
AIMS:
This study investigated the association between cardiorespiratory fitness and right ventricular (RV) strain in uncomplicated diabetic patients.
METHODS:
This cross-sectional study involved 70 controls and 61 uncomplicated patients with type 2 diabetes, who underwent laboratory analysis, comprehensive echocardiographic study and cardiopulmonary exercise testing.
RESULTS:
RV endocardial and mid-myocardial longitudinal strains were significantly reduced in diabetic subjects (-?27.5?±?4.2% vs. -?25.3?±?4.3%, p?=?0.004 for endocardial strain; -?25.6?±?3.5% vs. -?24.1?±?3.2%, p?=?0.012 for mid-myocardial strain). The same was revealed for endocardial and mid-myocardial of RV free wall. There was no difference in RV epicardial strain. VO was significantly lower in the diabetic group (27.8?±?4.5 ml/kg/min vs. 21.5?±?4.2 ml/kg/min, p?
CONCLUSION:
Diabetes impacts RV mechanics, but endocardial and mid-myocardial layers are more affected than epicardial layer. RV endocardial strain and HbA1c were independently associated with cardiorespiratory fitness in the whole study population. Our findings show that impairment in RV strain and cardiorespiratory fitness may be useful indicators in early type 2 diabetes, prior to the development of further complications.
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Determinants of Cardiorespiratory Fitness in Patients with Heart Failure Across a Wide Range of Ejection Fractions.
Am J Cardiol2019 Oct;():. doi: S0002-9149(19)31105-1.
van Wezenbeek Jessie, Canada Justin M, Ravindra Krishna, Carbone Salvatore, Kadariya Dinesh, Trankle Cory R, Wohlford George, Buckley Leo, Del Buono Marco Giuseppe, Billingsley Hayley, Viscusi Michele, Tchoukina Inna, Shah Keyur B, Arena Ross, Van Tassell Benjamin, Abbate Antonio,
Abstract
Impaired cardiorespiratory fitness (CRF) in heart failure (HF) is influenced by a complex array of cardiac and extracardiac factors. The study aimed to identify clinical determinants of CRF measured as peak oxygen consumption (peak VO) in HF patients, and to determine a peak VO prediction model using regression equations. Retrospective analysis of 200 HF patients who completed treadmill cardiopulmonary exercise testing and underwent Doppler echocardiography and/or biomarker analysis on the same day was performed. After univariate linear regression analysis, a multivariate peak VO prediction model was developed using significant variables in a stepwise linear regression analysis. In subjects with repeated testing, Pearson's correlation was used to assess correlations between measured and predicted change in peak VO (?peak VO) over time. Mean age was 57 years, with 55% being male. Stepwise linear regression was used to generate a weighted model for peak VO: 30.895?+?(-0.112?age[years])?+?(0.296?hemoglobin [g/dl])?+?(-0.101?E/e'[unit change]) + (-0.202? body mass index [kg/m])?+?(-0.593? N-terminal pro-brain natriuretic peptide [log pg/ml]))?+?(-1.349?CRP [log mg/L]). Predicted peak VO correlated strongly with measured peak VO in HF with reduced ejection fraction and HF with preserved ejection fraction patients (r?=?+0.63, p <0.001; r?=?+0.64, p <0.001, respectively). Predicted ?peak VO correlated with measured ?peak VO (r?=?+0.23, p <0.001). In conclusion, in patients with HF across a wide range of left ventricular ejection fraction, age, systemic inflammation, oxygen carrying capacity, obesity, and elevated filling pressures are the strongest predictors of impaired CRF. The proposed CRF model allows prediction of peak VO in HF patients and may be used to estimate peak VO changes over time.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Improved hemodynamics and cardiopulmonary function in patients with inoperable chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty.
Respir Res2019 Nov;20(1):250. doi: 10.1186/s12931-019-1211-y.
Jin Qi, Luo Qin, Yang Tao, Zeng Qixian, Yu Xue, Yan Lu, Zhang Yi, Zhao Qing, Ma Xiuping, An Chenhong, Xiong Changming, Zhao Zhihui, Liu Zhihong,
Abstract
BACKGROUND:
Balloon pulmonary angioplasty (BPA) has been demonstrated to improve cardiac function and exercise capacity in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its instant impact on cardiopulmonary function has seldom been evaluated. This study aims to determine the safety and efficacy of BPA and its immediate and lasting effects on cardiopulmonary function among CTEPH patients.
METHODS:
From May 2018 to January 2019, patients with inoperable CTEPH who underwent BPA sessions were consecutively enrolled. Hemodynamics were measured by right heart catheterization, selective pulmonary angiography and BPA were successively conducted. Hemodynamic variables, WHO functional class (WHO-FC), 6-min walk distance (6MWD) and serum NT-proBNP were evaluated before and after BPA sessions during hospitalization. Pulmonary function testing (PFT) and cardiopulmonary exercise testing (CPET) were performed within 1-3?days pre and post BPA to evaluate the effect of BPA on cardiopulmonary function.
RESULTS:
Twenty-five patients with inoperable CTEPH who underwent a total of forty BPA sessions were consecutively enrolled. A total of 183 segmental or subsegmental vessels (4.6?±?1.9 vessels per session) in 137 segments (3.4?±?1.6 segments per session) were dilated. No procedure-related complications occurred. Instant hemodynamics, WHO-FC, 6MWD and NT-proBNP were all significantly improved after a single BPA session. Significant improvement in cardiopulmonary function was also evident as assessed by PFT indexes (forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation) and CPET parameters (peak work rate, peak VO, oxygen uptake efficiency slope). Further analysis among ten CTEPH patients receiving multiple BPA sessions (2-4 sessions) indicated BPA resulted in lasting improvements in hemodynamics and cardiopulmonary function.
CONCLUSIONS:
BPA, a safe and effective approach, can bring instant improvements after a single session and lasting benefits after multiple sessions to hemodynamics and cardiopulmonary function for patients with inoperable CTEPH.
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Functional Capacity Is Affected by Younger Age of Repair in Tetralogy of Fallot Patients But Not by Era of Repair.
World J Pediatr Congenit Heart Surg2019 Nov;10(6):715-721. doi: 10.1177/2150135119878034.
Powell Adam W, Mays Wayne A, Chin Clifford,
Abstract
BACKGROUND:
Cardiopulmonary exercise testing is widely used to assess functional capacity in patients with tetralogy of Fallot after surgical repair. Little is known regarding the impact of age at the time of primary complete repair and surgical era effect on exercise capacity.
METHODS:
A retrospective, single-center chart review was done from 1976 to 2016 on pediatric patients with tetralogy of Fallot who underwent cardiopulmonary exercise testing with cycle ergometry utilizing the James protocol and were then sorted by repair before/after 1990 and by age of complete repair before/after one year. Exclusion criteria included submaximal tests, incomplete data, previous pulmonary valve replacement, and surgery prior to complete repair (ie, Blalock-Taussig shunt placement).
RESULTS:
When comparing the groups who underwent primary complete repair before (N = 39) and after (N = 26) one year of age, the younger group demonstrated a higher percentage of predicted peak oxygen consumption ( o peak; 83.1% ± 11.8% vs 73.1% ± 16.1%; = .005) despite having worse pulmonary insufficiency at the time of exercise testing. There were no differences in heart rate and blood pressure response. Age of repair was independently associated with o peak. Data were statistically similar to the study eras (repair before 1990, N = 23; repair after 1990, N = 65): percentage of predicted opeak (81.4% ± 13.6% vs 79.1% ± 14.4%, = .5), maximal systolic blood pressure (155.1 ± 22.4 mm Hg vs 153.9 ± 17 mm Hg, = .8), and percentage of predicted maximal heart rate (89.8% ± 9% vs 92% ± 7.1%, = .3).
CONCLUSIONS:
Older age at primary repair appears to negatively impact opeak; however, era effect does not appear to influence cardiopulmonary exercise testing outcomes.
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Clinical significance of rectus femoris diameter in heart failure patients.
Heart Vessels2019 Nov;():. doi: 10.1007/s00380-019-01534-7.
Sato Yoshimi, Shiraishi Hirokazu, Nakanishi Naohiko, Zen Kan, Nakamura Takeshi, Yamano Tetsuhiro, Shirayama Takeshi, Matoba Satoaki,
Abstract
Heart failure (HF) is often accompanied by skeletal muscle weakness and exercise intolerance, which are known as prognostic factors of HF. Comprehensive evaluation of physical function is important, but it is not commonly conducted because of the lack of equipment or appropriate expertise. Measurement of rectus femoris diameter (RFD) by ultrasound is convenient and noninvasive, but it has not been clarified that RFD could represent physical functions in HF patients. This study evaluated 185 consecutive HF patients and underwent assessment including RFD, grip power (GP), knee extension strength (KES), skeletal muscle index (SMI), nutrition status, cardiopulmonary exercise testing, and New York Heart Association (NYHA) functional class. RFD was related with NYHA class and significantly correlated with GP, KES, SMI, body mass index, pre-albumin level, geriatric nutritional risk index, and peak VO (r?=?0.631, 0.676, 0.510, 0.568, 0.380, 0.539, 0.527, respectively; p?
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Assessment of energy expenditure during high intensity cycling and running using a heart rate and activity monitor in young active adults.
PLoS One2019 ;14(11):e0224948. doi: 10.1371/journal.pone.0224948.
Klass Malgorzata, Faoro Vitalie, Carpentier Alain,
Abstract
OBJECTIVE:
Although high intensity physical activities may represent a great proportion of the total energy expenditure in active people, only sparse studies have investigated the accuracy of wearable monitors to assess activity related energy expenditure (AEE) during high intensity exercises. Therefore, the purpose of the present study was to investigate the accuracy of the Actiheart, a light portable monitor estimating AEE based on heart rate (HR) and activity counts (ACT), during two popular activities (running and cycling) performed at high intensities. The benefit of an individual calibration of the HR-AEE relationship established during a preliminary maximal test was also evaluated.
METHODS:
AEE was estimated in eighteen active adults (4 women and 14 men; 25 ± 4 yr) with indirect calorimetry using a respiratory gas analysis system (reference method) and the Actiheart during 5-min running and cycling at 60, 75 and 85% of maximal oxygen uptake (VO2max) previously determined during a maximal test performed on a treadmill or cycle ergometer. For the Actiheart, AEE was estimated either using the group or individual calibrated equations available in the dedicated software, and their respective HR, ACT or combined HR/ACT algorithms.
RESULTS:
When the HR algorithm was used for cycling and the HR or HR/ACT algorithms for running, AEE measured by the Actiheart increased proportionally to exercise intensity from 60 to 85% VO2max (P<0.001). Compared to indirect calorimetry, the Actiheart group calibrated equations slightly to moderately underestimated (3 to 20%) AEE for the three exercise intensities (P<0.001). Accuracy of AEE estimation was greatly improved by individual calibration of the HR-AEE relationship (underestimation below 5% and intraclass correlation coefficient [ICC]: 0.79-0.93) compared to group calibration (ICC: 0.64-0.79).
CONCLUSION:
The Actiheart enables to assess AEE during high intensity running and cycling when the appropriate algorithm is applied. Since an underestimation was present for group calibration, an individual and sport-specific calibration should be performed when a high accuracy is required.
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Combined effects of growth hormone and testosterone replacement treatment in heart failure.
ESC Heart Fail2019 Nov;():. doi: 10.1002/ehf2.12520.
Salzano Andrea, Marra Alberto M, Arcopinto Michele, D'Assante Roberta, Triggiani Vincenzo, Coscioni Enrico, Pasquali Daniela, Rengo Giuseppe, Suzuki Toru, Bossone Eduardo, Cittadini Antonio,
Abstract
AIMS:
Although preliminary studies have demonstrated safety and effectiveness of single replacement therapy for growth hormone deficiency or testosterone deficiency in heart failure (HF), no data are available regarding the combined treatment with both GH and T in this setting. Thus, the aim of the present hypothesis generating pilot study was to evaluate the effectiveness and safety of multiple hormonal replacement therapies in chronic HF.
METHODS AND RESULTS:
Five stable HF with reduced ejection fraction patients, with a concomitant diagnosis of growth hormone deficiency and testosterone deficiency, on top of guideline-based HF treatment underwent 1 year of GH replacement therapy by subcutaneous injections of somatotropin at a dose of 0.012 mg/kg every second day. After 12 months, a T replacement treatment was added at a dosage of 1000 mg every 3 months. Each patient underwent a complete M-mode, two-dimensional, and Doppler echocardiographic examination, and an incremental symptom-limited cardiopulmonary exercise test on a bicycle ergometer at baseline (BL), after 1 year of GH treatment (V1), and after 1 year of combined GH + T treatments (V2). One-year of GH treatment resulted in a significant improvement in left ventricular ejection fraction (+5.4%, P < 0.01), New York Heart Association functional class (P < 0.05), and peak oxygen consumption (VO peak) (+19.3%, P < 0.01), and in a significant reduction in NT-proBNP levels (-35.1%, P < 0.01). Notably, one additional year of combined GH and T replacement therapy induced a further increase in VO peak (+27.7%, final delta change + 52.44%, P < 0.01), as well as a significant improvement in muscular strength, as assessed by handgrip dynamometry (+17.5%, final delta change + 25.8%, P < 0.01). These beneficial effects were paralleled with an improvement of the overall clinical status (as assessed by New York Heart Association class). Of note, neither adverse effects nor cardiovascular events were reported during the follow-up period.
CONCLUSIONS:
Our preliminary data suggest for the first time that combined replacement therapy with GH and T could be considered safe and therapeutic in HF patients with multiple hormone deficiencies, supporting the hypothesis that multiple hormone deficiencies syndrome can be considered as a novel and promising therapeutic target in HF. Further studies with a more robust design and larger population are needed.
© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Metabolomics of exercise pulmonary hypertension are intermediate between controls and patients with pulmonary arterial hypertension.
Pulm Circ;9(4):2045894019882623. doi: 10.1177/2045894019882623.
Sanders Jason L, Han Yuchi, Urbina Mariana F, Systrom David M, Waxman Aaron B,
Abstract
Mechanisms underlying pulmonary arterial hypertension (PAH) remain elusive. Pulmonary arterial hypertension and exercise PH share similar physiologic consequences; it is debated whether they share biologic mechanisms and if exercise PH represents an early phase of pulmonary arterial hypertension. We conducted an observational study to test if there is a graded metabolic disturbance along the severity of PH, which may indicate shared or disparate pathophysiology. Individuals referred to an academic medical dyspnea center with unexplained exertional intolerance underwent invasive cardiopulmonary exercise testing. We identified controls with no hemodynamic exercise limitation, individuals with exercise PH (mean pulmonary arterial pressure (mPAP)??25?mmHg at rest without pulmonary venous hypertension) (?=?26 in each group). Unbiased metabolomics with chromatography mass spectrometry was performed on pulmonary arterial blood at rest and peak exercise. Random forest analysis and hierarchical clustering were used to quantify metabolite prediction of group membership and rank metabolites which were significantly different between groups. Compared to controls, pulmonary arterial hypertension subjects exhibited perturbations in pathways involving glycolysis, TCA cycle, fatty acid and complex lipid oxidation, collagen deposition and fibrosis, nucleotide metabolism, and others. The metabolic signature of exercise PH was uniquely between that of control and pulmonary arterial hypertension subjects. Accuracy predicting control, exercise PH, and pulmonary arterial hypertension group was 96%, 90%, and 88%, respectively, using paired rest-exercise metabolic changes. Our data suggest the metabolic profile of exercise PH is between that of controls and patients with pulmonary arterial hypertension.
© The Author(s) 2019.
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Eight-Section Brocade Exercises Improve the Sleep Quality and Memory Consolidation and Cardiopulmonary Function of Older Adults With Atrial Fibrillation-Associated Stroke.
Front Psychol2019 ;10():2348. doi: 10.3389/fpsyg.2019.02348.
Lv Wei, Wang Xinxin, Liu Jia, Yu Ping,
Abstract
Poor sleep quality is harmful for everyone and potentially even more harmful for older adults with atrial fibrillation-associated stroke (AFAS). This study aims to explore the effects of eight-section brocade (ESB) on sleep quality, memory, and cardiopulmonary function in the older adults with AFAS. Older adults with AFAS and sleep disorders were recruited and divided into the ESB (EG, = 85) and control groups (CG, general exercise, = 85). EG patients received 60 min ESB exercises 5 times a week for 12 weeks; CG patients received normal exercise. Pittsburgh sleep quality index (PSQI) scores (poor sleepers ?8 and normal sleepers < 8), memory for word pairs (poor memory ? 7 and normal memory > 7), left ventricular posterior wall (LVPW) thickness, and maximum ventilation (MV, to evaluate cardiopulmonary function) values were measured. The correlation between sleep and memory quality was analyzed using PSQI scores and word pairs via the Pearson correlation coefficients test. Adjusted Cox models were used to explore an interaction between PSQI and ESB exercise. After 12-week exercise intervention, ESB improved sleep quality, latency, duration, disturbance and daytime dysfunction when compared to conventional exercise. In similar cases, the MV values in the EG were also higher than that in the CG ( = 0.009). ESB intervention could not affect the cardiac structure and left ventricular ejection fraction. Compared with the CG, the ESB intervention reduced PSQI scores and increased memorized word pairs ( < 0.001 for poor and normal sleepers in both unadjusted and adjusted analysis, = 0.012 and 0.003 for poor and normal memory). The test of Pearson correlation coefficients showed that PSQI scores were strongly associated with the number of word pairs in both unadjusted and adjusted analyses ( < 0.0001). Eight-section brocade exercise improved sleep quality and memory consolidation and cardiopulmonary function by reducing PSQI scores, increasing word pairs and MV values in the older adults with AFAS.
Copyright © 2019 Lv, Wang, Liu and Yu.
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"Get a Grip on Hypertension": EXPLORING THE USE OF ISOMETRIC HANDGRIP TRAINING IN CARDIOPULMONARY REHABILITATION PATIENTS.
J Cardiopulm Rehabil Prev2019 Nov;39(6):E31-E34. doi: 10.1097/HCR.0000000000000468.
Gordon Benjamin D H, Whitmire Sarah, Zacherle Emily W, Doyle Shelton, Gulati Sanjeev, Leamy Larry J, Marino Joseph S, Bennett Jeanette M, Reitzel Adam M, Swaine Ian L, Howden Reuben,
Abstract
PURPOSE:
Isometric handgrip (IHG) training lowers systolic and diastolic blood pressure (SBP and DBP, respectively), but the efficacy of IHG training in cardiopulmonary rehabilitation patients is unknown. The purpose of this study was to determine if IHG decreases blood pressure in cardiopulmonary rehabilitation patients.
METHODS:
Cardiopulmonary rehabilitation program participants (n = 11; 50-80 yr old) were randomized to IHG (n = 6) or control (CON; no treatment; n = 5) groups. IHG participants completed an IHG training program at 30% maximal voluntary contraction, 3 d/wk for 6 wk. Resting SBP, DBP, and heart rate were assessed weekly.
RESULTS:
Mean regression for SBP following IHG was negative (-1.04 ± 0.80). Mean regression in the CON group was positive (0.50 ± 0.88), but there was no significant difference between groups. Separate analysis of weeks 1 to 7 yielded a negative mean regression (-1.12 ± 0.54) in the IHG group, but positive (1.2 ± 0.60) in the CON group. A Wilcoxon test of these differences yielded significance for SBP (P = .009). In 3 of 6 IHG participants, SBP was lower (mean ± SD: -16 ± 11 mm Hg; P = .12), and in 2 IHG participants, DBP was lower (-9 ± 1 mm Hg; P = .06) compared with baseline. In 2 of 5 CON participants, SBP was not significantly lower (-11 ± 7 mm Hg) and, in 3 of 5 CON participants, DBP was lower (-7 ± 4 mm Hg; P = .04).
CONCLUSIONS:
Our data suggest that standard IHG training may be inadequate for blood pressure management immediately following a major cardiac or pulmonary event. Future work with a larger cohort and more developed training protocol to determine the efficacy of IHG training in patients with cardiopulmonary disease is warranted.
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Exercise testing for assessment of heart failure in adults with congenital heart disease.
Heart Fail Rev2019 Nov;():. doi: 10.1007/s10741-019-09867-1.
Burstein Danielle S, Menachem Jonathan N, Opotowsky Alexander R,
Abstract
Congenital heart disease (CHD)-related heart failure is common and associated with significant morbidity, mortality, and resource utilization. In adults with CHD (ACHD), exercise limitation is often underestimated. Quantitative assessment with cardiopulmonary exercise testing (CPET) provides a comprehensive evaluation of exercise capacity and can help risk stratify patients, particularly across serial testing. CPET parameters must be interpreted within the context of the underlying anatomy, specifically for patients with either single ventricle physiology and/or cyanosis. Acknowledging differences in CPET parameters between ACHD and non-ACHD patients with heart failure are also important considerations when evaluating the overall benefit of advanced heart failure therapies. CPET testing can also guide safe exercise recommendation, including those with ACHD-related heart failure.
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The implications of dysglycaemia on aerobic exercise and ventilatory function in cystic fibrosis.
J Cyst Fibros2019 Nov;():. doi: S1569-1993(19)30895-1.
Causer Adam J, Shute Janis K, Cummings Michael H, Shepherd Anthony I, Wallbanks Samuel R, Allenby Mark I, Arregui-Fresneda Irantzu, Bright Victoria, Carroll Mary P, Connett Gary, Daniels Thomas, Meredith Tom, Saynor Zoe L,
Abstract
BACKGROUND:
The development of cystic fibrosis (CF)-related diabetes (CFRD) in paediatric groups is associated with a reduced aerobic fitness. However, this has yet to be investigated in adults with more severe lung disease.
METHODS:
Cardiopulmonary exercise and glycaemic control tests were retrospectively analysed in 46 adults with CF (age: 26.9 y [range: 16.3-66.5 y]; forced expiratory volume in 1s: 65.3% [range: 26.8-105.7%]; 26 males), diagnosed with CFRD (n?=?19), impaired glucose tolerance (IGT; n?=?8) or normal glucose tolerance (NGT; n?=?19).
RESULTS:
Maximal oxygen uptake (V?O) was reduced in adults with IGT and CFRD compared to their age- and gender-matched counterparts with NGT (p < 0.05); however, there was no difference when lung function was included as a covariate (all p > 0.05). V?O was greater in adults who experienced post-reactive hypoglycaemia vs. NGT without hypoglycaemia (p < 0.05). The frequency of ventilatory limitation (84%, 63% and 37%, respectively; p < 0.05) but not ventilation-perfusion mismatch (42%, 38% and 16%, respectively; p > 0.05), was greater with CFRD and IGT vs. NGT. There was also no difference in arterial oxygen saturation changes between groups (p > 0.05). Gender and body mass index were significant predictors of V?O (adjusted R?=?0.37, p < 0.01), but glycaemic control did not explain additional variance (p > 0.05).
CONCLUSIONS:
Adults with CF-related dysglycaemia had a reduced V?O compared to age- and gender-matched counterparts, due to a greater degree of CF lung disease in these populations.
Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.
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