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Pubblicazioni recenti - cardiopulmonary exercise
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Cardiorespiratory Fitness Is Associated With Better Cardiometabolic Health and Lower PTSD Severity in Post-9/11 Veterans.
Mil Med2020 Feb;():. doi: usaa005.
Whitworth James W, Hayes Scott M, Andrews Ryan J, Fonda Jennifer R, Beck Brigitta M, Hanlon Lilly B, Fortier Catherine B, Milberg William P, McGlinchey Regina E,
Abstract
INTRODUCTION:
Post-traumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular and metabolic diseases and physical inactivity. Cardiorespiratory fitness (CRF), which is modifiable by physical activity, is a strong independent predictor of cardiometabolic health. However, the relationship between CRF and cardiometabolic health in veterans with PTSD is unknown. Thus, this study aimed to explore the cross-sectional relationships among CRF, indices of cardiometabolic health (ie, HbA1c, blood lipids, blood pressure, waist-hip ratio, and body mass index), and PTSD severity in veterans with PTSD.
MATERIALS AND METHODS:
This study was approved by the local Institutional Review Board. All participants were informed of the study risks and provided consent prior to participation. Participants (n = 13) completed a cardiopulmonary exercise test, a fasting blood draw, and the Clinician Administered PTSD Scale. Correlations between CRF and cardiometabolic health were examined with Spearman's rank correlations, and differences in PTSD symptom severity were explored as a function of CRF (ie, low-to-moderate vs. high CRF), using multiple linear regression.
RESULTS:
Peak oxygen uptake ($\dot{\mathrm{V}}$O2peak) was correlated with high-density lipoproteins rho = 0.60, P = 0.04 and diastolic blood pressure rho = -0.56, P = 0.05. Ventilatory threshold was correlated with HbA1c rho = -0.61, P = 0.03 and diastolic blood pressure rho = -0.56, P = 0.05. Higher CRF was associated with lower total PTSD severity standardized ? = -0.84, P = 0.01, adjusted R2 = 0.47, total Cluster C symptoms (avoidance/numbing) ? = -0.71, P = 0.02, adjusted R2 = 0.49, and total Cluster D symptoms (hyperarousal) ? = -0.89, P = 0.01, adjusted R2 = 0.41, while adjusting for age and smoking status.
CONCLUSIONS:
These preliminary findings suggest that CRF and by proxy physical activity may be important factors in understanding the increased risk of cardiovascular and metabolic disease associated with PTSD.
Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by US Government employees and is in the public domain in the US.
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The Effect of Transition Period on Performance Parameters in Elite Female Soccer Players.
Int J Sports Med2020 Feb;():. doi: 10.1055/a-1103-2038.
Parpa Koulla Parpa, Michaelides Marcos A,
Abstract
The purpose of this study was to examine the effect of a 4-week off-season period (transition period) on the anthropometric and performance parameters in elite female soccer players who participated in the UEFA women's Champions league. Eighteen female players (age 23.6±4.3 years) underwent testing at the end of the competitive period and right after the transition period. An incremental cardiopulmonary testing, body composition assessment and isokinetic testing at 60 °/sec were performed on both occasions. The cardiopulmonary exercise testing revealed that VO (p=0.001) and time on the treadmill (p=0.000) were significantly reduced after the transition period that included a 2 times/week exercise regimen. Furthermore, the quadriceps torque production at 60 °/s was significantly reduced for both the right (p=0.013) and left quadriceps (p=0.004) following the transition period. Finally, body weight (p=0.001) and body fat (p=0.000) significantly increased after 4 weeks of significantly reduced training volume. It is concluded that the transition period negatively affected the anthropometric and performance parameters of the female players. These data maybe informative for coaches and trainers as they demonstrate that despite the efforts to keep the players physically active the performance parameters decreased significantly.
© Georg Thieme Verlag KG Stuttgart · New York.
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[Guidance to the Interpretation of Cardiopulmonary Exercise Testing].
Pneumologie2020 Feb;74(2):88-102. doi: 10.1055/a-1069-0611.
Glaab T, Schmidt O, Fritsch J,
Abstract
Cardiorespiratory fitness has been established as an independent overall predictor of morbidity and mortality. However, patients' symptoms or stated levels of exercise intolerance correlate only poorly with resting functional and imaging tests. Cardiopulmonary exercise testing (CPET) is the gold standard for the integrative assessment of the cardiocirculatory, pulmonary and metabolic response to exercise and can help identify the source of exercise limitation, monitor disease progression, evaluate treatment responsiveness and inform about prognosis. Though CPET offers more valuable and pertinent information with slightly more expenditure of time compared to other methods even at submaximal exercise levels, it remains underutilized for various reasons such as costs, reimbursement and expertise. CPET can be seen as a complex, but not necessarily difficult tool. The objective of this review was to provide a description of the underlying principles of physiology, and an easy-to-follow guidance to indications, methodology, and interpretative strategies of CPET.
© Georg Thieme Verlag KG Stuttgart · New York.
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Development and testing of a low cost simulation manikin for extracorporeal cardiopulmonary resuscitation (ECPR) using 3-dimensional printing.
Resuscitation2020 Feb;149():24-29. doi: S0300-9572(20)30058-7.
Pang G, Futter C, Pincus J, Dhanani J, Laupland K B,
Abstract
BACKGROUND:
There has been an explosive growth of ECPR within new and established ECMO programs worldwide with the concomitant need for simulation trainers. However, current commercially available ECMO simulation models are expensive and lack many standard cardiorespiratory resuscitative (CPR) features.
OBJECTIVE:
To use 3-dimensional (3D) printing to develop a training manikin for comprehensive ECPR simulation.
METHODS:
A standard commercially available CPR manikin with airway model was used as the base model for modification. An inexpensive 3D printer was used to print a modular plastic pelvis. A medical silicone gel incorporated silicone femoral vasculature component was manufactured with connection to a gravity fed vascular system.
RESULTS:
The resulting modified manikin included the modular in-house designed ECMO cannulation and vascular structures wedded to the commercially available airway and CPR components. In simulation exercise involving first responders, paramedics, and emergency and critical care physicians, the model was reported as realistic with ultrasound views, cannulation, and resuscitative components functional. The entire cost for development of the ECMO component was estimated at $2000 Australian dollars AUD, including the printer purchase and supplies. Future reuse of components is estimated to cost less than $5 AUD per simulation run.
CONCLUSIONS:
A novel in-house modified manikin for ECPR was developed that was cost-efficient and realistic to use from first response through to establishment of ECMO circulation.
Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.
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Developing and validating equations to predict [Formula: see text]O peak from the 6MWT in Childhood ALL Survivors.
Disabil Rehabil2020 Feb;():1-8. doi: 10.1080/09638288.2020.1725159.
Labonté Jennifer, Caru Maxime, Lemay Valérie, Alos Nathalie, Drouin Simon, Bertout Laurence, Andelfinger Gregor, Krajinovic Maja, Laverdière Caroline, Sinnett Daniel, Curnier Daniel,
Abstract
The 6-Minute Walking Test (6MWT) is a safe, standardized and well utilized method to assess the functional capacity. Recently, it was reported that the published prediction equations cannot accurately predict a valid maximal oxygen consumption ([Formula: see text]O peak) value in cancer survivors. Thus, the aim of this study was to establish and to validate a new equation based on the 6MWT to predict [Formula: see text]O peak in childhood acute lymphoblastic leukemia (ALL) survivors. A total of 200 childhood ALL survivors were enrolled in this study, among which 168 participants underwent a cardiopulmonary exercise test and a 6MWT to assess their functional capacity and their cardiorespiratory fitness. In addition, participants completed a physical activity questionnaire. Participants were randomly divided in two groups to establish the equations (?=?118 (70%)) and to validate it (?=?50 (30%)). Multiple linear regression analyses were used to determine a new prediction equation for [Formula: see text]O peak from 6MWT using clinical and specific variables related to the disease. The accuracy in between [Formula: see text]O peak measured and [Formula: see text]O peak predicted were assessed using the Bland and Altman method. The new establish clinical [Formula: see text]O peak equation is: [Formula: see text]O peak (mL.kg.min) = (-0.283*age(years)) - (0.099*weight(kg)) + (0.071*6MWD(meters)) -(0.135*HR end(bpm)) + 22.789 with a mean bias of 2.67?mL.kg.min (95% CI (-9.64 to 14.98)). The new establish disease-specific [Formula: see text]O peak equation is: [Formula: see text]O peak (mL.kg.min) = (-0.236*age(years)) - (0.094*weight(kg)) -(0.120*HR end(bpm)) + (0.067*6MWD(meters)) + (0.065*MVLPA(min/day)) - (0.204*DT(years)) + 25.145 with a mean bias of 2.51?mL.kg.min (95% CI (-9.98 to 15.01)). This is the first study that predicted [Formula: see text]O peak from a 6MWT using clinical and specific variables related to the disease of childhood ALL survivors. The availability of these newly established [Formula: see text]O peak equations makes them an accurate tool to provide a better follow-up and better adapted physical training for survivors. We invite researchers to use our assessment procedures for their further studies.IMPLICATIONS FOR REHABILITATIONIt is critical to understand the cardiorespiratory fitness of the childhood ALL survivorsThe maximal oxygen consumption (i.e., [Formula: see text]O peak) is recognized as the gold standard to measure the patient's cardiorespiratory fitness in the field of exercise physiologyThis study is novel and reports the validation of two new VO peak equations, from 6MWT, by using clinical and disease-specific variables of childhood ALL survivorsThe availability of such validated equations can better facilitate the follow-up of survivors' cardiorespiratory fitness, by relevant health care professionals and exercise physiologists.
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Phase I randomized single-blinded controlled study investigating the potential benefit of aerobic exercise in degenerative cerebellar disease.
Clin Rehabil2020 Feb;():269215520905073. doi: 10.1177/0269215520905073.
Barbuto Scott, Martelli Dario, Omofuma Isarime Babajide, Lee Nancy, Kuo Sheng-Han, Agrawal Sunil, Lee Seonjoo, O'Dell Michael, Stein Joel,
Abstract
OBJECTIVES:
To investigate whether people with cerebellar degeneration can perform rigorous aerobic exercise and to assess the clinical impact of training.
DESIGN:
Randomized single-blinded controlled, feasibility study comparing aerobic training to no training.
SETTING:
Home intervention, assessments conducted at an academic medical center.
SUBJECTS:
Twenty individuals with cerebellar degeneration caused by a range of genetic disorders.
INTERVENTION:
Aerobic training consisted of four weeks of stationary bicycle training, five times per week for 30-minute sessions. Intensity ranged from 65% to 80% of the participant's maximal heart rate determined during cardiopulmonary exercise testing.
MAIN MEASURES:
Primary outcome measure was change in the Scale for the Assessment and Rating of Ataxia scores. Recruitment rate, adherence, drop-out, and adverse events were also determined. The treatment was considered technically feasible if participants achieved target training frequency, duration, and intensity.
RESULTS:
The 20 participants mean age was 50?years (standard deviation 15.65?years) and average Scale for the Assessment and Rating of Ataxia score was 9.6 (standard deviation 3.13). Ten participants were randomized to aerobic training and 10 to no training. Seven participants in the aerobic group attained target training duration, frequency, and intensity. There was a mean reduction in ataxia severity of 2.1 points (standard deviation 1.26) with four weeks of aerobic training, whereas ataxia severity increased by 0.3 (standard deviation 0.62) in the control group over the same period. Walking speed, balance measures, and fitness also improved in individuals who performed aerobic exercise.
CONCLUSIONS:
Rigorous aerobic training is feasible in people with cerebellar degeneration. Improvements in ataxia, balance, and gait are promising.
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A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization.
Cardiol J2020 Feb;():. doi: 10.5603/CJ.a2020.0006.
Denegri Andrea, Rossi Valentina A, Vaghi Fabrizio, Di Muro Paolo, Regazzi Martino, Moccetti Tiziano, Pasotti Elena, Pedrazzini Giovanni B, Capoferri Mauro, Moccetti Marco,
Abstract
BACKGROUND:
Cardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT), and functional recovery remains under debate. The aim of the present study is to determine whether CR has a positive effect on physical exercise improvement and on pathological risk factors in IGT and diabetic patients with CAD.
METHODS:
One hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as a secondary endpoint.
RESULTS:
Euglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs, p = 0.018 vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 mL/min/kg to 22.5 ± 5.9, p = 0.003), while diabetic patients did not present a statistically significant trend (VO2-peak from 16.9 ± 4.4 mL/min/kg to 18.0 ± 3.8, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively).
CONCLUSIONS:
A multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.
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Active Participation in Outpatient Cardiac Rehabilitation Is Associated With Better Prognosis After Coronary Artery Bypass Graft Surgery?- J-REHAB CABG Study.
Circ J2020 Feb;():. doi: 10.1253/circj.CJ-19-0650.
Origuchi Hideki, Itoh Haruki, Momomura Shin-Ichi, Nohara Ryuji, Daida Hiroyuki, Masuda Takashi, Kohzuki Masahiro, Makita Shigeru, Ueshima Kenji, Nagayama Masatoshi, Omiya Kazuto, Adachi Hitoshi, Goto Yoichi,
Abstract
BACKGROUND:
There is little evidence regarding the effect of outpatient cardiac rehabilitation (CR) on exercise capacity or the long-term prognosis in patients after coronary artery bypass graft surgery (CABG). This study aimed to determine whether participation in outpatient CR improves exercise capacity and long-term prognosis in post-CABG Japanese patients in a multicenter cohort.Methods?and?Results:We enrolled 346 post-CABG patients who underwent cardiopulmonary exercise testing during early (2-3 weeks) and late (3-6 months) time points after surgery. They formed the Active (n=240) and Non-Active (n=106) CR participation groups and were followed for 3.5 years. Primary endpoint was a major adverse cardiac event (MACE): all-cause death or rehospitalization for acute myocardial infarction/unstable angina/worsening heart failure. Peak oxygen uptake at 3-5 months from baseline was significantly more increased in Active than in Non-Active patients (+26±24% vs. +19±20%, respectively; P<0.05), and the MACE rate was significantly lower in Active than Non-Active patients (3.4% vs. 10.5%, respectively; P=0.02). Multivariate Cox proportional hazard analysis showed that participation in outpatient CR was a significant prognostic determinant of MACE (P=0.03).
CONCLUSIONS:
This unique study showed that a multicenter cohort of patients who underwent CABG and actively participated in outpatient CR exhibited greater improvement in exercise capacity and better survival without cardiovascular events than their counterparts who did not participate.
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An unusual cause of exertional dyspnea in a 55 years old man.
Respir Med Case Rep2020 ;29():101004. doi: 10.1016/j.rmcr.2020.101004.
Vézina Félix-Antoine, Milad Daniel, Godbout Krystelle, Bernier Mélanie, Maltais François, Nadreau Éric, Sénéchal Mario,
Abstract
A 55-year-old former professional athlete reported out of proportion dyspnea on exertion. After a detailed cardiac investigation, a cardiopulmonary exercise test on an ergocycle demonstrated an abnormal and non-physiological ventilatory response characterized by a sharp rise in ventilation followed by a decrease while exercise workload was progressively increasing. This was accompanied by noisy breathing. A laryngoscopy with direct visualisation of larynx and vocal cord during voluntary eucapnic hyperventilation confirmed the diagnosis of exercise-induced laryngeal obstruction. The patient was treated with speech therapy and all the symptoms resolved. A second cardiopulmonary exercise test showed a normalisation of the ventilatory pattern during exercise. This case demonstrates the importance of recognizing the symptoms of an exercise-induced laryngeal obstruction regardless of age, and the effectiveness of the speech therapy on symptoms and on exercise testing.
© 2020 Published by Elsevier Ltd.
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Restrictive cardiac phenotype as primary cause of impaired aerobic capacity in Afro-Caribbean patients with val122ile variant transthyretin amyloid cardiomyopathy.
Amyloid2020 Feb;():1-8. doi: 10.1080/13506129.2020.1722098.
Monfort Astrid, Banydeen Rishika, Demoniere Fabrice, Courty Baptiste, Codiat Rebecca, Neviere Remi, Inamo Jocelyn,
Abstract
Impaired aerobic capacity in cardiac amyloidosis patients may be related to limited inotropic myocardial reserve and heart rate (HR) response limiting cardiac output rise. This study sought to investigate whether chronotropic incompetence (CI) and blunted HR recovery would be prevalent in patients with mutant transthyretin (ATTRv) cardiomyopathy. Eighteen ATTRv (Val122Ile) patients (72?±?8-year) and 15 age-matched controls (73?±?3-year) were prospectively enrolled. Patients' medical records, pulmonary function and cardiopulmonary exercise testing, including non-invasive cardiac hemodynamics and chronotropic response were studied. Compared with age-matched controls, maximal workload (91?±?8 65?±?20 watts) and peak VO (19.5?±?3.0 14.4?±?4.1?mL.kg.min) were lower in ATTRv patients. Despite reaching similar age-predicted maximal HR, ATTRv patients displayed smaller changes in stroke volume (SV) index relative to change in VO (49?±?26 67?±?18%). Adequate chronotropic-metabolic index was prevalent in ATTRv patients. HR recovery, as percent decrease in peak HR at 1 and 3-min, was blunded ATTv patients. In Val122Ile ATTRv patients, chronotropic response was appropriate relative to exercise intensity with only few patients displaying CI. HR response to exercise was further characterised by blunted HR recovery in ATTRv patients suggesting lower parasympathetic activity and greater sympathetic stimulation compared with controls.
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Exercise-Induced Oxygen Desaturation during the 6-Minute Walk Test.
Med Sci (Basel)2020 Jan;8(1):. doi: E8.
Gupta Raghav, Ruppel Gregg L, Espiritu Joseph Roland D,
Abstract
The 6-minute walk test (6MWT) is not intended to document oxygen (O) desaturation during exertion but is often used for this purpose. Because of this, it only has modest reproducibility in determining the need for ambulatory O therapy in patients with cardiopulmonary disease. The diagnostic and prognostic value of detecting exertional O desaturation is still unknown. The aims of this study were to estimate the prevalence of O desaturation during a 6MWT based on pulse oximetry measurements at the beginning and end of a 6MWT in a clinical population of patients with suspected cardiopulmonary disease and to determine whether the pulmonary function test (PFT) can predict exercise-induced desaturation during a 6MWT. This retrospective cohort study reviewed the results of the 6MWT and the PFT (i.e., spirometry, lung volumes, and diffusion capacity) of all patients who were evaluated for suspected cardiopulmonary disease at an academic medical center during a 5-year study period. The patients were categorized into three groups based on the change in O saturation by pulse oximetry (SpO) from start to end of the 6MWT: (1) SpO decreased by ?3%; (2) SpO unchanged (-2 ? ? ? 0%); and (3) SpO increased by ?1%. Demographic, anthropometric, and lung function measurements were analyzed to determine which factors predicted O desaturation during the 6MWT. Of the 319 patients who underwent the 6MWT and the PFT from November 2005 until December 2010 (mean age = 54 ± 0.78 years, 63% women, 58% Whites, body mass index = 29.63 ± 8.10 kg/m), 113 (35%) had a decreased SpO, 146 (46%) had no change, and 60 (19%) had an increased SpO from the start to end of test. Our bivariate analysis found age, spirometric measures, and diffusion capacity for carbon monoxide (DLCO) had statistically significant inverse associations with the SpO change category ( < 0.001). Both a 3% and 4% drop in SpO during the 6MWT were statistically significantly associated with an older age, a higher prevalence of obstruction, and reduced forced vital capacity (FVC), forced expiratory volume in one second (FEV), FEV/FVC, DLCO and 6-minute walk distance (6MWD). Multivariable logistic regression analyses revealed that only DLCO was a significant independent predictor of the change in SpO and a ? 4% O desaturation during a 6MWT. Receiver operating curve analysis indicates DLCO cut-off of 45% is 82% sensitive and 40% specific in identifying ?4% O desaturators, with an area under the curve of 0.788 ± 0.039 ( < 0.001). The prevalence of a ? 3% oxygen desaturation via pulse oximetry during a 6MWT in our clinical population of patients with suspected cardiopulmonary disease was 35%. Although age, spirometric lung volumes, and DLCO had statistically significant unadjusted inverse associations with the change in SpO during a 6MWT, the DLCO is the only significant independent predictor of both the magnitude of the change in SpO and the occurrence of O desaturation of at least 4%, respectively, during the test. Clinical Implications: A DLCO cut-off of 45% may be useful in identifying patients at risk for exertional hypoxemia during a 6MWT.
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Cardiovascular Functional Reserve Before and After Kidney Transplant.
JAMA Cardiol2020 Feb;():. doi: 10.1001/jamacardio.2019.5738.
Lim Kenneth, Ting Stephen M S, Hamborg Thomas, McGregor Gordon, Oxborough David, Tomkins Claudia, Xu Dihua, Thadhani Ravi, Lewis Gregory, Bland Rosemary, Banerjee Prithwish, Fletcher Simon, Krishnan Nithya S, Higgins Robert, Zehnder Daniel, Hiemstra Thomas F,
Abstract
Importance:
Restitution of kidney function by transplant confers a survival benefit in patients with end-stage renal disease. Investigations of mechanisms involved in improved cardiovascular survival have relied heavily on static measures from echocardiography or cardiac magnetic resonance imaging and have provided conflicting results to date.
Objectives:
To evaluate cardiovascular functional reserve in patients with end-stage renal disease before and after kidney transplant and to assess functional and morphologic alterations of structural-functional dynamics in this population.
Design, Setting, and Participants:
This prospective, nonrandomized, single-center, 3-arm, controlled cohort study, the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) study, included patients with stage 5 chronic kidney disease (CKD) who underwent kidney transplant (KTR group), patients with stage 5 CKD who were wait-listed and had not undergone transplant (NTWC group), and patients with hypertension only (HTC group) seen at a single center from April 1, 2010, to January 1, 2013. Patients were followed up longitudinally for up to 1 year after kidney transplant. Clinical data collection was completed February 2014. Data analysis was performed from June 1, 2014, to March 5, 2015. Further analysis on baseline and prospective data was performed from June 1, 2017, to July 31, 2019.
Main Outcomes and Measures:
Cardiovascular functional reserve was objectively quantified using state-of-the-art cardiopulmonary exercise testing in parallel with transthoracic echocardiography.
Results:
Of the 253 study participants (mean [SD] age, 48.5 [12.7] years; 141 [55.7%] male), 81 were in the KTR group, 85 in the NTWC group, and 87 in the HTC group. At baseline, mean (SD) maximum oxygen consumption (V?O2max) was significantly lower in the CKD groups (KTR, 20.7 [5.8] mL · min-1 · kg-1; NTWC, 18.9 [4.7] mL · min-1 · kg-1) compared with the HTC group (24.9 [7.1] mL · min-1 · kg-1) (P?
Conclusions and Relevance:
The findings suggest that kidney transplant is associated with improved cardiovascular functional reserve after 1 year. In addition, cardiopulmonary exercise testing was sensitive enough to detect a decline in cardiovascular functional reserve in wait-listed patients with CKD. Improved V?O2max may in part be independent from structural alterations of the heart and depend more on ultrastructural changes after reversal of uremia.
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Enhanced External Counterpulsation Efficacy on Exercise Endurance in COPD Patients and Healthy Subjects: A Pilot Randomized Clinical Trial.
Int J Chron Obstruct Pulmon Dis2020 ;15():25-31. doi: 10.2147/COPD.S225566.
Zhao Mingming, Huang Yanqun, Li Lian, Zhou Ling, Wu Zhixin, Liu Yujun, Zhang Haozhe, Hu Caiyou,
Abstract
Purpose:
Enhanced external counterpulsation (EECP) is popular in China for the treatment of coronary heart diseases, but it may be an effective treatment for other populations. This study aimed to explore the effect of EECP on exercise endurance of healthy people and chronic obstructive pulmonary disease (COPD) patients and provide intervention measures to improve their physical condition.
Patients and methods:
Patients were enrolled in this pilot randomized controlled trial at Jiangbin Hospital, China, between March 1st and May 30th, 2018. They were randomly divided into the EECP and non-EECP groups. According to their maximal oxygen uptake, the volunteers were also sub-grouped into the normal, low exercise endurance, and COPD subgroups. Differences in exercise endurance were evaluated between the EECP and non-EECP groups before and after treatment. Cardiopulmonary exercise testng included anaerobic threshold oxygen uptake (AT-VOKg), maximum oxygen uptake (Max-VOKg), anaerobic threshold pulse (AT-Opuls), anaerobic threshold metabolic equivalent (AT-Mets), and maximum metabolic equivalent (Max-Mets).
Results:
72 volunteers were enrolled. The EECP and non-EECP groups were similar in terms of age, sex, body mass index, blood pressure, heart rate, breathing frequency, AT-VOKg, Max-VOKg, AT-Opuls, AT-Mets, and Max-Mets (P > 0.05) before treatment. EECP significantly improved AT-VOKg, Max-VOKg, AT-Opuls, AT-Mets, and Max-Mets compared with the non-EECP group (P<0.05). When analyzed according to sub-groups, the AT-VOKg, Max-VOKg, AT-Opuls, AT-Mets, and Max-Mets of the normal, low exercise endurance, and COPD subgroups were all significantly increased after EECP (P<0.05).
Conclusion:
EECP significantly improved the exercise endurance of normal adults, low endurance adults, and COPD patients.
Registration number:
ChiCTR1900021993.
© 2020 Zhao et al.
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Clinical Evaluation of Deployed Military Personnel with Chronic Respiratory Symptoms: STAMPEDE (Study of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures) III.
Chest2020 Feb;():. doi: S0012-3692(20)30156-2.
Morris Michael J, Walter Robert J, McCann Edward T, Sherner John H, Murillo Christina, Barber Brian, Hunninghake John C, Holley Aaron B,
Abstract
BACKGROUND:
Chronic respiratory symptoms are frequently reported after southwest Asia deployment in support of combat operations. The full spectrum of clinical lung diseases related to these deployments is not well characterized.
METHODS:
Military personnel with chronic symptoms, primarily exertional dyspnea, underwent a standardized cardiopulmonary evaluation at two tertiary medical centers. Pulmonary function testing consisted of spirometry, lung volumes, diffusing capacity, impulse oscillometry, and bronchodilator testing. Further testing included methacholine challenge, exercise laryngoscopy, high resolution computed tomography, electrocardiogram, and transthoracic echocardiography.
RESULTS:
380 participants with mean age of 38.5 ± 8.4 years completed testing. Asthma was the most common diagnosis in 87 (22.9%) based on obstructive spirometry/IOS and evidence of airway hyperreactivity, while another 57 (15.0%) patients had reactivity with normal spirometry. Airway disorders included 25 (6.6%) with laryngeal disorders and 16 (4.2%) with excessive dynamic airway collapse. Interstitial lung disease was identified in six patients (1.6%), while 11 patients (2.9%) had fixed obstructive lung disorders. Forty patients (10.5%) had isolated pulmonary function abnormalities and 16 (4.2%) with miscellaneous disorders. The remaining 122 (32.1%) patients with normal studies were classified as undiagnosed exertional dyspnea. Significant co-morbidities identified included elevated body mass index > 30 kg/m (34.2%), smoking (36.4%), positive allergy testing (43.7%), sleep apnea (38.5%), and esophageal reflux (13.6%). Mental health disorders and post-traumatic stress disorder were likewise common.
CONCLUSION:
Post-deployment pulmonary evaluation should focus on common diseases such as asthma and airway hyperreactivity, and include testing for upper airway disorders. Diffuse lung diseases were rarely diagnosed while numerous co-morbidities were common.
Copyright © 2020. Published by Elsevier Inc.
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Influence of Complications of Diabetes Mellitus on Exercise Tolerance of Patients with Heart Failure: Focusing on autonomic nervous activity and heart rate response during cardiopulmonary exercise tests.
Phys Ther Res2019 ;22(2):81-89. doi: 10.1298/ptr.E9979.
Ishihara Kodai, Morisawa Tomoyuki, Kawada Junko, Nagare Yuko, Koyama Takuya, Yagi Hikari, Sueoka Mayuko, Yoshida Toshinobu, Tamaki Akira,
Abstract
PURPOSE:
The purpose of this study was to clarify the influence of complications of diabetes on the exercise tolerance of patients with heart failure.
METHODS:
The subjects of this study were 69 patients (44 men; mean age: 62.2 ± 13.4 years) who were hospitalized and diagnosed with heart failure between November 2016 and November 2017. The subjects all took part in a cardiopulmonary exercise test. The patients' medical background, indexes obtained from lower-limb muscle strength and the cardiopulmonary exercise test, heart rate response indexes [? heart rate (?HR)], and autonomic nervous activities were measured, and these individual indexes were compared between the diabetic group and the non-diabetic group.
RESULTS:
Compared with the non-diabetic group, the peak oxygen uptake (peak V?O) and ?HR in the diabetic group were significantly lower (13.0 ± 2.2 vs. 14.9 ± 4.4 ml/kg/min and 27.2 ± 11.7 vs. 36.7 ± 14.7 bpm, respectively) (p<0.05). Regarding the autonomic nervous activity during the cardiopulmonary exercise test in the diabetic group, there was a significant decrease of parasympathetic nerve activity and a significant lack of increase in sympathetic nerve activity (p<0.05).
CONCLUSIONS:
Patients with heart failure and diabetes had lower levels of exercise tolerance, as compared with patients without complications. It was suggested that the decrease in heart rate response was due to the decrease of autonomic nervous activity and that this may play a role in reduced exercise tolerance.
2019, JAPANESE PHYSICAL THERAPY ASSOCIATION.
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Performance of cardiopulmonary exercise testing for the prediction of post-operative complications in non cardiopulmonary surgery: A systematic review.
PLoS One2020 ;15(2):e0226480. doi: 10.1371/journal.pone.0226480.
Stubbs Daniel J, Grimes Lisa A, Ercole Ari,
Abstract
INTRODUCTION:
Cardiopulmonary exercise testing (CPET) is widely used within the United Kingdom for preoperative risk stratification. Despite this, CPET's performance in predicting adverse events has not been systematically evaluated within the framework of classifier performance.
METHODS:
After prospective registration on PROSPERO (CRD42018095508) we systematically identified studies where CPET was used to aid in the prognostication of mortality, cardiorespiratory complications, and unplanned intensive care unit (ICU) admission in individuals undergoing non-cardiopulmonary surgery. For all included studies we extracted or calculated measures of predictive performance whilst identifying and critiquing predictive models encompassing CPET derived variables.
RESULTS:
We identified 36 studies for qualitative review, from 27 of which measures of classifier performance could be calculated. We found studies to be highly heterogeneous in methodology and quality with high potential for bias and confounding. We found seven studies that presented risk prediction models for outcomes of interest. Of these, only four studies outlined a clear process of model development; assessment of discrimination and calibration were performed in only two and only one study undertook internal validation. No scores were externally validated. Systematically identified and calculated measures of test performance for CPET demonstrated mixed performance. Data was most complete for anaerobic threshold (AT) based predictions: calculated sensitivities ranged from 20-100% when used for predicting risk of mortality with high negative predictive values (96-100%). In contrast, positive predictive value (PPV) was poor (2.9-42.1%). PPV appeared to be generally higher for cardiorespiratory complications, with similar sensitivities. Similar patterns were seen for the association of Peak VO2 (sensitivity 85.7-100%, PPV 2.7-5.9%) and VE/VCO2 (Sensitivity 27.8%-100%, PPV 3.4-7.1%) with mortality.
CONCLUSIONS:
In general CPET's 'rule-out' capability appears better than its ability to 'rule-in' complications. Poor PPV may reflect the frequency of complications in studied populations. Our calculated estimates of classifier performance suggest the need for a balanced interpretation of the pros and cons of CPET guided pre-operative risk stratification.
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Establishing Reference Cardiorespiratory Fitness Parameters in Alzheimer's Disease.
Sports Med Int Open2020 Jan;4(1):E1-E7. doi: 10.1055/a-1089-4957.
Salisbury Dereck, Yu Fang,
Abstract
Evidence is growing for aerobic exercise training as a viable means to attenuate cognitive losses associated with Alzheimer's disease. The mechanism of action for aerobic exercise's cognitive benefits is likely enhanced cardiorespiratory fitness and its response to incremental aerobic exercise have been incompletely evaluated in Alzheimer's disease. The aim of this analysis was to establish cardiorespiratory fitness reference values in older adults with mild to moderate Alzheimer's disease using a cardiopulmonary graded exercise testing. Ninety-seven community-dwelling older adults with mild to moderate Alzheimer's disease underwent a symptom limited cardiopulmonary graded exercise test on a cycle ergometer. Differences between sexes and between Alzheimer's disease participants with and without diagnosis of cardiovascular diseases were assessed by independent T-tests. Peak oxygen consumption was 10-20% lower than those achieved by similar clinical populations on treadmill tests. As expected, males produced significantly higher peak oxygen consumption compared to females (p?=0?.02). However, the presence of concurrent cardiovascular disease did not result in statistically significant lower peak oxygen consumption compared to those without cardiovascular disease. These data provide a frame of reference for metabolic, cardiovascular, and ventilatory function during cardiopulmonary graded exercise testing performed on cycle ergometer in older adults with mild to moderate Alzheimer's disease.
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Safety and Utility of Cardiopulmonary Exercise Testing in Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.
J Am Heart Assoc2020 Feb;9(3):e013695. doi: 10.1161/JAHA.119.013695.
Scheel Paul J, Florido Roberta, Hsu Steven, Murray Brittney, Tichnell Crystal, James Cynthia A, Agafonova Julia, Tandri Harikrishna, Judge Daniel P, Russell Stuart D, Tedford Ryan J, Calkins Hugh, Gilotra Nisha A,
Abstract
Background Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is characterized by high arrhythmic burden and progressive heart failure, which can prompt referral for heart transplantation. Cardiopulmonary exercise testing (CPET) has an established role in risk stratification for advanced heart failure therapies, but has not been described in ARVC/D. This study sought to determine the safety and prognostic utility of CPET in patients with ARVC/D. Methods and Results Using the Johns Hopkins ARVC/D Registry, we examined patients with ARVC/D undergoing CPET. Baseline characteristics and transplant-free survival were compared on the basis of peak oxygen consumption (pVO2) (?14 or >14 mL/kg per minute) and ventilatory efficiency (Ve/VCO slope ?34 or >34). Thirty-eight patients underwent 50 CPETs. There were no sustained arrhythmic events. Twenty-nine patients achieved a maximal test. Patients with pVO2 ?14 mL/kg per minute were more often men (=0.042) compared with patients with pVO2 >14 mL/kg per minute. Patients with Ve/VCO slope >34 tended to have more moderate/severe right ventricular dilation (7/9 [78%] versus 10/26 [38%]; =0.060) and clinical heart failure (8/9 [89%] versus 13/26 [50%]; =0.056) compared with patients with Ve/VCO slope ?34. Patients who underwent heart transplantation were more likely to have clinical heart failure (10/10 [100%] versus 13/28 [46%]; =0.003). Patients with Ve/VCO slope >34 had worse transplant-free survival compared with patients with Ve/VCO slope ?34 (n=35; hazard ratio, 6.57 [95% CI, 1.28-33.72]; log-rank =0.010), whereas transplant-free survival was similar on the basis of pVO2 groups (n=29; hazard ratio, 3.38 [95% CI, 0.75-15.19]; log-rank =0.092). Conclusions CPET is safe to perform in patients with ARVC/D. Ve/VCO slope may be used for risk stratification and guide referral for heart transplantation in ARVC/D.
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Routine exercise-based cardiac rehabilitation does not increase aerobic fitness: A CARE CR study.
Int J Cardiol2020 Jan;():. doi: S0167-5273(19)35211-8.
Nichols S, Taylor C, Goodman T, Page R, Kallvikbacka-Bennett A, Nation F, Clark A L, Birkett S T, Carroll S, Ingle L,
Abstract
BACKGROUND:
Recent evidence suggests that routine exercise-based cardiac rehabilitation (CR) may not lead to a substantial increase in estimated peak oxygen uptake (V?O). This could reduce the potential benefits of CR and explain why CR no longer improves patient survival in recent studies. We aimed to determine whether routine exercise-based CR increases V?O using gold-standard maximal cardiopulmonary exercise testing (CPET), and to quantify the exercise training stimulus which might be insufficient in patients undertaking CR.
METHODS:
We studied the effects of a routine, twice weekly, exercise-based CR programme for eight weeks (intervention group) compared with abstention from supervised exercise training (control group) in patients with coronary heart disease. The primary outcome was V?O measured using CPET. We also measured changes in body composition using dual X-ray absorptiometry, carotid intima-media thickness, hs-CRP and N-terminal pro B-type natriuretic peptide at baseline, 10 weeks and 12 months. We also calculated the Calibre 5-year all-cause mortality risk score.
RESULTS:
Seventy patients (age 63.1 SD10.0 years; BMI 29.2 SD4.0 kg·m; 86% male) were recruited (n = 48 intervention; n = 22 controls). The mean aerobic exercise training duration was 23 min per training session, and the mean exercise training intensity was 45.9% of heart rate reserve. V?O was 23·3 ml·kg·min at baseline, and there were no changes in V?O between groups at any time point. The intervention had no effect on any of the secondary endpoints.
CONCLUSION:
Routine CR does not lead to an increase in V?O and is unlikely to improve long-term physiological outcomes.
Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.
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Cardiorespiratory function and VO kinetics after sleeve gastrectomy: a follow-up analysis.
Intern Emerg Med2020 Feb;():. doi: 10.1007/s11739-020-02279-2.
Daniel Neunhaeuserer, Francesco Savalla, Andrea Gasperetti, Anna Rami, Stefano Gobbo, Cristina Campi, Anna Belligoli, Luca Busetto, Mirto Foletto, Roberto Vettor, Marco Bergamin, Andrea Ermolao,
Abstract
Although poor cardiorespiratory function is a powerful predictor of mortality in patients with obesity, functional evaluation has been given little attention after laparoscopic sleeve gastrectomy (LSG). The aim of this study was thus to investigate the impact of LSG on functional capacity analysing a shorter and longer post-surgical follow-up. In this observational study, 24 patients with severe obesity (BMI 44.04?±?5.84 kg/m, age 47.0?±?9.0 years) performed cardiopulmonary exercise testing 7 months pre-, 6 and 16 months post-LSG. Exercise capacity, oxygen uptake and VO kinetics were analysed during treadmill exercise testing. Although patients showed an improved peak work capacity after LSG, parameters of maximal absolute aerobic capacity demonstrated a significant decrease, which was confirmed also in the follow-up analysis. Furthermore, the time constant Tau (?) of the fundamental component of VO kinetics was altered by LSG, however, within the 16 months of follow-up it returned towards baseline values. It can thus be concluded that LSG improved peak work capacity along with a lower maximal absolute aerobic capacity, which might be due to a loss of muscle mass and potentially impaired peripheral oxidative muscle metabolism. However, VO kinetics might suggest an initial restoration of peripheral oxidative muscle capacity after a longer follow-up.
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