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Bianchi F, Biganzoli EM, Bollati V, Clerici M, Lucini D, Mandò C, Rota F. HEBE project: Healthy aging versus inflamm-aging: The role of physical exercise in modulating the biomarkers of age-associated and environmentally determined chronic diseases, study protocol. PLoS One 2024; 19:e0300011. [PMID: 38687742 PMCID: PMC11060583 DOI: 10.1371/journal.pone.0300011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 05/02/2024] Open
Abstract
Inflamm-aging refers to the chronic low-grade inflammation that occurs with aging and cellular senescence, and it is linked to various diseases. Understanding the markers involved in inflammation and aging, as well as their interaction with environmental factors and bodily control mechanisms, can provide crucial tools for assessing the resilience (i.e. the ability to adapt and improve) of the human body, particularly in the presence of chronic degenerative conditions or vulnerable life stages, that place the individual and the community to which he belongs in a state of potential fragility. HEBE focuses on physical exercise, along with nutritional and lifestyle recommendations, to reduce systemic inflammation and promote healthy aging. HEBE encompasses multiple research lines (LR). In the ongoing LR1 ("proof of concept"), healthy lifestyle recommendations were provided to University of Milan employees, and changes in quality of life and well-being were assessed using a specialized questionnaire. The first 100 eligible subjects, who expressed their willingness to participate, underwent a personalized physical exercise protocol based on clinical and objective assessments. Biomedical samples were collected at baseline (T0) and follow-up (T1) to establish a shared biobank and identify non-invasive biomarkers that monitor the impact of physical exercise on individual characteristics such as cardiovascular and metabolic health. Subsequently (LR2-LR10), the proof of concept findings will be expanded to include various conditions of vulnerability such as obesity, cancer, endocrine disorders, cardiovascular diseases, infertility, functional syndromes, respiratory disorders, neurodegenerative diseases, and autoimmune conditions. The research lines will leverage the expertise of the 94 participating investigators to form a collaborative network that maximizes the potential for investigation and knowledge exchange. This approach fosters a culture of health promotion and disease prevention. ClinicalTrials.gov Identifier: NCT05815732.
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Affiliation(s)
- Francesca Bianchi
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
- Laboratorio Morfologia Umana Applicata, IRCCS Policlinico San Donato, Milan, Italy
| | - Elia Mario Biganzoli
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
- Data Science Research Center, University of Milan, Milan, Italy
| | - Valentina Bollati
- EPIGET—Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Don C. Gnocchi Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation, Milan, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, Milan, Italy
- Exercise Medicine Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Chiara Mandò
- Department of Biomedical and Clinical Sciences L. Sacco, Medical Statistics Unit, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Federica Rota
- EPIGET—Epidemiology, Epigenetics and Toxicology Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Giovanelli L, Biganzoli G, Spataro A, Malacarne M, Bernardelli G, Spada R, Pagani M, Biganzoli E, Lucini D. Body composition assessment in a large cohort of Olympic athletes with different training loads: possible reference values for fat mass and fat-free mass domains. Acta Diabetol 2024; 61:361-372. [PMID: 37945991 PMCID: PMC10948543 DOI: 10.1007/s00592-023-02203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
AIMS To assess body composition by means of BOD POD in the large cohort of Italian Olympic athletes of many sport disciplines (studied at the same time), and to provide possible reference values for body composition in elite athletes. METHODS 1556 elite athletes, who took part in the selection procedure for the 2016 Rio Olympic Games for the National Italian Olympic Committee (CONI), were retrospectively studied. Body composition was determined using air plethysmography-based BOD POD. RESULTS We observed that Fat Mass (FM) and Fat-free Mass (FFM) should be considered as two mutually independent domains in elite athletes. By performing Principal Component Analysis, we defined two independent main domains (respectively, representing FM and FFM), which presented different trends according to gender and static or dynamic exercise load. Lastly, we reported possible reference values for FM index and FFM index, respectively, representing the largest contributors to FM domain and FFM domain, and calculated as FM or FFM (kg)/height (m2). CONCLUSIONS Our findings might provide a basis to optimize the practical approach to body composition in athletes, highlighting the importance of considering indicators of fat mass and lean mass "simultaneously" and not specularly, according to different sport disciplines as well. Moreover, these data might contribute to standardize reference values for body composition in elite athletes, with a view to potentially helping to monitor and guide training regimens, prevent related detrimental practices and plan cardiometabolic prevention and rehabilitation programs.
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Affiliation(s)
| | - Giacomo Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | | | | | - Giuseppina Bernardelli
- DISCCO Department, University of Milan, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Elia Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, Milan, Italy.
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
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Cimolin V, Premoli C, Bernardelli G, Amenta E, Galli M, Donno L, Lucini D, Fatti LM, Cangiano B, Persani L, Vitale G. ACROMORFO study: gait analysis in a cohort of acromegalic patients. J Endocrinol Invest 2024:10.1007/s40618-024-02340-3. [PMID: 38416368 DOI: 10.1007/s40618-024-02340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE In acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly. STUDY POPULATION Thirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study. MEASUREMENTS Kinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population. RESULTS The acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern. CONCLUSION Acromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls' risk and improve QoL.
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Affiliation(s)
- V Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
- IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, Strada Luigi Cadorna 90, 28824, Piancavallo, Italy
| | - C Premoli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
| | - G Bernardelli
- DISCCO Department, University of Milan, 20122, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135, Milan, Italy
| | - E Amenta
- DISCCO Department, University of Milan, 20122, Milan, Italy
| | - M Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - L Donno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - D Lucini
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135, Milan, Italy
| | - L M Fatti
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - B Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - L Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy
- Department of Endocrine and Metabolic Medicine, IRCCS, Istituto Auxologico Italiano, 20149, Milan, Italy
| | - G Vitale
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122, Milan, Italy.
- Laboratory of Geriatric and Oncologic Neuroendocrinology Research, IRCCS, Istituto Auxologico Italiano, 20145, Milan, Italy.
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Solaro N, Pagani M, Spataro A, Lucini D. Assessing the cardiac autonomic response to bicycle exercise in Olympic athletes with different loads of endurance training: new insights from statistical indicators based on multilevel exploratory factor analysis. Front Physiol 2023; 14:1245310. [PMID: 37916219 PMCID: PMC10616979 DOI: 10.3389/fphys.2023.1245310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Aim: The mechanisms governing the organism's response to exercise are complex and difficult to study. Spectral analysis of heart rate variability (HRV) could represent a convenient methodology for studying humans' autonomic nervous system (ANS). However, difficulties in interpreting the multitude of correlated HRV-derived indices, mainly when computed over different time segments, may represent a barrier to its usage. This preliminary investigation addressed to elite athletes proposes a novel method describing the cardiac autonomic response to exercise based on multilevel exploratory factor analysis (MEFA), which reduces the multitude of HRV-derived indices to fewer uncorrelated ANS indicators capable of accounting for their interrelationships and overcoming the above difficulties. Methods: The study involved 30 Italian Olympic athletes, divided into 15 cyclists (prevalent high-intensity endurance training) and 15 shooters (prevalent technical training with low-intensity endurance component). All athletes underwent a complete test of a dynamic protocol, constituted by a rest-stand test followed by a stepwise bicycle stress test subdivided into a single bout of progressive endurance (from aerobic to anaerobic) exercise and recovery. Then, by spectral analysis, values of 12 ANS proxies were computed at each time segment (9 epochs in all) of the complete test. Results: We obtained two global ANS indicators (amplitude and frequency), expressing the athletes' overall autonomic response to the complete test, and three dynamic ANS indicators (amplitude, signal self-similarity, and oscillatory), describing the principal dynamics over time of the variability of RR interval (RRV). Globally, cyclists have significantly higher amplitude levels (median ± MAD: cyclists 69.9 ± 20.5; shooters 37.2 ± 19.4) and lower frequency levels (median ± MAD: cyclists 37.4 ± 14.8; shooters 78.2 ± 10.2) than shooters, i.e., a parasympathetic predominance compared to shooters. Regarding the RRV dynamics, the signal self-similarity and oscillatory indicators have the strongest sensitivity in detecting the rest-stand change; the amplitude indicator is highly effective in detecting the athletes' autonomic changes in the exercise fraction; the amplitude and oscillatory indicators present significant differences between cyclists and shooters in specific test epochs. Conclusion: This MEFA application permits a more straightforward representation of the complexity characterizing ANS modulation during exercise, simplifying the interpretation of the HRV-derived indices and facilitating the possible real-life use of this non-invasive methodology.
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Affiliation(s)
- Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Daniela Lucini
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- BIOMETRA Department, University of Milan, Milan, Italy
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Puci MV, Cavallo C, Gatti A, Carnevale Pellino V, Lucini D, Calcaterra V, Zuccotti G, Lovecchio N, Vandoni M. International fitness scale (IFIS): association with motor performance in children with obesity. PeerJ 2023; 11:e15765. [PMID: 37547723 PMCID: PMC10399561 DOI: 10.7717/peerj.15765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health; and compared with their normal-weight peers, these individuals tend to have a lower level of self-confidence, and consequently lower physical activity adherence. Due to these self-perceived barriers, the aim of our study was to evaluate the efficacy of an online training program on self-reported physical fitness (SRPF) in children with obesity (OB). Methods A total of 32 children with OB carried out physical fitness (PF) tests and were asked to complete the International Fitness Enjoyment Scale (IFIS) questionnaire. The physical fitness tests were the Standing Broad Jump (SBJ), the 6-Min Walking Test (6MWT) and the 4 × 10 m sprint test. Children participated in a 3-weekly 60-min training session through Zoom platform. Before the beginning of the training protocol, OB children were compared with normal weight (NW) ones for PF batteries and the IFIS questionnaire. Changes in performances after the training were assessed by paired Student t and Wilcoxon tests. Results After the online training program children increased their performance in 6MWT (mean difference (MD) = 54.93; p < 0.0001) in SBJ (MD = 10.00; p = 0.0001) and in 4 × 10 m sprint test (MD = -0.78; p < 0.0001). No differences were found in children's physical fitness perception. Discussion Our study highlighted how a structured online training program can lead to improvements in PF of children with OB. Instead, the lack of differences in SRPF after the training suggests interesting questions to be explored on the aspects linked to self-perception. Therefore, even if our training protocol could not directly improve SRPF in children with obesity, the enhancement of their PF could be a starting point for achieving this result with a longer training period and consequently improve PA participation for children with OB.
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Affiliation(s)
- Mariangela Valentina Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
| | - Caterina Cavallo
- Exercise and Sports, LUNEX International University of Health, Lussemburgo, Lussemburgo
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA)-Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA)-Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
- Department of Industrial Engineering, University of Roma “Tor Vergata”, Rome, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Nicola Lovecchio
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA)-Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
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Giovanelli L, Malacarne M, Pagani M, Biolo G, Mekjavic IB, Bernardelli G, Lucini D. Moderate Aerobic Exercise Reduces the Detrimental Effects of Hypoxia on Cardiac Autonomic Control in Healthy Volunteers. J Pers Med 2023; 13:jpm13040585. [PMID: 37108971 PMCID: PMC10146556 DOI: 10.3390/jpm13040585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Physical inactivity increases cardiometabolic risk through a variety of mechanisms, among which alterations of immunological, metabolic, and autonomic control systems may play a pivotal role. Physical inactivity is frequently associated with other factors that may further worsen prognosis. The association between physical inactivity and hypoxia is particularly interesting and characterizes several conditions—whether physiological (e.g., residing or trekking at high altitude and space flights) or pathological (e.g., chronic cardiopulmonary diseases and COVID-19). In this randomized intervention study, we investigated the combined effects of physical inactivity and hypoxia on autonomic control in eleven healthy and physically active male volunteers, both at baseline (ambulatory) conditions and, in a randomized order, hypoxic ambulatory, hypoxic bedrest, and normoxic bedrest (i.e., a simple experimental model of physical inactivity). Autoregressive spectral analysis of cardiovascular variabilities was employed to assess cardiac autonomic control. Notably, we found hypoxia to be associated with an impairment of cardiac autonomic control, especially when combined with bedrest. In particular, we observed an impairment of indices of baroreflex control, a reduction in the marker of prevalent vagal control to the SA node, and an increase in the marker of sympathetic control to vasculature.
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Mannarino S, Santacesaria S, Raso I, Garbin M, Pipolo A, Ghiglia S, Tarallo G, De Silvestri A, Vandoni M, Lucini D, Carnevale Pellino V, Bernardelli G, Gatti A, Rossi V, Calcaterra V, Zuccotti G. Benefits in Cardiac Function from a Remote Exercise Program in Children with Obesity. Int J Environ Res Public Health 2023; 20:1544. [PMID: 36674299 PMCID: PMC9861570 DOI: 10.3390/ijerph20021544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Physical activity (PA) is a crucial factor in preventing and treating obesity and related complications. In this one-arm pre−post longitudinal prospective study, we evaluated the effects of a 12-week online supervised training program on cardiac morphology, function and blood pressure (BP) in children with obesity. The training program consisted of three sessions per week, each lasting 60 min. Advanced echocardiographic imaging (tissue Doppler and longitudinal strain analysis) was used to detect subclinical changes in heart function. Categorical variables were described as counts and percentages; quantitative variables as the mean and standard deviation (SD) as they were normally distributed (Shapiro−Wilks test). Pre−post comparisons were made with a paired t-test. A total of 27/38 (71%) enrolled patients (18M/9F, 11 ± 2 years) completed the training protocol and were considered in the analysis. At baseline, no hypertensive patient was noted; all echocardiographic variables were within the normal range. After training, we observed a significant reduction in BP parameters, including systolic BP values and Z-score, diastolic BP values, centiles and Z-score, and mean arterial pressure (all p < 0.05). Significant variations in echocardiographic interventricular septum (IVSd) thickness (p = 0.011), IVSd Z-score (p = 0.001), left ventricular (LV) end-diastolic diameter (p = 0.045), LV posterior wall thickness Z-score (p = 0.017), and LV global longitudinal strain (p = 0.016) were detected. No differences in LV diastolic function and right ventricular strain were noted. PA plays a decisive role in improving BP control and has benefits on left ventricle systolic function, representing a strategic approach to limit CV risk. Online exercise could be an excellent method of training in children with obesity.
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Affiliation(s)
- Savina Mannarino
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Sara Santacesaria
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Irene Raso
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Andreana Pipolo
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Silvia Ghiglia
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Gabriele Tarallo
- Pediatric Cardiology Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Annalisa De Silvestri
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giuseppina Bernardelli
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- DISCCO Department, University of Milan, 20122 Milan, Italy
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Pediatric Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Unit, Pediatric Department, Buzzi Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milano, 20157 Milan, Italy
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Lucini D, Pagani E, Capria F, Galiano M, Marchese M, Cribellati S, Parati G. Age Influences on Lifestyle and Stress Perception in the Working Population. Nutrients 2023; 15:nu15020399. [PMID: 36678269 PMCID: PMC9865201 DOI: 10.3390/nu15020399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Workplace health promotion programs and services offered by insurers may play a fundamental role to foster health/well-being and to prevent chronic diseases. To this end, they should be tailored to companies/employees’ requirements and characteristics. In particular, age needs to be taken into account, considering both that young age workers are generally healthy, and that young age is the best period in lifespan to address prevention and instilling healthy behaviors. We employed an anonymous, simple web-based questionnaire (filled out by 1305 employees) which furnishes data regarding lifestyle (nutrition, exercise, smoking, stress, sleep, etc.), some of which were used to build a unique descriptor (Lifestyle Index; 0−100 higher scores being healthier). We considered three subgroups accordingly to age: ≤30; between 30 and 50; >50 years. This study showed age influences lifestyle and stress perception in the working population: the youngest employees (both men and women) presented the worst lifestyle index, particularly in its stress component. This observation may potentially be useful to tailor workplace health promotion programs and to personalize insurance protocols and services offered to employees. The practical message of our study is that in healthy young people focusing only on medical parameters (frequently within normal ranges in this cohort), albeit important, may be not sufficient to foster proactive actions to prevent chronic non-communicable diseases in adult life. Vice versa, driving their attention on current behaviors might elicit their proactive role to improve lifestyle, getting immediate advantages such as well-being improvement and the possibility to best manage stress.
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Affiliation(s)
- Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Correspondence: ; Tel.: +39-02-619112808
| | - Eleonora Pagani
- Department of Psychology, Catholic University of the Sacred Hearth, 20123 Milan, Italy
| | | | | | | | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
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Pagani E, Gavazzoni N, Bernardelli G, Malacarne M, Solaro N, Giusti E, Castelnuovo G, Volpi P, Carimati G, Lucini D. Psychological Intervention Based on Mental Relaxation to Manage Stress in Female Junior Elite Soccer Team: Improvement in Cardiac Autonomic Control, Perception of Stress and Overall Health. Int J Environ Res Public Health 2023; 20:942. [PMID: 36673698 PMCID: PMC9859004 DOI: 10.3390/ijerph20020942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
Chronic stress may represent one of the most important factors that negatively affects the health and performance of athletes. Finding a way to introduce psychological strategies to manage stress in everyday training routines is challenging, particularly in junior teams. We also must consider that a stress management intervention should be regarded as "efficacious" only if its application results in improvement of the complex underlying pathogenetic substratum, which considers mechanistically interrelated factors, such as immunological, endocrine and autonomic controls further to psychological functioning and behavior. In this study, we investigated the feasibility of implementing, in a standard training routine of the junior team of the Italian major soccer league, a stress management program based on mental relaxation training (MRT). We evaluated its effects on stress perception and cardiac autonomic regulation as assessed by means of ANSI, a single composite percentile-ranked proxy of autonomic balance, which is free of gender and age bias, economical, and simple to apply in a clinical setting. We observed that the simple employed MRT intervention was feasible in a female junior soccer team and was associated with a reduced perception of stress, an improved perception of overall health, and a betterment of cardiac autonomic control. This data may corroborate the scientific literature that indicates psychological intervention based on MRT as an efficacious strategy to improve performance, managing negative stress effects on cardiac autonomic control.
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Affiliation(s)
- Eleonora Pagani
- Department of General Psychology, Catholic University, 20123 Milan, Italy
| | | | - Giuseppina Bernardelli
- DISCCO Department, University of Milan, 20122 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
| | - Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Emanuele Giusti
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University, 20123 Milan, Italy
- Clinical Psychology Research laboratory, Istituto Auxologico Italiano, IRCCS, 28824 Verbania, Italy
| | - Piero Volpi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | | | - Daniela Lucini
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
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10
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Guaraldi P, Malacarne M, Barletta G, Scisciolo GD, Pagani M, Cortelli P, Lucini D. Effects of Spinal Cord Injury Site on Cardiac Autonomic Regulation: Insight from Analysis of Cardiovascular Beat by Beat Variability during Sleep and Orthostatic Challenge. J Funct Morphol Kinesiol 2022; 7:jfmk7040112. [PMID: 36547658 PMCID: PMC9787160 DOI: 10.3390/jfmk7040112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
The goal of this study on Spinal Cord Injury (SCI) patients with cervical or thoracic lesion was to assess whether disturbances of ANS control, according to location, might differently affect vagal and sympatho-vagal markers during sleep and orthostatic challenge. We analyzed with linear and nonlinear techniques beat-by-beat RR and arterial pressure (and respiration) variability signals, extracted from a polysomnographic study and a rest-tilt test. We considered spontaneous or induced sympathetic excitation, as obtained shifting from non-REM to REM sleep or from rest to passive tilt. We obtained evidence of ANS cardiac (dys)regulation, of greater importance for gradually proximal location (i.e., cervical) SCI, compatible with a progressive loss of modulatory role of sympathetic afferents to the spinal cord. Furthermore, in accordance with the dual, vagal and sympathetic bidirectional innervation, the results suggest that vagally mediated negative feedback baroreflexes were substantially maintained in all cases. Conversely, the LF and HF balance (expressed specifically by normalized units) appeared to be negatively affected by SCI, particularly in the case of cervical lesion (group p = 0.006, interaction p = 0.011). Multivariate analysis of cardiovascular variability may be a convenient technique to assess autonomic responsiveness and alteration of functionality in patients with SCI addressing selectively vagal or sympathetic alterations and injury location. This contention requires confirmatory studies with a larger population.
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Affiliation(s)
- Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
| | - Giorgio Barletta
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum–University of Bologna, 40123 Bologna, Italy
| | - Giuseppe De Scisciolo
- Neurofisiopatologia, Azienda Ospedaliero-Universitaria Careggi, 50134 Firenze, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum–University of Bologna, 40123 Bologna, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Correspondence: ; Tel.: +39-02619112808
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11
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Giovanelli L, Palombo C, Pina M, Facchetti S, Malacarne M, Pagani M, Nannipieri M, Berta R, Lucini D. Progressive Additive Benefits of Prehabilitation and Subsequent Bariatric Surgery on Cardiac Autonomic Regulation as Assessed by Means of a Simple Unitary Composite Index: Preliminary Data from an Observational Study. J Pers Med 2022; 12:jpm12081317. [PMID: 36013266 PMCID: PMC9409827 DOI: 10.3390/jpm12081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Obesity is associated with an increased risk of several chronic comorbidities, which may also be determined by dysfunctional autonomic nervous system (ANS). The influence of bariatric surgery (BS) on ANS balance was explored in previous studies, but with high heterogeneity in both the assessment timing and methods employed. In the present observational study, we applied a clinical protocol which considers two subsequent phases. Twenty-nine non-diabetic obese subjects were studied at baseline (T0), after one month of lifestyle modification (prehabilitation) (phase 1-T1), and after eight months following BS (phase 2-T2). ANS regulation was assessed across the three study epochs by means of ANSI, a single composite percent-ranked proxy of autonomic balance, being free of gender and age bias, economical and simple to apply in a clinical setting. The aim of the present study was to investigate the effects of the clinical protocol based on prehabilitation and subsequent BS on the ANS regulation by means of ANSI. Potential intertwined correlations with metabolic parameters were also investigated. Notably, we observed a progressive improvement in ANS control, even by employing ANSI. Moreover, the reduction in the markers of sympathetic overactivity was found to significantly correlate with the amelioration in some metabolic parameters (fasting glucose, insulin levels, and waist circumference), as well as in stress and tiredness perception. In conclusion, this study provides convincing evidence that a unitary proxy of cardiac autonomic regulation (CAR) may reflect the progressive improvement in autonomic regulation following behavioral and surgical interventions in obese patients. Intriguingly, this might contribute to reducing cardiovascular and metabolic risk.
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Affiliation(s)
- Luca Giovanelli
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Department of Endocrine and Metabolic Medicine, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - Carlo Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, 56126 Pisa, Italy
| | - Matteo Pina
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Simone Facchetti
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56216 Pisa, Italy
| | - Rossana Berta
- Obesity Surgery Division, Pisa University Hospital, 56216 Pisa, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy
- Correspondence: ; Tel.: +3902-619-1128-08
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12
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Barbier P, Palazzo Adriano E, Lucini D, Pagani M, Cusumano G, De Maria B, Dalla Vecchia LA. Determinants of Left Atrial Compliance in the Metabolic Syndrome: Insights from the "Linosa Study". J Pers Med 2022; 12:jpm12071044. [PMID: 35887541 PMCID: PMC9323981 DOI: 10.3390/jpm12071044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
The association between left atrial (LA) impairment and cardiovascular diseases (CVD) and between dyslipidaemia and CVD are well known. The present study aims to investigate the relationships between metabolic factors and LA dimensions and compliance, as well as test the hypothesis that metabolic factors influence LA function independent from hemodynamic mechanisms. Arterial blood pressure (BP), waist and hip circumference, metabolic indices, and a complete echocardiographic assessment were obtained from 148 selected inhabitants (M/F 89/59; age 20−86 years) of Linosa Island, who had no history of CVD. At enrollment, 27.7% of the subjects met the criteria for metabolic syndrome (MetS) and 15.5% for arterial hypertension (HTN). LA compliance was reduced in subjects with MetS compared to those without (53 ± 27% vs. 71 ± 29%, p = 0.04) and was even lower (32 ± 17%, p = 0.01) in those with MetS and HTN. At multiple regression analysis, the presence of MetS independently determined LA maximal area (r = 0.56, p < 0.001), whereas systolic BP and the total cholesterol/HDL cholesterol ratio determined LA compliance (r = 0.41, p < 0.001). In an apparently healthy population with a high prevalence of MetS, dyslipidaemia seems to independently influence LA compliance. At a 5-year follow-up, LA compliance was reduced in both all-cause and CVD mortality groups, and markedly impaired in those who died of CVD. These findings may contribute to understanding the prognostic role of LA function in CVD and strengthen the need for early and accurate lipid control strategies.
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Affiliation(s)
- Paolo Barbier
- Imaging Department, Jilin Heart Hospital, Changchun 130117, China
- Correspondence: ; Tel.: +86-175-1923-6042
| | - Edvige Palazzo Adriano
- IRCCS Istituti Clinici Scientifici Maugeri, Department of Cardiology, 20138 Milan, Italy; (E.P.A.); (B.D.M.); (L.A.D.V.)
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, 20122 Milan, Italy;
- Exercise Medicine Unit, IRCCS, Istituto Auxologico Italiano, 20135 Milan, Italy;
| | - Massimo Pagani
- Exercise Medicine Unit, IRCCS, Istituto Auxologico Italiano, 20135 Milan, Italy;
| | | | - Beatrice De Maria
- IRCCS Istituti Clinici Scientifici Maugeri, Department of Cardiology, 20138 Milan, Italy; (E.P.A.); (B.D.M.); (L.A.D.V.)
| | - Laura Adelaide Dalla Vecchia
- IRCCS Istituti Clinici Scientifici Maugeri, Department of Cardiology, 20138 Milan, Italy; (E.P.A.); (B.D.M.); (L.A.D.V.)
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13
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De Maria B, Lucini D, Gois MDO, Catai AM, Perego F, Malacarne M, Pagani M, Porta A, Dalla Vecchia LA. Improvement of Sympathovagal Balance by Regular Exercise May Counteract the Ageing Process. A Study by the Analysis of QT Variability. Front Physiol 2022; 13:880250. [PMID: 35514344 PMCID: PMC9065681 DOI: 10.3389/fphys.2022.880250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
QT interval (QT) variability analysis provides pathophysiological and prognostic information utilized in cardiac and non-cardiac diseases, complementary to those obtained from the analysis of heart period (HP) variability. An increased QT variability has been associated to a higher risk for cardiac events and poorest prognosis. Autonomic cardiovascular adaptation to internal and external challenges, such those occurring in athletes exposed to high levels of physical stress and in ageing could also be deepen by analyzing QT variability, searching for early prognostic signatures. The aim of the study was to analyze the QT variability and cardiac control complexity in a group of middle-aged half-marathon runners at baseline (B) and at a 10-year follow-up (FU). We found that the overall QT variability decreased at FU, despite the inescapable increase in age (52.3 ± 8.0 years at FU). This change was accompanied by an increase of the HP variability complexity without changes of the QT variability complexity. Of notice, over the years, the group of athletes maintained their regular physical activity by switching to a moderate intensity rather than strenuous. In conclusion, regular and moderate exercise over the years was beneficial for this group of athletes, as reflected by the decreased overall QT variability that is known to be associated to lower cardiovascular risk. The concomitant enhanced cardiac control complexity also suggests a trend opposite to what usually occurs with ageing, resulting in a more flexible cardiac control, typical of younger people.
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Affiliation(s)
| | - Daniela Lucini
- BIOMETRA Department, University of Milan, Milan, Italy.,Exercise Medicine Unit, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | | | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Mara Malacarne
- BIOMETRA Department, University of Milan, Milan, Italy.,Exercise Medicine Unit, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, Policlinico San Donato, San Donato Milanese, Milan, Italy
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14
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Lucini D, Pagani E, Capria F, Galliano M, Marchese M, Cribellati S. Evidence of Better Psychological Profile in Working Population Meeting Current Physical Activity Recommendations. Int J Environ Res Public Health 2021; 18:ijerph18178991. [PMID: 34501580 PMCID: PMC8430491 DOI: 10.3390/ijerph18178991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
Workplace Health Promotion (WHP) may improve health, productivity and safety and reduce absenteeism. However, although desirable, it is difficult to design tailored (and thus effective) WHP programs, particularly in small-medium companies, which rarely have access to sufficient economic and organizational resources. In this study, 1305 employees filled out an online anonymous lifestyle questionnaire hosted on the website of a non-profit organization, which aims to promote a healthy lifestyle among workers. The data show gender differences regarding stress perception and, in the working population meeting current physical activity recommendations (threshold = 600 MET·min/week), they point out the evidence of a better psychological and nutrition profile, a perception of better job performance, and improved sleep and health quality. Moreover, a unitary index (ranging from 0-100 (with higher scores being healthier)), combining self-reported metrics for diet, exercise and stress, was significantly higher in active employees (67.51 ± 12.46 vs. 39.84 ± 18.34, p < 0.001). The possibility of assessing individual lifestyle in an easy, timely and cost-effective manner, offers the opportunity to collect grouped data useful to drive tailored WHP policies and to have metric to quantify results of interventions. This potentiality may help in creating effective programs and in improving employees' and companies' motivation and attitude towards a feasible WHP.
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Affiliation(s)
- Daniela Lucini
- BIOMETRA Department, University of Milan, 20129 Milan, Italy
- Exercise Medicine Unit, Istituto Auxologico Italiano IRCCS, 20135 Milan, Italy
- Correspondence: or ; Tel.: +39-02-619-112-808
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15
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Lucini D, Malacarne M, Pagani M, Morizzo C, Kozakova M, Nannipieri M, Palombo C. A four-week prehabilitation program in candidates for bariatric surgery improves hemodynamic load, metabolism and cardiac autonomic regulation. Acta Diabetol 2021; 58:517-520. [PMID: 33515099 DOI: 10.1007/s00592-020-01645-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- D Lucini
- Exercise Medicine Unit, BIOMETRA Department, Humanitas Clinical and Research Center, University of Milan, Via Alessandro Manzoni, 56, Milan, Italy.
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - M Malacarne
- Exercise Medicine Unit, BIOMETRA Department, Humanitas Clinical and Research Center, University of Milan, Via Alessandro Manzoni, 56, Milan, Italy
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - M Pagani
- Exercise Medicine Unit, BIOMETRA Department, Humanitas Clinical and Research Center, University of Milan, Via Alessandro Manzoni, 56, Milan, Italy
| | - C Morizzo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | - M Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
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16
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Solaro N, Pagani M, Lucini D. Altered Cardiac Autonomic Regulation in Overweight and Obese Subjects: The Role of Age-and-Gender-Adjusted Statistical Indicators of Heart Rate Variability and Cardiac Baroreflex. Front Physiol 2021; 11:567312. [PMID: 33584323 PMCID: PMC7876296 DOI: 10.3389/fphys.2020.567312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
In the context of functional determinants of cardiovascular risk, a simple excess in body weight, as indexed by a rise in body mass index (BMI), plays a significant, well-recognized causal role. Conversely, BMI reductions toward normal result in an improvement of risk. Obesity is associated with impaired cardiac autonomic regulation (CAR), through either vagal or sympathetic mechanisms, which could favor the tendency to foster hypertension. Here we study the changing properties of the relationship between increasing grades of BMI and CAR in a population of 756 healthy subjects (age 35.9 ± 12.41 years, 37.4% males, 21.6% overweight, and 16% obese). Evaluation of CAR is based on autoregressive spectral analysis of short-term RR interval and systolic arterial pressure variability, from which a multitude of indices, treated overall as autonomic nervous system (ANS) proxies, is derived. Inspection of the study hypothesis that elevated BMI conditions associate significantly with alterations of CAR, independently of age and gender, is carried out using a mix of statistical transformations, exploratory factor analysis, non-parametric testing procedures, and graphical tools particularly well suited to address alterations of CAR as a disturbed process. In particular, to remove the effects of the inter-individual variability, deriving from components like age, gender or ethnicity, and to reduce the number of ANS proxies, we set up six age-and-gender-adjusted CAR indicators, corresponding to four ANS latent domains (oscillatory, amplitude, pressure, and pulse), cardiac baroreflex regulation, and autonomic nervous system index (ANSI). An impairment of the CAR indicators is overall evident in the overweight group and more marked in the obesity group. Empirical evidence is strong (9/9 concordant non-parametric test results) for pressure domain, almost strong (8/9) for ANSI, medium-strong for baroreflex (6/9) and pulse (7/9), weak for oscillatory (2/9) and amplitude (1/9) domains. In addition, the distribution of the CAR indicators corresponding to pressure, pulse, baroreflex, and ANSI is skewed toward the unfavorable abscissa extremity, particularly in the obese group. The significant association of increased BMI with progressive impairments of CAR regarding specifically the pressure domain and the overall ANS performance might underscore the strong hypertensive tendency observed in obesity.
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Affiliation(s)
- Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Massimo Pagani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Daniela Lucini
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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17
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De Maria B, de Oliveira Gois M, Catai AM, Marra C, Lucini D, Porta A, Pagani M, Dalla Vecchia LA. Ten-year follow-up of cardiac function and neural regulation in a group of amateur half-marathon runners. Open Heart 2021; 8:openhrt-2020-001561. [PMID: 33563778 PMCID: PMC7875294 DOI: 10.1136/openhrt-2020-001561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Objective In the last years, a debate exists about type, intensity and frequency of physical exercise that is really indicated to protect healthy subjects from cardiovascular disease. Regular physical training has been associated with an improved cardiovascular risk profile, but it has also been demonstrated that strenuous and uncontrolled physical exercise could be dangerous, in terms of increased cardiovascular morbidity and mortality. In the present study, we evaluated a group of 35 amateur half-marathon runners, who were likewise studied 10 years before (B). The results of B suggested that an increased cardiac sympathetic modulation could potentially represent a negative prognostic factor. The aim of this follow-up was to assess the medium–long-term effects of moderate to vigorous physical training on the cardiovascular neural control, cardiac function and occurrence of cardiovascular diseases. Methods Each enrolled subject underwent: (1) an interview and physical examination to ascertain the presence of cardiovascular disease; (2) standing test to evaluate the cardiovascular neural control by means of heart rate variability (HRV), arterial blood pressure (AP) variability and baroreflex sensitivity (BRS); (3) transthoracic echocardiography to evaluate cardiac function. Results At 10-year follow-up (FU), in this group of middle-aged athletes the occurrence of cardiovascular diseases was low, not unlike that of the overall population. The results of HRV analysis showed a decreased sympathetic and increased vagal modulation directed to the heart, compared with B. In addition, HRV, AP variability and BRS indices showed a physiological response to active standing. Finally, athletes had normal echocardiographic measures. Conclusion We conclude that in our group of athletes a regular moderate–vigorous physical training through the 10 years was quite beneficial as the prevalence of sympathetic cardiac modulation observed at B was not accompanied by increased cardiovascular risk, on the contrary a slight prevalence of vagal indices was observed at FU.
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Affiliation(s)
- Beatrice De Maria
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | | | - Aparecida Maria Catai
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Christian Marra
- Department of Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Milano, Italy
| | - Daniela Lucini
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Pagani
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milano, Italy
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18
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Cazzaniga ME, Giordano M, Bandera M, Cassani C, Bounous V, Lania A, Biasi G, Destro M, Ricci S, Lucini D, Biglia N, Pagani O. Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project. Clin Breast Cancer 2021; 21:e547-e560. [PMID: 33685833 DOI: 10.1016/j.clbc.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy.
| | - Monica Giordano
- Oncology Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Mirko Bandera
- Farmacie Sant'Agata, Pharmacy Group, Bulgarograsso (Como), Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Valentina Bounous
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Biomedicine Department, Humanitas University, Milan, Italy
| | - Giovanna Biasi
- Prevention Department, Unità Operativa Complessa Medicine and Sport and Exercise, Treviso, Italy
| | - Maurizio Destro
- Medical Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio (BG) Italy
| | - Sauro Ricci
- Executive Chef, Joja Restaurant, Milan, Italy
| | - Daniela Lucini
- Exercise Medicine Unit, University of Milan BIOMETRA Department, Humanitas Clinical and Research Center, Milan, Italy
| | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Olivia Pagani
- EOC Istituto Oncologico della Svizzera Italiana Ospedale Regionale Bellinzona e Valli 6500, Bellinzona, Switzerland
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19
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Lucini D, Pagani M. Exercise Prescription to Foster Health and Well-Being: A Behavioral Approach to Transform Barriers into Opportunities. Int J Environ Res Public Health 2021; 18:968. [PMID: 33499284 PMCID: PMC7908585 DOI: 10.3390/ijerph18030968] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/12/2022]
Abstract
The current literature contains multiple examples of exercise interventions to foster health and to prevent/treat many chronic non-communicable diseases; stress and functional syndromes. On the other hand, sedentariness is increasing and to transform a sedentary subject into a regular exerciser is not only very difficult but considered by some unrealistic in current clinical practice. Ideally a physical activity intervention may be considered actually efficacious when it outgrows the research setting and becomes embedded in a system, ensuring maintenance and sustainability of its health benefits. Physicians need specific skills to improve patients' exercise habits. These range from traditional clinical competencies, to technical competencies to correctly prescribe exercise, to competencies in behavioral medicine to motivate the subject. From a behavioral and medical point of view, an exercise prescription may be considered correct only if the subject actually performs the prescribed exercise and this results in an improvement of physiological mechanisms such as endocrine, immunological and autonomic controls. Here we describe a model of intervention intended to nurture exercise prescription in everyday clinical setting. It aims to a tailored prescription, starts from the subject's assessment, continues defining clinical goals/possible limitations and ends when the subject is performing exercise obtaining results.
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Affiliation(s)
- Daniela Lucini
- BIOMETRA Department, University of Milan, 20122 Milano, Italy;
- Exercise Medicine Unit, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
| | - Massimo Pagani
- BIOMETRA Department, University of Milan, 20122 Milano, Italy;
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Riglietti A, Fanfulla F, Pagani M, Lucini D, Malacarne M, Manconi M, Ferretti G, Esposito F, Cereda CW, Pons M. Obstructive and Central Sleep Apnea in First Ever Ischemic Stroke are Associated with Different Time Course and Autonomic Activation. Nat Sci Sleep 2021; 13:1167-1178. [PMID: 34295200 PMCID: PMC8291804 DOI: 10.2147/nss.s305850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Sleep-related breathing disorders are highly prevalent in patients with ischemic stroke. Among sleep-disordered breathing disorders, obstructive sleep apnea is the most represented one, but central sleep apnea, isolated or in the context of a periodic breathing/Cheyne-Stokes respiration, is frequently reported in these patients. Altered baroreflex responses have been reported in the acute phases of a cerebral event. METHODS We conducted, in a group of patients with ischemic stroke (n=60), a prospective 3-month follow-up physiological study to describe the breathing pattern during sleep and baroreflex sensitivity in the acute phase and in the recovery phase. RESULTS In the acute phase, within 10 days from the onset of symptoms, 22.4% of patients had a normal breathing pattern, 40.3% had an obstructive pattern, 16.4% had a central pattern, and 29.9% showed a mixed pattern. Smaller variations in the Apnea-Hypopnea Index were found in normal breathing and obstructive groups (ΔAHI 2.1±4.1 and -2.8±11.6, respectively) in comparison with central and mixed patterns (ΔAHI -6.9±15.1 and -12.5±13.1, respectively; ANOVA p=0.01). The obstructive pattern became the most frequent pattern, in 38.3% of patients at baseline and 61.7% of patients at follow-up. Modification of baroreflex sensitivity over time was influenced by the site of the lesion and by the sleep disorder pattern in the acute phase (MANOVA p=0.005). CONCLUSION We suggest that a down-regulation of autonomic activity, possibly related to reduced vagal modulation, may help the recovery after stroke, or a transitory disconnection from the cortical node that participates in the regulation of sympathetic outflow.
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Affiliation(s)
- Alessia Riglietti
- Department of Pulmonology, Regional Hospital of Lugano (EOC), Lugano, 6900, Switzerland
| | - Francesco Fanfulla
- Respiratory Function and Sleep Unit - Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Istituto Auxologico Italiano, MIlan, 20133, Italy
| | - Daniela Lucini
- Exercise Medicine Unit, Istituto Auxologico Italiano, MIlan, 20133, Italy.,University of Milan, BIOMETRA Department, Milan, Italy
| | - Mara Malacarne
- Exercise Medicine Unit, Istituto Auxologico Italiano, MIlan, 20133, Italy.,University of Milan, BIOMETRA Department, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Guido Ferretti
- Department APSI, University of Geneva, Geneva, Switzerland.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlo W Cereda
- Stroke Center EOC, Department of Neurology, Neurocenter of Southern Switzerland Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Marco Pons
- Department of Pulmonology, Regional Hospital of Lugano (EOC), Lugano, 6900, Switzerland
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21
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Lucini D, Gandolfi CE, Antonucci C, Cavagna A, Valzano E, Botta E, Chiari M, Mameli L, Nahum M, Brambilla MM, Castaldi SI, Biganzoli E. #StayHomeStayFit: UNIMI's approach to online healthy lifestyle promotion during the COVID-19 pandemic. Acta Biomed 2020; 91:e2020037. [PMID: 32921731 PMCID: PMC7716948 DOI: 10.23750/abm.v91i3.10375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 lockdown imposed radical changes in the lifestyles of the population through isolation measures, with considerable health, social, psychological and economic consequences. Lockdown measures may have exacerbated negative population behaviors regarding exercise and nutrition, with risk of weight gain and obesity, collectively predisposing to increased cardiometabolic risk and mortality. At particular risk of deleterious consequences were patients such as those affected by chronic non communicable diseases (CNCD). The benefits of regular exercise are evident at several levels of CNCD prevention, however, from a public health standpoint, it is important to consider they are also related to improved stress management, work/academic performance, and reduced illegal behavior, isolation and depression. Therefore, during enforced isolation, a primary goal for all individuals is to maintain energy balance. During lockdown, several lifestyle interventions were posted online, with the internet playing a major role in exercise and fitness promotion. Among these one must recognize the ambitious “#StayHomeStayFit” project by the University of Milan, providing useful general information and trustworthy advice regarding nutrition, physical activity, and psychological support, for the general population in a time of need. Data showed a total of 21224 views on various social media and webpages during the reference period, with a mean time of 4’ 17’’ spent per page/video. Given the health risks associated with population physical inactivity and unhealthy lifestyle, policymakers should evaluate the benefits of projects such as #StayHomeStayFit and consider how to maximize population perception and reach. After all, additional COVID-19 lockdowns might be implemented in the future. (www.actabiomedica.it)
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Affiliation(s)
- Daniela Lucini
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, Italy.
| | | | - Clara Antonucci
- Web and Graphics Communications Office, University of Milan, Italy.
| | - Anna Cavagna
- 1°level Institutional Communications Unit, University of Milan, Italy.
| | - Esther Valzano
- Internal Communications Office, University of Milan, Italy.
| | - Elena Botta
- Web and Graphics Communications Office, University of Milan, Italy.
| | - Matteo Chiari
- Internal Communications Office, University of Milan, Italy.
| | - Lorenzo Mameli
- Web and Graphics Communications Office, University of Milan, Italy.
| | - Margherita Nahum
- Web and Graphics Communications Office, University of Milan, Italy.
| | - Marina Marzia Brambilla
- Department of Language Mediation Sciences and Intercultural Studies, University of Milan, Italy.
| | | | - Elia Biganzoli
- Department of Clinical Sciences and Community Health, University of Milan, Italy.
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22
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Iellamo F, Lucini D, Volterrani M, Casasco M, Salvati A, Gianfelici A, Di Gianfrancesco A, Urso A, Manzi V. Autonomic nervous system responses to strength training in top-level weight lifters. Physiol Rep 2020; 7:e14233. [PMID: 31642195 PMCID: PMC6805848 DOI: 10.14814/phy2.14233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/10/2019] [Accepted: 07/24/2019] [Indexed: 11/24/2022] Open
Abstract
In athletes, spectral analysis of HR variability (HRV) has been shown capable to detect the adaptational changes in sympatho‐vagal control attending physical training. So far, studies investigated autonomic nervous system (ANS) changes occurring with endurance training, whereas adaptations to markedly different exercise modes, for example, strength training, have never been investigated. We assessed the changes in cardiac ANS parameters during long‐term training in weight lifters of the Italian team preparing for the European Championship, where athletes competed for obtaining the pass for Olympic Games. We investigated nine athletes. Subject trained 3 sessions/day, 6 days a week. The intensity of strength exercises varied from 70% to 95% 1 RM. Training load (TL) was calculated as: volume (min) × intensity (%1RM).All ANS parameters were significantly and highly correlated on an individual basis to the dose of exercise with a second‐order regression model (r2 ranged from 0.96 to 0.99; P < 0.001). The low‐frequency (LF) component of HRV and LF/HF ratio showed an initial increase with the progression of TL and then a decrease, resembling a bell‐shaped curve with a minimum at the highest TL. The high‐frequency (HF) component of HRV and R‐R interval showed a reciprocal pattern, with an initial decrease with progression of TL followed by an increase, resembling an U‐shaped curve with a maximum at the highest TL. These adaptations were at the opposite to those previously reported in endurance athletes. These results suggest that in Olympic weight lifters, ANS adaptations to training are dose‐related on individual basis and that ANS adaptations are mainly sport‐specific.
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Affiliation(s)
- Ferdinando Iellamo
- Department of Clinical Science and Translational Medicine and School of Sports Medicine, University Tor Vergata, Rome, Italy.,Scientific Institute of Research and Scientific Institute of Research and Care Care, San Raffaele Pisana, Rome, Italy
| | - Daniela Lucini
- BIOMETRA, Exercise Medicine Unit, University of Milan, Humanitas, Milan, Italy
| | - Maurizio Volterrani
- Scientific Institute of Research and Scientific Institute of Research and Care Care, San Raffaele Pisana, Rome, Italy
| | | | | | - Antonio Gianfelici
- Italian Federation of Sport Medicine, Rome, Italy.,Italian Federation of weight lifting, Rome, Italy
| | | | - Antonio Urso
- Italian Federation of weight lifting, Rome, Italy
| | - Vincenzo Manzi
- Scientific Institute of Research and Scientific Institute of Research and Care Care, San Raffaele Pisana, Rome, Italy
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23
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Affiliation(s)
- Leonarda Galiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, ROME
| | - Elisa Fedele
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, ROME
| | - Enrica Vitale
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, ROME
| | - Daniela Lucini
- Department of Cardiovascular Sciences, University of Milan, Milan, ITALY
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Cairo B, Bari V, De Maria B, Vaini E, Guaraldi P, Lucini D, Pagani M, Provini F, Buonaura GC, Cortelli P, Porta A. Assessing Synergy/Redundancy of Baroreflex and Non-Baroreflex Components of the Cardiac Control during Sleep. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4953-4956. [PMID: 31946971 DOI: 10.1109/embc.2019.8856887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular regulation and autonomic function change across sleep stages and compared to wake. Little information is present in literature about cardiac control during sleep especially in relation to new information-theoretic quantities such as synergy and redundancy. In the present work we compute synergy and redundancy of baroreflex and non-baroreflex components of the cardiac control according to two information-theoretic approaches, namely predictive information decomposition (PID) and minimal mutual information (MMI) methods. We applied a bivariate approach to heart period (HP) and systolic arterial pressure (SAP) beat-to-beat variability series during sleep in a healthy subject. PID approach computes the net balance between synergy and redundancy, while MMI calculates the two quantities as separate entities. Results suggested that: i) redundancy was dominant over synergy during NREM phases; ii) redundancy increased during NREM phase; iii) synergy did not change across the sleep stages. We interpret this result as a consequence of the vagal enhancement, slowing and deepening of respiration during NREM phases. These preliminary findings support the potential of assessing redundancy/synergy of baroreflex-related and unrelated regulations during sleep to improve our knowledge about physiological mechanisms.
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25
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Solaro N, Malacarne M, Pagani M, Lucini D. Cardiac Baroreflex, HRV, and Statistics: An Interdisciplinary Approach in Hypertension. Front Physiol 2019; 10:478. [PMID: 31114505 PMCID: PMC6503090 DOI: 10.3389/fphys.2019.00478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/05/2019] [Indexed: 01/04/2023] Open
Abstract
Interests about the fine underpinnings of cardiovascular beat-by-beat variability have historical roots. Over the last decades, various aspects of the relationships between arterial pressure and heart period were taken as a proxy of the baroreflex in physiology and medicine, stimulating the interest of investigators in several interconnected scientific fields, in particular, bioengineering, neurophysiology, and clinical medicine. Studies of the overall system facilitated the emergence of a simplified negative (vagal) feedback model of the baroreflex and overshadowed the simultaneous interaction with excitatory, sympathetic positive-feedback mechanisms that would, however, better suit the model of a "paired antagonistic (parasympathetic/sympathetic) innervation of the internal organs." From the bioengineering side, the simplicity of obtaining the series of subsequent RR intervals stimulated the analysis of beat-by-beat variations, providing a multitude of heart rate variability (HRV) indices considered as proxies of the underlying sympatho-vagal balance, and participating to the management of several important clinical conditions, such as hypertension. In this context, advanced statistical methods, used in an integrated manner and controlling for age and gender biases, might help shed new light on the relationship between cardiac baroreflex, assessed by the frequency domain index α, and the HRV indices with the varying of systolic arterial pressure (SAP) levels. The focus is also on a novel unitary Autonomic Nervous System Index (ANSI) built as a synthesis of HRV considering its three most informative proxies [RR, RR variance, and the rest-stand difference in the normalized power of low-frequency (LF) variability component]. Data from a relatively large set of healthy subjects (n = 1154) with a broad range of SAP [from normal (n Nt = 778) to elevated (n Ht = 232)] show that, e.g., α and ANSI significantly correlate overall (r = 0.523, p < 0.001), and that this correlation is lower in hypertensives (r = 0.444, p < 0.001) and higher in pre-hypertensives (r = 0.618, p < 0.001) than in normotensives (r = 0.5, p < 0.001). That suggests the existence of curvilinear "umbrella" patterns that might better describe the effects of the SAP states on the relationships between baroreflex and HRV. By a mix of robust, non-parametric and resampling statistical techniques, we give empirical support to this study hypothesis and show that the pre-hypertensive group results at the apex/bottom in most of the studied trends.
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Affiliation(s)
- Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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26
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Oggionni G, Spataro A, Pelliccia A, Malacarne M, Pagani M, Lucini D. Left ventricular hypertrophy in world class elite athletes is associated with signs of improved cardiac autonomic regulation. Eur J Prev Cardiol 2019; 28:1118-1124. [PMID: 37039767 DOI: 10.1177/2047487319830534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/23/2019] [Indexed: 12/20/2022]
Abstract
AIM In this study we sought to assess whether in elite athletes the physiological increase in cardiac mass attending severe long-term training leading to athlete's heart is accompanied by an improvement of autonomic performance, as assessed by post exercise vagal indices and a novel unitary Autonomic Nervous System Index for sports (ANSIs). METHODS The study involved 500 elite athletes (23.9 ± 6.4 years) participating in a screening organised by the National Italian Olympic Committee. All subjects underwent a complete medical examination, rest and stand autonomic assessment (heart rate variability) as well as bicycle exercise. ANSIs was also derived as radar plot from rest, stand and heart rate recovery individual proxies of autonomic nervous system regulation. All subjects were grouped into those with left ventricular hypertrophy present (LVH(+)), or not (LVH(-)), according to recognised thresholds. RESULTS We observed that LVH(+) athletes (24.8%) showed a marked increase of post-exercise vagal indices ( p < 0.001) and of ANSIs ( p < 0.001), while no difference was observed for heart-rate variability indices. These changes were contingent upon sport intensity categories. CONCLUSIONS Elite athletes with physiological cardiac hypertrophy (LVH(+)) present a selective profile of indices of autonomic nervous system performance, characterised by increases of markers of vagal recovery and of the novel unitary autonomic index for sports while RR variance and spectral indices seem to be unmodified. Athlete's heart may be characterised by a specific combination of anatomical and neurocardiac remodeling. This approach might furnish potential warning signs differentiating normal training induced physiology from pathological adaptation.
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Affiliation(s)
| | | | | | - Mara Malacarne
- 1 BIOMETRA Department, University of Milan, Italy.,3 Exercise Medicine Unit, Humanitas Clinical and Research Center, Italy
| | | | - Daniela Lucini
- 1 BIOMETRA Department, University of Milan, Italy.,3 Exercise Medicine Unit, Humanitas Clinical and Research Center, Italy
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Porta A, Bari V, Ranuzzi G, De Maria B, Malacarne M, Pagani M, Lucini D. Evaluating the association between cardiac and peripheral resistance arms of the baroreflex. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2017:3114-3117. [PMID: 29060557 DOI: 10.1109/embc.2017.8037516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The study proposes an extension of cardiac baroreflex (cBR) sequence analysis, traditionally performed over spontaneous fluctuations of heart period and systolic arterial pressure, to typify peripheral resistance baroreflex (prBR) from spontaneous variations of peripheral resistances and diastolic arterial pressure. The prBR baroreflex sensitivity (BRSprBR) and percentage of prBR sequences (SEQ%prBR) were computed along with analogous quantities assessed over cBR (i.e. BRScBR and SEQ%cBR). The cBR and prBR were typified in healthy subjects at rest (REST) and during light bicycle ergometer exercise at 10 percent of the maximal effort (EXE). Both cBR and prBR were affected by EXE: indeed, BRScBR and SEQ%prBR were significantly reduced. Moreover, while BRScBR and BRSprBR were not significantly associated, SEQ%cBR and SEQ%prBR were, and the correlation coefficient was positive. This study suggests that prBR can be typified from spontaneous variabilities along with the more traditional cBR, thus enlarging the possibility of monitoring human cardiovascular control mechanisms.
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Porta A, Bari V, De Maria B, Cairo B, Vaini E, Malacarne M, Pagani M, Lucini D. On the Relevance of Computing a Local Version of Sample Entropy in Cardiovascular Control Analysis. IEEE Trans Biomed Eng 2018; 66:623-631. [PMID: 29993481 DOI: 10.1109/tbme.2018.2852713] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Traditional definition of sample entropy (SampEn), here referred to as global SampEn (GSampEn), provides a conditional entropy estimate that blurs the local statistical properties of the time series. We hypothesized that a local version of SampEn (LSampEn) might be more powerful in the presence of determinism than GSampEn. METHODS LSampEn was computed by calculating the probability of the current sample conditioned on each reference pattern and averaging it over all reference patterns. The improved ability of LSampEn compared to GSampEn was demonstrated by simulating deterministic periodic, deterministic chaotic, and linear stochastic dynamics corrupted by additive noise and over real cardiovascular variability series recorded from 16 healthy subjects (max-min age range: 22-58 years) during incremental bicycle ergometer exercise. RESULTS We found that: i) LSampEn is more robust in describing deterministic periodic or nonlinear features in the presence of additive noise than GSampEn, ii) in association with a surrogate approach, LSampEn is more powerful in detecting nonlinear dynamics than GSampEn, iii) LSampEn and GSampEn are equivalent in the presence of stochastic linear dynamics, and iv) only LSampEn can detect the decrease of complexity of heart period variability during bicycle exercise being a likely hallmark of sympathetic activation. CONCLUSION LSampEn preserves the GSampEn capability in characterizing the complexity of short sequences but improves its reliability in the presence of deterministic patterns featuring sharp state transitions and nonlinear dynamics. SIGNIFICANCE Variations of complexity can be measured with a greater statistical power over short series using LSampEn, especially when nonlinear features are present.
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Porta A, Bari V, Maria BD, Cairo B, Vaini E, Malacarne M, Pagani M, Lucini D. Peripheral Resistance Baroreflex During Incremental Bicycle Ergometer Exercise: Characterization and Correlation With Cardiac Baroreflex. Front Physiol 2018; 9:688. [PMID: 29922179 PMCID: PMC5996055 DOI: 10.3389/fphys.2018.00688] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
The arm of the baroreflex (BR) controlling peripheral resistances (PR), labeled as BR of PR (prBR), was characterized through an extension of the cardiac BR (cBR) sequence analysis. The method exploits recordings of skin blood flow (SBF) from the palm of the non-dominant hand via a laser Doppler flowmeter and of arterial pressure (AP) from the middle finger of the same hand via a plethysmographic device. PR was estimated beat-by-beat as the ratio of mean AP to mean SBF computed over the same heart period (HP). Peripheral resistances-diastolic arterial pressure (PR-DAP) sequences featuring simultaneous increases of PR and decreases of diastolic AP (DAP) or vice versa were identified and the slope of the regression line in the (DAP, PR) plane was taken as an estimate of prBR sensitivity (BRSprBR). The percentage of prBR sequences (SEQ%prBR) was taken as a measure of prBR involvement and the prBR effectiveness index (EIprBR) was computed as the fraction of DAP sequences capable to drive antiparallel PR variations. Analogous markers were computed over cBR from HP and systolic AP (SAP) variability [i.e., cBR sensitivity (BRScBR), percentage of cBR sequences (SEQ%cBR), and effectiveness index of the cBR (EIcBR)]. prBR and cBR were typified during incremental light-to-moderate bicycle ergometer exercise at 10, 20, and 30% of the maximum effort in 16 healthy subjects (aged from 22 to 58 years, six males). We found that: (i) BRScBR decreased gradually with the challenge, while BRSprBR declined only at the heaviest workload; (ii) SEQ%cBR decreased solely at the lightest workload, while the decline of SEQ%prBR was significant regardless of the intensity of the challenge; (iii) EIprBR and EIcBR were not affected by exercise; (iv) after pooling together all the data regardless of the experimental conditions, BRSprBR and BRScBR were uncorrelated, while SEQ%cBR and SEQ%prBR as well as EIcBR and EIprBR, were significantly and positively correlated; (v) when the correlation between SEQ%cBR and SEQ%prBR and between EIcBR and EIprBR was assessed separately in each experimental condition, it was not systematically detected. This study suggests that prBR characterization provides information complementary to cBR that might be fruitfully exploited to improve patients' risk stratification.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Vlasta Bari
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Emanuele Vaini
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Mara Malacarne
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Pagani
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy
| | - Daniela Lucini
- Dipartimento di Biotecnologie Mediche e Medicina Traslazionale, University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Milan, Italy
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Lucini D, Solaro N, Pagani M. Autonomic Differentiation Map: A Novel Statistical Tool for Interpretation of Heart Rate Variability. Front Physiol 2018; 9:401. [PMID: 29740334 PMCID: PMC5924813 DOI: 10.3389/fphys.2018.00401] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/04/2018] [Indexed: 11/26/2022] Open
Abstract
In spite of the large body of evidence suggesting Heart Rate Variability (HRV) alone or combined with blood pressure variability (providing an estimate of baroreflex gain) as a useful technique to assess the autonomic regulation of the cardiovascular system, there is still an ongoing debate about methodology, interpretation, and clinical applications. In the present investigation, we hypothesize that non-parametric and multivariate exploratory statistical manipulation of HRV data could provide a novel informational tool useful to differentiate normal controls from clinical groups, such as athletes, or subjects affected by obesity, hypertension, or stress. With a data-driven protocol in 1,352 ambulant subjects, we compute HRV and baroreflex indices from short-term data series as proxies of autonomic (ANS) regulation. We apply a three-step statistical procedure, by first removing age and gender effects. Subsequently, by factor analysis, we extract four ANS latent domains that detain the large majority of information (86.94%), subdivided in oscillatory (40.84%), amplitude (18.04%), pressure (16.48%), and pulse domains (11.58%). Finally, we test the overall capacity to differentiate clinical groups vs. control. To give more practical value and improve readability, statistical results concerning individual discriminant ANS proxies and ANS differentiation profiles are displayed through peculiar graphical tools, i.e., significance diagram and ANS differentiation map, respectively. This approach, which simultaneously uses all available information about the system, shows what domains make up the difference in ANS discrimination. e.g., athletes differ from controls in all domains, but with a graded strength: maximal in the (normalized) oscillatory and in the pulse domains, slightly less in the pressure domain and minimal in the amplitude domain. The application of multiple (non-parametric and exploratory) statistical and graphical tools to ANS proxies defines differentiation profiles that could provide a better understanding of autonomic differences between clinical groups and controls. ANS differentiation map permits to rapidly and simply synthesize the possible difference between clinical groups and controls, evidencing the ANS latent domains that have at least a medium strength of discrimination, while the significance diagram permits to identify the single ANS proxies inside each ANS latent domain that resulted in significant comparisons according to statistical tests.
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Affiliation(s)
| | - Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Minetto MA, Motta G, Gorji NE, Lucini D, Biolo G, Pigozzi F, Portincasa P, Maffiuletti NA. Reproducibility and validity of the Italian version of the International Physical Activity Questionnaire in obese and diabetic patients. J Endocrinol Invest 2018; 41:343-349. [PMID: 28825210 DOI: 10.1007/s40618-017-0746-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/11/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Aims of this study were to evaluate the agreement between the short and long versions of the International Physical Activity Questionnaire (IPAQ: Italian versions), their reproducibility (agreement and reliability) and construct validity (relative to pedometry) in a clinical population. METHODS Ninety patients affected by obesity (N = 39), type 2 diabetes mellitus (N = 26) or both (N = 25) were recruited. They were asked to maintain their usual physical activity habits during two consecutive weeks and to fill the questionnaires twice (at the end of each week). They were also asked to wear a pedometer for 7 consecutive days after the first administration of the questionnaires. RESULTS We found acceptable agreement between the IPAQ short and long versions (ICC2,1 values were 0.81 and 0.77 for the 1st and 2nd administration), uncertain reproducibility (acceptable reliability but poor agreement) and inadequate validity relative to pedometry (the correlation coefficients between all IPAQ scores and daily steps were <0.50) for both IPAQ short and IPAQ long. CONCLUSIONS The IPAQ use may be justified in daily clinical practice and in clinical research (e.g., in cross-sectional studies) for a simple and rapid evaluation of the physical activity level for discriminative purposes. However, the use of these questionnaires does not appear suitable for prospective interventional studies in which the level of physical activity of the recruited patients has to be assessed over time.
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Affiliation(s)
- M A Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
- Division of Endocrinology, Diabetology and Metabolism, University of Turin, Turin, Italy.
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, University of Turin, Turin, Italy
| | - N E Gorji
- Division of Endocrinology, Diabetology and Metabolism, University of Turin, Turin, Italy
| | - D Lucini
- Biometra Department, University of Milan, Milan, Italy
| | - G Biolo
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - F Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - P Portincasa
- Department of Biomedical Sciences and Human Oncology, University "Aldo Moro" of Bari Medical School, Bari, Italy
| | - N A Maffiuletti
- Human Performance Laboratory, Schultess Clinic, Zurich, Switzerland
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Lucini D, Sala R, Spataro A, Malacarne M, Benzi M, Tamorri S, Pagani M. Can the use of a single integrated unitary autonomic index provide early clues for eventual eligibility for olympic games? Eur J Appl Physiol 2018; 118:919-926. [PMID: 29450627 DOI: 10.1007/s00421-018-3822-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/06/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Optimal autonomic regulation and stress resilience might be considered critical elements of athletic performance. We hypothesize that a novel unitary autonomic index for sports (ANSIs), together with a somatic stress related symptom score (4SQ) might help characterize athletes who were eventually selected for the Rio 2016 Olympic Games Italian team (Rio +). METHODS In this retrospective study we examined 778 athletes (age 24.4 ± 6.7 yrs) who underwent a planned yearly pre-participation screening. All athletes underwent clinical, autonomic and exercise ECG evaluation. The combination of vagal and sympathetic indices from RR variability into ANSIs was performed by radar plot and percent ranking of index variables. We assessed (Rio +) versus (Rio -) athletes also after subdivision into three sport intensity groups (low, mid and high intensity). RESULTS Overall there were no significant differences between (Rio +) and (Rio -) athletes when considering individual spectral derived variables. Conversely, the unitary Index ANSIs was significantly higher in (Rio +) compared to (Rio -) athletes (respectively 54.5 ± 29.5 and 47.9 ± 28.4 p = 0.014). This difference was particularly evident (p = 0.017) in the group of athletes characterized by both high static and dynamic components. 4SQ was smaller in the (Rio +) group, particularly in the groups of athletes characterized by both low-medium static and dynamic components. CONCLUSIONS ANSIs, a proxy of integrated cardiac autonomic regulation and simple assessment of resilience to stress, may differentiate Italian athletes who were eventually selected for participation in the 2016 Rio Olympic Games from those who were not, suggesting the possibility of a "winning functional phenotype".
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Affiliation(s)
- Daniela Lucini
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy. .,Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano (Milano), Italy.
| | - Roberto Sala
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy
| | | | - Mara Malacarne
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano (Milano), Italy
| | | | | | - Massimo Pagani
- BIOMETRA University of Milano, Via Alessandro Manzoni, 56, 20089, Rozzano (Milano), Italy
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Sala R, Malacarne M, Tosi F, Benzi M, Solaro N, Tamorri S, Spataro A, Pagani M, Lucini D. May a unitary autonomic index help assess autonomic cardiac regulation in elite athletes? Preliminary observations on the national Italian Olympic committee team. J Sports Med Phys Fitness 2017; 57:1702-1710. [DOI: 10.23736/s0022-4707.17.06998-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lucini D, Vigo C, Malacarne M, Gatzemeier W, Pagani M. Lifestyle changes as internal medicine. Eur J Intern Med 2017; 43:e40-e42. [PMID: 28602245 DOI: 10.1016/j.ejim.2017.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Daniela Lucini
- University of Milan, BIOMETRA Department, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Chiara Vigo
- University of Milan, BIOMETRA Department, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Mara Malacarne
- University of Milan, BIOMETRA Department, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Di Girolamo FG, Situlin R, Fiotti N, Tence M, De Colle P, Mearelli F, Minetto MA, Ghigo E, Pagani M, Lucini D, Pigozzi F, Portincasa P, Toigo G, Biolo G. Higher protein intake is associated with improved muscle strength in elite senior athletes. Nutrition 2017; 42:82-86. [PMID: 28870484 DOI: 10.1016/j.nut.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/31/2017] [Accepted: 05/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The optimal protein intake for elderly individuals who exercise regularly has not yet been clearly defined. The aim of this study was to test the hypothesis that protein intake level is associated with muscle strength in elderly elite athletes. METHODS We evaluated 50 elite senior athletes (38 men and 12 women) participating in the European Master Games 2011 in an observational cross-sectional study. Participants were divided into two groups-lower (LPI) or higher (HPI) protein intake-according to the median value of their ratio of urinary urea nitrogen to urinary creatinine (i.e., 8.8 g/L), as a marker of protein intake. A dietary interview confirmed differences in protein consumption between the LPI and HPI groups. We also evaluated body composition (bioimpedance), muscle strength, and hematochemical indices. RESULTS LPI and HPI groups were homogeneous for age (72 [68-74] and 71 [68-74] y, respectively), fat-free mass index (18.4 [17-19.4] and 18.2 [17-19.1] kg/m2), body fat (18.3% [12.3-20.7%] and 16.6% [13.6-21.2%]), and glomerular filtration rate (57.7 [53.8-64.9] and 62.7 [56.1-69.3] mL/min/1.73 m2). The HPI group showed greater leg and trunk muscle strength (N) compared with the LPI group (left leg extension, 339 [238-369] versus 454 [273-561], respectively, P < 0.05; right leg extension, 319 [249-417] versus 432 [334-635], P ≤ 0.05; trunk extension, 435 [370-467] versus 464 [390-568], P ≤ 0.05). CONCLUSIONS Higher protein intake in elite senior athletes is associated with a greater muscle strength.
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Affiliation(s)
- Filippo Giorgio Di Girolamo
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Roberta Situlin
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nicola Fiotti
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marcello Tence
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo De Colle
- Geriatric Unit ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Filippo Mearelli
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Marco Alessandro Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy; Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | | | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Piero Portincasa
- Department of Biomedical Sciences & Human Oncology, University "Aldo Moro" of Bari Medical School, Bari, Italy
| | - Gabriele Toigo
- Geriatric Unit ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Gianni Biolo
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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Lucini D, Marchetti I, Spataro A, Malacarne M, Benzi M, Tamorri S, Sala R, Pagani M. Heart rate variability to monitor performance in elite athletes: Criticalities and avoidable pitfalls. Int J Cardiol 2017; 240:307-312. [PMID: 28495249 DOI: 10.1016/j.ijcard.2017.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Spectral analysis of Heart Rate Variability (HRV) is a simple, non-invasive technique that is widely used in sport to assess sympatho-vagal regulation of the heart. Its employment is increasing partly due to the rising usage of wearable devices. However data acquisition using these devices may be suboptimal because they cannot discriminate between sinus and non-sinus beats and do not record any data regarding respiratory frequency. This information is mandatory for a correct clinical interpretation. METHODS This study involved 974 elite athletes, all of them underwent a complete autonomic assessment, by way of Autoregressive HRV analysis. RESULTS In 91 subjects (9% of the total population) we observed criticalities of either cardiac rhythm or respiration. Through perusal of one-lead ECG analysis we observed that 77 subjects had atrial or ventricular ectopy, i.e. conditions which impair stationarity and sinus rhythm. Running anyway autonomic nervous system analysis in this population, we observed that RR variance and raw values of LF and HF regions are significantly higher in arrhythmic subjects. In addition 14 subjects had slow (about 6 breath/min, 0.1Hz) respiration. This condition clouds the separation between LF from HF spectral regions of RR interval variability, respectively markers of the prevalent sympathetic and vagal modulation of SA node and of their synergistic interaction. CONCLUSIONS Caution must be payed when assessing HRV with non-ECG wearable devices. Recording ECG signal and ensuring that respiratory rate is higher than 10 breath/min are both prerequisites for a more reliable analysis of HRV particularly in athletes.
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Affiliation(s)
- Daniela Lucini
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy; Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano 20089, Italy.
| | - Ilaria Marchetti
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
| | - Antonio Spataro
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Mara Malacarne
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy; Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano 20089, Italy
| | - Manuela Benzi
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Stefano Tamorri
- Sports Medicine Institute CONI, largo G Onesti 1, Rome 00197, Italy
| | - Roberto Sala
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
| | - Massimo Pagani
- University of Milano, BIOMETRA, via Vanvitelli 32, Milano 20129, Italy
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Sala R, Malacarne M, Solaro N, Pagani M, Lucini D. A composite autonomic index as unitary metric for heart rate variability: a proof of concept. Eur J Clin Invest 2017; 47:241-249. [PMID: 28102898 DOI: 10.1111/eci.12730] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/16/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study addresses whether a unitary cardiac autonomic nervous system index (ANSI), obtained combining multiple metrics from heart rate variability (HRV) into a radar plot could provide an easy appreciation of autonomic performance in a clinical setting. MATERIALS AND METHODS Data are standardized using percentile ranking of autonomic proxies from a relatively large reference population (n = 1593, age 39 ± 13 years). Autonomic indices are obtained from autoregressive spectral analysis of (ECG derived) HRV at rest and during standing up. A reduced ANSI (using RR, RR variance and rest-stand difference of LFnu) is then constructed as a radar plot, quantified according to its combined area and tested against different risk subgroups. RESULTS With growing risk profile, there is a marked reduction of the rank value of ANSI, quantified individually by the radar plot area. The practical usefulness of the approach was tested in small groups of additional subjects putatively characterized by elevated or poor autonomic performance. Data show that elite endurance athletes are characterized by elevated values of ANSI (80·6 ± 14·9, P < 0·001) while subjects with either Type 1 or Type 2 diabetes show lower values (DM1 = 37·0 ± 18·9 and DM2 = 26·8 ± 23·3, P = 0·002), and patients with coronary artery disease (CAD) represent a nadir (17 ± 20, P < 0·001). CONCLUSIONS This observational study shows the feasibility of testing simpler metrics of cardiac autonomic regulation based on a multivariate unitary index in a preventive setting. This simple approach might foster a wider application of HRV in the clinical arena, and permit an easier appreciation of autonomic performance.
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Affiliation(s)
- Roberto Sala
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Mara Malacarne
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milano, Italy
| | - Massimo Pagani
- BIOMETRA Department, University of Milano, Milano, Italy
| | - Daniela Lucini
- BIOMETRA Department, University of Milano, Milano, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Hospital, Rozzano, Italy
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Sala R, Malacarne M, Pagani M, Lucini D. Association between aerobic fitness and indices of autonomic regulation: cardiovascular risk implications. J Sports Med Phys Fitness 2016; 56:794-801. [PMID: 25678208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND In the general population higher levels of exercise capacity seem to protect the cardiovascular system with effects well beyond traditional risk factors. We hypothesize that this phenomenon, called "risk factor gap", could be ascribed to functional components, such as autonomic adaptation to aerobic training. METHODS In 257 subjects (age 36.2±0.8 years) we measured VO2peak (incremental cycling exercise), together with arterial pressure and autonomic proxies (baroreflex gain, R-R variance and standing induced increase in marker of excitatory oscillatory regulation of the SA node, ∆LFRRnu). RESULTS Autonomic proxies appeared significantly correlated with indicators of aerobic fitness (age and gender corrected correlation between VO2peak, baroreflex gain: r=0.277, P<0.001, and DAP r=-0.228, P<0.001). Subsequently, subjects were subdivided in three age and gender adjusted categories of VO2peak (poor, medium and good). Autonomic indices and arterial pressure appeared significantly ordered with categories of VO2peak (P<0.006). In addition, within these categories the proportion of subjects with a desirable autonomic and pressure profile becomes significantly greater with better fitness levels. CONCLUSIONS The strong ordered relationship between categories of aerobic fitness and autonomic proxies speaks in favor of a complementary role of the autonomic nervous system in the management of cardiovascular risk factor gap at a population level.
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Affiliation(s)
- Roberto Sala
- Department of Sports Medicine, University of Milan, Milan, Italy -
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Lucini D, Zanuso S, Solaro N, Vigo C, Malacarne M, Pagani M. Reducing the risk of metabolic syndrome at the worksite: preliminary experience with an ecological approach. Acta Diabetol 2016; 53:63-71. [PMID: 25863782 DOI: 10.1007/s00592-015-0744-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/14/2015] [Indexed: 12/11/2022]
Abstract
AIM Given the time spent at work, the workplace represents an ideal setting to implement preventive programs for non-communicable diseases, the major cause of mortality and morbidity in Western and developing countries. We sought to verify if an ecological approach based on corporate culture, employees' education and concrete modifications of workplace environment, offering easy opportunity to assume healthy lifestyle, could be associated with reduced cardiometabolic risk. METHODS The study involved 1089 workers in two multinational companies following different workplace health promotion policies. Company A offered to all employees the opportunity to access a web platform dedicated to general information on health and diseases. Company B implemented an ecological model encompassing company culture, employees' education and concrete modifications of workplace environment, giving to all employees the opportunity to adopt healthy solutions throughout daily living at workplace. Participants volunteered self-reported clinical information using an IT tool. Numbers of Metabolic Syndrome components (MetS) were taken as proxy of cardiometabolic risk. RESULTS MetS probability obtained via statistical modeling was lower in company B as compared to company A, and absenteeism was also lower in company B. Our study shows that a work environment favoring assumption of healthy lifestyle, as in company B, is associated with a lower percentage of employees with MetS components and lower absenteeism. Moreover, statistical modeling shows that individual probabilities of being without MetS elements, controlling for age and gender, is remarkably higher in company B. CONCLUSIONS Our data suggest that ecological approaches might be useful in worksite prevention policies.
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Affiliation(s)
- Daniela Lucini
- BIOMETRA, University of Milano, Milan, Italy.
- Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy.
| | - Silvano Zanuso
- University of Greenwich, Chatham Maritime, London, UK
- Technogym Scientific Department, Cesena, Italy
| | - Nadia Solaro
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Chiara Vigo
- BIOMETRA, University of Milano, Milan, Italy
- Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
| | - Mara Malacarne
- BIOMETRA, University of Milano, Milan, Italy
- Sezione Medicina dell'Esercizio e Patologie Funzionali, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
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Lucini D, Cesana G, Vigo C, Malacarne M, Pagani M. Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept. Eur J Intern Med 2015; 26:680-4. [PMID: 26076943 DOI: 10.1016/j.ejim.2015.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors amenable to change. Accordingly, addressing behavior might represent a strategic change in the health delivery system. Improving lifestyle requires a specific strategy embedding the active collaboration of individuals with a multilevel team-oriented medical practice. With the present study we sought to assess whether the implementation of cognitive-behavioral strategies, following the principles of lifestyle medicine in an outpatient clinic provides better results in weight reduction as compared to simpler strategies as presently executed in General Practitioners' offices. METHODS This is an observational study on 173 subjects (age 53.1 ± 11.5), comparing three different groups of preventive practice: a personalized lifestyle medicine, combining cognitive behavioral strategies with patient tailored prescription of exercise and nutrition (Group A); a semi-structured approach with generic counseling (Group B); and an unstructured advice (Group C). RESULTS At the end of the intervention period (17-20 months), group A showed an average weight loss of 5.4 ± 5.1 kg, which was significantly (p<0.001)more than observed in group B (2.8 ± 5.1 kg) and group C (1.2 ± 4.8 kg). Likewise BMI and waist were progressively more reduced from A to C. CONCLUSIONS It is possible to implement preventive cognitive-behavioral lifestyle strategies in outpatient internal medicine clinics. This methodology appears more efficacious in inducing weight reduction after more than a year as compared to usual family medicine approaches.
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Affiliation(s)
- Daniela Lucini
- University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
| | | | - Chiara Vigo
- University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Mara Malacarne
- University of Milan, Department BIOMETRA, Milan, Italy; Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Massimo Pagani
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Sala R, Malacarne M, Pagani M, Lucini D. Evidence of increased cardiac parasympathetic drive in subjects meeting current physical activity recommendations. Clin Auton Res 2015; 25:285-91. [PMID: 26359269 DOI: 10.1007/s10286-015-0300-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Aerobic fitness seems to provide extra protection to the cardiovascular system beyond changing the traditional risk factors, a phenomenon referred to as the risk factor gap model. Aerobic fitness may possibly lead to improved autonomic regulation. The Task Force of the American Heart Association supports a national campaign to reach specific cardiovascular health goals considering various metrics, including recommended physical activity (PA) volumes. It may be clinically relevant to assess whether autonomic remodeling occurs in those who adhere to the PA recommendations. METHODS We studied 39 healthy subjects (22 males and 17 females), subdivided into two groups, according to whether they were meeting or not meeting PA recommendations (150 min/week of moderate aerobic activity, or 75 min/week of vigorous aerobic activity, or a combination of both). For each group, we evaluated aerobic capacity (VO2 Peak), body composition (Fat Mass) and autonomic nervous system profile, by way of mono and bivariate spectral analysis of cardiovascular beat by beat variability. RESULTS Subjects following PA recommendations show higher RR period, higher RR variance, greater absolute power of the respiratory component of RR variability (HFRR) and higher index alpha (a measure of spontaneous baroreflex). Moreover, as expected, the group that was meeting or exceeding current PA recommendations had higher VO2 peak, less fat mass and greater weekly energy expenditure. CONCLUSION Data show that subjects meeting current PA recommendations present a phenotype suggestive of enhanced parasympathetic drive to the SA node. This finding is compatible with the hypothesis that a more favorable autonomic profile is part of the mechanisms of the risk factor gap.
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Affiliation(s)
- Roberto Sala
- University of Milan, Milan, Italy.,Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Mara Malacarne
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy.,Biometra Department, University of Milan, Milan, Italy
| | | | - Daniela Lucini
- Exercise Medicine Unit, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy. .,Biometra Department, University of Milan, Milan, Italy.
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Salvioli B, Pellegatta G, Malacarne M, Pace F, Malesci A, Pagani M, Lucini D. Autonomic nervous system dysregulation in irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:423-30. [PMID: 25581440 DOI: 10.1111/nmo.12512] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autonomic nervous system (ANS) regulation may be altered in functional diseases, including irritable bowel syndrome (IBS), but published data are not clear to date. The aim of the study was to analyze ANS function in IBS subjects classified by Rome III criteria and healthy controls using standardized technique. METHODS ANS activity was evaluated by autoregressive spectral analysis of RR interval and systolic arterial pressure variabilities, to obtain indices of sympatho-vagal modulation of the heart and of spontaneous cardiac baroreflex (α index). A symptom list was used to score 18 somatic complaints (score 0-180) (4SQ). Fatigue and stress were assessed through the use of a global scoring index (0-10). KEY RESULTS We enrolled 41 IBS subjects (29 F, age 40 ± 2 years) and 42 healthy matched controls. Heart rate was higher in IBS than control subjects (69 ± 2 vs 61 ± 1; p < 0.001). The total variance of RR interval variability, and α index, were significantly lower in IBS compared to controls (1983.12 ± 384.64 ms(2) vs 4184.55 ± 649.59 ms(2) ; 18.1 ± 2 ms/mmHg vs 29 ± 3 ms/mmHg; p < 0.01). The α index results showed an inverse correlation with stress scores and somatic symptoms. CONCLUSIONS & INFERENCES IBS subjects display a significant reduction in α index, an established marker of cardiac baroreflex. ANS dysfunction appears to be involved in the pathophysiology of IBS and its assessment may open new perspectives for clinical management of patients suffering from IBS.
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Affiliation(s)
- B Salvioli
- University of Bologna, Bologna, Italy; Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy
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Pagani M, Lucini D. Cost-effectiveness of preparticipation screening of athletes with ECG in Europe and Algeria. Intern Emerg Med 2015; 10:125-7. [PMID: 25605676 DOI: 10.1007/s11739-014-1180-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Massimo Pagani
- University of Milano, Corso Magenta 83/2, 20123, Milan, Italy,
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Abstract
The evidence supporting the importance of a healthy lifestyle (active life, healthy diet, not smoking, and low stress) as a part of programs for primary and secondary prevention of cardiometabolic diseases is strong, compelling, and continuously growing. In this study, we test whether a simple web-based healthy lifestyle index, using self-reports, is related to indices of cardiovascular health and metabolic syndrome and could be employed in large wellness programs intended to promote healthy lifestyle. We studied 411 workers in an Italian multinational factory who were enrolled in a voluntary program consisting of a health checkup and an online questionnaire on lifestyle. These domains were combined into a single simple index. Participants were subdivided into three healthy lifestyle index (HI) groups (red, yellow, and green) ranging from poor to good HI quality (HI from red to green: 41.8 ± 14.6; 75.7 ± 8.5; 93.8 ± 2.2; p < 0.05). The groups differed in indicators of cardiovascular and metabolic health (waist circumference females: 82.1 ± 9.56, 78.9 ± 9.3, 72.7 ± 6.6; males: 95.2 ± 11.7, 90.0 ± 9.5, 85.7 ± 6.1 cm; group difference p < 0.05). Moreover, they differed significantly in the likelihood of having more components of the metabolic syndrome and, conversely, fewer components of the ideal cardiovascular health profile (with red having the worst profile). The red group was also characterized by the highest absenteeism. We report for the first time that a web-based self-reported poor health behavior was significantly associated with clinical and laboratory (partial correlation between HI and high-density cholesterol 0.192; body mass index -0.288; systolic blood pressure -0.130; all p < 0.05) results indicating a negative cardiometabolic profile.
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Affiliation(s)
- Daniela Lucini
- Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, University of Milano, Milano, Italy,
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Dalla Vecchia L, Traversi E, Porta A, Lucini D, Pagani M. On site assessment of cardiac function and neural regulation in amateur half marathon runners. Open Heart 2014; 1:e000005. [PMID: 25332775 PMCID: PMC4189300 DOI: 10.1136/openhrt-2013-000005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 12/31/2022] Open
Abstract
Objective Strenuous exercise variably modifies cardiovascular function. Only few data are available on intermediate levels of effort. We therefore planned a study in order to address the hypothesis that a half marathon distance would result in transient changes of cardiac mechanics, neural regulation and biochemical profile suggestive of a complex, integrated adaptation. Methods We enrolled 35 amateur athletes (42±7 years). Supine and standing heart rate variability and a complete echocardiographic evaluation were assessed on site after the completion of a half marathon (postrace) and about 1 month after (baseline). Biochemical tests were also measured postrace. Results Compared to baseline, the postrace left ventricular end-diastolic volume was smaller, peak velocity of E wave was lower, peak velocity of A wave higher, and accordingly the E/A ratio lower. The postrace heart and respiratory rate were higher and variance of RR interval lower, together with a clear shift towards a sympathetic predominance in supine position and a preserved response to orthostasis. At baseline, athletes were characterised by a lower, although still predominant, sympathetic drive with a preserved physiological response to standing. Conclusions Immediately after a half marathon there are clear marks that an elevated sympathetic cardiac drive outlasts the performance, together with decreased left ventricular diastolic volumes and slight modifications of the left ventricular filling pattern without additional signs of diastolic dysfunction or indices of transient left or right ventricular systolic abnormalities. Furthermore, no biochemical indices of any permanent cardiac damage were found.
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Affiliation(s)
- Laura Dalla Vecchia
- IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Milano , Milan , Italy
| | - Egidio Traversi
- IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Montescano , Pavia , Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health , Galeazzi Orthopedic Institute, University of Milan , Milan , Italy
| | - Daniela Lucini
- IRCCS Istituto Clinico Humanitas, Sezione Medicina dell'Esercizio e Sindromi Funzionali, Rozzano , Milan , Italy ; Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, University of Milan, U.O. Telemedicina e Medicina dello Sport, Ospedale 'Luigi Sacco' , Milano , Italy
| | - Massimo Pagani
- Centro di ricerca Terapia Neurovegetativa e Medicina dell'esercizio, University of Milan, U.O. Telemedicina e Medicina dello Sport, Ospedale 'Luigi Sacco' , Milano , Italy
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Marrocco-Trischitta MM, Cremona G, Lucini D, Natali-Sora MG, Cursi M, Cianflone D, Pagani M, Chiesa R. Peripheral baroreflex and chemoreflex function after eversion carotid endarterectomy. J Vasc Surg 2013; 58:136-44.e1. [DOI: 10.1016/j.jvs.2012.11.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/20/2012] [Accepted: 11/25/2012] [Indexed: 12/19/2022]
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Lucini D, Zuccotti GV, Scaramuzza A, Malacarne M, Gervasi F, Pagani M. Exercise might improve cardiovascular autonomic regulation in adolescents with type 1 diabetes. Acta Diabetol 2013; 50:341-9. [PMID: 22941280 DOI: 10.1007/s00592-012-0416-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/13/2012] [Indexed: 10/27/2022]
Abstract
Considering that changes in exercise routines might have relevance in treatment of adolescents with type 1 diabetes mellitus, we sought to assess whether spontaneous modifications to weekly exercise habits might occur in these patients and whether such variations would be accompanied by alterations in autonomic profile. In this observational study, we examined 77 patients (age 15.0 ± 0.6 years.) who in addition to a tailored optimal insulin treatment were invited to perform at least 1 h a day of moderate, aerobic exercise, as suggested by recent guidelines. Patients were studied at baseline (T0) and after 15.8 ± 0.7 months (T1). They were divided into three subgroups according to increased, unchanged and diminished total estimated weekly METs between T0 and T1. Autonomic profile was evaluated by assessing spontaneous baroreflex gain and low-frequency oscillation in arterial pressure, using spectral analysis of RR and systolic arterial pressure time series. Insulin therapy and biochemical data were similar among the 3 groups at T0 and T1, while body mass index standard deviation score was slightly reduced (p < 0.04) and markers of autonomic performance were improved (alpha index, from 17 ± 1 to 20 ± 2 ms/mmHg, p < 0.002) in the group who increased the amount of exercise (from 1627 ± 250 to 3582 ± 448 METs min wt(-1), p < 0.001). Furthermore, the change in total weekly METs significantly correlates with changes of key indices of autonomic regulation. The favourable autonomic effects of moderate increase in spontaneous exercise load suggest testing more formally this intervention in adolescents with type 1 diabetes.
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Affiliation(s)
- Daniela Lucini
- IRCCS, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milano, Italy.
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Adami A, Pizzinelli P, Bringard A, Capelli C, Malacarne M, Lucini D, Simunič B, Pišot R, Ferretti G. Cardiovascular re-adjustments and baroreflex response during clinical reambulation procedure at the end of 35-day bed rest in humans. Appl Physiol Nutr Metab 2013; 38:673-80. [DOI: 10.1139/apnm-2012-0396] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During the reambulation procedure after 35-day head-down tilt bed rest (HDTBR) for 9 men, we recorded for the first time heart rate (HR; with electrocardiogram) and arterial pressure profiles (fingertip plethysmography) for 5 min in HDTBR and horizontal (SUP) positions, followed by 12 min in standing position, during which 4 subjects fainted (intolerant, INT) and were laid horizontal again (Recovery). We computed: mean arterial pressure (P¯; pressure profiles integral mean), stroke volume (SV; obtained with Modelflow method), and cardiac output (Q̇; SV × HR). All cardiovascular data remained stable in HDTBR and SUP for both groups (EXP). Taking the upright posture, EXP showed a decrease in SV and an increase in HR, becoming significantly different from SUP within 1 min. Further evolution of these parameters kept Q̇ stable in both groups until the second minute of standing. Afterward, in INT, P̄ precipitated without further HR increases: SV stopped being corrected and Q̇ reached 2.9 ± 0.4 L·min−1 at the last 15 s of standing. Sudden drop in P̄ allowed identification of a low-pressure threshold in INT (70.7 ± 12.9 mm Hg), after which syncope occurred within 80 s. During Recovery, baroreflex curves showed a flat phase (P̄ increase, HR stable), followed by a steep phase (P̄ increased, HR decreased, starting when P̄ was 84.5 ± 12.5 mm Hg and Q̇ was 9.6 ± 1.5 L·min−1). INT, in contrast with tolerant subjects, did not sustain standing because HR was unable to correct for the P̄ drop. These results indicate a major role for impaired arterial baroreflexes in the onset of orthostatic intolerance.
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Affiliation(s)
- Alessandra Adami
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
| | - Paolo Pizzinelli
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Aurélien Bringard
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
| | - Carlo Capelli
- Dipartimento di Scienze Neurologiche, Neuropsicologiche, Morfologiche e Motorie, Facoltà di Scienze Motorie, Università di Verona, via F. Casorati, 54, 37100 Verona, Italia
| | - Mara Malacarne
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Daniela Lucini
- Dipartimento di Scienze Cliniche, Ospedale L. Sacco, Università di Milano, via GB. Grassi 74, Milano, Italia
| | - Boštjan Simunič
- Institute of Kinesiology Research, Science and Research Center, University of Primorska, Koper, Garibaldijeva street 1, 6000 Koper, Slovenia
| | - Rado Pišot
- Institute of Kinesiology Research, Science and Research Center, University of Primorska, Koper, Garibaldijeva street 1, 6000 Koper, Slovenia
| | - Guido Ferretti
- Département de Neuroscience Fondamentales, Centre Médical Universitaire, Université de Genève, 1 Rue Michel Servet, CH-1211 Genève 4, Switzerland
- Dipartimento di Scienze Biomediche e Biotecnologie, Facoltà di Medicina, Università di Brescia, Viale Europa 11, 25123 Brescia, Italia
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Lucini D, de Giacomi G, Tosi F, Malacarne M, Respizzi S, Pagani M. Altered cardiovascular autonomic regulation in overweight children engaged in regular physical activity. Heart 2012; 99:376-81. [DOI: 10.1136/heartjnl-2012-302616] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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