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Harber MP, Myers J, Bonikowske AR, Muntaner-Mas A, Molina-Garcia P, Arena R, Ortega FB. Assessing cardiorespiratory fitness in clinical and community settings: Lessons and advancements in the 100th year anniversary of VO 2max. Prog Cardiovasc Dis 2024; 83:36-42. [PMID: 38417771 DOI: 10.1016/j.pcad.2024.02.009] [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: 02/25/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
Cardiorespiratory fitness (CRF) is a well-established biomarker that has applications to all adults across the health and disease spectrum. Despite overwhelming evidence supporting the prognostic utility of CRF, it remains vastly underutilized. CRF is optimally measured via cardiopulmonary exercise testing which may not be feasible to implement on a large scale. Therefore, it is prudent to develop ways to accurately estimate CRF that can be applied in clinical and community settings. As such, several prediction equations incorporating non-exercise information that is readily available from routine clinical encounters have been developed that provide an adequate reflection of CRF that could be implemented to raise awareness of the importance of CRF. Further, technological advances in smartphone apps and consumer-grade wearables have demonstrated promise to provide reasonable estimates of CRF that are widely available, which could enhance the utilization of CRF in both clinical and community settings.
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Affiliation(s)
- Matthew P Harber
- Clinical Exercise Physiology, Ball State University, Muncie, IN, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, USA
| | | | - Adria Muntaner-Mas
- GICAFE "Physical Activity and Exercise Sciences Research Group", Faculty of Education, University of Balearic Islands, 07122 Palma, Spain
| | | | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, United States of America
| | - Francisco B Ortega
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Granada, Spain
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2
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Meijer R, Schep G, Regis M, Papen-Botterhuis NE, Savelberg HHCM, van Hooff M. Test-retest reliability of the FitMáx©-questionnaire in a clinical and healthy population. J Patient Rep Outcomes 2024; 8:3. [PMID: 38175456 PMCID: PMC10767039 DOI: 10.1186/s41687-023-00682-9] [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: 07/18/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The FitMáx© was developed as a questionnaire-based instrument to estimate Cardiorespiratory Fitness (CRF) expressed as oxygen uptake at peak exercise (VO2peak). Test-retest reliability is a clinometric measurement property, which defines stability over time if multiple measurements are performed (i.e. reliability). The present study aimed to assess the test-retest reliability of the FitMáx©-questionnaire in different patient groups. PATIENTS AND METHODS A total of 127 cardiac, pulmonary and oncology patients and healthy subjects aged 19-84 years who completed the questionnaire twice within an average of 18 days were included for analysis. Participants were in a stable clinical situation (no acute disease or participating in a training program). To determine the test-retest reliability, the Intraclass Correlation Coefficient (ICC) and Standard Error of the Measurement (SEM) was calculated between the first (T0) and second (T1) administration of the questionnaires. RESULTS An excellent agreement was found between the FitMáx©-questionnaire scores at T0 and T1, with an ICC of 0.97 (SEM 1.91) in the total study population and an ICC ranging from 0.93 to 0.98 (SEM 1.52-2.27) in the individual patient groups. CONCLUSION The FitMáx©-questionnaire proves to be reliable and stable over time to estimate CRF of patients and healthy subjects. Trial registration NTR (Netherlands Trial Register), NL8846. Registered 25 August 2020, https://trialsearch.who.int/Trial2.aspx?TrialID=NL8846.
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Affiliation(s)
- Renske Meijer
- Department of Sports and Exercise, Máxima Medical Centre (Máxima MC), Veldhoven, The Netherlands.
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Centre (Máxima MC), Veldhoven, The Netherlands
| | - Marta Regis
- Department of Mathematics and Computer Science, University of Technology, Eindhoven, The Netherlands
| | | | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Centre (Máxima MC), Veldhoven, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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3
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Cauwenberghs N, Haddad F, Daubert MA, Chatterjee R, Salerno M, Mega JL, Heidenreich P, Hernandez A, Amsallem M, Kobayashi Y, Mahaffey KW, Shah SH, Bloomfield GS, Kuznetsova T, Douglas PS. Clinical and Echocardiographic Diversity Associated With Physical Fitness in the Project Baseline Health Study: Implications for Heart Failure Staging. J Card Fail 2023; 29:1477-1489. [PMID: 37116641 DOI: 10.1016/j.cardfail.2023.04.008] [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: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Clinical and echocardiographic features may carry diverse information about the development of heart failure (HF). Therefore, we determined heterogeneity in clinical and echocardiographic phenotypes and its association with exercise capacity. METHODS In 2036 community-dwelling individuals, we defined echocardiographic profiles of left and right heart remodeling and dysfunction. We subdivided the cohort based on presence (+) or absence (-) of HF risk factors (RFs) and echocardiographic abnormalities (RF-/Echo-, RF-/Echo+, RF+/Echo-, RF+/Echo+). Multivariable-adjusted associations between subgroups and physical performance metrics from 6-minute walk and treadmill exercise testing were assessed. RESULTS The prevalence was 35.3% for RF-/Echo-, 4.7% for RF-/Echo+, 39.3% for RF+/Echo-, and 20.6% for RF+/Echo+. We observed large diversity in echocardiographic profiles in the Echo+ group. Participants with RF-/Echo+ (18.6% of Echo+) had predominantly echocardiographic abnormalities other than left ventricular (LV) diastolic dysfunction, hypertrophy and reduced ejection fraction, whereas their physical performance was similar to RF-/Echo-. In contrast, participants with RF+/Echo+ presented primarily with LV hypertrophy or dysfunction, features that related to lower 6-minute walking distance and lower exercise capacity. CONCLUSIONS Subclinical echocardiographic abnormalities suggest HF pathogenesis, but the presence of HF risk factors and type of echo abnormality should be considered so as to distinguish adverse from benign adaptation and to stratify HF risk.
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Affiliation(s)
- Nicholas Cauwenberghs
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Francois Haddad
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa A Daubert
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
| | - Ranee Chatterjee
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Salerno
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine and Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Paul Heidenreich
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Adrian Hernandez
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
| | - Myriam Amsallem
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yukari Kobayashi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford, CA, USA
| | - Svati H Shah
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Pamela S Douglas
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
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Weemaes ATR, Meijer R, Beelen M, van Hooff M, Weijenberg MP, Lenssen AF, van de Poll-Franse LV, Savelberg HHCM, Schep G. Monitoring aerobic capacity in cancer survivors using self-reported questionnaires: criterion validity and responsiveness. J Patient Rep Outcomes 2023; 7:73. [PMID: 37466784 PMCID: PMC10356721 DOI: 10.1186/s41687-023-00613-8] [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: 12/02/2022] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Evaluating the criterion validity and responsiveness of the self-reported FitMáx©-questionnaire, Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ) to monitor aerobic capacity in cancer survivors. METHODS Cancer survivors participating in a 10-week supervised exercise program were included. The FitMáx©-questionnaire, DASI, VSAQ and a cardiopulmonary exercise test (CPET) were completed before (T0) and after (T1) the program. Intraclass correlation coefficients (ICC) were calculated between VO2peak estimated by the questionnaires (questionnaire-VO2peak) and VO2peak measured during CPET (CPET-VO2peak), at T0 to examine criterion validity, and between changes in questionnaire-VO2peak and CPET-VO2peak (ΔT0-T1) to determine responsiveness. Receiver operating characteristic (ROC) analyses were performed to examine the ability of the questionnaires to detect true improvements (≥ 6%) in CPET-VO2peak. RESULTS Seventy participants were included. Outcomes at T1 were available for 58 participants (83%). Mean CPET-VO2peak significantly improved at T1 (Δ1.6 mL·kg- 1·min- 1 or 8%). Agreement between questionnaire-VO2peak and CPET-VO2peak at T0 was moderate for the FitMáx©-questionnaire (ICC = 0.69) and VSAQ (ICC = 0.53), and poor for DASI (ICC = 0.36). Poor agreement was found between ΔCPET-VO2peak and Δquestionnaire-VO2peak for all questionnaires (ICC 0.43, 0.19 and 0.18 for the FitMáx©-questionnaire, VSAQ and DASI, respectively). ROC analysis showed that the FitMáx©-questionnaire was able to detect improvements in CPET-VO2peak (area under the curve, AUC = 0.77), when using a cut-off value of 1.0 mL·kg- 1·min- 1, while VSAQ (AUC = 0.66) and DASI (AUC = 0.64) could not. CONCLUSION The self-reported FitMáx©-questionnaire has sufficient validity to estimate aerobic capacity in cancer survivors at group level. The responsiveness of the FitMáx©-questionnaire for absolute change is limited, but the questionnaire is able to detect whether aerobic capacity improved. The FitMáx©-questionnaire showed substantial better values of validity and responsiveness compared to DASI and VSAQ.
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Affiliation(s)
- Anouk T R Weemaes
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands.
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Renske Meijer
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Milou Beelen
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Center+, P.O. Box 5800, Maastricht, AZ, 6202, The Netherlands
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, The Netherlands
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Franssen RFW, Bongers BC, Vogelaar FJ, Janssen-Heijnen MLG. Feasibility of a tele-prehabilitation program in high-risk patients with colon or rectal cancer undergoing elective surgery: a feasibility study. Perioper Med (Lond) 2022; 11:28. [PMID: 35879732 PMCID: PMC9313601 DOI: 10.1186/s13741-022-00260-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Prehabilitation appears to be an effective strategy to reduce postoperative complications and enhance recovery after colorectal surgery. Although many patients prefer (unsupervised) home-based prehabilitation, adherence can be problematic. Combining home-based prehabilitation with tele-monitoring might demonstrate a higher adherence than unsupervised prehabilitation; however, evidence on its feasibility and effectiveness in patients with colorectal cancer scheduled for elective surgery who are at high risk for postoperative complications is lacking. The aim of this study was to assess the feasibility of a bimodal tele-prehabilitation program in patients with colorectal cancer at high risk for postoperative complications. Methods High-risk patients (oxygen uptake at the ventilatory anaerobic threshold ≤11 mL/kg/min or oxygen uptake at peak exercise ≤ 18 mL/kg/min) with colorectal cancer were included in a home-based bimodal tele-prehabilitation program. The program consisted of a personalized tele-monitored moderate to high-intensity interval training intervention and nutritional counseling. Feasibility was measured by participation rate, dropout rate, adherence to the physical exercise training session’s frequency, intensity, and time, and retention rate. Patient appreciation was measured by a patient appreciation questionnaire. Changes in preoperative physical fitness as secondary outcomes were quantified by time to exhaustion on a constant work rate (cycle) test, number of repetitions on the 30-s chair-stand test, and walking speed on the 4-m gait speed test. Results The participation rate was 81%, there were no adverse events, and all participants managed to complete the tele-prehabilitation program (retention rate of 100%). Adherence with regard to the exercise program’s frequency, intensity, and time was respectively 91%, 84%, and 100%. All participants appreciated the tele-prehabilitation program. Time to exhaustion on the constant work rate test improved (not statistically significant) from a pre-prehabilitation median score of 317 seconds to a post-prehabilitation median score of 412 seconds (p = 0.24). Median number of repetitions on the 30-s chair-stand test improved from 12 to 16 (p = 0.01). Conclusions Tele-prehabilitation seems feasible in high-risk patients with colorectal cancer, but efforts should be made to further improve adherence to physical exercise training intensity. More research is needed to establish the (cost-)effectiveness of tele-prehabilitation regarding preoperative improvements in preoperative aerobic fitness and postoperative reduction of complications. Trial registration ISRCTN, ISRCTN64482109. Registered 09 November 2021 - Retrospectively registered.
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Affiliation(s)
- Ruud F W Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Center, Tegelseweg 210 5912BL, Venlo, the Netherlands. .,Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.,Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands
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A Nonexercise Estimate of Cardiorespiratory Fitness Using a Symptom Questionnaire and Clinical Variables. J Cardiopulm Rehabil Prev 2022; 42:278-285. [PMID: 35474042 DOI: 10.1097/hcr.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Cardiorespiratory fitness (CRF) has recently been recognized as a risk factor for mortality, but it is not routinely measured in clinical settings. The purpose of this study was to assess a nonexercise method to estimate CRF (eCRF) and its association with mortality in a clinically referred population. METHODS A symptom tool, termed the Veterans Specific Activity Questionnaire (VSAQ), and nonexercise clinical variables were obtained from 1545 clinically referred subjects (60 ± 13 yr), and followed for a mean of 5.6 ± 4.2 yr. The VSAQ along with nonexercise clinical and historical variables was used to develop a multivariate model to predict achieved CRF from maximal exercise testing. Proportional hazards analysis was used to assess the association between measured and eCRF and all-cause mortality. RESULTS The eCRF model was significantly associated with achieved CRF (multiple R= 0.67, P< .001). Mean achieved CRF from maximal treadmill testing and eCRF were similar (8.6 ± 5.0 metabolic equivalents [METs] vs 8.7 ± 4.7 METs respectively, P= .27). Achieved CRF and eCRF performed similarly for predicting mortality. After full adjustment, each 1 MET higher increment in achieved CRF and eCRF was associated with 19% and 26% reductions in mortality risk, respectively. Compared with the lowest fit group (<5 METs), the highest CRF groups (>11 METs) had 88% and 87% lower risks for mortality for achieved CRF and eCRF, respectively. CONCLUSIONS A multivariable nonexercise model featuring a symptom questionnaire combined with clinical variables that are readily available during a typical clinical encounter had a reasonably strong association with achieved CRF and exhibited prognostic characteristics that were similar to achieved CRF.
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Meijer R, van Hooff M, Papen-Botterhuis NE, Molenaar CJL, Regis M, Timmers T, van de Poll-Franse LV, Savelberg HHCM, Schep G. Estimating VO2peak in 18–90 Year-Old Adults: Development and Validation of the FitMáx©-Questionnaire. Int J Gen Med 2022; 15:3727-3737. [PMID: 35411174 PMCID: PMC8994663 DOI: 10.2147/ijgm.s355589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Cardiorespiratory fitness (CRF) plays an essential role in health outcomes and quality of life. However, it is often not assessed nor estimated. Objective CRF assessment is costly, labour intensive and not widely available. Patient-reported outcome measures estimate CRF more cost-efficiently, but current questionnaires lack accuracy. The aim of this study is to develop a new self-reported questionnaire to estimate CRF. Materials and Methods The FitMáx©-questionnaire, consisting of only three questions assessing walking, stair climbing, and cycling capacity, was compared with the commonly used Duke Activity Status Index (DASI) and Veterans Specific Activity Questionnaire (VSAQ). These questionnaires were compared to peak oxygen uptake (VO2peak) as measured with cardiopulmonary exercise testing. This study included 759 cardiac, pulmonary and oncologic patients and healthy persons aged 18‒90. Results FitMáx© strongly correlated (r = 0.94 (0.92‒0.95) SEE = 4.14 mL∙kg−1∙min−1) with measured VO2peak. Bias between predicted and measured VO2peak was −0.24 (−9.23‒8.75; 95% limits of agreement) mL·kg−1·min−1. The FitMáx© scored superiorly on correlation and SEE compared with the DASI and VSAQ, r = 0.75 (0.68‒0.80) SEE = 4.62 mL∙kg−1∙min−1 and r = 0.87 (0.83‒0.90) SEE = 6.75 mL∙kg−1∙min−1, respectively. Conclusion FitMáx© is a valid and accessible questionnaire to estimate CRF expressed as VO2peak in clinical practice and shows substantial improvement compared to currently used questionnaires.
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Affiliation(s)
- Renske Meijer
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Correspondence: Renske Meijer, Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands, Tel +31 40 8888 000, Email ; ;
| | - Martijn van Hooff
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Marta Regis
- Academy, Máxima Medical Center, Veldhoven, the Netherlands
- Department of Mathematics and Computer Science, University of Technology, Eindhoven, the Netherlands
| | - Thomas Timmers
- Department of Research & Development, Interactive Studios, Rosmalen, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Net
herlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Goof Schep
- Department of Sports and Exercise, Máxima Medical Center, Veldhoven, the Netherlands
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8
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Balachandar S, Graves TJ, Shimonty A, Kerr K, Kilner J, Xiao S, Slade R, Sroya M, Alikian M, Curetean E, Thomas E, McConnell VPM, McKee S, Boardman-Pretty F, Devereau A, Fowler TA, Caulfield MJ, Alton EW, Ferguson T, Redhead J, McKnight AJ, Thomas GA, Aldred MA, Shovlin CL. Identification and validation of a novel pathogenic variant in GDF2 (BMP9) responsible for hereditary hemorrhagic telangiectasia and pulmonary arteriovenous malformations. Am J Med Genet A 2022; 188:959-964. [PMID: 34904380 PMCID: PMC9939255 DOI: 10.1002/ajmg.a.62584] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/02/2021] [Indexed: 01/14/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multisystemic vascular dysplasia, characterized by arteriovenous malformations (AVMs), mucocutaneous telangiectasia and nosebleeds. HHT is caused by a heterozygous null allele in ACVRL1, ENG, or SMAD4, which encode proteins mediating bone morphogenetic protein (BMP) signaling. Several missense and stop-gain variants identified in GDF2 (encoding BMP9) have been reported to cause a vascular anomaly syndrome similar to HHT, however none of these patients met diagnostic criteria for HHT. HHT families from UK NHS Genomic Medicine Centres were recruited to the Genomics England 100,000 Genomes Project. Whole genome sequencing and tiering protocols identified a novel, heterozygous GDF2 sequence variant in all three affected members of one HHT family who had previously screened negative for ACVRL1, ENG, and SMAD4. All three had nosebleeds and typical HHT telangiectasia, and the proband also had severe pulmonary AVMs from childhood. In vitro studies showed the mutant construct expressed the proprotein but lacked active mature BMP9 dimer, suggesting the mutation disrupts correct cleavage of the protein. Plasma BMP9 levels in the patients were significantly lower than controls. In conclusion, we propose that this heterozygous GDF2 variant is a rare cause of HHT associated with pulmonary AVMs.
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Affiliation(s)
- Srimmitha Balachandar
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tamara J. Graves
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Anika Shimonty
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Katie Kerr
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Jill Kilner
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Sihao Xiao
- National Heart and Lung Institute, Imperial College London, London, UK,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK
| | - Richard Slade
- National Heart and Lung Institute, Imperial College London, London, UK,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK
| | - Manveer Sroya
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mary Alikian
- Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK,West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Emanuel Curetean
- West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Ellen Thomas
- West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK,Genomics England, London, UK
| | | | - Shane McKee
- Regional Genetics Service, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Tom A. Fowler
- Genomics England, London, UK,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Mark J. Caulfield
- Genomics England, London, UK,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Eric W. Alton
- National Heart and Lung Institute, Imperial College London, London, UK,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK
| | - Teena Ferguson
- West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Julian Redhead
- West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Amy J. McKnight
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK
| | | | | | - Micheala A. Aldred
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK
| | - Claire L. Shovlin
- National Heart and Lung Institute, Imperial College London, London, UK,Genomics England Respiratory Clinical Interpretation Partnership (GeCIP), London, UK,West London Genomic Medicine Centre, Imperial College Healthcare NHS Trust, London, UK
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Wilgus ML, Abtin F, Markovic D, Tashkin DP, Phillips JE, Buhr RG, Flynn MJ, Dembek M, Cooper CB, Barjaktarevic I. Panlobular emphysema is associated with COPD disease severity: A study of emphysema subtype by computed tomography. Respir Med 2021; 192:106717. [PMID: 35026616 DOI: 10.1016/j.rmed.2021.106717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/30/2021] [Accepted: 12/12/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Computed tomography has the potential to inform COPD prognosis. We sought to determine associations of emphysema phenotype with clinical parameters including lung function, inflammatory markers, and quality of life. METHODS Participants of this single-center observational cohort (n = 83) were 40-80 years old, had ≥10 pack-year smoking, and a diagnosis of COPD confirmed by spirometry. All participants had available historic chest CT scans which were systematically reviewed by a single expert radiologist and scored for emphysema subtype, extent, and distribution. Associations between radiographic findings and clinical parameters were determined. RESULTS Median age of participants was 72 years, median smoking 40 pack-years, and median FEV1 59% predicted. 84% of the participants had radiographic emphysema. Of those, 26% had panlobular emphysema (PLE), 68% centrilobular emphysema (CLE), and 6% paraseptal emphysema (PSE). As compared to the participants with no radiographic emphysema, the presence of PLE-dominant emphysema was associated with a lower BMI (P = 0.012) and greater extent of emphysema (P = 0.014). After adjusting for age, sex, and pack-years smoking history, PLE was associated with greater airflow obstruction by FEV1% (48% vs 71%, P = 0.005), greater symptom burden by CAT score (18 vs 9, P = 0.015), worse quality of life by SGRQ score (43 vs 22, P = 0.025), and more systemic inflammation by erythrocyte sedimentation rate (P = 0.001). CLE- or PSE-dominant emphysema were not similarly associated with clinical features or symptom burden. CONCLUSIONS The presence of PLE-dominant emphysema was associated with greater extent of emphysema, greater airflow obstruction, increased respiratory symptoms, worse quality of life, and systemic inflammation. Further investigation is indicated to explore the pathogenesis of the PLE phenotype and the prognostic and treatment implications of PLE.
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Affiliation(s)
- M L Wilgus
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - F Abtin
- Division of Thoracic Radiology, Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - D Markovic
- Department of Medicine Statistics Core, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - D P Tashkin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - J E Phillips
- Inflammation Discovery Research, Amgen, Thousand Oaks, CA, USA
| | - R G Buhr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA; Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - M J Flynn
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA; Division of Pulmonology, Kaiser Permanente Sunnyside Medical Center, Clackamas, OR, USA
| | - M Dembek
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA; Department of Physician Assistant Studies, Bay Path University, Longmeadow, MA, USA
| | - C B Cooper
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA; Department of Physiology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - I Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
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Myers J, Chan KN, Chen Y, Lit Y, Massaband P, Kiratli BJ, Tan JC, Rabkin R. Association of physical function and performance with peak VO 2 in elderly patients with end stage kidney disease. Aging Clin Exp Res 2021; 33:2797-2806. [PMID: 33686542 DOI: 10.1007/s40520-021-01801-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physical function is impaired in end stage renal disease (ESRD). Various instruments have been used to assess the functional capabilities and health status of patients with ESRD, but it is not known which has the best association with peak VO2. AIMS To assess the association between functional measures in ESRD. METHODS Thirty nine elderly ESRD patients were evaluated with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing (CPET), 6-min walk (6MWT), sit-to-stand test (STS), Veterans Specific Activity Questionnaire (VSAQ), upper and lower body strength, pulmonary function tests, and body composition determined by dual X-ray absorptiometry. The association between performance on these functional tools, clinical variables, and exercise test responses was assessed, and a non-exercise test multivariate model was developed to predict peak VO2. RESULTS Peak VO2 was modestly related to VSAQ score (r = 0.59, p < 0.01), indices of upper and lower body strength (r = 0.45, p < 0.01 for both), and FEV1 (r = 0.51, p < 0.01). Functional and quality of life questionnaires were generally poorly related to one another and to peak VO2. In a multivariate model, 6MWT performance, forced expiratory volume in 1 s (FEV1), and VSAQ score were the best predictors of peak VO2, yielding a multiple R = 0.82, accounting for 67% of the variance in peak VO2. CONCLUSION Exercise capacity can be reasonably estimated using non-exercise test variables in patients with ESRD, including a symptom questionnaire (VSAQ), 6MWT and FEV1. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier: NCT01990495. Registered Nov 21, 2013.
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Affiliation(s)
- Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
- Cardiology Division, Stanford University, Stanford, CA, USA.
| | - Khin N Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Yu Chen
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Yiming Lit
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
| | - Payam Massaband
- Radiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - B Jenny Kiratli
- Spinal Cord Injury Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jane C Tan
- Division of Nephrology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ralph Rabkin
- Nephrology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Nephrology Division, Stanford University, Stanford, CA, USA
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11
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Venema AM, Sahinovic MM, Ramaker AJDWR, van de Riet YN, Absalom AR, Wietasch JKG. Performance of Basic Life Support by Lifeboat Crewmembers While Wearing a Survival Suit and Life Vest: A Randomized Controlled Trial. Front Public Health 2021; 9:666553. [PMID: 34295867 PMCID: PMC8290161 DOI: 10.3389/fpubh.2021.666553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Crewmembers of the “Royal Netherlands Sea Rescue Institution” (KNRM) lifeboats must wear heavy survival suits with integrated lifejackets. This and the challenging environment onboard (boat movements, limited space) might influence Basic Life Support (BLS) performance. The primary objective of this study was to assess the impact of the protective gear on single-rescuer BLS-quality. Material and Methods: Sixty-five active KNRM crewmembers who had recently undergone a BLS-refresher course were randomized to wear either their protective gear (n = 32) or their civilian clothes (n = 33; control group) and performed five 2-min sessions of single rescuer BLS on a mannequin on dry land. BLS-quality was assessed according to Dutch and European Resuscitation guidelines. A between group analysis (Mann-Whitney U) and a repeated within group analysis of both groups (Friedman test) were performed. Results: There were no major demographic differences between the groups. The protective gear did not significant impair BLS-quality. It was also not associated with a significant increase in the perceived exertion of BLS (Borg's Rating scale). Compression depth, compression frequency, the percentage of correct compression depth and of not leaning on the thorax, and ventilation volumes in both groups were suboptimal when evaluated according to the BLS-guidelines. Conclusions: The protective gear worn by KNRM lifeboat-crewmembers does not have a significant influence on BLS-quality under controlled study conditions. The impact and significance on outcome in real life situations needs to be studied further. This study provides valuable input for optimizing the BLS-skills of lifeboat crewmembers.
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Affiliation(s)
- Allart M Venema
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marko M Sahinovic
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Albert J D W R Ramaker
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Yvette N van de Riet
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - J K Götz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Epidemiological profile, cardiopulmonary fitness and health-related quality of life of patients with heart failure: a longitudinal study. Health Qual Life Outcomes 2021; 19:129. [PMID: 33892726 PMCID: PMC8063347 DOI: 10.1186/s12955-020-01634-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Heart failure (HF) is a severe and self-limiting syndrome. Its signs and symptoms are believed to predict poorer health-related quality of life scores, which are mainly influenced by deterioration in physical capacity. In the present study we try to analyze the influence of clinical and socioeconomic characteristics and physical capacity on the quality of life of people with HF diagnosis.
Methods A longitudinal study was conducted over 2 years with patients diagnosed with HF. To evaluate the patients the method of face-to-face visit and telephone monitoring was used. In the evaluations were applied: the Clinical and Socioeconomic Characterization Questionnaire, the Minnesota Living With Heart Failure Questionnaire (MLHFQ) for quality of life evaluation and the Veterans Specific Activity Questionnaire (VSAQ) for cardiopulmonary fitness analysis. Measures of central tendency, proportion, normality test, confidence intervals, comparison of data through paired Student t test and Wilcoxon or Mann Whitney test were performed and correlations were verified through Spearman coefficient. Results The study included 108 patients, most of them female (50.90%) and mean age of 66.62 ± 11.33 years. The median time of HF diagnosis was 5 ± 6 years, being Chagas’ disease the main etiologic cause for the disease (57.40%). As for the clinical condition, functional classes II (44.40%) and III (48.10%) of the New York Heart Association (NYHA) were the most frequent. There was a low cardiopulmonary fitness, with loss of capacity to perform daily activities (3 ± 1 to 3 ± 3) over the time of clinical follow-up. There was an increase in the MLHFQ instrument scores, from 50.98 ± 15.52 to 61.76 ± 19.95, over the analysis time. The analysis of correlations demonstrated that variables such as schooling, NYHA class, echocardiographic alterations and the drug profile have a significant relationship with the constructs of quality of life and physical fitness. Conclusion Individuals in HF have significant impairment of cardiorespiratory capacity and tend to present worsening of QL along the evolution of the disease.
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13
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Dore M, Provencher S, Poirier P, Gélinas C, Stoller JK, de Oliveira EM, Gallani MC. Validity of the Modified Dyspnea Index for the French-Canadian Population. J Nurs Meas 2021; 29:121-139. [PMID: 33593990 DOI: 10.1891/jnm-d-19-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Multidimensional tools could evaluate the dyspnea of patients with chronic lung disease. The aim was to validate the use of the French-Canadian version of the modified dyspnea index (MDI) among patients with pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD). METHODS The Spearman test analyzed the convergent validation of the MDI with pulmonary function tests (PFTs), New York Heart Association (NYHA) functional classification, the Modified Borg Scale, the Veterans Specific Activity Questionnaire (VSAQ), physical capacity, physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire [GSLTPAQ]), and quality of life (SF-12). RESULTS The MDI had a low correlation with PFT and physical activity; a moderate with physical capacity; a high with the physical dimension (SF-12). CONCLUSION The results support the convergent validation of the MDI French-Canadian version with PAH or ILD.
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Affiliation(s)
- Michel Dore
- Laval University, Québec, QC, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Steve Provencher
- Laval University, Québec, QC, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Paul Poirier
- Laval University, Québec, QC, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Celine Gélinas
- McGill University, Montreal, Canada.,Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Québec Nursing Intervention Research Network (RRISIQ), Montreal, Canada.,The Alan Edwards Center for Research on Pain, McGill University, Montréal, QC, Canada
| | - James K Stoller
- Education and Respiratory Institutes, Cleveland Clinic, Cleveland, OH, USA
| | - Elaine Machado de Oliveira
- Laval University, Québec, QC, Canada .,Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Maria Cecilia Gallani
- Laval University, Québec, QC, Canada.,Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
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14
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Diniz CO, McKenna Z, Canuto L, Magalhães F, Machado-Moreira CA, Shibuya E, da Cunha I, Maia PA, Roscani RC, Rocha-Vieira E, Santiago de Moraes Barros TM, Bitencourt D, Souza E Silva de Almeida F, Amorim FT. A Preliminary Evaluation of the Kidney Function of Sugarcane Cutters From Brazil. J Occup Environ Med 2021; 63:e53-e58. [PMID: 33229906 DOI: 10.1097/jom.0000000000002090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate clinical parameters, markers of kidney function, and skeletal muscle damage in a group of sugarcane cutters during harvesting season. METHODS Seventeen volunteers were assessed for anthropometrics and cardiorespiratory fitness. Blood and urine samples were collected 48-hours after the last work session. Blood was analyzed for glucose, creatine kinase, cholesterol, and a complete hemogram. Urine and blood samples were also analyzed for markers related to kidney function. RESULTS Volunteers were young (26 ± 6 y), had low body fat (13 ± 5%), and good cardiorespiratory fitness (41 ± 6 mL/kg/min). Classical markers of kidney function (eGFR, creatinine, cystatin C) were within the normal range. However, ten volunteers presented elevated resting serum creatine kinase (221 ± 68 U/L). CONCLUSION Manual sugarcane harvesting is associated with sustained skeletal muscle damage which may increase the risk for kidney injury in Brazilian sugarcane cutters.
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Affiliation(s)
- Caíque Olegário Diniz
- Programa Multicêntrico de Pós-Graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil (Mr Diniz, Mr Canuto, Dr Magalhães, Dr Rocha-Vieira, Dr Amorim); Departamento de Educação Física, Universidade Federal de Juiz de Fora, Governador Valadares, Minas Gerais, Brazil (Dr Machado-Moreira); Fundação Jorge Duprat Figueiredo de Segurança e Medicina do Trabalho, São Paulo, São Paulo, Brazil (Dr Shibuya, Dr da Cunha, Dr Maia, Dr Roscani, Dr Santiago de Moraes Barros, Dr Bitencourt); Faculdade de Ciências Médicas da Santa Casa, São Paulo, São Paulo, Brazil (Dr Souza e Silva de Almeida); University of New Mexico, Albuquerque, New Mexico (Mr McKenna, Dr Amorim)
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15
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Liang G, Huang X, Hirsch J, Mehmi S, Fonda H, Chan K, Huang NF, Aalami O, Froelicher VF, Lee DP, Myers J, Lee AS, Nguyen PK. Modest Gains After an 8-Week Exercise Program Correlate With Reductions in Non-traditional Markers of Cardiovascular Risk. Front Cardiovasc Med 2021; 8:669110. [PMID: 34222367 PMCID: PMC8245677 DOI: 10.3389/fcvm.2021.669110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Although engaging in physical exercise has been shown to reduce the incidence of cardiovascular events, the molecular mechanisms by which exercise mediates these benefits remain unclear. Based on epidemiological evidence, reductions in traditional risk factors only accounts for 50% of the protective effects of exercise, leaving the remaining mechanisms unexplained. The objective of this study was to determine whether engaging in a regular exercise program in a real world clinical setting mediates cardiovascular protection via modulation of non-traditional risk factors, such as those involved in coagulation, inflammation and metabolic regulation. Methods and Results: We performed a prospective, cohort study in 52 sedentary patients with cardiovascular disease or cardiovascular risk factors at two tertiary medical centers between January 1, 2016 and December 31, 2019. Prior to and at the completion of an 8-week exercise program, we collected information on traditional cardiovascular risk factors, exercise capacity, and physical activity and performed plasma analysis to measure levels of fibrinolytic, inflammatory and metabolic biomarkers to assess changes in non-traditional cardiovascular risk factors. The median weight change, improvement in physical fitness, and change in physical activity for the entire cohort were: -4.6 pounds (IQR: +2 pounds, -11.8 pounds), 0.37 METs (IQR: -0.076 METs, 1.06 METs), and 252.7 kcals/week (IQR: -119, 921.2 kcals/week). In addition to improvement in blood pressure and cholesterol, patients who lost at least 5 pounds, expended at least 1,000 additional kcals/week, and/or achieved ≥0.5 MET increase in fitness had a significant reduction in plasminogen activator inhibitor-1 [9.07 ng/mL (95% CI: 2.78-15.35 ng/mL); P = 0.026], platelet derived growth factor beta [376.077 pg/mL (95% CI: 44.69-707.46 pg/mL); P = 0.026); and angiopoietin-1 [(1104.11 pg/mL (95% CI: 2.92-2205.30 pg/mL); P = 0.049)]. Conclusion: Modest improvements in physical fitness, physical activity, and/or weight loss through a short-term exercise program was associated with decreased plasma levels of plasminogen activator inhibitor, platelet derived growth factor beta, and angiopoietin, which have been associated with impaired fibrinolysis and inflammation.
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Affiliation(s)
- Grace Liang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Xianxi Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Stanford Cardiovascular Institute, Stanford, CA, United States
| | - James Hirsch
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Sanjeev Mehmi
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Holly Fonda
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Khin Chan
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Ngan F. Huang
- Department of Cardiovascular Surgery, Stanford University, Stanford, CA, United States
| | - Oliver Aalami
- Vascular Surgery Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Victor F. Froelicher
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - David P. Lee
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
| | - Jonathan Myers
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
| | - Andrew S. Lee
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Patricia K. Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States
- Stanford Cardiovascular Institute, Stanford, CA, United States
- Cardiology Section, Department of Veteran Affairs, Palo Alto, CA, United States
- *Correspondence: Patricia K. Nguyen
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Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. Arch Cardiovasc Dis 2020; 114:150-172. [PMID: 33309203 DOI: 10.1016/j.acvd.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
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Valensi P, Henry P, Boccara F, Cosson E, Prevost G, Emmerich J, Ernande L, Marcadet D, Mousseaux E, Rouzet F, Sultan A, Ferrières J, Vergès B, Van Belle E. Risk stratification and screening for coronary artery disease in asymptomatic patients with diabetes mellitus: Position paper of the French Society of Cardiology and the French-speaking Society of Diabetology. DIABETES & METABOLISM 2020; 47:101185. [PMID: 32846201 DOI: 10.1016/j.diabet.2020.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Paul Valensi
- Unit of Endocrinology Diabetology Nutrition, AP-HP, Jean Verdier hospital, CINFO, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - Patrick Henry
- Department of Cardiology, Inserm U942, Lariboisiere Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France.
| | - Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-Inserm UMR S_938, Centre de Recherche Saint-Antoine, Paris, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Gaetan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Centre d'Investigation Clinique (CIC-CRB)-Inserm 1404, Rouen University Hospital, 76000 Rouen, France
| | - Joseph Emmerich
- Service de Médecine Vasculaire, Groupe Hospitalier Paris Saint-Joseph, Université de Paris, Inserm UMR1153-CRESS, 75674 Paris cedex 14, France
| | - Laura Ernande
- Service des explorations fonctionnelles, Hôpital Henri Mondor, AP-HP et Inserm U955, Université Paris-Est Créteil, France
| | - Dany Marcadet
- Centre Coeur et Santé Bernoulli - Cardiologie du sport et Réadaptation Cardiaque, 3, rue Bernoulli, 75008 Paris, France
| | - Elie Mousseaux
- Radiology Department, Hôpital Européen Georges Pompidou & Inserm U 970; Assistance Publique - Hôpitaux de Paris, University of Paris, French Society of Cardiovascular Imaging (SFICV), Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP Paris - Université de Paris, Laboratory for Vascular Translational Science, Inserm, UMR 1148, 75018 Paris, France
| | - Ariane Sultan
- Physiologie et Médecine Expérimentale du Coeur et des Muscles (PHYMEDEX), U1046 Inserm, UMR9214 CNRS, Université de Montpellier, 34295 Montpellier; Département Endocrinologie, Nutrition, Diabète, Equipe Nutrition, Diabète, CHRU Montpellier, 34090 Montpellier, France
| | - Jean Ferrières
- Department of Cardiology and UMR Inserm 1027, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Bruno Vergès
- Service Endocrinologie-Diabétologie, CHU Dijon - Inserm LNC-UMR 1231, Dijon, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France; Inserm, U1011, Institut Pasteur de Lille, EGID, Lille, France; Department of Medicine, Université de Lille, Lille, France
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18
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Cardiorespiratory Fitness, Lung Cancer Incidence, and Cancer Mortality in Male Smokers. Am J Prev Med 2019; 57:659-666. [PMID: 31564605 DOI: 10.1016/j.amepre.2019.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The preventive role of cardiorespiratory fitness in lung cancer among smokers is unknown. This study aims to evaluate the association between cardiorespiratory fitness and lung cancer incidence and cancer mortality in former and current male smokers. METHODS From 1987 to 2014, cardiorespiratory fitness (quantified from treadmill exercise testing) was assessed in 2,979 men (former smokers, n=1,602; current smokers, n=1,377) aged 59.1 (SD=17.4) years and prospectively followed up for 11.6 (SD=7) years. Multivariable Cox hazard models and population attributable fraction of low cardiorespiratory fitness (<5 METs) for cancer outcomes were analyzed during 2018. RESULTS Of the 99 case patients diagnosed with lung cancer, 79 died of cancer 3.6 (SD=4.6) years after diagnosis. Among former smokers, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 13% (p=0.016), 51%, and 77% (p-trend=0.015) reductions in lung cancer incidence, respectively. Among current smokers who were later diagnosed with lung cancer, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 18% (p=0.008), 84%, and 85% (p-trend<0.001) reductions in cancer mortality, respectively. The population attributable fraction for lung cancer incidence was 10.8% among former smokers and 22.3% for cancer mortality among current smokers. CONCLUSIONS Higher cardiorespiratory fitness is associated with lower risk of lung cancer incidence in former smokers and reduced risk of cancer mortality in current smokers who were diagnosed with lung cancer. Screening for low cardiorespiratory fitness and achieving at least moderate cardiorespiratory fitness could potentially reduce lung cancer morbidity and mortality, providing a preventive strategy for smokers.
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de Matos MA, Garcia BCC, Vieira DV, de Oliveira MFA, Costa KB, Aguiar PF, Magalhães FDC, Brito-Melo GA, Amorim FT, Rocha-Vieira E. High-intensity interval training reduces monocyte activation in obese adults. Brain Behav Immun 2019; 80:818-824. [PMID: 31125712 DOI: 10.1016/j.bbi.2019.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 02/06/2023] Open
Abstract
Alterations in the distribution and activation of monocyte subsets are frequently observed in individuals with obesity and their participation in the pathological complications of obesity is proposed. High-intensity interval training (HIIT) can be a time-efficient alternative to counteract the inflammatory outcomes of obesity, but so far, its effects on monocytes in obesity has not been fully explored. In this study, we investigated whether 8 weeks of HIIT can modify the distribution and activation of the three monocyte subsets (classical, intermediate and non-classical monocytes) in individuals with obesity. Our data show that individuals with obesity have a higher percentage of non-classical monocytes compared to control, lean individuals, and consequently an imbalance among the CD16+ monocyte subsets. Also, the expression of HLA-DR by intermediate monocytes is higher in insulin-resistant obese individuals, which indicates monocyte activation in obesity. After 8 weeks of HIIT, the percentage of non-classical monocytes was reduced in individuals with obesity, restoring the balance among the CD16+ monocytes. Also, the expression of HLA-DR by intermediate monocytes in insulin-resistant obese subjects was lower after HIIT. Both findings indicate that monocyte activation in individuals with obesity was reduced by HIIT. These modifications were observed in the absence of changes in weight and body composition, although they were accompanied by the improvement in the metabolic status (reduced insulin levels). Our findings indicate that HIIT can be considered a time-efficient strategy to manage obesity-related monocyte alterations and strengthen the immunomodulatory potential of HIIT.
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Affiliation(s)
- Mariana Aguiar de Matos
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Bruna Caroline Chaves Garcia
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Dênia Vargas Vieira
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Marcos Felipe Andrade de Oliveira
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Karine Beatriz Costa
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Paula Fernandes Aguiar
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Flávio de Castro Magalhães
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Departamento de Educação Física, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Gustavo Alvim Brito-Melo
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Departamento de Farmácia, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Fabiano Trigueiro Amorim
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Departament of Health, Exercise & Sport Sciences, University of New Mexico, USA
| | - Etel Rocha-Vieira
- Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
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20
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Gawecki F, Strangeways T, Amin A, Perks J, McKernan H, Thurainatnam S, Rizvi A, Jackson JE, Santhirapala V, Myers J, Brown J, Howard LSGE, Tighe HC, Shovlin CL. Exercise capacity reflects airflow limitation rather than hypoxaemia in patients with pulmonary arteriovenous malformations. QJM 2019; 112:335-342. [PMID: 30657990 DOI: 10.1093/qjmed/hcz023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pulmonary arteriovenous malformations (PAVMs) generate a right-to-left shunt. Impaired gas exchange results in hypoxaemia and impaired CO2 clearance. Most patients compensate effectively but some are dyspneic, and these are rarely the most hypoxaemic. AIM To test degrees of concurrent pathology influencing exercise capacity. DESIGN Replicate, sequential single centre, prospective studies. METHODS Cardiopulmonary exercise tests (CPETs) were performed in 26 patients with PAVMs, including individuals with and without known airflow obstruction. To replicate, relationships were tested prospectively in an independent cohort where self-reported exercise capacity evaluated by the Veterans Specific Activity Questionnaire (VSAQ) was used to calculate metabolic equivalents (METs) at peak exercise (n = 71). Additional measurements included oxygen saturation (SpO2), forced expiratory volume in 1 s (FEV1), vital capacity (VC), fractional exhaled nitric oxide (FeNO), haemoglobin and iron indices. RESULTS By CPET, the peak work rate was only minimally associated with low SpO2 or low arterial oxygen content (calculated as CaO2=1.34 × SpO2 × haemoglobin), but was reduced in patients with low FEV1 or VC. Supranormal work rates were seen in patients with severe right-to-left shunting and SpO2 < 90%, but only if FEV1 was >80% predicted. VSAQ-calculated METS also demonstrated little relationship with SpO2, and in crude and CaO2-adjusted regression, were lower in patients with lower FEV1 or VC. Bronchodilation increased airflow even where spirometry was in the normal range: exhaled nitric oxide measurements were normal in 80% of cases, and unrelated to any PAVM-specific variable. CONCLUSIONS Exercise capacity is reduced by relatively mild airflow limitation (obstructive or restrictive) in the setting of PAVMs.
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Affiliation(s)
- F Gawecki
- School of Medicine, Imperial College, London, UK
| | | | - A Amin
- School of Medicine, Imperial College, London, UK
| | - J Perks
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - H McKernan
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - A Rizvi
- School of Medicine, Imperial College, London, UK
| | - J E Jackson
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | | | - J Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - J Brown
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - L S G E Howard
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - H C Tighe
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - C L Shovlin
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
- NHLI Cardiovascular Sciences, Imperial College, London, UK
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21
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Myers J, Fonda H, Vasanawala M, Chung K, Segall G, Chan K, Nguyen P. PCI Alternative Using Sustained Exercise (PAUSE): Rationale and trial design. Contemp Clin Trials 2019; 79:37-43. [PMID: 30797041 DOI: 10.1016/j.cct.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) currently claims nearly one million lives yearly in the US, accounting for nearly 40% of all deaths. Coronary artery disease (CAD) accounts for the largest number of these deaths. While efforts aimed at treating CAD in recent decades have concentrated on surgical and catheter-based interventions, limited resources have been directed toward prevention and rehabilitation. CAD is commonly treated using percutaneous coronary intervention (PCI), and this treatment has increased exponentially since its adoption over three decades ago. Recent questions have been raised regarding the cost-effectiveness of PCI, the extent to which PCI is overused, and whether selected patients may benefit from optimal medical therapy in lieu of PCI. One alternative therapy that has been shown to improve outcomes in CAD is exercise therapy; exercise programs have been shown to have numerous physiological benefits, and a growing number of studies have demonstrated reductions in mortality. Given the high volume of PCI, its high cost, its lack of effect on survival and the potential for alternative treatments including exercise, the current study is termed "PCI Alternative Using Sustained Exercise" (PAUSE). The primary aim of PAUSE is to determine whether patients randomized to exercise and lifestyle intervention have greater improvement in coronary function and anatomy compared to those randomized to PCI. Coronary function and anatomy is determined using positron emission tomography combined with computed tomographic angiography (PET/CTA). Our objective is to demonstrate the utility of a non-invasive technology to document the efficacy of exercise as an alternative treatment strategy to PCI.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America.
| | - Holly Fonda
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Minal Vasanawala
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Kieran Chung
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - George Segall
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Khin Chan
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
| | - Patricia Nguyen
- Veterans Affairs Palo Alto Health Care System, Division of Cardiovascular Medicine, Stanford University, United States of America
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22
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Gawecki F, Myers J, Shovlin CL. Veterans Specific Activity Questionnaire (VSAQ): a new and efficient method of assessing exercise capacity in patients with pulmonary arteriovenous malformations. BMJ Open Respir Res 2019; 6:e000351. [PMID: 30956797 PMCID: PMC6424292 DOI: 10.1136/bmjresp-2018-000351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/20/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction Assessment of performance status is an important component of clinical management of patients with pulmonary arteriovenous malformations (PAVMs). Usual methods are time-consuming and insensitive to variations within normal or supranormal exercise capacity. Methods The Veterans Specific Activity Questionnaire (VSAQ) was modified to facilitate completion by patients independently. Patient-reported activity limitations were converted to the Medical Research Council (MRC) Dyspnoea Scale, New York Heart Association (NYHA) classification and metabolic equivalents (METs) in which 1 MET equals the consumption of 3.5 mL O2 per kilogram of body weight per minute. Results The study population consisted of 71 patients with PAVMs aged 20-85 (median 52) years. Oxygen saturation (SaO2) was 80%-99.5 % (median 96%), and haemoglobin was 73-169 g/L in women and 123-197 g/L in men (p<0.0001). Arterial oxygen content (CaO2) (1.34 × [haemoglobin × SaO2]/100) was maintained unless iron deficiency was present. Most patients (49/71, 69%) did not need to stop until activities more energetic than walking briskly at 4 mph were achieved (6.4 km per hour, VSAQ >5, MRC Dyspnoea Scale 1 or 2, NYHA class I). SaO2 was inversely associated with the MRC Dyspnoea Scale and NYHA class, but not the VSAQ. Raw VSAQ scores captured a marked difference between men and women. METs were also higher in men at 3.97-15.55 (median 8.84) kcal/kg/min, compared with 1.33-14.4 (median 8.25) kcal/kg/min (p=0.0039). There was only a modest association between METs and SaO2 (p=0.044), but a stronger association between METs and haemoglobin (p =0.001). In crude and sex-adjusted regression, the CaO2 was more strongly associated with METs than either SaO2 or haemoglobin in isolation. Conclusion The VSAQ, capturing patient-reported outcome measures, is an efficient and quantifiable measure of exercise capacity that can be readily employed in clinical services particularly where patients have normal to high exercise tolerance. In the PAVM population, exercise capacity reflects haemoglobin and CaO2 more than SaO2, even where SaO2 measurements are low.
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Affiliation(s)
- Filip Gawecki
- Imperial College School of Medicine, London, UK.,NHLI Respiratory Sciences, Imperial College London, London, UK
| | - Jonathan Myers
- Department of Cardiology, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Claire L Shovlin
- NHLI Vascular Sciences, Imperial College London, London, UK.,Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
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23
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Halliday BP, Wassall R, Lota AS, Khalique Z, Gregson J, Newsome S, Jackson R, Rahneva T, Wage R, Smith G, Venneri L, Tayal U, Auger D, Midwinter W, Whiffin N, Rajani R, Dungu JN, Pantazis A, Cook SA, Ware JS, Baksi AJ, Pennell DJ, Rosen SD, Cowie MR, Cleland JGF, Prasad SK. Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. Lancet 2019; 393:61-73. [PMID: 30429050 PMCID: PMC6319251 DOI: 10.1016/s0140-6736(18)32484-x] [Citation(s) in RCA: 335] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with dilated cardiomyopathy whose symptoms and cardiac function have recovered often ask whether their medications can be stopped. The safety of withdrawing treatment in this situation is unknown. METHODS We did an open-label, pilot, randomised trial to examine the effect of phased withdrawal of heart failure medications in patients with previous dilated cardiomyopathy who were now asymptomatic, whose left ventricular ejection fraction (LVEF) had improved from less than 40% to 50% or greater, whose left ventricular end-diastolic volume (LVEDV) had normalised, and who had an N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentration less than 250 ng/L. Patients were recruited from a network of hospitals in the UK, assessed at one centre (Royal Brompton and Harefield NHS Foundation Trust, London, UK), and randomly assigned (1:1) to phased withdrawal or continuation of treatment. After 6 months, patients in the continued treatment group had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months, defined by a reduction in LVEF of more than 10% and to less than 50%, an increase in LVEDV by more than 10% and to higher than the normal range, a two-fold rise in NT-pro-BNP concentration and to more than 400 ng/L, or clinical evidence of heart failure, at which point treatments were re-established. The primary analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02859311. FINDINGS Between April 21, 2016, and Aug 22, 2017, 51 patients were enrolled. 25 were randomly assigned to the treatment withdrawal group and 26 to continue treatment. Over the first 6 months, 11 (44%) patients randomly assigned to treatment withdrawal met the primary endpoint of relapse compared with none of those assigned to continue treatment (Kaplan-Meier estimate of event rate 45·7% [95% CI 28·5-67·2]; p=0·0001). After 6 months, 25 (96%) of 26 patients assigned initially to continue treatment attempted its withdrawal. During the following 6 months, nine patients met the primary endpoint of relapse (Kaplan-Meier estimate of event rate 36·0% [95% CI 20·6-57·8]). No deaths were reported in either group and three serious adverse events were reported in the treatment withdrawal group: hospital admissions for non-cardiac chest pain, sepsis, and an elective procedure. INTERPRETATION Many patients deemed to have recovered from dilated cardiomyopathy will relapse following treatment withdrawal. Until robust predictors of relapse are defined, treatment should continue indefinitely. FUNDING British Heart Foundation, Alexander Jansons Foundation, Royal Brompton Hospital and Imperial College London, Imperial College Biomedical Research Centre, Wellcome Trust, and Rosetrees Trust.
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Affiliation(s)
- Brian P Halliday
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Rebecca Wassall
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Amrit S Lota
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Zohya Khalique
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - John Gregson
- London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Newsome
- London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Jackson
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Tsveta Rahneva
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Rick Wage
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Gillian Smith
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Lucia Venneri
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Upasana Tayal
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Dominique Auger
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - William Midwinter
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicola Whiffin
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Ronak Rajani
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Jason N Dungu
- Basildon and Thurrock Hospitals NHS Foundation Trust, Essex, UK
| | - Antonis Pantazis
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK
| | - Stuart A Cook
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; MRC London Institute of Medical Sciences, Imperial College London, London, UK; National Heart Centre Singapore, Singapore
| | - James S Ware
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - A John Baksi
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Dudley J Pennell
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stuart D Rosen
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Department of Cardiology, Ealing Hospital, London, UK
| | - Martin R Cowie
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - John G F Cleland
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK; Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Sanjay K Prasad
- Cardiovascular Research Centre and Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
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24
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Implications of Cardio-Respiratory Fitness on the Performance of Exercise Tests. Heart Lung Circ 2018; 28:e64-e66. [PMID: 30269873 DOI: 10.1016/j.hlc.2018.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/30/2018] [Accepted: 07/24/2018] [Indexed: 11/21/2022]
Abstract
In 2016, the American Heart Association (AHA) produced a position paper on cardiorespiratory fitness (CRF) which defined CRF as the most important cardiac risk factor in the assessment of prognosis in a wide variety of clinical states [1]. The aim of the paper was to improve patient management and to encourage life-style based strategies designed to improve cardiovascular risk. The authors showed that: In this Brief Communication, we expand on how CRF can be assessed and reported in exercise testing.
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25
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Applying current normative data to prognosis in heart failure: The Fitness Registry and the Importance of Exercise National Database (FRIEND). Int J Cardiol 2018. [DOI: 10.1016/j.ijcard.2018.02.102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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26
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Ensari I, Burg MM, Diaz KM, Fu J, Duran AT, Suls JM, Sumner JA, Monane R, Julian JE, Zhao S, Chaplin WF, Shimbo D. Putative mechanisms Underlying Myocardial infarction onset and Emotions (PUME): a randomised controlled study protocol. BMJ Open 2018; 8:e020525. [PMID: 29858417 PMCID: PMC5988091 DOI: 10.1136/bmjopen-2017-020525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The experience of negative emotions (eg, anger, anxiety and sadness) is associated with an increased short-term risk of incident cardiovascular disease (CVD) events, independent of traditional CVD risk factors. Impairment in endothelial function is one possible biological mechanism which may explain the association between negative emotions and incident CVD events. This laboratory-based, single-blind, randomised controlled experimental study aims to investigate the impact of induced negative emotions including anger, anxiety and sadness on endothelial function. METHODS AND ANALYSIS In a between-subjects design, 280 healthy participants are randomised to one of four experimental negative emotion inductions: anger, anxiety, sadness or a neutral condition. Endothelium-dependent vasodilation, circulating levels of endothelial cell-derived microparticles and bone marrow-derived endothelial progenitor cells, and indices of nitric oxide inhibition are assessed before and 3, 40, 70 and 100 min after negative emotion induction. Finally, in a subsample of 84 participants, the potential moderating effects of cardiorespiratory fitness and habitual physical activity on the adverse effects of an acute negative emotion on endothelial function are investigated. ETHICS AND DISSEMINATION This study is conducted in compliance with the Helsinki Declaration and the Columbia University Medical Center Institutional Review Board. The results of the study will be disseminated at several research conferences and as published articles in peer reviewed journals. The study will be implemented and reported in line with the SPIRIT statement. TRIAL REGISTRATION NUMBER NCT01909895; Pre-results.
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Affiliation(s)
- Ipek Ensari
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Matthew M Burg
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Keith M Diaz
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jie Fu
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Andrea T Duran
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jerry M Suls
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa, USA
| | - Jennifer A Sumner
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rachel Monane
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jacob E Julian
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Shuqing Zhao
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | | | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
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27
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Berkel AEM, Bongers BC, van Kamp MJS, Kotte H, Weltevreden P, de Jongh FHC, Eijsvogel MMM, Wymenga ANM, Bigirwamungu-Bargeman M, van der Palen J, van Det MJ, van Meeteren NLU, Klaase JM. The effects of prehabilitation versus usual care to reduce postoperative complications in high-risk patients with colorectal cancer or dysplasia scheduled for elective colorectal resection: study protocol of a randomized controlled trial. BMC Gastroenterol 2018; 18:29. [PMID: 29466955 PMCID: PMC5822670 DOI: 10.1186/s12876-018-0754-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Annefleur E M Berkel
- Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands.
| | - Bart C Bongers
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marie-Janne S van Kamp
- Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Hayke Kotte
- Physical therapy practice, Fysio Twente, J.J. van Deinselaan 34a, 7541, PE, Enschede, The Netherlands
| | - Paul Weltevreden
- Physical therapy practice, FITclinic, Roomweg 180, 7523, BT, Enschede, The Netherlands
| | - Frans H C de Jongh
- Department of Pulmonology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Michiel M M Eijsvogel
- Department of Pulmonology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - A N Machteld Wymenga
- Department of Internal medicine, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Marloes Bigirwamungu-Bargeman
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Job van der Palen
- Epidemiology, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
| | - Marc J van Det
- Department of Surgery, Ziekenhuisgroep Twente, PO Box 7600, 7600, SZ, Almelo, The Netherlands
| | - Nico L U van Meeteren
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Top Sector Life Sciences and Health (Health~Holland), Laan van Nieuw Oost-Indië 334, 2593, CE, The Hague, The Netherlands
| | - Joost M Klaase
- Department of Surgery, Medisch Spectrum Twente, PO Box 50 000, 7500, KA, Enschede, The Netherlands
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Bongers BC, Berkel AE, Klaase JM, van Meeteren NL. An evaluation of the validity of the pre-operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Anaesthesia 2017; 72:1206-1216. [PMID: 28741667 DOI: 10.1111/anae.14003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 12/28/2022]
Abstract
This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg-1 .min-1 , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg-1 .min-1 , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.
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Affiliation(s)
- B C Bongers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - A E Berkel
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - J M Klaase
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - N L van Meeteren
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Gjestvang C, Stensrud T, Haakstad LAH. How is rating of perceived capacity related to VO 2max and what is VO 2max at onset of training? BMJ Open Sport Exerc Med 2017; 3:e000232. [PMID: 29259808 PMCID: PMC5731224 DOI: 10.1136/bmjsem-2017-000232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 02/01/2023] Open
Abstract
Objective To evaluate how rating of perceived capacity (RPC) is related to maximal oxygen uptake (VO2max) and examine VO2max at onset of training in healthy adults. Methods In total, 125 newly registered fitness centre members, equally men and women, answered the RPC scale and performed a treadmill test for measurement of VO2max. Eligible criteria were <4 weeks of fitness centre membership, physically inactive, ≥18 years and not pregnant. The RPC is a one-page scale (1–20) based on metabolic equivalent tasks, where the individual chooses the most strenuous activity that can be sustained for at least 30 min. Results The Bland-Altman plot demonstrated a tendency of overestimation, meaning that the participants ranked their own aerobic capacity 17.5% higher than objectively measured values of VO2max. The mean difference between the two methods were +4.92±1.96 and +6.35±1.96 mL/min/kg VO2 in men and women, respectively. The Pearson correlation coefficient was moderate, with r=0.426 (p<0.01). A linear regression analysis showed that both age and VO2max were significant predictors of RPC (p<0.01). Measured VO2max at onset of fitness centre membership was in men aged 38.7±11.7 and women aged 34.7±9.9, 40.5±7.2 and 35.0±6.0 mL/min/kg, respectively. Estimated VO2max from the RPC scale was 45.7±9.8 and 41.4±10.1 mL/min/kg in men and women, respectively. Conclusions The RPC seems less accurate at the individual level and may overestimate VO2max. Still, it may be considered useful in large-scale studies.
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Affiliation(s)
- Christina Gjestvang
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Lene A H Haakstad
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
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Mathes DD. The Preoperative Evaluation of the Patient With Cardiac Risk Factors for Noncardiac Surgery: Which Patients Need Further Cardiac Risk Stratification Tests? Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/scva.2001.23717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac risk stratification tests should be pursued only in the subgroup of patients who have a moderate to high incidence of significant coronary artery disease and only in those who will gain long-term benefit from coronary revascularization if they are found to have significant coronary artery disease. Furthermore, car diac risk stratification tests should be pursued only if the perioperative mortality and morbidity from com bined coronary revascularization followed by noncar diac surgery is not significantly higher than proceeding straight to noncardiac surgery alone. Indentification of the subgroup of patients who will need cardiac strati fication tests should be based on integration of the patient's cardiac risk factors and functional capacity with the risk and stress of the particular surgery.
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Affiliation(s)
- Donald D. Mathes
- Division of Cardiothoracic and Vascular Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710
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de Carvalho Bastone A, de Souza Moreira B, Teixeira CP, Dias JMD, Dias RC. Is the Veterans Specific Activity Questionnaire Valid to Assess Older Adults Aerobic Fitness? J Geriatr Phys Ther 2016; 39:117-24. [DOI: 10.1519/jpt.0000000000000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tossige-Gomes R, Costa KB, Ottone VDO, Magalhães FDC, Amorim FT, Rocha-Vieira E. Lymphocyte Redox Imbalance and Reduced Proliferation after a Single Session of High Intensity Interval Exercise. PLoS One 2016; 11:e0153647. [PMID: 27096389 PMCID: PMC4838252 DOI: 10.1371/journal.pone.0153647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/02/2016] [Indexed: 12/12/2022] Open
Abstract
This study investigated whether an acute session of high-intensity interval training (HIIT) is sufficient to alter lymphocyte function and redox status. Sixteen young healthy men underwent a HIIT session on a cycloergometer, consisting of eight bouts of 1 min at 90-100% of peak power, with 75 seconds of active recovery at 30 W between bouts. Venous blood was collected before, immediately after, and 30 minutes after the HIIT session. In response to Staphylococcus aureus superantigen B (SEB) stimulation, lymphocyte proliferation decreased and the IL-2 concentration increased after the HIIT session. However, the HIIT session had no effect on lymphocyte proliferation or IL-2 response to phytohemagglutinin stimulation. The HIIT session also induced lymphocyte redox imbalance, characterized by an increase in the concentration of thiobarbituric acid reactive substances and a decrease in the activity of the antioxidant enzyme catalase. Lymphocyte viability was not affected by the HIIT session. The frequencies of CD25+ and CD69+ T helper and B lymphocytes in response to superantigen stimulation were lower after exercise, suggesting that superantigen-induced lymphocyte activation was reduced by HIIT. However, HIIT also led to a reduction in the frequency of CD4+ and CD19+ cells, so the frequencies of CD25+ and CD69+ cells within the CD4 and CD19 cell populations were not affected by HIIT. These data indicate that the reduced lymphocyte proliferation observed after HIIT is not due to reduced early lymphocyte activation by superantigen. Our findings show that an acute HIIT session promotes lymphocyte redox imbalance and reduces lymphocyte proliferation in response to superantigenic, but not to mitogenic stimulation. This observation cannot be explained by alteration of the early lymphocyte activation response to superantigen. The manner in which lymphocyte function modulation by an acute HIIT session can affect individual immunity and susceptibility to infection is important and requires further investigation.
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Affiliation(s)
- Rosalina Tossige-Gomes
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Karine Beatriz Costa
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Vinícius de Oliveira Ottone
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Flávio de Castro Magalhães
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
- Departamento de Educação Física, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Fabiano Trigueiro Amorim
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
- Departamento de Educação Física, Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
| | - Etel Rocha-Vieira
- Sociedade Brasileira de Fisiologia, Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
- Faculdade de Medicina, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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de Matos MA, Duarte TC, Ottone VDO, Sampaio PFDM, Costa KB, de Oliveira MFA, Moseley PL, Schneider SM, Coimbra CC, Brito-Melo GEA, Magalhães FDC, Amorim FT, Rocha-Vieira E. The effect of insulin resistance and exercise on the percentage of CD16+monocyte subset in obese individuals. Cell Biochem Funct 2016; 34:209-16. [DOI: 10.1002/cbf.3178] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mariana A. de Matos
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Tamiris C. Duarte
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Vinícius de O. Ottone
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Pâmela F. da M. Sampaio
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Karine B. Costa
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | | | | | | | - Cândido C. Coimbra
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal de Minas Gerais; Endocrinology Laboratory; Belo Horizonte Brazil
| | - Gustavo E. A. Brito-Melo
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunology Laboratory; Diamantina Brazil
| | - Flávio de C. Magalhães
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Fabiano T. Amorim
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
| | - Etel Rocha-Vieira
- Sociedade Brasileira de Fisiologia (SBFis); Programa Multicêntrico de Pós-graduação em Ciências Fisiológicas (PMPGCF); Brazil
- Universidade Federal dos Vales do Jequitinhonha e Mucuri; Immunometabolism Group; Diamantina Brazil
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Zanco MF, Moraes H, Maranhão Neto G, Laks J, Deslandes AC. Assessing cardiorespiratory capacity in older adults with major depression and Alzheimer disease. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To assess cardiorespiratory capacity through subjective and objective tests in older adults diagnosed with major depression (MDD), Alzheimer disease (AD) and healthy older adults. Methods Fifty seven subjects (72 ± 7.9 years) were divided into three groups: MDD (n = 20), AD (n = 17) and Healthy (n = 20). The subjects answered Hamilton Scale (HAM-D), Mini-Mental State Examination (MMSE), Veterans Specific Activity Questionnaire (VSAQ) and 2-minute Step test. Results MDD and AD showed lower scores than healthy group for Nomogram VSAQ (p < 0.001) and 2-minute Step (p = 0.009; p = 0.008, respectively). Adjusted for age and educational level, no differences among groups were observed for Step (MDD, p = 0.097; AD, p = 0.102). AD group did not present differences to healthy group for Step, when adjusting for MMSE (p = 0.261). Conclusions Despite the lower cardiorespiratory fitness of elderly patients with DM and DA have been found in both evaluations, the results should be viewed with caution, since the tests showed low correlation and different risk classifications of functional loss. In addition, age, level educational and cognitive performance are variables that can influence the performance objective evaluation.
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Affiliation(s)
- Marcos Felipe Zanco
- Universidade Federal do Rio de Janeiro; Universidade Federal do Rio de Janeiro
| | | | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro; Conselho Nacional de Desenvolvimento Científico e Tecnológico
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Teren A, Zachariae S, Beutner F, Ubrich R, Sandri M, Engel C, Löffler M, Gielen S. Incremental value of Veterans Specific Activity Questionnaire and the YMCA-step test for the assessment of cardiorespiratory fitness in population-based studies. Eur J Prev Cardiol 2015; 23:1221-7. [DOI: 10.1177/2047487315621844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Andrej Teren
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Department of Internal Medicine/Cardiology, Heart Centre University of Leipzig, Germany
| | - Silke Zachariae
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
| | - Frank Beutner
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Department of Internal Medicine/Cardiology, Heart Centre University of Leipzig, Germany
| | - Romy Ubrich
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Department of Internal Medicine/Cardiology, Heart Centre University of Leipzig, Germany
| | - Marcus Sandri
- Department of Internal Medicine/Cardiology, Heart Centre University of Leipzig, Germany
| | - Christoph Engel
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
| | - Markus Löffler
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany
| | - Stephan Gielen
- LIFE – Leipzig Research Centre for Civilization Diseases, University of Leipzig, Germany
- Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, University Hospital Halle/Saale, Germany
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Costa DC, de Santi GL, Crescêncio JC, Seabra LP, Carvalho EEV, Papa V, Marques F, Gallo L, Schmidt A. Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men. Braz J Med Biol Res 2015; 48:1136-44. [PMID: 26397972 PMCID: PMC4661031 DOI: 10.1590/1414-431x20154692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the agreement between measurements of unloaded oxygen uptake and peak oxygen uptake based on equations proposed by Wasserman and on real measurements directly obtained with the ergospirometry system. We performed an incremental cardiopulmonary exercise test (CPET), which was applied to two groups of sedentary male subjects: one apparently healthy group (HG, n=12) and the other had stable coronary artery disease (n=16). The mean age in the HG was 47±4 years and that in the coronary artery disease group (CG) was 57±8 years. Both groups performed CPET on a cycle ergometer with a ramp-type protocol at an intensity that was calculated according to the Wasserman equation. In the HG, there was no significant difference between measurements predicted by the formula and real measurements obtained in CPET in the unloaded condition. However, at peak effort, a significant difference was observed between oxygen uptake (V˙O2)peak(predicted)and V˙O2peak(real)(nonparametric Wilcoxon test). In the CG, there was a significant difference of 116.26 mL/min between the predicted values by the formula and the real values obtained in the unloaded condition. A significant difference in peak effort was found, where V˙O2peak(real)was 40% lower than V˙O2peak(predicted)(nonparametric Wilcoxon test). There was no agreement between the real and predicted measurements as analyzed by Lin's coefficient or the Bland and Altman model. The Wasserman formula does not appear to be appropriate for prediction of functional capacity of volunteers. Therefore, this formula cannot precisely predict the increase in power in incremental CPET on a cycle ergometer.
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Affiliation(s)
- D. C. Costa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G. L. de Santi
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J. C. Crescêncio
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L. P. Seabra
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E. E. V. Carvalho
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V. Papa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F. Marques
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L. Gallo
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A. Schmidt
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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João TMS, Rodrigues RCM, Gallani MCBJ, Miura CTP, Domingues GDBL, Amireault S, Godin G. Validity of the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire. CAD SAUDE PUBLICA 2015; 31:1825-38. [PMID: 26578007 DOI: 10.1590/0102-311x00189713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 07/06/2015] [Indexed: 11/22/2022] Open
Abstract
This study provides evidence of construct validity for the Brazilian version of the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ), a 1-item instrument used among 236 participants referred for cardiopulmonary exercise testing. The Baecke Habitual Physical Activity Questionnaire (Baecke-HPA) was used to evaluate convergent and divergent validity. The self-reported measure of walking (QCAF) evaluated the convergent validity. Cardiorespiratory fitness assessed convergent validity by the Veterans Specific Activity Questionnaire (VSAQ), peak measured (VO2peak) and maximum predicted (VO2pred) oxygen uptake. Partial adjusted correlation coefficients between the GSLTPAQ, Baecke-HPA, QCAF, VO2pred and VSAQ provided evidence for convergent validity; while divergent validity was supported by the absence of correlations between the GSLTPAQ and the Occupational Physical Activity domain (Baecke-HPA). The GSLTPAQ presents level 3 of evidence of construct validity and may be useful to assess leisure-time physical activity among patients with cardiovascular disease and healthy individuals.
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Affiliation(s)
| | | | | | | | | | - Steve Amireault
- College of Health and Human Sciences, Purdue University, West Lafayette, U.S.A
| | - Gaston Godin
- Faculté des Sciences Infirmières, Université Laval, Québec, Canada
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Chachamovitz DSDO, Vigário PDS, Carvalho RC, Silvestre DHDS, Moerbeck AEV, Soffientini MG, Luna ÉLG, Rosemberg CW, Mainenti MRM, Vaisman M, Teixeira PDFDS. Does low serum TSH within the normal range have negative impact on physical exercise capacity and quality of life of healthy elderly people? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 60:236-45. [PMID: 26222231 PMCID: PMC10522298 DOI: 10.1590/2359-3997000000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Investigate the differences in cardiopulmonary (CP) capacity and Quality of Life (QOL) between healthy elderly (≥ 65 years) with different TSH levels (< 1.0 and ≥ 1.0 μIU/mL) both within the normal range. Also, evaluate the effects of TSH elevation on CP test and QOL, by administering methimazole to subjects with initial lower-normal TSH, in order to elevate it to superior-normal limit. MATERIALS AND METHODS Initially, a cross-sectional study was performed to compare CP capacity at peak exercise and QOL (using WHOQOL-OLD questionnaire) between healthy seniors (age ≥ 65 years) with TSH < 1.0 μIU/mL vs. TSH ≥1.0 μIU/mL. In the second phase, participants with TSH < 1.0 μIU/mL were included in a non-controlled-prospective-interventional study to investigate the effect of TSH elevation, using methimazole, on QOL and CP capacity at peak exercise. RESULTS From 89 elderly evaluated, 75 had TSH ≥ 1 μIU/mL and 14 TSH < 1 μIU/mL. The two groups had similar basal clinical characteristics. No difference in WHOQOL-OLD scores was observed between groups and they did not differ in terms of CP function at peak exercise. QOL and CP variables were not correlated with TSH levels. Twelve of 14 participants with TSH < 1.0 μIU/mL entered in the prospective study. After one year, no significant differences in clinical caracteristics, QOL, and CP variables were detected in paired analysis before and after methimazole intervention. CONCLUSIONS We found no differences in CP capacity and QOL between health elderly with different TSH levels within normal range and no impact after one year of methimazole treatment. More prospective-controlled-randomized studies are necessary to confirm or not the possible harm effect in normal low TSH.
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Affiliation(s)
- Dhiãnah Santini de Oliveira Chachamovitz
- Endocrine ClinicUniversity Hospital Clementino Fraga FilhoRio de JaneiroRJBrazilEndocrine Clinic, University Hospital Clementino Fraga Filho (HUCFF), Rio de Janeiro, RJ, Brazil
- Estácio de Sá UniversityRio de JaneiroRJBrazilEstácio de Sá University, Rio de Janeiro, RJ, Brazil
- Amil Clinical ResearchRio de JaneiroRJBrazilAmil Clinical Research, Rio de Janeiro, RJ, Brazil
| | - Patrícia dos Santos Vigário
- Ergospirometry and Kinanthropometry LaboratoryPhysical Education and Sports SchoolFederal University of Rio de JaneiroRio de JaneiroRJBrazilErgospirometry and Kinanthropometry Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro(UFRJ)Rio de Janeiro, RJ, Brazil
- Augusto Motta University CenterRio de JaneiroRJBrazilPostgraduate Program of Rehabilitation Sciences, Augusto Motta University Center (Unisuam), Rio de Janeiro, RJ, Brazil
| | - Rafael Cavalcante Carvalho
- Ergospirometry and Kinanthropometry LaboratoryPhysical Education and Sports SchoolFederal University of Rio de JaneiroRio de JaneiroRJBrazilErgospirometry and Kinanthropometry Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro(UFRJ)Rio de Janeiro, RJ, Brazil
| | - Diego Henrique da Silva Silvestre
- Ergospirometry and Kinanthropometry LaboratoryPhysical Education and Sports SchoolFederal University of Rio de JaneiroRio de JaneiroRJBrazilErgospirometry and Kinanthropometry Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro(UFRJ)Rio de Janeiro, RJ, Brazil
| | | | | | - Érika Luciana Gomes Luna
- Estácio de Sá UniversityRio de JaneiroRJBrazilEstácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Clara Werner Rosemberg
- Estácio de Sá UniversityRio de JaneiroRJBrazilEstácio de Sá University, Rio de Janeiro, RJ, Brazil
| | - Míriam Raquel Meira Mainenti
- Ergospirometry and Kinanthropometry LaboratoryPhysical Education and Sports SchoolFederal University of Rio de JaneiroRio de JaneiroRJBrazilErgospirometry and Kinanthropometry Laboratory, Physical Education and Sports School, Federal University of Rio de Janeiro(UFRJ)Rio de Janeiro, RJ, Brazil
- Augusto Motta University CenterRio de JaneiroRJBrazilPostgraduate Program of Rehabilitation Sciences, Augusto Motta University Center (Unisuam), Rio de Janeiro, RJ, Brazil
| | - Mário Vaisman
- Endocrine ClinicUniversity Hospital Clementino Fraga FilhoRio de JaneiroRJBrazilEndocrine Clinic, University Hospital Clementino Fraga Filho (HUCFF), Rio de Janeiro, RJ, Brazil
| | - Patricia de Fátima dos Santos Teixeira
- Endocrine ClinicUniversity Hospital Clementino Fraga FilhoRio de JaneiroRJBrazilEndocrine Clinic, University Hospital Clementino Fraga Filho (HUCFF), Rio de Janeiro, RJ, Brazil
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Ajiboye O, Anigbogu C, Ajuluchukwu J, Jaja S. Exercise training improves functional walking capacity and activity level of Nigerians with chronic biventricular heart failure. Hong Kong Physiother J 2015. [DOI: 10.1016/j.hkpj.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
An exercise program designed to improve fitness is essential for most adults. Exercise decreases the risk of cardiovascular disease, type 2 diabetes, some cancers, depression, and anxiety. Most fail to achieve recommended exercise levels. Only 1.3% of Australian general practice (GP) consultations provide exercise counseling and advice. Australia provides Medicare reimbursement for consultations with Accredited Exercise Physiologists through allied health care plans initiated through primary care. Exercise Is Medicine is an initiative to equip primary care providers with resources, education, and strategies to increase physical activity and reduce sedentary behavior. The objective of Exercise Is Medicine is to improve the health and well-being of our nation. We describe Exercise Is Medicine and encourage primary care providers to discuss physical activity and exercise with their patients and provide them with resources to encourage this activity and referral pathways to train exercise professionals. This will assist primary care providers in treating their patients.
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Affiliation(s)
| | - Jen Law
- University of New South Wales, Sydney, New South Wales, Australia
| | - Bill Lancashire
- University of New South Wales, Sydney, New South Wales, Australia
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Robert G. Fassett
- The University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
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Evidence-based clinical practice manual: Patient preparation for surgery and transfer to the operating room☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543010-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Manual de práctica clínica basado en la evidencia: preparación del paciente para el acto quirúrgico y traslado al quirófano. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2014.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Rincón-Valenzuela DA, Escobar B. Evidence-based clinical practice manual: Patient preparation for surgery and transfer to the operating room. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
Hip fracture is one of the most common orthopedic conditions associated with significant morbidity and mortality. Patients with hip fracture are usually older, with significant comorbidities. Delayed surgical treatment beyond 48 hours after admission is associated with significantly higher mortality. Hereby clinicians are presented with the challenge to optimize the complex hip fracture within a short time period. This article reviews the evidence regarding preoperative, intraoperative, and postoperative considerations, and provides insights into the best strategies with which to optimize the patient's condition and improve perioperative outcomes.
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Affiliation(s)
- Jiabin Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Jaimo Ahn
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Relationship between level of independence in activities of daily living and estimated cardiovascular capacity in elderly women. Arch Gerontol Geriatr 2014; 59:367-71. [DOI: 10.1016/j.archger.2014.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 11/18/2022]
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Sadik J, Myers J, Froelicher V. A modified nomogram for ramp treadmill testing using the Veterans Specific Activity Questionnaire. Am J Cardiol 2014; 114:803-5. [PMID: 25034327 DOI: 10.1016/j.amjcard.2014.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/17/2022]
Abstract
Studies performed over the past 2 decades have supported the recommendation that the exercise test protocol be individualized and that a targeted duration of 8 to 12 minutes is optimal. However, this is not always implemented clinically because of the complication of having to choose a specific ramp to match a patient. We present a simple nomogram based on a questionnaire to choose 1 of 4 possible ramp protocols that provide individualized ramp rates for subjects undergoing clinical exercise testing.
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Affiliation(s)
- Jamal Sadik
- VA Palo Alto Health Care System, Stanford University, Palo Alto, California
| | - Jonathan Myers
- VA Palo Alto Health Care System, Stanford University, Palo Alto, California
| | - Victor Froelicher
- VA Palo Alto Health Care System, Stanford University, Palo Alto, California.
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Maranhao Neto GA, Oliveira RB, Myers JN, Farinatti PTV. Prediction of peak oxygen pulse (O2Ppeak) without exercise testing in older adults. Arch Gerontol Geriatr 2014; 59:562-7. [PMID: 25085231 DOI: 10.1016/j.archger.2014.07.009] [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: 11/05/2013] [Revised: 01/27/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Peak oxygen pulse has been considered a surrogate of cardiovascular function and an independent predictor of all cause mortality. However, O2P(peak) depends on maximal volitional effort which may limit its utility in older subjects. The aim of this study was to develop a model to estimate O2P(peak) without exercise in an elderly sample. This cross-sectional study enrolled 67 community-dwelling older adults (69.4±7.1 years; 41 men) for the non-exercise model development and 30 community-dwelling older adults (67.7±6.4 years; n=30; 17 men) for cross-validation. The non-exercise model was derived through hierarchical regression model and cross-validated by means of PRESS statistics and comparison against an independent sample. Classification accuracy of the model for tertiles of estimated and actual O2P(peak) was tested by gamma (γ) nonparametric correlation. The following prediction equation was generated: -3.416+0.137 × weight (kg)+1.226 × Veterans Specific Activity Questionnaire (VSAQ) (metabolic equivalents, METs)+1.987 × gender (0=women, 1=men)-2.045 × β-Blockers use (0=no, 1=yes)-0.044 × resting heart rate (HR) (R(2)=0.83; standard error of estimate (SEE)=1.68 mL beat(-1)). Correlation in cross-validation group was 0.80 (P<0.001). A high probability was observed for the model to rank the values in the same tertile in validation and cross-validation groups (γ=0.98; γ=0.92, respectively, P<0.05). In conclusion, O2P(peak) can be estimated with reasonable precision without exercise testing, providing an alternative for elder subjects not capable to perform maximal effort.
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Affiliation(s)
| | | | | | - Paulo T V Farinatti
- Salgado de Oliveira University, Niteroi, RJ, Brazil; Rio de Janeiro State University, RJ, Brazil.
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Jagoda A, Myers JN, Kaminsky LA, Whaley MH. Heart rate response at the onset of exercise in an apparently healthy cohort. Eur J Appl Physiol 2014; 114:1367-75. [DOI: 10.1007/s00421-014-2867-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
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Meneghelo RS, Morhy SS, Zucchi P. Time of exercise as indicator of quality control in ergometry services. Arq Bras Cardiol 2014; 102:151-5. [PMID: 24676370 PMCID: PMC3987341 DOI: 10.5935/abc.20140005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/01/2013] [Accepted: 09/19/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The search for quality requires assessment tools in the various subdivisions of a health complex. In diagnostic medicine, they are scarce and in ergometry suggestions of indicators were not found. OBJECTIVE To establish indicator for quality control on ergometry based on III Guidelines of the Brazilian Cardiology Society About Ergometric Test; to verify the percentage of tests that have presented the indicator within the compliance in two services of the same institution before and after the publication of the document. METHODS A critical analysis of the guidelines in the search for indicator that would present: accuracy, reliability, simplicity, validity, sensitivity and ability to quantitatively measure the variations in the behavior of quality criteria and that would be applicable to all tests. The indicator was applied in tests of 2010 and 2011 prior to the publication, and after it was adopted by two services of the same institution. RESULTS The indicator that has met the criteria was the percentage of ergometric tests with exercise duration between 8 and 12 minutes. In the years 2010 and 2011, respectively, the percentage of ergometric tests within compliance were 85.5% and 86.1% (p=0.068) at the General Hospital, and 81.5% and 85.7% (p<0.001) the Service of Periodic Health Assessment. CONCLUSION The exercise time between 8 and 12 minutes can be used as a quality criterion in ergometric and services where it was applied, at least 80% of the ergometric tests were compliant.
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Affiliation(s)
| | | | - Paola Zucchi
- Grupo Interdepartamental de Economia da Saúde-GRIDES - Universidade
Federal de São Paulo-UNIFESP, São Paulo, SP - Brazil
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Azarbal F, Singh M, Finocchiaro G, Le VV, Schnittger I, Wang P, Myers J, Ashley E, Perez M. Exercise capacity and paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. Heart 2013; 100:624-30. [DOI: 10.1136/heartjnl-2013-304908] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common arrhythmia among patients with hypertrophic cardiomyopathy (HCM). The relationship between paroxysmal AF and exercise capacity in this population is incompletely understood.MethodsPatients with HCM underwent symptom-limited cardiopulmonary testing with expired gas analysis at Stanford Hospital between October 2006 and October 2012. Baseline demographics, medical histories and resting echocardiograms were obtained for all subjects. Diagnosis of AF was established by review of medical records and baseline ECG. Those with paroxysmal AF were in sinus rhythm at the time of cardiopulmonary testing with expired gas analysis. Exercise intolerance was defined as peak VO2<20 mL/kg/min. We used multivariate logistic regression to evaluate the association between exercise intolerance and paroxysmal AF.ResultsAmong the 265 patients recruited, 55 had AF (28 paroxysmal and 27 permanent). Compared with those without AF, subjects with paroxysmal AF were older, more likely to use antiarrhythmic and anticoagulant medications, and had larger left atria. Patients with paroxysmal AF achieved lower peak VO2 (21.9±9.2 mL/kg/min vs 26.9±10.8 mL/kg/min, p=0.02) and were more likely to have exercise intolerance (61% vs 28%, p<0.001) compared with those without AF. After adjustment for age, sex and body mass index (BMI) exercise intolerance remained significantly associated with paroxysmal AF (OR 4.65, 95% CI 1.83 to 11.83, p=0.001).ConclusionsPatients with HCM and paroxysmal AF demonstrate exercise intolerance despite being in sinus rhythm at the time of exercise testing.
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