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Hüzmeli İ, Katayıfçı N, Abay B, Akkuş O, Özer AY. The effectiveness of functional inspiratory muscle training on exercise capacity and peripheral muscle strength in patients with essential hypertension: a three-arm randomized controlled trial. BMC Sports Sci Med Rehabil 2025; 17:29. [PMID: 40022256 PMCID: PMC11869749 DOI: 10.1186/s13102-025-01082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 02/14/2025] [Indexed: 03/03/2025]
Abstract
BACKGROUND The effect of inspiratory muscle training (IMT) applied along with function in Hypertension (HT) patients is uncertain. In this study, it was to determine the effectiveness of functional IMT (F-IMT) on functional lower and upper exercise capacity, mobility, peripheral and respiratory muscle strength, blood pressure, fatigue, physical activity, and quality of life (HRQoL) in HT patients. METHODS Prospective, randomized controlled, assessor-blinded, parallel three-armed trial. Forty-five patients with HT were divided into F-IMT group (IMT with 50% maximal inspiratory pressure (MIP)/4 weeks + exercise and IMT with 50% MIP/4 weeks, n = 15), IMT group (MIP 50%, n = 15) and control group (CG, breathing exercises, n = 15). 6-min walking test (6-MWT), 6-min pegboard ring test (6PBRT), 1-min sit to stand test (1STS), mobility, peripheral muscle strength, MIP, maximal expiratory pressure (MEP), systolic& diastolic blood pressure (SBP, DBP), fatigue, physical activity, and HRQoL were evaluated before and after 8 weeks of training. RESULTS Increases in 6-MWT were higher in F-IMT (p < 0.001). 6PBRT, 1STS, quadriceps femoris strength were improved and SBP reduced in F-IMT and IMT than CG (p < 0.001). Mobility, handgrip, HRQoL, and physical activity level increased within groups (p < 0.05). MIP increased within F-IMT and IMT; MEP, fatigue, DBP improved only within F-IMT (p < 0.05). CONCLUSIONS F-IMT is more effective in enhancing exercise capacity, reducing fatigue and DBP, and improving MEP. Both IMT and F-IMT show similar benefits for upper extremity exercise capacity, quadriceps femoris strength, SBP, and MIP. Mobility, HRQoL, and physical activity levels are increased with F-IMT, IMT, and breathing exercises. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT06343246 (03/29/2024).
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Affiliation(s)
- İrem Hüzmeli
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, 31000, Turkey.
| | - Nihan Katayıfçı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hatay Mustafa Kemal University, Hatay, 31000, Turkey
| | - Büşra Abay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Oğuz Akkuş
- Department of Cardiology, Tayfur Ata Sökmen Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Aysel Yıldız Özer
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Cheng J, Bu C, Zheng X. Prospective association of estimated cardiorespiratory fitness and risk of chronic kidney diseases. Sci Rep 2025; 15:5260. [PMID: 39939393 PMCID: PMC11821850 DOI: 10.1038/s41598-025-89569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 02/06/2025] [Indexed: 02/14/2025] Open
Abstract
Previous studies have reported that cardiorespiratory fitness (CRF) was associated with decreased risk of chronic kidney disease (CKD) in westerner. The aim of present study was to investigate the potential association between estimated eCRF (eCRF) and CKD risk in Chinese general population. A total of 5,199 participants from the China Health and Retirement Longitudinal Study were including in analysis. The sex-specific models including age, physical activity, resting heart rate, and waist circumference were used to calculate eCRF. Participants were divided into three subgroups according to age and sex-specific tertiles of eCRF. Cox proportional hazards regression models were used to examine the associations between eCRF and CKD. During 9 years of follow-up, a total of 511 respondents experienced CKD. After adjustment for potential variables, the hazard ratio (95% confidence intervals) for the tertile 2 and tertile 3 of eCRF- WC was 0.80 (0.66-0.96) and 0.74 (0.60-0.92), respectively, compared with the lowest tertiles. Moreover, each 1-SD increase of eCRF- WC was associated with 6% (95%CIs, 1-11%) decreased risk of CKD. Similar associations were also found in both male and female subgroups. When the current study calculated eCRF using body mass index instead of waist circumference, the highest tertiles of eCRF- BMI was significantly associated with decreased risk of CKD in overall and female participants. A higher eCRF was associated with a decreased risk of CKD in general Chinese population. Future well-designed prospective clinical studies are needed to verify our findings and to assess the effect of eCRF interventions in CKD prevention.
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Affiliation(s)
- Jufang Cheng
- Department of Neonatology, Wuxi Children's Hospital, Wuxi School of Medicine, Affiliated Children's Hospital of Jiangnan University, Jiangnan University, Wuxi, China
| | - Chaozhi Bu
- Research Institute for Reproductive Health and Genetic Diseases, Wuxi School of Medicine, Wuxi Maternity and Child Health Care Hospital, Affiliated Women's Hospital of Jiangnan University, Wuxi, 214002, China.
| | - Xiaowei Zheng
- Public Health Research Center, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Wuxi, 214122, Jiangsu Province, China.
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Vanzella LM, Ribeiro F, Laurino MJL, Takahashi C, Vanderlei FM, da Silva AKF, Dagostinho DBB, Silva JPLN, Vanderlei LCM. Unveiling the link between physical parameters and safety in cardiac rehabilitation: Longitudinal observational study: Physical parameters and cardiac adverse events. Curr Probl Cardiol 2025; 50:102916. [PMID: 39489316 DOI: 10.1016/j.cpcardiol.2024.102916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 10/28/2024] [Indexed: 11/05/2024]
Abstract
OBJECTIVE To identify the associations between cardiorespiratory fitness and quadriceps muscle strength and the occurrence of minor adverse events in a cardiac rehabilitation (CR) program. DESIGN Prospective cohort study. SETTING Output of a CR programme for primary or secondary prevention of cardiovascular disease (CVD). PATIENTS Seventy individuals who were diagnosed with CVD and/or risk factors and 7 who were excluded due to a low adherence rate in exercise sessions (<70%), 4 due to errors in oxygen consumption recorded during the cardiopulmonary exercise test (CPET) and 11 because they decided to withdraw from the study. The data of 38 participants were analyzed. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Quadriceps muscle strength was assessed by an isokinetic dynamometer and by a manual dynamometer. Functional capacity was assessed by the CPET and by a six-minute walk test (6MWT). Participants were monitored by a physiotherapist during 24 exercise sessions to identify and register adverse events. RESULTS Significant associations were detected between adverse events and quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-2.0(-2.0;0.0), p=0.047), between functional capacity assessed by the CPET (peak torque, B=-0.3(-2.4;0.0), p=0.019), between fatigue and functional capacity assessed by the CPET (VO2max, B=-1.3(-2.9;0.0), p=0.005) and between quadriceps muscle strength assessed by an isokinetic dynamometer (peak torque, B=-10.0(-2.7;0.0); p=0.010). CONCLUSIONS Lower functional capacity and quadriceps muscle strength seem to be associated with a greater incidence of adverse events during exercise sessions.
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Affiliation(s)
- Laís Manata Vanzella
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Felipe Ribeiro
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil.
| | - Maria Júlia Lopez Laurino
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Carolina Takahashi
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Franciele Marques Vanderlei
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Anne Kastelianne França da Silva
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Denise Brugnoli Balbi Dagostinho
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - João Pedro Lucas Neves Silva
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
| | - Luiz Carlos Marques Vanderlei
- Educational Center, Physiotherapy Department, School of Technology Sciences, São Paulo State University, Presidente Prudente St. Roberto Simonsen, 305 19060-900, São Paulo, Brazil
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Alghadir AH, Gabr SA, Iqbal A. The effects of supervised aerobic training on dyslipidaemia among diabetic older patients. BMC Endocr Disord 2024; 24:212. [PMID: 39385223 PMCID: PMC11462724 DOI: 10.1186/s12902-024-01745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 09/26/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Higher prevalence rates of diabetes and its complications have been reported among individuals with poor physical activity and a sedentary lifestyle. This study explored the influence of six months of moderate-intensity supervised aerobic training on the serum lipid profile, hs-CRP level, and variable-related correlations in prediabetic and type 2 diabetes patients (T2DM). DESIGN The study was based on a two-arm parallel group pretest‒posttest comparative design. METHODS A total of 50 subjects who were diagnosed with diabetes for more than five years and aged 30-70 years were included in this study. The subjects were classified into two groups on the basis of their glycated haemoglobin (HbA1c%) values: Group 1 (patients with the prediabetes; HbA1c % ≤ 6.5, n = 25) and Group 2 (patients with the T2DM; HbA1c % ≥ 6.5, n = 25). Blood sugar, HbA1c %, insulin, lipid profile, and highly sensitive CRP (hs-CRP) were measured via colorimetric and immunoassay techniques at baseline and six months postintervention with moderate aerobic exercise. RESULTS The results revealed that participation in moderate aerobic training interventions for six months resulted in a significant reduction in BMI, fasting blood sugar, glycosylated haemoglobin, hs-CRP, and lipid profile parameters such as T-Cholest, TG, and LDL-C as well as significant improvement in the level of insulin with a reduction in the values of HOMA-IR towards normal values in the patients with prediabetes (P < 0.01) in group 1 and patients with diabetes in group 2 (P < 0.001). The change in VO2max with good physical fitness significantly improved with the exercise program after six months. The reduced levels of hs-CRP, HOMA-IR, and lipid profile and improved levels of insulin were significantly positively correlated with the levels of glycated haemoglobin (HbA1c%) in the patients with prediabetes (P < 0.01) and those with diabetes (P < 0.001) following six months of moderate aerobic training interventions. Moreover, hs-CRP was positively correlated with T-Cholest, TG, and LDL-C (p = 0.01) and negatively correlated with HDL-C. The data revealed improved glycemic control factors, lipid profiles, and hs-CRP levels as cardio-predictive markers in patients with both prediabetes and diabetes as well. These findings suggest that the anti-inflammatory effect of physical activity gained from moderate exercise training for six months may counteract increased cardiovascular complications associated with increased CRP levels and lipid profiles in prediabetes and T2DM patients. CONCLUSIONS Moderate aerobic training for six months favourably affects glycemic parameters, lipid profiles, and inflammatory hs-CRP indicators and improves VO2max, an indicator of physical fitness, in prediabetic and diabetic patients. The data obtained suggest the positive effect of moderate exercise training as a protective modulator of cardiovascular disorders, including the dyslipidaemic profile, glycaemic control, and hs-CRP inflammatory markers, in prediabetes and T2DM patients. Thus, regular exercise, owing to its anti-inflammatory effects and ability to improve cardiorespiratory fitness, lipid profiles, blood glucose levels, and insulin resistance, may help reduce the severity of cardiovascular diseases in prediabetes and T2DM patients and healthy controls. TRIAL REGISTRATION Retrospectively registered with ClinicalTrials.gov PRS under trial identifier ID: NCT06246435 dated 30/01/2024.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Sami A Gabr
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia
| | - Amir Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
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Narai E, Yoshimura Y, Honaga T, Mizoguchi H, Yamanaka A, Hiyama TY, Watanabe T, Koba S. Orexinergic neurons contribute to autonomic cardiovascular regulation for locomotor exercise. J Physiol 2024. [PMID: 38380995 DOI: 10.1113/jp285791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Abstract
While the hypothalamic orexinergic nervous system is established as having a pivotal role in the long-term regulation of various organismic functions, including wakefulness, metabolism and hypertensive states, whether this system contributes to the rapid autonomic cardiovascular regulation during physical activity remains elusive. This study aimed to elucidate the role of the orexinergic nervous system in transmitting volitional motor signals, i.e. central command, to drive somatomotor and sympathetic cardiovascular responses. We first found that this system is activated by voluntary locomotor exercise as evidenced by an increased expression of Fos, a marker of neural activation, in the orexinergic neurons of Sprague-Dawley rats engaged in spontaneous wheel running. Next, using transgenic Orexin-Cre rats for optogenetic manipulation of orexinergic neurons, we found that optogenetic excitation of orexinergic neurons caused sympathoexcitation on a subsecond timescale under anaesthesia. In freely moving conscious rats, this excitatory stimulation rapidly elicited exploration-like behaviours, predominantly locomotor activity, along with pressor and tachycardiac responses. Meanwhile, optogenetic inhibition of orexinergic neurons during spontaneous wheel running immediately suppressed locomotor activities and blood pressure elevation without affecting basal cardiovascular homeostasis. Taken together, these findings demonstrate the essential role of the orexinergic nervous system in the central circuitry that transmits central command signals for locomotor exercise. This study not only offers insights into the brain circuit mechanisms precisely regulating autonomic cardiovascular systems during voluntary exercise but also likely contributes to our understanding of brain mechanisms underlying abnormal cardiovascular adjustments to exercise in pathological conditions, such as hypertension. KEY POINTS: The hypothalamic orexinergic nervous system plays various roles in the long-term regulation of autonomic and endocrine functions, as well as motivated behaviours. We present a novel, rapid role of the orexinergic nervous system, revealing its significance as a crucial substrate in the brain circuit mechanisms that coordinate somatomotor and autonomic cardiovascular controls for locomotor exercise. Our data demonstrate that orexinergic neurons relay volitional motor signals, playing a necessary and sufficient role in the autonomic cardiovascular regulation required for locomotor exercise in rats. The findings contribute to our understanding of how the brain precisely regulates autonomic cardiovascular systems during voluntary exercise, providing insights into the central neural mechanisms that enhance physical performance moment-by-moment during exercise.
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Affiliation(s)
- Emi Narai
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Yuki Yoshimura
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Takaho Honaga
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroyuki Mizoguchi
- Department of Neuropsychopharmacology and Hospital Pharmacy, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Akihiro Yamanaka
- Chinese Institute for Brain Research, Beijing (CIBR), Beijing, China
| | - Takeshi Y Hiyama
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Tatsuo Watanabe
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
| | - Satoshi Koba
- Division of Integrative Physiology, Tottori University Faculty of Medicine, Yonago, Japan
- Division of Veterinary Physiology, Tottori University Faculty of Agriculture, Tottori, Japan
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Rijal A, Adhikari TB, Dhakal S, Maagaard M, Piri R, Nielsen EE, Neupane D, Jakobsen JC, Olsen MH. Effect of exercise on functional capacity and body weight for people with hypertension, type 2 diabetes, or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. BMC Sports Sci Med Rehabil 2024; 16:38. [PMID: 38321506 PMCID: PMC10848448 DOI: 10.1186/s13102-024-00829-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Hypertension, type 2 diabetes, and cardiovascular disease affect the activities of daily living at varying degree. While the effects of aerobic exercise on functional capacity are well-documented, the extent of change for different types of exercise in these chronic conditions remains unexplored. Additionally, there is conflicting evidence regarding the role of exercise in reducing body weight. METHODS We conducted systematic review with meta-analysis and trial sequential analysis and searched various databases from inception to July 2020. We included randomised clinical trials adding any form of trialist defined exercise to usual care versus usual care in people with either hypertension, type 2 diabetes, and/or cardiovascular disease irrespective of setting, publication status, year, and language. The outcomes assessed were i) functional capacity assessed through different scales separately i.e., Maximal Oxygen Uptake (VO2max), 6-min walk test (6MWT), 10-m walk test (10MWT), and ii) body weight. RESULTS We included 950 studies out of which 444 trials randomising 20,098 participants reported on various functional outcomes (355 trials) and body weight (169 trials). The median follow-up was 3 months (Interquartile ranges (IQR): 2.25 to 6). Exercise added to the usual care, improved VO2max (Mean Difference (MD):2.72 ml/kg/min; 95% Confidence Interval (CI) 2.38 to 3.06; p < 0.01; I2 = 96%), 6MWT (MD: 42.5 m; 95%CI 34.95 to 50.06; p < 0.01; I2 = 96%), and 10MWT (MD: 0.06 m/s; 95%CI 0.03 to 0.10; p < 0.01; I2 = 93%). Dynamic aerobic and resistance exercise showed a consistent improvement across various functional outcomes, whereas body-mind therapies (MD: 3.23 ml/kg/min; 95%CI 1.97 to 4.49, p < 0.01) seemed especially beneficial for VO2max and inspiratory muscle training (MD: 59.32 m; 95%CI 33.84 to 84.80; p < 0.01) for 6MWT. Exercise yielded significant reduction in body weight for people with hypertension (MD: -1.45 kg; 95%CI -2.47 to -0.43; p < 0.01), and type 2 diabetes (MD: -1.53 kg; 95%CI -2.19 to -0.87; p < 0.01) but not for cardiovascular disease with most pronounced for combined exercise (MD: -1.73 kg; 95%CI -3.08 to -0.39; p < 0.05). The very low certainty of evidence warrants cautious interpretations of the results. CONCLUSION Exercise seemed to improve functional capacity for people with hypertension, type 2 diabetes, and/or cardiovascular disease but the effectiveness seems to vary with different forms of exercise. The potentially superior improvement in VO2max and 6MWT by body-mind therapies and inspiratory muscle training calls for further exploration. Additionally, prescribing exercise for the sole purpose of losing weight may be a potential strategy for people with hypertension and type 2 diabetes. The extent of improvement in functional capacity and body weight reduction differed with different exercise regimens hence personalised exercise prescriptions tailored to individual needs may be of importance. PROSPERO REGISTRATION: PROSPERO registration number: CRD42019142313.
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Affiliation(s)
- Anupa Rijal
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.
| | - Tara Ballav Adhikari
- Department of Public Health, Research Unit for Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Sarmila Dhakal
- Center for Research on Environment, Health and Population Activities (CREPHA), Kusunti, Lalitpur, Nepal
| | - Mathias Maagaard
- Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koge, Denmark
| | - Reza Piri
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emil Eik Nielsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University Baltimore, Maryland, USA
| | - Janus Christian Jakobsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
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Farkas GJ, Caldera LJ, Nash MS. Assessing the efficacy of duration and intensity prescription for physical activity in mitigating cardiometabolic risk after spinal cord injury. Curr Opin Neurol 2023; 36:531-540. [PMID: 37865846 DOI: 10.1097/wco.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) heightens susceptibility to cardiometabolic risk (CMR), predisposing individuals to cardiovascular disease. This monograph aims to assess the optimal duration and intensity of physical activity (PA) for managing CMR factors, particularly obesity, after SCI and provide modality-specific PA durations for optimal energy expenditure. RECENT FINDINGS PA guidelines recommend at least 150 min/week of moderate-intensity activity. However, non-SCI literature supports the effectiveness of engaging in vigorous-intensity PA (≥6 METs) and dedicating 250-300 min/week (≈2000 kcal/week) to reduce CMR factors. Engaging in this volume of PA has shown a dose-response relationship, wherein increased activity results in decreased obesity and other CMR factors in persons without SCI. SUMMARY To optimize cardiometabolic health, individuals with SCI require a longer duration and higher intensity of PA to achieve energy expenditures comparable to individuals without SCI. Therefore, individuals with SCI who can engage in or approach vigorous-intensity PA should prioritize doing so for at least 150 min/wk. At the same time, those unable to reach such intensities should engage in at least 250-300 min/week of PA at a challenging yet comfortable intensity, aiming to achieve an optimal intensity level based on their abilities. Given the potential to decrease CMR after SCI, increasing PA duration and intensity merits careful consideration in future SCI PA directives.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Lizeth J Caldera
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
| | - Mark S Nash
- Department of Physical Medicine and Rehabilitation, University of Miami
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis
- The Miami Project to Cure Paralysis, Department of Neurological Surgery
- Department of Physical Therapy, University of Miami, Miami, FL, USA
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Matsuki H, Genma T, Mandai S, Fujiki T, Mori Y, Ando F, Mori T, Susa K, Iimori S, Naito S, Sohara E, Rai T, Fushimi K, Uchida S. National Trends in Mortality and Urgent Dialysis after Acute Hypertension in Japan From 2010 Through 2019. Hypertension 2023; 80:2591-2600. [PMID: 37818643 DOI: 10.1161/hypertensionaha.123.21880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Despite increasing incidences of hypertension, recent trends in mortality and urgent dialysis following acute hypertension (AHT) remain undetermined. METHODS This retrospective observational cohort study evaluated 50 316 hospitalized AHT patients from 2010 to 2019, using an administrative claims database in Japan. We examined trends in incidence, urgent dialysis, mortality, and its risk factors using Poisson regression models. Using International Classification of Disease and Related Health Problems, 10th Revision codes, AHT was categorized into 5 spectrums: malignant hypertension (n=1792), hypertensive emergency (n=17 907), hypertensive urgency (n=1562), hypertensive encephalopathy (n=6593), and hypertensive heart failure (HHF; n=22 462). RESULTS The median age of the patients was 76 years, and 54.9% were women. The total AHT incidence was 70 cases per 100 000 admission year. The absolute death rate increased from 1.83% (95% CI, 1.40-2.40) to 2.88% ([95% CI, 2.42-3.41]; Cochran-Armitage trend test, P<0.0001). Upward trends were observed in patients aged ≥80, with lean body mass index ≤18.4, and with HHF. Urgent dialysis rates increased from 1.52% (95% CI, 1.12-2.06) to 2.60% (2.17-3.1; Cochran-Armitage trend test; P=0.0071) in 48 235 patients, excluding maintenance dialysis patients. Older age, men, lean body mass, malignant hypertension, HHF, and underlying chronic kidney disease correlated with higher mortality risk; greater hospital volume correlated with lower mortality risk; and malignant hypertension, HHF, diabetes, chronic kidney disease, and scleroderma correlated with a higher risk of urgent dialysis. CONCLUSIONS Mortality and urgent dialysis rates following AHT have increased. Aging, complex comorbidities, and HHF-type AHT contributed to the rising trend of mortality.
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Affiliation(s)
- Hisazumi Matsuki
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Taku Genma
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Tamami Fujiki
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Yutaro Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Fumiaki Ando
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Takayasu Mori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Koichiro Susa
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Soichiro Iimori
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
- Department of Nephrology and Hypertension, Dokkyo Medical University, Shimotsuga, Tochigi, Japan (T.R.)
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (K.F.)
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan (H.M., T.G., S.M., T.F., Y.M., F.A., T.M., K.S., S.I., S.N., E.S., T.R., S.U.)
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9
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Cheng Y, Zamrini E, Faselis C, Redd D, Shao Y, Morgan CJ, Sheriff HM, Ahmed A, Kokkinos P, Zeng-Treitler Q. Cardiorespiratory fitness and risk of Alzheimer's disease and related dementias among American veterans. Alzheimers Dement 2023; 19:4325-4334. [PMID: 36946469 PMCID: PMC10729726 DOI: 10.1002/alz.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) is associated with improved health and survival. Less is known about its association with Alzheimer's disease and related dementias (ADRD). METHODS We identified 649,605 US veterans 30 to 95 years of age and free of ADRD who completed a standardized exercise tolerance test between 2000 and 2017 with no evidence of ischemia. We examined the association between five age- and sex-specific CRF categories and ADRD incidence using multivariate Cox regression models. RESULTS During up to 20 (median 8.3) years of follow-up, incident ADRD occurred in 44,105 (6.8%) participants, with an incidence rate of 7.7/1000 person-years. Compared to the least-fit, multivariable-adjusted hazard ratios (95% confidence intervals) for incident ADRD were: 0.87 (0.85-0.90), 0.80 (0.78-0.83), 0.74 (0.72-0.76), and 0.67 (0.65-0.70), for low-fit, moderate-fit, fit, and high-fit individuals, respectively. DISSCUSSION These findings demonstrate an independent, inverse, and graded association between CRF and incident ADRD. Future studies may determine the amount and duration of physical activity needed to optimize ADRD risk reduction.
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Affiliation(s)
- Yan Cheng
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Edward Zamrini
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
- University of Utah, Salt Lake City, Utah
- Irvine Clinical Research, Irvine, CA
| | - Charles Faselis
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
- Uniformed Services University, Washington, DC
| | - Douglas Redd
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Yijun Shao
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
| | | | - Helen M. Sheriff
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
| | - Ali Ahmed
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
- Georgetown University, Washington, DC
| | - Peter Kokkinos
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
- Rutgers University, New Brunswick, NJ
| | - Qing Zeng-Treitler
- Washington DC VA Medical Center, Washington, DC
- George Washington University, Washington, DC
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10
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Huang WM, Chang HC, Chen CN, Huang CJ, Yu WC, Cheng HM, Guo CY, Chiang CE, Chen CH, Sung SH. Symptom-limited exercise capacity is associated with long-term survival. Medicine (Baltimore) 2023; 102:e34948. [PMID: 37773832 PMCID: PMC10545336 DOI: 10.1097/md.0000000000034948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 10/01/2023] Open
Abstract
The prognostic value of exercise capacity has been demonstrated in subjects with established cardiovascular diseases. We aim to evaluate the independence of exercise capacity measured by treadmill exercise test (TET) in predicting long-term outcomes among various comorbidities. This study was conducted from January 2003 to December 2012 in a tertiary medical center in Taiwan. Subjects referred for symptom-limited TET were recruited. Peak achieved metabolic equivalents (METs) were determined by treadmill grade and speed at peak exercise. The main outcomes were cardiovascular and all-cause mortality by linking to the National Death Registry. A total of 18,954 participants (57.8 ± 12.8 years, 62% men) achieved a mean peak METs of 9.2. Subjects in the lowest tertile of peak METs were older, had poorer renal function, lower hemoglobin, and more comorbidities. During a median follow-up of 4.3 years, there were 642 mortalities and 132 cardiovascular deaths. Peak METs significantly predicted cardiovascular death and all-cause mortality in the multivariable Cox regression models [hazard ratio (95% confidence intervals): 0.788 (0.660-0.940) and 0.835 (0.772-0.903), respectively]. The prognostic influence of peak METs consistently appeared in the subgroups, regardless of age, gender, body weight, comorbidities, use of beta-blockers, or the presence of exercise-induced ischemia. The fitness was more predictive of long-term outcomes in young or those with ischemic changes during TET (P for interaction: 0.035 and 0.018, respectively). The benefit of fitness was nonlinearly associated with long-term survival. The prognostic impacts of exercise capacity were universally observed in subjects with or without various comorbidities.
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Affiliation(s)
- Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Kinmen Hospital, Ministry of Health and Welfare, Taiwan
| | - Hao-Chih Chang
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Chiao-Nan Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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de Souza Mesquita FO, Gambassi BB, de Oliveira Silva M, Moreira SR, Neves VR, Gomes-Neto M, Schwingel PA. Effect of High-Intensity Interval Training on Exercise Capacity, Blood Pressure, and Autonomic Responses in Patients With Hypertension: A Systematic Review and Meta-analysis. Sports Health 2023; 15:571-578. [PMID: 36529986 PMCID: PMC10293559 DOI: 10.1177/19417381221139343] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
CONTEXT Despite the well-known positive effects of exercise in hypertensive patients, the best mode of exercise is still under discussion. OBJECTIVE A systematic review of the literature, synthesizing data on the effects of high-intensity interval training (HIIT) on peak oxygen consumption (VO2 peak), blood pressure (BP), cardiac autonomic modulation, and resting heart rate (HR) in patients with hypertension. DATA SOURCES MEDLINE (via PubMed), CENTRAL, PEDro database, and SciELO (from the earliest date available to December 31, 2020). STUDY SELECTION Randomized controlled trials (RCTs) that evaluated the effects of HIIT in hypertensive patients. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Mean differences (MDs) with a 95% CI were calculated, and heterogeneity was assessed using the I2 test. RESULTS Nine RCTs encompassing 569 patients met the eligibility criteria and were included in the systematic review. Five trials compared supervised HIIT with moderate-intensity continuous training (MICT) and a control; 1 trial compared HIIT with MICT, and 3 compared HIIT with a control. In comparison with MICT, HIIT improved VO2 peak MD (3.3 mL.kg-1.min-1; 95% CI, 1.4-5.3; N = 130). In comparison with controls, HIIT improved VO2 peak MD (4.4 mL.kg-1.min-1; 95% CI, 2.5-6.2; N = 162). CONCLUSION Despite the low quality of the evidence, HIIT is superior to MICT in improving VO2 peak in patients with hypertension. HIIT effectively improved VO2 peak, BP, and resting HR when compared with controls. HIIT appears to be safe only when performed in a supervised manner for stage 1 hypertension patients without associated risk factors.
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Affiliation(s)
- Fabricio Olinda de Souza Mesquita
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
| | - Bruno Bavaresco Gambassi
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Gestão de Programas e Serviços de Saúde (MGPSS), São Luís, Maranhão, Brazil
| | | | - Sérgio Rodrigues Moreira
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Ciências da Saúde e Biológicas (PPGCSB), Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Pernambuco, Brazil
| | - Victor Ribeiro Neves
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGRDF), UPE, Petrolina, Pernambuco, Brazil
| | - Mansueto Gomes-Neto
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Departamento de Fisioterapia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Paulo Adriano Schwingel
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGRDF), UPE, Petrolina, Pernambuco, Brazil
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12
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Wu T, Yan Y, Luo Y, Wang Z, Wang Y. 12-week Brisk Walking Improved Chronotropic Response in Hypertensive Patients. Int J Sports Med 2023; 44:376-384. [PMID: 36377188 DOI: 10.1055/a-1978-5907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the effects of 12-week brisk walking on chronotropic response in hypertensive patients aged 40-69. 77 participants in exercise group underwent 12-week brisk walking, while 66 participants in control group received health education. Chronotropic parameters, resting blood pressure, and physical fitness including peak oxygen consumption (VO2peak) were measured. After 12 weeks, the systolic blood pressure (SBP) was decreased (-6.104 mmHg, 95%CI -8.913 to -3.295 mmHg, P<0.0001), while metabolic chronotropic relationship (MCR) slope and VO2peak were increased (0.073, 95%CI 0.001 to 0.145, P=0.046; 1.756 mL/kg/min, 95%CI 0.891 to 2.622 mL/kg/min, P<0.0001) in exercise group compared to baseline. The chronotropic response index (CRI) at 25-75 W load were decreased (-0.210, 95%CI -0.307 to -0.112, P<0.0001; -0.144, 95%CI - 0.204 to -0.083, P<0.0001; -0.078, 95%CI -0.135 to -0.022, P=0.007) in control group after 12 weeks. The relative changes (%Δ) of systolic and diastolic blood pressure were negatively correlated with %ΔVO2peak (r=-0.233, r=-0.187), while %ΔMCR and %ΔCRI at 50-75 W load were positively correlated with %ΔVO2peak after 12 weeks (r=0.330, r=0.282, r =0.370). %ΔSBP was also positively correlated with %ΔMCR (r =-0.213). In conclusion, 12-week brisk walking reduced SBP by improving chronotropic response in hypertensive patients aged 40-69. The enhanced chronotropic response was associated with enhanced cardiorespiratory fitness.
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Affiliation(s)
- Tong Wu
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yan Yan
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.,College of Physical Education, Guangxi University, Nanning, China
| | - Yong Luo
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Zhengzhen Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yan Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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13
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Salmanpour M, Soori R, H'mida C, Halouani J, Clarck CT, Pournemati P, Yari SM, Trabelsi K, Ammar A, Chtourou H, Taheri M. The effect of 8 weeks of combined interval (resistance-interval training) and combined endurance (endurance-resistance training) on plasma levels of adropin and nitric oxide in males with high blood pressure. Ir J Med Sci 2022; 191:2559-2568. [PMID: 35029793 DOI: 10.1007/s11845-021-02873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nitric oxide (NO) is a vasodilator that plays an important role in blood pressure control. The purpose of the present study was to compare the effect of 8 weeks of resistance-interval and endurance-resistance trainings on plasma levels of adropin and NO in males with hypertension. METHOD Forty-five patients with hypertension were recruited and divided into 3 groups of control (age = 51.1 ± 6.4 years, body mass = 80.4 ± 9.2 kg), resistance-interval training (age = 50.7 ± 5.5 years, body mass = 78.1 ± 11 kg), and endurance-resistance training (age = 52.8 ± 6.1 years, body mass = 79.6 ± 9.2 kg). The resistance training program was performed in 2 sets, 10 to 15 repetitions, with 50% intensity of one repetition maximum. Increasing endurance training was performed for 30-40 min at 60-70% of maximum heart rate (HRmax) on the bike. The high-intensity interval training program consisted of 4 intervals of 80 to 90% of HRmax and 3-min recovery periods of 60 to 70% of HRmax. Blood samples were collected 1 week before the start of the training program and 48 h after the last training session. Plasma levels of adropin and nitrite/nitrate were measured by ELISA before and after the exercise interventions. RESULTS Eight weeks of resistance-interval and endurance-resistance trainings increased plasma levels of adropin and NO and decreased blood pressure (P ≤ 0.05). Furthermore, plasma levels of adropin increased in both exercise groups, whereas NO levels increased only in the endurance-resistance training. Systolic blood pressure decreased in the resistance-interval training (P ≤ 0.05) while it remained unchanged in the endurance-resistance group. CONCLUSION Resistance-interval and endurance-resistance trainings are effective in decreasing blood pressure by increasing cardiorespiratory capacity and plasma levels of adropin and NO.
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Affiliation(s)
| | - Rahman Soori
- Professor of Exercise Physiology, Faculty of Sport and Exercise Sciences, University of Tehran, Tehran, Iran.
| | - Cyrine H'mida
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Jamel Halouani
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Cain T Clarck
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Parisa Pournemati
- Department of Sport Physiology, Faculty of Physical Education, University of Tehran, Tehran, Iran
| | | | - Khaled Trabelsi
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Research Laboratory: Education, Motricity, Sport and Health. EM2S, LR19JS01., High Institute of Sport and Physical Education of Sfax., Sfax, Tunisia
| | - Achraf Ammar
- Institute of Sport Science, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany
| | - Hamdi Chtourou
- Institut Supérieur du Sport Et de L'éducation Physique de Sfax, Université de Sfax, Sfax, Tunisia
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, Tunis, Tunisia
| | - Morteza Taheri
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
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14
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Del Seppia C, Federighi G, Lapi D, Gerosolimo F, Scuri R. Effects of a catechins-enriched diet associated with moderate physical exercise in the prevention of hypertension in spontaneously hypertensive rats. Sci Rep 2022; 12:17303. [PMID: 36243879 PMCID: PMC9569358 DOI: 10.1038/s41598-022-21458-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/27/2022] [Indexed: 01/10/2023] Open
Abstract
Hypertension represents the main risk factor for the onset of cardiovascular diseases. Pharmacological treatments to control hypertension have been associated with new treatments involving physical activity and/or the intake of natural components (nutraceuticals). We here report the effects produced by a combination of a natural component (catechins) and a moderate exercise program on the development of hypertension in spontaneous hypertensive rats compared with those of each individual treatment. Arterial blood pressure and heart rate were measured with a non-invasive method in 28 rats randomly assigned to four groups: rats subjected to moderate physical exercise; rats with a catechins-enriched diet; rats subjected to moderate physical exercise combined with a catechins-enriched diet; control, untreated-rats left to age. All treatments were applied for 6 weeks. The statistical analysis revealed that the three treatments significantly reduced the weekly increase in arterial blood pressure observed in control rats (SBP, P < 0.0001; DBP, P = 0.005). However, the reduction of arterial blood pressure induced by combined treatments was not higher than that induced by the single treatment, but more prolonged. All treatments showed strong antioxidative properties. Our data show that physical activity and a diet enriched with catechins individually have an important hypotensive effect, while the association did not produce a higher hypotensive effect than the single treatment, even if it was able to decrease blood pressure for a longer time. These findings have important implications for developing a protocol to apply in novel hypertension prevention procedures.
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Affiliation(s)
- Cristina Del Seppia
- Institute of Clinical Physiology, National Council of Research (CNR), Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Giuseppe Federighi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Dosminga Lapi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Federico Gerosolimo
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rossana Scuri
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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15
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Moreira-Reis A, Maté-Muñoz JL, Hernández-Lougedo J, Vilches-Sáez S, Benet M, García-Fernández P, Pleguezuelos E, Carbonell T, Alva N, Garnacho-Castaño MV. Aerobic Dance on an Air Dissipation Platform Improves Cardiorespiratory, Muscular and Cellular Fitness in the Overweight and Obese Elderly. BIOLOGY 2022; 11:579. [PMID: 35453778 PMCID: PMC9031850 DOI: 10.3390/biology11040579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
Background: Obesity is a global health problem associated with a high number of comorbidities that decrease functional capacity, especially in elderly people. Aerobic dance is considered a viable strategy to prevent the effects of aging, mainly in obese and overweight elderly people. This study aimed to evaluate the effects of aerobic dance on an air dissipation platform (ADP) on body composition, oxidative stress and muscular and cardiorespiratory fitness in elderly people. Methods: In total, 32 elderly adults (67.1 ± 3.6) were divided into 3 groups based on body mass index: healthy (HG), overweight (OWG) and obese (OG). Training program of aerobic dance on an ADP was carried out twice a week for 12 weeks. Results: OWG (p = 0.016) and OG decreased their weight (p < 0.001). There was a significant decrease in malondialdehyde concentrations in all experimental groups (p < 0.05). OWG and OG significantly improved their peak oxygen uptake (p < 0.01). HG increased the vertical jump height (p < 0.05), and HG and OG improved the power output of the lower extremities (p < 0.05). Conclusions: The aerobic dance on an ADP may be an effective alternative to lose weight, prevent oxidative stress and improve cardiorespiratory fitness in obese and overweight elderly people.
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Affiliation(s)
- Alessandra Moreira-Reis
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (A.M.-R.); (S.V.-S.); (T.C.); (N.A.)
| | - José Luis Maté-Muñoz
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.L.M.-M.); (P.G.-F.)
| | - Juan Hernández-Lougedo
- Laboratory of Biomechanics and Exercise Physiology, Department of Physical Activity and Sports Science, Alfonso X El Sabio University, 28691 Madrid, Spain;
| | - Sergio Vilches-Sáez
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (A.M.-R.); (S.V.-S.); (T.C.); (N.A.)
| | - Marta Benet
- Campus Docent Sant Joan de Déu, University of Barcelona, 08034 Barcelona, Spain;
| | - Pablo García-Fernández
- Department of Radiology, Rehabilitation and Physiotherapy, Complutense University of Madrid, 28040 Madrid, Spain; (J.L.M.-M.); (P.G.-F.)
- IdISSC, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Eulogio Pleguezuelos
- Physical Medicine and Rehabilitation Department, Hospital de Mataró, 08304 Barcelona, Spain;
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (A.M.-R.); (S.V.-S.); (T.C.); (N.A.)
| | - Norma Alva
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; (A.M.-R.); (S.V.-S.); (T.C.); (N.A.)
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16
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Self-Administered Six-Minute Walk Test Using a Free Smartphone App in Asymptomatic Adults: Reliability and Reproducibility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031118. [PMID: 35162141 PMCID: PMC8834251 DOI: 10.3390/ijerph19031118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
Background: The 6-min walk test (6MWT) is a simple, inexpensive, reliable, and reproducible test that provides a reasonable estimate of the cardiorespiratory fitness (CRF). We aimed to assess the reliability and reproducibility of a self-administered 6MWT in asymptomatic adults using a free smartphone app. Methods: In the 1st phase, 93 participants underwent a supervised 6MWT (6MWTsup) in a 30 m indoor corridor, using a triaxial accelerometer and their smartphones to compare the total step counts and to develop a 6-min walk distance (6MWD) prediction equation. In the 2nd phase, 25 participants performed the 6MWTsup and two self-administered 6MWTs outdoors (6MWTsa1 and 6MWTsa2, at least 48 h apart) using a free smartphone app. Results: The agreement between accelerometer- and app-based total step counts was limited (mean difference, −58.7 steps (−8.7%): 95% confidence interval, −326.5 (−46.8%) to 209.1 (29.3%)). The best algorithm for predicting the 6MWTsupm included: 795.456 + (0.815 heightm app-steps) − (1.620 ageyears) − (3.005 weightkg) − (1.155 app-steps), R2 = 0.609). The intraclass correlation coefficient between 6MWTsa2 and 6MWTsa1 was excellent (0.91: 0.81–0.96). The coefficient of variation was 6.4%. The agreement between the two self-administered tests was narrow (−1.9 (0.2%) meters: −57.4 (−9.5%) to 61.3 (9.9%)). Conclusions: The self-administered 6MWT has excellent reliability and reproducibility in asymptomatic adults, being a valuable tool for assessing CRF in community-based interventions.
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Gyöngyösi H, Kőrösi B, Batta D, Nemcsik-Bencze Z, László A, Tislér A, Cseprekál O, Torzsa P, Eörsi D, Nemcsik J. Comparison of Different Cardiovascular Risk Score and Pulse Wave Velocity-Based Methods for Vascular Age Calculation. Heart Lung Circ 2021; 30:1744-1751. [PMID: 34426072 DOI: 10.1016/j.hlc.2021.06.518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The calculation of vascular age can help patients understand the importance of adherence to healthy lifestyle and medications. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) and carotid-femoral pulse wave velocity (PWV). METHODS Consecutive subjects between the age of 40-65 years, who took part in a screening program in three general practitioner practices were involved. PWV was measured by tonometry and was compared with normal values. Vascular age was defined based on FRS and SCORE according to literature data. RESULTS One hundred and seventy-two (172) patients were involved. The median chronological age was 55.5 (48.8-61.2) years. The median vascular age based on FRS and SCORE were 64 (54-79) years and 55 (44.2-60.7) years, respectively (p<0.05). Based on PWV, FRS and SCORE, 40.1%, 78.5% and 32% of the subjects had increased vascular age compared with chronological age, respectively (PWV+, FRS+, SCORE+, p<0.05). Fifty-eight (58) (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (n=47, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+. CONCLUSION The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further detailed comparison of different vascular age calculation methods.
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Affiliation(s)
- Helga Gyöngyösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Beáta Kőrösi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dóra Batta
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Zsófia Nemcsik-Bencze
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | | | - András Tislér
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Eörsi
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - János Nemcsik
- Department of Family Medicine, Semmelweis University, Budapest, Hungary; Health Service of Zugló (ZESZ), Budapest, Hungary.
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Ely MR, Taylor JA. The Practical Utility of Functional Electrical Stimulation Exercise for Cardiovascular Health in Individuals with Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Sugita Y, Ito K, Sakurai S, Sakai S, Kuno S. Epicardial adipose tissue is associated with cardiorespiratory fitness and hemodynamics among Japanese individuals of various ages and of both sexes. PLoS One 2021; 16:e0254733. [PMID: 34260663 PMCID: PMC8279356 DOI: 10.1371/journal.pone.0254733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Epicardial adipose tissue may affect hemodynamics and cardiorespiratory fitness as it is a metabolically active visceral adipose tissue and a source of inflammatory bioactive substances that can substantially modulate cardiovascular morphology and function. However, the associations between epicardial adipose tissue and hemodynamics and cardiorespiratory fitness remain unclear. This cross-sectional study aimed to examine the association between epicardial adipose tissue volume and hemodynamics, and cardiorespiratory fitness among Japanese individuals of various ages and of both sexes. Epicardial adipose tissue volume was measured in 120 participants (age, 21-85 years) by cardiac magnetic resonance imaging. To evaluate cardiorespiratory fitness, peak oxygen uptake was measured by cardiopulmonary exercise testing. Peak cardiac output and arteriovenous oxygen difference were calculated by impedance cardiography. The epicardial adipose tissue volume was significantly increased in middle-aged and older women. The epicardial adipose tissue volume was significantly and negatively correlated to peak cardiac output and peak oxygen uptake, regardless of age and sex; furthermore, epicardial adipose tissue showed a strong negative correlation with peak heart rate. Epicardial adipose tissue and peak cardiac output were significantly associated (β = -0.359, 95% confidence interval, -0.119 to -0.049, p < 0.001), even after multivariate adjustment (R2 = 0.778). However, in the multiple regression analysis with peak oxygen uptake as a dependent variable, the epicardial adipose tissue volume was not an independent predictor. These data suggest that increased epicardial adipose tissue volume may be correlated with decreased peak oxygen uptake, which might have mediated the abnormal hemodynamics among Japanese people of various ages and of both sexes. Interventions targeting epicardial adipose tissue could potentially improve hemodynamics and cardiorespiratory fitness.
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Affiliation(s)
- Yousuke Sugita
- Faculty of Health Sciences, Tsukuba University of Technology, Kasuga, Tsukuba-shi, Ibaraki, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennoudai, Tsukuba-shi, Ibaraki, Japan
| | - Katsuhiko Ito
- Department of Rehabilitation, Saitama National Hospital, Suwa, Wakoh-shi, Saitama, Japan
| | - Shigeki Sakurai
- Department of Cardiology, Sakurai Clinic, Shibasaki, Takasaki-shi, Gunma, Japan
| | - Satoshi Sakai
- Faculty of Health Sciences, Tsukuba University of Technology, Kasuga, Tsukuba-shi, Ibaraki, Japan
| | - Shinya Kuno
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tennoudai, Tsukuba-shi, Ibaraki, Japan
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20
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Faselis C, Lam PH, Zile MR, Bhyan P, Tsimploulis A, Arundel C, Patel S, Kokkinos P, Deedwania P, Bhatt DL, Zeng-Trietler Q, Morgan CJ, Aronow WS, Allman RM, Fonarow GC, Ahmed A. Systolic Blood Pressure and Outcomes in Older Patients with HFpEF and Hypertension. Am J Med 2021; 134:e252-e263. [PMID: 33010225 PMCID: PMC8941991 DOI: 10.1016/j.amjmed.2020.08.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND New hypertension and heart failure guidelines recommend that systolic blood pressure (SBP) in patients with heart failure with preserved ejection fraction (HFpEF) and hypertension be lowered to <130 mm Hg. METHODS Of the 6778 hospitalized patients with HFpEF and a history of hypertension in the Medicare-linked OPTIMIZE-HF registry, 3111 had a discharge SBP <130 mm Hg. Using propensity scores for SBP <130 mm Hg, we assembled a matched cohort of 1979 pairs with SBP <130 versus ≥130 mm Hg, balanced on 66 baseline characteristics (mean age, 79 years; 69% women; 12% African American). We then assembled a second matched cohort of 1326 pairs with SBP <120 versus ≥130 mm Hg. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes associated with SBP <130 and <120 mm Hg were separately estimated in the matched cohorts using SBP ≥130 mm Hg as the reference. RESULTS HRs (95% CIs) for 30-day, 12-month, and 6-year all-cause mortality associated with SBP <130 mm Hg were 1.20 (0.91-1.59; P = 0.200), 1.11 (0.99-1.26; P = 0.080), and 1.05 (0.98-1.14; P = 0.186), respectively. Respective HRs (95% CIs) associated with SBP <120 mm Hg were 1.68 (1.21-2.34; P = 0.002), 1.28 (1.11-1.48; P = 0.001), and 1.11 (1.02-1.22; P = 0.022). There was no association with readmission. CONCLUSIONS Among older patients with HFpEF and hypertension, compared with SBP ≥130 mm Hg, the new target SBP <130 mm Hg had no association with outcomes but SBP <120 mm Hg was associated with a higher risk of death but not of readmission. Future prospective studies need to evaluate optimal SBP treatment goals in these patients.
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Affiliation(s)
- Charles Faselis
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Uniformed Services University, Washington, DC.
| | - Phillip H Lam
- Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Washington Hospital Center, Washington, DC
| | - Michael R Zile
- Medical University of South Carolina, Charleston; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Poonam Bhyan
- Cape Fear Valley Medical Center, Fayetteville, NC; Department of Epidemiology, Johns Hopkins University, Baltimore, Md
| | | | - Cherinne Arundel
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC
| | - Samir Patel
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Peter Kokkinos
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Prakash Deedwania
- Veterans Affairs Medical Center, Washington, DC; University of California, San Francisco
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
| | - Qing Zeng-Trietler
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC
| | - Charity J Morgan
- Veterans Affairs Medical Center, Washington, DC; University of Alabama at Birmingham, Birmingham
| | - Wilbert S Aronow
- New York Medical College and Westchester Medical Center, Valhalla, NY
| | - Richard M Allman
- George Washington University, Washington, DC; University of Alabama at Birmingham, Birmingham
| | | | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Georgetown University, Washington, DC.
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Chaieb F, Ben Saad H. The Chronic Effects of Narghile Use on Males' Cardiovascular Response During Exercise: A Systematic Review. Am J Mens Health 2021; 15:1557988321997706. [PMID: 33729068 PMCID: PMC7975579 DOI: 10.1177/1557988321997706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Narghile use has regained popularity throughout the world. Public opinion misjudges its chronic harmful effects on health, especially on the cardiovascular system. This systematic review aimed to evaluate the chronic effects of narghile use on cardiovascular response during exercise. It followed the preferred reporting items for systematic reviews guidelines. Original articles from PubMed and Scopus published until January 31, 2020, written in English, and tackling the chronic effects of narghile use on human cardiovascular response during exercise were considered. Five studies met the inclusion criteria. Only males were included in these studies. They were published between 2014 and 2017 by teams from Tunisia (n = 4) and Jordan (n = 1). One study applied the 6-min walk test, and four studies opted for the cardiopulmonary exercise test. Narghile use was associated with reduced submaximal (e.g., lower 6-min walk distance) and maximal aerobic capacities (e.g., lower maximal oxygen uptake) with abnormal cardiovascular status at rest (e.g., increase in heart rate and blood pressures), at the end of the exercise (e.g., lower heart rate, tendency to chronotropic insufficiency) and during the recovery period (e.g., lower recovery index). To conclude, chronic narghile use has negative effects on cardiovascular response to exercise with reduced submaximal and maximal exercise capacities.
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Affiliation(s)
- Faten Chaieb
- University of Sousse, Faculty of
Medicine of Sousse, Laboratory of Physiology, Sousse, Tunisia,Department of Physiology and Functional
Exploration, Farhat Hached University Hospital of Sousse, Tunisia
| | - Helmi Ben Saad
- University of Sousse, Faculty of
Medicine of Sousse, Laboratory of Physiology, Sousse, Tunisia,Heart Failure Research Laboratory
(LR12SP09), Farhat Hached Hospital, Sousse, Tunisia,Helmi Ben Saad (MD, PhD), Laboratory of
Physiology, Faculty of Medicine of Sousse, University of Sousse, Street Mohamed
Karoui, Sousse 4000, Tunisia.
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22
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Tadic M, Suzic-Lazic J, Vukomanovic V, Cuspidi C, Ilic S, Celic V. Functional capacity and left ventricular diastolic function in patients with type 2 diabetes. Acta Diabetol 2021; 58:107-113. [PMID: 32888068 DOI: 10.1007/s00592-020-01600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
AIMS The study sought to evaluate cardiorespiratory fitness in patients with type 2 diabetes mellitus (DM) with different levels of left ventricular (LV) diastolic dysfunction (LVDD). METHODS This investigation included 55 controls and 85 uncomplicated diabetic patients, who underwent laboratory analysis, echocardiographic evaluation and cardiopulmonary exercise testing. All DM subjects were separated into 3 groups using the level of LV diastolic function as main criterion: normal, intermediate and LVDD. RESULTS Echocardiographic parameters of LV hypertrophy were significantly higher in DM subjects, particularly those with intermediate LV diastolic function and LVDD comparing with controls. The same is valid for parameters of LV diastolic function (E/e', left atrial volume index and tricuspid regurgitation velocity). Peak oxygen uptake was lower, whereas ventilation/carbon dioxide slope was higher, in DM subjects with intermediate LV diastolic function and LVDD in comparison to controls. In the whole study population HbA1c, LV mass index and mitral E/e' were independently related with peak oxygen uptake and ventilation/carbon dioxide slope. CONCLUSIONS LVDD significantly impacted functional capacity in DM patients. Glycemic control, LV mass index and LVDD were independently related with peak oxygen consumption and ventilation/carbon dioxide slope in the study population. These results show that timely diagnosis of LVDD and more intensive antidiabetic treatment could prevent target organ damage in DM patients.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Viale della Resistenza 23, 20036, Meda, Italy
| | - Sanja Ilic
- Department of Endocrinology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia
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Abstract
Functional capacity represents an important predictor for cardiovascular and all-cause mortality in patients with diabetes mellitus (DM). Impaired cardiopulmonary fitness is frequently seen in DM patients, and it might partly explain morbidity and mortality in these patients. There are several potential reasons that could explain impaired functional capacity in DM patients: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular impairment, myocardial dysfunction, and skeletal muscle changes. These changes are partly reversible, and improvement of any of these components might increase functional capacity in DM patients and improve their outcome. Physical activity is related with decreased cardiovascular disease and all-cause mortality in patients with type 2 DM. Diabetic cardiomyopathy is the most important clinical entity in DM patients that involves left ventricular diastolic dysfunction and cardiac autonomic neuropathy, which potentially induce heart failure with preserved ejection fraction. Development of diabetic cardiomyopathy may slow oxygen uptake kinetics and affect the cardiorespiratory fitness in DM patients, but it can also induce development of heart failure. Improvement of functional capacity in DM patients represents an important therapeutic task, and it can be achieved mainly with exercise training and significantly less with pharmacological treatment. Exercise training reduces body weight and improves glycemic control, as well as left ventricular structure and function. The aim of this review was to summarize current knowledge about importance of functional capacity in DM patients, as well as possible mechanisms that could explain the relationship between DM and oxygen kinetics.
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Ahn N, Kim K. Can Active Aerobic Exercise Reduce the Risk of Cardiovascular Disease in Prehypertensive Elderly Women by Improving HDL Cholesterol and Inflammatory Markers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165910. [PMID: 32824020 PMCID: PMC7459903 DOI: 10.3390/ijerph17165910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022]
Abstract
This study aims to verify the efficacy of exercise programs designed to prevent and treat hypertension-induced cardiovascular disease (CVD) by analyzing the effects of a 6-month active aerobic exercise program, administered to prehypertensive elderly women, on reducing the risk of developing CVD by enhancing their physical fitness level and improving the detailed markers of high-density lipoprotein cholesterol (HDL-C) and inflammatory markers. We assigned the elderly women (≥65 years) recruited into normal blood pressure (120–129/80–84; NBP, n = 18) and high-normal blood pressure (130–139/85–89; HNBP, n = 12) groups according to the European guidelines for the management of arterial hypertension. The exercise program was made up of combined workouts of elastic band resistance exercise and aerobics with dance music. The program took place three times a week for six months, with each session lasting 60 min. We measured pre- and post-intervention body composition, blood pressure, physical fitness level, blood lipids profile, HDL-C, SAA, TNF-α, IL-6, IL-4, IL-15, CRP, and HSP70 and calculated the Framingham risk scores for comparison. A significant post-intervention reduction in the mean systolic blood pressure (SBP) was observed in the HNBP group (p < 0.001), with significant increase in HDL-C (p < 0.01) and significant decrease in serum amyloid A (SAA) concentration (p < 0.01). A significant improvement in physical fitness factors such as physical efficiency index (PEI) was also observed in the HNBP group (p < 0.05). The post-intervention TNF-α, IL-6, and SAA concentrations were more significantly lower in the HNBP than in the NBP group (p < 0.05). Compared to the baseline values, a significant decrease in SAA concentration (p < 0.01) and significant increase in HSP70 concentration (p < 0.001) were observed in the HNBP group. The HNBP group’s 10-year CVD risk was also significantly reduced (p < 0.05). The pre–post differences in SBP and DBP were significantly correlated with those in the anti-inflammatory markers IL-4 and IL-15 (p < 0.01). In conclusion, the 6-month active aerobic exercise program of moderate intensity administered to prehypertensive elderly women (≥65 years) had the effect of reducing the 10-year CVD risk through a substantial reduction in SBP, overall physical fitness improvement, increase in HDL-C, decrease in SAA concentration, and substantial decrease in inflammatory biomarkers. It was also confirmed that an increase in anti-inflammatory markers, which showed a small range of increase with respect to the decrease in blood pressure, may have a major effect.
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25
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Leal JM, Galliano LM, Del Vecchio FB. Effectiveness of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in Hypertensive Patients: a Systematic Review and Meta-Analysis. Curr Hypertens Rep 2020; 22:26. [PMID: 32125550 DOI: 10.1007/s11906-020-1030-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this meta-analysis is to compare the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on blood pressure of hypertensive individuals. RECENT FINDINGS Continuous aerobic training programs are successful in health promotion and are effective in systolic blood pressure (SBP) and diastolic blood pressure (DBP) modulation. However, HIIT seems to be superior to MICT to improvement of cardiorespiratory fitness. PubMed, ScienceDirect, and Google Scholar were searched for randomized clinical trials that compared chronic effects of HIIT and MICT on BP in hypertensive subjects. Pre- and post-intervention changes in maximal oxygen uptake (VO2max) between MICT and HIIT were analyzed. Both interventions presented significant differences in SBP (MICT: mean difference (MD), 3.7 mmHg [95% CI = 2.57, 4.82], p < 0.00001; and HIIT: MD, 5.64 mmHg [95% CI = 1.69, 9.52], p = 0.005) and in DBP (MICT: MD, 2.41 mmHg [95% CI = 1.09, 3.72], p = 0.0003; and HIIT: MD, 4.8 mmHg [95% CI = 2.9, 6.7], p < 0.00001) compared with the control group. No differences were found in the SBP values (MD, 1.13 mmHg [95% CI = - 0.01, 2.27], p = 0.05); however, differences were found between groups in DBP (MD, 1.63 mmHg [95% CI = 0.83, 2.44], p = 0.0001). In the secondary outcome, both interventions increased VO2max in comparison with control groups (MICT: MD, 1.30 ml/kg/min [95% CI = 0.92, 1.68], p < 0.00001; and HIIT: MD, 4.90 ml/kg/min [95% CI = 3.77, 6.04], p < 0.00001), and HIIT promoted greater improvement than MICT (MD, 2.52 ml/kg/min [95% CI = 1.90, 3.13], p < 0.0001). In conclusion, HIIT and MICT promote reduction in SBP in adults with hypertension, and HIIT showed a greater magnitude in DBP reduction. For hypertensive patients, HIIT may be associated with a greater improvement in VO2max than MICT might.
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Affiliation(s)
- Juliana Moraes Leal
- Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil. .,, Pelotas, Brazil.
| | - Leony Morgana Galliano
- Superior School of Physical Education, Federal University of Pelotas, Pelotas, RS, Brazil
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Tadic M, Cuspidi C, Suzic‐Lazic J, Andric A, Sala C, Santoro C, Iracek O, Celic V. Influence of circadian blood pressure patterns and cardiopulmonary functional capacity in hypertensive patients. J Clin Hypertens (Greenwich) 2019; 21:1551-1557. [DOI: 10.1111/jch.13671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
- Department of Internal Medicine and Cardiology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Cesare Cuspidi
- Clinical Research Unit University of Milan‐Bicocca and Istituto Auxologico Italiano IRCCS Meda Italy
| | - Jelena Suzic‐Lazic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Anita Andric
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Carla Sala
- Clinical Research Unit University of Milan‐Bicocca and Istituto Auxologico Italiano IRCCS Meda Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences Federico II University Hospital Naples Italy
| | - Olinka Iracek
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Vera Celic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
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What Is the Optimal Exercise Prescription for Patients With Dilated Cardiomyopathy in Cardiac Rehabilitation? A SYSTEMATIC REVIEW. J Cardiopulm Rehabil Prev 2019; 39:235-240. [DOI: 10.1097/hcr.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pymer S, Nichols S, Prosser J, Birkett S, Carroll S, Ingle L. Does exercise prescription based on estimated heart rate training zones exceed the ventilatory anaerobic threshold in patients with coronary heart disease undergoing usual-care cardiovascular rehabilitation? A United Kingdom perspective. Eur J Prev Cardiol 2019; 27:579-589. [DOI: 10.1177/2047487319852711] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In the United Kingdom (UK), exercise intensity is prescribed from a fixed percentage range (% heart rate reserve (%HRR)) in cardiac rehabilitation programmes. We aimed to determine the accuracy of this approach by comparing it with an objective, threshold-based approach incorporating the accurate determination of ventilatory anaerobic threshold (VAT). We also aimed to investigate the role of baseline cardiorespiratory fitness status and exercise testing mode dependency (cycle vs. treadmill ergometer) on these relationships. Design and methods A maximal cardiopulmonary exercise test was conducted on a cycle ergometer or a treadmill before and following usual-care circuit training from two separate cardiac rehabilitation programmes from a single region in the UK. The heart rate corresponding to VAT was compared with current heart rate-based exercise prescription guidelines. Results We included 112 referred patients (61 years (59–63); body mass index 29 kg·m–2 (29–30); 88% male). There was a significant but relatively weak correlation ( r = 0.32; p = 0.001) between measured and predicted %HRR, and values were significantly different from each other ( p = 0.005). Within this cohort, we found that 55% of patients had their VAT identified outside of the 40–70% predicted HRR exercise training zone. In the majority of participants (45%), the VAT occurred at an exercise intensity <40% HRR. Moreover, 57% of patients with low levels of cardiorespiratory fitness achieved VAT at <40% HRR, whereas 30% of patients with higher fitness achieved their VAT at >70% HRR. VAT was significantly higher on the treadmill than the cycle ergometer ( p < 0.001). Conclusion In the UK, current guidelines for prescribing exercise intensity are based on a fixed percentage range. Our findings indicate that this approach may be inaccurate in a large proportion of patients undertaking cardiac rehabilitation.
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Affiliation(s)
- Sean Pymer
- Academic Vascular Surgical Unit Hull York Medical School, Hull, UK
| | - Simon Nichols
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | | | - Stefan Birkett
- School of Sport & Wellbeing, University of Central Lancashire, Preston, UK
| | - Sean Carroll
- School of Sport and Health Sciences, University of Hull, UK
| | - Lee Ingle
- School of Sport and Health Sciences, University of Hull, UK
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Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open 2018; 1:e183605. [PMID: 30646252 PMCID: PMC6324439 DOI: 10.1001/jamanetworkopen.2018.3605] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness. OBJECTIVE To assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (≥97.7th percentile). EXPOSURES Cardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS The study population included 122 007 patients (mean [SD] age, 53.4 [12.6] years; 72 173 [59.2%] male). Death occurred in 13 637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P < .001; elite vs high: adjusted HR, 0.77; 95% CI, 0.63-0.95; P = .02). The increase in all-cause mortality associated with reduced cardiorespiratory fitness (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P < .001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P < .001) was comparable to or greater than traditional clinical risk factors (coronary artery disease: adjusted HR, 1.29; 95% CI, 1.24-1.35; P < .001; smoking: adjusted HR, 1.41; 95% CI, 1.36-1.46; P < .001; diabetes: adjusted HR, 1.40; 95% CI, 1.34-1.46; P < .001). In subgroup analysis, the benefit of elite over high performance was present in patients 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04) and patients with hypertension (adjusted HR, 0.70; 95% CI, 0.50-0.99; P = .05). Extreme cardiorespiratory fitness (≥2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups. CONCLUSIONS AND RELEVANCE Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.
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Affiliation(s)
| | - Serge Harb
- Cleveland Clinic Foundation, Cleveland, Ohio
| | - Paul Cremer
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Wael Jaber
- Cleveland Clinic Foundation, Cleveland, Ohio
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30
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Liu Y, Shu XO, Wen W, Saito E, Rahman MS, Tsugane S, Tamakoshi A, Xiang YB, Yuan JM, Gao YT, Tsuji I, Kanemura S, Nagata C, Shin MH, Pan WH, Koh WP, Sawada N, Cai H, Li HL, Tomata Y, Sugawara Y, Wada K, Ahn YO, Yoo KY, Ashan H, Chia KS, Boffetta P, Inoue M, Kang D, Potter JD, Zheng W. Association of leisure-time physical activity with total and cause-specific mortality: a pooled analysis of nearly a half million adults in the Asia Cohort Consortium. Int J Epidemiol 2018; 47:771-779. [PMID: 29490039 PMCID: PMC6005114 DOI: 10.1093/ije/dyy024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most previous studies evaluating the association between leisure-time physical activity (LTPA) and risk of death were conducted among generally healthy individuals of European ancestry. We investigated the association of LTPA with all-cause and cause-specific mortality among East Asian populations, including healthy individuals and those with existing chronic diseases, which has been less well characterized. METHODS We performed pooled analyses among 467 729 East Asian individuals recruited in nine prospective cohorts included in the Asia Cohort Consortium. Cox proportional hazards regressions were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs) associated with LTPA after adjusting for age, sex, education and marital and smoking status. RESULTS During a mean follow-up period of 13.6 years, 65 858 deaths were identified. Compared with those who reported no or less than 1 h of LTPA per week, an inverse association was observed between the amount of LTPA and all-cause and cause-specific mortality (P for trend < 0.001). The strength of the inverse association was stronger for death due to cardiovascular diseases and causes other than cancer deaths. An inverse association of LTPA with total mortality was observed among individuals with a severe and often life-threatening disease: cancer, stroke or coronary heart disease [hazard ratio (HR) = 0.81, 95% CI = 0.73-0.89 for high vs low LTPA) and those with other chronic diseases such as diabetes or hypertension (HR = 0.86, 95% CI = 0.80-0.93 for high vs low LTPA). No clear modifying effects by sex, body mass index or smoking status were identified. CONCLUSIONS Regular participation in LTPA is associated with reduced mortality in middle-aged and elder Asians regardless pre-existing health conditions.
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Affiliation(s)
- Ying Liu
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA
| | - Wanqing Wen
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA
| | - Eiko Saito
- Division of Cancer Statistics Integration, National Cancer Center, Tokyo, Japan
| | - M Shafiur Rahman
- Department of Global Health Policy, University of Tokyo, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Akiko Tamakoshi
- Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yong-Bing Xiang
- Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, PR China
| | - Jian-Min Yuan
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Division of Cancer Control and Population Science, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Yu-Tang Gao
- Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, PR China
| | - Ichiro Tsuji
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Seiki Kanemura
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Chisato Nagata
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wen-Harn Pan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Woon-Puay Koh
- Duke-NUS Medical School Singapore
- Saw Swee Hock School of Public Health, Singapore, Republic of Singapore
| | - Norie Sawada
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Hui Cai
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA
| | - Hong-Lan Li
- Shanghai Cancer Institute, Shanghai Jiaotong University, Shanghai, PR China
| | - Yasutake Tomata
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Yumi Sugawara
- Tohoku University Graduate School of Medicine, Miyagi Prefecture, Japan
| | - Keiko Wada
- Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | - Keun-Young Yoo
- Armed Forces Capital Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Habibul Ashan
- Departments of Health Studies, Medicine and Human Genetics and Cancer Research Center, University of Chicago, Chicago, IL, USA
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, Singapore, Republic of Singapore
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manami Inoue
- Epidemiology and Prevention Group, National Cancer Center, Tokyo, Japan
| | - Daehee Kang
- Department of Preventive Medicine
- Department of Biomedical Sciences
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - John D Potter
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Centre for Public Health Research, Massey University, Wellington, New Zealand
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Wei Zheng
- Division of Epidemiology, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Nashville, TN, USA
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Merlo C, Sorino N, Myers J, Sassone B, Pasanisi G, Mandini S, Guerzoni F, Napoli N, Conconi F, Mazzoni G, Chiaranda G, Grazzi G. Moderate walking speed predicts hospitalisation in hypertensive patients with cardiovascular disease. Eur J Prev Cardiol 2018; 25:1558-1560. [PMID: 29673267 DOI: 10.1177/2047487318767463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlotta Merlo
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy
| | - Nicola Sorino
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy
| | - Jonathan Myers
- 2 Division of Cardiology, VA Palo Alto, USA.,3 Stanford University School of Medicine, Stanford, USA
| | - Biagio Sassone
- 4 Department of Medicine, Division of Cardiology, Cento Hospital, AUSL Ferrara, Italy
| | - Giovanni Pasanisi
- 5 Department of Medicine, Division of Cardiology, 'Delta' Hospital, AUSL Ferrara, Italy
| | - Simona Mandini
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy
| | - Franco Guerzoni
- 6 Department of Medical Statistics, St Anna General Hospital, Ferrara, Italy
| | - Nicola Napoli
- 6 Department of Medical Statistics, St Anna General Hospital, Ferrara, Italy
| | - Francesco Conconi
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy
| | - Gianni Mazzoni
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy.,7 Public Health Department, AUSL Ferrara, Italy
| | - Giorgio Chiaranda
- 8 Public Health Department, AUSL Piacenza, Italy.,9 General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
| | - Giovanni Grazzi
- 1 Centre for Biomedical Studies applied to Sports, University of Ferrara, Italy.,7 Public Health Department, AUSL Ferrara, Italy
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Leggio M, Fusco A, Limongelli G, Sgorbini L. Exercise training in patients with pulmonary and systemic hypertension: A unique therapy for two different diseases. Eur J Intern Med 2018; 47:17-24. [PMID: 28911936 DOI: 10.1016/j.ejim.2017.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Pulmonary hypertension is a potentially life-threatening condition. Given its evolving definition, the incidence and prevalence of the disease is difficult to define, but registries suggest an increased global awareness. The management of patients with pulmonary arterial hypertension is highly specialised and requires multi-disciplinary input from a range of healthcare professionals, including cardiologists, respiratory physicians, rheumatologists, rehabilitation physicians and cardio-pulmonary physiotherapists. Historically, exercise training in pulmonary hypertension has not been recommended because of safety concerns. However, an increasing number of studies have demonstrated the benefit of exercise training on exercise capacity, peak oxygen consumption and quality of life. Systemic hypertension is one of the most important risk factors for cardiovascular disease, and has been ranked as the leading cause for death and disability worldwide: therefore, adequate control of blood pressure is important for public health. Lowering of blood pressure and prevention of hypertension is in first instance preferable by lifestyle changes. These include weight loss, moderation of alcohol intake, a diet with increased fresh fruit and vegetables, reduced saturated fat, reduced salt intake, reduced stress, and, finally, increased physical activity. With regard to the latter, former guidelines predominantly recommended aerobic exercises such as walking, jogging, and cycling for lowering blood pressure. The main focus of this narrative overview paper is to briefly examine and summarize the benefit of exercise training in patients with pulmonary and systemic hypertension, suggest mechanisms by which exercise may improve symptoms and function and provide evidence-based recommendations regarding the frequency and intensity of exercise in these patients.
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Affiliation(s)
- Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, San Filippo Neri Hospital - Salus Infirmorum Clinic, Rome, Italy.
| | - Augusto Fusco
- Physical Medicine and Neurorehabilitation Operative Unit, Salus Infirmorum Clinic, Rome, Italy
| | - Giorgio Limongelli
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
| | - Luca Sgorbini
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, Santo Spirito Hospital - Villa Betania Clinic, Rome, Italy
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High-intensity interval training lowers blood pressure and improves apelin and NOx plasma levels in older treated hypertensive individuals. J Physiol Biochem 2017; 74:47-55. [PMID: 29214526 DOI: 10.1007/s13105-017-0602-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/28/2017] [Indexed: 01/11/2023]
Abstract
Hypertension is the major risk factor for cardiovascular diseases and is one of the primary causes of morbidity and mortality worldwide. Apelin levels and NO bioavailability are impaired in older hypertensive patients. Exercise is an effective intervention for treating hypertension. Our purpose was to evaluate the effect of high-intensity interval training on blood pressure, apelin, and NOx plasma levels in older treated hypertensive individuals. Thirty treated hypertensive subjects (61.70 ± 5.78 years, 17 males, 13 females) were randomly divided into 6 weeks of high-intensity interval training (n = 15) and control (n = 15). The exercise training was conducted for three 35-min sessions a week (1.5-min interval at 85-90% of heart rate reserve [HRR] and 2 min active phase at 50-55% of HRR). Assessment of plasma apelin, nitrite/nitrate (NOx), and endothelin-1 (ET-1) was performed before and after the intervention. At the end of the study, apelin, and NOx plasma levels increased significantly in the high-intensity interval training (HIIT) group (P = 0.021, P = 0.003, respectively). Conversely, ET-1 plasma levels significantly decreased in the training group after the intervention (P = 0.015). Moreover, there was a positive correlation between the change of plasma apelin and change of plasma NOx (r = 0. 771, P = 0.0008). In addition, there was a negative correlation between the change of plasma ET-1, change of plasma apelin (r = - 0.595, P = 0.019), and variation of NOx (r = - 0.572, P = 0.025). This study indicates that, by increasing of apelin and NOx plasma levels, HIIT may be effective in reducing blood pressure.
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Oktay AA, Lavie CJ, Kokkinos PF, Parto P, Pandey A, Ventura HO. The Interaction of Cardiorespiratory Fitness With Obesity and the Obesity Paradox in Cardiovascular Disease. Prog Cardiovasc Dis 2017; 60:30-44. [DOI: 10.1016/j.pcad.2017.05.005] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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35
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[Therapeutic education in primary cardiovascular prevention: 4 years sustained interest]. Ann Cardiol Angeiol (Paris) 2017; 67:14-17. [PMID: 28506575 DOI: 10.1016/j.ancard.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/26/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our patient therapeutic education program yields improvements in health after one year. But what can we see after 4 years, when the patient alone is responsible for following the program? PATIENTS AND METHODS Two hundred and ninety-one patients participated in the first part of our study and were followed during one year. Four years into the ongoing study, we reviewed the progress of the first 200 patients. We compared the already published Risk Factors and Eating Habits scores between the beginning of the study (T0), one year later (T1) and after 4 years (T4). RESULTS The Risk Factor score at T0 is 9.5±7.8, moving to 7±7.5 at T1, and then to 6.8±7.8 at T4 (P<0.001 between T0 and T1 and T0 and T4). Endurance physical activities saw the greatest improvement: 0.79±5 at T0, -1.07±4.5 at T1 and -1.61±4.5 at T4 (P<0.001 between T0 and T1 and T0 and T4). The Eating Habits score went from -18.2±7.3 to -22.2±6.4 and then to -23.5±6.4 (P<0.001 between T0 and T1 and T0 and T4). The best results were obtained through increased consumption of whole grains, green vegetables and fish. CONCLUSION The positive results of the progress of risk factors and eating habits, noted after one year, are even greater four years after the end of the therapeutic education program.
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Kokkinos PF, Faselis C, Myers J, Narayan P, Sui X, Zhang J, Lavie CJ, Moore H, Karasik P, Fletcher R. Cardiorespiratory Fitness and Incidence of Major Adverse Cardiovascular Events in US Veterans: A Cohort Study. Mayo Clin Proc 2017; 92:39-48. [PMID: 27876315 DOI: 10.1016/j.mayocp.2016.09.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/27/2016] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of major adverse cardiovascular events (MACEs). PATIENTS AND METHODS A symptom-limited exercise tolerance test was performed to assess exercise capacity in 20,590 US veterans (12,975 blacks and 7615 whites; mean ± SD age, 58.2±11.0 years) from the Veterans Affairs medical centers in Washington, District of Columbia, and Palo Alto, California. None had a history of MACE or evidence of ischemia at the time of or before their exercise tolerance test. We established quintiles of cardiorespiratory fitness (CRF) categories based on age-specific peak metabolic equivalents (METs) achieved. We also defined the age-specific MET level associated with no risk for MACE (hazard ratio [HR], 1.0) and formed 4 additional CRF categories based on METs achieved below (least fit and low fit) and above (moderately fit and highly fit) that level. Multivariate Cox models were used to estimate HR and 95% CIs for mortality across fitness categories. RESULTS During follow-up (median, 11.3 years; range, 0.3-33.0 years), 2846 individuals experienced MACEs. The CRF-MACE association was inverse and graded. The risk for MACE declined precipitously for those with a CRF level of 6.0 METs or higher. When considering CFR categories based on the age-specific MET threshold, the risk increased for those in the 2 CFR categories below that threshold (HR, 1.95; 95% CI, 1.73-2.21 and HR, 1.41; 95% CI, 1.27-1.56 for the least-fit and low-fit individuals, respectively) and decreased for those above it (HR, 0.77; 95% CI, 0.68-0.87 and HR, 0.57; 95% CI, 0.48-0.67 for moderately fit and highly fit, respectively). CONCLUSION Increased CRF is inversely and independently associated with the risk for MACE. When an age-specific MET threshold was defined, the risk for MACE increased significantly for those below that threshold and decreased for those above it (P<.001).
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Affiliation(s)
- Peter F Kokkinos
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Charles Faselis
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Puneet Narayan
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA
| | - Hans Moore
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
| | - Pamela Karasik
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ross Fletcher
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC; Georgetown University School of Medicine, Washington, DC
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Jung MH, Ihm SH, Lee DH, Chung WB, Jung HO, Youn HJ. Prehypertension is associated with early complications of atherosclerosis but not with exercise capacity. Int J Cardiol 2017; 227:387-392. [DOI: 10.1016/j.ijcard.2016.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/21/2016] [Accepted: 11/05/2016] [Indexed: 11/30/2022]
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Effects of chronic nitric oxide synthase inhibition on V'O 2max and exercise capacity in mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2016; 390:235-244. [PMID: 27915453 DOI: 10.1007/s00210-016-1318-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
Acute inhibition of NOS by L-NAME (Nω-nitro-L-arginine methyl ester) is known to decrease maximal oxygen consumption (V'O2max) and impair maximal exercise capacity, whereas the effects of chronic L-NAME treatment on V'O2max and exercise performance have not been studied so far. In this study, we analysed the effect of L-NAME treatment, (LN2 and LN12, respectively) on V'O2max and exercise capacity (in maximal incremental running and prolonged sub-maximal incremental running tests), systemic NO bioavailability (plasma nitrite (NO2-) and nitrate (NO3-)) and prostacyclin (PGI2) production in C57BL6/J mice. Mice treated with L-NAME for 2 weeks (LN2) displayed higher V'O2max and better running capacity than age-matched control mice. In LN2 mice, NO bioavailability was preserved, as evidenced by maintained NO2- plasma concentration. PGI2 production was activated (increased 6-keto-PGF1α plasma concentration) and the number of circulating erythrocytes (RBC) and haemoglobin concentration were increased. In mice treated with L-NAME for 12 weeks (LN12), NO bioavailability was decreased (lower NO2- plasma concentration), and 6-keto-PGF1α plasma concentration and RBC number were not elevated compared to age-matched control mice. However, LN12 mice still performed better during the maximal incremental running test despite having lower V'O2max. Interestingly, the LN12 mice showed poorer running capacity during the prolonged sub-maximal incremental running test. To conclude, short-term (2 weeks) but not long-term (12 weeks) treatment with L-NAME activated robust compensatory mechanisms involving preservation of NO2- plasma concentration, overproduction of PGI2 and increased number of RBCs, which might explain the fully preserved exercise capacity despite the inhibition of NOS.
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Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X, Wisløff U. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e653-e699. [PMID: 27881567 DOI: 10.1161/cir.0000000000000461] [Citation(s) in RCA: 1505] [Impact Index Per Article: 167.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association's 2020 goals.
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Long Term Home-Based Exercise is Effective to Reduce Blood Pressure in Low Income Brazilian Hypertensive Patients: A Controlled Trial. High Blood Press Cardiovasc Prev 2016; 23:395-404. [PMID: 27658925 DOI: 10.1007/s40292-016-0169-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/08/2016] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Home-based exercise programs may increase adherence to physical activity among groups with poor access to exercise facilities. However, their effectiveness to lower blood pressure of hypertensive patients remains undefined. AIMS This controlled clinical trial investigated the influence of a home-based exercise program upon blood pressure, blood metabolic profile, and physical fitness in a Brazilian cohort of low income patients diagnosed with hypertension. METHODS Twenty-nine patients (22 women, age: 53 ± 11 years) underwent 16 months of home-based exercise, including 30 min of moderate intensity walking and stretching exercises. Fourteen patients (9 women, age: 48 ± 5 years) composed a non-exercise control group. Primary outcomes were assessed each two months. RESULTS Body mass (3.6 ± 0.2 kg; P = 0.03) and sum of skinfolds (3.0 ± 1.2 cm; P = 0.04) increased in controls vs. baseline. Mean compliance to home-based exercise was 83 ± 7 %, which induced significant improvements from baseline vs. controls in body mass (-5.4 ± 2.0 kg; P = 0.04), body fat (-4.7 ± 0.3 %; P = 0.03), waist circumference (-6.1 ± 1.2 cm; P = 0.03), sum of skinfolds (-14.8 ± 3.7; P = 0.02); aerobic efficiency reflected by slopes of relationships between heart rate and workload (-0.05 ± 0.01; P = 0.05), trunk flexibility (7.8 ± 1.7 cm; P = 0.02), HDL (1.8 ± 0.9 mg/dL; P = 0.04), triglycerides (-12.3 ± 1.0 mg/dL; P = 0.03), and glucose (-6.9 ± 2.9 mg/dL; P = 0.05). Systolic and diastolic BP decreased until the sixth month of intervention vs. baseline and controls, remaining stable at lower levels thereafter (systolic blood pressure: -4.5 ± 0.3 mmHg; P = 0.03; diastolic blood pressure: -2.5 ± 0.6 mmHg; P = 0.05). CONCLUSIONS Low income hypertensive patients complied with a long-term home-based exercise program, which was effective for improving their functional capacity, blood metabolic profile, and blood pressure.
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Huerta JM, Chirlaque MD, Tormo MJ, Buckland G, Ardanaz E, Arriola L, Gavrila D, Salmerón D, Cirera L, Carpe B, Molina-Montes E, Chamosa S, Travier N, Quirós JR, Barricarte A, Agudo A, Sánchez MJ, Navarro C. Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort. Prev Med 2016; 85:106-112. [PMID: 26861751 DOI: 10.1016/j.ypmed.2016.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Large-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study. METHODS 38,379 participants (62.4% women), 30-65years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders. RESULTS After 13.6years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1=0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend=0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1=0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality. CONCLUSIONS HPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.
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Affiliation(s)
- José Mª Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - María José Tormo
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Larraitz Arriola
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Diego Salmerón
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Bienvenida Carpe
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain.
| | - Esther Molina-Montes
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Saioa Chamosa
- Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Noemie Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - José R Quirós
- Public Health Directorate, Ciriaco Miguel Vigil, 9, 33006 Oviedo, Spain.
| | - Aurelio Barricarte
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - María José Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
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Shaya GE, Al-Mallah MH, Hung RK, Nasir K, Blumenthal RS, Ehrman JK, Keteyian SJ, Brawner CA, Qureshi WT, Blaha MJ. High Exercise Capacity Attenuates the Risk of Early Mortality After a First Myocardial Infarction: The Henry Ford Exercise Testing (FIT) Project. Mayo Clin Proc 2016; 91:129-39. [PMID: 26848000 DOI: 10.1016/j.mayocp.2015.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/01/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the effect of objectively measured exercise capacity (EC) on early mortality (EM) after a first myocardial infarction (MI). PATIENTS AND METHODS This retrospective cohort study included 2061 patients without a history of MI (mean age, 62±12 years; 38% [n=790] women; 56% [n=1153] white) who underwent clinical treadmill stress testing in the Henry Ford Health System from January 1, 1991, through May 31, 2009, and suffered MI during follow-up (MI event proportion, 3.4%; mean time from the exercise test to MI, 6.1±4.3 years). Exercise capacity was categorized on the basis of peak metabolic equivalents (METs) achieved: less than 6, 6 to 9, 10 to 11, and 12 or more METs. Early mortality was defined as all-cause mortality within 28, 90, or 365 days of MI. Multivariable logistic regression models were used to assess the effect of EC on the risk of mortality at each time point post-MI adjusting for baseline demographic characteristics, cardiovascular risk factors, medication use, indication for stress testing, and year of MI. RESULTS The 28-day EM rate was 10.6% overall, and 13.9%, 10.7%, 6.9%, and 6.0% in the less than 6, 6 to 9, 10 to 11, and 12 or more METs categories, respectively (P<.001). Patients who died were more likely to be older, be less fit, be nonobese, have treated hypertension, and have a longer duration from baseline to incident MI (P<.05). Adjusted regression analyses revealed a decreased risk of EM with increasing EC categories. A 1-MET higher EC was associated with an 8% to 10% lower risk of mortality across all time points (28 days: odds ratio [OR], 0.92; 95% CI, 0.87-0.98; P=.006; 90 days: OR, 0.90; 95% CI, 0.86-0.95; P<.001; 365 days: OR, 0.91; 95% CI, 0.87-0.94; P<.001). CONCLUSION Higher baseline EC was independently associated with a lower risk of early death after a first MI.
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Affiliation(s)
- Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL
| | - Mouaz H Al-Mallah
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia; Henry Ford Hospital, Detroit, MI
| | - Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | | | | | - Waqas T Qureshi
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Hung RK, Al-Mallah MH, Qadi MA, Shaya GE, Blumenthal RS, Nasir K, Brawner CA, Keteyian SJ, Blaha MJ. Cardiorespiratory fitness attenuates risk for major adverse cardiac events in hyperlipidemic men and women independent of statin therapy: The Henry Ford ExercIse Testing Project. Am Heart J 2015; 170:390-9. [PMID: 26299238 DOI: 10.1016/j.ahj.2015.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/15/2015] [Indexed: 12/21/2022]
Abstract
AIMS We sought to evaluate the effect of cardiorespiratory fitness (CRF) in predicting mortality, myocardial infarction (MI), and revascularization in patients with hyperlipidemia after stratification by gender and statin therapy. METHODS AND RESULTS This retrospective cohort study included 33,204 patients with hyperlipidemia (57 ± 12 years old, 56% men, 25% black) who underwent physician-referred treadmill stress testing at the Henry Ford Health System from 1991 to 2009. Patients were stratified by gender, baseline statin therapy, and estimated metabolic equivalents from stress testing. We computed hazard ratios using Cox regression models after adjusting for demographics, cardiac risk factors, comorbidities, pertinent medications, interaction terms, and indication for stress testing. RESULTS There were 4,851 deaths, 1,962 MIs, and 2,686 revascularizations over a median follow-up of 10.3 years. In men and women not on statin therapy and men and women on statin therapy, each 1-metabolic equivalent increment in CRF was associated with hazard ratios of 0.86 (95% CI 0.85-0.88), 0.83 (95% CI 0.81-0.85), 0.85 (95% CI 0.83-0.87), and 0.84 (95% CI 0.81-0.87) for mortality; 0.93 (95% CI 0.90-0.96), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.86-0.92), and 0.90 (95% CI 0.86-0.95) for MI; and 0.91 (95% CI 0.88-0.93), 0.87 (95% CI 0.83-0.91), 0.89 (95% CI 0.87-0.92), and 0.90 (95% CI 0.86-0.94) for revascularization, respectively. No significant interactions were observed between CRF and statin therapy (P > .23). CONCLUSION Higher CRF attenuated risk for mortality, MI, and revascularization independent of gender and statin therapy in patients with hyperlipidemia. These results reinforce the prognostic value of CRF and support greater promotion of CRF in this patient population.
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Affiliation(s)
- Rupert K Hung
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Mouaz H Al-Mallah
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; King Abdul-Aziz Cardiac Center, Riyadh, Saudi Arabia
| | - Mohamud A Qadi
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Gabriel E Shaya
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; University of Miami Miller School of Medicine, Miami, FL
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD; Baptist Health South Florida, Miami, FL
| | | | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.
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Santos RZD, Bundchen DC, Amboni R, Santos MBD, Ghisi GLDM, Herdy AH, Benetti M. Treinamento aeróbio intenso promove redução da pressão arterial em hipertensos. REV BRAS MED ESPORTE 2015. [DOI: 10.1590/1517-869220152104139357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O treinamento físico promove importantes respostas adaptativas no organismo que diminuem a morbidade e a mortalidade em hipertensos. Entretanto, são poucos os estudos que avaliaram a resposta pressórica do treinamento aeróbio de diferentes intensidades em hipertensos. Objetivo: Analisar os efeitos do treinamento físico aeróbio intenso com relação ao treinamento físico moderado sobre a pressão arterial ambulatorial em hipertensos.MÉTODOS: Participaram do estudo 32 hipertensos (48 ± 9 anos) randomizados como: grupo de treinamento aeróbio de intensidade moderada (IM), intensidade de 60-65% da frequência cardíaca de reserva, 40 minutos, três sessões por semana (n=12); exercício aeróbio de alta intensidade (AI), intensidade de 80% a 85% da frequência cardíaca de reserva (n=12), com a duração ajustada para atingir o mesmo gasto energético que a IM e um grupo controle (GC) sem exercícios (n=10). Nos três grupos foram avaliadas variáveis da monitorização ambulatorial da pressão arterial de 24 horas (MAPA) antes e após as oito semanas de intervenção.RESULTADOS: Após a intervenção a pressão arterial sistólica (PAS) da vigília reduziu 10,1 mmHg (p=0,024) em AI e 9,7 mmHg (p=0,035) em IM e a pressão arterial diastólica (PAD) da vigília reduziu 12,3 mmHg (p=0,002) em AI e 8,4 mmHg (p<0,001) em IM. A PAS do sono reduziu 9,5 mmHg (p=0,004) apenas em AI e 9,8 mmHg (p=0,005) em IM. A PAD do sono reduziu 8,2 mmHg (p=0,006) em AI e 4,8 mmHg (p<0,007) em IM. As cargas pressóricas sistólicas e diastólicas da vigília e do sono reduziram-se significativamente apenas em AI.CONCLUSÃO: Treinamento físico aeróbio moderado e intenso com duração equalizada pelo gasto calórico tem efeito hipotensor semelhante em hipertensos. A carga pressórica reduziu apenas na AI, sendo assim intensidade-dependente.
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Ritvo P, Stefanyk LE, Azargive S, Stojanovic S, Stollon F, Habot J, Khaykin Y, Fair T, Pirbaglou M. Functional capacity and heart rate response: associations with nocturnal hypertension. BMC Cardiovasc Disord 2015. [PMID: 26197812 PMCID: PMC4511245 DOI: 10.1186/s12872-015-0064-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Absences of normative, 10–20 % declines in blood pressure (BP) at night, termed nocturnal non-dipping, are linked to increased cardiovascular mortality risks. Current literature has linked these absences to psychological states, hormonal imbalance, and disorders involving hyper-arousal. This study focuses on evaluating associations between nocturnal non-dipping and indices of functional cardiac capacity and fitness. Methods The current study was a cross-sectional evaluation of the associations between physical capacity variables e.g. Metabolic Equivalent (MET) and Maximum Heart Rate (MHR), Heart rate reserve (HRR), and degree of reduction in nocturnal systolic blood pressure (SBP) or diastolic blood pressure (DBP), also known as ‘dipping’. The study sample included 96 cardiac patient participants assessed for physical capacity and ambulatory blood pressure monitoring. In addition to evaluating differences between groups on nocturnal BP ‘dipping’, physical capacity, diagnoses, and medications, linear regression analyses were used to evaluate potential associations between nocturnal SBP and DBP ‘dipping’, and physical capacity indices. Results 45 males and 14 females or 61.5 % of 96 consented participants met criteria as non-dippers (<10 % drop in nocturnal BP). Although non-dippers were older (p = .01) and had a lower maximum heart rate during the Bruce stress test (p = .05), dipping was only significantly associated with Type 2 Diabetes co-morbidity and was not associated with type of medication. Within separate linear regression models controlling for participant sex, MHR (β = 0.26, p = .01, R2 = .06), HRR (β = 0. 19, p = .05, R2 = .05), and METs (β = 0.21, p = .04, R2 = .04) emerged as significant but small predictors of degree of nighttime SBP dipping. Similar relationships were not observed for DBP. Conclusions Since the variables reflecting basic heart function and fitness (MHR and METs), did not account for appreciable variances in nighttime BP, nocturnal hypertension appears to be a complex, multi-faceted phenomena.
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Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada. .,Department of Psychology, York University, Toronto, ON, Canada. .,Research, Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada.
| | - Leslie E Stefanyk
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Saam Azargive
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Slobodan Stojanovic
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Faye Stollon
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Juda Habot
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada.
| | - Yaariv Khaykin
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada. .,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Terry Fair
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada.
| | - Meysam Pirbaglou
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
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Kokkinos P, Faselis C, Myers J, Sui X, Zhang J, Tsimploulis A, Chawla L, Palant C. Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study. Mayo Clin Proc 2015; 90:461-8. [PMID: 25792243 DOI: 10.1016/j.mayocp.2015.01.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/12/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD). PATIENTS AND METHODS Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.5 years) from the Veterans Affairs Medical Center, Washington, DC. Study participants had an estimated glomerular filtration rate of 60 mL/min per 1.73 m(2) or more 6 months before exercise testing and no evidence of CKD. Those who developed CKD during follow-up were initially identified by the International Classification of Diseases, Ninth Revision and further verified by at least 2 consecutive estimated glomerular filtration rate values of less than 60 mL/min per 1.73 m(2) 3 months or more apart. Normal kidney function for CKD-free individuals was confirmed by sequential normal eGFR levels. We established 4 fitness categories on the basis of age-stratified quartiles of peak metabolic equivalents (METs) achieved: least-fit (≤25%; 4.8±0.90 METs; n=1258); low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and high-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the association between exercise capacity and CKD. RESULTS During a median follow-up period of 7.9 years, 1010 developed CKD (20.4/1000 person-years). Exercise capacity was inversely related to CKD incidence. The risk was 22% lower (hazard ratio, 0.78; 95% CI, 0.75-0.82; P<.001) for every 1-MET increase in exercise capacity. Compared with the least-fit individuals, hazard ratios were 0.87 (95% CI, 0.74-1.03) for low-fit, 0.55 (95% CI, 0.47-0.65) for moderate-fit, and 0.42 (95% CI, 0.33-0.52) for high-fit individuals. CONCLUSION Higher exercise capacity attenuated the risk of developing CKD. The association was independent and graded.
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Affiliation(s)
- Peter Kokkinos
- Cardiology Department, Veterans Affairs Medical Center, Washington, DC; Georgetown University Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia.
| | - Charles Faselis
- George Washington University School of Medicine, Washington, DC; Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Stanford University, Stanford, CA
| | - Xuemei Sui
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | | | - Lakhmir Chawla
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
| | - Carlos Palant
- George Washington University School of Medicine, Washington, DC; Nephrology Department, Veterans Affairs Medical Center, Washington, DC
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Scholl J, Bots ML, Peters SAE. Contribution of cardiorespiratory fitness, relative to traditional cardiovascular disease risk factors, to common carotid intima-media thickness. J Intern Med 2015; 277:439-46. [PMID: 24844122 DOI: 10.1111/joim.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Studies have suggested that being slightly overweight but fit is better for cardiovascular health than being somewhat leaner but unfit. Here, we sought to determine the contribution of cardiorespiratory fitness (CRF), relative to the presence of risk factors, to common carotid intima-media thickness (CIMT), a measurement of atherosclerosis and cardiovascular disease risk. METHODS Data were analysed from a cohort of 7300 German employed individuals aged 46 (±7) years who participated in a preventive health check-up at a specialized prevention centre. In addition to traditional cardiovascular disease risk factor assessment, participants performed an exercise test with spirometry to exhaustion, and common CIMT was measured. Individuals were defined as being fit or unfit based on the median age- and sex-specific relative maximum oxygen consumption. RESULTS In a multivariable analysis, there was a strong inverse association between CRF and common CIMT. Individuals who were considered fit and did not have any cardiovascular disease risk factors had the lowest common CIMT values (reference group). Those who were unfit and had an increased risk factor level always had the highest common CIMT values. Good CRF partly compensated for the increased common CIMT due to a risk factor. However, unfit individuals without increased risk factor levels had a common CIMT that was not significantly different from that of the reference group, whereas fit individuals who smoked, had a high body mass index, a low HDL cholesterol concentration or a high systolic blood pressure had an increase in common CIMT. CONCLUSION Cardiorespiratory fitness is a major determinant of common CIMT. Improved CRF does slightly, but not completely, abolish the adverse consequences of cardiovascular disease risk factors on common CIMT.
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Affiliation(s)
- J Scholl
- Dr. Scholl Prevention First GmbH, Private Practice for Preventive Medicine, Ruedesheim am Rhein, Germany
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Gkaliagkousi E, Gavriilaki E, Douma S. Effects of acute and chronic exercise in patients with essential hypertension: benefits and risks. Am J Hypertens 2015; 28:429-39. [PMID: 25362114 DOI: 10.1093/ajh/hpu203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The importance of regular physical activity in essential hypertension has been extensively investigated over the last decades and has emerged as a major modifiable factor contributing to optimal blood pressure control. Aerobic exercise exerts its beneficial effects on the cardiovascular system by promoting traditional cardiovascular risk factor regulation, as well as by favorably regulating sympathetic nervous system (SNS) activity, molecular effects, cardiac, and vascular function. Benefits of resistance exercise need further validation. On the other hand, acute exercise is now an established trigger of acute cardiac events. A number of possible pathophysiological links have been proposed, including SNS, vascular function, coagulation, fibrinolysis, and platelet function. In order to fully interpret this knowledge into clinical practice, we need to better understand the role of exercise intensity and duration in this pathophysiological cascade and in special populations. Further studies in hypertensive patients are also warranted in order to clarify the possibly favorable effect of antihypertensive treatment on exercise-induced effects.
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Affiliation(s)
- Eugenia Gkaliagkousi
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ben Saad H, Ben Hassen I, Ghannouchi I, Latiri I, Rouatbi S, Escourrou P, Ben Salem H, Benzarti M, Abdelghani A. 6-Min walk-test data in severe obstructive-sleep-apnea-hypopnea-syndrome (OSAHS) under continuous-positive-airway-pressure (CPAP) treatment. Respir Med 2015; 109:642-55. [PMID: 25820157 DOI: 10.1016/j.rmed.2015.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Few studies have evaluated the functional capacity of severe OSAHS. AIMS To assess their functional capacity, identify their 6-min walking-distance (6MWD) influencing factors and compare their data with those of two control-groups. METHODS Sixty (42 males) clinically consecutive stable patients with severe OSAHS under CPAP were included. Clinical, Epworth questionnaire, anthropometric, polysomnographic, plethysmographic and 6-min walk-test (6MWT) data were collected. Univariate and multivariate analyses were used to identify the 6MWD influencing factors. Data of a subgroup of severe OSAHS aged ≥40 Yrs (n = 49) were compared with those of non-obese (n = 174) and obese (n = 55) groups. RESULTS The means ± SD of age and apnea-hypopnea-index were, respectively, 49 ± 10 Yr and 62 ± 18/h. The profile of OSAHS patients carrying the 6MWT, was as follows: at the end of the 6MWT, 31% and 25% had, respectively, a high dyspnea (>5/10, visual analogue scale) and a low heart-rate (<60% of-maximal-predicted), 13% had an abnormal 6MWD (<lower-limit-of-normal), 13% had an oxy-hemoglobin saturation (oxy-sat) fall> 5 points and 3% stopped the walk. The factors that significantly influenced the 6MWD, explaining 80% of its variability, are included in the following equation: 6MWD (m) = 29.66 × first-second-forced-expiratory-volume (L) - 4.19 × Body-mass-index (kg/m(2)) - 51.89 × arterial-hypertension (0. No; 1. Yes) + 263.53 × Height (m) + 2.63 × average oxy-sat during sleep (%) - 51.06 × Diuretic-use (0. No; 1. Yes) - 20.68 × Dyspnea (NYHA) (0. No; 1. Yes) - 38.09 × Anemia (0. No; 1. Yes) + 5.79 × Resting oxy-sat (%) - 586.25. Compared with non-obese and obese groups, the subgroup of OSAHS has a significantly lower 6MWD [100 ± 9%, 100 ± 8% and 83 ± 12%, respectively). CONCLUSION Severe OSAHS may play a role in reducing the functional capacity.
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Affiliation(s)
- Helmi Ben Saad
- Research Laboratory LR14ES05: Interaction of the Cardiorespiratory System, Faculty of Medicine of Sousse, Sousse, Tunisia; Laboratory of Physiology, Faculty of Medicine, University of Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.
| | | | - Ines Ghannouchi
- Laboratory of Physiology, Faculty of Medicine, University of Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Imed Latiri
- Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratory of Physiology, Faculty of Medicine, University of Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
| | - Pierre Escourrou
- Laboratory of Functional Exploration, Hospital Antoine Béclère, Clamart, France
| | | | | | - Ahmed Abdelghani
- Research Laboratory LR14ES05: Interaction of the Cardiorespiratory System, Faculty of Medicine of Sousse, Sousse, Tunisia; Pulmonary Department, Farhat HACHED Hospital, Sousse, Tunisia
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