Myocardial dimensions and hemodynamics during 24-h ultraendurance ergometry

The effect of cardiac rehabilitation prescription on medication complications and ET-1, WMSI in elderly patients with coronary heart disease

OBJECTIVE

To explore the effects of cardiac rehabilitation prescriptions on medication complications, Endothelin 1 (ET-1), and Wall Motion Score Index (WMSI) in elderly patients with coronary heart disease.

METHODS

98 elderly patients with coronary heart disease admitted to the Department of Cardiology of a hospital from January 2020 to June 2022 are selected. According to the red and blue ball method, 98 research subjects are divided into a control group and an observation group. The control group receives routine treatment and exercise intervention, while the observation group receives cardiac rehabilitation prescriptions. After a follow-up of 6 months, the incidence of medication complications between the two groups is compared. The changes in ET-1 and WMSI levels are compared before treatment, 1 month, 3 months, and 6 months after treatment.

RESULTS

The two groups had no significant difference in ET-1 and WMSI levels before intervention. After intervention, both groups showed significant reductions in ET-1 and WMSI compared with baseline. The ET-1 of the observation group decreased significantly faster than the control group after 1 month, 3 months, and 6 months of intervention. The WMSI decreased more significantly at 6 months. The repeated measurement variance showed that there was a significant difference in the trend of ET-1 changes between the two groups, while the difference between the WMSI groups was not significant. The incidence of medication complications in the observation group was 10.20%, significantly lower than the 26.53% in the control group.

CONCLUSION

Cardiac rehabilitation prescriptions can reduce the incidence of medication complications in elderly patients with coronary heart disease. It can reduce ET-1 levels faster, improve myocardial motor function, which has better myocardial function and medication safety than conventional treatment.

Non-Invasive Cardiac Output Measurement Using Inert Gas Rebreathing Method during Cardiopulmonary Exercise Testing-A Systematic Review

BACKGROUND

The use of inert gas rebreathing for the non-invasive cardiac output measurement has produced measurements comparable to those obtained by various other methods. However, there are no guidelines for the inert gas rebreathing method during a cardiopulmonary exercise test (CPET). In addition, there is also a lack of specific standards for assessing the non-invasive measurement of cardiac output during CPET, both for healthy patients and those suffering from diseases and conditions.

AIM

This systematic review aims to describe the use of IGR for a non-invasive assessment of cardiac output during cardiopulmonary exercise testing and, based on the information extracted, to identify a proposed CPET report that includes an assessment of the cardiac output using the IGR method.

METHODS

This systematic review was conducted by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines. PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from inception until 29 December 2022. The primary search returned 261 articles, of which 47 studies met the inclusion criteria for this review.

RESULTS AND CONCLUSIONS

This systematic review provides a comprehensive description of protocols, indications, technical details, and proposed reporting standards for a non-invasive cardiac output assessment using IGR during CPET. It highlights the need for standardized approaches to CPET and identifies gaps in the literature. The review critically analyzes the strengths and limitations of the studies included and offers recommendations for future research by proposing a combined report from CPET-IGR along with its clinical application.

Exercise duration: Independent effects on acute physiologic responses and the need for an individualized prescription

An individualization of exercise prescription is implemented mainly in terms of intensity but not for duration. To survey the need for an individualized exercise duration prescription, we investigated acute physiologic responses during constant‐load exercise of maximal duration (t_max) and determined so‐called duration thresholds. Differences between absolute (min) and relative terms (% t_max) of exercise duration were analyzed. Healthy young and trained male and female participants (n = 11) performed an incremental exercise test and one t_max constant‐load exercise test at a target intensity of 10% of maximal power output below the second lactate turn point (LTP₂). Blood lactate, heart rate, and spirometric data were measured during all tests. t_max was markedly different across subjects (69.6 ± 14.8 min; range: 40–90 min). However, distinct duration phases separated by duration thresholds (DTh) were found in most measured variables. These duration thresholds (except DTh1) were significantly related to t_max (DTh2: r² = 0.90, p < 0.0001; DTh3: r² = 0.98, p < 0.0001) and showed substantial interindividual differences if expressed in absolute terms (DTh2: 24.8 ± 6.0 min; DTh3: 47.4 ± 10.6 min) but not in relative terms (DTh2: 35.4 ± 2.7% t_max; DTh3: 67.9 ± 2.4% t_max). Our data showed that (1) maximal duration was individually different despite the same relative intensity, (2) duration thresholds that were related to t_max could be determined in most measured variables, and (3) duration thresholds were comparable between subjects if expressed in relative terms. We therefore conclude that duration needs to be concerned as an independent variable of exercise prescription.

The Importance of 'Durability' in the Physiological Profiling of Endurance Athletes

Profiling physiological attributes is an important role for applied exercise physiologists working with endurance athletes. These attributes are typically assessed in well-rested athletes. However, as has been demonstrated in the literature and supported by field data presented here, the attributes measured during routine physiological-profiling assessments are not static, but change over time during prolonged exercise. If not accounted for, shifts in these physiological attributes during prolonged exercise have implications for the accuracy of their use in intensity regulation during prolonged training sessions or competitions, quantifying training adaptations, training-load programming and monitoring, and the prediction of exercise performance. In this review, we argue that current models used in the routine physiological profiling of endurance athletes do not account for these shifts. Therefore, applied exercise physiologists working with endurance athletes would benefit from development of physiological-profiling models that account for shifts in physiological-profiling variables during prolonged exercise and quantify the 'durability' of individual athletes, here defined as the time of onset and magnitude of deterioration in physiological-profiling characteristics over time during prolonged exercise. We propose directions for future research and applied practice that may enable better understanding of athlete durability.

The First Lactate Threshold Is a Limit for Heavy Occupational Work

Long-term heavy physical work often leads to early retirement and disability pension due to chronic overload, with a need to define upper limits. The aim of this study was to evaluate the value of the first lactate threshold (LTP₁) as a physiological marker for heavy occupational work. A total of 188 male and 52 female workers performed an incremental cycle ergometer test to determine maximal exercise performance and the first and second lactate (LTP₁; LTP₂) and ventilatory thresholds (VT₁; VT₂). Heart rate (HR) recordings were obtained during one eight-hour shift (HR_8h) and oxygen uptake was measured during 20 minutes of a representative work phase. Energy expenditure (EE) was calculated from gas-exchange measures. Maximal power output (P_max), maximal oxygen consumption (VO_{2 max}) and power output at LTP₁ and LTP₂ were significantly different between male and female workers. HR_8h was not significantly different between male and female workers. A significant relationship was found between P_max and power output at LTP₁. HR_8h as a percentage of maximum HR significantly declined with increasing performance (P_max:r = −0.56; p < 0.01; P_LTP1:r = −0.49; p < 0.01). Despite different cardio-respiratory fitness-levels; 95.4% of all workers performed their usual work below LTP₁. It is therefore suggested that LTP₁ represents the upper limit for sustained heavy occupational work; which supports its use to determine work capability and assessing the limits of heavy occupational work.

Absolute Accelerometer-Based Intensity Prescription Compared to Physiological Variables in Pregnant and Nonpregnant Women

Estimation of the intensity of physical activity (PA) based on absolute accelerometer cut points (Cp) likely over- or underestimates intensity for a specific individual. The purpose of this study was to investigate the relationship between absolute moderate intensity Cp and the first ventilatory threshold (VT₁). A group of 24 pregnant and 15 nonpregnant women who performed a submaximal incremental walking test with measures of ventilatory parameters and accelerations from three different accelerometers on the wrist (ActiGraph wGT3X-BT, GENEActiv, Axivity AX3) and one on the hip (Actigraph wGT3X-BT) were analyzed. Cp were determined corresponding to 3 metabolic equivalents of task (MET), using the conventional MET definition (Cp_3.5) (3.5 mL/kg×min) and individual resting metabolic rate (Cp_ind). The ventilatory equivalent (VE/VO₂) was used to determine VT₁. Accelerations at VT₁ were significantly higher (p < 0.01) compared to Cp_3.5 and Cp_ind in both groups. Cp_3.5 and Cp_ind were significantly different in nonpregnant (p < 0.01) but not in pregnant women. Walking speed at VT₁ (5.7 ± 0.5/6.2 ± 0.8 km/h) was significantly lower (p < 0.01) in pregnant compared to nonpregnant women and correspondent to 3.8 ± 0.7/4.9 ± 1.4 conventional METs. Intensity at absolute Cp was lower compared to the intensity at VT₁ independent of the device or placement in pregnant and nonpregnant women. Therefore, we recommend individually tailored cut points such as the VT₁ to better assess the effect of the intensity of PA.

Intensity- and Duration-Based Options to Regulate Endurance Training

The regulation of endurance training is usually based on the prescription of exercise intensity. Exercise duration, another important variable of training load, is rarely prescribed by individual measures and mostly set from experience. As the specific exercise duration for any intensity plays a substantial role regarding the different kind of cellular stressors, degree, and kind of fatigue as well as training effects, concepts integrating the prescription of both intensity and duration within one model are needed. An according recent approach was the critical power concept which seems to have a physiological basis; however, the mathematical approach of this concept does not allow applying the three zones/two threshold model of metabolism and its different physiological consequences. Here we show the combination of exercise intensity and duration prescription on an individual basis applying the power/speed to distance/time relationship. The concept is based on both the differentiation of intensities by two lactate or gas exchange variables derived turn points, and on the relationship between power (or velocity) and duration (or distance). The turn points define three zones of intensities with distinct acute metabolic, hormonal, and cardio-respiratory responses for endurance exercise. A maximal duration exists for any single power or velocity such as described in the power-duration relationship. Using percentages of the maximal duration allows regulating fatigue, recovery time, and adaptation for any single endurance training session. Four domains of duration with respect to induced fatigue can be derived from maximal duration obtained by the power-duration curve. For any micro-cycle, target intensities and durations may be chosen on an individual basis. The model described here is the first conceptual framework of integrating physiologically defined intensities and fatigue related durations to optimize high-performance exercise training.

Progressive and biphasic cardiac responses during extreme mountain ultramarathon

Investigations on the cardiac function consequences of mountain ultramarathon (MUM) >100 h are lacking. The present study assessed the progressive cardiac responses during the world's most challenging MUM (Tor des Géants; Italy; 330 km; 24,000 m of cumulative elevation gain). Resting echocardiographic evaluation of morphology, function, and mechanics of left and right ventricle (LV and RV) including speckle tracking echocardiography was conducted in 15 male participants (46 ± 13 yr) before (pre), during (mid; 148 km), and after (post) the race. Runners completed the race in 126 ± 15 h. From pre to post, the increase in stroke volume (SV) (103 ± 19 vs. 110 ± 23 vs. 116 ± 21 ml; P < 0.001 at pre, mid, and post) was concomitant to the increase in LV early filling (peak E; 72.9 ± 15.7 vs. 74.6 ± 13.1 vs. 82.1 ± 11.5 cm/s; P < 0.05). Left and right atrial end-diastolic areas, RV end-diastolic area, and LV end-diastolic volume were 12-19% higher at post compared with pre (P < 0.05). Resting heart rate and LV systolic strain rates demonstrated a biphasic adaptation with an increase from pre to mid (55 ± 8 vs. 72 ± 11 beats/min, P < 0.001) and a return to baseline values from mid to post (59 ± 8 beats/min). Significant correlations were found between pre-to-post percent changes in peak E and LV end-diastolic volume (r = 0.63, P < 0.05) or RV (r = 0.82, P < 0.001) or atrial end-diastolic areas (r = 0.83, P < 0.001). An extreme MUM induced a biphasic pattern of heart rate in parallel with specific cardiac responses characterized by a progressive increase in diastolic filling, biventricular volumes, and SV. The underlying mechanisms and their clinical implications remain challenging for the future.

Fluid retention, muscle damage, and altered body composition at the Ultraman triathlon

PURPOSE

The primary purpose of this investigation was to determine the effects of participation in a 3-day multistage ultraendurance triathlon (stage 1 = 10 km swim, 144.8 km bike; stage 2 = 275.4 km bike; stage 3 = 84.4 km run) on body mass and composition, hydration status, hormones, muscle damage, and blood glucose.

METHODS

Eighteen triathletes (mean ± SD; age 41 ± 7.5 years; height 175 ± 9 cm; weight 73.5 ± 9.8 kg; male n = 14, female n = 4) were assessed before and after each stage of the race. Body mass and composition were measured via bioelectrical impedance, hydration status via urine specific gravity, hormones and muscle damage via venous blood draw, and blood glucose via fingerstick.

RESULTS

Following the race, significant changes included reductions in body mass (qualified effect size: trivial), fat mass (moderate), and percent body fat (small); increases in percent total body water (moderate) and urine specific gravity (large); and unchanged absolute total body water and fat-free mass. There were also extremely large increases in creatine kinase, C-reactive protein, aldosterone and cortisol combined with reductions in testosterone (small) and the testosterone:cortisol ratio (moderate). There were associations between post-race aldosterone and total body water (r = -0.504) and changes in cortisol and fat-free mass (r = -0.536). Finally, blood glucose increased in a stepwise manner prior to each stage.

CONCLUSIONS

Participation in Ultraman Florida leads to fluid retention and dramatic alterations in body composition, muscle health, hormones, and metabolism.

Energy balance of triathletes during an ultra-endurance event

The nutritional strategy during an ultra-endurance triathlon (UET) is one of the main concerns of athletes competing in such events. The purpose of this study is to provide a proper characterization of the energy and fluid intake during real competition in male triathletes during a complete UET and to estimate the energy expenditure (EE) and the fluid balance through the race.

METHODS

Eleven triathletes performed a UET. All food and drinks ingested during the race were weighed and recorded in order to assess the energy intake (EI) during the race. The EE was estimated from heart rate (HR) recordings during the race, using the individual HR-oxygen uptake (Vo2) regressions developed from three incremental tests on the 50-m swimming pool, cycle ergometer, and running treadmill. Additionally, body mass (BM), total body water (TBW) and intracellular (ICW) and extracellular water (ECW) were assessed before and after the race using a multifrequency bioimpedance device (BIA).

RESULTS

Mean competition time and HR was 755 ± 69 min and 137 ± 6 beats/min, respectively. Mean EI was 3643 ± 1219 kcal and the estimated EE was 11,009 ± 664 kcal. Consequently, athletes showed an energy deficit of 7365 ± 1286 kcal (66.9% ± 11.7%). BM decreased significantly after the race and significant losses of TBW were found. Such losses were more related to a reduction of extracellular fluids than intracellular fluids.

CONCLUSIONS

Our results confirm the high energy demands of UET races, which are not compensated by nutrient and fluid intake, resulting in a large energy deficit.

Ultra-endurance exercise induces stress and inflammation and affects circulating hematopoietic progenitor cell function

Although amateur sports have become increasingly competitive within recent decades, there are as yet few studies on the possible health risks for athletes. This study aims to determine the impact of ultra-endurance exercise-induced stress on the number and function of circulating hematopoietic progenitor cells (CPCs) and hematological, inflammatory, clinical, metabolic, and stress parameters in moderately trained amateur athletes. Following ultra-endurance exercise, there were significant increases in leukocytes, platelets, interleukin-6, fibrinogen, tissue enzymes, blood lactate, serum cortisol, and matrix metalloproteinase-9. Ultra-endurance exercise did not influence the number of CPCs but resulted in a highly significant decline of CPC functionality after the competition. Furthermore, Epstein-Barr virus was seen to be reactivated in one of seven athletes. The link between exercise-induced stress and decline of CPC functionality is supported by a negative correlation between cortisol and CPC function. We conclude that ultra-endurance exercise induces metabolic stress and an inflammatory response that affects not only mature hematopoietic cells but also the function of the immature hematopoietic stem and progenitor cell fraction, which make up the immune system and provide for regeneration.