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Pubblicazioni recenti - cardiopulmonary exercise
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[Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with ?Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease].
Zhongguo Fei Ai Za Zhi2022 Jan;25(1):14-20. doi: 10.3779/j.issn.1009-3419.2021.102.51.
Yu Zhonghua, Xie Guosheng, Qin Changlong, Qiu Xiaoming,
Abstract
BACKGROUND:
Chronic obstructive pulmonary diseases (COPD) affects 45%-63% of lung cancer patients worldwide. Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk, and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer. Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients, but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training. This study intends to explore the effects of postoperative exercise training on exercise endurance, daily activity and lung function of lung cancer patients with COPD.
METHODS:
Seventy-four patients with non-small cell lung cancer (NSCLC) complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5, 2020 to August 25, 2021 were prospectively analyzed. They were randomly divided into exercise group and control group; The patients in the two groups received routine postoperative rehabilitation in the first week after operation, and the control group was given routine nursing from the second week. On this basis, the exercise group received postoperative exercise rehabilitation training for two weeks. Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation.
RESULTS:
The exercise endurance, daily activity and pulmonary function test results of the two groups decreased from baseline to the end point. However, after the operation and intervention program, the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group [(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]. The average number of we-chat steps in the exercise group was also significantly better than that in the control group (4,381±397 vs 3,478±342, P=0.035). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the exercise group were better than those in the control group, but the difference did not reach a statistically significant level [(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467].
CONCLUSIONS:
Postoperative exercise rehabilitation training can improve exercise endurance and daily activity ability of patients with lung cancer complicated with COPD and promote postoperative rehabilitation.
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Effects of exercise rehabilitation in patients with long COVID-19.
Eur J Prev Cardiol2022 Jan;():. doi: zwac019.
Barbara Cristina, Clavario Piero, De Marzo Vincenzo, Lotti Roberta, Guglielmi Giulia, Porcile Annalisa, Russo Carmelo, Griffo Raffaele, Mäkikallio Timo, Hautala Arto Jorma, Porto Italo,
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Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide.
Ann Thorac Surg2022 Jan;():. doi: S0003-4975(22)00060-1.
Brat Kristian, Homolka Pavel, Merta Zdenek, Chobola Milos, Heroutova Michaela, Bratova Monika, Mitas Ladislav, Chovanec Zdenek, Horvath Teodor, Benej Michal, Ivicic Jaroslav, Svoboda Michal, Sramek Vladimir, Olson Lyle J, Cundrle Ivan,
Abstract
BACKGROUND:
Cardiopulmonary exercise testing parameters including ventilatory efficiency (V/VCO slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. V/VCO slope is closely related to the partial pressure of end-tidal carbon dioxide (PCO). We hypothesized PCO at rest predicts post-operative pulmonary complications.
METHODS:
Consecutive lung resection candidates were included in this prospective multicenter study. Post-operative respiratory complications were assessed from the first 30 post-operative days or from the hospital stay. Student t-test or Mann-Whitney U test was used for comparison. Multivariate stepwise logistic regression analysis was used to analyze association with the development of post-operative pulmonary complications. The De Long test was used to compare AUCs. Data are summarized as median (IQR).
RESULTS:
Three hundred fifty-three subjects were analyzed of which 59 (17%) developed post-operative pulmonary complications. PCO at rest was significantly lower [27 (24-30) vs. 29 (26-32) mmHg; P
CONCLUSIONS:
PCO at rest has similar prognostic utility as V/VCO slope suggesting rest PCO may be used for post-operative pulmonary complications prediction in lung resection candidates.
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Prescribing walking training in interstitial lung disease from the 6-minute walk test.
Physiother Theory Pract2022 Jan;():1-5. doi: 10.1080/09593985.2022.2029992.
Nakazawa Atsuhito, Dowman Leona M, Cox Narelle S, Brazzale Danny J, McDonald Christine F, Hill Catherine J, Lee Annemarie, Holland Anne E,
Abstract
INTRODUCTION AND OBJECTIVE:
Endurance training during PR requires exercise prescription at sufficient intensity to achieve physiological benefits. This analysis sought to investigate whether walking training prescribed from 6-minute walk test (6MWT) average speed provides an appropriate training intensity for people with ILD during PR.
METHODS:
Individuals with ILD completed cardiopulmonary exercise test (CPET) and 6MWT in random order. A 10-minute constant speed treadmill walk test (10MTW) was undertaken at 80% of the average 6MWT speed. Oxygen uptake (VO) was measured during all tests. Percentage VOpeak during 10MTW was main outcome measure.
RESULTS:
Eleven people with ILD (age 71 (8) years; forced vital capacity 73 (18) %predicted, 6-minute walk distance 481 (99) meters, and VOpeak during CPET 1.3 (0.2) L.min) undertook testing. Average VOpeak during 10MTW was 91 (18) % of CPET VOpeak [range 67-116%]. Participants who achieved a greater VOpeak during CPET walked at a smaller %VOpeak during 10MTW (r = -0.6; p = .04).
CONCLUSIONS:
For people with ILD, walking training prescribed at 80% of 6MWT average speed can provide adequate exercise training intensity for PR.
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Six-minute walk test distance does not reflect oxygen uptake in patients undergoing maintenance hemodialysis.
Clin Nephrol2022 Jan;():. doi: 10.5414/CN110556.
Sun Jiajia, Xu Qinjuan, Zhang Qing, Hu Huagang, Wang Li,
Abstract
AIMS:
By evaluating the exercise capacity of patients on maintenance hemodialysis (MHD), this study aimed to determine the representability of a 6-minute walk test (6MWT) distance for the cardiopulmonary endurance capacity of patients on MHD.
MATERIALS AND METHODS:
The volume of oxygen uptake (VO) at a respiratory exchange ratio equal to 1 (VO) was measured during a graded cycling test, and the 6MWT distance was tested in 27 Chinese patients on MHD and 44 age-matched non-MHD subjects (CON).
RESULTS:
VO in MHD was lower than the levels of CON (834.44 ± 232.73 and 1,255.08 ± 340.49 mL/min, respectively (t = 5.65, p
CONCLUSION:
Results indicate a significantly reduced cardiopulmonary endurance capacity and functional walk ability among Chinese patients on MHD. Moreover, 6MWT may not be a proper method to evaluate the cardiopulmonary endurance capacity of patients on MHD due to the absence of a correlation between 6MWT distance and oxygen uptake during exercise.
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Cardiorespiratory Responses During High-Intensity Interval Training Prescribed by Rating of Perceived Exertion in Patients After Myocardial Infarction Enrolled in Early Outpatient Cardiac Rehabilitation.
Front Cardiovasc Med2021 ;8():772815. doi: 10.3389/fcvm.2021.772815.
Dun Yaoshan, Hammer Shane M, Smith Joshua R, MacGillivray Mary C, Simmons Benjamin S, Squires Ray W, Liu Suixin, Olson Thomas P,
Abstract
We aimed to determine the cardiorespiratory responses during, and adaptations to, high-intensity interval training (HIIT) prescribed using ratings of perceived exertion (RPE) in patients after myocardial infarction (MI) during early outpatient cardiac rehabilitation (CR). We prospectively recruited 29 MI patients after percutaneous coronary intervention who began CR within 2 weeks after hospital discharge. Eleven patients (seven men; four women; age: 61 ± 11 yrs) who completed ?24 supervised HIIT sessions with metabolic gas exchange measured during HIIT once weekly for 8 weeks and performed pre- and post- CR cardiopulmonary exercise tests were included in the study. Each HIIT session consisted of 5-8 high-intensity intervals [HIIs, 1-min RPE 14-17 (Borg 6-20 scale)] and low-intensity intervals (LIIs, 4-min RPE 0.05). increased by an average of 9% from pre-CR to post-CR. No adverse events occurred. Our results demonstrate that HIIT can be effectively prescribed using RPE in MI patients during early outpatient CR. Participation in RPE-prescribed HIIT increases exercise workload and during exercise training without increased perception of effort or excessive increases in heart rate or blood pressure.
Copyright © 2022 Dun, Hammer, Smith, MacGillivray, Simmons, Squires, Liu and Olson.
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Exercise Intolerance, Benefits, and Prescription for People Living With a Fontan Circulation: The Fontan Fitness Intervention Trial (F-FIT)-Rationale and Design.
Front Pediatr2021 ;9():799125. doi: 10.3389/fped.2021.799125.
Tran Derek L, Gibson Hannah, Maiorana Andrew J, Verrall Charlotte E, Baker David W, Clode Melanie, Lubans David R, Zannino Diana, Bullock Andrew, Ferrie Suzie, Briody Julie, Simm Peter, Wijesekera Vishva, D'Almeida Michelle, Gosbell Sally E, Davis Glen M, Weintraub Robert, Keech Anthony C, Puranik Rajesh, Ugander Martin, Justo Robert, Zentner Dominica, Majumdar Avik, Grigg Leeanne, Coombes Jeff S, d'Udekem Yves, Morris Norman R, Ayer Julian, Celermajer David S, Cordina Rachael,
Abstract
Despite developments in surgical techniques and medical care, people with a Fontan circulation still experience long-term complications; non-invasive therapies to optimize the circulation have not been established. Exercise intolerance affects the majority of the population and is associated with worse prognosis. Historically, people living with a Fontan circulation were advised to avoid physical activity, but a small number of heterogenous, predominantly uncontrolled studies have shown that exercise training is safe-and for unique reasons, may even be of heightened importance in the setting of Fontan physiology. The mechanisms underlying improvements in aerobic exercise capacity and the effects of exercise training on circulatory and end-organ function remain incompletely understood. Furthermore, the optimal methods of exercise prescription are poorly characterized. This highlights the need for large, well-designed, multi-center, randomized, controlled trials. The Fontan Fitness Intervention Trial (F-FIT)-a phase III clinical trial-aims to optimize exercise prescription and delivery in people with a Fontan circulation. In this multi-center, randomized, controlled study, eligible Fontan participants will be randomized to either a 4-month supervised aerobic and resistance exercise training program of moderate-to-vigorous intensity followed by an 8-month maintenance phase; or usual care (control group). Adolescent and adult (?16 years) Fontan participants will be randomized to either traditional face-to-face exercise training, telehealth exercise training, or usual care in a three-arm trial with an allocation of 2:2:1 (traditional:telehealth:control). Children (
Copyright © 2022 Tran, Gibson, Maiorana, Verrall, Baker, Clode, Lubans, Zannino, Bullock, Ferrie, Briody, Simm, Wijesekera, D'Almeida, Gosbell, Davis, Weintraub, Keech, Puranik, Ugander, Justo, Zentner, Majumdar, Grigg, Coombes, d'Udekem, Morris, Ayer, Celermajer and Cordina.
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Rationale and design of the Early Chronic Obstructive Pulmonary Disease (ECOPD) study in Guangdong, China: a prospective observational cohort study.
J Thorac Dis2021 Dec;13(12):6924-6935. doi: 10.21037/jtd-21-1379.
Wu Fan, Zhou Yumin, Peng Jieqi, Deng Zhishan, Wen Xiang, Wang Zihui, Zheng Youlan, Tian Heshen, Yang Huajing, Huang Peiyu, Zhao Ningning, Sun Ruiting, Chen Rongchang, Ran Pixin,
Abstract
Background:
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease and its clinically relevant subtypes are not well understood. Which clinical characteristics are more likely to be present among individuals who develop COPD remains to be studied in depth. Therefore, we designed a prospective observational cohort study, entitled the Early Chronic Obstructive Pulmonary Disease (ECOPD) study, to fill this evidence gap. The ECOPD study has four specific aims: (I) identification of characteristics, parameters, and biomarkers that may predict the development of airflow obstruction and annual decline in lung function with normal spirometry; (II) identification of clinically relevant early COPD subtypes; (III) identification of characteristics, parameters, and biomarkers that may predict disease progression in these early COPD subtypes; (IV) development and validation of machine learning models to predict development of airflow obstruction and disease progression.
Methods:
We will recruit approximately 2,000 participants aged 40-80 years, including approximately 1,000 with COPD [post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)
Discussion:
The ECOPD study will provide insight into many aspects of early COPD and improve our understanding of COPD development, which may facilitate therapeutic interventions with the potential to modify the course of disease.
Trial Registration:
Chinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July, 2019.
2021 Journal of Thoracic Disease. All rights reserved.
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Deducing the Impact of Physical Activity, Sedentary Behavior, and Physical Performance on Cognitive Function in Healthy Older Adults.
Front Aging Neurosci2021 ;13():777490. doi: 10.3389/fnagi.2021.777490.
Gerten Sina, Engeroff Tobias, Fleckenstein Johannes, Füzéki Eszter, Matura Silke, Pilatus Ulrich, Vogt Lutz, Pantel Johannes, Banzer Winfried,
Abstract
Participating in physical activity and maintaining physical performance as well as reducing sedentary behavior are discussed to be beneficially associated with cognitive function in older adults. The purpose of this cross-sectional analysis was to differentiate the relevance of objectively measured physical activity, physical performance, and sedentary behavior on cognitive function in healthy older adults ( = 56, age = 76 ± 7 yrs, gender = 30 female). Accelerometer based physical activity and sedentary behavior were analyzed as minutes per week spent sedentary and physically active with light or moderate to vigorous intensity. Participants' physical performance was assessed via cardiopulmonary exercise testing and analyzed as maximal workload and heart rate, heart rate reserve and peak oxygen uptake. The assessment of cognitive function included working memory, attention, executive function, and verbal memory. Data was analyzed with Spearman and partial correlations. Trial registration: NCT02343029. Light physical activity was moderately associated with executive function ( = -0.339, = 0.015). Attention was significantly associated with maximal workload ( = -0.286, = 0.042) and peak oxygen uptake ( = -0.337, = 0.015). Working memory was associated with maximal workload ( = 0.329, = 0.017). Whereas a broad range of cognitive function were beneficially linked to physical performance, light intensity activities in particular showed an impact on executive function. Our research underlines the need to separate the impact of physical performance and physical activity on cognitive function and highlights the relevance of light physical activity.
Copyright © 2022 Gerten, Engeroff, Fleckenstein, Füzéki, Matura, Pilatus, Vogt, Pantel and Banzer.
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The aerobic capacity - fatigue relationship in persons with Multiple Sclerosis is not reproducible in a pooled analysis of two randomized controlled trials.
Mult Scler Relat Disord2021 Dec;58():103476. doi: S2211-0348(21)00742-2.
Wolf Florian, Rademacher Annette, Joisten Niklas, Proschinger Sebastian, Schlagheck Marit Lea, Bloch Wilhelm, Gonzenbach Roman, Kool Jan, Bansi Jens, Zimmer Philipp,
Abstract
BACKGROUND:
Fatigue is one of the most frequent symptoms of persons with Multiple Sclerosis (pwMS) but has limited treatment options. Aerobic capacity and endurance training have been discussed as relevant factors to improve fatigue. However, over the last decades, results have been equivocal. This secondary analysis of two pooled parallel group RCTs of three weeks of endurance training (high intensity interval training (HIIT) and moderate continuous training (MCT)) for pwMS aimed to (I) reproduce reported associations between aerobic capacity and fatigue on a cross-sectional and interventional level. The analysis further aimed to (II) investigate intervention effects on fatigue in a severely fatigued subgroup and (III) analyze differences in changes of fatigue between peak oxygen uptake (VO) responders and non-responders.
METHODS:
Both RCTs were conducted in the same inpatient rehabilitation clinic in Valens, Switzerland. Original primary outcomes were cognitive function (RCT1) and change in proportion of circulating regulatory T-cells (RCT2). PwMS (n = 131) with a relapsing-remitting or secondary progressive MS phenotype and Expanded Disability Status Scale score between 1 - 6.5 were eligible. Over the two studies participants exercised 3 - 5 times per week on cycle ergometers at intensities of 65 - 70% of maximum heart rate (HR) for 30 min (MCT groups) or three times per week with five 90 - 180 s intervals at intensities of 85% - 100% of HR and 90 s rest intervals (HIIT groups). Main outcome measures for the present secondary analysis were VO measured during a cardiopulmonary exercise test and the Fatigue Scale for Motor and Cognitive Functions (FSMC), both assessed at the start and end of inpatient rehabilitation.
RESULTS:
Baseline correlations did not reveal a significant association between VO and FSMC. There were no significant improvements in fatigue after the HIIT and MCT in the overall sample or the subsample of severely fatigued pwMS and no significant differences in fatigue changes between VO-responders and non-responders.
CONCLUSIONS:
Our analysis did not confirm the aerobic capacity - fatigue relationship on a cross-sectional and experimental level, even when analyzing subgroups that should benefit the most according to proposed hypotheses.
Copyright © 2021. Published by Elsevier B.V.
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How we do it - Using cardiopulmonary exercise testing to understand dyspnea and exercise intolerance in respiratory disease.
Chest2022 Jan;():. doi: S0012-3692(22)00145-3.
Stickland Michael K, Neder J Alberto, Guenette Jordan A, O'Donnell Denis E, Jensen Dennis,
Abstract
Cardiopulmonary exercise testing (CPET) is ideally suited to quantify exercise tolerance and evaluate the pathophysiological mechanism(s) of dyspnea and exercise limitation in people with chronic respiratory disease. While there are several statements on CPET and many outstanding resources detailing the cardiorespiratory and perceptual responses to exercise, there is limited information available to support the healthcare provider in conducting a practical CPET evaluation. This 'How we do it' manuscript provides the healthcare provider with practical and timely information on how to use CPET data to understand dyspnea and exercise intolerance in people with chronic respiratory diseases. Information on CPET protocol, as well as how to evaluate: 1) maximal patient effort, 2) peak rate of oxygen consumption, 3) ventilatory demand, 4) pulmonary gas exchange, 5) ventilatory reserve, 6) operating lung volumes, and 7) exertional dyspnea are presented. Two case examples are also described to highlight how these parameters are evaluated to provide a clinical interpretation of CPET data.
Copyright © 2022. Published by Elsevier Inc.
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Inhaled nitric oxide does not improve maximal oxygen consumption in endurance trained and untrained healthy individuals.
Eur J Appl Physiol2022 Jan;():. doi: 10.1007/s00421-021-04866-3.
Brotto Andrew R, Phillips Devin B, Meah Victoria L, Ross Bryan A, Fuhr Desi P, Beaudry Rhys I, van Diepen Sean, Stickland Michael K,
Abstract
PURPOSE:
Previous work suggests that endurance-trained athletes have superior pulmonary vasculature function as compared to untrained individuals, which may contribute to their greater maximal oxygen uptake ([Formula: see text]O). Inhaled nitric oxide (iNO) reduces pulmonary vascular resistance in healthy individuals, which could translate into greater cardiac output and improved [Formula: see text]O, particularly in untrained individuals. The purpose of the study was to examine whether iNO improved [Formula: see text]O in endurance trained and untrained individuals.
METHODS:
Sixteen endurance-trained and sixteen untrained individuals with normal lung function completed this randomized double-blind cross-over study over four sessions. Experimental cardiopulmonary exercise tests were completed while breathing either normoxia (placebo) or 40 ppm of iNO, on separate days (order randomized). On an additional day, echocardiography was used to determine pulmonary artery systolic pressure at rest and during sub-maximal exercise (60 Watts) while participants breathed normoxia or iNO.
RESULTS:
Right ventricular systolic pressure was significantly reduced by iNO during exercise (Placebo: 34?±?7 vs. iNO: 32?±?7; p?=?0.04). [Formula: see text]O was greater in the endurance trained group (Untrained: 3.1?±?0.7 vs. Endurance: 4.3?±?0.9 L min; p?0.01), however, there was no effect of condition (p?=?0.79) and no group by condition interaction (p?=?0.68). Peak cardiac output was also unchanged by iNO in either group.
CONCLUSION:
Despite a reduction in right ventricular systolic pressure, the lack of change in [Formula: see text]O with iNO suggests that the pulmonary vasculature does not limit [Formula: see text]O in young healthy individuals, regardless of fitness level.
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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Assessment of Exercise Function in Children and Young Adults with Hypertrophic Cardiomyopathy and Correlation with Transthoracic Echocardiographic Parameters.
Pediatr Cardiol2022 Jan;():. doi: 10.1007/s00246-022-02822-2.
Przybylski Robert, Fischer Ilana R, Gauvreau Kimberlee, Alexander Mark E, Shafer Keri M, Colan Steven D, Miliaresis Christa, Rhodes Jonathan,
Abstract
Exercise function is well characterized in adults with hypertrophic cardiomyopathy (HCM); however, there is a paucity of data in children and young adults with HCM. Here we sought to characterize exercise function in young people with HCM, understand limitations in exercise function by correlating exercise function parameters with echocardiogram parameters and identify prognostic value of exercise parameters. We performed a retrospective, single-center cohort study characterizing exercise function in patients?26 years old with HCM undergoing cardiopulmonary exercise testing (CPET). Patients with syndromic HCM or submaximal effort were excluded. We compared exercise function in this cohort to population normal values and measured changes in exercise function over time. We correlated exercise function parameters with echocardiographic parameters and investigated the relationship between exercise test parameters and a clinical composite outcome comprised of significant ventricular arrhythmia, death, or heart transplantation. We identified 229 CPETs performed by 117 patients (mean age at time of first CPET 15.6?±?3.2 years). Mean %-predicted peak VO2, O2 pulse, and peak heart rate were statistically significantly depressed compared to population normal values and exercise function gradually worsened over time. Abnormal exercise testing correlated closely with echocardiographic indices of diastolic dysfunction. There was a trend toward increased incidence of poor clinical outcome in patients with abnormal exercise function. While adverse clinical outcomes were rare, normal exercise function appears to be a marker of low risk for adverse clinical outcomes in this population.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Effect of Weight Self-Stigma and Self-Esteem on Aerobic Exercise Capacity in Adult Women with Different Body Compositions.
Int J Environ Res Public Health2022 Jan;19(2):. doi: 873.
Aldhahi Monira I, Al Khalil Wafa K, Almutiri Rawan B, Alyousefi Mada M, Alharkan Bayader S, AnNasban Haya,
Abstract
BACKGROUND:
Overweight individuals face weight-related stigmatization, driving self-exclusion from exercise and physical activity. The extent to which weight self-stigma and self-esteem are associated with aerobic capacity remains unclear. Therefore, this study aimed to characterize the cardiopulmonary fitness, weight self-stigma, and self-esteem of overweight women and examine whether weight self-stigma and self-esteem predict cardiopulmonary aerobic capacity.
METHODS:
A cross-sectional study was conducted with 66 women stratified into two groups: a normal weight (NW) group and an overweight (OW) group. The mean body mass indexes and ages of the NW and OW groups were 20.4 ± 0.36 kg/m and 29.5 ± 0.8 kg/m, and 24 ± 7 years and 21 ± 3 years, respectively. Submaximal exercise testing using the modified Bruce treadmill protocol was conducted to measure the predicted oxygen uptake (VO) and energy expenditure. The Weight Self-Stigma Questionnaire and the Rosenberg Self-Esteem Scale were used.
RESULTS:
Significantly lower mean of predicted VO and higher mean of energy expenditure were reported in the OW group compared with the NW group (25.8 ± 5.3 mL/kg/min vs. 28.7 ± 4.8 mL/kg/min, = 0.001 and 9.7 ± 1.9 kcal/min vs. 7.5 ± 1.8 kcal, = 0.03, respectively). There was a significant difference in weight self-stigma and self-esteem between the groups. Regression model analysis indicated that weight self-stigma and self-esteem explained 45% of the variance in the predicted VO.
CONCLUSION:
Strategies enhancing self-esteem and avoiding stigmatization should be embraced to promote fitness and engagement in physical activity among OW women.
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Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET).
J Clin Med2022 Jan;11(2):. doi: 451.
Vriz Olga, Palatini Paolo, Rudski Lawrence, Frumento Paolo, Kasprzak Jaros?aw D, Ferrara Francesco, Cocchia Rosangela, Gargani Luna, Wierzbowska-Drabik Karina, Capone Valentina, Ranieri Brigida, Salzano Andrea, Stanziola Anna Agnese, Marra Alberto Maria, Annunziata Roberto, Chianese Salvatore, Rega Salvatore, Saltalamacchia Teresa, Maramaldi Renato, Sepe Chiara, Limongelli Giuseppe, Cademartiri Filippo, D'Andrea Antonello, D'Alto Michele, Izzo Raffaele, Ferrara Nicola, Mauro Ciro, Cittadini Antonio, Ekkehard Grünig, Guazzi Marco, Bossone Eduardo,
Abstract
BACKGROUND:
Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E' and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age.
METHODS:
EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively,
RESULTS:
Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E' that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E' but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E' and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (
CONCLUSION:
Age and HTN have a synergic negative effect on E/E' and TAPSE at peak exercise in hypertensive subjects.
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Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level.
J Cardiovasc Dev Dis2022 Jan;9(1):. doi: 26.
Leonardi Benedetta, Gentili Federica, Perrone Marco Alfonso, Sollazzo Fabrizio, Cocomello Lucia, Silva Kikina Stefani, Wald Rachel M, Palmieri Vincenzo, Secinaro Aurelio, Gagliardi Maria Giulia, Parisi Attilio, Turchetta Attilio, Galletti Lorenzo, Bianco Massimiliano, Drago Fabrizio,
Abstract
Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 ± 8.4 years) showed a reduction in exercise capacity (median peak VO 30 mL/kg/min (range 25-33); median percent predicted peak VO 68% (range 61-78)). Peak VO, correlated with biventricular stroke volumes (RVSV: ? = 6.11 (95%CI, 2.38 to 9.85), = 0.002; LVSV: ? = 15.69 (95% CI 10.16 to 21.21),
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Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study.
J Cardiovasc Dev Dis2022 Jan;9(1):. doi: 21.
Sakamoto Maaya, Suematsu Yasunori, Yano Yuiko, Kaino Koji, Teshima Reiko, Matsuda Takuro, Fujita Masaomi, Tazawa Rie, Fujimi Kanta, Miura Shin-Ichiro,
Abstract
BACKGROUND:
Cardiac rehabilitation (CR) combined with stress management training has been shown to be associated with fewer clinical events than CR alone. However, there have been no reports on the associations of CR with the psychological condition and detailed physical activities evaluated on the same day.
METHOD:
One hundred outpatients who participated in a CR program were graded on the hospital anxiety and depression scale (HADS). We divided them into a high HADS group ( = 32) and a normal HADS group ( = 68) and investigated by whole patients, ischemic heart disease (IHD) patients, and heart failure patients.
RESULTS:
Overall, the patient age was 70.5 ± 9.6 years, the percentage of males was 73.0%, and the body mass index was 23.4 (21.7-26.0) kg/m. In the high HADS group, overall functional mobility was poor and the distance in a two-minute walking test was short. Especially in IHD patients, the high HADS group showed high fat mass in body composition and low exercise tolerance and ventilator equivalents in cardiopulmonary exercise test.
CONCLUSIONS:
Depression and anxiety involved poor physical performance in CR outpatients and particularly involved low exercise tolerance in IHD patients. To evaluate accurate physical performance, it is necessary to investigate psychological condition.
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Abnormal whole-body energy metabolism in iron-deficient humans despite preserved skeletal muscle oxidative phosphorylation.
Sci Rep2022 Jan;12(1):998. doi: 10.1038/s41598-021-03968-4.
Frise Matthew C, Holdsworth David A, Johnson Andrew W, Chung Yu Jin, Curtis M Kate, Cox Pete J, Clarke Kieran, Tyler Damian J, Roberts David J, Ratcliffe Peter J, Dorrington Keith L, Robbins Peter A,
Abstract
Iron deficiency impairs skeletal muscle metabolism. The underlying mechanisms are incompletely characterised, but animal and human experiments suggest the involvement of signalling pathways co-dependent upon oxygen and iron availability, including the pathway associated with hypoxia-inducible factor (HIF). We performed a prospective, case-control, clinical physiology study to explore the effects of iron deficiency on human metabolism, using exercise as a stressor. Thirteen iron-deficient (ID) individuals and thirteen iron-replete (IR) control participants each underwent P-magnetic resonance spectroscopy of exercising calf muscle to investigate differences in oxidative phosphorylation, followed by whole-body cardiopulmonary exercise testing. Thereafter, individuals were given an intravenous (IV) infusion, randomised to either iron or saline, and the assessments repeated?~?1 week later. Neither baseline iron status nor IV iron significantly influenced high-energy phosphate metabolism. During submaximal cardiopulmonary exercise, the rate of decline in blood lactate concentration was diminished in the ID group (P?=?0.005). Intravenous iron corrected this abnormality. Furthermore, IV iron increased lactate threshold during maximal cardiopulmonary exercise by?~?10%, regardless of baseline iron status. These findings demonstrate abnormal whole-body energy metabolism in iron-deficient but otherwise healthy humans. Iron deficiency promotes a more glycolytic phenotype without having a detectable effect on mitochondrial bioenergetics.
© 2022. The Author(s).
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Hospice Care Services Associated With a Lower Utilization of Life-Sustaining Treatments During End-Of-Life Care Among People Living With HIV/AIDS: A Population-Based Cohort Study.
Am J Hosp Palliat Care2022 Jan;():10499091211072240. doi: 10.1177/10499091211072240.
Lai Yun-Ju, Ko Ming-Chung, Chan Shang-Yih, Chou Yi-Sheng, Wang Chun-Chieh, Ku Po-Wen, Chen Li-Jung, Hsu Li-Fei, Chuang Pei-Hung, Chen Chu-Chieh, Yen Yung-Feng,
Abstract
Hospice care involves improving quality of end-of-life (EOL) care and respecting patients' preferences regarding EOL treatment. However, the impact of hospice care services on the utilization of life-sustaining treatments during EOL care in patients with life-limiting diseases has not been extensively studied. This nationwide cohort study aimed to determine the impact of hospice care services on the utilization of life-sustaining treatments during the last 3 months of life among people living with HIV/AIDS (PLWHA) in Taiwan. From 2000 to 2018, we identified adult PLWHA from Taiwan centers for disease control HIV Surveillance System. HIV-infected individuals were defined as positive HIV-1 Western blot. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, and defibrillation. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression. Of 5691 PLWHA, 2595 (45.9%) subjects utilized life-sustaining treatments during the last 3 months of life. After adjusting for other covariates, PLWHA with hospice care services were less likely to receive life-sustaining treatments during the last 3 months of life than those without the services (adjusted odds ratio [AOR] = .50, 95% confidence interval [CI]: .37-.66). Considering the type of life-sustaining treatments, hospice care services were associated with lower likelihood of receiving cardiopulmonary resuscitation (AOR = .22, 95% CI: .13-.39), endotracheal intubation (AOR = .48, 95% CI: .35-.65), and mechanical ventilation support (AOR = .56, 95% CI: .42-.75). Hospice care services were associated with a lower utilization of life-sustaining treatments during the last 3 months of life among PLWHA.
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Feasibility of continuous epidural analgesia in patients with failed back surgery syndrome and spinal stenosis.
J Anesth2022 Jan;():. doi: 10.1007/s00540-022-03039-6.
Heck Vincent J, Himpe Bastian, Kessler Paul, Almajali Asem, Prasse Tobias, Schmidt Sven, Rauschmann Michael,
Abstract
PURPOSE:
The purpose of this study was to outline the feasibility of continuous epidural analgesia in the treatment of failed back surgery syndrome (FBSS) or spinal stenosis.
METHODS:
We queried our prospective collected institutional database to include all consecutive patients, who underwent continuous epidural analgesia with accompanying intensive physiotherapeutic exercise within a timeframe of 4 years. Patients suffered from FBSS or spinal stenosis; protocolled continuous epidural analgesia was planned for 4 days within the framework of an inpatient multimodal pain therapy concept. The instillation technique of the epidural catheter, the capability to attend in accompanying physiotherapy, and the peri-interventional complications were evaluated.
RESULTS:
153 patients with an average age of 57.4 years (±?11.9) were enrolled in this study. 105 patients suffered from FBSS and 48 patients had spinal stenosis. Overall, 148 patients (96.7%) reported the pain reduction and were able to perform daily intensified physiotherapeutic exercise. There were no serious adverse events, neither infection nor bleeding, no cardiopulmonary complication or permanent neurological deficits. The most common side effect was neurological impairment, such as numbness, dysesthesia, or weakness of the lower limbs with complete regression after flow rate adjustment. Patients with FBSS were more likely to develop dysesthesia (p?=?0.007).
CONCLUSIONS:
Continuous epidural analgesia is feasible in patients with FBSS or spinal stenosis. This treatment enables extensive physiotherapeutic treatment even in patients with severe pain conditions and can be considered as an alternative to epidural injections. An increased complication rate in comparison to short-term perioperative or perinatal application was not observed.
© 2022. The Author(s).
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