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Potential Therapeutic Role of Respiratory Muscle Training in Dyspnea Management of Cancer Survivors: A Narrative Review. World J Oncol 2024; 15:337-347. [PMID: 38751708 PMCID: PMC11092410 DOI: 10.14740/wjon1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024] Open
Abstract
Dyspnea is a disabling symptom presented in approximately half of all cancer survivors. From a clinical perspective, despite the availability of pharmacotherapies, evidence-based effective treatments are limited for relieving dyspnea in cancer survivors. Preliminary evidence supports the potential of respiratory muscle training to reduce dyspnea in cancer survivors, although large randomized controlled studies are warranted. The aims of this article were to review the relevant scientific literature on the potential therapeutic role of respiratory muscle training in dyspnea management of cancer survivor, and to identify possible mechanisms, strengths and limitations of the evidence as well as important gaps for future research directions.
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Cardiorespiratory Fitness and Incidence of Digestive System Cancers in Men. J Gastrointest Cancer 2024; 55:410-417. [PMID: 37917299 DOI: 10.1007/s12029-023-00981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To assess the association between cardiorespiratory fitness (CRF) and incidence of digestive system cancers (DSCs) in men. METHODS A prospective cohort of 4,540 men aged 55.2 ± 13.1 years who were free from malignancy at baseline was studied. Exposure was CRF quantified from treadmill exercise testing (individualized ramp protocol) in metabolic equivalents (METs). Incidence of DSCs was the primary outcome, utilizing medical records of any new diagnosed DSC. Cox proportional hazard analyses were conducted adjusting for established cancer risk factors. RESULTS Mean CRF was 8.3 ± 3.5 METs. During 13 ± 7.6 years follow up, 250 (5.5%) DSC cases were diagnosed (colorectal = 163, gallbladder = 46, liver = 23, esophagus = 8, pancreas = 7 and other digestive organ cancers = 3). For each 1-MET increase in CRF there were 6% [Hazard Ratio = 0.94, 95% CI (0.91-0.98), p = 0.006], and 9% [Hazard Ratio = 0.91, 95% CI (0.85-0.97), p = 0.006] lower risks of DSC incidence in the total cohort and among men younger than 60 years old, respectively. Additionally, each 1-MET increase in CRF was associated with 9% lower risks of DSC incidence among never and current smokers. CRF was not associated with DSC incidence among men ≥ 60 years old and among former smokers. CONCLUSION Higher CRF was associated with lower risk of DSC incidence in men, particularly in those younger than 60 years, and never and current smokers. These findings suggest that higher CRF has potential preventive benefits against the development of DSCs, although additional large studies are needed. CRF screening and achieving higher levels could serve as a complementary preventive strategy for public health.
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Non-exercise estimated cardiorespiratory fitness and cancer incidence: The NIH-AARP diet and health study. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:739-746. [PMID: 36828228 PMCID: PMC10658321 DOI: 10.1016/j.jshs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Non-exercise estimated cardiorespiratory fitness (NEE-CRF) has been shown to be associated with mortality, although its association with cancer incidence is unknown. The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women. METHODS The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50-71 years who were free from cancer at baseline (1995-1996) (men (n = 238,835) and women (n = 163,713)) and were followed until December 31, 2015. The exposure variable was NEE-CRF expressed in metabolic equivalents. NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires. Primary outcomes were total cancer incidence and incidence of prostate, breast, lung, and colorectal cancers. Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors. RESULTS During 13.7 ± 3.2 years of follow-up (mean ± SD), 64,344 men and 31,315 women developed a new cancer. For every 1-metabolic equivalent higher NEE-CRF, the hazard ratios and 95% confidence intervals (95%CIs) were 0.96 (95%CI: 0.94-0.97) and 0.88 (95%CI: 0.84-0.92) of total and colorectal cancer incidence among men, and 0.95 (95%CI: 0.93-0.97) and 0.94 (95%CI: 0.91-0.97) of total and breast cancer incidence among women, respectively (all p < 0.001). NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women. CONCLUSION These results suggest that higher CRF levels, as assessed by the applied non-exercise estimated method, may provide preventive benefits against the development of cancer, while low CRF could potentially serve as a modifiable cancer risk factor. Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.
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Haemodynamic gain index and heart failure incidence- Prognostic and preventive value. Eur J Prev Cardiol 2023; 30:1404-1411. [PMID: 37523734 DOI: 10.1093/eurjpc/zwad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
AIMS Heart failure (HF) is a non-curable, life-threatening condition, characterized by impaired haemodynamic function and poor survival. This study aimed to assess the association between haemodynamic gain index (HGI) and HF incidence in men. METHODS AND RESULTS Exposure was HGI, [(HRpeak*SBPpeak) - (HRrest*SBPrest)]/(HRrest*SBPrest) measured from treadmill exercise testing in 5539 men aged 59 ± 11.5 years who were free from HF at baseline. The outcome was the incidence of HF. Cox hazard models adjusted for established risk factors were analysed for the association between HGI and HF. During 14.3 ± 6 years of follow-up, 297 cases of HF occurred (average annual incidence rate 3.7 events per 1000 person-years) and average HGI was 1.6 ± 0.7 bpm/mmHg. In a continuous model, every one unit higher in HGI was associated with a 44% [hazard ratio 0.56, 95% confidence interval (0.45-0.69), P < 0.001] lower risk of HF incidence. In a categorical model, compared with those in quartile-4 (HGI > 2.0), those in quartile-3 (HGI 1.51-2.0), quartile-2 (HGI 1.05-1.5), and quartile-1 (HGI < 1.05) exhibited 70%, 220%, and 280% higher risks for developing HF, respectively (P trend < 0.001). CONCLUSION HGI was found to be a strong predictor of HF incidence in men, supporting its prognostic value. Higher HGI was independently associated with lower risk of HF incidence, while low HGI could serve as a prognostic risk factor for HF. Integrating HGI in the screening and early detection paradigm and referring individuals with low HGI to exercise rehabilitation could potentially enhance public health and prevention strategies against HF.
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Dyslipidemia paradox: Analysis from the veterans exercise testing study. PLoS One 2023; 18:e0287923. [PMID: 37467298 DOI: 10.1371/journal.pone.0287923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Dyslipidemia is a well-established cardiovascular disease (CVD) risk factor, although its association with mortality is less clear. This study aimed to assess the association between established dyslipidemia criteria [National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults [Adult Treatment Panel (ATP) III] and all-cause mortality in men. METHODS Prospective cohort study of 1,479 men aged 59.7±10.7 years was conducted between 1987 and 2012. At baseline, dyslipidemia markers of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were assessed as an exposure. Cox proportional hazard models were analyzed adjusting for conventional health risk factors using all-cause mortality as an outcome. RESULTS Mean and standard deviations of TC, LDL-C and HDL-C were 199.5±45.2, 149.4±47.4 and 44.3±12.2 mg/dL, respectively. During 8.9±4.5 years follow-up, 284 participants died. Compared to TC <200 mg/dL, levels of 200-239 mg/dL and ≥240 mg/dL were associated with 13% [hazard ratio (HR) = 0.87, 95% confidence intervals (CI) (0.66-1.1)] and 37% [HR = 0.63, 95% CI (0.44-0.92)] lower risks of mortality (p trend = 0.048), respectively. Compared to LDL-C <130 mg/dL, levels of 130-189 mg/dL and ≥190 mg/dL were associated with 26% [HR = 0.74, 95% CI (0.57-0.97)] and 32% [HR = 0.68, 95% CI (0.48-0.98)] lower risks of mortality (p trend = 0.044), respectively. Mean survival time was 0.9 to 1.9 years longer with higher TC and LDL-C categories (both p = 0.001). HDL-C was not associated with mortality. CONCLUSION In reference to established dyslipidemia criteria, this study showed that higher TC and LDL-C were independently and paradoxically associated with lower risk of all-cause mortality and longer survival time in men. Along with previous reports, these novel findings support a rigorous reevaluation of evidence on dyslipidemia and health risks. Systematic review and meta-analysis are warranted for evidence-based recommendations on dyslipidemia for primary and secondary prevention of CVD.
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Could sarcopenia-related mortality in end-stage renal disease be underpinned by the number of hospitalizations and cardiovascular diseases? Int Urol Nephrol 2023; 55:157-163. [PMID: 35819667 DOI: 10.1007/s11255-022-03291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/26/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the association between sarcopenia with the number of all-cause mortality, hospitalizations, and cardiovascular diseases in patients with end-stage renal disease (ESRD). METHODS 247 patients with ESRD (women, n = 97) (66.6 ± 3.53 years) participated in this study. At baseline, all participants were measured with dual-energy X-ray absorptiometry and handgrip dynamometer and were prospectively followed up for 5 years. The European Working Group on Sarcopenia in Older People guidelines were utilized for Sarcopenia determination. Cox proportional hazard analysis adjusted for established risk factors was used to quantify the risk between Sarcopenia and all-cause mortality. RESULTS Sixty-five participants (26%) were determined to have Sarcopenia at baseline and 38 (15%) have died during the follow-up. At baseline, Participants with Sarcopenia had lower body mass index and fat-free mass index. Moreover, through the 5-year follow-up, sarcopenic patients had higher number of cardiovascular disease (56.9% vs. 12.6%) and hospitalizations (93.8% vs. 49.5%) (all P < 0.0001). Sarcopenia was associated with significantly higher risk of mortality, [Hazard ratio = 3.3, (95% CI: 1.6-6.9), P = 0.001]. CONCLUSION Sarcopenia may be a risk factor for hospitalizations, cardiovascular diseases, and all-cause mortality in patients with ESRD. These results provide support of the relevance in assessing sarcopenia in the clinical practice of chronic kidney disease and how muscle mass and strength may negatively impact the daily life of ESRD patients undergoing hemodialysis. Greater efforts at preventing muscle wasting and malfunctioning are needed through the worldwide healthcare system.
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Non-exercise estimated cardiorespiratory fitness and mortality from all-causes, cardiovascular disease, and cancer in the NIH-AARP diet and health study. Eur J Prev Cardiol 2022; 29:599-607. [PMID: 33624091 PMCID: PMC8489355 DOI: 10.1093/eurjpc/zwaa131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/24/2020] [Accepted: 11/11/2020] [Indexed: 04/23/2024]
Abstract
AIMS Impractical methods and relatively small cohort have limited the applications of non-exercise estimated cardiorespiratory fitness (NEE-CRF). This study aimed to assess the association between a pragmatic NEE-CRF method and mortality outcomes in a large prospective cohort. METHODS AND RESULTS A total of 330 769 participants [men (n = 186 469) and women (n = 144 300)] aged 50-71 years from the NIH-AARP Diet and Health Study were assessed at baseline (1995-96) and prospectively followed until 31 December 2015 (14.9 ± 2.1 years). Non-exercise estimated cardiorespiratory fitness was estimated using pragmatic and previously validated equation, and Cox hazard analysis for mortality was conducted. Non-exercise estimated cardiorespiratory fitness was 9.9 ± 1.5 metabolic equivalents (METs) in men and 7.2 ± 1.6 METs in women. In total, 34 317 men and 20 295 women died during the follow-up. Higher NEE-CRF was associated with lower mortality risk from all-causes, cardiovascular disease, and cancer. Compared to the lowest quartile of NEE-CRF, the hazard ratios and 95% confidence interval for all-cause mortality in the second, third, and fourth quartiles were: 0.82 (0.79-0.84), 0.74 (0.72-0.77), and 0.70 (0.67-0.73) for men, and 0.84 (0.81-0.88), 0.78 (0.75-0.82), and 0.72 (0.68-0.77) for women (P trend <0.001 for all). For each 1-MET increase in NEE-CRF, risks for mortality due to cardiovascular disease and cancer were 0.85 (0.82-0.88) and 0.89 (0.87-0.91) in men, and 0.84 (0.81-0.88) and 0.89 (0.87-0.91) in women, respectively (P < 0.001 for all). CONCLUSION Higher NEE-CRF is independently associated with lower mortality risk in a large prospective cohort of men and women. These results support the utility of the applied NEE-CRF method for risk stratification, prevention, and rehabilitation programs and application in large epidemiological studies.
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Non-exercise Estimated Cardiorespiratory Fitness And Cancer Incidence: The NIH-AARP Diet And Health Study. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000764700.88298.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Long-term outcomes of metallic endobronchial stents in lung transplant recipients are not affected by bacterial colonization. Interact Cardiovasc Thorac Surg 2021; 32:47-54. [PMID: 33372228 DOI: 10.1093/icvts/ivaa221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We evaluated associations of endobronchial stenting with airway bacterial colonization, the antimicrobial resistance profile, hospitalizations for pneumonia and survival in lung transplant recipients. METHODS This is a retrospective single-centre study of 582 recipients of lung transplant during 2002-2018. We compared outcomes of 57 patients (9.7%) who received endobronchial stents (intervention group) to a control group of 57 patients without stents who were matched one to one for age, sex, year of transplantation, unilateral/bilateral transplantation and underlying disease. RESULTS For the intervention compared to the control group, airway colonization was more common for Pseudomonas (86% vs 35%, P < 0.001), Acinetobacter (21% vs 7%, P = 0.05), Klebsiella (21% vs 5%, P = 0.02) and Staphylococcus species (11% vs 0%, P = 0.02). The respective proportions of patients with positive bronchoalveolar lavage cultures on the third post-transplantation day, the day of stent insertion and 6-month post-stent insertion were 47.4%, 50.9% and 65.4% for Pseudomonas sp.; 15.8%, 12.3% and 3.8% for Klebsiella sp.; and 8.8%, 5.3% and 5.8% for Acinetobacter sp. The mean number of hospitalizations for pneumonia per patient was higher, without statistical significance, in the intervention than the control group (1.5 ± 1.7 vs 0.9 ± 1.5, P = 0.1). Kaplan-Meier survival curves did not show a statistically significant difference between the intervention group and the entire group without endobronchial stents (n = 525) (P = 0.4). CONCLUSIONS Lung transplant recipients with endobronchial stents were more likely to be colonized with pathologic bacteria and having pneumonia; however, stent placement was not associated with increased long-term mortality with appropriate stent maintenance.
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Poor handgrip strength determined clinically is associated with falls in older women. J Frailty Sarcopenia Falls 2021; 6:43-49. [PMID: 34131600 PMCID: PMC8173535 DOI: 10.22540/jfsf-06-043] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: To assess the association between poor handgrip strength (HGS) determined by clinical criterion and incidence of falls in older women. Methods: The cohort included 195 women (68.1±6.2 years) who were assessed for HGS (Jamar Dynamometer) at baseline and were prospectively followed for 18 months. FNIH Sarcopenia threshold of HGS adjusted for body mass index (<0.56) was used for clinical determination of poor HGS. Association between poor HGS and incidence of falls was analyzed using Cox hazard models in the total cohort and in a stratified analysis by balance status. Results: During the follow-up, 53 (27%) women experienced at least one fall. In a multivariable model, poor HGS was associated with approximately 3-fold increased risk for falls [Hazard Ratio (HR)=2.73, 95% Confidence Interval (CI)=1.28–5.82, p=0.009]. In a stratified analysis, women with impaired balance exhibited even greater risk for falls (HR=3.85, 95%CI=1.47–10.12, p=0.011), although no association was found in women with normal balance (p=0.459). Conclusions: Poor HGS based on clinical criterion is independently associated with higher risk of falls in older women, particularly in those with impaired balance. These results suggest potential prognostic value of FNIH Sarcopenia threshold for risk stratification and referring high-risk individuals to fall prevention programs.
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Retraction notice to "Facemasks in the COVID-19 era: A health hypothesis" [Medical Hypotheses 146 (2021) 5]. Med Hypotheses 2021; 152:110601. [PMID: 33992504 PMCID: PMC8114149 DOI: 10.1016/j.mehy.2021.110601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Physical Activity, Cardiorespiratory Fitness, and Population-Attributable Risk. Mayo Clin Proc 2021; 96:342-349. [PMID: 33549255 DOI: 10.1016/j.mayocp.2020.04.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine population-attributable risk (PAR) and exposure impact number (EIN) for mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity, and other risk markers among veteran subjects. METHODS The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause mortality was the end point. Cox multivariable hazard models were performed to determine clinical, demographic, and exercise-test determinants of mortality. Population-attributable risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed, accounting for competing events. RESULTS There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8 years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate 3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the treadmill was associated with a 15% reduction in mortality (hazard ratio [HR]=0.85; 95% confidence interval [CI], 0.83 to 0.88; P<.001). Nearly half the sample was inactive, and these subjects had a 23% higher mortality risk and a PAR of 8.8%. The least fit quartile (<5.0 METs) had relative risks of ≈6.0 compared with the most-fit group (HR=5.99; 95% CI, 4.9 to 7.3). The least-active tertile had ≈2-fold higher risks of mortality vs the most active subjects (HR=1.9; 95% CI, 0.91 to 4.1). The lowest EIN was observed for low fitness (3.8; 95% CI, 3.4 to 4.3, P<.001), followed by diabetes, smoking, hypertension, and physical inactivity (all P<.001 except for diabetes, P=.008). CONCLUSION Both higher CRF and physical activity provide protection against all-cause mortality in subjects referred for exercise testing for clinical reasons. Encouraging physical activity with the aim of increasing CRF would have a significant impact on reducing mortality.
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Retracted: Facemasks in the COVID-19 era: A health hypothesis. Med Hypotheses 2020; 146:110411. [PMID: 33303303 PMCID: PMC7680614 DOI: 10.1016/j.mehy.2020.110411] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/28/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
Many countries across the globe utilized medical and non-medical facemasks as non-pharmaceutical intervention for reducing the transmission and infectivity of coronavirus disease-2019 (COVID-19). Although, scientific evidence supporting facemasks’ efficacy is lacking, adverse physiological, psychological and health effects are established. Is has been hypothesized that facemasks have compromised safety and efficacy profile and should be avoided from use. The current article comprehensively summarizes scientific evidences with respect to wearing facemasks in the COVID-19 era, providing prosper information for public health and decisions making.
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Normative Values of Knee Extensor Isokinetic Strength for Older Women and Implications for Physical Function. J Geriatr Phys Ther 2020; 42:E25-E31. [PMID: 29794885 DOI: 10.1519/jpt.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Lower-limb strength is required for everyday activities and thus its evaluation has been especially emphasized in older adults. Isokinetic testing is a criterion standard method to assess muscle strength; however, lack of reference values limits its usefulness in geriatric evaluation and rehabilitation. The aim of this study was to develop reference values of knee extensor isokinetic strength for older women. As a secondary aim, functional tests were performed for clinical significance validation. METHODS A total of 453 older women aged 60 to 84 years participated in this study. Knee extensor isokinetic strength was measured using the Biodex System dynamometer at 60° per second. The Timed Up and Go test and the 5 times Sit-to-Stand test were used for functional performance evaluation. Participants were categorized into age groups of 5 years range. The 20th, 40th, 60th, and 80th percentiles were used for stratification purposes. RESULTS AND DISCUSSION As expected, mean strength values significantly decreased with advancing age groups. Isokinetic percentile groups are presented according to age. Individuals in the lower percentile strata showed significantly reduced performance in both the Timed Up and Go and 5 times Sit-to-Stand tests (P < .05). CONCLUSION This study provides normative values of isokinetic knee extensor strength in older women. The association between lower isokinetic knee extensor strength strata and reduced functional capacity supports the potential application of these reference values in clinical and research settings. Future studies should ascertain these findings in different female populations.
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Dynapenic abdominal obesity and the incidence of falls in older women: a prospective study. Aging Clin Exp Res 2020; 32:1263-1270. [PMID: 31489597 DOI: 10.1007/s40520-019-01318-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/10/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dynapenic abdominal obesity (D/AO) has been associated with negative outcomes in older people, including trait of falls. AIMS To assess the association between D/AO and the incidence of falls over 18 months in older community-dwelling women. METHODS A total of 201 older women (67.97 ± 6.02 years; 27.70 kg/m2) underwent waist circumference measurement, and had handgrip strength assessed using a hydraulic dynamometer. Dynapenia was classified using the lower tertile of handgrip strength, while abdominal obesity was considered as a waist circumference > 88 cm. D/AO was the combination of both aforementioned criteria. Volunteers were classified into four groups: normal, abdominal obesity, dynapenic, and D/AO. Participants were then tracked by phone calls for ascertainment of falls during a follow-up period of 18 months. Chi-square and multivariable Cox proportional regressions were conducted. RESULTS The overall incidence of falls over the follow-up was 27.5%; and for normal, dynapenic, abdominal obesity, and D/AO were 14.7%, 17.2%, 27.5%, and 40.4% (X2 = 8.341; P = 0.039), respectively. D/AO was associated with a higher risk of falls (hazard ratio: 3.595 [95% CI: 1.317-9.815], even after adjustments for age, body mass index, physical activity level, regular use of medications, peripheral sensation, chronic diseases, and history of lower-limbs pain. CONCLUSIONS D/AO is more closely related to falls than either dynapenia or abdominal obesity alone, and is independently associated with an increased incidence of falls in older women. These results provide support for the concept that the combined evaluation of muscle strength and central obesity may be clinically relevant in this population.
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Non-Exercise Estimated Cardiorespiratory Fitness And Mortality From All-Causes, Cardiovascular Disease And Cancer In The NIH-AARP Diet And Health Study. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000680144.96419.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Poor Handgrip Strength And Risk Of Falls In Older Women. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000678136.19808.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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NONTUBERCULOUS MYCOBACTERIAL INFECTIONS DECREASE THE SURVIVAL OF LUNG TRANSPLANT RECIPIENTS. Chest 2020. [DOI: 10.1016/j.chest.2020.05.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Reference Standards for Ventilatory Threshold Measured With Cardiopulmonary Exercise Testing. Chest 2020; 157:1531-1537. [DOI: 10.1016/j.chest.2019.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022] Open
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The Etiology and Prognosis of Delayed Postoperative Leukocytosis in Lung Transplant Recipients. Prog Transplant 2020; 30:111-116. [PMID: 32238048 DOI: 10.1177/1526924820913516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Leukocytosis (white blood cell count >12 000/µL) in the delayed postoperative period (4-7 days) after lung transplantation is due to diverse etiologies. We aimed to describe the etiologies of delayed postoperative leukocytosis in lung transplant recipients and to evaluate the association of leukocytosis causes with short-term survival. METHODS A retrospective chart review of 274 lung transplantations performed in our institution during 2006 to 2013. RESULTS Delayed postoperative leukocytosis was seen in 159 (58.0%) of lung transplant recipients. In 57 (35.8%) of them, the etiology of the leukocytosis was not identified. The etiologies of leukocytosis that were identified were infection (n = 39), second surgery, acute rejection (n = 12), primary graft dysfunction (n = 3), multiple etiologies (n = 17), and other causes (n = 10). On multivariate analysis, delayed postoperative leukocytosis was one of the variables that most significantly associated with decreased survival in the entire sample (hazard ratio [HR] = 1.52, 95% confidence interval [CI]: 1.01-2.29, P = .040). On additional analysis for mortality assessing each leukocytosis subgroup, the data were acute graft rejection (HR = 8.21, 95% CI: 4.09-16.49, P < .001), second surgery (HR = 2.05, 95% CI: 1.08-3.90, P = .020), primary graft dysfunction (HR = 2.72, 95% CI: 0.65-11.33, P = .169), other causes (HR = 1.30, 95% CI: 0.47-3.62, P = .620), and unknown etiology (HR = 0.94, 95% CI: 0.54-1.62, P = .800). CONCLUSIONS Delayed post-lung transplant leukocytosis is a poor prognostic sign, especially when attributed to acute graft rejection, infection, and multiple etiologies. In the absence of an identifiable etiology, it can be attributed to postoperative reactive stress, is not associated with increased mortality, and likely does not warrant further diagnostic investigation.
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Cardiorespiratory fitness and cancer in men with cardiovascular disease: Analysis from the Veterans Exercise Testing Study. Eur J Prev Cardiol 2020; 28:715-721. [DOI: 10.1177/2047487320916595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 03/12/2020] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Cardiovascular disease and cancer share similar risk factors and are the leading causes of death worldwide. This study aimed to assess the association between cardiorespiratory fitness, cancer incidence and cancer mortality in men with cardiovascular disease.
Methods
Baseline cardiorespiratory fitness (treadmill exercise test) was assessed in 565 men aged 58.9 ± 17 with documented cardiovascular disease and free from any malignancy. Cox multivariable hazard models, population attributable fraction and exposure impact number were analyzed in model accounting for competing events for cancer outcomes.
Results
Mean cardiorespiratory fitness was 7.6 ± 3.4 metabolic equivalents. During a 12.0 ± 7.5 year follow-up, 147 participants developed any type of cancer, 70 died from cancer, and five died from causes other than cancer as competing events. Compared to low cardiorespiratory fitness (<5 metabolic equivalents), moderate (5–10 metabolic equivalents) and high cardiorespiratory fitness (>10 metabolic equivalents) were associated with 50% (0.50, 95% confidence interval (0.27–0.91)) and 68% (0.32 (0.11–0.88)) reduced risks for cancer mortality (p trend = 0.026), respectively. Survival time was longer among individuals with moderate (20.8 (19.7–22) years) and high (24.9 (23–26.7) years) compared to low cardiorespiratory fitness (17.2 (15.1–19.3) years), p < 0.001. Population attributable fraction and exposure impact number for cancer mortality were 13% (4.1–17.7) and 10.8 (5.1–56.4), p = 0.01, respectively. Cardiorespiratory fitness was not associated with cancer incidence.
Conclusion
Higher cardiorespiratory fitness was independently associated with lower risk of cancer mortality and extended survival time in men with cardiovascular disease, although it was not associated with cancer incidence. Improving cardiorespiratory fitness through supervised exercise rehabilitation programs could potentially serve as a cost-effective public-health strategy for secondary prevention and survivorship in men with cardiovascular disease.
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Routine comprehensive Aspergillus screening of bronchoalveolar lavage samples in lung transplant recipients. Clin Transplant 2020; 34:e13811. [DOI: 10.1111/ctr.13811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 12/08/2019] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
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The preventive role of cardiorespiratory fitness in current male smokers who meet the American Cancer Society criteria for lung cancer screening: a prospective pilot study. Cancer Causes Control 2020; 31:153-159. [DOI: 10.1007/s10552-019-01262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
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IPF patients are limited by mechanical and not pulmonary-vascular factors - results of a derivation-validation cohort study. BMC Pulm Med 2019; 19:244. [PMID: 31829145 PMCID: PMC6907136 DOI: 10.1186/s12890-019-1015-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/28/2019] [Indexed: 03/26/2023] Open
Abstract
Background During cardiopulmonary exercise testing (CPET), Idiopathic Pulmonary Fibrosis (IPF) patients do not reach their direct maximum voluntary ventilation (MVV) and have deranged gas exchange. Their exercise limitation is therefore attributed to a pulmonary vascular mechanism. Methods We studied two cohorts (derivation and validation) of IPF patients with lung function testing and CPET. Maximal ventilation at exercise (VEpeak) was compared to direct MVV by Bland-Altman analysis. Results In the derivation cohort (n = 101), direct MVV over-estimated VEpeak by a factor of 1.51, driven by respiratory rate during MVV that was 1.99 times higher at rest as compared to VEpeak at exercise. The formula (FEV1 × 20.1) + 15.4 was shown to predict VEpeak (r2 = 0.56) in the derivation cohort. In the validation cohort of 78 patients, VEpeak was within a factor of 1.27 (6.8 l/min) of predicted according to the novel formula. According to the novel prediction formula the majority of patients (58%) in the entire cohort have VEpeak within 85% of their predicted MVV, which would indicate a mechanical respiratory limitation to exercise. Conclusion Estimation of direct MVV performed at rest leads to significant over-estimation of the breathing reserve in IPF patients. This may lead to over-diagnosis of pulmonary vascular limitation in these patients. Expected maximal ventilation at exercise may be accurately predicted indirectly by an IPF-specific formula.
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Improved Survival With Higher Pre-diagnosis Cardiorespiratory Fitness in Men Who Developed Digestive System Cancers: A Prospective Pilot Study. Anticancer Res 2019; 39:5551-5557. [PMID: 31570449 DOI: 10.21873/anticanres.13748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Digestive system cancers are the leading cause of cancer mortality and have poor survival particularly in men. The study aimed to assess the association between pre-diagnosis cardiorespiratory fitness (CRF) and cancer mortality in a pilot sample of men who developed digestive system cancers. PATIENTS AND METHODS Pre-diagnosis CRF (treadmill exercise test) was assessed in 342 men (68.9±21.8 years) who developed digestive system cancers during 6.7±5 years from baseline evaluation. Cox multivariable hazard models were analyzed for total cancer mortality. RESULTS During 7.2±5 years follow-up from baseline, 120 participants died from cancer. Compared to low CRF, moderate and high CRF levels were associated with 57% [0.43, 95%CI=0.24-0.74] and 73% [0.27, 95%CI=0.12-0.59] reduced risks for cancer mortality, respectively (p trend=0.002). Survival time from baseline was longer among those with moderate [13.5 (range=12.1-14.9) years] and high [16.1 (range=14.0-18.2) years] compared to low CRF [7.9 (range=5.7-10.1) years]. CONCLUSION Higher pre-diagnosis CRF is independently associated with lower risk of cancer mortality and longer survival in men who later developed digestive system cancers.
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A reference equation for normal standards for knee extensor isokinetic strength in Brazilian older women. Aging Clin Exp Res 2019; 31:1531-1537. [PMID: 30515723 DOI: 10.1007/s40520-018-1084-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/21/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Knee extensor strength assessment has been especially emphasized in older people, but lack of reference values limits its usefulness in geriatric evaluation. AIMS The aim of this study was to develop a reference equation for knee extensor isokinetic strength standards in older women. METHODS Knee extensor isokinetic tests at 60°/s were performed in 390 Brazilian older women aged 60-84 years (67.38 ± 5.56 years) and in a separate validation sample of 110 women (67.94 ± 6.13 years). A regression equation for peak torque (PT) was derived and compared to commonly used formulas: the equations of Neder and Gross. Age, weight and height were the only significant predictors (multiple R = 0.55; R2 = 0.30; p < 0.001). The proposed equation was examined in the independent sample. Percent from predicted values was calculated and Bland-Altman plots were constructed. RESULTS Both the Neder and Gross equations significantly underestimated predicted PT values (both p < 0.001); mean bias were 6.79 and 6.75, respectively. The proposed equation [PT = 39.72 - (1.24 × age) + (0.44 × weight) + (69.70 × height)] was matched with the independent sample, with a percent predicted isokinetic strength of approximately 95%, a mean bias approximately 40% lower 4.23 than the other equations, and stable across all age groups. CONCLUSIONS Available equations for knee extensor isokinetic strength are not adequate for older women. The equation developed in the present study provided considerably lower average error and thus with more suitable reference values.
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Cardiorespiratory fitness and cancer in women: A prospective pilot study. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:457-462. [PMID: 31534820 PMCID: PMC6742677 DOI: 10.1016/j.jshs.2019.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/27/2018] [Accepted: 12/11/2018] [Indexed: 05/23/2023]
Abstract
PURPOSE To assess the association between cardiorespiratory fitness (CRF) and the incidence and mortality from cancer in women, and to evaluate the potential public health implications for cancer prevention. METHODS Maximal exercise testing was performed in a pilot cohort of 184 women (59.3 ± 15.2 years) who were followed for 12.0 ± 6.9 years. Cox hazard models adjusted for established cancer risk factors and accounting for competing events were analyzed for all-type cancer incidence and mortality from cancer. Population-attributable risks and exposure impact number were determined for low CRF (<5 metabolic equivalents (METs)) as a risk factor. RESULTS During the follow-up, 11.4% of the participants were diagnosed with cancer and 3.2% died from cancer. CRF was inversely and independently associated with cancer outcomes. For every 1-metabolic equivalent increase in CRF, there was a 20% decrease in the risk of cancer incidence (hazard ratio (HR) = 0.80, 95% confidence interval (CI): 0.69-0.92; p = 0.001) and a 26% reduction in risk of cancer mortality (HR = 0.74, 95%CI: 0.61-0.90; p = 0.002). The population-attributable risks of low CRF were 11.6% and 14% for incidence and mortality of cancer, respectively, and the respective exposure impact numbers were 8 and 20. CONCLUSION Greater CRF was independently associated with a lower risk of incidence and mortality from cancer in women. Screening for low CRF as a cancer risk factor and referring unfit individuals to a supervised exercise program could be a public health strategy for cancer prevention in middle-age women.
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Behavioral and Physiological Health-Related Risk Factors in College Students. Am J Lifestyle Med 2019; 15:322-329. [PMID: 34025325 DOI: 10.1177/1559827619872436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to assess the behavioral and physiological health-related risk factors in college students. A cross-sectional study was conducted in 1620 college students (21.3 ± 1.7 years, 897 males, and 723 females). Physical activity (PA), sitting time, body composition, cardiorespiratory fitness (CRF), muscular endurance (ME), and blood test were assessed. In the total sample, 15.2% were not meeting PA guidelines, 33% were sedentary, 13.3% were obese, 10.7% had low CRF, 36.8% had poor ME, 33.7% had dyslipidemia and 5.9% presented with prediabetes. Obesity and poor CRF were more prevalent in male students, whereas inactivity was more prevalent in female students. Individuals with poor CRF were more likely to be obese (odds ratio = 5.2, 95% CI = 3.5-7.8, P = .007 for male students, and 9.4, 95% CI = 1.5-57.8, P = .021 for female students). Sitting time positively correlated with fat percentage (fat%) and inversely with lean body mass (LBM) in male students, whereas ME inversely correlated with fat% and positively with LBM in female students. Although most students were active, significant prevalence of health-related risk factors were observed. Sedentary behavior and poor fitness were associated with a compromised body composition in both sexes. Improving fitness and reducing sedentary behavior in college students could be a public health strategy for health promotion and chronic diseases prevention.
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Prognostic Value and Clinical Usefulness of the Hemodynamic Gain Index in Men. Am J Cardiol 2019; 124:644-649. [PMID: 31196561 DOI: 10.1016/j.amjcard.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/22/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Although hemodynamic responses to exercise have been studied for decades, comprehensive and definitive prognostic markers are lacking. The present study aimed to assess the association between a new hemodynamic index and all-cause mortality in men. Treadmill exercise testing was performed between 1987 and 2012 in 11,455 men aged 58.5 ± 11 years who were prospectively followed for 9.8 ± 5.8 years. Heart rate (HR) and systolic blood pressure (SBP) responses were used to develop a hemodynamic gain index (HGI) = [(HRpeak × SBPpeak) - (HRrest × SBPrest)]/(HRrest × SBPrest). Multivariable Cox hazard models adjusted for established cardiometabolic diseases, risk factors, cardiorespiratory fitness, and medications were analyzed for HGI and all-cause mortality. During the follow-up, 2,804 participants (24.5%) died, and mean HGI was 1.68 ± 0.83 bpm/mm Hg. In a continuous model, every 1 unit higher in HGI was associated with a 23% (hazard ratio 0.77, 95% confidence interval 0.71-0.82, p <0.001) reduced risk of mortality. In a categorical model, compared with participants <25th percentile (HGI <1.1), participants who were between the 25th and 50th (HGI 1.1-1.59), 50th to 75th (HGI 1.6-2.1) and >75th percentile (HGI >2.1) exhibited 12%, 24%, and 36% reductions in mortality risk (p trend <0.001), respectively. The inverse association between HGI and death was significant across wide-range of age groups and among participants with varied chronic conditions. In conclusion, these novel findings indicate that higher HGI is inversely and independently associated with lower risk of all-cause mortality in men, suggesting its potential prognostic value for risk stratification in clinical and research settings.
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Cardiorespiratory Fitness Incidence and Mortality from Lung Cancer in Male Smokers. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561835.66133.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sedentary behavior and physiological health determinants in male and female college students. Physiol Behav 2019; 204:277-282. [PMID: 30831185 DOI: 10.1016/j.physbeh.2019.02.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sedentary behaviors are associated with numerous adverse physiological health outcomes, morbidity and mortality, although with limited knowledge in young adults. AIM To assess the association between sedentary behavior, muscular strength and body composition in male and female young adult college students. METHODS A cross-sectional pilot study was conducted among 94 college students (20.2 ± 1.6 years, 46 males and 48 females) from a University in the Mid-Atlantic region, US. Students were assessed for sedentary behavior, physical activity and objective physiological variables including lean body mass (LBM), fat% and muscular strength [1-Repetition Maximum (1-RM)]. Descriptive statistics and linear regression analysis were conducted. RESULTS Sedentary behavior (sitting time ≥ 6 h/day) was prevalent in 69% of females and in 46% of males, p = .036, although most students (84-94%) met the physical activity recommendations. Sitting time inversely correlated with LBM (r = -0.58, p = .01) and trending for positive correlation with fat% in females, whereas in males, sitting time inversely correlated with 1-RM upper body strength (r = -0.46, p = .017). Female students who sat ≥7.5 h/day had approximately 10-fold increased chance of being obese [odds ratio = 9.6, 95% confidence interval (1.5 to 62.7), p = .019] compared to non-sedentary. CONCLUSIONS Although most students were physically active, considerable prevalence of sedentary behavior was observed. The novel findings showed that, sedentary behavior was associated with compromised physiological health determinants of body composition in females and muscular strength in males. Reducing sedentary behavior among active college students could be a public health strategy for health promotion and chronic disease prevention.
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8-Foot-Up-and-Go Test is Associated with Hospitalizations and Mortality in Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study. Lung 2019; 197:81-88. [PMID: 30600393 DOI: 10.1007/s00408-018-0189-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/16/2018] [Indexed: 05/05/2023]
Abstract
PURPOSE To assess the prognostic value of the 8-foot-up-and-go test (8-FUGT) in pilot cohort of patients with idiopathic pulmonary fibrosis (IPF). METHODS Thirty-four patients with IPF (68 ± 8 years) underwent 8-FUGT at baseline and were followed for up to 40 months. Receiver operating characteristics and age-adjusted Cox hazard ratios (HR) were analyzed for 8-FUGT, hospitalizations, and mortality. Correlation coefficients were determined between 8-FUGT and other exercise tests. RESULTS 8-FUGT ≥ 6.9 s was found to be associated with hospitalization (sensitivity = 77%, specificity = 76%, p = 0.03) and mortality (sensitivity = 91%, specificity = 70% p = 0.008) in patients with IPF. Categorical models demonstrated that 8-FUGT ≥ 6.9 s was associated with 14.1- (p < 0.001) and 55.4-fold (p = 0.001) increased risks for hospitalization and mortality, respectively. In continuous models, for every 1-s slower performance in the 8-FUGT there were 54% [HR = 1.54, 95% CI (1.11-2.15) p = 0.01] increased risk for hospitalization and 94% [HR = 1.94, 95% CI (1.26-2.99) p = 0.003] increased risk for mortality. 8-FUGT was inversely related to 6-min walk distance (r = - 0.61), peak oxygen consumption (r = - 0.58), and peak work rate (r = - 0.72), all p < 0.001. CONCLUSIONS The 8-FUGT was strongly associated with hospitalizations and mortality in patients with IPF, as well as correlated with established prognostic markers. These novel findings suggest a prognostic value of the 8-FUGT for risk stratification, referral to pulmonary rehabilitation, and considering listing for lung transplantation. 8-FUGT is an inexpensive and practical tool that has prospective for implementation in clinical and research settings in IPF. Future prospective studies should evaluate the effect of changes in 8-FUGT on clinical outcomes. TRIAL REGISTRATION NCT01499745, Clinicaltrials.gov.
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Exercise Oscillatory Ventilation: Interreviewer Agreement and a Novel Determination. Med Sci Sports Exerc 2018; 50:369-374. [PMID: 28902683 DOI: 10.1249/mss.0000000000001423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Determination of exercise oscillatory ventilation (EOV) is subjective, and the interreviewer agreement has not been reported. The purposes of this study were, among patients with heart failure (HF), as follows: 1) to determine the interreviewer agreement for EOV and 2) to describe a novel, objective, and quantifiable measure of EOV. METHODS This was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by six individuals on the basis of their interpretation of the EOV literature. Interreviewer agreement was assessed using Fleiss kappa (κ). Final determination of EOV was based on agreement by four of the six reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test, and its ability to predict EOV was assessed with the receiver operator characteristics curve. RESULTS Among 243 patients with HF (age, 60 ± 12 yr; 45% women), the interreviewer agreement for EOV was fair (κ = 0.303) with 10-s discrete data averages and significantly better, but only moderate (κ = 0.429) with 30-s rolling data averages. Prevalence rates of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV, with areas under the receiver operator characteristics curve of 0.852 to 0.890. CONCLUSIONS Interreviewer agreement for EOV in patients with HF is fair to moderate, which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such, it might be a useful measure of prognosis in patients with HF.
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Cardiorespiratory fitness, incidence and mortality of lung cancer in men: A prospective cohort study. J Sci Med Sport 2018; 22:403-407. [PMID: 30803499 DOI: 10.1016/j.jsams.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To evaluate the association between cardiorespiratory fitness (CRF), lung cancer incidence and cancer mortality in men. DESIGN Prospective cohort study. METHODS Maximal exercise testing was performed in 4920 men (59.2±11.4years) free from malignancy at baseline. Multivariate Cox hazard models adjusted for established cancer risk factors including smoking were analyzed for lung cancer incidence and cancer mortality among those who were diagnosed with lung cancer. Population attributable risks (PAR) of low CRF (<5 METs) were determined. RESULTS During 12.7±7.5years follow-up, 105 (2.1%) participants were diagnosed with lung cancer and 83 (79%) of those died from cancer after 3.6±4.6 years from diagnosis. CRF was inversely and independently associated with cancer outcomes. A 1-MET increase and categories of moderate and high CRF were associated with 10%, 47% and 65% reduction in lung cancer incidence (p=0.002), and 13%, 58% and 76% reduction in cancer mortality (p=0.002), respectively. Also, individuals who were diagnosed with lung cancer and were at moderate or high CRF categories at baseline exhibited longer survival time (p<0.001). The PARs% for lung cancer incidence and cancer mortality were 8.7% and 18.5%, respectively. CONCLUSIONS Higher CRF is associated with lower lung cancer incidence in men. Among individuals who were diagnosed with lung cancer, higher CRF was associated with reduced cancer mortality and longer survival time. These results support the protective benefits of higher CRF in the prevention of lung cancer outcomes. Eliminating low CRF as a risk factor would potentially prevent considerable lung cancer morbidity and mortality.
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Precancer diagnosis cardiorespiratory fitness, physical activity and cancer mortality in men. J Sports Med Phys Fitness 2018; 59:1405-1412. [PMID: 30293409 DOI: 10.23736/s0022-4707.18.08989-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The preventive role of precancer diagnosis cardiorespiratory fitness (CRF) and physical activity (PA) in cancer mortality is poorly characterized. The aim of this study was to assess the association between CRF, PA at precancer-diagnosis and cancer mortality in men who diagnosed with cancer later in life. METHODS A total of 699 men (63±10 years) who were diagnosed with cancer during 7.5±4.9 years from a baseline treadmill exercise test and reported PA were analyzed. Multivariate Cox models for CRF and univariate model for PA were conducted. Population Attributable Risks (PARs%) and exposure impact number (EIN) of low CRF (<5 METs) and inactivity were determined. RESULTS During 6.5±5.2 years from cancer diagnosis, 56% died from cancer. CRF was inversely, graded and independently associated with cancer death. A 1-MET increase and categories of moderate and high CRF were associated with 7%, 28% and 51% reductions in risk of cancer death, respectively. Active compared to inactive individuals had a 23% reduced risk of cancer mortality (HR=0.77, 95% CI [0.63-0.94], P=0.01). PARs% of low CRF and inactivity were 4.8% and 9.4%, respectively, while the respective EIN were 3 and 9. CONCLUSIONS Higher CRF and being active at precancer-diagnosis were associated with lower cancer mortality and longer survival time in men who developed cancer later in life. Screening and intervening for low CRF and inactivity as risk factors during middle-age and maintaining at least moderate CRF and activity levels may be effective strategies for prevention of cancer mortality.
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Safety of exertional desaturation in idiopathic pulmonary fibrosis: An electrocardiography study. CLINICAL RESPIRATORY JOURNAL 2018; 12:2426-2432. [PMID: 30074679 DOI: 10.1111/crj.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/30/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Exertional desaturation is a cardinal manifestation of idiopathic pulmonary fibrosis (IPF) which raises concerns for serious complications. OBJECTIVES To evaluate the safety of clinically significant desaturation (CSD) during exercise and to assess whether abnormal electrocardiographic (ECG) changes are associated with mortality and hospitalizations in patients with IPF. METHODS Thirty-four IPF patients (68 ± 8 years, 35% women) underwent maximal cycle cardiopulmonary exercise testing (CPET) using 12-lead ECG and pulse oximetry (SpO2 ) and were followed up to 40 months. CSD was considered as SpO2 <95% or decline from baseline ≥5%. The level of agreement between abnormal ECG changes and CSD was evaluated. Risks for mortality and hospitalizations were assessed in relation to abnormal ECG changes. RESULTS All patients completed CPET without adverse events or life-threating ECG changes. Comparing rest to exercise conditions, the prevalence of mild ventricular arrhythmia rose from 3% to 18% (P = .025) and CSD rose from 21% to 79% (P < .001). There was no agreement between the prevalence of arrhythmia and CSD during exercise (kappa = -.065, χ2 = .72, P = .40). A trend for lower prevalence was observed in ST-T segment deviation during exercise. Resting and exercise ECG abnormalities were not associated with mortality or hospitalizations during the follow-up. CONCLUSIONS CSD during CPET was not associated with ventricular arrhythmias, ischemia, or complications in patients with IPF. These findings suggest that CPET is generally a safe procedure for IPF, although carefully monitoring for signs and symptoms including ECG is strongly recommended. Additional research is warranted to confirm these results.
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Step oximetry test: a validation study. BMJ Open Respir Res 2018; 5:e000320. [PMID: 30116538 PMCID: PMC6089267 DOI: 10.1136/bmjresp-2018-000320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Step climbing is a potentially useful modality for testing exercise capacity. However, there are significant variations between test protocols and lack of consistent validation against gold standard cycle ergometry cardiopulmonary exercise testing (CPET). The purpose of the study was to validate a novel technique of exercise testing using a dedicated device. Methods We built a step oximetry device from an adapted aerobics step and pulse oximeter connected to a computer. Subjects performed lung function tests, a standard incremental cycle CPET and also a CPET while stepping on and off the step oximetry device to maximal exertion. Data from the step oximetry device were processed and correlated with standard measurements of pulmonary function and cycle CPET. Results We recruited 89 subjects (57 years, 50 men). Oxygen uptake (VO2) was 0.9 mL/kg/min (95% CI −3.6 to 5.4) higher in the step test compared with the gold standard cycle CPET, p<0.001. VO2 in the two techniques was highly correlated (R=0.87, p<0.001). Work rate during stair climbing showed the best correlation with VO2 (R=0.69, p<0.0001). Desaturation during step climbing correlated negatively with diffusion capacity for carbon monoxide (r=−0.43, p<0.005). No adverse events occurred. Conclusions The step oximetry test was a maximal test of exertion in the subjects studied, achieving slightly higher VO2 than during the standard test. The test was safe to perform and well tolerated by the patients. Parameters derived from the step oximetry device correlated well with gold standard measurements. The step oximetry test could become a useful and standardisable exercise test for clinical settings where advanced testing is not available or appropriate.
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Comparison of Methods Assessing Body Composition in Young Adults. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535628.87643.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lifestyle Behaviors and Body Composition in Young Adults. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535629.25762.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lifestyle Behaviors and Muscular Strength in Young Adults. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535235.10335.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Severity of sarcopenia is associated with postural balance and risk of falls in community-dwelling older women. Exp Aging Res 2018; 44:258-269. [DOI: 10.1080/0361073x.2018.1449591] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Cardiorespiratory fitness versus physical activity as predictors of all-cause mortality in men. Am Heart J 2018; 196:156-162. [PMID: 29421008 DOI: 10.1016/j.ahj.2017.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although both cardiorespiratory fitness (CRF) and physical activity (PA) are associated with mortality, whether they are associated with all-cause mortality independent of each other is unclear. METHODS CRF was assessed by a maximal exercise test and PA was measured by self-report in 8,171 male veterans. The predictive power of CRF and PA, along with clinical variables, was assessed for all-cause mortality during a mean (±SD) follow-up 8.7 (4.4) years during which there were 1,349 deaths. RESULTS CRF was associated with mortality after adjusting for clinical variables and remained a strong predictor of mortality after further adjusting for PA (hazard ratio 0.85, 95% CI 0.83-0.87). PA was a significant predictor of mortality after controlling for clinical variables; however, the association was eliminated after further adjusting for CRF (hazard ratio 0.98, 95% CI 0.88-1.10). In CRF-stratified analysis, being active (≥150 min/wk) was not associated with mortality within the unfit or fit categories (P>.4). However, in PA-stratified analysis, subjects categorized as fit (≥7 metabolic equivalents [METS]) had a lower risk of mortality regardless of PA status (P<.001). CONCLUSIONS In adult men, PA was associated with mortality independent of established risk factors, but not CRF. Conversely, CRF remained a strong predictor of mortality independent of PA status and established risk factors.
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A method for determining exercise oscillatory ventilation in heart failure: Prognostic value and practical implications. Int J Cardiol 2017; 249:287-291. [DOI: 10.1016/j.ijcard.2017.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/04/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
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Cardiorespiratory Fitness, Adiposity, and Cancer Mortality in Men. Obesity (Silver Spring) 2017; 25 Suppl 2:S66-S71. [PMID: 29086513 DOI: 10.1002/oby.22009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/30/2017] [Accepted: 08/09/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study sought to evaluate the association between cardiorespiratory fitness (CRF) and cancer mortality in men with overweight and obesity. METHODS Maximal exercise testing was performed in 3,610 men (58.8 ± 17.5 years) (n = 2,100 with overweight and n = 1,510 with obesity) free from malignancy at baseline who were followed for 12.3 ± 7.4 years. Body mass index of 25.0 to 29.9 kg/m2 for overweight and ≥ 30.0 for obesity categories was used. Hazard ratios and population-attributable risks (PAR) were determined. RESULTS During the follow-up period, 11.1% and 9.1% died from cancer among those who had overweight and obesity, respectively. CRF had an inverse and graded association with cancer mortality. Compared with low CRF (< 5 metabolic equivalents), moderate and high CRF levels were associated with 48% and 79% reduced risks for cancer mortality in men who had overweight (P < 0.001) and 55% and 83% lower risks in those who had obesity (P < 0.001), respectively. Low CRF had PARs of 9.3% and 10.5% for cancer mortality in subjects who had overweight and obesity, respectively. CONCLUSIONS Among men with overweight and obesity, higher CRF is associated with lower cancer mortality. Eliminating low CRF as a risk factor would potentially prevent a considerable number of cancer deaths and reduce the associated societal and economic burden in these high-risk populations.
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Lifestyle Behaviors and Clinical Outcomes in Idiopathic Pulmonary Fibrosis. Respiration 2017; 95:27-34. [PMID: 29045951 DOI: 10.1159/000481202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lifestyle behaviors are not well-characterized in idiopathic pulmonary fibrosis (IPF). OBJECTIVES To assess the association between lifestyle behaviors and clinical outcomes in patients with IPF. METHODS A total of 34 IPF patients (median age 68 years) were assessed for daily sitting and weekly walking times using the International Physical Activity Questionnaire by in-person interview at baseline, and they were followed up for up to 40 months. Cox proportional hazard analysis was conducted for cardiorespiratory-related hospitalizations and mortality as outcomes. RESULTS Fifty percent of all patients were hospitalized, and 32% died during the follow-up period. Sitting and walking times were associated with hospitalizations and mortality in IPF. Compared to patients who reported a sitting time of <5 h/day, patients who sat 5 to <10 and ≥10 h/day experienced an increased risk of 2.4 and 5.8 (p trend = 0.036) for hospitalization and of 4.6 and 21.2 (p trend = 0.018) for mortality, respectively. Compared to patients walking <100 min/week, patients with a walking time of 100 to <150 and ≥150 min/week were associated with a 49 and 74% reduced risk for hospitalizations (p trend = 0.022) and a 62 and 86% reduced risk for mortality (p trend = 0.018), respectively. The risk for mortality was further reduced with a combination of shorter sitting and extended walking times. CONCLUSIONS Shorter daily sitting and longer weekly walking times were associated with reduced hospitalization and mortality risks in patients with IPF. These findings suggest a clinical importance of assessing lifestyle behaviors in a comprehensive evaluation and prognostication of IPF patients. The results underscore potential clinical benefits of reducing sedentary behaviors among IPF patients; however, this warrants further investigation.
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Cardiorespiratory fitness, physical activity and cancer mortality in men. Prev Med 2017; 100:89-94. [PMID: 28412186 DOI: 10.1016/j.ypmed.2017.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/25/2022]
Abstract
The preventive role of cardiorespiratory fitness (CRF) and physical activity (PA) in cancer mortality is not well-established. This study sought to evaluate the association between CRF, PA and cancer mortality in men. Maximal exercise testing was performed at the VA Palo Alto Health Care System in 5876 male veterans (60.5±11years) free from malignancy at baseline who were followed for mean of 9.9 (range 0.11 to 26.8) years. PA status was assessed in a sub-group of 4034 participants. Relative risks and population attributable risks (PAR%) for cancer-related mortality were determined. During the follow-up, 447 men (7.6%) died from cancer. Forty-nine percent of the sample was considered physically active (defined as meeting the minimal PA guidelines); this group exhibited a 20% reduction in cancer mortality risk [95% confidence interval (0.67-0.97), p=0.02]. CRF was inversely associated with cancer death. For each 1 MET increase in CRF there was a 5% reduction in risk for cancer mortality (p=0.01). Compared to the least fit group (<5.0 METs), subjects with moderate to high CRF exhibited 26-46% reduced risks of cancer mortality (p for trend=0.002). The PARs% for low CRF and inactivity were 6.6% and 8.5%, respectively. Moderate and high CRF levels and meeting the minimal PA guidelines have protective benefits against cancer mortality in men. Eliminating inactivity and low CRF as risk factors could potentially prevent a considerable number of cancer deaths and reduce the associated societal and economic burden.
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Cardiorespiratory fitness and cancer incidence in men. Ann Epidemiol 2017; 27:442-447. [PMID: 28789775 DOI: 10.1016/j.annepidem.2017.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/12/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The preventive role of cardiorespiratory fitness (CRF) in cancer is not well established. The present study sought to evaluate the association between CRF and cancer incidence in men. METHODS Maximal exercise testing was performed in 4920 men (59.2 ± 11.4 years) free from malignancy at baseline who were followed for 12.7 ± 7.5 years. Relative risks and population attributable risks were determined. RESULTS During the follow-up, 25.8% were diagnosed with any type of cancer. CRF was inversely associated with total cancer incidence; for each one metabolic equivalent increase in CRF, there was a 4% reduction in cancer incidence (P < .001). Compared with low CRF, moderate and high CRF levels were associated with 14% (95% CI [0.74-0.99]) and 26% (95% CI [0.62-0.89]) reduced risks for all cancers, respectively (P for trend = .004). Low CRF had a population attributable risk of 3.0% for cancer incidence. The associations between CRF, prostate, skin and colorectal cancers were not significant. CONCLUSIONS Higher CRF is associated with lower total cancer incidence in men. A novel finding suggests that eliminating low CRF as a risk factor would potentially prevent considerable cancer morbidity and reduce the societal and economic burden associated with cancer. These findings underscore the importance of CRF for primary cancer prevention.
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Cardiorespiratory Fitness Versus Physical Activity as Predictors of All-Cause Mortality in Men. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519261.75339.2b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Exercise Training Improves Ventilatory Efficiency in Patients With Small Abdominal Aortic Aneurysm. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000519259.98209.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Supervised exercise training improves exercise cardiovascular function in idiopathic pulmonary fibrosis. Eur J Phys Rehabil Med 2016; 53:209-218. [PMID: 27996217 DOI: 10.23736/s1973-9087.16.04319-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal interstitial lung disease associated with cardiovascular impairments which compromise exercise tolerance and worsen prognosis. AIM To examine the effect of participating in supervised exercise training (ET) program on cardiovascular function in patients with IPF. DESIGN A randomized controlled study. SETTING Outpatient hospital. POPULATION Thirty-two IPF patients (68±8 years). METHODS An ET group (N.=15) participated in a 12-week twice a week 60-minute supervised exercise program while a control group (N.=17) received usual care. At baseline and after the 12-week intervention all patients underwent resting echocardiography, cardiopulmonary exercise testing and N-terminal pro-brain natriuretic peptide (NT-proBNP) assessments. RESULTS The ET group significantly improved peak values of exercise cardiovascular indexes while the control group showed a trend of deterioration in the outcomes. The mean difference between the groups (95% CI) for circulatory power was 638 mLO2/kg/min/mmHg (95% CI: 197-1080) (P=0.006), cardiac power output 0.3 W (95% CI: 0.1 to 0.6) (P=0.041), and stroke work 312 mL/beat/mmHg (95% CI: 52-573) (P=0.02). No significant differences between groups were detected in most echocardiography measures and NT-proBNP. Changes in exercise cardiovascular indexes showed significant correlation with improvements in functional capacity, dyspnea and quality of life among ET group. CONCLUSIONS Participation in supervised ET program can improve exercise cardiovascular function in patients with IPF, however resting cardiac evaluations seem to be less sensitive to detect such changes. CLINICAL REHABILITATION IMPACT These findings underscore the utility of supervised ET for cardiovascular enhancement which may also be clinically beneficial in reducing the cardiovascular morbidity and mortality in IPF patients.
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