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Christou GA, Christou MA, Davos CH, Markozannes G, Christou KA, Mantzoukas S, Christodoulou DK, Kiortsis DN, Christou PA, Tigas S, Nikoletou D. Ergophysiological evaluation of heart failure patients with reduced ejection fraction undergoing exercise-based cardiac rehabilitation: A systematic review and meta-analysis. Hellenic J Cardiol 2024; 77:106-119. [PMID: 38246276 DOI: 10.1016/j.hjc.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to explore in heart failure (HF) patients with reduced ejection fraction (EF) undergoing exercise-based cardiac rehabilitation the following: 1) the comparison of temporal changes between peak oxygen uptake (VO2peak) and first ventilatory threshold (VO2VT1), 2) the association of VO2peak and VO2VT1 changes with physiological factors, and 3) the differential effects of continuous aerobic exercise (CAE) and interval training (IT) on VO2peak and VO2VT1. METHODS A systematic literature search was conducted in PubMed, CENTRAL, and Scopus. Inclusion criteria were 1) original research articles using exercise-based cardiac rehabilitation, 2) stable HF patients with reduced EF, 3) available values of VO2peak and VO2VT1 (in mL/kg/min) both at baseline and after exercise training with comparison between these time points. RESULTS Among the 30 eligible trials, 24 used CAE, 5 IT, and one CAE and IT. Multivariable meta-regression with duration of exercise training and percentage of males as independent variables and the change in VO2peak as a dependent variable showed that the change in VO2peak was negatively associated with duration of exercise training (coefficient=-0.061, p=0.027), implying the possible existence of a waning effect of exercise training on VO2peak in the long term. Multivariable meta-regression demonstrated that both age (coefficient=-0.140, p<0.001) and EF (coefficient=-0.149, p<0.001) could predict the change in VO2VT1, whereas only age (coefficient=-0.095, p=0.022), but not EF (coefficient = 0.082, p = 0.100), could predict the change in VO2peak. The posttraining peak respiratory exchange ratio, as an index of maximum effort during exercise testing, correlated positively with the change in VO2peak (coefficient=-0.021, p=0.044). The exercise-induced changes of VO2peak (p = 0.438) and VO2VT1 (p = 0.474) did not differ between CAE and IT groups. CONCLUSIONS Improvement of endurance capacity during cardiac rehabilitation may be detected more accurately with the assessment of VO2VT1 rather than VO2peak.
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Affiliation(s)
- Georgios A Christou
- Laboratory of Physiology, Faculty of Medicine, University of Ioannina, Ioannina, Greece; MSc Sports Cardiology, St George's University of London, London, United Kingdom.
| | - Maria A Christou
- Department of Endocrinology, University Hospital of Ioannina, Ioannina, Greece; Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos A Christou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Stefanos Mantzoukas
- Research Laboratory of Integrated Care, Health and Well-being, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Research Laboratory of Integrated Care, Health and Well-being, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios N Kiortsis
- Atherothrombosis Research Centre, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Stelios Tigas
- Department of Endocrinology, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitra Nikoletou
- MSc Sports Cardiology, St George's University of London, London, United Kingdom
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Marinus N, Cornelissen V, Meesen R, Coninx K, Hansen D. Are exercise prescriptions for patients with cardiovascular disease, made by physiotherapists, in agreement with European recommendations? Eur J Cardiovasc Nurs 2024; 23:230-240. [PMID: 37439451 DOI: 10.1093/eurjcn/zvad065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
AIMS Physiotherapists often treat patients with (elevated risk for) cardiovascular disease (CVD), and should thus be able to provide evidence-based exercise advice to these patients. This study, therefore, aims to examine whether exercise prescriptions by physiotherapists to patients with CVD are in accordance with European recommendations. METHODS AND RESULTS This prospective observational survey included forty-seven Belgian physiotherapists. The participants agreed to prescribe exercise intensity, frequency, session duration, program duration, and exercise type (endurance or strength training) for the same three patient cases. Exercise prescriptions were compared between physiotherapists and relations with their characteristics were studied. The agreement between physiotherapists' exercise prescriptions and those from European recommendations ('agreement score': based on a maximal score of 60/per case) was assessed. A wide inter-clinician variability was noticed for all exercise modalities, leading to a large variance for total peak-effort training minutes (from 461 up to 9000 over the three cases). The exercise frequency was prescribed fully out of range of the recommendations and the prescription of additional exercise modes was generally flawed. Exercise intensity and program duration were prescribed partially correct. The addition of strength exercises and session duration was prescribed correctly. This led to physiotherapist agreement scores of 25.3 ± 9.6, 23.2 ± 9.9, and 27.1 ± 10.6 (all out of 60), for cases one, two, and three, respectively. A greater agreement score was found in younger colleagues and those holding a Ph.D. CONCLUSION Exercise prescriptions for CVD patients vary widely among physiotherapists and often disagree with European recommendations. REGISTRATION ClinicalTrials.gov NCT05449652.
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Affiliation(s)
- Nastasia Marinus
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, 3000 Leuven, Belgium
| | - Raf Meesen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- Faculty of Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Dominique Hansen
- Faculty of Rehabilitation Sciences and Physiotherapy, Hasselt University, Agoralaan Building A, 3590 Diepenbeek, Belgium
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Lakušić N, Sopek Merkaš I. Quo vadis cardiac rehabilitation; the role of comprehensive cardiac rehabilitation in modern cardiology. World J Cardiol 2023; 15:627-632. [PMID: 38173904 PMCID: PMC10758603 DOI: 10.4330/wjc.v15.i12.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023] Open
Abstract
In accordance with the guidelines established by prominent European and global cardiology associations, comprehensive cardiac rehabilitation (CR) stands as an officially endorsed and highly recommended therapeutic approach (class I recommendations; level of evidence A) for a diverse spectrum of cardiac patients. Nevertheless, it is a cause for concern to observe that fewer than 50% of eligible patients are being effectively referred for CR, whether in an outpatient or inpatient setting. Concurrently, studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors, including hypertension, lipid levels, and diabetes. Beyond the conventional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention, as well as patients who have undergone coronary or valvular surgery, contemporary CR now emphasizes specialized subgroups of patients. These include frail elderly patients, the female population with its unique considerations, individuals burdened by multiple cardiovascular comorbidities, those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure. This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.
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Affiliation(s)
- Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia.
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Hansen D, Coninx K, Beckers P, Cornelissen V, Kouidi E, Neunhauserer D, Niebauer J, Spruit MA, Takken T, Dendale P. Appropriate exercise prescription in primary and secondary prevention of cardiovascular disease: why this skill remains to be improved among clinicians and healthcare professionals. A call for action from the EXPERT Network†. Eur J Prev Cardiol 2023; 30:1986-1995. [PMID: 37458001 DOI: 10.1093/eurjpc/zwad232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
In Europe alone, on a yearly basis, millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynamic moderate-intensity resistance exercise 2 days/week). However, recent evidence shows that this one size does not fit all and that individual adjustments should be made according to the patient's underlying disease(s), risk profile, and individual needs, to maximize the clinical benefits of exercise. In this paper, we (i) argue that this general exercise prescription simply provided to all patients with CVD, or elevated risk for CVD, is insufficient for optimal CVD prevention, and (ii) show that clinicians and healthcare professionals perform heterogeneously when asked to adjust exercise characteristics (e.g. intensity, volume, and type) according to the patient's condition, thereby leading to suboptimal CVD risk factor control. Since exercise training is a class 1A intervention in the primary and secondary prevention of CVD, the awareness of the need to improve exercise prescription has to be raised among clinicians and healthcare professionals if optimized prevention of CVD is ambitioned.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
| | - Karin Coninx
- UHasselt, Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Hasselt, Belgium
| | - Paul Beckers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp Hasselt, Belgium
| | - Véronique Cornelissen
- Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Neunhauserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Rehab-Center Salzburg, Ludwig Boltzmann Institute for digital Health and Prevention, Salzburg, Austria
| | - Martijn A Spruit
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre), Hasselt University, Hasselt, Belgium
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Hansen D, Marinus N, Cornelissen V, Ramakers W, Coninx K. Exercise prescription by physiotherapists to patients with cardiovascular disease is in greater agreement with European recommendations after using the EXPERT training tool. MEDICAL EDUCATION ONLINE 2023; 28:2182660. [PMID: 36853878 PMCID: PMC9980021 DOI: 10.1080/10872981.2023.2182660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/02/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement. AIM To assess whether exercise prescriptions by physiotherapists to patients with CVD are better in agreement with European (ESC/EAPC) recommendations when the EXPERT (EXercise Prescription in Everyday practice & Rehabilitative Training) Training tool is used for digital educational training. DESIGN In a prospective non-randomized intervention study. METHODS Twenty-three belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a one-month digital training by using the EXPERT Training tool and completed 31 ± 13 training cases. The EXPERT tool is a training and decision support system that automatically generates a (personalised) exercise prescription according to the patient's characteristics, thus integrating the exercise prescriptions for different CVDs and risk factors, all based on ESC/EAPC recommendations. Thereafter, the same three patient cases as at entry of study were filled out again, with re-assessment of level of agreement with ESC/EAPC recommendations. RESULTS After using the EXPERT Training tool, the physiotherapists prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p < 0.05). In cases 1, 2 and 3, the agreement score increased from 29 ± 9 (out of 60), 28 ± 9, and 34 ± 7 to 41 ± 9, 41 ± 10, and 45 ± 8, respectively (p < 0.001). Hence, the total agreement score increased from 91 ± 17 (out of 180) to 127 ± 19 (p < 0.001, +44 ± 32%). A lower starting agreement score and younger age correlated with a greater improvement in total agreement score (p < 0.05). CONCLUSIONS Exercise prescriptions to patients with CVD, generated by physiotherapists, are significantly better in agreement with European recommendations when the EXPERT Training tool is used, indicating its educational potential.
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Affiliation(s)
- Dominique Hansen
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Nastasia Marinus
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Véronique Cornelissen
- Research Group of Rehabilitation for Internal Disorders, University of Leuven, Leuven, Belgium
| | - Wim Ramakers
- Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| | - Karin Coninx
- Human-Computer Interaction and eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
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Venna A, Deshpande S, Downing T, John A, d'Udekem Y. Are dynamic measurements of central venous pressure in Fontan circulation during exercise or volume loading superior to resting measurements? Cardiol Young 2023:1-12. [PMID: 37981897 DOI: 10.1017/s1047951123003797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND The main objective measure to assess the health of the Fontan circulation is the pressure measurement of the superior vena cava or pulmonary arteries. We reviewed the literature for benefits of measuring resting pressure in the Fontan circuit and explored whether dynamic measurement by volume loading or exercise has the potential to refine this diagnostic tool. METHODS PubMed was searched for articles showing a relationship between resting post-operative central venous pressure or pulmonary artery pressure and Fontan failure. Relationships between post-operative central venous pressure or pulmonary artery pressure and volume loading changes, such as during exercise or volume loading during cardiac catheterization, were also queried. RESULTS A total of 44 articles mentioned relationships between resting central venous pressure or pulmonary artery pressure and Fontan failure. Only 26 included an analysis between the variables and only seven of those articles found pressure to be predictive of Fontan failure. Ten articles examined the relationship between exercise or volume loading and outcomes and demonstrated a large individual variation of pressures under these dynamic conditions. CONCLUSIONS Based on current literature, there is not a lot of strong evidence to show that elevated resting central venous pressure or pulmonary artery pressure is predictive of Fontan failure. Some individuals experience dramatic increases in central venous pressure or pulmonary artery pressure under increased loading conditions with exercise or bolus fluid infusion, while others experience increases closer to that of a healthy control population. Further studies are needed to examine whether more dynamic and continuous monitoring of systemic venous pressures might better predict outcomes in patients with Fontan circulation.
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Affiliation(s)
- Alyssia Venna
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
| | | | - Tacy Downing
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Anitha John
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC, USA
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Hansen D, Beckers P, Neunhäuserer D, Bjarnason-Wehrens B, Piepoli MF, Rauch B, Völler H, Corrà U, Garcia-Porrero E, Schmid JP, Lamotte M, Doherty P, Reibis R, Niebauer J, Dendale P, Davos CH, Kouidi E, Spruit MA, Vanhees L, Cornelissen V, Edelmann F, Barna O, Stettler C, Tonoli C, Greco E, Pedretti R, Abreu A, Ambrosetti M, Braga SS, Bussotti M, Faggiano P, Takken T, Vigorito C, Schwaab B, Coninx K. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 2023; 53:2013-2037. [PMID: 37648876 DOI: 10.1007/s40279-023-01909-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.
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Affiliation(s)
- Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium.
| | - Paul Beckers
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
- Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium
| | - Daniel Neunhäuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | - Massimo F Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany
| | - Heinz Völler
- Department of Cardiology, Klinik am See, Rüdersdorf, Germany
- Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany
| | - Ugo Corrà
- Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy
| | | | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland
| | | | | | - Rona Reibis
- Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Martijn A Spruit
- UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium
- Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Luc Vanhees
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Véronique Cornelissen
- Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department Rehabilitation Sciences, University Leuven, Leuven, Belgium
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Olga Barna
- Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine
| | - Christoph Stettler
- Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland
| | - Cajsa Tonoli
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | | | - Ana Abreu
- Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy
| | | | - Maurizio Bussotti
- Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy
| | | | - Tim Takken
- Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy
| | - Bernhard Schwaab
- Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany
| | - Karin Coninx
- UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium
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Edwards JJ, Deenmamode AHP, Griffiths M, Arnold O, Cooper NJ, Wiles JD, O'Driscoll JM. Exercise training and resting blood pressure: a large-scale pairwise and network meta-analysis of randomised controlled trials. Br J Sports Med 2023; 57:1317-1326. [PMID: 37491419 DOI: 10.1136/bjsports-2022-106503] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To perform a large-scale pairwise and network meta-analysis on the effects of all relevant exercise training modes on resting blood pressure to establish optimal antihypertensive exercise prescription practices. DESIGN Systematic review and network meta-analysis. DATA SOURCES PubMed (Medline), the Cochrane library and Web of Science were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1990 and February 2023. All relevant work reporting reductions in systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) following an exercise intervention of ≥2 weeks, with an eligible non-intervention control group, were included. RESULTS 270 randomised controlled trials were ultimately included in the final analysis, with a pooled sample size of 15 827 participants. Pairwise analyses demonstrated significant reductions in resting SBP and DBP following aerobic exercise training (-4.49/-2.53 mm Hg, p<0.001), dynamic resistance training (-4.55/-3.04 mm Hg, p<0.001), combined training (-6.04/-2.54 mm Hg, p<0.001), high-intensity interval training (-4.08/-2.50 mm Hg, p<0.001) and isometric exercise training (-8.24/-4.00 mm Hg, p<0.001). As shown in the network meta-analysis, the rank order of effectiveness based on the surface under the cumulative ranking curve (SUCRA) values for SBP were isometric exercise training (SUCRA: 98.3%), combined training (75.7%), dynamic resistance training (46.1%), aerobic exercise training (40.5%) and high-intensity interval training (39.4%). Secondary network meta-analyses revealed isometric wall squat and running as the most effective submodes for reducing SBP (90.4%) and DBP (91.3%), respectively. CONCLUSION Various exercise training modes improve resting blood pressure, particularly isometric exercise. The results of this analysis should inform future exercise guideline recommendations for the prevention and treatment of arterial hypertension.
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Affiliation(s)
- Jamie J Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Algis H P Deenmamode
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Megan Griffiths
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Oliver Arnold
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Nicola J Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jonathan D Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Jamie M O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, Kent, UK
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Ruzzolini M, Ambrosetti M. Cardiopulmonary exercise testing in cardiac rehabilitation: From the reporting form to structured exercise prescription. A proposal from the Italian alliance for cardiovascular rehabilitation and prevention (Itacare-P). INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200191. [PMID: 37455787 PMCID: PMC10344646 DOI: 10.1016/j.ijcrp.2023.200191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
The cardiopulmonary exercise test (CPET) is the gold standard for the diagnostic evaluation of exercise intolerance, as for individualized prescription of structured physical training. Exercise is a core component of cardiovascular prevention and rehabilitation activites, but unfortunately the limited availability of CPET-derived informations often leads to unpowered program's prescription in real life. The Italian Alliance for Cardiovascular Rehabilitation and Prevention (ITACARE-P) has developed a CPET reporting form specifically oriented to exercise prescription, in order to facilitate interventions on lifestyle and during phase II/phase III cardiac rehabilitation programmes. The ITACARE-P CPET reporting form includes a limited number of key variables for clinical practice and individual domains of exercise intensity, suitable both for threshold-based and range-based aerobic training protocols. The adoption of the ITACARE-P CPET reporting form could improve non-pharmacological intervention in preventive cardioloy and facilitate collaborative research on physical training within the network of cardiac rehabilitation facilities.
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Affiliation(s)
- Matteo Ruzzolini
- Cardiology Division, Fatebenefratelli-Isola Tiberina Hospital, Rome, Italy
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
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10
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Bletsa E, Oikonomou E, Dimitriadis K, Stampouloglou PK, Fragoulis C, Lontou SP, Korakas E, Beneki E, Kalogeras K, Lambadiari V, Tsioufis K, Vavouranakis M, Siasos G. Exercise Effects on Left Ventricular Remodeling in Patients with Cardiometabolic Risk Factors. Life (Basel) 2023; 13:1742. [PMID: 37629599 PMCID: PMC10456116 DOI: 10.3390/life13081742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Left ventricular (LV) remodeling is a dynamic process, which is characterized by changes in ventricular size, shape, and wall thickness, thus altering myocardial geometry and function, and is considered as a negative prognostic factor in patients with heart failure (HF). Hypertension, type 2 diabetes (T2D), and obesity are strongly correlated with the development and the progression of LV remodeling, LV hypertrophy, and LV systolic and/or diastolic dysfunction. Indeed, the beneficial impact of exercise training on primary and secondary prevention of cardiovascular disease (CVD) has been well-established. Recent studies have highlighted that exercise training enhances functional capacity, muscle strength and endurance, cardiac function, and cardiac-related biomarkers among patients with established coronary artery disease (CAD) or HF, thus substantially improving their cardiovascular prognosis, survival rates, and need for rehospitalization. Therefore, in this review article, we discuss the evidence of LV remodeling in patients with cardiometabolic risk factors, such as hypertension, T2D, and obesity, and also highlight the current studies evaluating the effect of exercise training on LV remodeling in these patients.
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Affiliation(s)
- Evanthia Bletsa
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
| | - Kyriakos Dimitriadis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Panagiota K. Stampouloglou
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Christos Fragoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Stavroula P. Lontou
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Emmanouil Korakas
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Eirini Beneki
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
| | - Konstantinos Kalogeras
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Vaia Lambadiari
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
- 2nd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 12462 Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece; (K.D.); (C.F.); (E.B.); (K.T.)
- Heart and Diabetes Center, National and Kapodistrian University of Athens, Medical School, Hippokrateion General Hospital, 11527 Athens, Greece;
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.B.); (P.K.S.); (K.K.); (M.V.); (G.S.)
- Cardiometabolic Disease Unit, 3rd Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, 11527 Athens, Greece; (E.K.); (V.L.)
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11
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De Wilde C, Bekhuis Y, Kuznetsova T, Claes J, Claessen G, Coninx K, Decorte E, De Smedt D, Hansen D, Lannoo M, Van Craenenbroeck EM, Verhaeghe N, Cornelissen VA. Personalized remotely guided preventive exercise therapy for a healthy heart (PRIORITY): protocol for an assessor-blinded, multicenter randomized controlled trial. Front Cardiovasc Med 2023; 10:1194693. [PMID: 37456813 PMCID: PMC10339344 DOI: 10.3389/fcvm.2023.1194693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Aims A key treatment for patients with varying stages of heart failure with preserved ejection fraction (HFpEF) is exercise. Yet, despite a Class 1A recommendation, only one-third of patients exercise sufficiently. A huge treatment gap exists between guidelines and clinical practice. PRIORITY aims to establish the feasibility, clinical effectiveness and cost-effectiveness of a hybrid centre and home-based personalized exercise and physical activity intervention for patients along the HFpEF continuum. Methods An assessor-blinded, multicenter randomized controlled trial will be conducted among 312 patients along the HFpEF continuum. Participants will be randomized (1:1) to the PRIORITY intervention or a comparator group receiving only a written exercise prescription. Participants in the PRIORITY group will receive 18 supervised centre-based exercise sessions during one year, supplemented with a remotely guided home-based physical activity program. Outcomes will be assessed at baseline, 4 months, one and two years. The primary outcome is the peak oxygen uptake (pVO2) at 1-year. Secondary outcomes include physical activity, other physical fitness parameters, cardiovascular health, echocardiographic parameters, health-related quality of life and costs at 1-year FU. Machine learning algorithms will analyse big data on physical activity collected during the 1-year intervention to develop models that can predict physical activity uptake and adherence as well as changes in fitness and health. A cost-utility analysis will be performed to evaluate the cost-effectiveness of the PRIORITY intervention compared to the control condition. Discussion We anticipate that participants in the supervised home-based exercise intervention group will have a greater increase in pVO2 compared to those receiving a written exercise prescription. Trial registration number This trial is registered at ClinicalTrials.gov (NCT04745013) and is currently in the recruitment stage.
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Affiliation(s)
- Camille De Wilde
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Youri Bekhuis
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
- REVAL—Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Karin Coninx
- HCI And eHealth, Faculty of Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elise Decorte
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research, Ghent University, Ghent, Belgium
| | - Dominique Hansen
- REVAL—Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Matthias Lannoo
- Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium
| | - Emeline M. Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research, Ghent University, Ghent, Belgium
- Department of Public Health, Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Véronique A. Cornelissen
- Research Group of Rehabilitation of Internal Disorders, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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12
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Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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13
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Lăcraru AE, Busnatu ȘS, Pană MA, Olteanu G, Șerbănoiu L, Gand K, Schlieter H, Kyriazakos S, Ceban O, Andrei CL, Sinescu CJ. Assessing the Efficacy of a Virtual Assistant in the Remote Cardiac Rehabilitation of Heart Failure and Ischemic Heart Disease Patients: Case-Control Study of Romanian Adult Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3937. [PMID: 36900948 PMCID: PMC10002163 DOI: 10.3390/ijerph20053937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality in Europe, with potentially more than 60 million deaths per year, with an age-standardized rate of morbidity-mortality higher in men than women, exceeding deaths from cancer. Heart attacks and strokes account for more than four out of every five CVD fatalities globally. After a patient overcomes an acute cardiovascular event, they are referred for rehabilitation to help them to restore most of their normal cardiac functions. One effective way to provide this activity regimen is via virtual models or telerehabilitation, where the patient can avail themselves of the rehabilitation services from the comfort of their homes at designated timings. Under the funding of the European Union's Horizon 2020 Research and Innovation program, grant no 769807, a virtual rehabilitation assistant has been designed for elderly patients (vCare), with the overall objective of supporting recovery and an active life at home, enhancing patients' quality of life, lowering disease-specific risk factors, and ensuring better adherence to a home rehabilitation program. In the vCare project, the Carol Davila University of Bucharest (UMFCD) was in charge of the heart failure (HF) and ischemic heart disease (IHD) groups of patients. By creating a digital environment at patients' homes, the vCare system's effectiveness, use, and feasibility was evaluated. A total of 30 heart failure patients and 20 ischemic heart disease patients were included in the study. Despite the COVID-19 restrictions and a few technical difficulties, HF and IHD patients who performed cardiac rehabilitation using the vCare system had similar results compared to the ambulatory group, and better results compared to the control group.
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Affiliation(s)
- Andreea-Elena Lăcraru
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Ștefan-Sebastian Busnatu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Maria-Alexandra Pană
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Gabriel Olteanu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Liviu Șerbănoiu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Kai Gand
- Research Group Digital Health, Faculty of Business and Economics, Technische Universitat Dresden, 01062 Dresden, Germany
| | - Hannes Schlieter
- Research Group Digital Health, Faculty of Business and Economics, Technische Universitat Dresden, 01062 Dresden, Germany
| | - Sofoklis Kyriazakos
- Department of Business Development and Technology, Aarhus University, 7400 Aarhus, Denmark
| | - Octavian Ceban
- Economic Cybernetics and Informatics Department, University of Economic Studies, 010374 Bucharest, Romania
| | - Cătălina Liliana Andrei
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
| | - Crina-Julieta Sinescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 050474 Bucharest, Romania
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14
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Wu C, Li X, Zhao H, Ling Y, Ying Y, He Y, Zhang S, Liang S, Wei J, Gan X. Resistance exercise promotes the resolution and recanalization of deep venous thrombosis in a mouse model via SIRT1 upregulation. BMC Cardiovasc Disord 2023; 23:18. [PMID: 36639616 PMCID: PMC9837998 DOI: 10.1186/s12872-022-02908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Early exercise for acute deep venous thrombosis (DVT) improves the patient's symptoms and does not increase the risk of pulmonary embolism. However, information about its effect on thrombus resolution is limited. The aim of this study was to investigate the role of resistance exercise (RE) in thrombus resolution and recanalization and determine its underlying mechanisms. METHODS: Ninety-six C57BL/6 J mice were randomly divided into four groups: Control group (C, n = 24); DVT group (D, n = 24); RE + DVT group (ED, n = 24); and inhibitor + RE + DVT group (IED, n = 24). A DVT model was induced by stenosis of the inferior vena cava (IVC). After undergoing IVC ultrasound within 24 h post-operation to confirm DVT formation, mice without thrombosis were excluded. Other mice were sacrificed and specimens were obtained 14 or 28 days after operation. Thrombus-containing IVC was weighed, and the thrombus area and recanalization rate were calculated using HE staining. Masson's trichrome staining was used to analyze the collagen content. RT-PCR and ELISA were performed to examine IL-6, TNF-α, IL-10, and VEGF expression levels. SIRT1 expression was assessed using immunohistochemistry staining and RT-PCR. VEGF-A protein expression and CD-31-positive microvascular density (MVD) in the thrombus were observed using immunohistochemistry. RESULTS: RE did not increase the incidence of pulmonary embolism. It reduced the weight and size of the thrombus and the collagen content. Conversely, it increased the recanalization rate. It also decreased the levels of the pro-inflammatory factors IL-6 and TNF-α and increased the expression levels of the anti-inflammatory factor IL-10. RE enhanced VEGF and SIRT1 expression levels and increased the MVD in the thrombosis area. After EX527 (SIRT1 inhibitor) was applied, the positive effects of exercise were suppressed. CONCLUSIONS RE can inhibit inflammatory responses, reduce collagen deposition, and increase angiogenesis in DVT mice, thereby promoting thrombus resolution and recanalization. Its underlying mechanism may be associated with the upregulation of SIRT1 expression.
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Affiliation(s)
- Caijiao Wu
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xiaorong Li
- grid.412594.f0000 0004 1757 2961Department of Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Huihan Zhao
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Ying Ling
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Yanping Ying
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Yu He
- grid.412594.f0000 0004 1757 2961Medical Lab, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Shaohan Zhang
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Shijing Liang
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Jiani Wei
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
| | - Xiao Gan
- grid.412594.f0000 0004 1757 2961Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021 Guangxi China
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15
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Edwards J, Shanmugam N, Ray R, Jouhra F, Mancio J, Wiles J, Marciniak A, Sharma R, O’Driscoll J. Exercise Mode in Heart Failure: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2023; 9:3. [PMID: 36622511 PMCID: PMC9829948 DOI: 10.1186/s40798-022-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Optimising exercise prescription in heart failure (HF) with a preserved (HFpEF) or reduced (HFrEF) ejection fraction is clinically important. As such, the aim of this meta-analysis was to compare traditional moderate intensity training (MIT) against combined aerobic and resistance training (CT) and high-intensity interval training (HIIT) for improving aerobic capacity (VO2), as well as other clinically relevant parameters. METHODS A comprehensive systematic search was performed to identify randomised controlled trials published between 1990 and May 2021. Research trials reporting the effects of MIT against CT or HIIT on peak VO2 in HFpEF or HFrEF were considered. Left-ventricular ejection fraction (LVEF) and various markers of diastolic function were also analysed. RESULTS Seventeen studies were included in the final analysis, 4 of which compared MIT against CT and 13 compared MIT against HIIT. There were no significant differences between MIT and CT for peak VO2 (weighted mean difference [WMD]: 0.521 ml min-1 kg-1, [95% CI] = - 0.7 to 1.8, Pfixed = 0.412) or LVEF (WMD: - 1.129%, [95% CI] = - 3.8 to 1.5, Pfixed = 0.408). However, HIIT was significantly more effective than MIT at improving peak VO2 (WMD: 1.62 ml min-1 kg-1, [95% CI] = 0.6-2.6, Prandom = 0.002) and LVEF (WMD: 3.24%, [95% CI] = 1.7-4.8, Prandom < 0.001) in HF patients. When dichotomized by HF phenotype, HIIT remained significantly more effective than MIT in all analyses except for peak VO2 in HFpEF. CONCLUSIONS HIIT is significantly more effective than MIT for improving peak VO2 and LVEF in HF patients. With the exception of peak VO2 in HFpEF, these findings remain consistent in both phenotypes. Separately, there is no difference in peak VO2 and LVEF change following MIT or CT, suggesting that the addition of resistance exercise does not inhibit aerobic adaptations in HF.
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Affiliation(s)
- Jamie Edwards
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Nesan Shanmugam
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Robin Ray
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Fadi Jouhra
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jennifer Mancio
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jonathan Wiles
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Anna Marciniak
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Rajan Sharma
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jamie O’Driscoll
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK ,grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
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16
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Guan R, Li H, Jiao Y, Yu H. A nonrandomized controlled trial of individualized exercise prescription combined with remote exercise management in patients who are overweight or obese. BMC Sports Sci Med Rehabil 2022; 14:99. [PMID: 35655279 PMCID: PMC9161188 DOI: 10.1186/s13102-022-00479-1] [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] [Received: 06/27/2021] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Between 2012 and 2020, the obesity rate increased among Chinese people aged 18 years and above, along with blood pressure, fasting blood glucose, serum total cholesterol, and triglycerides. Purpose Our objective was to compare the effects of a combined intervention, including individualized exercise prescription plus remote management versus individualized exercise prescription only, on cardiovascular risk factors in patients who are overweight or obese, with the aim of establishing a more effective remote model of health management than self-management. Methods This nonrandomized controlled trial (ChiCTR2100046307) studied patients who are overweight or obese at model labor health management centers from January 2019 to December 2019, including 55 people in the experimental group and 34 in the control group. The relevant indexes of all the research objects from both experimental group and control group were examined. Participants in the experimental group were given individualized exercise prescription combined with remote exercise management over a period of 3 months. The control group was prescribed exercise only at time of enrollment and taught about exercise once, followed by voluntary exercise and self-management for 3 months. Result After adjusting for baseline differences, the changes in weight (−2.72 ± 4.03 kg versus 0.32 ± 2.50 kg, P < 0.0001), body mass index (−0.99 ± 1.44 kg/m2 versus 0.11 ± 0.92 kg/m2, P < 0.0001), waist circumference (−2.98 ± 6.29 cm versus 0.60 ± 5.33 cm, P < 0.0001), visceral fat area (−9.75 ± 19.68 cm2 versus −1.31 ± 12.37 cm2, P = 0.028), body fat (− 2.65 ± 3.52 kg versus 0.54 ± 2.67 kg, P < 0.0001), body fat rate (−2.50 ± 3.32% versus 0.21 ± 3.30%, P < 0.0001), uric acid (−9.75 ± 19.68 µmol/L versus −1.31 ± 12.37 µmol/L, P = 0.028), serum total cholesterol (−0.11 ± 0.40 mmol/L versus −0.11 ± 0.59 mmol/L, P = 0.004), fasting insulin (− 2.36 ± 5.20 μU/mL versus 1.22 ± 7.34 μU/mL, P = 0.009), and homeostatic model assessment of insulin resistance (−0.62 ± 1.25 versus 0.14 ± 1.83, P = 0.022) were significantly better in the experimental group than in the control group after intervention. Conclusion Individualized exercise prescription combined with remote management in patients who are obese or overweight facilitated weight and fat loss, lowered blood pressure and serum total cholesterol, improved glucose metabolism and insulin resistance, and reduced cardiovascular risk factors. The intervention was superior to conventional education in terms of weight loss, fat reduction, total cholesterol reduction, fasting insulin reduction, and amelioration of insulin resistance.
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Affiliation(s)
- Rui Guan
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing, 100144, China
| | - Haijing Li
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing, 100144, China
| | - Yang Jiao
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing, 100144, China.
| | - Hong Yu
- Department of Health Management, Beijing Rehabilitation Hospital, Capital Medical University, Xixiazhuang, Badachu, Shijingshan District, Beijing, 100144, China.
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Freitas Gonçalves KS, Queiroz Godoy Daniel AC, Tatagiba Lamas JL, Oliveira HC, Cloutier L, De Campos Pereira Silveira RC, Veiga EV. Device and nondevice‐guided slow breathing to reduce blood pressure in hypertensive patients: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e636. [PMID: 35601033 PMCID: PMC9110782 DOI: 10.1002/hsr2.636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/09/2022] Open
Abstract
Backgroud and Aims Hypertension (HTN) is a multifactorial chronic disease. Considering the high prevalence rates of this disease, treatment of HTN is necessary, not only to reduce blood pressure (BP) levels but also to prevent the development of cardiovascular, cerebrovascular, and kidney diseases. This treatment can be through medication, which will be determined according to the BP values, obtained either in medical consultations or at home; presence of cardiovascular risk factors, and the presence of target organ damage identified during anamnesis. The aim of this systematic review and meta‐analysis is to summarize the effects of device‐guided slow breathing (DGSB) and nondevice‐guided slow breathing (NDGSB) on BP levels of patients with HTN. Methods This study is a systematic review and meta‐analysis of randomized clinical trials, pertaining to hypertensive patients, with or without comorbidity, over 18 years old, of both sexes, and with or without hypertensive medication. The selected studies showed comparisons between groups that performed DGSB and/or NDGSB with control conditions. The primary outcome was the value of systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the interventions. Results Twenty‐two studies involving 17,214 participants were included in the quantitative analysis. Considerable heterogeneity was revealed between studies. Using random effect model, it was found that DGSB did not significantly reduce SBP and DBP compared to usual care, both in terms BP values and in relation to their variations (SBP, mean difference [MD]: −2.13 mmHg, (95% confidence interval [CI]: −12.71 to 8.44), 288 individuals; I2 = 93%, high heterogenity: DBP, MD: −0.90, 95% CI: −3.97 to 2.11, 288 individuals; I2 = 63%, substantial heterogenity. SBP variations MD: −2.42, 95% CI: −7.24 to 2.40, 443 individuals; I2 = 85% high heterogenity/DBP variations MD: −1.67, 95% CI: −4.57 to 1.24, 443 individuals; I2 = 80%, high heterogenity). Conclusion Based on these results it appears that DGSB did not reduce BP in hypertensive patients and NDGSB is a new path for the future.
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Affiliation(s)
- Kamila S. Freitas Gonçalves
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
| | - Ana C. Queiroz Godoy Daniel
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
| | | | | | - Lyne Cloutier
- Department of Nursing Université du Québec à Trois‐Rivières Québec Canada
| | | | - Eugenia V. Veiga
- WHO Collaborating Centre for Nursing Research Development, College of Nursing University of São Paulo Ribeirão Preto Brazil
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18
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Artificial Intelligence (AI) and Data-Driven Rehabilitation: The next frontier in the management of cardiometabolic disorders. Arch Phys Med Rehabil 2022; 103:1693-1695. [PMID: 35489379 DOI: 10.1016/j.apmr.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
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19
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20
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de Freitas Gonçalves KS, Queiroz Godoy Daniel AC, Tatagiba Lamas JL, Ceretta Oliveira H, Silveira RCCP, Cloutier L, Velludo Veiga E. Device- and Nondevice-Guided Slow Breathing to Reduce Blood Pressure in Patients with Hypertension: Protocol for a Systematic Review and Meta-analysis. JMIR Res Protoc 2022; 11:e33579. [PMID: 35254284 PMCID: PMC8933807 DOI: 10.2196/33579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/23/2021] [Accepted: 12/22/2021] [Indexed: 01/01/2023] Open
Abstract
Background Physiotherapy can include both device-guided slow breathing (DGSB) and nondevice-guided slow breathing (NDGSB) in the treatment of systemic arterial hypertension. Objective The aim of this study is to summarize the effects of DGSB on blood pressure levels of patients with hypertension based on the published literature to date. Methods A systematic search of all published randomized controlled trials (RCTs) on the effects of device-guided and nondevice-guided slow breathing in patients with hypertension, without language restriction, was carried out up to a publication date of January 2020 in nine databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Physiotherapy Evidence Database (PEDro), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus, Web of Science, and Livivo. Clinical trial records databases (ClinicalTrials.gov), and bases for the open gray literature, including Gray Literature Report and ProQuest Central (Citation, Abstract or Indexing, and Dissertations and Theses), were also searched for potentially eligible RCTs. The quality assessment of the included studies will be performed using the Cochrane Risk of Bias Tool for Randomized Trials. The overall quality of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendations, Development and Evaluation) system. Results As of December 2021, the review was completed and all data from continuous variables referring to blood pressure values (mmHg) were synthesized. Conclusions This systematic review will provide a summary of the current evidence on the effects of both DGSB and NDGSB on blood pressure levels. This information can contribute to decision-making by health professionals related to the use of these interventions in patients with hypertension. Trial Registration PROSPERO (Prospective International Register of Systematic Reviews) CRD42020147554; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=147554 International Registered Report Identifier (IRRID) RR1-10.2196/33579
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Affiliation(s)
| | | | | | | | - Renata C C P Silveira
- WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Ribeirão Preto, Brazil
| | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Quebec, QC, Canada
| | - Eugenia Velludo Veiga
- WHO Collaborating Centre for Nursing Research Development, University of São Paulo, Ribeirão Preto, Brazil
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21
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Guo H, Li J, Liu H, He J. Learning dynamic treatment strategies for coronary heart diseases by artificial intelligence: real-world data-driven study. BMC Med Inform Decis Mak 2022; 22:39. [PMID: 35168623 PMCID: PMC8845235 DOI: 10.1186/s12911-022-01774-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) has become the leading cause of death and one of the most serious epidemic diseases worldwide. CHD is characterized by urgency, danger and severity, and dynamic treatment strategies for CHD patients are needed. We aimed to build and validate an AI model for dynamic treatment recommendations for CHD patients with the goal of improving patient outcomes and learning best practices from clinicians to help clinical decision support for treating CHD patients. METHODS We formed the treatment strategy as a sequential decision problem, and applied an AI supervised reinforcement learning-long short-term memory (SRL-LSTM) framework that combined supervised learning (SL) and reinforcement learning (RL) with an LSTM network to track patients' states to learn a recommendation model that took a patient's diagnosis and evolving health status as input and provided a treatment recommendation in the form of whether to take specific drugs. The experiments were conducted by leveraging a real-world intensive care unit (ICU) database with 13,762 admitted patients diagnosed with CHD. We compared the performance of the applied SRL-LSTM model and several state-of-the-art SL and RL models in reducing the estimated in-hospital mortality and the Jaccard similarity with clinicians' decisions. We used a random forest algorithm to calculate the feature importance of both the clinician policy and the AI policy to illustrate the interpretability of the AI model. RESULTS Our experimental study demonstrated that the AI model could help reduce the estimated in-hospital mortality through its RL function and learn the best practice from clinicians through its SL function. The similarity between the clinician policy and the AI policy regarding the surviving patients was high, while for the expired patients, it was much lower. The dynamic treatment strategies made by the AI model were clinically interpretable and relied on sensible clinical features extracted according to monitoring indexes and risk factors for CHD patients. CONCLUSIONS We proposed a pipeline for constructing an AI model to learn dynamic treatment strategies for CHD patients that could improve patient outcomes and mimic the best practices of clinicians. And a lot of further studies and efforts are needed to make it practical.
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Affiliation(s)
- Haihong Guo
- School of Information, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, 100872, China
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Data Engineering and Knowledge Engineering, Ministry of Education, Beijing, China
| | - Jiao Li
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyan Liu
- School of Economics and Management, Tsinghua University, Beijing, China
| | - Jun He
- School of Information, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, 100872, China.
- Key Laboratory of Data Engineering and Knowledge Engineering, Ministry of Education, Beijing, China.
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22
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Van Ryckeghem L, Keytsman C, De Brandt J, Verboven K, Verbaanderd E, Marinus N, Franssen WMA, Frederix I, Bakelants E, Petit T, Jogani S, Stroobants S, Dendale P, Bito V, Verwerft J, Hansen D. Impact of continuous vs. interval training on oxygen extraction and cardiac function during exercise in type 2 diabetes mellitus. Eur J Appl Physiol 2022; 122:875-887. [PMID: 35038022 DOI: 10.1007/s00421-022-04884-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Exercise training improves exercise capacity in type 2 diabetes mellitus (T2DM). It remains to be elucidated whether such improvements result from cardiac or peripheral muscular adaptations, and whether these are intensity dependent. METHODS 27 patients with T2DM [without known cardiovascular disease (CVD)] were randomized to high-intensity interval training (HIIT, n = 15) or moderate-intensity endurance training (MIT, n = 12) for 24 weeks (3 sessions/week). Exercise echocardiography was applied to investigate cardiac output (CO) and oxygen (O2) extraction during exercise, while exercise capacity [([Formula: see text] (mL/kg/min)] was examined via cardiopulmonary exercise testing at baseline and after 12 and 24 weeks of exercise training, respectively. Changes in glycaemic control (HbA1c and glucose tolerance), lipid profile and body composition were also evaluated. RESULTS 19 patients completed 24 weeks of HIIT (n = 10, 66 ± 11 years) or MIT (n = 9, 61 ± 5 years). HIIT and MIT similarly improved glucose tolerance (pTime = 0.001, pInteraction > 0.05), [Formula: see text] (mL/kg/min) (pTime = 0.001, pInteraction > 0.05), and exercise performance (Wpeak) (pTime < 0.001, pInteraction > 0.05). O2 extraction increased to a greater extent after 24 weeks of MIT (56.5%, p1 = 0.009, pTime = 0.001, pInteraction = 0.007). CO and left ventricular longitudinal strain (LS) during exercise remained unchanged (pTime > 0.05). A reduction in HbA1c was correlated with absolute changes in LS after 12 weeks of MIT (r = - 0.792, p = 0.019, LS at rest) or HIIT (r = - 0.782, p = 0.038, LS at peak exercise). CONCLUSION In patients with well-controlled T2DM, MIT and HIIT improved exercise capacity, mainly resulting from increments in O2 extraction capacity, rather than changes in cardiac output. In particular, MIT seemed highly effective to generate these peripheral adaptations. TRIAL REGISTRATION NCT03299790, initially released 09/12/2017.
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Affiliation(s)
- Lisa Van Ryckeghem
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium. .,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Charly Keytsman
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jana De Brandt
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kenneth Verboven
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Elvire Verbaanderd
- Physical Activity, Sport and Health Research Group, Faculty of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Nastasia Marinus
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Wouter M A Franssen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Ines Frederix
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Elise Bakelants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Thibault Petit
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.,Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Siddharth Jogani
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Sarah Stroobants
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Paul Dendale
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Virginie Bito
- BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jan Verwerft
- Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
| | - Dominique Hansen
- REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.,BIOMED-Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Virga Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
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23
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Dimitriadis K, Bletsa E, Lazarou E, Leontsinis I, Stampouloglou P, Dri E, Sakalidis A, Pyrpyris N, Tsioufis P, Siasos G, Tsiachris D, Tsioufis K. A Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere”. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Edwards J, De Caux A, Donaldson J, Wiles J, O'Driscoll J. Isometric exercise versus high-intensity interval training for the management of blood pressure: a systematic review and meta-analysis. Br J Sports Med 2021; 56:506-514. [PMID: 34911677 DOI: 10.1136/bjsports-2021-104642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE We aimed to compare the efficacy of isometric exercise training (IET) versus high-intensity interval training (HIIT) in the management of resting blood pressure (BP). DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed (MEDLINE), the Cochrane library and SPORTDiscus were systematically searched. ELIGIBILITY CRITERIA Randomised controlled trials published between 1 January 2000 and 1 September 2020. Research trials reporting the effects of IET or HIIT on resting BP following a short-term intervention (2-12 weeks). RESULTS 38 studies were analysed (18 IET and 20 HIIT), including 1583 (672 IET and 911 HIIT) participants, of which 612 (268 IET and 344 HIIT) were controls.IET produced significantly greater reductions in resting BP compared with HIIT with systolic, diastolic and mean BP effect sizes of 8.50 mm Hg vs 2.86 mm Hg (Q=17.10, p<0.001), 4.07 mm Hg vs 2.48 mm Hg (Q=4.71, p=0.03) and 6.46 mm Hg vs 3.15 mm Hg (Q=4.21, p=0.04) respectively. However, HIIT reduced resting heart rate significantly more than IET (3.17bpm vs 1.34bpm, Q=7.63, p=0.006). CONCLUSION While both modes are efficacious, IET appears to be the superior mode of exercise in the management of resting BP. However, HIIT may achieve wider physiological benefits, with greater reductions in resting heart rate.
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Affiliation(s)
- Jamie Edwards
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Anthony De Caux
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - James Donaldson
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK.,Department of Sport Science, Nottingham Trent University, Nottingham, UK
| | - Jonathan Wiles
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Jamie O'Driscoll
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
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25
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2021; 29:5-115. [PMID: 34558602 DOI: 10.1093/eurjpc/zwab154] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA).,International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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26
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Amjad A, Brubaker PH, Upadhya B. Exercise training for prevention and treatment of older adults with heart failure with preserved ejection fraction. Exp Gerontol 2021; 155:111559. [PMID: 34547406 DOI: 10.1016/j.exger.2021.111559] [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: 05/24/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.
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Affiliation(s)
- Aysha Amjad
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston Salem, USA
| | - Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA.
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27
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Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42:3227-3337. [PMID: 34458905 DOI: 10.1093/eurheartj/ehab484] [Citation(s) in RCA: 2092] [Impact Index Per Article: 697.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Alessandro Biffi
- European Federation of Sports Medicine Association (EFSMA)
- International Federation of Sport Medicine (FIMS)
| | | | | | | | | | | | | | | | | | | | - F D Richard Hobbs
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) - Europe
| | | | | | | | | | | | | | | | | | | | | | - Christoph Wanner
- European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
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28
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Efficacy of CPET Combined with Systematic Education of Cardiac Rehabilitation After PCI: A Real-World Evaluation in ACS Patients. Adv Ther 2021; 38:4836-4846. [PMID: 34351565 PMCID: PMC8408080 DOI: 10.1007/s12325-021-01871-y] [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: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022]
Abstract
Introduction There are scarce real-world data on the long-term efficacy and safety of cardiopulmonary exercise testing (CPET) combined with the systematic education of cardiac rehabilitation (CR) approach for patients post-coronary stenting, which is, therefore, the subject of this study. Methods Data collected between 1 April 2015 and 20 May 2017 from 11,345 patients in the rehabilitation center database at our hospital were retrospectively analyzed. Five hundred thirty-six patients with incomplete information, or unable to cooperate with telephone follow-up, were excluded; 4001 patients received the combined CR approach; and 6808 patients received only routine post-procedure education (controls). Of these, 2805 CR participants (CR group) were matched 1:1 to controls (control group) using propensity scores. The main outcome was quality of life in Seattle Angina Questionnaire (SAQ) scores. SAQ was measured in hospital and at follow-up; meanwhile, volume/type of habitual exercise, major adverse cardiovascular event (MACE), and its components of target vessel revascularization, myocardial infarction, and cardiac death were recorded and analyzed. Results At median 583 (range 184–963) day follow-up, compared with controls, the CR group showed fewer patients not engaging in physical exercise (22 vs. 956, p < 0.05); more cumulative exercise time (h/week) (8.22 ± 6.17 h vs. 3.00 ± 1.65 h, p < 0.05); higher SAQ scores (physical limitation, 69.59 ± 10.96 vs. 57.49 ± 7.19; anginal stability, 80.50 ± 18.21 vs. 58.82 ± 11.95; anginal frequency, 78.58 ± 11.07 vs. 67.14 ± 22.41; treatment satisfaction, 82.33 ± 13.21 vs. 56.84 ± 21.61; quality of life, 68.69 ± 18.33 vs. 60.26 ± 17.13, all p < 0.01), but a similar MACE rate (log-rank p = 0.621). Conclusion Compared with only routine post-procedure education, CR combining at least one-time CPET with a systematic cardiac education program before discharge improved engagement in physical activity and quality of life for patients after percutaneous coronary intervention (PCI) without increasing clinical adverse events. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01871-y.
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Osteresch R, Fach A, Frielitz FS, Meyer S, Schmucker J, Rühle S, Retzlaff T, Hadwiger M, Härle T, Elsässer A, Katalinic A, Eitel I, Hambrecht R, Wienbergen H. Long-Term Effects of an Intensive Prevention Program After Acute Myocardial Infarction. Am J Cardiol 2021; 154:7-13. [PMID: 34238446 DOI: 10.1016/j.amjcard.2021.05.034] [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] [Received: 04/02/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
Effective long-term prevention after myocardial infarction (MI) is crucial to reduce recurrent events. In this study the effects of a 12-months intensive prevention program (IPP), based on repetitive contacts between non-physician "prevention assistants" and patients, were evaluated. Patients after MI were randomly assigned to the IPP versus usual care (UC). Effects of IPP on risk factor control, clinical events and costs were investigated after 24 months. In a substudy efficacy of short reinterventions after more than 24 months ("Prevention Boosts") was analyzed. IPP was associated with a significantly better risk factor control compared to UC after 24 months and a trend towards less serious clinical events (12.5% vs 20.9%, log-rank p = 0.06). Economic analyses revealed that already after 24 months cost savings due to event reduction outweighted the costs of the prevention program (costs per patient 1,070 € in IPP vs 1,170 € in UC). Short reinterventions ("Prevention Boosts") more than 24 months after MI further improved risk factor control, such as LDL cholesterol and blood pressure lowering. In conclusion, IPP was associated with numerous beneficial effects on risk factor control, clinical events and costs. The study thereby demonstrates the efficacy of preventive long-term concepts after MI, based on repetitive contacts between non-physician coworkers and patients.
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Wang R, Dai L, Zhong Y, Xie G. Usefulness of the triglyceride glucose-body mass index in evaluating nonalcoholic fatty liver disease: insights from a general population. Lipids Health Dis 2021; 20:77. [PMID: 34321005 PMCID: PMC8317400 DOI: 10.1186/s12944-021-01506-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Triglyceride glucose-body mass index (TyG-BMI) is a recently developed alternative indicator to identify insulin resistance. However, few studies have investigated the association between the TyG-BMI and nonalcoholic fatty liver disease (NAFLD). Therefore, this study aimed to study the relationship between NAFLD and the TyG-BMI in the general population and its predictive value. Methods A cross-sectional study was conducted on 14,251 general subjects who took part in a comprehensive health examination. The anthropological characteristics and many risk factors for NAFLD were measured. Results After fully adjusting for confounding variables, a stable positive correlation was found between NAFLD and the TyG-BMI (OR: 3.90 per SD increase; 95% CI: 3.54 to 4.29; P-trend< 0.00001). This positive correlation was not simply linear but a stable non-linear correlation. Additionally, obvious threshold effects and saturation effects were found, in which a threshold effect occurred when the TyG-BMI was between 100 and 150; when the TyG-BMI was between 300 and 400, the corresponding NAFLD risk appeared saturated. Furthermore, receiver operating characteristic analysis showed that the TyG-BMI could better predict the risk of NAFLD than other traditional indicators [TyG-BMI (AUC): 0.886; 95% CI: 0.8797–0.8927; P < 0.0001], particularly among young and middle-aged and non-obese people. Conclusions This epidemiological study is the first on the association between the TyG-BMI and NAFLD risk in the general population. In this large data set from the general population, the TyG-BMI showed an independent positive correlation with NAFLD. The discovery of the threshold effect and saturation effect between them provides a new idea to prevent and treat NAFLD. Supplementary Information The online version contains supplementary material available at 10.1186/s12944-021-01506-9.
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Affiliation(s)
- Rongsheng Wang
- Department of Intensive Care Unit, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, P.R. China, 330006
| | - Longlong Dai
- Department of Cardiology, Ruichang People's Hospital, Jiujiang, P.R. China, 332200
| | - Yanjia Zhong
- Department of Endocrinology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, P.R. China, 330006
| | - Guobo Xie
- Department of Cardiology, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, P.R. China, 330006.
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Li WG, Huang Z, Zhang XA. Exercise prescription in cardiac rehabilitation needs to be more accurate. Eur J Prev Cardiol 2021; 28:e33-e34. [PMID: 32605457 DOI: 10.1177/2047487320936021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Wei-Guang Li
- Cardiology Department, Liaoning Province Jinqiu Hospital, China
- College of Kinesiology, Shenyang Sport University, China
| | - Zheng Huang
- Cardiology Department, Liaoning Province Jinqiu Hospital, China
| | - Xin-An Zhang
- College of Kinesiology, Shenyang Sport University, China
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Foccardi G, Vecchiato M, Neunhaeuserer D, Mezzaro M, Quinto G, Battista F, Duregon F, Carlon R, Ermolao A. Effectiveness of Text Messaging as an Incentive to Maintain Physical Activity after Cardiac Rehabilitation: A Randomized Controlled Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126645. [PMID: 34205551 PMCID: PMC8296387 DOI: 10.3390/ijerph18126645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/04/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023]
Abstract
Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term.
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Affiliation(s)
- Giulia Foccardi
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-8217456
| | - Michele Mezzaro
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
| | - Giulia Quinto
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
| | - Roberto Carlon
- UOA Cardiology, Rehabilitation Cardiology, ASSL 6 “Euganea”, Cittadella Hospital, 35013 Cittadella, Italy;
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.F.); (M.V.); (M.M.); (G.Q.); (F.B.); (F.D.); (A.E.)
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, 35128 Padova, Italy
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O'Regan A, Pollock M, D'Sa S, Niranjan V. ABC of prescribing exercise as medicine: a narrative review of the experiences of general practitioners and patients. BMJ Open Sport Exerc Med 2021; 7:e001050. [PMID: 34150320 PMCID: PMC8174512 DOI: 10.1136/bmjsem-2021-001050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exercise prescribing can help patients to overcome physical inactivity, but its use in general practice is limited. The purpose of this narrative review was to investigate contemporaneous experiences of general practitioners and patients with exercise prescribing. METHOD PubMed, Scopus, Science Direct and Cochrane reviews were reviewed using the terms 'exercise prescription', 'exercise prescribing', 'family practice', 'general practice', 'adults' and 'physical activity prescribing'. RESULTS After screening by title, abstract and full paper, 23 studies were selected for inclusion. Qualitative, quantitative and mixed-methods studies revealed key experiences of general practitioners and patients. Barriers identified included: physician characteristics, patients' physical and psychosocial factors, systems and cultural failures, as well as ambiguity around exercise prescribing. We present a synthesis of the key strategies to overcome these using an ABC approach: A: assessment of physical activity: involves asking about physical activity, barriers and risks to undertaking an exercise prescription; B: brief intervention: advice, written prescription detailing frequency, intensity, timing and type of exercise; and C: continued support: providing ongoing monitoring, accountability and progression of the prescription. Multiple supports were identified: user-friendly resources, workshops for doctors, guidelines for specific illnesses and multimorbidity, electronic devices, health system support and collaboration with other healthcare and exercise professionals. DISCUSSION This review has identified levers for facilitating exercise prescribing and adherence to it. The findings have been presented in an ABC format as a guide and support for general practitioners to prescribe exercise.
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Affiliation(s)
- Andrew O'Regan
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Saskia D'Sa
- School of Medicine, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University College Dublin, Dublin, Ireland
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Ambrosetti M, Abreu A, Cornelissen V, Hansen D, Iliou MC, Kemps H, Pedretti RFE, Voller H, Wilhelm M, Piepoli MF, Beccaluva CG, Beckers P, Berger T, Davos CH, Dendale P, Doehner W, Frederix I, Gaita D, Gevaert A, Kouidi E, Kraenkel N, Laukkanen J, Maranta F, Mazza A, Mendes M, Neunhaeuserer D, Niebauer J, Pavy B, Gil CP, Rauch B, Sarzi Braga S, Simonenko M, Cohen-Solal A, Sommaruga M, Venturini E, Vigorito C. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era. Eur J Prev Cardiol 2021; 28:541-557. [PMID: 33624042 PMCID: PMC7717287 DOI: 10.1093/eurjpc/zwaa080] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023]
Abstract
This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.
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Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Via S. Maugeri, 4, 27100 Pavia, Italy.,Cardiac Rehabilitation Unit, ASST Crema, Crema, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | | | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Marie Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, Paris, France
| | - Hareld Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Heinz Voller
- Klinik am See, Rehabilitation Center for Internal Medicine, Berlin, Germany.,Department of Rehabilitation Medicine, University of Potsdam, Potsdam, Germany
| | - Mathias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Paul Beckers
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp University, Crema, Belgium
| | | | - Costantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Hasselt University, Hasselt, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Berlin, Germany.,BCRT - Berlin Institute of Health Center for Regenerative Therapies, Center for Stroke Research Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Ines Frederix
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Dan Gaita
- Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Timisoara, Romania
| | - Andreas Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium.,Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Antwerp, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Kuopio, Finland
| | - Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Mazza
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Via S. Maugeri, 4, 27100 Pavia, Italy
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Karnaxide, Portugal
| | - Daniel Neunhaeuserer
- Sport and Exercise Medicine Division, Department of Medicine, University of Padova,Padova, Italy
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, Machecoul, France
| | - Carlos Peña Gil
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, CV, SERGAS CIBER, IDIS, Santiago, Spain
| | - Bernhard Rauch
- IHF - Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Simona Sarzi Braga
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Tradate, Italy
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Saint Petersburg, Russian Federation
| | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, UMRS-942, Paris University, Paris, France
| | - Marinella Sommaruga
- Psychology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Camaldoli Institute, Milano, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, Cecina, Italy
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Verboven K, Hansen D. Critical Reappraisal of the Role and Importance of Exercise Intervention in the Treatment of Obesity in Adults. Sports Med 2021; 51:379-389. [PMID: 33332014 DOI: 10.1007/s40279-020-01392-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the treatment of obesity in adults, exercise intervention is recommended and some people with obesity even prefer exercise above dietary intervention as a single weight-loss strategy. However, evidence is accumulating that the long-term body weight and adipose tissue mass loss as a result of exercise intervention in these individuals is disappointingly small. Although this could be related to various clinical reasons, more recent evidence reveals that also (patho)physiological abnormalities are involved which cannot be remediated by exercise intervention, especially in metabolically compromised patients. As a result, the role and importance of exercise intervention in the treatment of obesity deserve significant reconsideration to avoid confusion and disappointment amongst clinicians, patients and society. Hence, to reduce adipose tissue mass and body weight, dietary intervention is much more effective than exercise intervention, and is, therefore, of key importance in this endeavour. However, dietary interventions must be supplemented by exercise training to induce clinically relevant changes in specific cardiovascular or metabolic risk factors like blood pressure, blood triglycerides and high-density lipoprotein cholesterol concentrations, as well as visceral adipose tissue mass, physical fitness, muscle mass and strength, quality of life and life expectancy. This allows individuals with obesity to preserve their cardiometabolic health or to shift from a metabolically unhealthy phenotype to a metabolically healthy phenotype. Signifying the true clinical value of exercise interventions might lead to a better understanding and appreciation of the goals and associated effects when implemented in the multidisciplinary treatment of obesity, for which a proper tailoring of exercise prescription is required.
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Affiliation(s)
- Kenneth Verboven
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590, AgoralaanDiepenbeek, Belgium. .,BIOMED-Biomedical Research Center, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590, AgoralaanDiepenbeek, Belgium.,BIOMED-Biomedical Research Center, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium
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Sun T, Xu Y, Xie H, Ma Z, Wang Y. Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers: Pretest-Posttest Study. J Med Internet Res 2021; 23:e28221. [PMID: 34028359 PMCID: PMC8185615 DOI: 10.2196/28221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A scientific, personalized, and quantitative exercise prescription that has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease is highly recommended. However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (eg, prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalized prescription is thus worth exploring. OBJECTIVE The aim of this study was to investigate whether a year-long cloud platform-based and intelligent personalized exercise prescription intervention could improve Chinese middle-aged and older adult community dwellers' health outcomes. METHODS A total of 177 participants (aged 52-85 years; mean 67.93, SD 7.05) were recruited from 2 Chinese community health service centers in Anhui Province, China. The exercise intervention was delivered over 12 months with a single-group pretest-posttest design. After being assessed in terms of physical activity, health-related lifestyle, history of chronic diseases and drug use, family history of disease and cardiovascular function, body composition, bone mineral density, and physical fitness through an eHealth promotion system, participants with relative contraindications for exercise were personally prescribed the health care exercise mode by an intelligent system, while those without relative contraindication and who had a regular exercise habit were prescribed the scientific fitness mode. Paired t tests were used for the analysis. RESULTS A total of 97 participants were classified into the health care mode, and the remaining 80 participants were assigned to the scientific fitness mode. Significant changes in heart rate (mean difference [MD] 2.97; 95% CI 1.1-4.84; P=.002), subendocardial viability ratio (MD -0.13; CI: -1.19 to -0.63; P<.001), weight (MD 0.99; CI 0.29-1.69; P=.006), BMI (MD 0.38; CI 0.11-0.64; P=.006), body fat rate (MD 0.88; CI 0.24-1.51; P=.007), fat mass (MD 0.92; CI 0.33-1.53; P=.003), and brachial-ankle pulse wave velocity (MD: -0.72; CI -1.17 to -0.27; P=.002) were observed among participants with the health care mode exercise prescriptions at the 12-month postintervention versus the baseline assessment, while no changes in systolic blood pressure, diastolic blood pressure, muscle mass, bone mineral density, t value, z value, balance, or ability were discerned. The results showed a functional decline in the physical fitness of both groups, including in handgrip strength (healthcare mode: MD 4.41; scientific fitness mode: MD 3.11), vital capacity (healthcare mode: MD 261.99; scientific fitness mode: MD 250.78), and agility (healthcare mode MD=-0.35; scientific fitness mode: MD=-0.39) with all P values <.001, except handgrip strength in the scientific fitness mode (P=.002). There were no significant differences in other parameters among participants with scientific fitness mode exercise prescriptions. CONCLUSIONS The observations suggest that our exercise prescription intervention program might promote certain health outcomes in Chinese middle-aged and older adult community dwellers, yet we are unable to recommend such a program given the existing limitations. Future randomized controlled trials with diverse samples are warranted to confirm our findings.
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Affiliation(s)
- Ting Sun
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Yang Xu
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Hui Xie
- School of Nursing, Bengbu Medical College, Bengbu, China
| | - Zuchang Ma
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
| | - Yu Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Intelligent Machines, Hefei Institutes of Physical Sciences, Chinese Academy of Sciences, Hefei, China
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37
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Hansen D, Decroix L, Devos Y, Nocca D, Cornelissen V, Dillemans B, Lannoo M. Towards Optimized Care After Bariatric Surgery by Physical Activity and Exercise Intervention: a Review. Obes Surg 2021; 30:1118-1125. [PMID: 31912467 DOI: 10.1007/s11695-020-04390-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
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Affiliation(s)
- Dominique Hansen
- Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan, Building A, Diepenbeek, 3590, Hasselt, Belgium. .,Hasselt University, BIOMED, Hasselt, Belgium. .,Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.
| | - Lieselot Decroix
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Devos
- Fitness als Medicijn®-Medisch Fitness Centrum, Ternat, Belgium
| | - David Nocca
- Department of Surgery, Université de Montpellier, Montpellier, France
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
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Davos CH. Is ARIS (aerobic/resistance/inspiratory muscle training) the optimal exercise training programme for chronic heart failure patients? Eur J Prev Cardiol 2021; 28:1636-1638. [PMID: 33824964 DOI: 10.1093/eurjpc/zwab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou Street, 11527 Athens, Greece
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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40
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Jeffares I, Merriman NA, Doyle F, Horgan F, Hickey A. Inclusion of stroke patients in expanded cardiac rehabilitation services: a cross-national qualitative study with cardiac and stroke rehabilitation professionals. Disabil Rehabil 2021; 44:3610-3622. [PMID: 33529535 DOI: 10.1080/09638288.2021.1874548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This qualitative study explored healthcare professionals' views in relation to the potential expansion of cardiac rehabilitation services to include stroke patients, thereby becoming a cardiovascular rehabilitation model. DESIGN AND METHODS 23 semi-structured interviews were completed with hospital and community-based stroke and cardiac rehabilitation professionals in Switzerland (n = 7) and Ireland (n = 19). The sample comprised physiotherapists, occupational therapists, speech and language therapists, stroke physicians, cardiologists, psychologists, dieticians and nurses. Interviews were audio-recorded and the transcripts were analysed in NVivo using inductive Thematic Analysis. RESULTS Barriers and facilitators to cardiovascular rehabilitation were captured under four broad themes; (i) Cardiac rehabilitation as "low-hanging fruit," (ii) Cognitive impairment ("the elephant in the room"), (iii) Adapted cardiac rehabilitation for mild stroke, and (iv) Resistance to change. CONCLUSIONS Hybrid cardiac rehabilitation programmes could be tailored to deliver stroke-specific education, exercises and multidisciplinary expertise. Post-stroke cognitive impairment was identified as a key barrier to participation in cardiac rehabilitation. A cognitive rehabilitation intervention could potentially be delivered as part of cardiac rehabilitation, to address the cognitive needs of stroke and cardiac patients.Implications for rehabilitationThe cardiac rehabilitation model has the potential to be expanded to include mild stroke patients given the commonality of secondary prevention needs.Up to half of stroke survivors are affected by post-stroke cognitive impairment, consequently mild stroke patients may not be such an "easy fit" for cardiac rehabilitation.A cardiovascular programme which includes common rehabilitation modules, in addition to stroke- and cardiac-specific content is recommended.A cognitive rehabilitation module could potentially be added as part of the cardiac rehabilitation programme to address the cognitive needs of stroke and cardiac patients.
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Affiliation(s)
- Isabelle Jeffares
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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42
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Hansen D, Rovelo Ruiz G, Coninx K. Computerized decision support for exercise prescription in cardiovascular rehabilitation: high hopes…but still a long way to go. Eur J Prev Cardiol 2020; 28:569-571. [PMID: 33624079 DOI: 10.1093/eurjpc/zwaa105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.,BIOMED-Biomedical Research Center, Hasselt University, Agoralaan, Building C, 3590 Diepenbeek, Belgium
| | - Gustavo Rovelo Ruiz
- EDM-Expertise centre for Digital Media, Hasselt University, Wetenschapspark 2, 3590 Diepenbeek, Belgium
| | - Karin Coninx
- EDM-Expertise centre for Digital Media, Hasselt University, Wetenschapspark 2, 3590 Diepenbeek, Belgium
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43
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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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44
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Physical Activity, Exercise Prescription for Health and Home-Based Rehabilitation. SUSTAINABILITY 2020. [DOI: 10.3390/su122410230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this overview was to recommend individual training plans using exercise prescriptions for adults and older adults during home-based rehabilitation. Over the last decade, many regular physical activity studies with large prospective cohorts have been conducted. Taken together, more than a million subjects have been included in these exercise studies. The risk of morbidity and mortality has been reduced by 30% to 40% as a result of exercise. These risk reductions hold true for many diseases, as well as for prevention and rehabilitation. Physical activity has also been in the treatment of many diseases, such as cardiopulmonary, metabolic or neurologic/psychiatric diseases, all with positive results. Based on these results, the prescription of exercise was developed and is now known as the exercise prescription for health in many European countries. Details have been published by the European Federation of Sports Medicine Associations (EFSMA). The exercise prescription is strongly recommended for inpatients, discharged patients and outpatients who have recovered from severe diseases. Rehabilitation improves general health, physical fitness, quality of life and may increase longevity of life.
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45
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Mazza A, Paneroni M. Gym space in the era of digital cardiovascular rehabilitation: Often overlooked but critically important. Eur J Prev Cardiol 2020; 27:2059-2062. [DOI: 10.1177/2047487319869576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Antonio Mazza
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Pavia, Italy
| | - Mara Paneroni
- Department of Pneumology Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane (BS), Italy
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46
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Nagyova I, Jendrichovsky M, Kucinsky R, Lachytova M, Rus V. Effects of Nordic walking on cardiovascular performance and quality of life in coronary artery disease. Eur J Phys Rehabil Med 2020; 56:616-624. [DOI: 10.23736/s1973-9087.20.06120-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Marçal IR, Fernandes B, Viana AA, Ciolac EG. The Urgent Need for Recommending Physical Activity for the Management of Diabetes During and Beyond COVID-19 Outbreak. Front Endocrinol (Lausanne) 2020; 11:584642. [PMID: 33250859 PMCID: PMC7673403 DOI: 10.3389/fendo.2020.584642] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Diabetes is the second most prevalent non-communicable chronic diseases (NCDs) in patients with coronavirus disease 2019 (COVID-19) and is highly associated with increased incidence of disease severity and mortality. Individuals with diabetes and poor glycemic control have an even worse prognosis. Despite of the need/effectiveness of social distancing measures (i.e.: home confinement, quarantine and/or lockdown) during COVID-19 outbreak, preliminary findings showed an increase in negative behaviors during COVID-19 home confinement (i.e.: ~33.5% reduction in physical activity, ~28.6% (~3.10h) increase in sedentary behavior (i.e.: daily sitting, reclining and lying down time), and more unhealthy food consumption and meal pattern), which may have important clinical implications. For example, we estimated that this reduction in physical activity can increase the cases of type 2 diabetes (from ~7.2% to ~9.6%; ~11.1 million cases per year) and all-cause mortality (from ~9.4% to ~12.5%; ~1.7 million deaths per year) worldwide. Few weeks of reduction in physical activity levels result in deleterious effects on several cardiometabolic (i.e.: glycemic control, body composition, inflammatory cytokines, blood pressure, vascular function…) and functional parameters (i.e.: cardiorespiratory/muscle fitness, balance, agility…). In contrast, physical activity and exercise are important tools for preventing and treating diabetes and others NCDs. Home-based exercise programs are useful, safe and effective for the management of diabetes, and could be widely used during COVID-19 outbreak. In this context, there is an urgent need for recommending physical activity/exercise, during and beyond COVID-19 outbreak, for improving the management of diabetes, as well as to prevent the increase in global burden of COVID-19, diabetes and others NCDs.
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Affiliation(s)
| | | | | | - Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory (ECDR), Department of Physical Education, School of Sciences, Campus Bauru (UNESP), São Paulo State University, Bauru, Brazil
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48
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García-Sánchez E, Rubio-Arias JÁ, Ávila-Gandía V, López-Román FJ, Menarguez-Puche JF. Effects of Two Community-Based Exercise Programs on Adherence, Cardiometabolic Markers, and Body Composition in Older People with Cardiovascular Risk Factors: A Prospective Observational Cohort Study. J Pers Med 2020; 10:jpm10040176. [PMID: 33081361 PMCID: PMC7711811 DOI: 10.3390/jpm10040176] [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] [Received: 09/10/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/02/2022] Open
Abstract
Cardiovascular disease is one of the leading causes of death globally, and cardiovascular risk factors (CRFs) are major behavioral risk factors. Therefore, community-based programs are being designed based on the prescription of physical exercise from primary care centers to improve people’s health through changes in lifestyle. The objective was to compare the effects of two types of community exercise on adherence, lipid profile, body composition and blood pressure. A prospective observational cohort study was designed with two cohorts of study depending on the duration and type of physical exercise program performed. Fifty-one participants (82.4% women) with CRF completed the observation period in which they carried out a short-term, non-individualized exercise program (3 months), and 42 participants (71.4% women) with CRF completed the observation period in which they conducted a long-term, individualized exercise program (6 months). The results suggest that participants who carried out the longer program with an individualized progression produced greater adherence to physical exercise and a decrease in diastolic blood pressure. In addition, LDL and insulin levels decreased in both groups. Therefore, our results suggest that a longer duration and individualized evolution of the loads of a community exercise program lead to higher levels of physical activity (PA) and improvements diastolic blood pressure.
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Affiliation(s)
- Esther García-Sánchez
- Fundación para la Formación e Investigación Sanitaria de la Región de Murcia (FFIS), Calle Luis Fontes Pagán 9, 1ª planta, 30003 Murcia, Spain;
| | - Jacobo Á. Rubio-Arias
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Correspondence: or ; Tel.: +34-9106-77964
| | - Vicente Ávila-Gandía
- Sports Physiology Department, Catholic University of Murcia (UCAM), 30107 Murcia, Spain; (V.Á.-G.); (F.J.L.-R.)
| | - F. Javier López-Román
- Sports Physiology Department, Catholic University of Murcia (UCAM), 30107 Murcia, Spain; (V.Á.-G.); (F.J.L.-R.)
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30107 Murcia, Spain
| | - Juan F. Menarguez-Puche
- Primary Care Health Center, Jesús Marín, Calle Enrique Bernal Capel, 4, Molina de Segura, 30500 Murcia, Spain;
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49
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Ibeggazene S, Moore C, Tsakirides C, Swainson M, Ispoglou T, Birch K. UK cardiac rehabilitation fit for purpose? A community-based observational cohort study. BMJ Open 2020; 10:e037980. [PMID: 33040006 PMCID: PMC7549464 DOI: 10.1136/bmjopen-2020-037980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
OBJECTIVES This study aimed to characterise the exercise performed in UK cardiac rehabilitation (CR) and explore relationships between exercise dose and changes in physiological variables. DESIGN Observational cohort study. SETTING Outpatient community-based CR in Leeds, UK. Rehabilitation sessions were provided twice per week for 6 weeks. PARTICIPANTS Sixty patients (45 male/15 female 33-86 years) were recruited following referral to local outpatient CR. OUTCOME MEASURES The primary outcome was heart rate achieved during exercise sessions. Secondary outcomes were measured before and after CR and included incremental shuttle walk test (ISWT) distance and speed, blood pressure, brachial artery flow-mediated dilatation, carotid arterial stiffness and accelerometer-derived habitual physical activity behaviours. RESULTS The mean % of heart rate reserve patients exercised at was low and variable at the start of CR (42%±16 %) and did not progress by the middle (48%±17 %) or end (48%±16 %) of the programme. ISWT performance increased following CR (440±150 m vs 633±217 m, p<0.001); however, blood pressure, body weight, endothelial function, arterial stiffness and habitual physical activity behaviours were unchanged following 6 weeks of CR (p>0.05). CONCLUSION Patients in a UK CR cohort exercise at intensities that are variable but generally low. The exercise dose achieved using this CR format appears inadequate to impact markers of health. Attending CR had no effect on physical activity behaviours. Strategies to increase the dose of exercise patients achieve during CR and influence habitual physical activity behaviours may enhance the effectiveness of UK CR.
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Affiliation(s)
- Saïd Ibeggazene
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Chelsea Moore
- Department of Sport and Exercise Sciences, Wrexham Glyndwr University, Wrexham, Clwyd, UK
| | - Costas Tsakirides
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Michelle Swainson
- Lancaster University Lancaster Medical School, Lancaster, Lancashire, UK
| | - Theocharis Ispoglou
- Carnegie School of Sport, Leeds Beckett University School of Sport, Leeds, West Yorkshire, UK
| | - Karen Birch
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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50
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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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