1
|
de Koning IA, Heutinck JM, Vromen T, Bakker EA, Maessen MFH, Smolders J, Eijsvogels TMH, Grutters JPC, van Geuns RJM, Kemps HMC, Thijssen DHJ. Cardiac Rehabilitation versus Percutaneous Coronary Intervention for Stable Angina Pectoris: A Retrospective Study of Effects on Major Adverse Cardiovascular Events and Associated Healthcare Costs. Eur J Prev Cardiol 2024:zwae164. [PMID: 38711377 DOI: 10.1093/eurjpc/zwae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/24/2024] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Iris A de Koning
- Department of Medical BioSciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joyce M Heutinck
- Department of Medical BioSciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology, P.O. Box 513, 6500 MB, Eindhoven, The Netherlands
| | - Tom Vromen
- Department of cardiology, Maxima Medical Centre, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - Esmée A Bakker
- Department of Medical BioSciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Department of Physical Education and Sports, Sport and Health University Research Institute (iMUDS), University of Granada, C. Menéndez Pelayo 32, 18016, Granada, Spain
| | - Martijn F H Maessen
- Coöperatie VGZ, Customer Intelligence, Nieuwe Stationstraat 12, 6811 KS, Arnhem, The Netherlands
| | - Jurgen Smolders
- Coöperatie VGZ, Customer Intelligence, Nieuwe Stationstraat 12, 6811 KS, Arnhem, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Janneke P C Grutters
- Department for Health Evidence, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Robert-Jan M van Geuns
- Department of Cardiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Hareld M C Kemps
- Department of Industrial Design, Eindhoven University of Technology, P.O. Box 513, 6500 MB, Eindhoven, The Netherlands
- Department of cardiology, Maxima Medical Centre, P.O. Box 7777, 5500 MB, Veldhoven, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Rodney House, 70 Mount Pleasant, Liverpool L3 5UX, United Kingdom
| |
Collapse
|
2
|
Vonk T, Maessen MFH, Hopman MTE, Snoek JA, Aengevaeren VL, Franklin BA, Eijsvogels TMH, Bakker EA. Temporal Trends in Cardiac Rehabilitation Participation and Its Core Components: A Nationwide Cohort Study From the Netherlands. J Cardiopulm Rehabil Prev 2024; 44:180-186. [PMID: 38373064 DOI: 10.1097/hcr.0000000000000858] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
PURPOSE Patient- and disease-specific data on cardiac rehabilitation (CR) participation and changes over time are limited. The objective of this study was to describe time trends in CR participation between 2013 and 2019 and provides insights into the utilization of CR components. METHODS Patients with cardiovascular disease (CVD) with an indication for CR were enrolled between 2013 and 2019. Dutch health insurance claims data were used to identify CR participation and its components. RESULTS In total, 106 212 patients with CVD were included of which 37% participated in CR. Participation significantly increased from 28% in 2013 to 41% in 2016 but remained unchanged thereafter. Participation was highest in the youngest age groups (<50 yrs 52%; 50-65 yrs 50%), men (48%), patients with ST-segment elevation myocardial infarction (73%), non-ST-segment elevation myocardial infarction (59%), and coronary artery bypass grafting (82%). In contrast, it was the lowest in the oldest age group (≥85 yrs 8%), women (30%), and in patients with heart failure (11%). Most participants in CR received referral plus an admission session (97%) and exercise training (82%), whereas complementary services related to dietary (14%) and mental health counseling (10%) had a low utilization. CONCLUSIONS CR participation rates increased to 41% in 2016 but remained unchanged thereafter. Participation modulators included age, sex, CVD diagnosis, and undergoing a cardiothoracic procedure. Education and exercise sessions were frequently adopted, but dietary and mental health counseling had a low utilization rate. These findings suggest the need for reinvigorated referral and novel enrollment strategies in specific CVD subgroups to further promote CR participation and its associated underutilized adjunctive services.
Collapse
Affiliation(s)
- Thijs Vonk
- Author Affiliations: Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands (Mr Vonk and Drs Hopman, Aengevaeren, Eijsvogels, and Bakker); Customer Intelligence, Coöperatie VGZ, Arnhem, The Netherlands (Dr Maessen); Isala Heart Center, Zwolle, The Netherlands (Dr Snoek); Department of Preventive Cardiology, Beaumont Health & Wellness Center, Royal Oak, Michigan, USA (Dr Franklin); and PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (Dr Bakker)
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Bakker EA, van Bakel BMA, Maessen MFH, Franklin BA, Thompson PD, Eijsvogels TMH. Clinical Implications of Suspending and Altering Cardiac Rehabilitation Programs During the COVID-19 Pandemic. J Cardiopulm Rehabil Prev 2024; 44:74-76. [PMID: 38079246 DOI: 10.1097/hcr.0000000000000840] [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] [Indexed: 12/30/2023]
Affiliation(s)
- Esmée A Bakker
- Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain (Dr Bakker); Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (Drs Bakker, van Bakel, and Eijsvogels); Customer Intelligence, Coöperatie VGZ, Arnhem, the Netherlands (Dr Maessen); Department of Preventive Cardiology/Cardiac Rehabilitation, Beaumont Health and Wellness Center, Royal Oak, Michigan, United States (Dr Franklin); Division of Cardiology, Hartford Hospital, Hartford, Connecticut, United States (Dr Thompson); and Massachusetts General Hospital, Boston, Massachusetts, United States (Dr Thompson)
| | | | | | | | | | | |
Collapse
|
4
|
Vonk T, Nuijten MAH, Maessen MFH, Meindersma EP, Koornstra-Wortel HJJ, Waskowsky MM, Snoek JA, Eijsvogels TMH, Hopman MTE. Identifying Reasons for Nonattendance and Noncompletion of Cardiac Rehabilitation: INSIGHTS FROM GERMANY AND THE NETHERLANDS. J Cardiopulm Rehabil Prev 2021; 41:153-158. [PMID: 33797455 PMCID: PMC8081445 DOI: 10.1097/hcr.0000000000000580] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite strong recommendations and beneficial health effects of cardiac rehabilitation (CR), participation rates remain low. Little data are available on reasons beyond quantitative factors in the underutilization of CR. The aim of this study was to identify personal reasons for nonattenders and noncompletions of CR among Dutch and German patients with cardiovascular diseases (CVD) eligible for CR. METHODS Between December 2017 and January 2019, a total of 4265 questionnaires were distributed among eligible patients for CR in the bordering area of the eastern Netherlands and western Germany. Patients were eligible if they had an indication for CR according to national guidelines. Questionnaires were used to assess reasons of nonattendance and noncompletion of CR, when applicable. RESULTS A total of 1829 patients with CVD completed the questionnaire. Of these, 1278 indicated that they received referral to CR. Despite referral, 192 patients decided not to participate in CR and 88 patients with CVD withdrew from the CR program. The three most reported reasons for nonattendance were as follows: (1) did not need the supervision (56%, n = 108), (2) did not need the CR trajectory (55%, n = 105), and (3) already exercised regularly (39%, n = 74). The most reported reasons for noncompletion were as follows: (1) could no longer participate because of other physical problems (30%, n = 26), (2) did not need the CR trajectory (26%, n = 23), and (3) the CR program was not personal enough (23%, n = 20). CONCLUSIONS Most patients had motivational or perceptive reasons for nonattendance or noncompletion to CR. These possible misconceptions as well as perceived shortcomings of traditional CR underline the need for adequate motivation, information, and more personalized solutions (eg, eHealth, home-based CR) to increase the uptake and completion of CR.
Collapse
Affiliation(s)
- Thijs Vonk
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Malou A. H. Nuijten
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Martijn F. H. Maessen
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Esther P. Meindersma
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Hetty J. J. Koornstra-Wortel
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Marc M. Waskowsky
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Johan A. Snoek
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Thijs M. H. Eijsvogels
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| | - Maria. T. E. Hopman
- Departments of Physiology (Mr Vonk, Ms Nuijten, and Drs Maessen, Eijsvogels and Hopman) and Cardiology (Dr Meindersma), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Maasziekenhuis Pantein, Boxmeer, the Netherlands (Dr Koornstra-Wortel); and Isala Heart Centre, Zwolle, the Netherlands (Drs Waskowsky and Snoek)
| |
Collapse
|
5
|
Eijsvogels TMH, Maessen MFH, Bakker EA, Meindersma EP, van Gorp N, Pijnenburg N, Thompson PD, Hopman MTE. Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open 2020; 3:e2011686. [PMID: 32716516 DOI: 10.1001/jamanetworkopen.2020.11686] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Cardiac rehabilitation (CR) is an effective strategy to improve clinical outcomes, but it remains underused in some subgroups of patients with cardiovascular disease (CVD). OBJECTIVE To investigate the implications of sex, age, socioeconomic status, CVD diagnosis, cardiothoracic surgery, and comorbidity for the association between CR participation and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study with patient enrollment between July 1, 2012, and December 31, 2017, and a follow-up to March 19, 2020. The dates of analysis were March to May 2020. This study was performed among Dutch patients with CVD with a multidisciplinary outpatient CR program indication and who were insured at Coöperatie Volksgezondheidszorg, one of the largest health insurance companies in the Netherlands. Among 4.1 million beneficiaries, patients with CVD with an acute coronary event (myocardial infarction or unstable angina pectoris), stable angina pectoris, chronic heart failure, or cardiothoracic surgery (coronary artery bypass grafting, valve replacement, or percutaneous coronary intervention) were identified by inpatient diagnosis codes and included in the study. MAIN OUTCOMES AND MEASURES Cox proportional hazards models were used to evaluate the association between CR participation and all-cause mortality. Stabilized inverse propensity score weighting was used to account for patient and disease characteristics associated with CR participation. RESULTS Among 83 687 eligible patients with CVD (mean [SD] age, 67 [12] years; 60.4% [n = 50 512] men), only 31.3% (n = 26 171) participated in CR, with large variation across different subgroups (range, 5.1%-73.0%). During a mean (SD) of 4.7 (1.8) years of follow-up, 1966 CR participants (7.5%) and 13 443 CR nonparticipants (23.4%) died. After multivariable adjustment, CR participation was associated with a 32% lower risk of all-cause mortality (adjusted hazard ratio, 0.68; 95% CI, 0.65-0.71) compared with nonparticipation. Sex, age, socioeconomic status, and comorbidity did not alter risk reduction after CR participation, but a statistically significant interaction association was found across categories of CVD diagnosis and cardiothoracic surgery. Larger reductions in risk estimates for all-cause mortality were found after CR participation for STEMI (adjusted HR, 0.59; 95% CI, 0.52-0.68 vs 0.72; 95% CI, 0.65-0.79; P < .001), NSTEMI (adjusted HR, 0.64; 95% CI, 0.58-0.70 vs 0.72; 95% CI, 0.65-0.79; P < .001), and stable AP (adjusted HR, 0.69; 95% CI, 0.63-0.76 vs 0.72; 95% CI, 0.65-0.79; P < .001) compared with patients with chronic heart failure, whereas unstable AP had a smaller risk reduction (adjusted HR, 0.75; 95% CI, 0.67-0.85 vs 0.72; 95% CI, 0.65-0.79; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, CR participation was associated with a 32% risk reduction in all-cause mortality, and this benefit was independent of sex, age, socioeconomic status, and comorbidity. These findings reinforce the importance of CR participation in secondary prevention and highlight the possibility that CR should be prescribed more widely to vulnerable patients with CVD, such as older adults with chronic diseases or multimorbidity.
Collapse
Affiliation(s)
- Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn F H Maessen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Esmée A Bakker
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Esther P Meindersma
- Department of Cardiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Niels van Gorp
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Nicole Pijnenburg
- Coöperatie Volksgezondheidszorg, Business Intelligence Services, Arnhem, the Netherlands
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Maria T E Hopman
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
6
|
Ten Haaf DSM, Nuijten MAH, Maessen MFH, Horstman AMH, Eijsvogels TMH, Hopman MTE. Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: a systematic review and meta-analysis. Am J Clin Nutr 2018; 108:1043-1059. [PMID: 30475963 DOI: 10.1093/ajcn/nqy192] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/16/2018] [Indexed: 12/18/2022] Open
Abstract
Background Increasing protein intake has been suggested as an effective strategy to ameliorate age-related loss of muscle mass and strength. Current reviews assessing the effect of protein supplementation are strongly influenced by the inclusion of studies with frail older adults. Objectives We assessed the effect of protein supplementation on lean body mass, muscle strength, and physical performance in exclusively nonfrail community-dwelling older adults. Moreover, we assessed the superior effects of protein supplementation during concomitant resistance exercise training on muscle characteristics. Design A systematic literature search was conducted on PubMed, Embase, and Web of Science up to 15 May 2018. We included randomized controlled trials that assessed the effect of protein supplementation on lean body mass, muscle thigh cross-sectional area, muscle strength, gait speed, and chair-rise ability and performed random-effects meta-analyses. Results Data from 36 studies with 1682 participants showed no significant effects of protein supplementation on changes in lean body mass [standardized mean difference (SMD): 0.11; 95% CI: -0.06, 0.28], handgrip strength (SMD: 0.58; 95% CI: -0.08, 1.24), lower extremity muscle strength (SMD: 0.03; 95% CI: -0.20, 0.27), gait speed (SMD: 0.41; 95% CI: -0.04, 0.85), or chair-rise ability (SMD: 0.10; 95%: CI -0.08, 0.28) compared with a control condition in nonfrail community-dwelling older adults. Moreover, no superior effects of protein supplementation were found during concomitant resistance exercise training on muscle characteristics. Conclusions Protein supplementation in nonfrail community-dwelling older adults does not lead to increases in lean body mass, muscle cross-sectional area, muscle strength, or physical performance compared with control conditions; nor does it exert superior effects when added to resistance exercise training. Habitual protein intakes of most study participants were already sufficient, and protein interventions differed in terms of type of protein, amount, and timing. Future research should clarify what specific protein supplementation protocol is beneficial for nonfrail community-dwelling older adults with low habitual protein intake.
Collapse
Affiliation(s)
- Dominique S M Ten Haaf
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Malou A H Nuijten
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn F H Maessen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| |
Collapse
|
7
|
Maessen MFH, Eijsvogels TMH, Hijmans-Kersten BTP, Grotens A, Schreuder THA, Hopman MTE, Thijssen DHJ. Vascular Function and Structure in Veteran Athletes after Myocardial Infarction. Med Sci Sports Exerc 2017; 49:21-28. [PMID: 27992395 DOI: 10.1249/mss.0000000000001075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Although athletes demonstrate lower cardiovascular risk and superior vascular function compared with sedentary peers, they are not exempted from cardiac events (i.e., myocardial infarction [MI]). The presence of an MI is associated with increased cardiovascular risk and impaired vascular function. We tested the hypothesis that lifelong exercise training in post-MI athletes, similar as in healthy controls, is associated with a superior peripheral vascular function and structure compared with a sedentary lifestyle in post-MI individuals. METHODS We included 18 veteran athletes (ATH) (>20 yr) and 18 sedentary controls (SED). To understand the effect of lifelong exercise training after MI, we included 20 veteran post-MI athletes (ATH + MI) and 19 sedentary post-MI controls (SED + MI). Participants underwent comprehensive assessment using vascular ultrasound (vascular stiffness, intima-media thickness, and endothelium (in)dependent mediated dilatation). Lifetime risk score was calculated for a 30-yr risk prediction of cardiovascular disease mortality of the participants. RESULTS ATH demonstrated a lower vascular stiffness and smaller femoral intima-media thickness compared with SED. Vascular function and structure did not differ between ATH + MI and SED + MI. ATH (4.0% ± 5.1%) and ATH + MI (6.1% ± 3.7%) had a significantly better lifetime risk score compared with their sedentary peers (SED: 6.9% ± 3.7% and SED + MI: 9.3% ± 4.8%). ATH + MI had no secondary events versus two recurrent MI and six elective percutaneous coronary interventions within SED + MI (P < 0.05). CONCLUSION Although veteran post-MI athletes did not have a superior peripheral vascular function and structure compared with their sedentary post-MI peers, benefits of lifelong exercise training in veteran post-MI athletes relate to a better cardiovascular risk profile and lower occurrence of secondary events.
Collapse
Affiliation(s)
- Martijn F H Maessen
- 1Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS; 2Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UNITED KINGDOM; and 3Radboud Institute for Health Sciences, Department of Neurology, Radboud University Medical Center, Nijmegen, THE NETHERLANDS
| | | | | | | | | | | | | |
Collapse
|
8
|
Wouters H, Aalbers T, Maessen MFH, Verbeek ALM, Rikkert MGMO, Kessels RPC, Hopman MTE, Eijsvogels TMH. Physical Activity and Cognitive Function of Long-Distance Walkers: Studying Four Days Marches Participants. Rejuvenation Res 2017; 20:367-374. [PMID: 28602152 DOI: 10.1089/rej.2016.1876] [Citation(s) in RCA: 5] [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] [Indexed: 11/13/2022] Open
Abstract
Studies show physical activity to be beneficial for cognitive function. However, studies usually included individuals who were not particularly inclined to exercise. Following research among master athletes, we examined associations between physical activity and cognitive function in participants of the International Nijmegen Four Days Marches. These individuals are also inclined to exercise. On 4 consecutive days >40,000 participants walk a daily distance of 30-50 km (120-200 km or 75-125 miles in total). Four Days Marches participants and less active or inactive control participants from the Nijmegen Exercise Study were examined. Self-reported current and lifelong physical activities were quantified in Metabolic Equivalent of Task minutes/day, and training walking speed was estimated in km/h. Cognitive functioning in the domains of working memory, executive function, and visuospatial short-term memory was assessed using the validated Brain Aging Monitor. Data from 521 participants (mean age 54.7, standard deviation 12.9) showed neither positive associations between lifelong physical activity and working memory, executive function, and visuospatial short-term memory nor positive associations between current physical activity and cognitive functioning in these domains (p-values >0.05). However, a positive association between training walking speed and working memory was revealed (age adjusted β = 0.18, p-value <0.01). Walking speed as a surrogate marker of fitness, but not lifelong and current physical activity levels was associated with cognitive function. Therefore, walking speed deserves more attention in research aimed at unraveling associations between physical activity and cognitive function.
Collapse
Affiliation(s)
- Hans Wouters
- 1 Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen , Groningen, The Netherlands
| | - Teun Aalbers
- 2 Department of Geriatric Medicine, Radboud University Medical Centre , Nijmegen, The Netherlands .,3 Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Martijn F H Maessen
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - André L M Verbeek
- 5 Department of Health Evidence, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Marcel G M Olde Rikkert
- 2 Department of Geriatric Medicine, Radboud University Medical Centre , Nijmegen, The Netherlands .,3 Radboudumc Alzheimer Centre, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Roy P C Kessels
- 6 Donders Institute for Brain, Cognition and Behaviour, Radboud University , Nijmegen, The Netherlands .,7 Department of Medical Psychology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Maria T E Hopman
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- 4 Department of Physiology, Radboud University Medical Centre , Nijmegen, The Netherlands .,8 Research Institute for Sports and Exercise Sciences, Liverpool John Moores University , Liverpool, United Kingdom
| |
Collapse
|
9
|
Maessen MFH, Eijsvogels TMH, Grotens A, Hopman MTE, Thijssen DHJ, Hansen HHG. Feasibility and relevance of compound strain imaging in non-stenotic arteries: comparison between individuals with cardiovascular diseases and healthy controls. Cardiovasc Ultrasound 2017; 15:13. [PMID: 28521772 PMCID: PMC5437491 DOI: 10.1186/s12947-017-0104-9] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compound strain imaging is a novel method to noninvasively evaluate arterial wall deformation which has recently shown to enable differentiation between fibrous and (fibro-)atheromatous plaques in patients with severe stenosis. We tested the hypothesis that compound strain imaging is feasible in non-stenotic arteries and provides incremental discriminative power to traditional measures of vascular health (i.e., distensibility coefficient (DC), central pulse wave velocity [cPWV], and intima-media thickness [IMT]) for differentiating between participants with and without a history of cardiovascular diseases (CVD). METHODS Seventy two participants (60 ± 7 years) with non-stenotic arteries (IMT < 1.1 mm) were categorized in healthy participants (CON, n = 36) and CVD patients (n = 36) based on CVD history. Participants underwent standardised ultrasound-based assessment (DC, cPWV, and IMT) and compound strain imaging (radial [RS] and circumferential [CS] strain) in left common carotid artery. Area under receiver operating characteristics (AROC)-curve was used to determine the discriminatory power between CVD and CON of the various measures. RESULTS CON had a significantly (P < 0.05) smaller carotid IMT (0.68 [0.58 to 0.76] mm) than CVD patients (0.76 [0.68 to 0.80] mm). DC, cPWV, RS, and CS did not significantly differ between groups (P > 0.05). A higher CS or RS was associated with a higher DC (CS: r = -0.32;p < 0.05 and RS: r = 0.24;p < 0.05) and lower cPWV (CS: r = 0.24;p < 0.05 and RS: r = -0.25;p < 0.05). IMT could identify CVD (AROC: 0.66, 95%-CI: 0.53 to 0.79), whilst the other measurements, alone or in combination, did not significantly increase the discriminatory power compared to IMT. CONCLUSIONS In non-stenotic arteries, compound strain imaging is feasible, but does not seem to provide incremental discriminative power to traditional measures of vascular health for differentiation between individuals with and without a history of CVD.
Collapse
Affiliation(s)
- Martijn F H Maessen
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands.,Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ayla Grotens
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands.,Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Hendrik H G Hansen
- Department of Radiology and Nuclear Medicine, Radboud university medical center, Medical UltraSound Imaging Center (MUSIC), P.O. Box 9101 (766), 6500, HB, Nijmegen, The Netherlands.
| |
Collapse
|
10
|
Maessen MFH, van Mil ACCM, Straathof Y, Riksen NP, Rongen GAPJM, Hopman MTE, Eijsvogels TMH, Thijssen DHJ. Impact of lifelong exercise training on endothelial ischemia-reperfusion and ischemic preconditioning in humans. Am J Physiol Regul Integr Comp Physiol 2017; 312:R828-R834. [DOI: 10.1152/ajpregu.00466.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 12/26/2022]
Abstract
Reperfusion is essential for ischemic tissue survival, but causes additional damage to the endothelium [i.e., ischemia-reperfusion (I/R) injury]. Ischemic preconditioning (IPC) refers to short repetitive episodes of ischemia that can protect against I/R. However, IPC efficacy attenuates with older age. Whether physical inactivity contributes to the attenuated efficacy of IPC to protect against I/R injury in older humans is unclear. We tested the hypotheses that lifelong exercise training relates to 1) attenuated endothelial I/R and 2) maintained IPC efficacy that protects veteran athletes against endothelial I/R. In 18 sedentary male individuals (SED, <1 exercise h/wk for >20 yr, 63 ± 7 yr) and 20 veteran male athletes (ATH, >5 exercise h/wk for >20 yr, 63 ± 6 yr), we measured brachial artery endothelial function with flow-mediated dilation (FMD) before and after I/R. We induced I/R by 20 min of ischemia followed by 20 min of reperfusion. Randomized over 2 days, participants underwent either 35-min rest or IPC (3 cycles of 5-min cuff inflation to 220 mmHg with 5 min of rest) before I/R. In SED, FMD decreased after I/R [median (interquartile range)]: [3.0% (2.0–4.7) to 2.1% (1.5–3.9), P = 0.046] and IPC did not prevent this decline [4.1% (2.6–5.2) to 2.8% (2.2–3.6), P = 0.012]. In ATH, FMD was preserved after I/R [3.0% (1.7–5.4) to 3.0% (1.9–4.1), P = 0.82] and when IPC preceded I/R [3.2% (1.9–4.2) to 2.8% (1.4–4.6), P = 0.18]. These findings indicate that lifelong exercise training is associated with increased tolerance against endothelial I/R. These protective, preconditioning effects of lifelong exercise against endothelial I/R may contribute to the cardioprotective effects of exercise training.
Collapse
Affiliation(s)
- Martijn F. H. Maessen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke C. C. M. van Mil
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Yaïra Straathof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels P. Riksen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; and
| | - Gerard A. P. J. M. Rongen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; and
- Department of Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M. H. Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
11
|
Maessen MFH, Schalkwijk CG, Verheggen RJHM, Aengevaeren VL, Hopman MTE, Eijsvogels TMH. A comparison of dicarbonyl stress and advanced glycation endproducts in lifelong endurance athletes vs. sedentary controls. J Sci Med Sport 2017; 20:921-926. [PMID: 28416154 DOI: 10.1016/j.jsams.2017.03.011] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 02/14/2017] [Accepted: 03/03/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Dicarbonyl stress and high concentrations of advanced glycation endproducts (AGEs) relate to an elevated risk for cardiovascular diseases (CVD). Exercise training lowers the risk for future CVD. We tested the hypothesis that lifelong endurance athletes have lower dicarbonyl stress and AGEs compared to sedentary controls and that these differences relate to a better cardiovascular health profile. DESIGN Cross-sectional study. METHODS We included 18 lifelong endurance athletes (ATH, 61±7years) and 18 sedentary controls (SED, 58±7years) and measured circulating glyoxal (GO), methylglyoxal (MGO) and 3-deoxyglucosone (3DG) as markers of dicarbonyl stress. Furthermore, we measured serum levels of protein-bound AGEs NƐ-(carboxymethyl)lysine (CML), NƐ-(carboxyethyl)lysine (CEL), methylglyoxal-derived hydroimidazolone-1 (MG-H1), and pentosidine. Additionally, we measured cardiorespiratory fitness (VO2peak) and cardiovascular health markers. RESULTS ATH had lower concentrations of MGO (196 [180-246] vs. 242 [207-292] nmol/mmol lysine, p=0.043) and 3DG (927 [868-972] vs. 1061 [982-1114] nmol/mmol lysine, p<0.01), but no GO compared to SED. ATH demonstrated higher concentrations CML and CEL compared to SED. Pentosidine did not differ across groups and MG-H1 was significantly lower in ATH compared to SED. Concentrations of MGO en 3DG were inversely correlated with cardiovascular health markers, whereas CML and CEL were positively correlated with VO2peak and cardiovascular health markers. CONCLUSION Lifelong exercise training relates to lower dicarbonyl stress (MGO and 3DG) and the AGE MG-H1. The underlying mechanism and (clinical) relevance of higher CML and CEL concentrations among lifelong athletes warrants future research, since it conflicts with the idea that higher AGE concentrations relate to poor cardiovascular health outcomes.
Collapse
Affiliation(s)
- Martijn F H Maessen
- Department of Physiology, Radboud university medical center, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, The Netherlands
| | | | | | - Maria T E Hopman
- Department of Physiology, Radboud university medical center, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud university medical center, The Netherlands; Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, United Kingdom.
| |
Collapse
|
12
|
Verheggen RJHM, Maessen MFH, Green DJ, Hermus ARMM, Hopman MTE, Thijssen DHT. A systematic review and meta-analysis on the effects of exercise training versus hypocaloric diet: distinct effects on body weight and visceral adipose tissue. Obes Rev 2016; 17:664-90. [PMID: 27213481 DOI: 10.1111/obr.12406] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [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: 11/04/2015] [Revised: 01/25/2016] [Accepted: 02/12/2016] [Indexed: 12/12/2022]
Abstract
Exercise training ('exercise') and hypocaloric diet ('diet') are frequently prescribed for weight loss in obesity. Whilst body weight changes are commonly used to evaluate lifestyle interventions, visceral adiposity (VAT) is a more relevant and stronger predictor for morbidity and mortality. A meta-analysis was performed to assess the effects of exercise or diet on VAT (quantified by radiographic imaging). Relevant databases were searched through May 2014. One hundred seventeen studies (n = 4,815) were included. We found that both exercise and diet cause VAT loss (P < 0.0001). When comparing diet versus training, diet caused a larger weight loss (P = 0.04). In contrast, a trend was observed towards a larger VAT decrease in exercise (P = 0.08). Changes in weight and VAT showed a strong correlation after diet (R(2) = 0.737, P < 0.001), and a modest correlation after exercise (R(2) = 0.451, P < 0.001). In the absence of weight loss, exercise is related to 6.1% decrease in VAT, whilst diet showed virtually no change (1.1%). In conclusion, both exercise and diet reduce VAT. Despite a larger effect of diet on total body weight loss, exercise tends to have superior effects in reducing VAT. Finally, total body weight loss does not necessarily reflect changes in VAT and may represent a poor marker when evaluating benefits of lifestyle-interventions.
Collapse
Affiliation(s)
- R J H M Verheggen
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M F H Maessen
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D J Green
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,School of Sport Science, Exercise and Health, the University of Western Australia, Crawley, Western Australia, Australia
| | - A R M M Hermus
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D H T Thijssen
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
13
|
Maessen MFH, Verbeek ALM, Bakker EA, Thompson PD, Hopman MTE, Eijsvogels TMH. Lifelong Exercise Patterns and Cardiovascular Health. Mayo Clin Proc 2016; 91:745-54. [PMID: 27140541 DOI: 10.1016/j.mayocp.2016.02.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 12/03/2015] [Accepted: 02/29/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the relationship between lifelong exercise dose and the prevalence of cardiovascular morbidity. PATIENTS AND METHODS From June 1, 2011, through December 31, 2014, 21,266 individuals completed an online questionnaire regarding their lifelong exercise patterns and cardiovascular health status. Cardiovascular disease (CVD) was defined as a diagnosis of myocardial infarction, stroke, or heart failure, and cardiovascular risk factors (CVRFs) were defined as hypertension, hypercholesterolemia, or type 2 diabetes. Lifelong exercise patterns were measured over a median of 32 years for 405 patients with CVD, 1379 patients with CVRFs, and 10,656 controls. Participants were categorized into nonexercisers and quintiles (Q1-Q5) of exercise dose (metabolic equivalent task [MET] minutes per week). RESULTS The CVD/CVRF prevalence was lower for each exercise quintile compared with nonexercisers (CVD: nonexercisers, 9.6% vs Q1: 4.4%, Q2: 2.8%, Q3: 2.4%, Q4: 3.6%, Q5: 3.9%; P<.001; CVRF: nonexercisers, 24.6% vs Q1: 13.8%, Q2: 10.2%, Q3: 9.0%, Q4: 9.4%, Q5: 12.0%; P<.001). The lowest exercise dose (Q1) significantly reduced CVD and CVRF prevalence, but the largest reductions were found at 764 to 1091 MET-min/wk for CVD (adjusted odds ratio=0.31; 95% CI, 0.20-0.48) and CVRFs (adjusted odds ratio=0.36; 95% CI, 0.28-0.47). The CVD/CVRF prevalence did not further decrease in higher exercise dose groups. Exercise intensity did not influence the relationship between exercise patterns and CVD or CVRFs. CONCLUSION These findings demonstrate a curvilinear relationship between lifelong exercise patterns and cardiovascular morbidity. Low exercise doses can effectively reduce CVD/CVRF prevalence, but engagement in exercise for 764 to 1091 MET-min/wk is associated with the lowest CVD/CVRF prevalence. Higher exercise doses do not yield additional benefits.
Collapse
Affiliation(s)
- Martijn F H Maessen
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - André L M Verbeek
- Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmée A Bakker
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Maria T E Hopman
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Physiology, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Division of Cardiology, Hartford Hospital, Hartford, CT; Research Institute for Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
| |
Collapse
|
14
|
Maessen MFH, Eijsvogels TMH, Verheggen RJHM, Hopman MTE, Verbeek ALM, de Vegt F. Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status. PLoS One 2014; 9:e107212. [PMID: 25229394 PMCID: PMC4167703 DOI: 10.1371/journal.pone.0107212] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/14/2014] [Indexed: 01/01/2023] Open
Abstract
Background The Body Mass Index (BMI) and Waist Circumference (WC) are well-used anthropometric predictors for cardiovascular diseases (CVD), but their validity is regularly questioned. Recently, A Body Shape Index (ABSI) and Body Roundness Index (BRI) were introduced as alternative anthropometric indices that may better reflect health status. Objective This study assessed the capacity of ABSI and BRI in identifying cardiovascular diseases and cardiovascular disease risk factors and determined whether they are superior to BMI and WC. Design and Methods 4627 Participants (54±12 years) of the Nijmegen Exercise Study completed an online questionnaire concerning CVD health status (defined as history of CVD or CVD risk factors) and anthropometric characteristics. Quintiles of ABSI, BRI, BMI, and WC were used regarding CVD prevalence. Odds ratios (OR), adjusted for age, sex, and smoking, were calculated per anthropometric index. Results 1332 participants (27.7%) reported presence of CVD or CVD risk factors. The prevalence of CVD increased across quintiles for BMI, ABSI, BRI, and WC. Comparing the lowest with the highest quintile, adjusted OR (95% CI) for CVD were significantly different for BRI 3.2 (1.4–7.2), BMI 2.4 (1.9–3.1), and WC 3.0 (1.6–5.6). The adjusted OR (95% CI) for CVD risk factors was for BRI 2.5 (2.0–3.3), BMI 3.3 (1.6–6.8), and WC 2.0 (1.6–2.5). No association was observed for ABSI in both groups. Conclusions BRI, BMI, and WC are able to determine CVD presence, while ABSI is not capable. Nevertheless, the capacity of BRI as a novel body index to identify CVD was not superior compared to established anthropometric indices like BMI and WC.
Collapse
Affiliation(s)
- Martijn F. H. Maessen
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- * E-mail:
| | - Thijs M. H. Eijsvogels
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut, United States of America
| | | | - Maria T. E. Hopman
- Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - André L. M. Verbeek
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femmie de Vegt
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
15
|
Tanck E, Maessen MFH, Hannink G, van Kuppeveld SMHF, Bolhuis S, Kooloos JGM. The effect of a daily quiz (TOPday) on self-confidence, enthusiasm, and test results for biomechanics. Perspect Med Educ 2014; 3:4-14. [PMID: 24288127 PMCID: PMC3889994 DOI: 10.1007/s40037-013-0096-6] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Many students in Biomedical Sciences have difficulty understanding biomechanics. In a second-year course, biomechanics is taught in the first week and examined at the end of the fourth week. Knowledge is retained longer if the subject material is repeated. However, how does one encourage students to repeat the subject matter? For this study, we developed 'two opportunities to practice per day (TOPday)', consisting of multiple-choice questions on biomechanics with immediate feedback, which were sent via e-mail. We investigated the effect of TOPday on self-confidence, enthusiasm, and test results for biomechanics. All second-year students (n = 95) received a TOPday of biomechanics on every regular course day with increasing difficulty during the course. At the end of the course, a non-anonymous questionnaire was conducted. The students were asked how many TOPday questions they completed (0-6 questions [group A]; 7-18 questions [group B]; 19-24 questions [group C]). Other questions included the appreciation for TOPday, and increase (no/yes) in self-confidence and enthusiasm for biomechanics. Seventy-eight students participated in the examination and completed the questionnaire. The appreciation for TOPday in group A (n = 14), B (n = 23) and C (n = 41) was 7.0 (95 % CI 6.5-7.5), 7.4 (95 % CI 7.0-7.8), and 7.9 (95 % CI 7.6-8.1), respectively (p < 0.01 between A and C). Of the students who actively participated (B and C), 91 and 80 % reported an increase in their self-confidence and enthusiasm, respectively, for biomechanics due to TOPday. In addition, they had a higher test result for biomechanics (p < 0.01) compared with those who did not actively participate (A). In conclusion, the teaching method 'TOPday' seems an effective way to encourage students to repeat the subject material, with the extra advantage that students are stimulated to keep on practising for the examination. The appreciation was high and there was a positive association between active participation, on the one hand, and self-confidence, enthusiasm, and test results for biomechanics on the other.
Collapse
Affiliation(s)
- Esther Tanck
- Orthopaedic Research Laboratory, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Martijn F H Maessen
- Orthopaedic Research Laboratory, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Sascha M H F van Kuppeveld
- Department for Evaluation, Quality and Development of Medical Education, Radboud university medical center, Nijmegen, the Netherlands
| | - Sanneke Bolhuis
- Department for Evaluation, Quality and Development of Medical Education, Radboud university medical center, Nijmegen, the Netherlands
| | - Jan G M Kooloos
- Department of Anatomy, Radboud university medical center, Nijmegen, the Netherlands
| |
Collapse
|