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Pubblicazioni recenti - cardiopulmonary exercise
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The novel effectiveness of Tai Chi on cardiopulmonary fitness among stroke patients in the recovery phase: a study protocol for a randomized controlled trial.
Trials2021 Sep;22(1):614. doi: 10.1186/s13063-021-05565-2.
Tan Tianyang, Meng Yanyan, Li Xinyu, Bai Ruina, Wang Chengchao, Lyu Jiaxuan, Yan Kang, Liu Meng, Zhang Chaoyang, Wei Yulong,
Abstract
BACKGROUND:
Stroke is the leading cause of death worldwide. China faces a similar risk of stroke as developed countries because of considerable changes in lifestyle, such as overeating and smoking. Tai Chi is a traditional form of mind-body exercise that has been widely practiced in China for thousands of years. However, there are few studies on the effect of Tai Chi on the cardiopulmonary function of stroke patients in the recovery phase. Therefore, it is necessary to observe the effect of Tai Chi on the cardiorespiratory fitness of patients after stroke.
METHODS:
This is a parallel-design, two-arm, analyst assessor-blinded, randomized controlled trial. A total of 226 stroke patients in the recovery phase will be recruited and assigned randomly to a control group or Tai Chi group at a 1:1 ratio. The patients in the Tai Chi group will perform the Tai Chi exercise. The patients in the control group will perform walking exercises. Patients in both groups will receive conventional treatments and healthy education. The primary outcomes will be VO and scores on the MOS item short form health survey (SF-36) scale. Secondary outcomes will include vital capacity (VC), ejection fractions (EF), and cardiac output (CO). The assessments of the tests will be performed at three time points (before exercise, at the end of exercise, and 6?weeks after exercise). Adverse events will be recorded faithfully during the study.
DISCUSSION:
If the results are positive, this study will contribute to the establishment of further guided Tai Chi rehabilitation programs.
TRIAL REGISTRATION:
Chinese Clinical Trial Registry ChiCTR2000034719 . Registered on 16 July 2020.
© 2021. The Author(s).
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Alterations to the urinary metabolome following semi-controlled short exposures to ultrafine particles at a major airport.
Int J Hyg Environ Health2021 Aug;237():113803. doi: S1438-4639(21)00118-8.
Selley Liza, Lammers Ariana, Le Guennec Adrien, Pirhadi Milad, Sioutas Constantinos, Janssen Nicole, Maitland-van der Zee Anke H, Mudway Ian, Cassee Flemming,
Abstract
BACKGROUND:
Inflammation, oxidative stress and reduced cardiopulmonary function following exposure to ultrafine particles (UFP) from airports has been reported but the biological pathways underlying these toxicological endpoints remain to be explored. Urinary metabolomics offers a robust method by which changes in cellular pathway activity can be characterised following environmental exposures.
OBJECTIVE:
We assessed the impact of short-term exposures to UFP from different sources at a major airport on the human urinary metabolome.
METHODS:
21 healthy, non-smoking volunteers (aged 19-27 years) were repeatedly (2-5 visits) exposed for 5h to ambient air at Amsterdam Airport Schiphol, while performing intermittent, moderate exercise. Pre- to-post exposure changes in urinary metabolite concentrations were assessed via H NMR spectroscopy and related to total and source-specific particle number concentrations (PNC) using linear mixed effects models.
RESULTS:
Total PNC at the exposure site was on average, 53,500 particles/cm (range 10,500-173,200) and associated with significant reductions in urinary taurine (-0.262 AU, 95% CI: -0.507 to -0.020) and dimethylamine concentrations (-0.021 AU, 95% CI: -0.040 to -0.067). Aviation UFP exposure accounted for these changes, with the reductions in taurine and dimethylamine associating with UFP produced during both aircraft landing and take-off. Significant reductions in pyroglutamate concentration were also associated with aviation UFP specifically, (-0.005 AU, 95% CI: -0.010 -
DISCUSSION:
Following short-term exposures at a major airport, aviation-related UFP caused the greatest changes to the urinary metabolome. These were consistent with a heightened antioxidant response and altered nitric oxide synthesis. Although some of these responses could be adaptive, they appeared after short-term exposures in healthy adults. Further study is required to determine whether long-term exposures induce injurious effects.
Copyright © 2021 The Authors. Published by Elsevier GmbH.. All rights reserved.
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Efficacy and Safety of Different Aerobic Exercise Intensities in Patients With Heart Failure With Reduced Ejection Fraction: Design of a Multicenter Randomized Controlled Trial (HF-EI Trial).
Front Cardiovasc Med2021 ;8():705972. doi: 10.3389/fcvm.2021.705972.
Shen Ting, Liu Xiaoling, Zhuang Bo, Luo Qian, Jin Yishan, Li Guanghe, Jiang Yumei, Li Dejie, Chen Xianchuan, Tang Nuo, Xu Zhimin, Wang Lemin, Zheng Liang, Shen Yuqin,
Abstract
Heart failure (HF) is one of the major causes of mortality worldwide, representing the terminal stage of several cardiovascular diseases. Exercise-based rehabilitation is a beneficial therapy for patients with chronic heart failure (CHF). However, there is a lack of specific guidance on clinical decision-making regarding optimal exercise intensity. It is necessary to optimize the clinical recommendations for HF exercises. We will evaluate the efficacy and safety of different aerobic exercise intensities in patients with heart failure with reduced ejection fraction (HFrEF): the HF-EI trial. This trial aims to assess the appropriate exercise intensity for patients with HFrEF. After a baseline assessment to determine the safety of exercise, 180 patients will be randomly assigned to supervised high-intensity exercise training (ET) group, supervised moderate intensity training (MIT) group, and control group at a ratio of 1:1:1. Patients randomly receiving high intensity training (HIT) undergo supervised ET (3 times/week, 30 min) for aerobic endurance at 70% peak oxygen consumption (peak VO) intensity for 12 weeks. The MIT patients will perform supervised aerobic ET (3 times/week, 35-42 min) at the anaerobic threshold (AT) intensity for 12 weeks. The control group will continue to maintain their daily activities and will not receive ET. During the baseline and follow-up period, physical examination, laboratory tests, cardiology diagnostic tests, cardiopulmonary exercise tests (CPET), 6-min walk distance (6MWD), scale scores, exercise steps, medications, and clinical events will be monitored. Throughout the research, sport bracelets and patient diaries will be used to monitor and record overall physical activity, training courses, and compliance. The HF-EI trial will evaluate the effects of different aerobic exercise intensities on peak VO, quality of life (QoL), and clinical events among patients with HFrEF. The findings of this trial will provide a basis for formulating exercise prescriptions for patients with HFrEF. http://www.chictr.org.cn/, identifier: ChiCTR2000036381.
Copyright © 2021 Shen, Liu, Zhuang, Luo, Jin, Li, Jiang, Li, Chen, Tang, Xu, Wang, Zheng and Shen.
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Exercise Capacity, Functioning and Quality of Life 12 Weeks after Traumatic Thoracic Spinal Cord Injury.
Ortop Traumatol Rehabil2021 Aug;23(4):257-262. doi: 10.5604/01.3001.0015.2362.
Kowalczyk-Jurgiel Sylwia, Scheel-Sailer Anke, Frotzler Angela, Flueck Joëlle Leonie, Jegier Anna, Perret Claudio,
Abstract
BACKGROUND:
A spinal cord injury (SCI) leads to patho-physiological changes that can affect physical and psychological performance. The aim of this observational study was to evaluate the relationship between exercise capacity, functioning and quality of life in patients 12 weeks after traumatic paraplegia participating in early rehabilitation.
MATERIAL AND METHODS:
13 patients participated in this study and performed cardio-pulmonary exercise testing (CPET) on an arm-crank ergometer to determine peak exercise capacity (VO2peak). Data from the spinal cord independence measure (SCIM) were used to assess different areas of functioning. The 12-item short form survey (SF12) questionnaire was applied to measure quality of life. Spearman correlations were used to relate VO2peak with SCIM data and results from the SF12 questionnaire.
RESULTS:
VO2peak ranged between 12.6 and 28.1 ml/kg/min. A significant relationship was found between VO2peak and the physical component of the SF12 questionnaire, whereas no correlations were found with either SCIM sub or total score, or with the mental component or the total score of the SF12 questionnaire.
CONCLUSIONS:
1. Patients with traumatic paraplegia showed fair to average exercise capacity after 12 weeks of early rehabilitation. 2. A significant relationship between VO2peak and subjectively rated physical fitness exists at this time point. 3. The implementation of an individual fitness program tailored to the patients' needs based on CPET results is highly recommended in order to improve functioning and quality of life.
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Listing Criteria for Heart Transplant: Role of Cardiopulmonary Exercise Test and of Prognostic Scores.
Heart Fail Clin2021 Oct;17(4):635-646. doi: S1551-7136(21)00061-1.
Segreti Andrea, Verolino Giuseppe, Crispino Simone Pasquale, Agostoni Piergiuseppe,
Abstract
Patients with advanced heart failure (AdHF) have a reduced quality of life and poor prognosis. A heart transplant (HT) is an effective treatment for such patients. Still, because of a shortage of donor organs, the final decision to place a patient without contraindications on the HT waiting list is based on detailed risk-benefit analysis. Cardiopulmonary exercise tests (CPETs) play a pivotal role in guiding selection in patients with AdHF considered for an HT. Furthermore, several validated multivariable predicting scores obtained through various techniques, including the CPETs, are available and part of the decision-making process for HT listing.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Cardiorespiratory Abnormalities in Patients Recovering from COVID-19.
J Am Soc Echocardiogr2021 Sep;():. doi: S0894-7317(21)00701-X.
Szekely Yishay, Lichter Yael, Sadon Sapir, Lupu Lior, Taieb Philippe, Banai Ariel, Sapir Orly, Granot Yoav, Hochstadt Aviram, Friedman Shirley, Laufer-Perl Michal, Banai Shmuel, Topilsky Yan,
Abstract
BACKGROUND:
Large number of patients around the world are recovering from COVID-19; many of them report persistence of symptoms.
OBJECTIVES:
We sought to test pulmonary, cardiovascular and peripheral responses to exercise in patients recovering from COVID-19.
METHODS:
We prospectively evaluated patients who recovered from COVID-19 using a combined anatomic/functional assessment. All patients underwent clinical examination, laboratory tests, and a combined stress echocardiography and cardiopulmonary exercise test. We measured left ventricular volumes, ejection fraction, stroke volume, heart rate, E/e' ratio, right ventricular function, VO, lung volumes, Ventilatory efficiency, O saturation and muscle O extraction in all effort stages and compared them to historical controls.
RESULTS:
A total of 71 patients were assessed 90.6±26 days after onset of COVID-19 symptoms. Only 23 (33%) were asymptomatic. The most common symptoms were fatigue (34%), muscle weakness/pain (27%) and dyspnea (22%). VO was lower among post-COVID-19 patients compared to controls (p=0.03, group by time interaction p=0.007). Reduction in peak VO was due to a combination of chronotropic incompetence (75% of post-COVID-19 patients vs. 8% of controls, p
CONCLUSIONS:
Patients recovering from COVID-19 have symptoms associated with objective reduction in peak VO. The mechanism of this reduction is complex and mainly involves a combination of attenuated heart rate and stroke volume reserve.
Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
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Effects of the exercise training on skeletal muscle oxygen consumption in heart failure patients with reduced ejection fraction.
Int J Cardiol2021 Sep;():. doi: S0167-5273(21)01318-8.
Guimarães Guilherme Veiga, Ribeiro Fernando, Castro Rafael Ertner, Roque Jean Marcelo, Machado Alexander D T, Antunes-Correa Ligia M, Ferreira Silvia Ayub, Bocchi Edimar Alcides,
Abstract
AIMS:
Skeletal muscle dysfunction is a systemic consequence of heart failure (HF) that correlates with functional capacity. However, the impairment within the skeletal muscle is not well established. We investigated the effect of exercise training on peripheral muscular performance and oxygenation in HF patients.
METHODS AND RESULTS:
HF patients with ejection fraction ?40% were randomized 2:1 to exercise training or control for 12?weeks. Muscle tissue oxygen was measured noninvasively by near-infrared spectroscopy (NIRS) during rest and a symptom-limited cardiopulmonary exercise test (CPET) before and after intervention. Measurements included skeletal muscle oxygenated hemoglobin concentration, deoxygenated hemoglobin concentration, total hemoglobin concentration, VO peak, VE/VCO slope, and heart rate. Muscle sympathetic nerve activity by microneurography, and muscle blood flow by plethysmography were also assessed at rest pre and post 12?weeks. Twenty-four participants (47.5?±?7.4?years, 58% men, 75% no ischemic) were allocated to exercise training (ET, n?=?16) or control (CG, n?=?8). At baseline, no differences between groups were found. Exercise improved VO peak, slope VE/VCO, and heart rate. After the intervention, significant improvements at rest were seen in the ET group in muscle sympathetic nerve activity and muscle blood flow. Concomitantly, a significant decreased in Oxy-Hb (from 29.4?±?20.4 to 15.7?±?9.0??mol, p?=?0.01), Deoxi-Hb (from 16.3?±?8.2 to 12.2?±?6.0??mol, p?=?0.003) and HbT (from 45.7?±?27.6 to 27.7?±?13.4??mol, p?=?0.008) was detected at peak exercise after training. No changes were observed in the control group.
CONCLUSION:
Exercise training improves skeletal muscle function and functional capacity in HF patients with reduced ejection fraction. This improvement was associated with increased oxygenation of the peripheral muscles, increased muscle blood flow, and decreased sympathetic nerve activity.
Copyright © 2021. Published by Elsevier B.V.
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Development of a New Submaximal Walk Test to Predict Maximal Oxygen Consumption in Healthy Adults.
Sensors (Basel)2021 Aug;21(17):. doi: 5726.
Yang Hyuk In, Cho Wonhee, Lee Dong Hoon, Suh Sang-Hoon, Jeon Justin Y,
Abstract
The aim of the study was to develop a simple submaximal walk test protocol and equation using heart rate (HR) response variables to predict maximal oxygen consumption (VOmax). A total of 60 healthy adults were recruited to test the validity of 3 min walk tests (3MWT). VOmax and HR responses during the 3MWTs were measured. Multiple regression analysis was used to develop prediction equations. As a result, HR response variables including resting HR and HR during walking and recovery at two different cadences were significantly correlated with VOmax. The equations developed using multiple regression analyses were able to predict VOmax values (r = 0.75-0.84; r = 0.57-0.70; standard error of estimate (SEE) = 4.80-5.25 mL/kg/min). The equation that predicted VOmax the best was at the cadence of 120 steps per minute, which included sex; age; height; weight; body mass index; resting HR; HR at 1 min, 2 min and 3 min; HR recovery at 1 min and 2 min; and other HR variables calculated based on these measured HR variables (r = 0.84; r = 0.70; SEE = 4.80 mL/kg/min). In conclusion, the 3MWT developed in this study is a safe and practical submaximal exercise protocol for healthy adults to predict VOmax accurately, even compared to the well-established submaximal exercise protocols, and merits further investigation.
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Is It Really Home-Based? A Commentary on the Necessity for Accurate Definitions across Exercise and Physical Activity Programmes.
Int J Environ Res Public Health2021 09;18(17):. doi: 9244.
Denton Francesca, Power Sofie, Waddell Alexander, Birkett Stefan, Duncan Michael, Harwood Amy, McGregor Gordon, Rowley Nikita, Broom David,
Abstract
: There is wide discrepancy in how published research defines and reports home-based exercise programmes. Studies consisting of fundamentally different designs have been labelled as home-based, making searching for relevant literature challenging and time consuming. This issue has been further highlighted by an increased demand for these programmes following the COVID-19 pandemic and associated government-imposed lockdowns. : To examine what specifically constitutes home-based exercise by: (1) developing definitions for a range of terms used when reporting exercise and physical activity programmes and (2) providing examples to contextualise these definitions for use when reporting exercise and physical activity programmes. : A literature search was undertaken to identify previous attempts to define home-based exercise programmes. A working document, including initial definitions and examples were developed, which were then discussed between six experts for further refinement. : We generated definitions for universal key terms within three domains (and subdomains) of programme design: location (home-based, community/centre-based, or clinical setting), prescription (structured or unstructured) and delivery (supervised, facilitated, or unsupervised). Examples for possible combinations of design terms were produced. : Definitions will provide consistency when using reporting tools and the intention is to discuss the issues presented as part of a Delphi study. This is of paramount importance due to the predicted increase in emerging research regarding home-based exercise.
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Overshoot of the Respiratory Exchange Ratio during Recovery from Maximal Exercise Testing in Kidney Transplant Recipients.
Int J Environ Res Public Health2021 Sep;18(17):. doi: 9236.
Patti Alessandro, Neunhaeuserer Daniel, Gasperetti Andrea, Baioccato Veronica, Vecchiato Marco, Battista Francesca, Marchini Francesco, Bergamin Marco, Furian Lucrezia, Ermolao Andrea,
Abstract
The overshoot of the respiratory exchange ratio (RER) during recovery from exercise has been found to be reduced in magnitude among patients with heart failure. The aim of this study is to investigate whether this phenomenon could also be present in patients with peripheral, and not cardiac, limitations to exercise such as kidney transplant recipients (KTRs). In this retrospective cross-sectional study, KTRs were evaluated with maximal cardiopulmonary exercise testing (CPET) assessing the RER overshoot parameters during recovery: the RER at peak exercise, the maximum RER value reached during recovery, the magnitude of the RER overshoot (RER mag = (RER max-peak RER)/peak RER%) and the linear slope of the RER increase after the end of exercise. A total of 57 KTRs were included in the study (16 females), all of them showing a significant RER overshoot (RER mag: 28.4 ± 12.7%). Moreover, the RER mag showed significant correlations with the fitness of patients (peak VO: ? = 0.57,
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Long COVID: Distinction between Organ Damage and Deconditioning.
J Clin Med2021 Aug;10(17):. doi: 3782.
Kersten Johannes, Baumhardt Michael, Hartveg Paul, Hoyo Luis, Hüll Elina, Imhof Armin, Kropf-Sanchen Cornelia, Nita Nicoleta, Mörike Johannes, Rattka Manuel, Andreß Stefanie, Scharnbeck Dominik, Schmidtke-Schrezenmeier Gerlinde, Tadic Marijana, Wolf Alexander, Rottbauer Wolfgang, Buckert Dominik,
Abstract
(1) Background: Long COVID syndrome refers to long-term sequelae of the novel viral disease, which occur even in patients with initially mild disease courses. However, there is still little evidence of the actual organic consequences and their frequency, and there is no standardized workup to diagnose long COVID syndrome yet. In this study, we aim to determine the efficiency of a stepwise diagnostic approach for reconvalescent COVID-19 patients with cardiopulmonary symptoms. (2) Methods: The diagnostic workup for long COVID syndrome included three steps. In the first step, the focus was on broad applicability (e.g., blood tests and body plethysmography). In the second step, cardiopulmonary exercise testing (CPET) and cardiac MRI (CMR) were used. The third step was tailored to the individual needs of each patient. The observation period lasted from 22 February to 14 May 2021. (3) Results: We examined 231 patients in our long COVID unit (mean [SD] age, 47.8 [14.9], 132 [57.1%] women). Acute illness occurred a mean (SD) of 121 (77) days previously. Suspicious findings in the first visit were seen in 80 (34.6%) patients, prompting further diagnostics. Thirty-six patients were further examined with CPET and CMR. Of those, 16 (44.4%) had pathological findings. The rest had functional complaints without organ damage ("functional long COVID"). Cardiopulmonary sequelae were found in asymptomatic as well as severe courses of the initial COVID-19 disease. (4) Conclusions: A structured diagnostic pathway for the diagnosis of long COVID syndrome is practicable and rational in terms of resource allocation. With this approach, manifest organ damage can be accurately and comprehensively diagnosed and distinguished from functional complaints.
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Reduced Exercise Capacity in Adults Born Very Low Birth Weight: A Population-Based Cohort Study.
Am J Respir Crit Care Med2021 Sep;():. doi: 10.1164/rccm.202103-0755OC.
Yang Jun, Epton Michael J, Harris Sarah L, Horwood John, Kingsford Rachel A, Troughton Richard, Greer Charlotte, Darlow Brian A,
Abstract
RATIONALE:
Population-based data regarding the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult exercise capacity is limited.
OBJECTIVES:
To compare exercise capacity in a national VLBW cohort with term-born controls and explore factors contributing to the differences.
METHODS:
At 26-30 years of age, 228 VLBW survivors and 100 controls underwent lung function tests, cardiopulmonary exercise testing and assessment of resting cardiac structure/function using echocardiography. Data on self-reported physical activity were collected.
MEASUREMENTS AND MAIN RESULTS:
Compared with controls, VLBW adults demonstrated reduced oxygen uptake, work rate and oxygen pulse at peak exercise (9.3%, 10.7%, 10.8% lower, respectively) and earlier anaerobic threshold (all p
CONCLUSIONS:
Exercise capacity was significantly reduced in VLBW adults, which we speculate is from combined effects of impaired lung function, altered heart structure/function and reduced physical activity. Perinatal factors including BPD were not associated with a reduced exercise capacity.
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The effects of arm crank training on aerobic capacity, physical performance, quality of life, and health-related disability in patients with Parkinson's disease.
Ir J Med Sci2021 Sep;():. doi: 10.1007/s11845-021-02772-3.
Da? Figen, Çimen Özlem Bölgen, Do?u Okan,
Abstract
BACKGROUND:
Aerobic exercise training contributes to improvement of cardiopulmonary capacity, mobility, neurological function, and quality of life.
AIMS:
To investigate the effects of arm crank ergometer training on aerobic capacity, quality of life, and Parkinson's disease (PD)-related disability METHODS: Seventeen patients with PD were recruited to study. Assessments were performed at baseline and at the end of an 8-week arm crank ergometer (ACE) training program (3 days/week; 1 h per session, 50-70% VO) with patients acting as their own control. Outcome measures included aerobic capacity assessment, 6-min walk test (6MWT), timed up and go test (TUG), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), Beck Depression Index (BDI), the Falls Efficacy Scale (FES), and Montreal Cognitive Assessment (MoCA).
RESULTS:
At the end of the study, an increase of 30.49% in aerobic capacity was observed. Statistically significant improvements were found for the 6MWT (p?=?0.001), TUG test (p?=?0.001), UPDRS total score (p?=?0.002), quality of life assessed with PDQ-39 (p?=?0.006), BDI (p?=?0.001), and FES scores (p?=?0.002) after an 8-week ACE training. No significant effect on MoCA was found (p?=?0.264).
CONCLUSION:
An 8-week ACE training led to significant improvement in aerobic capacity, physical performance, and PD-related disabilities.
© 2021. Royal Academy of Medicine in Ireland.
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Peak oxygen uptake in sportsmen with spinal cord injury: importance of body composition.
Eur J Phys Rehabil Med2021 Sep;():. doi: 10.23736/S1973-9087.21.07028-3.
Gervasi Salvatore F, Orvieto Sebastiano, Sollazzo Fabrizio, Bianco Massimiliano, Cuccaro Francesco, Zeppilli Paolo, Palmieri Vincenzo,
Abstract
BACKGROUND:
Although peak oxygen uptake (VO2peak) is considered the most useful index of functional capacity, it's difficult to interpret the results of cardiopulmonary exercise testing (CPET) in individuals with spinal cord injury (SCI). In fact, VO2peak is usually normalized for total body weight, but body composition in persons with SCI largely varies depending on physical activity and time since injury, with a progressive loss of fat-free mass (FFM). This can lead to a misinterpretation of the cardiopulmonary fitness in this population.
AIM:
Our study proposes a methodology of evaluation, based on bioelectrical impedance analysis (BIA), which could provide more individualized and accurate data in sportsmen with SCI.
DESIGN:
Case-control study.
SETTING:
Ambulatory evaluations at the Sports Medicine Unit of the Fondazione IRCSS Policlinico A. Gemelli, Rome, Italy.
METHODS AND POPULATION:
Comparison of data derived from BIA, echocardiography and CPET between 10 male sportsmen with complete, high SCI (Group T) and 10 able-bodied controls (Group C).
RESULTS:
Mean VO2peak, weight-normalized VO2peak, Fat-Free Mass (FFM)-normalized VO2peak and body cellular mass (BCM)-normalized values were significantly lower in Group T. At the same heart rate (on average the 55% of the maximal theoretical for age), mean of absolute VO2, weight-normalized VO2 and FFM-normalized VO2 were still significantly lower in Group T. Considering the BCM- normalized VO2, the Group T showed greater values than controls, 39.4 (7.8) vs 31.1 (8.5) ml/Kg/min.
CONCLUSIONS:
Body composition is a crucial factor for properly interpreting a CPET in individuals with SCI. In particular, normalization of VO2peak values for the BCM seems the most reliable tool to assess the real functional capacity in this population.
CLINICAL REHABILITATION IMPACT:
A more accurate definition of the aerobic power and functional capacity of people with SCI can improve the monitoring of rehabilitations protocols and physical exercise in this population.
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Mechanisms of Exertional Dyspnea in Patients with Mild COPD and a Low Resting DL.
COPD2021 Sep;():1-10. doi: 10.1080/15412555.2021.1932782.
James Matthew D, Phillips Devin B, Elbehairy Amany F, Milne Kathryn M, Vincent Sandra G, Domnik Nicolle J, Torres Juan P de, Neder J Alberto, O'Donnell Denis E,
Abstract
Patients with mild chronic obstructive pulmonary disease (COPD) and lower resting diffusing capacity for carbon monoxide (DL) often report troublesome dyspnea during exercise although the mechanisms are not clear. We postulated that in such individuals, exertional dyspnea is linked to relatively high inspiratory neural drive (IND) due, in part, to the effects of reduced ventilatory efficiency. This cross-sectional study included 28 patients with GOLD I COPD stratified into two groups with (?=?15) and without (?=?13) DL less than the lower limit of normal (
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Actigraphy informs distinct patient-centered outcomes in Pre-COPD.
Respir Med2021 Jul;187():106543. doi: S0954-6111(21)00249-3.
Chen Jianhong, Weldemichael Lemlem, Zeng Siyang, Giang Brian, Geerts Jeroen, Ching Wendy Czerina, Nishihama Melissa, Gold Warren M, Arjomandi Mehrdad,
Abstract
BACKGROUND:
Actigraphy can provide useful patient-centered outcomes for quantification of physical activity in the "real-world" setting.
METHODS:
To characterize the relationship of actigraphy outputs with "in-laboratory" measures of cardiopulmonary function and respiratory symptoms in pre-COPD, we obtained actigraphy data for 8 h/day for 5 consecutive days a week before in-laboratory administration of respiratory questionnaires, PFT, and CPET to a subgroup of subjects participating in the larger study of the health effects of exposure to secondhand tobacco smoke who had air trapping but no spirometric obstruction (pre-COPD). Using machine learning approaches, we identified the most relevant actigraphy predictors and examined their associations with symptoms, lung function, and exercise outcomes.
RESULTS:
Sixty-one subjects (age = 66±7 years; BMI = 24±3 kg/m; FEV/FVC = 0.75 ± 0.05; FEV = 103 ± 17 %predicted) completed the nested study. In the hierarchical cluster analysis, the activity, distance, and energy domains of actigraphy, including moderate to vigorous physical activity, were closely correlated with each other, but were only loosely associated with spirometric and peak exercise measures of oxygen consumption, ventilation, oxygen-pulse, and anaerobic threshold (VO), and were divergent from symptom measures. Conversely, the sedentary domain clustered with respiratory symptoms, air trapping, airflow indices, and ventilatory efficiency. In Regression modeling, sedentary domain was inversely associated with baseline lung volumes and tidal breathing at peak exercise, while the activity domains were associated with VO. Respiratory symptoms and PFT data were not associated with actigraphy outcomes.
DISCUSSION:
Outpatient actigraphy can provide information for "real-world" patient-centered outcomes that are not captured by standardized respiratory questionnaires, lung function, or exercise testing. Actigraphy activity and sedentary domains inform of distinct outcomes.
Published by Elsevier Ltd.
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Exercise training reduces sympathetic nerve activity and improves executive performance in individuals with obstructive sleep apnea.
Clinics (Sao Paulo)2021 ;76():e2786. doi: S1807-59322021000100306.
Goya Thiago Tanaka, Ferreira-Silva Rosyvaldo, Gara Elisangela Macedo, Guerra Renan Segalla, Barbosa Eline Rozária Ferreira, Toschi-Dias Edgar, Cunha Paulo Jannuzzi, Negrão Carlos Eduardo, Lorenzi-Filho Geraldo, Ueno-Pardi Linda Massako,
Abstract
OBJECTIVE:
To investigate the effects of exercise training (ET) on muscle sympathetic nerve activity (MSNA) and executive performance during Stroop Color Word Test (SCWT) also referred to as mental stress test.
METHODS:
Forty-four individuals with obstructive sleep apnea (OSA) and no significant co-morbidities were randomized into 2 groups; 15 individuals completed the control period, and 18 individuals completed the ET. Mini-mental state of examination and intelligence quotient were also assessed. MSNA assessed by microneurography, heart rate by electrocardiography, blood pressure (automated oscillometric device) were measured at baseline and during 3 min of the SCWT. Peak oxygen uptake (VO2 peak) was evaluated using cardiopulmonary exercise testing. Executive performance was assessed by the total correct responses during 3 min of the SCWT. ET consisted of 3 weekly sessions of aerobic exercise, resistance exercises, and flexibility (72 sessions, achieved in 40±3.9 weeks).
RESULTS:
Baseline parameters were similar between groups. Heart rate, blood pressure, and MSNA responses during SCWT were similar between groups (p>0.05). The comparisons between groups showed that the changes in VO2 (4.7±0.8 vs -1.2±0.4) and apnea-hypopnea index (-7.4±3.1 vs 5.5±3.3) in the exercise-trained group were significantly greater than those observed in the control group respectively (p0.05).
CONCLUSIONS:
ET improves sympathetic response and executive performance during SCWT, suggesting a prominent positive impact of ET on prefrontal functioning in individuals with OSA. ClinicalTrials.gov: NCT002289625.
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Prognostic Value of Cardiopulmonary Exercise Test Parameters in Ventricular Assist Device Therapy.
ASAIO J2021 Sep;():. doi: 10.1097/MAT.0000000000001571.
Dorken Gallastegi Ander, Ergi Güne? D, Kahraman Ümit, Ya?mur Burcu, Çinar Ece, Karapolat Hale, Nalbantgil Sanem, Engin Ça?atay, Ya?di Tahir, Özbaran Mustafa,
Abstract
Cardiopulmonary exercise test (CPET) parameters are established prognosticators in heart failure. However, the prognostic value of preimplantation and postimplantation CPET parameters in left ventricular assist device (LVAD) therapy is unclear and it is evaluated in this study. Adult patients who were implanted with an LVAD and underwent CPET during the preimplantation or postimplantation period were retrospectively analyzed. Five CPET parameters were calculated: vO2 max, oxygen uptake efficiency slope (OUES), VE/vCO2 Slope, VE/vCO2 min, and VE/vCO2 max. The relationship between CPET parameters and postimplantation outcomes was evaluated with multivariable analysis. Pre and postimplantation CPET cohorts included 191 and 122 patients, respectively. Among preimplantation CPET parameters: vO2 max and OUES were associated with 1, 3, and 5 year mortality, VE/vCO2 min was associated with 3 and 5 year mortality, whereas VE/vCO2 Slope was associated with 5 year mortality. From postimplantation CPET parameters: vO2 max was an independent predictor of 3 and 5 year mortality, whereas VE/vCO2 max was an independent predictor of 3 year mortality following LVAD implantation. Preimplantation CPET parameters have a prognostic value for long-term survival following LVAD implantation, whereas their association with early postimplantation outcomes appears to be weaker. Postimplantation vO2 max and VE/vCO2 max values are associated with survival on device support and may provide a second chance for prognostication in patients without preimplantation CPET data.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players.
Sci Rep2021 09;11(1):17798. doi: 10.1038/s41598-021-97120-x.
Fikenzer S, Kogel A, Pietsch C, Lavall D, Stöbe St, Rudolph U, Laufs U, Hepp P, Hagendorff A,
Abstract
There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27?±?3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22?±?2.6 y). Infected athletes were examined 19?±?7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (-?17.7% vs.?-?18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping:?+?4.1 ms, p?=?0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (-?292 ml/min,?-?7.0%), oxygen pulse (-?2.4 ml/beat,?-?10.4%), and respiratory minute volume (VE) (-?18.9 l/min,?-?13.8%) in athletes with a history of SARS-CoV2 infection (p?0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.
© 2021. The Author(s).
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Exercise Dose and Aerobic Fitness Response in Alzheimer's Dementia in the FIT-AD Trial.
Int J Sports Med2021 Sep;():. doi: 10.1055/a-1639-2307.
Salisbury Dereck, Mathiason Michelle A, Yu Fang,
Abstract
The purpose of this study was to examine the effects of a 6-month cycling aerobic exercise intervention on cardiorespiratory fitness and the dose-response relationship in community-dwelling older adults with mild-to-moderate Alzheimer's dementia. The FIT-AD trial was a single blind, 2-parallel group, pilot randomized controlled trial. The aerobic exercise group participated in a 6-month, thrice weekly, moderate-vigorous intensity cycling intervention while control group performed stretching. Cardiorespiratory fitness was evaluated by peak oxygen consumption from cardiopulmonary exercise test and peak walking distance from the shuttle walk test and 6-minute walk test. Aerobic exercise dose was calculated using the novel heart rate physical activity score. The aerobic exercise group significantly increased peak oxygen consumption (1.28 ml/kg/min; p=.03) in subgroup who achieved maximal criteria on cardiopulmonary exercise test. Changes in peak oxygen consumption and peak walking distance on the shuttle walk and 6-minute walk tests did not significantly differ between aerobic exercise and stretching groups. Notably, the aerobic exercise dose was strongly and significantly correlated to change in peak oxygen consumption (r=.60; n=16; p=.01), in subset who met maximal test criteria. Emphasis on exercise dose is needed in aerobic exercise programs to maximize cardiorespiratory fitness gains in persons with mild-moderate Alzheimer's dementia.
Thieme. All rights reserved.
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