Associations between physical activity, sedentary behaviour and left ventricular structure and function from the Echocardiographic Study of Latinos (ECHO-SOL)

Echocardiography in the cardiac assessment of young athletes: a 2025 guideline from the British Society of Echocardiography (endorsed by Cardiac Risk in the Young)

Sudden cardiac death in a young physically active individual or athlete is a rare but tragic event. Pre-participation screening and follow-up investigations are utilised to reduce the risk and occurrence of these events. Echocardiography plays a key role in the cardiac diagnostic pathway and aims to identify underlying inherited or congenital structural cardiac conditions. In 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint guidance document to support echocardiographers in this setting. The document was subsequently updated in 2018, and it is now timely to provide a further update to the guideline drawing on the advances in our knowledge alongside the developments in ultrasound technology within this nuanced area of sports cardiology.

Accelerometer-based sedentary time and physical activity from childhood through young adulthood with progressive cardiac changes: a 13-year longitudinal study

AIMS

Longitudinal evidence on the relationship of sedentary time (ST), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) with changes in cardiac structure and function in the paediatric population is scarce. This evidence is clinically important due to the impact ST can have on the long-term prognosis of healthy young population in the lifetime continuum. This prospective observational study examined the relationships of cumulative ST, LPA, and MVPA from childhood with longitudinal changes in cardiac structure and function.

METHODS AND RESULTS

This is a secondary analysis from the Avon Longitudinal Study of Parents and Children, UK birth cohort of 1682 children aged 11 years. Participants who had at least one follow-up timepoints accelerometer-measured ST, LPA, and MVPA over a period of 13 years and repeated echocardiography-measured cardiac structure and function at ages 17- and 24-year clinic visit were included. Left ventricular mass indexed for height2.7 (LVMI2.7) and left ventricular (LV) diastolic function from mitral E/A ratio (LVDF) were computed. Among 1682 children (mean [SD] age, 11.75 [0.24] years; 1054 [62.7%] females), the cumulative one-min/day increase in ST from ages 11 to 24 years was associated with progressively increased LVMI2.7 {effect estimate 0.002 g/m2.7 [confidence interval (CI) 0.001-0.003], P < 0.001}, irrespective of sex, obesity, and hypertensive status. Cumulative one-min/day increase in LPA was associated with a decreased LVMI2.7 (-0.005 g/m2.7 [-0.006 to -0.003], P < 0.0001) but an increased LVDF. Cumulative one-minute/day increase in MVPA was associated with progressively increased LVMI2.7 (0.003 g/m2.7 [0.001-0.006], P = 0.015).

CONCLUSION

ST contributed +40% to the 7-year increase in cardiac mass, MVPA increased cardiac mass by +5%, but LPA reduced cardiac mass by -49%. Increased ST may have long-term pathologic effects on cardiac structure and function during growth from childhood through young adulthood; however, engaging in LPA may enhance cardiac health in the young population.

Accumulating Sedentary Time and Physical Activity From Childhood to Adolescence and Cardiac Function in Adolescence

BACKGROUND

Increased physical activity (PA) may mitigate the negative cardiovascular health effects of sedentary behavior in adolescents. However, the relationship of PA and sedentary time from childhood with cardiac function in adolescence remains underexplored. Therefore, we investigated the associations of cumulative sedentary time and PA from childhood to adolescence with cardiac function in adolescence.

METHODS AND RESULTS

Participants were 153 adolescents (69 girls) who were aged 6 to 8 years at baseline, 8 to 10 years at 2-year follow-up, and 15 to 17 years at 8-year follow-up. Cumulative sedentary time and PA exposure between baseline and 2-year follow-up and between baseline and 8-year follow-up were measured using a combined accelerometer and heart rate monitor. Cardiac function was assessed using impedance cardiography at 8-year follow-up. The data were analyzed using linear regression analyses adjusted for age and sex. Cumulative moderate to vigorous PA (standardized regression coefficient [β]=-0.323 [95% CI, -0.527 to -0.119]) and vigorous PA (β=-0.295 [95% CI, -0.508 to -0.083]) from baseline to 8-year follow-up were inversely associated with cardiac work at 8-year follow-up. Conversely, cumulative sedentary time had a positive association (β=0.245 [95% CI, 0.092-0.398]). Cumulative vigorous PA from baseline to 8-year follow-up was inversely associated with cardiac work index at 8-year follow-up (β=-0.218 [95% CI, -0.436 to 0.000]).

CONCLUSIONS

Higher levels of sedentary time and lower levels of PA during childhood were associated with higher cardiac work in adolescence, highlighting the importance of increasing PA and reducing sedentary time from childhood.

Lifestyle and Cardiac Structure and Function in Healthy Midlife Population

The association between lifestyle and cardiac structure and function measures, such as global longitudinal strain and diastolic function in a healthy midlife general population, is not well known. A subpopulation of the Northern Finland Birth Cohort 1966 took part in follow-up, including echocardiography (n = 1,155) at the age of 46. All antihypertensive medication users (n = 164), patients with diabetes (n = 70), subjects with any cardiac diseases (n = 24), and subjects with echocardiography abnormalities (n = 21) were excluded. Moderate to vigorous physical activity (MVPA) was recorded with a wrist-worn accelerometer over 14 days and categorized into high, moderate, and low MVPA groups. Similarly, alcohol consumption was categorized as low, moderate, and high-dose users of alcohol and smoking as nonsmokers, former, and current smokers. The total number of healthy subjects included in the study was 715 (44% males). Left ventricular mass index and left atrial end-systolic volume index were significantly higher in the high MVPA group compared with the low MVPA group (adjusted main effect p = 0.002 and p <0.001, respectively). Cardiac function did not differ among the physical activity groups. High alcohol consumption was associated with impaired global longitudinal strain and diastolic function (adjusted main effect p = 0.002 and p = 0.004, respectively) but not with any cardiac structure variables. Smoking was not associated with cardiac structure or function. In healthy middle-aged adults, MVPA was independently associated with structural changes in the heart but not with cardiac function. High alcohol consumption was associated with impaired modern cardiac function measures but not with cardiac structure.

Preventing new-onset heart failure: Intervening at stage A

Heart failure (HF) prevention is an urgent public health need with national and global implications. Stage A HF patients do not show HF symptoms or structural heart disease but are at risk of HF development. There are no unique recommendations on detecting Stage A patients. Patients in Stage A are heterogeneous; many patients have different combinations of risk factors and, therefore, have markedly different absolute risks for HF. Comprehensive strategies to prevent HF at Stage A include intensive blood pressure lowering, adequate glycemic and lipid management, and heart-healthy behaviors (adopting Life's Essential 8). First and foremost, it is imperative to improve public awareness of HF risk factors and implement healthy lifestyle choices very early. In addition, recognize the HF risk-enhancing factors, which are nontraditional cardiovascular (CV) risk factors that identify individuals at high risk for HF (genetic susceptibility for HF, atrial fibrillation, chronic kidney disease, chronic liver disease, chronic inflammatory disease, sleep-disordered breathing, adverse pregnancy outcomes, radiation therapy, a history of cardiotoxic chemotherapy exposure, and COVID-19). Early use of biomarkers, imaging markers, and echocardiography (noninvasive measures of subclinical systolic and diastolic dysfunction) may enhance risk prediction among individuals without established CV disease and prevent chemotherapy-induced cardiomyopathy. Efforts are needed to address social determinants of HF risk for primordial HF prevention.Central illustrationPolicies developed by organizations such as the American Heart Association, American College of Cardiology, and the American Diabetes Association to reduce CV disease events must go beyond secondary prevention and encompass primordial and primary prevention.

Associations of accelerometer-based sedentary time, light physical activity and moderate-to-vigorous physical activity with resting cardiac structure and function in adolescents according to sex, fat mass, lean mass, BMI, and hypertensive status

BACKGROUND

This study examined the independent relationships of device-based measured sedentary time (ST) and physical activity (PA) in relation to cardiac structural and functional geometry among adolescents.

METHODS

From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 530 (50% female) adolescents aged 17 years had complete ST, PA, cardiac, and covariate measures. Echocardiography cardiac measures were left ventricular mass indexed for height2.7 (LVMI2.7 ), relative wall thickness, LV diastolic function (LVDF), and LV filling pressure (LVFP). Overweight/obesity and elevated systolic/BP hypertension were categorized as body mass index >24.99 kg/m2 and ≥130 mmHg, respectively. Data were analyzed with linear regression models adjusting for cardiometabolic factors and lifestyle factors.

RESULTS

The prevalence of overweight/obesity in males and females was 17.9% and 24.5%, respectively. The prevalence of elevated systolic BP/hypertension was 11.6% in males and 1.1% among females. The average ST was 484 ± 78 min/day, light PA was 274 ± 62 min/day, and moderate-to-vigorous PA (MVPA) was 41 ± 24 min/day, among females. Average ST, LPA, and MVPA were 468 ± 87 min/day, 293 ± 70 min/day, and 56 ± 30 min/day, respectively, among males. Higher ST was associated with higher LVMI2.7 (standardized β = 0.16; p = 0.01) among females, but higher ST was associated with lower LVDF in males (β = -0.14; p = 0.04). Higher ST and MVPA were associated with higher LVMI2.7 in the total cohort, normal weight, and overweight/obese adolescents. Light PA was associated with higher LVDF in the total cohort and normotensives and lower LVFP among adolescents with high lean mass.

CONCLUSIONS

Higher ST and MVPA were associated with higher LVMI; however, ST-associated LVMI increase was threefold higher than MVPA-associated LVMI increase. Higher LPA was associated with better cardiac function. Reducing ST and increasing LPA may attenuate the risk of altered cardiac structure and function in adolescents.

Accelerometer-Measured Physical Activity Data Sets (Global Physical Activity Data Set Catalogue) That Include Markers of Cardiometabolic Health: Systematic Scoping Review

BACKGROUND

Cardiovascular disease accounts for 17.9 million deaths globally each year. Many research study data sets have been collected to answer questions regarding the relationship between cardiometabolic health and accelerometer-measured physical activity. This scoping review aimed to map the available data sets that have collected accelerometer-measured physical activity and cardiometabolic health markers. These data were then used to inform the development of a publicly available resource, the Global Physical Activity Data set (GPAD) catalogue.

OBJECTIVE

This review aimed to systematically identify data sets that have measured physical activity using accelerometers and cardiometabolic health markers using either an observational or interventional study design.

METHODS

Databases, trial registries, and gray literature (inception until February 2021; updated search from February 2021 to September 2022) were systematically searched to identify studies that analyzed data sets of physical activity and cardiometabolic health outcomes. To be eligible for inclusion, data sets must have measured physical activity using an accelerometric device in adults aged ≥18 years; a sample size >400 participants (unless recruited participants in a low- and middle-income country where a sample size threshold was reduced to 100); used an observational, longitudinal, or trial-based study design; and collected at least 1 cardiometabolic health marker (unless only body mass was measured). Two reviewers screened the search results to identify eligible studies, and from these, the unique names of each data set were recorded, and characteristics about each data set were extracted from several sources.

RESULTS

A total of 17,391 study reports were identified, and after screening, 319 were eligible, with 122 unique data sets in these study reports meeting the review inclusion criteria. Data sets were found in 49 countries across 5 continents, with the most developed in Europe (n=53) and the least in Africa and Oceania (n=4 and n=3, respectively). The most common accelerometric brand and device wear location was Actigraph and the waist, respectively. Height and body mass were the most frequently measured cardiometabolic health markers in the data sets (119/122, 97.5% data sets), followed by blood pressure (82/122, 67.2% data sets). The number of participants in the included data sets ranged from 103,712 to 120. Once the review processes had been completed, the GPAD catalogue was developed to house all the identified data sets.

CONCLUSIONS

This review identified and mapped the contents of data sets from around the world that have collected potentially harmonizable accelerometer-measured physical activity and cardiometabolic health markers. The GPAD catalogue is a web-based open-source resource developed from the results of this review, which aims to facilitate the harmonization of data sets to produce evidence that will reduce the burden of disease from physical inactivity.

The effect of physical activity level on the severity of diastolic dysfunction

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.

The Influence of Special Military Training on Left Ventricular Adaptation to Exercise in Elite Air Force Soldiers

Purpose

The purpose of this study was to observe the influence of level physical training intensity on left ventricular (LV) adaptation in elite air force soldiers compared to regular basic military training.

Methods

The LV adaptation of special military physical training for elite air force soldiers was compared with basic military training for regular troops. A group of the nonmilitary subject was also evaluated as a control group. The presence of LV adaptation was evaluated using some echocardiography parameters, including LV mass index (LVMI), LV ejection fraction (LVEF), global longitudinal strain (GLS), and myocardial work index. The parameters of the myocardial work index include global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE).

Results

Forty-three elite air force soldiers underwent special military training, 43 regular troops underwent basic military training, and 23 nonmilitary subjects as a control group. Age, heart rate, blood pressure, and Cooper test results significantly differed among the three groups. Multivariate analysis among all groups showed that the level of physical training was associated with the LVMI (coefficient β = 6.061; 95% confidence interval [CI] = 1.91-10.22; P = 0.005), LVEF (coefficient β = -1.409; 95% CI = -2.41-[-0.41]; P = 0.006), LVGLS (coefficient β = 1.726; 95% CI = 1.20-2.25; P < 0.001), GWW (coefficient β = -13.875; 95% CI = -20.88-[-6.87]; P < 0.001), GWE (coefficient β = 0.954; 95% CI = 0.62-1.26; P < 0.001), GCW (coefficient β = 176.128; 95% CI = 121.16-231.10; P < 0.001), and GWI (coefficient β = 196.494; 95% CI = 144.61-248.38; P < 0.001).

Conclusions

Higher intensity of physical training observed in a special military training is associated with higher LV GLS, GWE, GCW, GWI, and lower GWW value suggesting greater physiological adaptation than the lower intensity training.