1
|
Klarenberg H, van der Velde JHPM, Peeters CFW, Dekkers IA, de Mutsert R, Jukema JW, Rosendaal FR, Leiner T, Froeling M, Jorstad H, Boekholdt SM, Strijkers GJ, Lamb HJ. Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health. BMJ Open Sport Exerc Med 2024; 10:e001778. [PMID: 38347856 PMCID: PMC10860076 DOI: 10.1136/bmjsem-2023-001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Objectives To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health. Methods This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load. Results Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006). Conclusions A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.
Collapse
Affiliation(s)
- Hugo Klarenberg
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Carel FW Peeters
- Division of Mathematical & Statistical Methods – Biometris, Wageningen University & Research, Wageningen, The Netherlands
- Department of Epidemiology & Datascience, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tim Leiner
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Harald Jorstad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
2
|
Narendrula A, Brinza E, Horvat Davey C, Longenecker CT, Webel AR. Relationship between objectively measured physical activity and subclinical cardiovascular disease: a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001596. [PMID: 38292295 PMCID: PMC10826575 DOI: 10.1136/bmjsem-2023-001596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Introduction The association of physical activity (PA) with subclinical cardiovascular disease (CVD) is unclear. Clarifying this relationship may inform cardiovascular prevention strategies. Methods We performed a systematic review (CRD42021226089) using Medline, Embase, CINAHL and Cochrane (1 January 2000 to 1 September 2023). Studies published with adult populations exploring the relationship between objectively measured PA and subclinical CVD were included. Subclinical CVD was assessed using: ankle-brachial index (ABI); arterial stiffness; carotid artery disease; coronary artery atherosclerosis; endothelial function; and measures of cardiac structure and function. The Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) and Cochrane Risk of Bias tools were used for quality review. Results Of 68 included studies, most supported an inverse relationship between PA and subclinical CVD. Arterial stiffness was the most common outcome (n=40), and 33 studies suggested that less sedentary behaviour (SB), increased PA and/or higher intensity PA was associated with less arterial stiffness. Ten studies of carotid artery disease (total n=18), six of endothelial function (n=10), two of coronary artery disease (n=3) and all of ABI (n=6) suggested that PA or less SB is associated with less subclinical disease. Five studies assessing cardiac structure/function (n=6) suggested alterations in structure/function with PA. Conclusions PA reduces the risk of CVD events, and this systematic review demonstrates that some of the benefits may be mediated by an inverse association between PA and subclinical CVD. Interventions to increase PA are important for CVD prevention, so we provide a comprehensive overview of which surrogate outcome measures may be most useful to assess future CVD prevention interventions. PROSPERO registration number CRD42021226089.
Collapse
Affiliation(s)
- Aparna Narendrula
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Ellen Brinza
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Horvat Davey
- Case Western Reserve University Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Chris T Longenecker
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison R Webel
- University of Washington School of Nursing, Seattle, Washington, USA
| |
Collapse
|
3
|
Ashraf A, Rimaz S, Seddighinejad A, Karimi A, Hassanzadeh-Rad A, Gholipour M, Motiei M, Yazdanipour MA, Rimaz S. The effect of physical activity level on the severity of diastolic dysfunction. BMC Sports Sci Med Rehabil 2023; 15:74. [PMID: 37391808 DOI: 10.1186/s13102-023-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a risk factor for cardiovascular events in patients undergoing non-cardiac surgeries. Investigators aimed to assess the effect of physical activity level on the diastolic function of the left ventricle (LV) in patients attending the preoperative visit. METHODS This analytic cross-sectional study was conducted on 228 patients referred to Poursina hospital from November 2021 to March 2022. To define the physical activity level, we used the short form of the International Physical Activity Questionnaire (IPAQ). We categorized patients into inactive, minimally active, and health-enhancing physical activity groups. We also divided participants into three groups based on their daily sitting time. Also, echocardiographic parameters were calculated. The diastolic function of LV was evaluated, and its grading was defined from mild (grade1) to severe (grade 3). RESULTS Results showed that patients with DD had significantly higher age and lower levels of education (P < 0.001 and P = 0.005, respectively). After assessing echocardiographic parameters, we found that E/e', TR Velocity, left atrial volume index, and pulmonary artery pressure had a statistically significant inverse relationship with physical activity level (P < 0.001 for all). Comparing physical activity level of subgroups showed that in HEPA (health-enhancing physical activity), the chance of developing grade 2 or 3 DD was reduced by 97% compared to the inactive group (OR = 0.03, P < 0.001). Still, there was no significant difference between the inactive and minimally active groups (P = 0.223). CONCLUSIONS This study showed an inverse relationship between physical activity level and DD of the LV in a sample of 228 individuals attending the Anesthesia Clinic, independent of potentially confounding variables.Therefore, due to lower rate of DD in patients who are physically active, we can expect lower occurrence rate of cardiovascular events during surgery.
Collapse
Affiliation(s)
- Ali Ashraf
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Siamak Rimaz
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Seddighinejad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Amin Karimi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Afagh Hassanzadeh-Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mahsa Motiei
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | | | - Sheida Rimaz
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| |
Collapse
|
4
|
Heitmann KA, Welde B, Løchen ML, Stylidis M, Schirmer H, Morseth B. Longitudinal Associations Between Cumulative Physical Activity and Change in Structure and Function of the Left Side of the Heart: The Tromsø Study 2007–2016. Front Cardiovasc Med 2022; 9:882077. [PMID: 35647060 PMCID: PMC9133513 DOI: 10.3389/fcvm.2022.882077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current knowledge about the relationship between physical activity (PA) and cardiac remodeling is mainly derived from cross-sectional studies of athletes, and there is a knowledge gap of this association in the general adult and elderly population. Therefore, we aimed to explore the longitudinal association between cumulative PA and change in cardiac structure and function in a general adult and elderly population. Methods This longitudinal study includes 594 participants from the sixth (Tromsø6, 2007–08) and seventh (Tromsø7, 2015–16) survey of the Tromsø Study. Cardiac structure and function were assessed by echocardiography at two time points, and PA was self-reported by questionnaire at both time points. PA volume was expressed as cumulative PA (Low, Moderate, and Hard) and the association with left atrial (LA) and left ventricular (LV) structure and function was assessed using ANCOVA. Results Overall, LA diameter index (LADi) increased significantly more in Hard compared to Moderate PA (+0.08 cm/m2, 95% CI 0.01–0.15, p = 0.020) from Tromsø6 to Tromsø7. When stratified by sex or age, higher levels of cumulative PA were associated with increased LADi in males and in participants <65 years only. Indexed LV mass (LVMi) increased significantly more in Moderate than in Low PA (+3.9 g/m2.7, 95% CI 0.23–7.57, p = 0.037). When stratified by sex or age, these changes in LVMi and indexed LV diameter (LVDi) were only significant in females. No significant associations were observed between cumulative PA and change in relative wall thickness, E/e' ratio, e' velocity, LV ejection fraction, and LADi/LVDi ratio. Conclusion Higher levels of cumulative PA were associated with increased LADi in males and participants <65 years, and with increased LVMi and LVDi in females. Despite cardiac chamber enlargement, the pump function of the heart did not change with higher levels of PA, and the atrioventricular ratio was unchanged. Our results indicate that cardiac chamber enlargement is a physiological response to PA.
Collapse
Affiliation(s)
- Kim Arne Heitmann
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of Northern Norway, Tromsø, Norway
- *Correspondence: Kim Arne Heitmann
| | - Boye Welde
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of Northern Norway, Tromsø, Norway
| |
Collapse
|
5
|
Heitmann KA, Løchen ML, Stylidis M, Hopstock LA, Schirmer H, Morseth B. Associations between physical activity, left atrial size and incident atrial fibrillation: the Tromsø Study 1994-2016. Open Heart 2022; 9:e001823. [PMID: 35074937 PMCID: PMC8788327 DOI: 10.1136/openhrt-2021-001823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022] Open
Abstract
AIMS Left atrial (LA) enlargement is an independent risk factor for atrial fibrillation (AF). Interestingly, some athletes have increased risk of AF, which may be linked to LA enlargement; however, little is known about the relationship between LA enlargement and AF risk at moderate-level physical activity (PA). We aimed to explore the associations between PA, LA size and risk of incident AF, and if PA can attenuate the risk of AF with LA enlargement. METHODS This prospective study followed 2479 participants (52.4% female), free from known cardiac pathology, for median 20.2 years. Participants were followed up for hospital-diagnosed AF, confirmed by electrocardiography, from 1994-95 through 2016. At baseline, LA size was evaluated by anteroposterior LA diameter, and PA was self-reported by questionnaire. RESULTS We observed a U-shaped relationship between PA and AF, and moderately active had 32% lower AF risk than inactive (HRadjusted 0.68, 95% CI 0.50 to 0.93). Participants with LA enlargement had 38% higher AF risk compared with participants with normal LA size (HRadjusted 1.38, 95% CI 1.12 to 1.69). However, the increased AF risk with LA enlargement was attenuated by PA; compared with inactive participants with LA enlargement, the AF risk was 45% lower among active with LA enlargement (HRadjusted 0.55, 95% CI 0.39 to 0.79). AF risk in active participants with LA enlargement did not differ from active with normal LA size. These patterns were observed in both men and women, and in participants over/under 65 years. CONCLUSION Moderate PA was associated with reduced AF risk, and PA attenuated the increased risk of AF with LA enlargement in both men and women and all age groups.
Collapse
Affiliation(s)
- Kim Arne Heitmann
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
6
|
Cuspidi C, Carugo S, Tadic M. Looking at the best indexing method of left atrial volume in the hypertensive setting. Hypertens Res 2021; 44:722-724. [PMID: 33707759 DOI: 10.1038/s41440-021-00642-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. .,Istituto Auxologico Italiano, Milano, Italy.
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico di Milano, Milano, Italy
| | - Marijana Tadic
- University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Belgrade, Serbia
| |
Collapse
|