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Schaich CL, Hughes TM, Kitzman DW, Jung Y, Chen H, Nicklas BJ, Houston DK, Brubaker P, Molina AJ, Hugenschmidt CE. Neurocognitive Impairments and Their Improvement Following Exercise and Dietary Interventions in Older Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2024; 17:e011134. [PMID: 38037817 PMCID: PMC10842717 DOI: 10.1161/circheartfailure.123.011134] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Christopher L. Schaich
- Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Timothy M. Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine
| | - Dalane W. Kitzman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine
| | - Youngkyoo Jung
- Department of Radiology, UC Davis School of Medicine, Sacramento, CA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - Barbara J. Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| | - Denise K. Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Anthony J.A. Molina
- Division of Geriatrics, Gerontology and Palliative Care, UC San Diego School of Medicine, La Jolla, CA
| | - Christina E. Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
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Alexander HB, Arnel M, O'Connell N, Munger Clary HM, Fanning J, Brubaker P, Fountain NB, Duncan P. A single-center survey on physical activity barriers, behaviors and preferences in adults with epilepsy. Epilepsy Behav 2023; 149:109491. [PMID: 37951132 PMCID: PMC10842096 DOI: 10.1016/j.yebeh.2023.109491] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND Improved understanding of physical activity barriersand preferences in people with epilepsyis needed to successfully design and perform larger, more robust effectivenesstrials. METHODS Adult patients at a single tertiary epilepsy center between January and April 2020 were surveyed. The survey included a validated physical activity questionnaire (Physical Activity Scale for the Elderly) plus 15 items aimed to address 1) perceptions and beliefs regarding physical activity, 2) barriers to routine physical activity, and 3) willingness and ability to participate in a physical activity intervention and 4) current physical abilities, activities, and preferences. RESULTS 95 participants with epilepsy (age 42 ± 16.2, 59 % female) completed the survey. Sixty-five participants (68.4 %) reported that they believe that physical activity could improve their seizure frequency. However, 40 % of those surveyed said their neurologist had never talked to them about physical activity. The most commonly reported barriers to physical activity were lack of time (24.7 %) and fear of having a seizure (19.7 %), while barriers to intervention participation included being unable to come to in-person sessions (53 % of those willing to participate),living far away (39.3 %), time constraints (28.6 %), and lack of transportation (21.4 %). CONCLUSION Future physical activity studies in people with epilepsy should focus on using tailored interventions that accommodate their unique beliefs and barriers.
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Affiliation(s)
- Halley B Alexander
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA.
| | - Madison Arnel
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | - Nathaniel O'Connell
- Wake Forest School of Medicine, Department of Biostatistics and Data Science in the Division of Public Health Sciences, Winston-Salem, NC, USA
| | - Heidi M Munger Clary
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | - Jason Fanning
- Wake Forest University, Department of Health and Exercise Science, Winston-Salem, NC, USA
| | - Peter Brubaker
- Wake Forest University, Department of Health and Exercise Science, Winston-Salem, NC, USA
| | - Nathan B Fountain
- University of Virginia, Department of Neurology, Charlottesville, VA, USA
| | - Pamela Duncan
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
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Bellissimo MP, Canada JM, Jordan JH, Ladd AC, Reding KW, Moore TL, Ntim WO, Heiston EM, Brubaker P, Mihalko SL, D’Agostino R, O’Connell N, Ky B, Wagner LI, Hackney MH, Weaver KE, Lesser GJ, Avis NE, Sutton AL, Lucas AR, Franco RL, Fuemmeler BF, Salloum FN, Hundley WG. Physical Activity During Breast Cancer Therapy Associates With Preserved Exercise Capacity and Cardiac Function (WF97415). JACC CardioOncol 2023; 5:641-652. [PMID: 37969655 PMCID: PMC10635881 DOI: 10.1016/j.jaccao.2022.12.011] [Citation(s) in RCA: 1] [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: 07/19/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 11/17/2023] Open
Abstract
Background Cancer treatment increases cardiovascular disease risk, but physical activity (PA) may prevent cardiovascular disease. Objectives This study examined whether greater PA was associated with better submaximal exercise capacity and cardiac function during cancer therapy. Methods Participants included 223 women with stage I to III breast cancer (BC) before and 3 months after undergoing treatment and 126 control participants. Leisure-time PA (LTPA) was reported using the Godin-Shephard LTPA questionnaire. Cardiac function was assessed by cardiac magnetic resonance. Submaximal exercise capacity was determined by 6-minute walk distance. Results BC participants reported similar baseline LTPA scores (24.7; 95% CI: 21.7-28.0) as control participants (29.4; 95% CI: 25.0-34.2). The BC group declined to 16.9 (95% CI: 14.4-19.6) at 3 months relative to 30.8 (95% CI: 26.2-35.8) in control participants. Among BC participants, more LTPA was related to better exercise capacity (β ± SE: 7.1 ± 1.6; 95% CI: 4.0-10.1) and left ventricular (LV) circumferential strain (-0.16 ± 0.07; 95% CI: -0.29 to -0.02). Increased LTPA over the 3 months was associated with decreased likelihood of treatment-induced cardiac dysfunction according to LV circumferential strain classifications (OR: 0.98; 95% CI: 0.97-0.998). BC participants reporting insufficient LTPA according to PA guidelines exhibited deteriorations in exercise capacity (adjusted mean difference ± SE: -29 ± 10 m; P = 0.029), LV end-systolic volume (5.8 ± 1.3 mL; P < 0.001), LV ejection fraction (-3.2% ± 0.8%; P = 0.002), and LV circumferential strain (2.5% ± 0.5%; P < 0.001), but BC participants meeting LTPA guidelines did not exhibit these adverse changes. Conclusions PA declined during BC therapy; however, PA participation was associated with attenuated declines in exercise capacity and cardiac function that are often observed in this population. (Understanding and Predicting Breast Cancer Events After Treatment [WF97415 UPBEAT]; NCT02791581).
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Affiliation(s)
- Moriah P. Bellissimo
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Justin M. Canada
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Jennifer H. Jordan
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amy C. Ladd
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kerryn W. Reding
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
| | - Tonya L. Moore
- Department of Cardiovascular Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - William O. Ntim
- UNC School of Medicine, Novant Health Campus, Novant Health Heart & Vascular Institute, Charlotte, North Carolina, USA
| | - Emily M. Heiston
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Shannon L. Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ralph D’Agostino
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nate O’Connell
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Bonnie Ky
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynne I. Wagner
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mary Helen Hackney
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kathryn E. Weaver
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Glenn J. Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy E. Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Arnethea L. Sutton
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Alexander R. Lucas
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - R. Lee Franco
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bernard F. Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Fadi N. Salloum
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - W. Gregory Hundley
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - UPBEAT Study Group
- Department of Internal Medicine, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
- Department of Cardiovascular Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
- UNC School of Medicine, Novant Health Campus, Novant Health Heart & Vascular Institute, Charlotte, North Carolina, USA
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
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Scandalis L, Kitzman DW, Nicklas BJ, Lyles M, Brubaker P, Nelson MB, Gordon M, Stone J, Bergstrom J, Neufer PD, Gnaiger E, Molina AJA. Skeletal Muscle Mitochondrial Respiration and Exercise Intolerance in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Cardiol 2023; 8:575-584. [PMID: 37163294 PMCID: PMC10173105 DOI: 10.1001/jamacardio.2023.0957] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/17/2023] [Indexed: 05/11/2023]
Abstract
Importance The pathophysiology of exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely understood. Multiple lines of evidence suggest that abnormal skeletal muscle metabolism is a key contributor, but the mechanisms underlying metabolic dysfunction remain unresolved. Objective To evaluate the associations of skeletal muscle mitochondrial function using respirometric analysis of biopsied muscle fiber bundles from patients with HFpEF with exercise performance. Design, Setting, and Participants In this cross-sectional study, muscle fiber bundles prepared from fresh vastus lateralis biopsies were analyzed by high-resolution respirometry to provide detailed analyses of mitochondrial oxidative phosphorylation, including maximal capacity and the individual contributions of complex I-linked and complex II-linked respiration. These bioenergetic data were compared between patients with stable chronic HFpEF older than 60 years and age-matched healthy control (HC) participants and analyzed for intergroup differences and associations with exercise performance. All participants were treated at a university referral center, were clinically stable, and were not undergoing regular exercise or diet programs. Data were collected from March 2016 to December 2017, and data were analyzed from November 2020 to May 2021. Main Outcomes and Measures Skeletal muscle mitochondrial function, including maximal capacity and respiration linked to complex I and complex II. Exercise performance was assessed by peak exercise oxygen consumption, 6-minute walk distance, and the Short Physical Performance Battery. Results Of 72 included patients, 50 (69%) were women, and the mean (SD) age was 69.6 (6.1) years. Skeletal muscle mitochondrial function measures were all markedly lower in skeletal muscle fibers obtained from patients with HFpEF compared with HCs, even when adjusting for age, sex, and body mass index. Maximal capacity was strongly and significantly correlated with peak exercise oxygen consumption (R = 0.69; P < .001), 6-minute walk distance (R = 0.70; P < .001), and Short Physical Performance Battery score (R = 0.46; P < .001). Conclusions and Relevance In this study, patients with HFpEF had marked abnormalities in skeletal muscle mitochondrial function. Severely reduced maximal capacity and complex I-linked and complex II-linked respiration were associated with exercise intolerance and represent promising therapeutic targets.
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Affiliation(s)
- Lina Scandalis
- Division of Geriatrics, Gerontology, and Palliative Care, UC San Diego School of Medicine, University of California, San Diego
| | - Dalane W. Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara J. Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mary Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Peter Brubaker
- Department of Health and Exercise Science at Wake Forest University, Winston-Salem, North Carolina
| | - M. Benjamin Nelson
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michelle Gordon
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Stone
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jaclyn Bergstrom
- Division of Geriatrics, Gerontology, and Palliative Care, UC San Diego School of Medicine, University of California, San Diego
| | - P. Darrell Neufer
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | - Anthony J. A. Molina
- Division of Geriatrics, Gerontology, and Palliative Care, UC San Diego School of Medicine, University of California, San Diego
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Bellissimo MP, Canada JM, Jordan JH, Ladd AC, Heiston EM, Brubaker P, Mihalko SL, Reding K, D Agostino R, O Connell N, Hackney MH, Weaver KE, Lesser GJ, Avis NE, Hundley WG. Changes in Physical Activity, Functional Capacity, and Cardiac Function during Breast Cancer Therapy. Cancer Epidemiol Biomarkers Prev 2022; 31:1509. [PMID: 35775211 DOI: 10.1158/1055-9965.epi-22-0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Functional capacity and cardiac function can decline during breast cancer (BC) therapy. In non-cancer populations, higher physical activity (PA) is associated with better physical function and cardiac health. This study compared baseline PA, functional capacity, and cardiac function between women with and without BC and tested if greater PA participation was related to higher functional capacity and/or better heart function after three months of BC therapy. METHODS Data was collected in 104 women without BC (82% Caucasian, baseline only) and 110 women with stage I-III BC (82% Caucasian) before therapy and after three months of treatment. Participants self-reported PA and underwent six-minute walk distance (6MWD) testing to measure functional capacity and cardiovascular magnetic resonance to assess left ventricular ejection fraction (LVEF). Analyses were adjusted for age, race, body mass index (BMI), and medication use. RESULTS The BC group was older (56.2 ± 10.7 vs 52.1 ± 14.7 yrs, P=0.02) with a higher average BMI than the non-cancer group (30.3 ± 6.8 vs 27.7 ± 6.2 kg/m2, P<0.01). Pre-treatment, BC participants reported lower PA scores (27.9 ± 2.8 vs 34.9 ± 2.8, P=0.04) with similar 6MWD and LVEF relative to those without cancer (485 ± 11 vs 496 ± 11 m, P=0.4 and 59.7 ± 0.7 vs 58.9 ± 0.8%, P=0.37, respectively). After three months of BC therapy, declines were observed for PA scores (27.9 ± 2.8 vs 18.3 ± 2.5, P=0.02), 6MWD (485 ± 11 vs 428 ± 10 m, P<0.001), and LVEF (59.7 ± 0.7 vs 56.1 ± 0.7%, P<0.001). Compared to BC participants who reported no PA at three months (n=24, 22%), BC women who reported any PA (n=78, 86%) had higher 6MWD (442 ± 11 vs 389 ± 17 m, P=0.006) but similar LVEF (56.5 ± 0.9 vs 55.3 ± 1.5%, p=0.5). Women who reported any PA were less likely to exhibit an LVEF below normal (<50%) or decline in LVEF of 'â•10 points compared to inactive women (BMI-adjusted, OR [95% CI]: 0.27 [0.09, 0.85]). CONCLUSIONS These preliminary results indicate that self-reported PA, LVEF and 6MWD decline in the first three months of BC treatment, but PA participation during BC treatment may mitigate declines in functional capacity and cardiac function. Further research is needed to identify barriers and facilitators of PA participation during BC therapy. FUNDING Data collection was funded by the Wake Forest NCORP Research Base grant 2UG1CA189824 with support of the NCI Community Oncology Research Program (NCORP). Additional funding for this study was provided by grants from the National Institutes of Health, National Cancer Institute (1R01CA199167 and 5T32CA093423). CLINICAL TRIAL ID NCT02791581 for WF97415 UPBEAT.
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Justice JN, Pajewski NM, Espeland MA, Brubaker P, Houston DK, Marcovina S, Nicklas BJ, Kritchevsky SB, Kitzman DW. Evaluation of a blood-based geroscience biomarker index in a randomized trial of caloric restriction and exercise in older adults with heart failure with preserved ejection fraction. GeroScience 2022; 44:983-995. [PMID: 35013909 PMCID: PMC9135899 DOI: 10.1007/s11357-021-00509-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/22/2021] [Indexed: 12/27/2022] Open
Abstract
Intermediate endpoints are needed to evaluate the effect of interventions targeting the biology of aging in clinical trials. A working group identified five blood-based biomarkers that may serve such a purpose as an integrated index. We evaluated the responsiveness of the panel to caloric restriction or aerobic exercise in the context of a randomized clinical trial conducted in patients with heart failure with preserved ejection fraction (HFpEF) with obese phenotype who were predominantly female. Obese HFpEF is highly prevalent in women, and is a geriatric syndrome whose disease pathology is driven by non-cardiac factors and shared drivers of aging. We measured serum Interleukin-6, TNF-α-receptor-I, growth differentiating factor-15, cystatin C, and N-terminal pro-b-type natriuretic peptide at baseline and after 20 weeks in older participants with stable obese HFpEF participating in a randomized, controlled, 2 × 2 factorial trial of caloric restriction and/or aerobic exercise. We calculated a composite biomarker index, summing baseline quintile scores for each biomarker, and analyzed the effect of the interventions on the index and individual biomarkers and their associations with changes in physical performance. This post hoc analysis included 88 randomized participants (71 women [81%]). The mean ± SD age was 66.6 ± 5.3 years, and body mass index (BMI) was 39.3 ± 6.3 kg/m2. Using mixed models, mean values of the biomarker index improved over 20 weeks with caloric restriction (- 0.82 [Formula: see text] 0.58 points, p = 0.05), but not with exercise (- 0.28 [Formula: see text] 0.59 points, p = [Formula: see text]), with no evidence of an interaction effect of CR [Formula: see text] EX [Formula: see text] time (p = 0.80) with adjustment for age, gender, and BMI. At baseline, the biomarker index was inversely correlated with 6-min walk distance, scores on the short physical performance battery, treadmill test peak workload and exercise time to exhaustion (all [Formula: see text] s = between - 0.21 and - 0.24). A reduction in the biomarker index was also associated with increased 4-m usual walk speed ([Formula: see text] s = - 0.31). Among older patients with chronic obese HFpEF, caloric restriction improved a biomarker index designed to reflect biological aging. Moreover, the index was associated with physical performance and exercise tolerance.
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Affiliation(s)
- Jamie N Justice
- Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark A Espeland
- Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Peter Brubaker
- Department of Health and Exercise Science at Wake, Forest University in Winston-Salem, NC, USA
| | - Denise K Houston
- Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Barbara J Nicklas
- Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section On Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dalane W Kitzman
- Department of Internal Medicine, Section On Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Kershner K, Fanning J, Furlipa J, Brubaker P, Brooks A, Page L, Ehlers D. The Effect of a Virtual Reality Delivered Physical Activity Intervention on the Physical Function of Older Adults. Innov Aging 2021. [PMCID: PMC8682066 DOI: 10.1093/geroni/igab046.3643] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
COVID-19 public health recommendations have prohibited many older adults from attending in-person physical activity (PA) programs that improve physical function and promote functional independence. Most PA programs have shifted towards a video conference (VC) format, but this modality has been noted to “flatten” the social experience which is fundamental for lasting behavior change. Virtual reality (VR) is now designed for immersion and place-presence and may be better suited for instilling a feeling of social connection, which will likely improve physical function. The purpose of this study was to evaluate differences in physical function after a 4-week in-home VR or VC based PA intervention. Low-active adults (66.8±4.8 years) were randomized to VR (n=5) or VC (n=4) based PA counselling and instructed to find activities that were intrinsically motivating. VR participants were asked to select pre-approved available active games in addition to enjoyable real-world activities. ANCOVA models were used to explore group differences in six-minute walk distances across time. Results are reported using η^2 effect sizes based on the small sample size. After controlling for baseline values, the ANCOVA models revealed a moderate-to-large magnitude effect for distance traveled during the six-minute walk test (η^2=.10). Additionally, the VR group participants walked 42.63 meters further, which approaches a clinically meaningful difference. These promising early findings suggest there is value to exploring the impact of VR-delivered, group-mediated activity promotion on physical functioning in older adults. Future research should investigate aspects of VR that promote increased social connection and physical function in the older adult population.
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Affiliation(s)
- Kyle Kershner
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Jason Fanning
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Joy Furlipa
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Peter Brubaker
- Wake Forest University, Winston-Salem, North Carolina, United States
| | - Amber Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, North Carolina, United States
| | - Lindsey Page
- University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Diane Ehlers
- University of Nebraska Medical Center, Omaha, Nebraska, United States
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Singleton MJ, Nelson MB, Samuel TJ, Kitzman DW, Brubaker P, Haykowsky MJ, Upadhya B, Chen H, Nelson MD. Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail 2021; 28:567-575. [PMID: 34774747 DOI: 10.1016/j.cardfail.2021.10.010] [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: 09/09/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of HF and is associated with high morbidity and mortality. The primary chronic symptom in HFpEF is exercise intolerance, associated with reduced quality of life. Emerging evidence implicates left atrial (LA) dysfunction as an important pathophysiologic mechanism. Here we extend prior observations by relating LA dysfunction to peak oxygen uptake (peak VO2), physical function (distance walked in 6 minutes [6MWD]) and quality of life (Kansas City Cardiomyopathy Questionnaire). METHODS AND RESULTS We compared 75 older, obese, patients with HFpEF with 53 healthy age-matched controls. LA strain was assessed by magnetic resonance cine imaging using feature tracking. LA function was defined according to its 3 distinct phases, with the LA serving as a reservoir during systole, as a conduit during early diastole, and as a booster pump at the end of diastole. The LA stiffness index was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e', by Doppler ultrasound examination) and LA reservoir strain. HFpEF had a decreased reservoir strain (16.4 ± 4.4% vs 18.2 ± 3.5%, P = .018), lower conduit strain (7.7 ± 3.3% vs 9.1 ± 3.4%, P = .028), and increased stiffness index (0.86 ± 0.39 vs 0.53 ± 0.18, P < .001), as well as decreased peak VO2, 6MWD, and lower quality of life. Increased LA stiffness was independently associated with impaired peak VO2 (β = 9.0 ± 1.6, P < .001), 6MWD (β = 117 ± 22, P = .003), and Kansas City Cardiomyopathy Questionnaire score (β = -23 ± 5, P = .001), even after adjusting for clinical covariates. CONCLUSIONS LA stiffness is independently associated with impaired exercise tolerance and quality of life and may be an important therapeutic target in obese HFpEF. REGISTRATION NCT00959660.
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Affiliation(s)
- Matthew J Singleton
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - M Benjamin Nelson
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - T Jake Samuel
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Dalane W Kitzman
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Bharathi Upadhya
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Nelson
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas.
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9
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Aladin AI, Whellan D, Mentz RJ, Pastva AM, Nelson MB, Brubaker P, Duncan P, Reeves G, Rosenberg P, Kitzman DW. Relationship of physical function with quality of life in older patients with acute heart failure. J Am Geriatr Soc 2021; 69:1836-1845. [PMID: 33837953 DOI: 10.1111/jgs.17156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Older patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design. METHODS We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class. RESULTS Participants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p < 0.001; r = 0.30, p < 0.001; and r = 0.24, p = 0.001, respectively); and between SPPB and KCCQ Physical and SF-12 Physical Scores (r = 0.20, p = 0.004, and r = 0.19, p = 0.007, respectively). Both 6MWD and SPPB were correlated with multiple components of the EuroQol-5D-5L. 6MWD was a significant, weak predictor of KCCQ Overall Score and SF-12 Physical Score (estimate = 0.05 ± 0.01, p < 0.001 and estimate = 0.05 ± 0.02, p = 0.012, respectively). SPPB was a significant, weak predictor of KCCQ Physical Score and SF-12 Physical Score (estimate = 1.37 ± 0.66, p = 0.040 and estimate = 0.54 ± 0.25, p = 0.030, respectively). CONCLUSION In older, hospitalized ADHF patients, PF and QOL are both severely impaired but are only modestly related, suggesting that PF and QOL provide complementary information and assessment of both should be considered to fully assess clinically meaningful patient-oriented outcomes.
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Affiliation(s)
- Amer I Aladin
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - David Whellan
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, United States
| | - Amy M Pastva
- Division of Physical Therapy, Duke University School of Medicine, Durham, North Carolina, United States
| | - M Benjamin Nelson
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Gordon Reeves
- Novant Health Heart and Vascular Institute, Charlotte, North Carolina, United States
| | - Paul Rosenberg
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, United States
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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10
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Samuel TJ, Kitzman DW, Haykowsky MJ, Upadhya B, Brubaker P, Nelson MB, Hundley WG, Nelson MD. Left ventricular diastolic dysfunction and exercise intolerance in obese heart failure with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2021; 320:H1535-H1542. [PMID: 33577436 PMCID: PMC8260389 DOI: 10.1152/ajpheart.00610.2020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese patients with heart failure with preserved ejection fraction (HFpEF), and related to decreased peak exercise oxygen uptake (peak V̇o2). LV strain and strain rate were measured by feature tracking of magnetic resonance cine images in 79 older obese patients with HFpEF (mean age: 66 yr; mean body mass index: 38 kg/m2) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e'), and correlated to peak V̇o2. LV circumferential early diastolic strain rate was impaired in HFpEF compared with controls (0.93 ± 0.05/s vs. 1.20 ± 0.07/s, P = 0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e' amplified the group difference in early LV diastolic circumferential strain rate (0.08 ± 0.03 vs. 0.13 ± 0.05, P < 0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e', early LV diastolic strain rates from all three principal strains, were modestly related with peak V̇o2 (R = 0.36, -0.27, and 0.35, respectively, all P < 0.01); this response, however, was almost entirely driven by E/e' itself, (R = -0.52, P < 0.001). Taken together, we found that although LV relaxation is impaired in older obese patients with HFpEF, and modestly correlates with their severely reduced peak exercise V̇o2, LV filling pressures appear to play a much more important role in determining exercise intolerance.NEW & NOTEWORTHY Using a multimodal imaging approach to uncouple tissue deformation from atrial pressure, we found that left ventricular (LV) relaxation is impaired in older obese patients with HFpEF, but only modestly correlates with their severely reduced peak V̇o2. In contrast, the data show a much stronger relationship between elevated LV filling pressures and exercise intolerance, refocusing future therapeutic priorities.
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Affiliation(s)
- T Jake Samuel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina.,Section on Gerontology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, North Carolina
| | - M Benjamin Nelson
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - W Gregory Hundley
- Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Michael D Nelson
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas.,Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
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11
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Schultz H, Brubaker P, Roberts T, Christensen B, Kitzman D. Examining Energy Expenditure During Aerobic And Resistance Exercise In Overweight Patients With HFpEF. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000683976.25060.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Sullivan S, Fleet N, Brubaker P. Comparison of Functional Tests of Leg Power in Collegiate Athletes. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563307.56697.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Reding KW, Brubaker P, D’Agostino R, Kitzman DW, Nicklas B, Langford D, Grodesky M, Hundley WG. Increased skeletal intermuscular fat is associated with reduced exercise capacity in cancer survivors: a cross-sectional study. Cardiooncology 2019; 5:3. [PMID: 32154010 PMCID: PMC7048042 DOI: 10.1186/s40959-019-0038-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/17/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cancer survivors experience on average a 20% reduction in peak exercise capacity (VO2 peak) post-cancer treatment. Intermuscular fat (IMF) is a strong predictor of reduced exercise capacity in heart failure (HF) patients; however it is unknown whether increased IMF is related to reduced VO2 peak in cancer survivors. METHODS AND RESULTS Twenty eight individuals: 14 cancer survivors > 12-months post-cancer treatment and 14 individuals without cancer were matched on age, gender, and body mass index (BMI). Participants underwent magnetic resonance imaging (MRI) assessments of IMF within the paraspinal muscles, VO2 peak and exercise-associated measures of left ventricular ejection fraction (LVEF). Blinded analyses were performed. Associations between the ratio of IMF to skeletal muscle (SM) were estimated using Pearson's partial correlation coefficients. Individuals with cancer and non-cancer comparators were of similar age (54 ± 17 versus 54 ± 15 years; p = 1.0), gender (5 men and 9 women, both groups), and BMI (27 ± 4 versus 26 ± 4; p = 0.57). Peak VO2 was 22% lower in cancer survivors versus non-cancer comparators (26.9 vs 34.3 ml/kg/min; p = 0.005), and was correlated with IMF:SM in both cancer survivors and non-cancer individuals after accounting for exercise-associated LVEF, resting LVEF, BMI, other body fat depots, and cardiovascular disease (CVD) co-morbidities (p < 0.001 to 0.08 for all adjusted correlations). CONCLUSION Among cancer survivors that previously received anthracyclines, increased intermuscular fat is associated with reduced VO2 peak even after accounting for exercise-associated cardiac function. This suggests IMF is important in the development of exercise intolerance, an outcome experienced by a large number of cancer survivors.
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Affiliation(s)
- Kerryn W. Reding
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA USA
- Department of Cancer Prevention, Public Health Sciences, Fred Hutch Cancer Research Center, Seattle, WA USA
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC USA
| | - Ralph D’Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Dalane W. Kitzman
- Department of Internal Medicine (Section on Cardiology), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045 USA
| | - Barbara Nicklas
- Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Dale Langford
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Michael Grodesky
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA USA
| | - W. Gregory Hundley
- Department of Internal Medicine (Section on Cardiology), Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045 USA
- Pauley Heart Center, Virginia Commonwealth University Health System, Richmond, VA USA
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14
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Reding K, Brubaker P, Dagostino R, Kitzman D, Hundley WW, Nicklas B, Jordan JH, Langford DJ, Grodesky M, Hundley W. THE ROLE OF INTERMUSCULAR FAT IN REDUCED EXERCISE CAPACITY IN CANCER SURVIVORS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Vermillion SA, James A, Dorrell RD, Brubaker P, Mihalko SL, Hill AR, Clark CJ. Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review. Syst Rev 2018; 7:103. [PMID: 30041694 PMCID: PMC6058356 DOI: 10.1186/s13643-018-0771-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gastrointestinal cancer patients are susceptible to significant postoperative morbidity. The aim of this systematic review was to examine the effects of preoperative exercise therapy (PET) on patients undergoing surgery for GI malignancies. METHODS In accordance with PRISMA statement, all prospective clinical trials of PET for patients diagnosed with GI cancer were identified by searching MEDLINE, Embase, Cochrane Library, ProQuest, PROSPERO, and DARE (March 8, 2017). The characteristics and outcomes of each study were extracted and reviewed. Risk of bias was evaluated using the Cochrane risk of bias tool by two independent reviewers. RESULTS Nine studies (534 total patients) were included in the systematic review. All interventions involved aerobic training but varied in terms of frequency, duration, and intensity. PET was effective in reducing heart rate, as well as increasing oxygen consumption and peak power output. The postoperative course was also improved, as PET was associated with more rapid recovery to baseline functional capacity after surgery. CONCLUSIONS PET for surgical patients with gastrointestinal malignancies may improve physical fitness and aid in postoperative recovery.
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Affiliation(s)
- Sarah A Vermillion
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Alston James
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Robert D Dorrell
- Bowman Gray Center for Medical Education, Wake Forest University School of Medicine, 475 Vine Street, Winston-Salem, NC, 27101, USA
| | - Peter Brubaker
- Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO BOX 7868, Winston-Salem, NC, 27109, USA
| | - Shannon L Mihalko
- Health and Exercise Science, Wake Forest University, Worrell Professional Center 2164B, PO BOX 7868, Winston-Salem, NC, 27109, USA
| | - Adrienne R Hill
- Department of Physical Medicine and Rehabilitation, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Clancy J Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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16
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Becton T, Muller J, Brubaker P, Nicklas B, Kitzman DW. Long-term Changes Following Weight Loss in Older Patients with Heart Failure with Preserved Ejection Fraction. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000516974.08388.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Pandey A, Kitzman DW, Brubaker P, Haykowsky MJ, Morgan T, Becton JT, Berry JD. Response to Endurance Exercise Training in Older Adults with Heart Failure with Preserved or Reduced Ejection Fraction. J Am Geriatr Soc 2017; 65:1698-1704. [PMID: 28338229 DOI: 10.1111/jgs.14867] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 12/11/2022]
Abstract
OBJECTIVES To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). DESIGN Secondary analysis of a randomized controlled trial. SETTING Outpatient cardiac rehabilitation program. PARTICIPANTS Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. MEASUREMENTS The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak ) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. RESULTS Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs -0.3 ± 15.4%, P < .001). In univariate analysis, echocardiographic abnormalities in left ventricular structure and function and lower body mass index were associated with blunted response of VO2peak with exercise training. In multivariate regression analysis using stepwise selection, submaximal exercise systolic blood pressure, and resting early deceleration time were independent predictors of change in VO2peak . CONCLUSION The change in VO2peak in response to endurance exercise training in older adults with HF differs significantly according to HF subtype, with greater VO2peak improvement in HFpEF than HFrEF. These results suggest that the current Centers for Medicare and Medicaid Services policy excluding individuals with HFpEF from reimbursement from cardiac rehabilitation may need to be revisited.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dalane W Kitzman
- Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Peter Brubaker
- Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.,Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina
| | - Mark J Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Timothy Morgan
- Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - J Thomas Becton
- Section of Cardiovascular Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sections of Geriatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Jarett D Berry
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Kheirkhahan M, Tudor-Locke C, Axtell R, Buman MP, Fielding RA, Glynn NW, Guralnik JM, King AC, White DK, Miller ME, Siddique J, Brubaker P, Rejeski WJ, Ranshous S, Pahor M, Ranka S, Manini TM. Actigraphy features for predicting mobility disability in older adults. Physiol Meas 2016; 37:1813-1833. [PMID: 27653966 DOI: 10.1088/0967-3334/37/10/1813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Actigraphy has attracted much attention for assessing physical activity in the past decade. Many algorithms have been developed to automate the analysis process, but none has targeted a general model to discover related features for detecting or predicting mobility function, or more specifically, mobility impairment and major mobility disability (MMD). Men (N = 357) and women (N = 778) aged 70-89 years wore a tri-axial accelerometer (Actigraph GT3X) on the right hip during free-living conditions for 8.4 ± 3.0 d. One-second epoch data were summarized into 67 features. Several machine learning techniques were used to select features from the free-living condition to predict mobility impairment, defined as 400 m walking speed <0.80 m s-1. Selected features were also included in a model to predict the first occurrence of MMD-defined as the loss in the ability to walk 400 m. Each method yielded a similar estimate of 400 m walking speed with a root mean square error of ~0.07 m s-1 and an R-squared values ranging from 0.37-0.41. Sensitivity and specificity of identifying slow walkers was approximately 70% and 80% for all methods, respectively. The top five features, which were related to movement pace and amount (activity counts and steps), length in activity engagement (bout length), accumulation patterns of activity, and movement variability significantly improved the prediction of MMD beyond that found with common covariates (age, diseases, anthropometry, etc). This study identified a subset of actigraphy features collected in free-living conditions that are moderately accurate in identifying persons with clinically-assessed mobility impaired and significantly improve the prediction of MMD. These findings suggest that the combination of features as opposed to a specific feature is important to consider when choosing features and/or combinations of features for prediction of mobility phenotypes in older adults.
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Affiliation(s)
- Matin Kheirkhahan
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA. Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, USA
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19
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Eggebeen J, Kim-Shapiro DB, Haykowsky M, Morgan TM, Basu S, Brubaker P, Rejeski J, Kitzman DW. One Week of Daily Dosing With Beetroot Juice Improves Submaximal Endurance and Blood Pressure in Older Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail 2016; 4:428-37. [PMID: 26874390 DOI: 10.1016/j.jchf.2015.12.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to determine whether a relatively low single dose or a week-long dosage of dietary inorganic nitrate could improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND Exercise intolerance is the primary manifestation of HFpEF and is largely due to noncardiac factors that reduce oxygen delivery to active skeletal muscles. A recent study showed improved exercise capacity in patients with HFpEF after a single, acute dose of beetroot juice (BRJ) (12.9 mmol inorganic nitrate) while another recent study showed neutral and negative effects of an organic nitrate. METHODS Twenty HFpEF patients (69 ± 7 years of age ) were enrolled in an initial cross-over design comparing a single, acute dose of BRJ (6.1 mmol nitrate) to a nitrate-depleted placebo BRJ. A second phase, 1 week of daily doses, used an all-treated design in which patients consumed BRJ for an average of 7 days. The primary outcome of the study was submaximal aerobic endurance, measured as cycling time to exhaustion at 75% of measured maximal power output. RESULTS No adverse events were associated with the intervention. Submaximal aerobic endurance improved 24% after 1 week of daily BRJ dosing (p = 0.02) but was not affected by the single, acute dose of the BRJ compared to placebo. Consumption of BRJ significantly reduced resting systolic blood pressure and increased plasma nitrate and nitrite in both of the dosing schemes. CONCLUSIONS One week of daily dosing with BRJ (6.1 mmol inorganic nitrate) significantly improves submaximal aerobic endurance and blood pressure in elderly HFpEF patients.
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Affiliation(s)
- Joel Eggebeen
- Sections of Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel B Kim-Shapiro
- Department of Physics, Wake Forest University, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.
| | - Mark Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Timothy M Morgan
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Swati Basu
- Department of Physics, Wake Forest University, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina
| | - Peter Brubaker
- Translational Science Center, Wake Forest University, Winston-Salem, North Carolina; Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina
| | - Jack Rejeski
- Translational Science Center, Wake Forest University, Winston-Salem, North Carolina; Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina
| | - Dalane W Kitzman
- Sections of Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.
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20
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Kitzman DW, Brubaker P, Morgan T, Haykowsky M, Hundley G, Kraus WE, Eggebeen J, Nicklas BJ. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. JAMA 2016; 315:36-46. [PMID: 26746456 PMCID: PMC4787295 DOI: 10.1001/jama.2015.17346] [Citation(s) in RCA: 521] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE More than 80% of patients with heart failure with preserved ejection fraction (HFPEF), the most common form of heart failure among older persons, are overweight or obese. Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL). OBJECTIVE To determine whether caloric restriction (diet) or aerobic exercise training (exercise) improves exercise capacity and QOL in obese older patients with HFPEF. DESIGN, SETTING, AND PARTICIPANTS Randomized, attention-controlled, 2 × 2 factorial trial conducted from February 2009 through November 2014 in an urban academic medical center. Of 577 initially screened participants, 100 older obese participants (mean [SD]: age, 67 years [5]; body mass index, 39.3 [5.6]) with chronic, stable HFPEF were enrolled (366 excluded by inclusion and exclusion criteria, 31 for other reasons, and 80 declined participation). INTERVENTIONS Twenty weeks of diet, exercise, or both; attention control consisted of telephone calls every 2 weeks. MAIN OUTCOMES AND MEASURES Exercise capacity measured as peak oxygen consumption (V̇O2, mL/kg/min; co-primary outcome) and QOL measured by the Minnesota Living with Heart Failure (MLHF) Questionnaire (score range: 0-105, higher scores indicate worse heart failure-related QOL; co-primary outcome). RESULTS Of the 100 enrolled participants, 26 participants were randomized to exercise; 24 to diet; 25 to exercise + diet; 25 to control. Of these, 92 participants completed the trial. Exercise attendance was 84% (SD, 14%) and diet adherence was 99% (SD, 1%). By main effects analysis, peak V̇O2 was increased significantly by both interventions: exercise, 1.2 mL/kg body mass/min (95% CI, 0.7 to 1.7), P < .001; diet, 1.3 mL/kg body mass/min (95% CI, 0.8 to 1.8), P < .001. The combination of exercise + diet was additive (complementary) for peak V̇O2 (joint effect, 2.5 mL/kg/min). There was no statistically significant change in MLHF total score with exercise and with diet (main effect: exercise, -1 unit [95% CI, -8 to 5], P = .70; diet, -6 units [95% CI, -12 to 1], P = .08). The change in peak V̇O2 was positively correlated with the change in percent lean body mass (r = 0.32; P = .003) and the change in thigh muscle:intermuscular fat ratio (r = 0.27; P = .02). There were no study-related serious adverse events. Body weight decreased by 7% (7 kg [SD, 1]) in the diet group, 3% (4 kg [SD, 1]) in the exercise group, 10% (11 kg [SD, 1] in the exercise + diet group, and 1% (1 kg [SD, 1]) in the control group. CONCLUSIONS AND RELEVANCE Among obese older patients with clinically stable HFPEF, caloric restriction or aerobic exercise training increased peak V̇O2, and the effects may be additive. Neither intervention had a significant effect on quality of life as measured by the MLHF Questionnaire. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00959660.
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Affiliation(s)
- Dalane W. Kitzman
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University
| | - Timothy Morgan
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Mark Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington
| | - Gregory Hundley
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine
| | | | | | - Barbara J. Nicklas
- Geriatrics and Gerontology Section, Department of Internal Medicine, Wake Forest School of Medicine
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Li W, Brubaker P, Guthold M. Investigation of Fibrin Fiber Internal Structure. Biophys J 2015. [DOI: 10.1016/j.bpj.2014.11.932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Denne CM, Ross J, Bledsoe A, Wooten N, Brubaker P. Longitudinal Assessment Of Bone Mineral Density Levels In Division I Male And Female Cross Country Runners. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496347.39696.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li W, Sigley J, Baker S, Brubaker P, Pieters M, Helms C, Guthold M. The Effect of Disease and Exercise on Single Fibrin Fiber Mechanical Properties. Biophys J 2014. [DOI: 10.1016/j.bpj.2013.11.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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24
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Keteyian SJ, Kitzman D, Zannad F, Landzberg J, Arnold JM, Brubaker P, Brawner CA, Bensimhon D, Hellkamp AS, Ewald G. Predicting maximal HR in heart failure patients on β-blockade therapy. Med Sci Sports Exerc 2012; 44:371-6. [PMID: 21900844 DOI: 10.1249/mss.0b013e318234316f] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Standards for estimating maximal HR are important when interpreting the adequacy of physiologic stress during exercise testing, assessing chronotropic response, and prescribing an exercise training regimen. The equation 220 - age is used to estimate maximum HR; however, it overestimates measured maximal HR in patients taking β-adrenergic blockade (βB) therapy. This study developed and validated a practical equation to predict maximal HR in patients with heart failure (HF) taking βB therapy. METHODS Data from symptom-limited exercise tests completed on patients with systolic HF participating in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training trial and taking a βB agent were used to develop a simplified equation, which was validated using bootstrapping. RESULTS The simplified derived equation was 119 + 0.5 (resting HR) - 0.5 (age) - (0, if test was completed using a treadmill; 5, if using a stationary bike). The R2 and SEE were 0.28 and 18 beats·min(-1), respectively. Validation of this equation yielded a mean R and SEE of 0.28 and 18 beats·min(-1), respectively. For the equation 220 - age, the R2 was -2.93, and the SEE was 43 beats·min(-1). CONCLUSIONS We report a valid and simple population-specific equation for estimating peak HR in patients with HF taking βB therapy. This equation should be helpful when evaluating chronotropic response or assessing if a maximum effort was provided during exercise testing. We caution, however, that the magnitude of the variation (SEE = 18 beats·min(-1)) associated with this prediction equation may make it impractical when prescribing exercise intensity.
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Affiliation(s)
- Steven J Keteyian
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
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Kitzman DW, Morgan T, Haykowsky M, Brubaker P. Reply. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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26
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman DW, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Cardiopulmonary exercise testing is equally prognostic in young, middle-aged and older individuals diagnosed with heart failure. Int J Cardiol 2010; 151:278-83. [PMID: 20580105 DOI: 10.1016/j.ijcard.2010.05.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 04/20/2010] [Accepted: 05/30/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous research has demonstrated the prognostic value of cardiopulmonary exercise testing (CPX) in elderly patients with heart failure (HF). Investigations that have comprehensively examined the value of CPX across different age groups are lacking. The purpose of the present investigation was to evaluate the prognostic value of CPX in young, middle-aged and older patients with HF. METHODS A total of 1605 subjects (age: 59.2 ± 13.7 years, 78% male) underwent CPX and were subsequently tracked for major cardiac events. Ventilatory efficiency (VE/VCO(2) slope) and peak oxygen consumption (VO(2)), both absolute and percent-predicted, were determined. The prognostic value of these CPX variables was assessed in ≤ 45, 46-65 and ≥ 66 year subgroups. RESULTS The three year event rates for major cardiac events in the ≤ 45, 46-65 and ≥ 66 year subgroups were 8.8%, 6.0% and 5.7%, respectively. The VE/VCO(2) slope (Hazard ratio ≥ 1.07, p<0.001), peak VO(2) (Hazard ratio ≤ 0.87, p<0.001) and percent-predicted peak VO(2) (Hazard ratio 0 ≤ 0.98, p<0.001) were all significant prognostic markers in each age subgroup. While the VE/VCO(2) slope carried the greatest prognostic strength, peak VO(2) and percent-predicted peak VO(2) were retained in multivariate analyses (Residual Chi-Square ≥ 5.2, p<0.05). With respect to peak VO(2), the actual value was the more robust prognostic marker in the ≤ 45 and ≥ 66 year subgroups while the percent-predicted expression provided better predictive resolution in subjects who were 46-65 years old. CONCLUSIONS These results indicate that, irrespective of a patient's age at presentation, CPX provides valuable prognostic information in the HF population.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA.
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John JM, Haykowsky M, Brubaker P, Stewart K, Kitzman DW. Decreased left ventricular distensibility in response to postural change in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ Physiol 2010; 299:H883-9. [PMID: 20562334 DOI: 10.1152/ajpheart.00332.2010] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Most elderly persons with heart failure have a preserved left ventricular (LV) ejection fraction (HFPEF). The pathophysiology of this disorder is not well understood, and there are conflicting data regarding the role of decreased LV distensibility. To assess LV distensibility over a range of preload conditions while minimizing the large, confounding changes in contractility, afterload, and heart rate characteristic of exercise, we measured LV end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO) using two-dimensional echocardiography in 48 elderly (mean age, 69 yr) HFPEF patients and 25 healthy age-matched controls during quiet supine rest, 45 degrees head-up tilt (HUT), and 45 degrees head-down tilt (HDT). As a result, when compared with controls, HFPEF patients had reduced percent changes in EDV (-7 +/- 2 vs. -17 +/- 2%; P = 0.003), SV (-7 +/- 3 vs. -27 +/- 2%; P = 0.003), and CO (-6 +/- 4 vs. -34 +/- 4%; P = 0.001) during the transition from supine to HUT. HFPEF also had reduced percent changes in EDV (8 +/- 2 vs. 15 +/- 2%; P = 0.02), SV (11 +/- 3 vs. 21 +/- 3%; P = 0.002), and CO (1 +/- 4 vs. 12 +/- 4%; P = 0.04) during the transition from HUT to HDT. In conclusion, HFNEF patients have reduced LV distensibility in response to postural change, resulting in blunted EDV, SV, and CO. This provides further support for the hypothesis that a blunted Frank-Starling mechanism may contribute to the pathophysiology of HFPEF.
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Affiliation(s)
- Jerry M John
- Division of Cardiology, Department of Medicine, University of Toledo, Toledo, Ohio, USA
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman DW, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Cardiopulmonary Exercise Testing is Equally Prognostic in Young, Middle-Aged and Older Individuals Diagnosed with Heart Failure. Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385551.13230.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman DE, Guazzi M. Defining the optimal prognostic window for cardiopulmonary exercise testing in patients with heart failure. Circ Heart Fail 2010; 3:405-11. [PMID: 20200329 PMCID: PMC2953766 DOI: 10.1161/circheartfailure.109.906446] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventilatory efficiency (VE/VCO(2) slope) and peak oxygen consumption (VO) provide robust prognostic information in patients with heart failure undergoing cardiopulmonary exercise testing (CPX). The purpose of this study is to assess the change in prognostic characteristics of CPX at different time intervals. METHODS AND RESULTS Seven hundred ninety-one subjects (74% male, mean age: 60.7+/-12.9 years, ejection fraction: 34.6+/-15.0%, ischemic etiology: 51%) underwent CPX and were tracked for major cardiac events over a 4-year period. All event-free subjects were tracked for at least 3 years. Mean VE/VCO(2) slope and peak VO(2) were 35.0+/-10.0 and 16.0+/-6.4 mL O(2) . kg(-1) . min(-1), respectively. There were a total of 263 major cardiac events (199 deaths, 45 transplants, and 19 left ventricular assist device implantations). Both continuous and dichotomous expressions of the VE/VCO(2) slope and peak VO(2) were prognostically significant up to 18 months post-CPX. Continuous and dichotomous expressions of the VE/VCO(2) slope remained prognostically significant up to 36 months post-CPX, whereas peak VO(2) was not predictive during the third and fourth year of follow-up. In a multivariate analysis, the VE/VCO(2) slope was consistently the superior prognostic marker, whereas peak VO(2) added predictive value and was retained in the regression up to 18 months post-CPX. CONCLUSIONS These results indicate that commonly assessed CPX variables retain prognostic value for at least 2 years. The VE/VCO(2) slope is the superior predictor of adverse events throughout follow-up, although peak VO(2) provides additive prognostic information during the first 2 years of follow-up.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Guazzi M. Prognostic significance of the oxygen uptake efficiency slope: percent-predicted versus actual value. Am J Cardiol 2010; 105:757-8. [PMID: 20185029 DOI: 10.1016/j.amjcard.2009.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 10/08/2009] [Accepted: 10/13/2009] [Indexed: 11/17/2022]
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Myers J, Arena R, Oliveira RB, Bensimhon D, Hsu L, Chase P, Guazzi M, Brubaker P, Moore B, Kitzman D, Peberdy MA. The lowest VE/VCO2 ratio during exercise as a predictor of outcomes in patients with heart failure. J Card Fail 2009; 15:756-62. [PMID: 19879461 DOI: 10.1016/j.cardfail.2009.05.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 05/15/2009] [Accepted: 05/21/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The lowest minute ventilation (VE) and carbon dioxide production (VCO(2)) ratio during exercise has been suggested to be the most stable and reproducible marker of ventilatory efficiency in patients with heart failure (HF). However, the prognostic power of this index is unknown. METHODS AND RESULTS A total of 847 HF patients underwent cardiopulmonary exercise testing (CPX) and were followed for 3 years. The associations between the lowest VE/VCO(2) ratio, maximal oxygen uptake (peak VO(2)), the VE/VCO(2) slope, and major events (death or transplantation) were evaluated using proportional hazards analysis; adequacy of the predictive models was assessed using Akaike information criterion (AIC) weights. There were 147 major adverse events. In multivariate analysis, the lowest VE/VCO(2) ratio (higher ratio associated with greater risk) was similar to the VE/VCO(2) slope in predicting risk (hazard ratios [HR] per unit increment 2.0, 95% CI 1.1-3.4, and 2.2, 95% CI 1.3-3.7, respectively; P < .01), followed by peak VO(2) (HR 1.6, 95% CI 1.1-2.4, P=.01). Patients exhibiting abnormalities for all 3 responses had an 11.6-fold higher risk. The AIC weight for the 3 variables combined (0.94) was higher than any single response or any combination of 2. The model including all 3 responses remained the most powerful after adjustment for beta-blocker use, type of HF, and after applying different cut points for high risk. CONCLUSIONS The lowest VE/VCO(2) ratio adds to the prognostic power of conventional CPX responses in HF.
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Affiliation(s)
- Jonathan Myers
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Forman D, West E, Guazzi M. Determining the preferred percent-predicted equation for peak oxygen consumption in patients with heart failure. Circ Heart Fail 2009; 2:113-20. [PMID: 19808326 DOI: 10.1161/circheartfailure.108.834168] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peak oxygen consumption (Vo(2)) is routinely assessed in patients with heart failure undergoing cardiopulmonary exercise testing. The purpose of the present investigation was to determine the prognostic ability of several established peak Vo(2) prediction equations in a large heart failure cohort. METHODS AND RESULTS One thousand one hundred sixty-five subjects (70% males; age, 57.0+/-13.8 years; ischemic etiology, 43%) diagnosed with heart failure underwent cardiopulmonary exercise testing. Percent-predicted peak Vo(2) was calculated according to normative values proposed by Wasserman and Hansen (equation), Jones et al (equation), the Cooper Clinic (below low fitness threshold), a Veteran's Administration male referral data set (4 equations), and the St James Take Heart Project for women (equation). The prognostic significance of percent-predicted Vo(2) values derived from the 2 latter, sex-specific equations were assessed collectively. There were 179 major cardiac events (117 deaths, 44 heart transplantations, and 18 left ventricular assist device implantations) during the 2-year tracking period (annual event rate, 10%). Measured peak Vo(2) and all percent-predicted peak Vo(2) calculations were significant univariate predictors of adverse events (chi(2)> or =31.9, P<0.001) and added prognostic value to ventilatory efficiency (VE/Vco(2) slope), the strongest cardiopulmonary exercise testing predictor of adverse events (chi(2)=150.7, P<0.001), in a multivariate regression. The Wasserman/Hansen prediction equation provided optimal prognostic information. CONCLUSIONS Actual peak Vo(2) and the percent-predicted models included in this analysis all were significant predictors of adverse events. It seems that the percent-predicted peak Vo(2) value derived from the Wasserman/Hansen equations may outperform other expressions of this cardiopulmonary exercise testing variable.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA 23298-0224, USA.
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Arena R, Brubaker P, Moore B, Kitzman D. The oxygen uptake efficiency slope is reduced in older patients with heart failure and a normal ejection fraction. Int J Cardiol 2009; 144:101-2. [PMID: 19174312 DOI: 10.1016/j.ijcard.2008.12.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 12/13/2008] [Indexed: 11/29/2022]
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Arena R, Myers J, Abella J, Pinkstaff S, Brubaker P, Moore B, Kitzman D, Peberdy MA, Bensimhon D, Chase P, Guazzi M. The partial pressure of resting end-tidal carbon dioxide predicts major cardiac events in patients with systolic heart failure. Am Heart J 2008; 156:982-8. [PMID: 19061716 DOI: 10.1016/j.ahj.2008.06.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Accepted: 06/10/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The resting partial pressure of end-tidal carbon dioxide (Petco2) has been shown to reflect cardiac performance in acute care settings in patients with heart failure (HF). The purpose of the present study was to compare the prognostic ability of the partial pressure of Petco2 at rest to other commonly collected resting variables in patients with systolic HF. METHODS A total of 353 patients (mean age 58.6+/-13.7, 72% male) with systolic HF were included in this study. All patients underwent cardiopulmonary exercise testing where New York Heart Association (NYHA) class, resting Petco2, peak oxygen consumption, and the minute ventilation/carbon dioxide production slope were determined. Subjects were then followed for major cardiac events (mortality, left ventricular assist device implantation implantation, urgent heart transplantation). RESULTS There were 104 major cardiac events during the 23.6+/-17.0-month tracking period. Multivariate Cox regression analysis revealed NYHA class (chi2 28.7, P<.001), left ventricular ejection fraction (residual chi2 21.7, P<.001), and resting Petco2 (residual chi2 14.1, P<.001) were all prognostically significant and retained in the regression. In a separate Cox regression analysis, left ventricular ejection fraction (residual chi2 8.8, P=.003), NYHA class (residual chi2 7.7, P=.005), and resting Petco2 (residual chi2 5.7, P=.02) added prognostic value to the minute ventilation/carbon dioxide production slope (chi2 26.0, P<.001). CONCLUSION Resting Petco2 can be noninvasively collected from subjects in a short period, at a low cost, and with no risk or discomfort to the patient. Given the prognostic value demonstrated in the present study, the clinical assessment of resting Petco2 in the HF population may be warranted.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, Virginia Commonwealth University, Health Sciences Campus, Richmond, VA 23298-0224, USA.
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Grimm J, Grimm S, Jacob D, Sarkar A, Simpson L, Steffy E, Brubaker P. SU-GG-T-434: Submillimeter XKnife End-To-End Alignment Accuracy Using SAlinac and the Lucy Phantom. Med Phys 2008. [DOI: 10.1118/1.2962182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Park EK, Joo KC, Brubaker P, Ahn WH, Jin YS. The Effects of 12-Week Dome Ball Exercise Program on Physical Function in Post-Stroke Patients. Med Sci Sports Exerc 2008. [DOI: 10.1249/01.mss.0000322150.34736.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kouba EJ, Hundley G, Brubaker P, Nicklas B, Kitzman DW. Skeletal muscle remodeling and exercise intolerance in elderly patients with diastolic heart failure. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dorn K, Ocel J, Craft L, Wilder E, Herbert W, Brubaker P, Miller H. CIRCULATORY, HORMONAL, AND METABOLIC EFFECTS OF ARBUTAMINE COMPARED TO EXERCISE IN PERSONS WITH CORONARY ARTERY DISEASE. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-00280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Van Geluwe S, Ocel J, Craft L, Dom K, Wilder E, Herbert W, Brubaker P, Miller H. COMPARISON OF ARBUTAMINE AND EXERCISE TESTING ON RATE PRESSURE PRODUCT INDICATORS OF MYOCARDIAL ISCHEMIA. Med Sci Sports Exerc 1995. [DOI: 10.1249/00005768-199505001-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morley D, Boigon M, Fesniak H, Brubaker P, Walter J, Fitzpatrick J, Chojnowski D, Smith A, Alpern J, Brozena S. Posttransplantation hemodynamics and exercise function are not affected by body-size matching of donor and recipient. J Heart Lung Transplant 1993; 12:770-8. [PMID: 8241214] [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: 01/29/2023] Open
Abstract
Because the number of heart transplantations performed is limited by the number of available donor hearts, many centers have expanded the acceptable criteria for donor hearts in an attempt to provide a sufficient number of donors for the number of patients awaiting heart transplantation. Traditionally, body-size matching has been an important criteria for matching donors with potential heart transplant recipients. Although initially thought to be detrimental, studies have shown no difference in survival of patients who receive hearts from smaller donors, but heart performance in this subset of patients who receive undersized hearts has not been extensively examined. We assessed exercise capacity and 1-year posttransplantation hemodynamics in 72 consecutive adult orthotopic heart transplant recipients, grouped according to donor-recipient weight ratio and the ratio of donor to recipient body surface area. Total exercise time and relative oxygen consumption were not significantly different among three groups of patients grouped according to donor-recipient body weight ratio as follows: low, 0.60 to 0.79; mid, 0.80 to 1.0; high, more than 1.0. No difference was noted among the three donor-recipient weight ratio groups with respect to 1-year posttransplantation hemodynamics. Similarly, 1-year posttransplantation hemodynamics were not different between patients with a body surface area ratio of less than 1.0 versus those with a body surface area ratio of 1.0 or more. Differences in pretransplantation hemodynamics or graft preservation did not affect our results. Neither donor-recipient weight ratio nor body surface area ratio correlated with any posttransplantation hemodynamic measurement.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Morley
- Failure and Transplant Center, Hahnemann University, Philadelphia, Pa. 19102-1192
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Buchsbaum D, Lloyd R, Juni J, Wollner I, Brubaker P, Hanna D, Spicker J, Burns F, Steplewski Z, Colcher D. Localization and imaging of radiolabeled monoclonal antibodies against colorectal carcinoma in tumor-bearing nude mice. Cancer Res 1988; 48:4324-33. [PMID: 3390828] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Four monoclonal antibodies (MoAbs) (35, 115, 17-1A, and B72.3) directed towards human carcinoma surface antigens have been studied in athymic nude mice with LS174T, CO112, or SW948 colon carcinoma xenografts or negative control melanoma (MEL-1), lymphoma (Namalwa), and breast (MCF-7) carcinoma xenografts to evaluate the effects of antigenic heterogeneity and time after administration on localization and imaging. 125I-labeled 115 showed the highest uptake of any antibody in LS174T tumors. MoAbs 35 and B72.3 showed similar but lower levels of uptake in LS174T and CO112 tumors, but B72.3 concentrated less in SW948 tumors. 17-1A showed the highest degree of accumulation in SW948 tumor xenografts. No specific uptake of the four anti-carcinoma MoAbs was observed in MEL-1, Namalwa, or MCF-7 xenografts. The specificity of the in vivo tumor localization of the four anti-carcinoma MoAbs was confirmed by the low degree of accumulation of a control MoAb against influenza virus in LS174T tumors. Imaging studies with 131I-labeled colorectal cancer MoAbs showed specific uptake and retention in LS174T tumors, with progressive clearance from the whole body. The colorectal cancer MoAbs were compared for immunohistochemical binding against biopsies from patients with colorectal cancer and adjacent normal colonic tissue. Most colorectal cancer specimens showed moderate to strong staining with the four MoAbs. The percentage of positive cells varied within and between tumors demonstrating antigenic heterogeneity. Absent to slight focal staining was seen with normal colon tissue. B72.3 showed the highest degree of staining specificity. This study indicates a difference in the immunohistochemical binding of a panel of MoAbs against biopsies of colon adenocarcinoma and a dependence of in vivo localization on the human colon cancer cell line used as target. This has important implications for future clinical diagnostic and therapeutic studies.
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Affiliation(s)
- D Buchsbaum
- Department of Radiation Oncology, University of Michigan, Ann Arbor 48109
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Blumenthal JA, Rejeski WJ, Walsh-Riddle M, Emery CF, Miller H, Roark S, Ribisl PM, Morris PB, Brubaker P, Williams RS. Comparison of high- and low-intensity exercise training early after acute myocardial infarction. Am J Cardiol 1988; 61:26-30. [PMID: 3337013 DOI: 10.1016/0002-9149(88)91298-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The effects of the intensity of exercise training on cardiorespiratory variables were investigated in a consecutive series of men with recent (median 8 weeks) acute myocardial infarction. Forty-five patients were randomly assigned either to a high- (65 to 75% maximum oxygen consumption rate [VO2max]) or to a low-intensity (less than 45% VO2max) exercise group. Patients engaged in medically supervised aerobic training 3 sessions a week for 12 weeks. With training, mean VO2max significantly increased by 11% (2.09 to 2.31 liters/min) within the high group and by 14% (1.93 to 2.21 liters/min) within the low group. Differences between groups were not statistically significant. Both groups also had comparable changes in heart rate, blood pressure and double-product at submaximal and maximal workloads. Analysis of blood lipids revealed that both groups experienced a significant increase in high density lipoprotein cholesterol. There were no significant changes in total serum cholesterol or triglycerides. These findings suggest that within an unselected population of patients after acute myocardial infarction referred for cardiac rehabilitation, low- and high-intensity exercise training produces relatively similar changes in cardiorespiratory variables during the initial 3 months of exercise training.
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Affiliation(s)
- J A Blumenthal
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710
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