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Beussink-Nelson L, Freed BH, Chirinos JA, Brubaker PH, Kitzman DW, Yeboah J, Rosas SE, Hu M, Lima JAC, Pandit J, Bertoni AG, Shah SJ. Multi-Ethnic Study of Atherosclerosis Early Heart Failure Study: Rationale, Design, and Baseline Characteristics. Circ Heart Fail 2024; 17:e010289. [PMID: 38456289 PMCID: PMC11073782 DOI: 10.1161/circheartfailure.122.010289] [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: 10/25/2022] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Current prevalence estimates of heart failure (HF) are primarily based on self-report or HF hospitalizations. There is an unmet need to define the prevalence and pathogenesis of early symptomatic HF, which may be undiagnosed and precedes HF hospitalization. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) Early HF study was conducted during MESA exam 6 to determine the prevalence of early HF and investigate the transition from risk factors to early HF in a diverse population-based cohort of older adults. Between 2016 and 2018, 3285 MESA participants from 6 field centers underwent comprehensive speckle-tracking echocardiography with passive leg raise maneuver, Kansas City Cardiomyopathy Questionnaire, 6-minute walk test, arterial stiffness assessment, and proteomics (including NT-proBNP [N-terminal pro-B-type natriuretic peptide]). RESULTS Median age was 73 (25th-75th percentile 67-81) years, 53.2% were female, 25.6% were Black, 12.8% were Chinese, and 40.0% were White. The prevalence of HF risk factors was high: hypertension, 61.9%; former or current smoking, 53.7%; obesity 34.8%; diabetes; 24.7%; and chronic kidney disease; 22%. Overt cardiovascular disease, which ranged from 2.1% (HF) to 13.6% (atrial fibrillation), was less common. Of the 3285 participants, 96% underwent proteomics, 94% Kansas City Cardiomyopathy Questionnaire, 93% speckle-tracking echocardiography with passive leg raise, 82% arterial stiffness exam, and 77% 6-minute walk test. Feasibility of resting speckle-tracking echocardiography (87%-99% across cardiac chambers) and passive leg raise Doppler/speckle-tracking echocardiography (>84%) measurements was high. A total of 120 unique echocardiographic indices were measured. CONCLUSIONS The MESA Early HF study is a key resource for cardiovascular researchers who are interested in improving the epidemiological and phenotypic characterization of early HF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
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Affiliation(s)
- Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Benjamin H Freed
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia (J.A.C.)
| | - Peter H Brubaker
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Dalane W Kitzman
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Joseph Yeboah
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center (S.E.R.), Harvard Medical School, Boston, MA
| | - Mo Hu
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.A.C.L.)
| | - Jay Pandit
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Alain G Bertoni
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
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Kaminsky LA, Myers J, Brubaker PH, Franklin BA, Bonikowske AR, German C, Arena R. 2023 update: The importance of cardiorespiratory fitness in the United States. Prog Cardiovasc Dis 2024; 83:3-9. [PMID: 38360462 DOI: 10.1016/j.pcad.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
The American Heart Association issued a Policy Statement in 2013 that characterized the importance of cardiorespiratory fitness (CRF) as an essential marker of health outcomes and specifically the need for increased assessment of CRF. This statement summarized the evidence demonstrating that CRF is "one of the most important correlates of overall health status and a potent predictor of an individual's future risk of cardiovascular disease." Subsequently, this Policy Statement led to the development of a National Registry for CRF (Fitness Registry and the Importance of Exercise: A National Data Base [FRIEND]) which established normative reference values for CRF for adults in the United States (US). This review provides an overview of the progress made in the past decade to further our understanding of the importance of CRF, specifically related to prevention and for clinical populations. Additionally, this review overviews the evolvement and additional uses of FRIEND and summarizes a hierarchy of assessment methods for CRF. In summary, continued efforts are needed to expand the representation of data from across the US, and to include data from pediatric populations, to further develop the CRF Reference Standards for the US as well as further develop Global CRF Reference Standards.
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Affiliation(s)
- Leonard A Kaminsky
- Clinical Exercise Physiology, Ball State University, Muncie, IN, United States of America; Fisher Institute of Health and Well-Being, Ball State University, Muncie, IN, United States of America; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Veterans Affairs Palo Alto Healthcare System and Stanford University, Palo Alto, CA, United States of America
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, United States of America
| | - Barry A Franklin
- Corewell Health East, William Beaumont University Hospital, Preventive Cardiology and Cardiac Rehabilitation, Oakland University William Beaumont School of Medicine, Beaumont Health and Wellness Center, Royal Oak, MI, United States of America
| | - Amanda R Bonikowske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, United States of America
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, United States of America; Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL, United States of America
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Mihalko SL, Katula JA, Brubaker PH. Not a One-Way Street: UNDERSTANDING THE MANY ROADS THAT LEAD TO EXERCISE ADHERENCE. J Cardiopulm Rehabil Prev 2023; 43:153-155. [PMID: 37115953 DOI: 10.1097/hcr.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Shannon L Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
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Brubaker PH, Nelson WB, Kitzman DW. Response by Brubaker et al to Letter Regarding "A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction". Circ Heart Fail 2023; 16:e010419. [PMID: 37070429 PMCID: PMC10192000 DOI: 10.1161/circheartfailure.123.010419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC (P.H.B.)
| | - W Benjamin Nelson
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (B.N., D.W.K.)
| | - Dalane W Kitzman
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC (B.N., D.W.K.)
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC (D.W.K.)
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Brubaker PH, Nicklas BJ, Houston DK, Hundley WG, Chen H, Molina AJA, Lyles WM, Nelson B, Upadhya B, Newland R, Kitzman DW. A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2023; 16:e010161. [PMID: 36314122 PMCID: PMC9974606 DOI: 10.1161/circheartfailure.122.010161] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/07/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We have shown that combined caloric restriction (CR) and aerobic exercise training (AT) improve peak exercise O2 consumption (VO2peak), and quality-of-life in older patients with obese heart failure with preserved ejection fraction. However, ≈35% of weight lost during CR+AT was skeletal muscle mass. We examined whether addition of resistance training (RT) to CR+AT would reduce skeletal muscle loss and further improve outcomes. METHODS This study is a randomized, controlled, single-blind, 20-week trial of RT+CR+AT versus CR+AT in 88 patients with chronic heart failure with preserved ejection fraction and body mass index (BMI) ≥28 kg/m2. Outcomes at 20 weeks included the primary outcome (VO2peak); MRI and dual X-ray absorptiometry; leg muscle strength and quality (leg strength ÷ leg skeletal muscle area); and Kansas City Cardiomyopathy Questionnaire. RESULTS Seventy-seven participants completed the trial. RT+CR+AT and CR+AT produced nonsignificant differences in weight loss: mean (95% CI): -8 (-9, -7) versus -9 (-11, -8; P=0.21). RT+CR+AT and CR+AT had non-significantly differences in the reduction of body fat [-6.5 (-7.2, -5.8) versus -7.4 (-8.1, -6.7) kg] and skeletal muscle [-2.1 (-2.7, -1.5) versus -2.1 (-2.7, -1.4) kg] (P=0.20 and 0.23, respectively). RT+CR+AT produced significantly greater increases in leg muscle strength [4.9 (0.7, 9.0) versus -1.1 (-5.5, 3.2) Nm, P=0.05] and leg muscle quality [0.07 (0.03, 0.11) versus 0.02 (-0.02, 0.06) Nm/cm2, P=0.04]. Both RT+CR+AT and CR+AT produced significant improvements in VO2peak [108 (958, 157) versus 80 (30, 130) mL/min; P=0.001 and 0.002, respectively], and Kansas City Cardiomyopathy Questionnaire score [17 (12, 22) versus 23 (17, 28); P=0.001 for both], with no significant between-group differences. Both RT+CR+AT and CR+AT significantly reduced LV mass and arterial stiffness. There were no study-related serious adverse events. CONCLUSIONS In older obese heart failure with preserved ejection fraction patients, CR+AT produces large improvements in VO2peak and quality-of-life. Adding RT to CR+AT increased leg strength and muscle quality without attenuating skeletal muscle loss or further increasing VO2peak or quality-of-life. REGISTRATION URL: https://ClincalTrials.gov; Unique identifier: NCT02636439.
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Affiliation(s)
- Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (P.H.B.)
| | - Barbara J Nicklas
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Denise K Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - W Gregory Hundley
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond (W.G.H.)
| | - Haiying Chen
- Department of Biostatistical Sciences, Division of Public Health Sciences (H.C.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anthony J A Molina
- Department of Medicine, Division of Geriatrics, Gerontology and Palliative Care, University of California San Diego, La Jolla (A.J.A.M.)
| | - W Mary Lyles
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Benjamin Nelson
- Section on Cardiology, Department of Internal Medicine (B.N., B.U., R.N., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bharathi Upadhya
- Section on Cardiology, Department of Internal Medicine (B.N., B.U., R.N., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Russell Newland
- Section on Cardiology, Department of Internal Medicine (B.N., B.U., R.N., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dalane W Kitzman
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine (B.J.N., D.K.H., W.M.L., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
- Section on Cardiology, Department of Internal Medicine (B.N., B.U., R.N., D.W.K.), Wake Forest University School of Medicine, Winston-Salem, NC
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:E108-E111. [PMID: 37860981 DOI: 10.1097/hcr.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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7
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:380-383. [PMID: 37860952 DOI: 10.1097/hcr.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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8
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:291-294. [PMID: 37694544 DOI: 10.1097/hcr.0000000000000725] [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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9
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Avis NE, Levine BJ, Mihalko SL, Klepin HD, Brubaker PH, Calhoun T, Dent SF, Hackney MH, Ky B, Ladd A, Ntim WO, Wagner LI, Weaver KE, Hundley WG. The impact of anthracycline-based chemotherapy on fatigue: Results from WF-97415. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24115 Background: Chemotherapy (CT) is one of the most common factors associated with fatigue among breast cancer (BC) patients. However, there is a paucity of research on the impact of different types of CT on fatigue, specifically, whether women who receive anthracycline-based (Anth) CT experience greater fatigue than those who receive non-anthracycline-based (noAnth) CT. Methods: Analyses are from the longitudinal Understanding and Predicting fatigue, cardiovascular decline, and events after BrEast cAncer sTudy (UPBEAT: WF 97415)), conducted through the NCI Community Oncology Research Program (NCORP). We compared fatigue 3-months after initiating cancer treatment, controlling for fatigue measured just prior to beginning CT (baseline), in 3 groups of women: BC patients receiving Anth CT (N = 103 at baseline), BC patients receiving NoAnth CT (N = 155), and women without cancer (N = 145). Fatigue was measured by the Functional Assessment of Chronic Illness Therapy Fatigue scale where lower scores indicate greater fatigue. Scores < 30 indicate severe fatigue. We used ANOVA and ANCOVA models (PROC GLM; SAS v. 9.4) to generate unadjusted and adjusted mean fatigue scores in the 3 groups at the relevant time point. Given that selection to CT type was not random, we further adjusted for patient characteristics that influence treatment type (stage and comorbidities) in a model with the two CT groups only. Results: Mean age of participants (75.7% White and 18.1% Black) was 53.9 years. Among BC patients, the Anth group had higher tumor stage compared to the NoAnth group. Both cancer treatment groups reported significantly greater (unadjusted) fatigue pre-chemotherapy and at 3 months than healthy controls, but did not differ from each other. Adjusting for age and baseline fatigue, 3-month fatigue scores were significantly worse for the two CT groups (32.3 for Anth group, 34.3 for the NoAnth group) compared to the controls (44.6) (p < .0001). In a model of cancer patients only, the difference between Anth and NoAnth groups remained non-significant (p = 0.10), after adjusting additionally for number of comorbidities and cancer stage. The unadjusted percentage of women with severe fatigue at 3 months was significantly greater for the BC patients (39% in the Anth group; 38% in the NoAnth group) compared to the healthy controls (1%), but again the two chemotherapy groups were not significantly different from each other. Adjustment for covariates listed above did not change this finding. Conclusions: Analyses support previous studies showing significant fatigue among BC patients treated with CT compared to women without cancer. Our data suggest that fatigue significantly impacts patients receiving CT irrespective of the regimen selected.[Table: see text]
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Affiliation(s)
- Nancy E Avis
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | - Heidi D. Klepin
- Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC
| | | | | | | | | | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amy Ladd
- Virginia Commonwealth University, Richmond, VA
| | - William Ofori Ntim
- UNC School of Medicine, Novant Health Campus, Novant Health Heart & Vascular Institute, Charlotte, NC
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Heiston EM, Mabudian L, O'Connell NS, D'Agostino R, Brubaker PH, Mihalko SL, Reding K, Bellissimo M, Ladd A, Lucas A, Jordan J, Ky B, Calhoun T, Hackney MH, Weaver KE, Lesser GJ, Hundley WG. Impact of cardiometabolic health and abdominal adipose tissue on physical function in women with breast cancer (WF-97415). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18696] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18696 Background: Breast cancer treatments often result in a decline in physical function that may be worsened by high levels of abdominal adipose tissue (AAT). However, the role of cardiometabolic health, which is comprised of interrelated risk factors of insulin resistance, dyslipidemia, hypertension, and central adiposity, has been infrequently addressed. Thus, we evaluated the relationship between physical function and cardiometabolic health controlling for AAT in women with breast cancer before and during receipt of potentially cardiotoxic chemotherapy. Methods: Women recruited through NCORP with stage I-III breast cancer completed a six-minute walk distance (6MWD) test to determine physical function, magnetic resonance imaging (MRI) to evaluate AAT, and assessments of cardiometabolic health before and following 3 months of chemotherapy. Specifically, MRI was used to measure waist circumference (WC), and AAT components of subcutaneous (SAT) and visceral adipose tissue (VAT). To assess cardiometabolic health, individual metabolic syndrome (MetS) components of WC, mean arterial pressure (MAP), glucose (FPG), high-density lipoprotein cholesterol (HDL), and triglycerides (TG) were used to calculate a MetS severity z-score (MetS-Z) = [(WC-88)/SD] + [(MAP-100)/SD] + [(FPG-100)/SD] + [(50-HDL)/SD] + [(TG-150)/SD]. All measures were assessed by individuals blinded to visit, demographic data, and other components of the study. Baseline and 3-month data were compared via paired t-tests. Regression analyses were used to identify the relationship between 6MWD and MetS-Z and possible mediation effects of AAT (i.e., SAT and VAT). Results: One hundred eleven women with a mean age of 56.1 ± 11.0 yrs completed assessments. After 3 months of chemotherapy, 6MWD was lower (457 ± 90.7 vs 428 ± 92.9 m, P= 0.001) and MetS-Z was increased (-1.13 ± 3.01 vs 0.30 ± 3.97 AU, P< 0.001) compared to baseline. The increase in MetS-Z was mainly attributed to elevations in TG (120 ± 81 vs 154 ± 111 mg/dl, P< 0.001) and decreases in HDL (58.6 ± 14.3 vs 47.7 ± 13.9 mg/dl, P< 0.001). No changes were observed in SAT ( P= 0.15) or VAT ( P= 0.42). Although MetS-Z was associated with 6MWD at baseline ( P= 0.01), MetS-Z was not significant predictor after controlling for SAT and VAT (B = -3.39, P= 0.34, 95% CI [-10.4, 3.62]). MetS-Z also associated wtih 6MWD at 3 months ( P= 0.002) and this remained significant after controlling for SAT and VAT (B = -5.36, P= 0.03, 95% CI [-10.3, -0.46]). Conclusions: AAT may be more strongly associated with physical function prior to chemotherapy whereas cardiometabolic traits may have clinical implications during treatment in women with breast cancer. Additional longitudinal work investigating the effects of concurrent treatments (e.g., exercise, diet, pharmacological) on the relationship between cardiometabolic health and physical function is warranted. Clinical trial information: NCT02791581.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Amy Ladd
- Virginia Commonwealth University, Richmond, VA
| | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Kitamura M, Izawa KP, Ishihara K, Brubaker PH, Matsuda H, Okamura S, Fujioka K. Differences in Health-Related Quality of Life in Older People with and without Sarcopenia Covered by Long-Term Care Insurance. Eur J Investig Health Psychol Educ 2022; 12:536-548. [PMID: 35735461 PMCID: PMC9222037 DOI: 10.3390/ejihpe12060040] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 01/28/2023] Open
Abstract
Background: As a result of the increase in older people covered by long-term care insurance (LTCI), prevention of sarcopenia and maintenance and improvement of health-related quality of life (HRQOL) have become important themes. This study aimed to clarify both the differences in HRQOL in older people with and without sarcopenia covered by LTCI and the correlation between HRQOL and physical function. Methods: Participants were 101 older people with LTCI at a daycare center in Japan. We investigated clinical factors using the EuroQol five-dimension three-level questionnaire (EQ-5D-3L). Analysis was by unpaired t-test, Mann−Whitney U test, chi-square test, analysis of covariance, Pearson’s correlation coefficient, and Spearman’s rank correlation coefficient. Results: Compared to the no sarcopenia group (n = 40), the sarcopenia group (n = 24) had significantly lower body mass index, skeletal muscle mass index, gait speed, EQ-5D-3L, and adjusted EQ-5D-3L (p < 0.05). The EQ-5D-3L showed a significant correlation with handgrip strength in the sarcopenia group (p = 0.02) and significant correlations with gait speed and one-leg standing time (both, p = 0.01) in the no sarcopenia group. Conclusion: We clarified differences in HRQOL in older people with and without sarcopenia covered by LTCI. This information on the interrelationship between HRQOL and physical function may help maintain and improve HRQOL in these people.
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Affiliation(s)
- Masahiro Kitamura
- School of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, 2-1-12 Wajirogaoka, Fukuoka 811-0213, Japan;
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan;
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan;
- Correspondence: ; Tel.: +81-78-796-4566
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomogaoka, Kobe 654-0142, Japan;
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan;
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Okayama 700-0804, Japan
| | - Peter H. Brubaker
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan;
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27106, USA
| | - Hiroaki Matsuda
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
| | - Soichiro Okamura
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
| | - Koji Fujioka
- Department of Rehabilitation, Rifuru Yukuhashi Day Care Center, 379-1 Takase, Yukuhashi 824-0027, Japan; (H.M.); (S.O.); (K.F.)
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German CA, Fanning J, Singleton MJ, Shapiro MD, Brubaker PH, Bertoni AG, Yeboah J. Physical Activity, Coronary Artery Calcium, and Cardiovascular Outcomes in the Multi-Ethnic Study of Atherosclerosis (MESA). Med Sci Sports Exerc 2022; 54:800-806. [PMID: 34967800 PMCID: PMC9203864 DOI: 10.1249/mss.0000000000002856] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although the inverse relationship between physical activity (PA) and cardiovascular disease (CVD) is well established, observational studies suggest that very high levels of PA may be harmful. This study sought to understand the relationship between PA, coronary artery calcium (CAC), and cardiovascular outcomes among individuals at different levels of risk. METHODS PA and CAC were assessed in 6777 baseline participants of the Multi-Ethnic Study of Atherosclerosis. Total PA in MET-minutes per week was categorized into quartiles, and CAC was categorized as "low risk" (<100 Agatston units; n = 5180) and "high risk" (≥100 Agatston units; n = 1597). Cox proportional hazard regression analyses and Kaplan-Meier curves were generated to understand relationships between PA and CAC with CVD and all-cause mortality. RESULTS In low-risk participants in the highest PA quartile, there was a decrease in the adjusted hazard ratio (HR) for CVD (HR, 0.72; 95% confidence interval (CI), 0.56-0.94) and all-cause mortality (HR, 0.69; 95% CI, 0.57-0.84) compared with those in the lowest PA quartile. In high-risk participants in the highest PA quartile, there was a decrease in the adjusted HR for all-cause mortality (HR, 0.59; 95% CI, 0.47-0.74) compared with those in the lowest PA quartile. High PA was not associated with an increased risk of either outcome, regardless of CAC category, sex, or race/ethnicity. CONCLUSIONS Our research suggests that there is no increased risk associated with high levels of PA, even among individuals at high risk of CVD.
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Affiliation(s)
- Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL
| | - Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Matthew J Singleton
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael D Shapiro
- Section of Cardiology, Center for Prevention of Cardiovascular Disease, Wake Forest School of Medicine, Winston-Salem, NC
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
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13
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:211-214. [PMID: 37694529 DOI: 10.1097/hcr.0000000000000712] [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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14
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:137-140. [PMID: 37694509 DOI: 10.1097/hcr.0000000000000697] [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: 11/27/2022]
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15
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2022; 42:70-73. [PMID: 37694512 DOI: 10.1097/hcr.0000000000000678] [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: 11/25/2022]
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16
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Kubo I, Izawa KP, Kajisa N, Ogura A, Ogawa M, Kanai M, Brubaker PH, Sato S. Impact of cardiac surgery-associated acute kidney injury on activities of daily living at discharge in elderly cardiac surgery patients. Rev Cardiovasc Med 2021; 22:1553-1562. [PMID: 34957795 DOI: 10.31083/j.rcm2204160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 11/06/2022] Open
Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a critical complication associated with mortality and morbidity. This study aimed to clarify the impact of CSA-AKI on activities of daily living (ADL) at discharge in elderly cardiac surgery patients. We included 122 cardiac patients who underwent coronary artery bypass surgery, valve surgery, or combined surgery by mid-line incision followed by postoperative cardiac rehabilitation (CR) from March 2015 to May 2020. CSA-AKI was based on KDIGO criteria. The index of ADL was the Functional Independence Measure (FIM). We compared background factors, clinical parameters, activity level before hospitalization, CR progress, and FIM in patients with or without CSA-AKI. Multiple regression analysis was performed with FIM at discharge as the dependent variable and items with p < 0.01 in bivariate correlation as independent variables. Ultimately, 122 patients were divided into the non-CSA-AKI group (n = 84) and CSA-AKI group (n = 38). CR progression in the CSA-AKI group was significantly slower and FIM was lower than that in the non-CSA-AKI group. Moreover, even after adjustment for confounding factors, CSA-AKI (β = -0.18), start day of walking (β = -0.34), postoperative atrial fibrillation (β = -0.15), and activity level before hospitalization (β = -0.37) were predictive factors of ADL decline at discharge (adjusted R2 = 0.52). CSA-AKI of elderly cardiac surgery patients was a predictive factor of ADL decline at discharge.
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Affiliation(s)
- Ikko Kubo
- Department of Rehabilitation, Yodogawa Christian Hospital, 533-0024 Osaka, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, 654-0142 Kobe, Japan.,Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 654-0142 Kobe, Japan.,Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan
| | - Nozomu Kajisa
- Department of Rehabilitation, Yodogawa Christian Hospital, 533-0024 Osaka, Japan
| | - Asami Ogura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 654-0142 Kobe, Japan.,Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan
| | - Masato Ogawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 654-0142 Kobe, Japan.,Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan
| | - Masashi Kanai
- Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan
| | - Peter H Brubaker
- Cardiovascular stroke Renal Project (CRP), 654-0142 Kobe, Japan.,Departments of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27106, USA
| | - Shunsuke Sato
- Department of Cardiovascular surgery, Yodogawa Christian Hospital, 533-0024 Osaka, Japan
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Kaminsky LA, German C, Imboden M, Ozemek C, Peterman JE, Brubaker PH. The importance of healthy lifestyle behaviors in the prevention of cardiovascular disease. Prog Cardiovasc Dis 2021; 70:8-15. [PMID: 34922952 DOI: 10.1016/j.pcad.2021.12.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/12/2021] [Indexed: 12/29/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Advancements in the treatment of CVD have reduced mortality rates, yet the global burden of CVD remains high. Considering that CVD is still largely a preventable disease, prioritizing preventative measures through healthy lifestyle (HL) behaviors is necessary to lessen the burden of CVD. HL behaviors, such as regular exercise, healthy eating habits, adequate sleep, and smoking cessation, can influence a number of traditional CVD risk factors as well as a less commonly measured risk factor, cardiorespiratory fitness (CRF). It is important to note that cardiac rehabilitation programs, which traditionally have focused on secondary prevention, also emphasize the importance of making comprehensive HL behavior changes. This review discusses preventative measures to reduce the burden of CVD through an increased uptake and assessment of HL behaviors. An overview of the importance of CRF as a risk factor is discussed along with how to improve CRF and other risk factors through HL behavior interventions. The role of the clinician for promoting HL behaviors to prevent CVD is also reviewed.
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Affiliation(s)
- Leonard A Kaminsky
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Charles German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mary Imboden
- George Fox University, USA; Health Enhancement Research Organization, USA
| | - Cemal Ozemek
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - James E Peterman
- Fisher Institute of Health and Well-Being, College of Health, Ball State University, Muncie, IN, United States; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA
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18
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:443-446. [PMID: 37694537 DOI: 10.1097/hcr.0000000000000662] [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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19
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Izawa KP, Kasahara Y, Watanabe S, Oka K, Brubaker PH, Kida K, Akashi YJ. Association of objectively measured daily physical activity and health utility to disease severity in chronic heart failure patients: A cross-sectional study. Am Heart J Plus 2021; 10:100051. [PMID: 38560645 PMCID: PMC10978131 DOI: 10.1016/j.ahjo.2021.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 04/04/2024]
Abstract
Background and aims Physical activity (PA) levels are related to mortality and morbidity in patients with chronic heart failure (CHF). Health utility (HU), a very important cost-effectiveness analysis for health care and health status, is measured by several preference-based utility measures. This study aimed to evaluate the relation between PA and HU and the effect of disease severity on PA and HU in patients with CHF. Methods We enrolled 226 consecutive outpatients with CHF (mean age, 57.5 years; males, 79.6%) in this retrospective cross-sectional study. Patients were divided into three groups by NYHA class for classification of disease severity. Patient characteristics, average step count in steps/day, PA energy expenditure (PAEE) in kcal/day for 7 days as assessed by accelerometer, and HU assessed by Short Form-6D were compared between the groups. Results Average step count (r = 0.37, P < 0.01) and average PAEE (r = 0.36, P < 0.01) correlated positively with HU in all patients. Patients were classified into three groups by NYHA class: class I (n = 92), class II (n = 97), and class III (n = 37). Average step counts (7618.58, 6452.51, and 4225.63 steps/day, P < 0.001), average PAEE (244.65, 176.88, and 103.72 kcal/day, P < 0.001), and HU (0.68, 0.63, and 0.57, P < 0.001) respectively decreased with the increase in NYHA class (P < 0.001). Conclusion This study showed a significant relationship of daily PA and HU to disease severity in patients with CHF. Although causation cannot be determined from this study, these results suggest that PA and HU may provide important information related to the severity of disease in patients with CHF.
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Affiliation(s)
- Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Yusuke Kasahara
- Department of Rehabilitation Medicine, St. Marianna University Yokohama-city Seibu Hospital, Yokohama, Japan
| | - Satoshi Watanabe
- Department of Rehabilitation Center, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Peter H. Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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20
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Amjad A, Brubaker PH, Upadhya B. Exercise training for prevention and treatment of older adults with heart failure with preserved ejection fraction. Exp Gerontol 2021; 155:111559. [PMID: 34547406 DOI: 10.1016/j.exger.2021.111559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.
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Affiliation(s)
- Aysha Amjad
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest School of Medicine, Winston Salem, USA
| | - Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, USA.
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21
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:363-365. [PMID: 37694446 DOI: 10.1097/hcr.0000000000000652] [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: 11/27/2022]
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22
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Brubaker PH, Keteyian SJ, Tucker WJ. Effect of Training on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction. JAMA 2021; 326:770. [PMID: 34427609 DOI: 10.1001/jama.2021.10052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Wesley J Tucker
- Department of Nutrition and Food Sciences, Texas Woman's University, Houston
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23
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Sullivan SW, Fleet NA, Brooks VA, Bido J, Nwachukwu BU, Brubaker PH. Comparison of Different Functional Tests for Leg Power and Normative Bilateral Asymmetry Index in Healthy Collegiate Athletes. Open Access J Sports Med 2021; 12:119-128. [PMID: 34393525 PMCID: PMC8354771 DOI: 10.2147/oajsm.s315162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background Bilateral leg power is being increasingly investigated as a proxy for the recovery of muscle performance after injury. Functional tests like the single leg hop for distance (SLHD) and single leg vertical jump (SLVJ) are often used to determine symmetry and return to play (RTP) readiness. As an injury predictor, leg power is accurately measured with the Keiser Air420 seated leg press. Purpose To measure and analyze lower leg asymmetry in healthy collegiate athletes across each test battery. Methods Eighty-eight healthy student-athletes (44 males, 44 females) across 14 varsity teams at Wake Forest University performed the SLHD, SLVJ, and the Keiser. Horizontal and vertical displacement were measured via the SLHD and SLVJ, respectively. Peak power was recorded via the Keiser Air420 leg press. Pearson correlations and repeated measures ANOVA were used to calculate associations and compare bilateral asymmetry indices (BAI) and raw scores. Results There was a significant effect on each test’s raw BAI (P < 0.01). The mean absolute BAI were 5.42 ± 4.9%, 6.64 ± 4.9% and 5.36 ± 4.7% for the SLHD, SLVJ and Keiser, respectively. The SLVJ and Keiser (dominant leg r = 0.832, nondominant leg r = 0.826) were more highly correlated than the SLHD and Keiser (dominant leg r = 0.645, nondominant leg r = 0.687), all of which were statistically significant (P < 0.01). Conclusion At the 90th percentile, healthy collegiate athletes attained <15% BAI. We recommend the implementation of a battery of tests to determine normative lower limb asymmetry. A battery of functional tests may present different asymmetry indices as opposed the 10% reference asymmetry.
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Affiliation(s)
- Spencer W Sullivan
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, 27106, USA.,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Niles A Fleet
- Department of Sports Medicine, Wake Forest University, Winston-Salem, NC, 27106, USA
| | - Vanessa A Brooks
- Department of Sports Medicine, Wake Forest University, Winston-Salem, NC, 27106, USA
| | - Jennifer Bido
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Benedict U Nwachukwu
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, 27106, USA
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:292-294. [PMID: 37694510 DOI: 10.1097/hcr.0000000000000633] [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: 11/25/2022]
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25
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German CA, Brubaker PH, Nelson MB, Fanning J, Ye F, Kitzman DW. Relationships Between Objectively Measured Physical Activity, Exercise Capacity, and Quality of Life in Older Patients With Obese Heart Failure and Preserved Ejection Fraction. J Card Fail 2021; 27:635-641. [PMID: 34088379 DOI: 10.1016/j.cardfail.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/24/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relationship between physical activity (PA), exercise capacity, and quality of life (QOL) in obese heart failure with preserved ejection fraction is poorly understood. METHODS AND RESULTS This was an ancillary study to a clinical trial. Accelerometers were used to measure light PA, moderate to vigorous PA, total PA, PA energy expenditure, and steps. Peak VO2, exercise time, and 6-minute walk distance, as well as QOL measures were obtained. Pearson correlations were performed to examine relationships between PA, exercise capacity, and QOL. Patients (n = 58) were 68.0 ± 5.7 years old, 78% female, 59% White, and obese (body mass index 39.1 ± 6.1 kg/m2). Patients had low levels of objectively measured PA as well as decreased exercise capacity and poor QOL. Light PA (r = 0.32, P = .014) and steps per day (r = 0.30, P = .022) were modestly correlated with peak VO2. All PA variables were modestly correlated with exercise time (r = 0.33-0.49, all P < .02) and 6-minute walk distance (r = 0.25-0.48, all P < .01). None of the PA variables were correlated with QOL. CONCLUSIONS PA variables were modestly correlated with measures of exercise capacity and were not significantly correlated with QOL. Our findings indicate that PA, exercise capacity, and QOL assess different aspects of the patient experience in older obese patients with heart failure with preserved ejection fraction.
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Affiliation(s)
- Chares A German
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine
| | | | - M Benjamin Nelson
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine
| | | | - Fan Ye
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine
| | - Dalane W Kitzman
- Cardiology Section, Department of Internal Medicine, Wake Forest School of Medicine; Department of Geriatric Medicine, Sticht Center, Wake Forest University, Winston-Salem, North Carolina
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26
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Ogura A, Izawa KP, Sato S, Tawa H, Kureha F, Wada M, Kanai M, Kubo I, Brubaker PH, Yoshikawa R, Matsuda Y. Relationship of end-tidal oxygen partial pressure to the determinants of anaerobic threshold in post-myocardial infarction patients. Heart Vessels 2021; 36:1811-1817. [PMID: 33990894 DOI: 10.1007/s00380-021-01870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
The anaerobic threshold (AT), obtained during cardiopulmonary exercise testing (CPET), is an important prognostic measure and can be used to develop an exercise prescription in patients after a myocardial infarction (post-MI). The purpose of this study was to examine the central and peripheral determinants of AT in post-MI patients end-tidal oxygen partial pressure (PETO2) measures. We performed cardiopulmonary exercise testing (CPET) on 148 consecutively enrolled post-MI patients to determine PETO2 measured at the AT (AT PETO2) and ΔPETO2 (difference between resting PETO2 and AT PETO2). We subsequently investigated the relationship between these measures of PETO2 and the individual AT for each patient. Multivariate linear regression analysis indicated that AT PETO2 and ΔPETO2 were independently and significantly associated with the AT (β = -0.344, p < 0.001 and β = 0.228, p < 0.001, respectively). Furthermore, the independent factors of AT PETO2 were left ventricular ejection fraction (p = 0.005), resting ventilatory equivalent for carbon dioxide (p = 0.002), and resting dead-space gas volume to tidal volume ratio (p < 0.001). However, the independent factors for ΔPETO2 were history of diabetes (p = 0.047), estimated glomerular filtration rate (p = 0.001), and resting systolic blood pressure (p = 0.017). These findings suggested that AT PETO2 was associated with central determinants; whereas, and ΔPETO2 was associated with peripheral determinants, The AT PETO2 and ΔPETO2 provide variable insight regarding the cause of exercise intolerance and can be used to determine appropriate therapies.
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Affiliation(s)
- Asami Ogura
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan.,Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular stroke Renal Project (CRP), Kobe, Japan
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan. .,Cardiovascular stroke Renal Project (CRP), Kobe, Japan.
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University, Tokyo, Japan
| | - Hideto Tawa
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Fumie Kureha
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
| | - Masaaki Wada
- Department of Rehabilitation, Sanda City Hospital, Sanda, Japan
| | - Masashi Kanai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular stroke Renal Project (CRP), Kobe, Japan
| | - Ikko Kubo
- Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome Suma, Kobe, 654-0142, Japan.,Cardiovascular stroke Renal Project (CRP), Kobe, Japan
| | - Peter H Brubaker
- Departments of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | | | - Yuichi Matsuda
- Department of Cardiology, Sanda City Hospital, Sanda, Japan
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:202-205. [PMID: 37694541 DOI: 10.1097/hcr.0000000000000618] [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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28
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O'Doherty AF, Humphreys H, Dawkes S, Cowie A, Hinton S, Brubaker PH, Butler T, Nichols S. How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR. BMJ Open 2021; 11:e046051. [PMID: 33879492 PMCID: PMC8061561 DOI: 10.1136/bmjopen-2020-046051] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation. DESIGN A mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety. SETTING International survey of exercise-based cardiac rehabilitation programmes. PARTICIPANTS Healthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide. MAIN OUTCOME MEASURES The proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation. RESULTS Three hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing. CONCLUSIONS The rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.
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Affiliation(s)
- Alasdair F O'Doherty
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Helen Humphreys
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Susan Dawkes
- School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, Scotland, UK
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
| | - Aynsley Cowie
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
- Cardiac Rehabilitation, Lister Centre, University Hospital Crosshouse, Kilmarnock, Scotland, UK
| | - Sally Hinton
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Tom Butler
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Simon Nichols
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
- British Association for Cardiovascular Prevention and Rehabilitation, London, UK
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Qian J, Walkup MP, Chen SH, Brubaker PH, Bond DS, Richey PA, Jakicic JM, Hu K, Scheer FAJL, Middelbeek RJW. Association of Objectively Measured Timing of Physical Activity Bouts With Cardiovascular Health in Type 2 Diabetes. Diabetes Care 2021; 44:1046-1054. [PMID: 33597215 PMCID: PMC7985432 DOI: 10.2337/dc20-2178] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 09/01/2020] [Accepted: 01/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Moderate- to vigorous-intensity physical activity (MVPA) improves cardiovascular health. Few studies have examined MVPA timing. We examined the associations of timing of bout-related MVPA with cardiorespiratory fitness and cardiovascular risk in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Baseline 7-day hip-worn accelerometry data from Look AHEAD participants (n = 2,153, 57% women) were analyzed to identify bout-related MVPA (≥3 METs/min for ≥10 min). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups on the basis of the time of day with the majority of bout-related MVPA (METs × min): ≥50% of bout-related MVPA during the same time window (morning, midday, afternoon, or evening), <50% of bout-related MVPA in any time category (mixed; the reference group), and ≤1 day with bout-related MVPA per week (inactive). RESULTS Cardiorespiratory fitness was highly associated with timing of bout-related MVPA (P = 0.0005), independent of weekly bout-related MVPA volume and intensity. Importantly, this association varied by sex (P = 0.02). In men, the midday group had the lowest fitness (β = -0.46 [95% CI -0.87, -0.06]), while the mixed group in women was the least fit. Framingham risk score (FRS) was associated with timing of bout-related MVPA (P = 0.02), which also differed by sex (P = 0.0007). The male morning group had the highest 4-year FRS (2.18% [0.70, 3.65]), but no association was observed in women. CONCLUSIONS Timing of bout-related MVPA is associated with cardiorespiratory fitness and cardiovascular risk in men with type 2 diabetes, independent of bout-related MVPA volume and intensity. Prospective studies are needed to determine the impacts of MVPA timing on cardiovascular health.
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Affiliation(s)
- Jingyi Qian
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA .,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | | | | | - Peter H Brubaker
- Wake Forest University Health & Exercise Science, Winston-Salem, NC
| | - Dale S Bond
- The Miriam Hospital/Brown Alpert Medical School, Providence, RI
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - John M Jakicic
- Healthy Lifestyle Institute, University of Pittsburgh, Pittsburgh, PA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:132-135. [PMID: 37696581 DOI: 10.1097/hcr.0000000000000600] [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: 11/25/2022]
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31
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2021; 41:58-60. [PMID: 37694393 DOI: 10.1097/hcr.0000000000000582] [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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MALDONADO-MARTIN SARA, Gorostegi-Anduaga I, Corres P, MartinezAguirre-Betolaza A, Dominguez-Martinez S, Saracho R, Jurio-Iriarte B, Tous-Espelosín M, Brubaker PH. Sex Differences In Leptin And Cardiometabolic Profile After Exercise Intervention In Obese And Hypertensive Adults. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000677192.23723.b9] [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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33
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Dent SF, Reding K, Lesser GJ, Klepin HD, Wagner LI, Kitzman D, Brubaker PH, Mihalko S, Avis NE, Winkfield KM, Ky B, Crotts T, Kikuchi R, Calhoun T, Hundley WG. Understanding and predicting fatigue, cardiovascular (CV) decline & events after breast cancer treatment (UPBEAT): A prospective multi-center wake forest NCORP research-base study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps602] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS602 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients, treated with modern anticancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and the future development of CV events. The comprehensive assessment includes: ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, expanded short physical performance battery), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2 peak via cardiopulmonary exercise test), and fatigue (via FACT-F). Eligibility criteria: age > 18 years; ECOG 0-2, able to walk without symptoms; receiving chemotherapy +/- HER2 targeted agent(s). To date, 244 participants are enrolled through 12 NCORP or ECOG-ACRIN sites. An additional 7 sites are onboarding and will be enrolling later in the year. Participants will be followed for 9 years with active surveillance of CV events (i.e., heart failure, myocardial infarction, stroke, all-cause and CV death). EA NCORP Grant: 2 UG1 CA189828 06; Research Base Grant: 2UG1 CA189824; R01: 1R01CA199167. Clinical trial information: NCT02791581 .
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Affiliation(s)
| | | | | | - Heidi D. Klepin
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC
| | | | | | | | | | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Kalra S, Brubaker PH. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2020. [DOI: 10.1097/hcr.0000000000000522] [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: 11/25/2022]
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35
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Jordan JH, D’Agostino RB, Avis NE, Mihalko SL, Brubaker PH, Kitzman D, Winkfield KM, Suerkin CK, Reding KW, Klepin HD, Lesser GJ, Hundley WG. Fatigue, Cardiovascular Decline, and Events after Breast Cancer Treatment: Rationale and Design of UPBEAT Study. JACC CardioOncol 2020; 2:114-118. [PMID: 34396215 PMCID: PMC8352177 DOI: 10.1016/j.jaccao.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - W. Gregory Hundley
- Virginia Commonwealth University, 1200 East Broad Street, P.O. Box 980335, Richmond, Virginia 23298 @VCUHealthHeart@JenJordanPhD
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Kitamura M, Izawa KP, Yaekura M, Mimura Y, Ikeda Y, Nagashima H, Brubaker PH. Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure. Int J Environ Res Public Health 2019; 16:ijerph16245068. [PMID: 31842307 PMCID: PMC6950285 DOI: 10.3390/ijerph16245068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.
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Affiliation(s)
- Masahiro Kitamura
- Department of Physical Therapy, Kokura Rehabilitation College, Kitakyushu, Kitakyushu 800-0206, Japan;
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: ; Tel.: +81-78-796-4566
| | - Masakazu Yaekura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yumi Mimura
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Yuichi Ikeda
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Hitomi Nagashima
- Department of Rehabilitation, Shinyukuhashi Hospital, Yukuhashi 824-0026, Japan; (M.Y.); (Y.M.); (Y.I.); (H.N.)
| | - Peter H. Brubaker
- Cardiovascular stroke Renal Project (CRP), Institute, Kobe 654-0142, Japan;
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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Pandey A, Kraus WE, Brubaker PH, Kitzman DW. Healthy Aging and Cardiovascular Function: Invasive Hemodynamics During Rest and Exercise in 104 Healthy Volunteers. JACC Heart Fail 2019; 8:111-121. [PMID: 31706837 PMCID: PMC10367061 DOI: 10.1016/j.jchf.2019.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between age and invasive cardiovascular hemodynamics during upright exercise among healthy adults. BACKGROUND The marked age-related decline in maximal exercise oxygen uptake (peak VO2) may contribute to the high burden of heart failure among older individuals and their greater severity of exertional symptoms. However, the mechanisms underlying this decline are not well understood. METHODS A total of 104 healthy community-dwelling volunteers age 20 to 76 years well screened for cardiovascular disease underwent exhaustive upright exercise with brachial and pulmonary artery catheters; radionuclide ventriculography; and expired gas analysis for the measurement of peak VO2, cardiac output, left ventricular stroke volume, end-diastolic volume, end-systolic volume, ejection fraction, pulmonary capillary wedge pressure, and arteriovenous oxygen difference. RESULTS Over a 5.5-decade age range, there was a 40% decline in peak VO2 due primarily to reduced peak exercise cardiac output; peak arteriovenous oxygen difference was unaffected by age. The lower age-related exercise cardiac output was related to lower peak exercise heart rate and stroke volume. Aging was also associated with lower peak exercise ejection fraction, indicating reduced inotropic reserve. Peak exercise end-diastolic volume was lower with aging despite similar left ventricular filling pressure, suggesting age-related reduced diastolic compliance limiting the use of the Frank-Starling mechanism to compensate for reduced chronotropic and inotropic reserves. These age relationships were unaffected by sex. CONCLUSIONS The age-related decline in exercise capacity among healthy persons is due predominantly to cardiac mechanisms, including reduced chronotropic and inotropic reserve and possibly reduced Frank-Starling reserve. Peak exercise left ventricular filling pressure and arteriovenous oxygen difference are unchanged with healthy aging.
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Affiliation(s)
- Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Peter H Brubaker
- Department of Exercise and Health Science, Wake Forest University, Winston-Salem, North Carolina
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Brubaker PH, Kalra S. Selected Abstracts From Recent Publications in Cardiopulmonary Disease Prevention and Rehabilitation. J Cardiopulm Rehabil Prev 2019. [DOI: 10.1097/hcr.0000000000000490] [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: 11/25/2022]
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39
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Jordan JH, Castellino SM, Meléndez GC, Klepin HD, Ellis LR, Lamar Z, Vasu S, Kitzman DW, Ntim WO, Brubaker PH, Reichek N, D'Agostino RB, Hundley WG. Left Ventricular Mass Change After Anthracycline Chemotherapy. Circ Heart Fail 2019; 11:e004560. [PMID: 29991488 DOI: 10.1161/circheartfailure.117.004560] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [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] [Received: 09/08/2017] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment. METHODS AND RESULTS We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non-Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ2 tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF (P<0.0001) and LV mass (P=0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups (P=0.11-0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines (r=-0.27; P<0.01) but not with LVEF declines (r=0.11; P=0.45). Moreover, this finding was independent of LVEF changes and body weight. CONCLUSIONS Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.
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Affiliation(s)
- Jennifer H Jordan
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | | | - Giselle C Meléndez
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.).,Department of Internal Medicine, Section on Comparative Medicine, Department of Pathology (G.C.M.)
| | | | | | | | - Sujethra Vasu
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - William O Ntim
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Peter H Brubaker
- Wake Forest School of Medicine, and Department of Health and Exercise Sciences (P.H.B)
| | - Nathaniel Reichek
- Wake Forest University, Winston-Salem, NC. Research and Education, The Heart Center, St Francis Hospital, Roslyn, NY (N.R.)
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Division of Public Health Sciences (R.B.D'A.)
| | - W Gregory Hundley
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.) .,Department of Radiological Sciences (W.G.H.)
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Kitzman DW, Upadhya B, Brubaker PH, Haykowsky MJ, Nelson MD. Reply: Heart Failure With Preserved Ejection Fraction: Types 1 and 2? JACC Heart Fail 2019; 7:632-633. [PMID: 31248574 DOI: 10.1016/j.jchf.2019.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/04/2019] [Indexed: 10/26/2022]
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41
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Christensen BL, Brubaker PH, Tiarks G, Becton JT, Kitzman D. Examining the Impact of Obesity on Ventilatory Responses During Acute Exercise in Patients with HFpEF. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561841.40584.91] [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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Reding K, D'Agostino R, Lesser GJ, Klepin HD, Wagner LI, Kitzman D, Brubaker PH, Mihalko S, Jordan J, Avis NE, Winkfield KM, Ky B, Dent SF, Crotts T, Calhoun T, Lane K, Hundley WG. Understanding and predicting fatigue, cardiovascular (CV) decline, and events after breast cancer treatment (UPBEAT): A prospective cardio-oncology study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps11634] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS11634 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients,treated with modern cancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and future development of CV events. The comprehensive assessment of factors includes ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, Expanded SPPB), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points, include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2peak via cardiopulmonary exercise test), fatigue (via FACT-F). Eligibility criteria are: age >18 years; ECOG 0-2, able to walk without symptoms; and for BC patients, treatment with chemotherapy. 143 participants are accrued and currently enrolling through ECOG and NCORP sites. Participants will be followed for 9 years with active surveillance of CV events, i.e., heart failure, myocardial infarction, stroke, all-cause and CV death. Clinical trial information: NCT02791581.
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Affiliation(s)
- Kerryn Reding
- Fred Hutchinson Cancer Research Center & University of Washington, School of Nursing, Seattle, WA
| | | | | | - Heidi D. Klepin
- Comprehensive Cancer Center, Wake Forest Baptist Health, Winston Salem, NC
| | - Lynne I. Wagner
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | | | | | - Bonnie Ky
- Hospital of the University of Pennsylvania, Philadelphia, PA
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Tucker WJ, Brubaker PH, Haykowsky MJ. Improving Exercise Capacity in Recent Heart Transplant Recipients. Circulation 2019; 139:2212-2214. [PMID: 31059321 DOI: 10.1161/circulationaha.119.039845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wesley J Tucker
- College of Nursing and Health Innovation (W.J.T., M.J.H.), University of Texas at Arlington.,Department of Kinesiology (W.J.T.), University of Texas at Arlington
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC (P.H.B.)
| | - Mark J Haykowsky
- College of Nursing and Health Innovation (W.J.T., M.J.H.), University of Texas at Arlington
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Jurio-Iriarte B, Brubaker PH, Gorostegi-Anduaga I, Corres P, Martinez Aguirre-Betolaza A, Maldonado-Martin S. Validity of the modified shuttle walk test to assess cardiorespiratory fitness after exercise intervention in overweight/obese adults with primary hypertension. Clin Exp Hypertens 2018; 41:336-341. [PMID: 29902061 DOI: 10.1080/10641963.2018.1481423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The study aimed to assess whether the Modified Shuttle Walk Test (MSWT) can detect changes in cardiorespiratory fitness (CRF) in overweight/obese people with hypertension (HTN) after an exercise intervention evaluating the equation presented in the previous research by Jurio-Iriarte et al. Participants (N= 248) performed a peak cardiorespiratory exercise test (CPET) and MSWT before and after 16-weeks of different types of aerobic exercise intervention. The formula of Jurio-Iriarte et al. was used to predict peak oxygen uptake (V̇O2peak). The correlation between measured and predicted V̇O2peak was strong (r= 0.76, P< 0.001) with a standard error of estimate (SEE) of 4.9 mL·kg-1·min-1; SEE%= 17%. The intraclass correlation coefficient indicates a moderate level of association and agreement (ICC= 0.69; 95% CI 0.34-0.82; P< 0.001) between the measured and predicted V̇O2peak. When analyzing obese participants alone (N= 128), MSWT equation was more accurate compared to the whole sample (ICC= 0.76; 95% CI 0.52-0.87). The relationship between the change of measured and predicted V̇O2peak at follow-up was weak (r= 0.42, P< 0.001) with a 31% SEE, and a low level of association and agreement (ICC= 0.31; 95% CI 0.06-0.49; P< 0.001). In conclusion, although MSWT does not accurately predict CRF in people with HTN after exercise intervention and questions its validity, the new equation may have practical application to estimate V̇O2peak for obese people with HTN when CPET is not available. Abbreviations: AC: Attention Control; BM: Body Mass; BP: Blood Pressure; CI: Confidence Interval; CRF: Cardiorespiratory Fitness; CPET: Cardiopulmonary Exercise Test; HTN: Primary Hypertension; HR: Heart Rate; HV-HIIT: High-Volume and High-Intensity Interval Training; ICC: Intraclass Correlation Coefficient; LV-HIIT: Low-Volume and High-Intensity Interval Training; MICT: Moderate-intensity continuous training; MSWT: Modified Shuttle Walk Test; SD: Standard Deviation; SEE: Standard Error of Estimate; V̇O2peak: Peak Oxygen Uptake.
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Affiliation(s)
- Borja Jurio-Iriarte
- a Physical Education and Sport , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Peter H Brubaker
- b Department of Health and Exercise Science , Wake Forest University (WFU) , Winston-Salem , USA
| | - Ilargi Gorostegi-Anduaga
- a Physical Education and Sport , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | - Pablo Corres
- a Physical Education and Sport , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
| | | | - Sara Maldonado-Martin
- a Physical Education and Sport , University of the Basque Country (UPV/EHU) , Vitoria-Gasteiz , Spain
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Brubaker PH, Ross JH, Joo KC. Contemporary Approaches to Prescribing Exercise in Coronary Artery Disease Patients. Am J Lifestyle Med 2018; 12:130-139. [PMID: 30202385 PMCID: PMC6124989 DOI: 10.1177/1559827615625482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/03/2015] [Revised: 12/07/2015] [Accepted: 12/14/2015] [Indexed: 01/20/2023] Open
Abstract
Health care professionals engaged in the management of coronary artery disease (CAD) patients, both in primary and secondary prevention settings, should possess the knowledge to develop and modify both aerobic exercise as well as musculoskeletal resistance exercise training programs. The traditional exercise prescription (ExRx) for aerobic-type exercise describes the intensity, frequency, duration, and mode of exercise, as well as the rate of progression. The more contemporary ExRx focuses on the energy expenditure associated with all physical activity not just structured exercise bouts. The total "volume or dose" of physical activity is associated with important health outcomes, including the potential to prevent and potentially reverse CAD lesions. Also, emerging evidence supporting the use of high-intensity interval training in CAD patients will also be provided. Furthermore, this review will also address the issue of generating an appropriate ExRx in the absence of maximal exercise "stress" test data, a common occurrence in the primary care setting and in this era of health care cost containment. Prescribing resistance exercise for CAD patients requires careful consideration and will be discussed in this review. Finally, this review will conclude with a section that describes the special considerations and/or modifications for some common comorbidities seen in CAD patients.
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Affiliation(s)
- Peter H. Brubaker
- Peter H. Brubaker, PhD, Department of Health and Exercise Science, Wake Forest University, PO Box 7628, Winston-Salem, NC 27109; e-mail:
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Lee JY, Joo KC, Brubaker PH. Aqua walking as an alternative exercise modality during cardiac rehabilitation for coronary artery disease in older patients with lower extremity osteoarthritis. BMC Cardiovasc Disord 2017; 17:252. [PMID: 28934945 PMCID: PMC5609027 DOI: 10.1186/s12872-017-0681-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this study was to examine the effects of aqua walking (AW) on coronary artery disease (CAD) and cardiorespiratory fitness in older adults with osteoarthritis in the lower extremity and compare it with that of traditional over-ground walking. Methods Sixty consecutive eligible patients who had undergone percutaneous coronary intervention for CAD with limited ambulation due to lower extremity osteoarthritis were recruited. They were randomly assigned to the AW program group, treadmill/track walking (TW) program group, or non-exercise control group (CON). Assessments were performed before and after 24 weeks of medically supervised exercise training. Results Significant differences were observed in the change in %body fat (TW: −2.7%, AW: −2.8%, CON: −0.4%), total cholesterol level (TW: −23.6 mg/dL, AW: −27.2 mg/dL, CON: 15.8 mg/dL), resting heart rate (TW: −6.3 bpm, AW: −6.9 bpm, CON: 1.3 bpm), and cardiorespiratory fitness expressed as VO2 peak (TW: 2.3 mL/kg·min−1, AW: 2.0 mL/kg·min−1, CON: −2.5 mL/kg·min−1) over 24 weeks among the groups. However, no significant differences in the change in these measures were found between the TW and AW groups. Conclusion AW appears to be a feasible alternative exercise modality to over-ground walking for cardiac rehabilitation and can be recommended for older adults with CAD and osteoarthritis.
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Affiliation(s)
- Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Chan Joo
- Department of Clinical Exercise Physiology, Seowon University, 377-3 Musimseo-ro, Seowon-gu, Cheongju, Chuncheongbuk, 28674, Republic of Korea.
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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Shaltout HA, Eggebeen J, Marsh AP, Brubaker PH, Laurienti PJ, Burdette JH, Basu S, Morgan A, Dos Santos PC, Norris JL, Morgan TM, Miller GD, Rejeski WJ, Hawfield AT, Diz DI, Becton JT, Kim-Shapiro DB, Kitzman DW. Effects of supervised exercise and dietary nitrate in older adults with controlled hypertension and/or heart failure with preserved ejection fraction. Nitric Oxide 2017; 69:78-90. [PMID: 28549665 DOI: 10.1016/j.niox.2017.05.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 12/22/2016] [Revised: 05/15/2017] [Accepted: 05/20/2017] [Indexed: 01/25/2023]
Abstract
Aerobic exercise training is an effective therapy to improve peak aerobic power (peak VO2) in individuals with hypertension (HTN, AHA/ACC class A) and heart failure patients with preserved ejection fraction (HFpEF). High nitrate containing beetroot juice (BRJ) also improves sub-maximal endurance and decreases blood pressure in both HTN and HFpEF. We hypothesized that combining an aerobic exercise and dietary nitrate intervention would result in additive or even synergistic positive effects on exercise tolerance and blood pressure in HTN or HFpEF. We report results from two pilot studies examining the effects of supervised aerobic exercise combined with dietary nitrate in patients with controlled HTN (n = 26, average age 65 ± 5 years) and in patients with HFpEF (n = 20, average age 69 ± 7 years). All patients underwent an aerobic exercise training regimen; half were randomly assigned to consume a high nitrate-containing beet juice beverage (BRJ containing 6.1 mmol nitrate for the HFpEF study consumed three times a week and 8 mmol nitrate for the HTN study consumed daily) while the other half consumed a beet juice beverage with the nitrate removed (placebo). The main result was that there was no added benefit observed for any outcomes when comparing BRJ to placebo in either HTN or HFpEF patients undergoing exercise training (p ≥ 0.14). There were within-group benefits. In the pilot study in patients with HFpEF, aerobic endurance (primary outcome), defined as the exercise time to volitional exhaustion during submaximal cycling at 75% of maximal power output, improved during exercise training within each group from baseline to end of study, 369 ± 149 s vs 520 ± 257 s (p = 0.04) for the placebo group and 384 ± 129 s vs 483 ± 258 s for the BRJ group (p = 0.15). Resting systolic blood pressure in patients with HFpEF also improved during exercise training in both groups, 136 ± 16 mm Hg vs 122 ± 3 mm Hg for the placebo group (p < 0.05) and 132 ± 12 mm Hg vs 119 ± 9 mm Hg for the BRJ group (p < 0.05). In the HTN pilot study, during a treadmill graded exercise test, peak oxygen consumption (primary outcome) did not change significantly, but time to exhaustion (also a primary outcome) improved in both groups, 504 ± 32 s vs 601 ± 38 s (p < 0.05) for the placebo group and 690 ± 38 s vs 772 ± 95 s for the BRJ group (p < 0.05) which was associated with a reduction in supine resting systolic blood pressure in BRJ group. Arterial compliance also improved during aerobic exercise training in both the HFpEF and the HTN patients for both BRJ and placebo groups. Future work is needed to determine if larger nitrate doses would provide an added benefit to supervised aerobic exercise in HTN and HFpEF patients.
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Affiliation(s)
- Hossam A Shaltout
- Section on Obstetrics & Gynecology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Joel Eggebeen
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA
| | - Paul J Laurienti
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 2757, USA
| | - Jonathan H Burdette
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 2757, USA
| | - Swati Basu
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Department of Physics, Wake Forest University, Winston-Salem, NC 27104, USA
| | - Ashley Morgan
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC 2757, USA
| | - Patricia C Dos Santos
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Department of Chemistry, Wake Forest University, Winston-Salem, NC 27104, USA
| | - James L Norris
- Department of Mathematics, Wake Forest University, Winston-Salem, NC 27104, USA
| | - Timothy M Morgan
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Gary D Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA
| | - Amret T Hawfield
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Debra I Diz
- Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - J Thomas Becton
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Daniel B Kim-Shapiro
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA; Department of Physics, Wake Forest University, Winston-Salem, NC 27104, USA.
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Translational Science Center, Wake Forest University, Winston-Salem, NC 27104, USA.
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Upadhya B, Hundley WG, Brubaker PH, Morgan TM, Stewart KP, Kitzman DW. Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc 2017; 65:2374-2382. [PMID: 28542926 DOI: 10.1111/jgs.14940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF). DESIGN Randomized, placebo-controlled, double-blind trial. SETTING Academic medical center, Winston-Salem, North Carolina. PARTICIPANTS Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP). MEASUREMENTS Participants were randomized into a 9-month treatment of spironolactone 25 mg/d vs placebo. Assessments were peak exercise oxygen consumption (VO2 ), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), cardiac magnetic resonance imaging, Doppler echocardiography, and vascular ultrasound. RESULTS Seventy-one participants completed the trial: 37 in the spironolactone group and 34 in the placebo group. Adherence according to pill count was excellent (spironolactone 95%, placebo 97%). Mean spironolactone dose was 24.3 ± 2.9 mg/d and was well tolerated. Spironolactone significantly reduced systolic and diastolic BP at rest and peak exercise. At 9-month follow-up, baseline-adjusted peak VO2, the primary outcome, was 13.5 ± 0.3 mL/kg per minute in the spironolactone group versus 13.9 ± 0.3 mL/kg per minute in the placebo group (adjusted mean difference -0.4 mL/kg per minute; 95% confidence interval = -1.1-0.4 mL/kg per minute; P = .38). The 95% confidence intervals of spironolactone's effect on peak VO2 (-8.2% to 3.2%) excluded a clinically significant beneficial effect. There were also no significant differences in 6-minute walk distance, arterial stiffness, left ventricular (LV) mass, LV mass/end-diastolic volume, or MLHFQ score. CONCLUSION In older adults with stable compensated HFpEF, 9 months of spironolactone 25 mg/d was well tolerated and reduced BP but did not improve exercise capacity, quality of life, LV mass, or arterial stiffness.
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Affiliation(s)
- Bharathi Upadhya
- Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - William G Hundley
- Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Peter H Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Timothy M Morgan
- Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Kathryn P Stewart
- Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Dalane W Kitzman
- Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Joo KC, Brubaker PH, Ok HT. Effect Of Aqua-walking On Cad Risk Factors And Fitness In Older Adults. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517991.38314.00] [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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Larson AM, Brubaker PH, Jordan J, Hundley G. Stroke Volume and Cardiac Output Response to Maximal Exercise is Attenuated in Anthracycline Treated Cancer Survivors. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517781.71931.6a] [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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