Reference values for and cross-validation of time to exhaustion on a modified Balke protocol in Norwegian men and women

Pediatric youth who have obesity have high rates of adult criminal behavior and low rates of homeownership

Objectives:

The social outcomes in adulthood for pediatric patients with obesity are not well-described. This study investigated lifetime criminal behavior and homeownership in youth with obesity.

Methods:

Retrospective data on all children enrolled in the weight management program from 1999 to 2009 and who completed exercise testing were collected. Demographic and public record collection included body habitus, death records, real estate transactions, and criminal conviction history with comparisons made to published normative data.

Results:

In the children with obesity studied (N = 716; 12.0 ± 3.1 years old), the now-adult patients (28.5 ± 3.7 years) had a 1.5% mortality rate (11/716). Overall, 9.6% of these adults were convicted of a felony compared to ~7% lifetime prevalence in Ohio (p = 0.03). Also, 14.7% of study patients purchased a home compared to 38.3% of Midwest adults <30 years old (p < 0.0001). Mortality, history of a criminal conviction, or homeownership was associated with any exercise or study parameter.

Conclusion:

Children with obesity appear to have greater social risk than their peers in adulthood with higher rates of criminal behavior and lower rates of homeownership. This appears to highlight the need for treatment in this vulnerable group of children and young adults.

A Cross-Sectional Comparison of Arterial Stiffness and Cognitive Performances in Physically Active Late Pre- and Early Post-Menopausal Females

Menopause accelerates increases in arterial stiffness and decreases cognitive performances. The objective of this study was to compare cognitive performances in physically active pre- and post-menopausal females and their relationship with arterial stiffness. We performed a cross-sectional comparison of blood pressure, carotid−femoral pulse wave velocity (cf-PWV) and cognitive performances between physically active late pre- and early post-menopausal females. Systolic (post-menopause—pre-menopause: +6 mmHg [95% CI −1; +13], p = 0.27; ŋ2 = 0.04) and diastolic (+6 mmHg [95% CI +2; +11], p = 0.06; ŋ2 = 0.12) blood pressures, and cf-PWV (+0.29 m/s [95% CI −1.03; 1.62], p = 0.48; ŋ2 = 0.02) did not differ between groups. Post-menopausal females performed as well as pre-menopausal females on tests evaluating executive functions, episodic memory and processing speed. Group differences were observed on the computerized working memory task. Post-menopausal females had lower accuracy (p = 0.02; ŋ2 = 0.25) but similar reaction time (p = 0.70; ŋ2 < 0.01). Moreover, this performance was inversely associated with the severity of menopausal symptoms (r = −0.38; p = 0.05). These results suggest that arterial stiffness and performance on tests assessing episodic memory and processing speed and executive functions assessing inhibition and switching abilities did not differ between physically active pre- and post-menopausal females. However, post-menopausal females had lower performance on a challenging condition of a working memory task, and this difference in working memory between groups cannot be explained by increased arterial stiffness.

Comparison of Blood Pressure and Vascular Health in Physically Active Late Pre- and Early Postmenopausal Females

PURPOSE

The benefits of exercise on vascular health are inconsistent in postmenopausal females. We investigated if blood pressure and markers of vascular function differ between physically active early post- and late premenopausal females.

METHODS

We performed a cross-sectional comparison of 24-h blood pressure, brachial artery flow-mediated dilation, microvascular reactivity (reactive hyperemia), carotid-femoral pulse wave velocity, and cardiac baroreflex sensitivity between physically active late premenopausal (n = 16, 48 ± 2 yr) and early postmenopausal (n = 14, 53 ± 2 yr) females.

RESULTS

Physical activity level was similar between premenopausal (490 ± 214 min·wk-1) and postmenopausal (550 ± 303 min·wk-1) females (P = 0.868). Brachial artery flow-mediated dilation (pre, 4.6 ± 3.9, vs post, 4.7% ± 2.2%; P = 0.724), 24-h systolic (+5 mm Hg, 95% confidence interval [CI] = -1 to +10, P = 0.972) and diastolic (+4 mm Hg, 95% CI = -1 to +9, P = 0.655) blood pressures, total reactive hyperemia (pre, 1.2 ± 0.5, vs post, 1.0 ± 0.5 mL·mm Hg-1; P = 0.479), carotid-femoral pulse wave velocity (pre, 7.9 ± 1.7, vs post, 8.1 ± 1.8 m·s-1; P = 0.477), and cardiac baroreflex sensitivity (-8 ms·mm Hg-1, 95% CI = -20.55 to 4.62, P = 0.249) did not differ between groups. By contrast, peak reactive hyperemia (-0.36 mL·min-1⋅mm Hg-1, 95% CI = -0.87 to +0.15, P = 0.009) was lower in postmenopausal females.

CONCLUSIONS

These results suggest that blood pressure and markers of vascular function do not differ between physically active late pre- and early postmenopausal females.

The Fontan and the Sea: First-in-Man Data on Swimming and Diving Physiology in Fontan Patients

While swimming represents a popular recreational activity, the immersion of the human body into the water requires a complex physiologic adaption of the whole cardiopulmonary and circulatory system. While this sport is regarded as beneficial, especially in cardiovascular patients, current guidelines hypothesized a possible hazardous effect of swimming and especially diving in patients with univentricular hearts after Fontan palliation. Yet, actual data to underline or contradict these assumptions are lacking. Therefore, this study aimed to conduct a first feasibility study for the evaluation of these effects on Fontan physiology and elucidate the gap of evidence currently preventing patients after Fontan palliation from being restricted from swimming or diving on doctoral advice. Patients recruited from the Heart Center Leipzig, Department of pediatric cardiology, underwent spiroergometry treadmill testing followed by a spiroergometry swimming stress test in a counter current pool. Physiologic data were recorded. A short apnea diving test was performed. The current study found similar physiologic reactions comparing treadmill and swimming exercise stress testing. Heart rate response and oxygen uptake were comparable on land and in the water. This study presents the first-in-man data on swimming and diving in Fontan patients. In this small study cohort of three Fontan patients, there were no adverse events triggered by swimming and breath-hold diving seen. Basically, the physiologic response to exercise was comparable on land and in the water.

Normative cardiopulmonary exercise data for endurance athletes: the Cardiopulmonary Health and Endurance Exercise Registry (CHEER)

AIMS

Accurate interpretation of cardiopulmonary exercise testing (CPET) relies on age, gender, and exercise modality-specific reference values. To date, clinically applicable CPET reference values derived from a source population of endurance athletes (EAs) have been lacking. The purpose of this study was to generate CPET reference values for use in the clinical assessment of EA.

METHODS AND RESULTS

Prospective data accrued during the clinical care of healthy EA were used to derive CPET reference values and to develop novel equations for V˙O2peak. The performance of these equations was compared to the contemporary standard of care equations and assessed in a discrete EA validation cohort. A total of 272 EA (age = 42 ± 15 years, female = 31%, V˙O2peak = 3.6 ± 0.83 L/min) met inclusion criteria and comprised the derivation cohort. V˙O2peak prediction equations derived from general population cohorts described a modest amount of V˙O2peak variability [R2 = 0.58-0.70, root mean square error (RMSE) = 0.46-0.54 L/min] but were mis-calibrated (calibration-in-the-large = 0.45-1.18 L/min) among EA leading to significant V˙O2peak underestimation. Newly derived, externally validated V˙O2peak prediction equations for EA that included age, sex, and height for both treadmill (R2 = 0.74, RMSE = 0.42 L/min) and cycle ergometer CPET (Cycle: R2 = 0.69, RMSE = 0.42 L/min) demonstrated improved accuracy.

CONCLUSION

Commonly used V˙O2peak prediction equations derived from general population cohorts perform poorly among competitive EA. Newly derived CPET reference values including novel V˙O2peak prediction equations may improve the clinical utility of CPET in this rapidly growing patient population.

Reference data on anthropometrics, aerobic fitness and muscle strength in young Norwegian men and women

Purpose

Anthropometrics, aerobic fitness and muscle strength are measured in one-third of all 18-year-old Norwegian men and women during yearly selection for compulsory military service. The large sample size and geographical representativity make these data valuable for reference. The main purpose of this study was to present reference data for anthropometrics and physical fitness in young Norwegian men and women.

Methods

All 154,659 subjects (66% men and 34% women, 17–21 years old) who completed physical examinations at conscript selection from 2011 to 2019 were included in the study. Body mass index (BMI) was calculated from height and weight measurements. Peak oxygen uptake (VO_2peak) was estimated from performance on a maximal treadmill test. Muscle strength was measured by isometric chest and leg press, or seated medicine ball throw, standing long jump and pull-ups.

Results

Mean BMI (SD) was 23.1 (3.4) and 22.9 (3.3) kg·m⁻² in men and women, respectively (P < 0.001), and 24% of men and 21% of women had a BMI ≥ 25 kg·m⁻². Estimated VO_2peak was 52.9 (4.6) and 42.7 (3.9) mL·kg⁻¹·min⁻¹ in men and women, respectively (P < 0.001). Men performed significantly better than women on all muscle strength tests, with corresponding effect sizes varying from 1.14 for isometric leg press to 2.96 for seated medicine ball throw.

Conclusion

The presented reference data on physical fitness in young Norwegian men and women can be used to evaluate population health, serve as reference material for future studies and describes sex differences in several physical fitness parameters.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-021-04784-4.

Validation of a Modified Submaximal Balke Protocol to Assess Cardiorespiratory Fitness in Individuals at High Risk of or With Chronic Health Conditions-A Pilot Study

Objectives: This study aims to validate a submaximal treadmill walking test for estimation of maximal oxygen consumption (VO_2max) in individuals at high risk of or with chronic health conditions. Method: Eighteen participants (age 62 ± 16 years; VO_2max 31.2 ± 5.9 ml kg^-1 min^-1) at high risk of getting or with established chronic diseases performed two valid modified Balke treadmill walking protocols, one submaximal protocol, and one maximal protocol. Test duration, heart rate (HR), and rate of perceived exertion (RPE) were measured during both tests. VO_2max was measured during the maximal test. VO_2max was estimated from the submaximal test by multiple regression using time to RPE ≥ 17, gender, age, and body mass as independent variables. Model fit was reported as explained variance (R ²) and standard error of the estimate (SEE). Results: The model fit for estimation of VO_2max from time to RPE ≥ 17 at the submaximal test, body mass, age, and gender was R ² = 0.78 (SEE = 3.1 ml kg^-1 min^-1, p ≤ 0.001). Including heart rate measurement did not improve the model fit. Conclusions: The submaximal walking test is feasible and valid for assessing cardiorespiratory fitness in individuals with high risk of or chronic health conditions.

Estimation of maximal oxygen uptake from the 3,000 m run in adult men and women

The 3,000 m run is a frequently used field test for evaluating aerobic fitness. The test has previously been validated using smaller sample sizes and with focus restricted to the correlation between run performance and maximal oxygen uptake (V̇O_2max). The aim of the present study was to generate equations for converting 3,000 m performance into predicted V̇O_2max , and present corresponding validity statistics. In total 259 (30 female) military cadets and recruits (18-39 years) participated in the study. The subjects carried out a 3,000 m run and a direct treadmill V̇O_2max test. The Pearson r between V̇O_2max and average 3,000 m run speed were 0.74 and 0.79 in men and women, respectively. Two V̇O_2max prediction equations were generated: (1) Men: Ŷ = 17.5 + 2.57X and (2) Women: Ŷ = 14.6 + 2.48X (X = 3,000 m average run speed in km·h^-1). The equations produced a standard error of estimate of 3.3 and 2.6 mL·kg^-1·min^-1, and limits of agreement of 6.4 and 5.0 mL·kg^-1·min^-1 in men and women, respectively. The validity of the 3,000 m test is comparable to other indirect maximal running tests and is a time-effective alternative aerobic fitness test in healthy and motivated subjects.

Healthy Life Centres: a 3-month behaviour change programme's impact on participants' physical activity levels, aerobic fitness and obesity: an observational study

OBJECTIVES

Individuals with low socioeconomic status and multimorbidity tend to have lower physical activity (PA) levels than the general population. Primary care is an important setting for reaching high-risk individuals to support behaviour change. This study aimed to investigate the impact of behaviour change interventions delivered by Norwegian Healthy Life Centres (HLCs) on participants' PA levels, aerobic fitness and obesity, and furthermore to investigate possible predictors of change.

DESIGN

An observational study with a pre-post design and a 3-month follow-up.

SETTING

Thirty-two HLCs in Norway were included.

PARTICIPANTS

A total of 713 participants (72% of the participants included at baseline), 71% women, with a mean age of 51 (18-87 years) and body mass index (BMI) of 32 (SD 7) met to follow-up.

INTERVENTION

Individual consultations and tailored individual and group-based exercise and courses organised by the HLCs and cooperating providers.

OUTCOME MEASURES

The primary outcome was time spent in moderate to vigorous PA (MVPA, min/day) (ActiGraph GT3X+ accelerometer). The secondary outcomes were light PA (LPA, min/day), number of steps per day, time spent sedentary (SED, min/day), aerobic fitness (submaximal treadmill test, min), BMI (kg/m²) and waist circumference (WC, cm).

RESULTS

There was no change in MVPA (B 1.4, 95% CI -0.4 to 3.1) after 3 months. The participants had improved LPA (4.0, 95% CI 0.5 to 7.5), increased number of steps (362, 95% CI 172 to 552), reduced SED (-5.6, 95% CI -9.8 to -1.3), improved fitness (0.8, 95% CI 0.6 to 1.0), reduced BMI (-0.2, 95% CI -0.1 to -0.3) and reduced WC (-1.7, 95% CI -2.0 to -1.3). Positive predictors of change were number of exercise sessions completed per week, duration of adherence to HLC offers and participation in exercise organised by HLC.

CONCLUSION

Participation in the HLC interventions had small positive impacts on participants' PA levels, aerobic fitness and obesity. Further research to develop effective behaviour change programmes targeting individuals with complex health challenges is needed.

TRIAL REGISTRATION NUMBER

NCT03026296.

Impact and implementation of Healthy Life Centres, a primary-care service intervention for behaviour change in Norway: Study design

Aims: This ongoing study is investigating the implementation and long-term impact of Healthy Life Centres (HLCs), a primary-care service intervention for behaviour change in Norway. The primary aim is to study changes in objectively measured physical activity (PA) levels following a HLC intervention in the short (three months) and long term (15 months). Furthermore, the study is evaluating determinants concerning implementation and adaption of the HLC intervention that influence reach and impact on participants outcomes. Methods: This prospective observational study includes 32 HLCs from four different geographical regions in Norway. Subjects aged ⩾18 years were invited to participate. The study has a pre-post design with a 15-month follow-up. The HLC intervention is a three-month individualised program, containing personal consultations and group-based behaviour-specific courses on PA, diet and smoking cessation. Data collection consists of registration of objectively measured PA level, physical examinations, interviews and questionnaires. In addition, HLC organisation, offers, professions and resources are being examined. The Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework is being applied to study the external validation of the HLC intervention. The study enrolled 1020 participants who gave their written informed consent. Post-tests and follow-up data collection is still ongoing and will continue until August 2019. Conclusions: By exploring the HLC intervention in a real-world setting and addressing the elements of RE-AIM, this study will contribute to an improved understanding and development of effective primary-care behaviour interventions such as the HLC model. The strengths of the study are the large sample size and the many HLCs and regions included.

Physical fitness is a modifiable predictor of early cardiovascular death: A 35-year follow-up study of 2014 healthy middle-aged men

Background

Physical fitness has been shown to predict cardiovascular death during long-term follow-up. In the present study we aimed to investigate how physical fitness and other cardiovascular risk factors at middle-age influenced the risk of cardiovascular death during the early (0–11 years), intermediate (12–23 years) and late (24–35 years) parts of a 35-year observation period.

Methods and results

Age-adjusted physical fitness was calculated in 2014 apparently healthy, middle-aged men after maximal bicycle electrocardiogram-tests in 1972–1975 (Survey 1) and 1979–1982 (Survey 2). The men were assessed through 35 years after Survey 1, and 28 years after Survey 2 by Cox proportional hazards models. Low Survey 1 physical fitness was independently associated with increased risks of early and intermediate, but not late, cardiovascular death. Survey 1 to Survey 2 change in physical fitness, age, smoking status, systolic blood pressure and cholesterol impacted cardiovascular death risks in all periods. Family history of coronary heart disease impacted early and intermediate, but not late, cardiovascular death.

Conclusions

Most classical cardiovascular risk factors were strong predictors of early, intermediate and late cardiovascular death. Physical fitness measured at median age 50 years was independently associated with risk of early cardiovascular death, but the association weakened as time progressed. Change in physical fitness during middle-age impacted cardiovascular death risk in a full lifetime perspective. Thus, our data suggest that physical fitness is a modifiable cardiovascular risk factor with limited duration in contrast to the sustained impact of smoking, blood pressure and cholesterol on cardiovascular mortality.