Cycle Ergometer Exercise Test Research Articles

Revealing the unrevealed: echocardiography for non-ischemic scar tissue detection.

The detection of myocardial scar tissue profoundly influences athletes care and prognostic categorization. Athletes appear to be at risk of developing fatal arrhythmias when harboring a quiescent cardiac disorder. Early identification of disease in asymptomatic individuals through preparticipation screening is means to prevent these events. We presented a male marathon runner master athlete who came at our Department of Sports Medicine for a preparticipation screening. Baseline 12-lead standard electrocardiogram was normal. A maximal cycle ergometer exercise test revealed exercise-induced premature ventricular contractions (PVCs) with uncommon morphology. Echocardiography revealed an hyperechogenic zone at mid-basal posterior segments of the left ventricle. Twenty-four-hours ECG Holter monitoring, with training session, showed some isolated polymorphic PVCs even during training session. Cardiac magnetic resonance (CMR) confirmed the presence of a non-ischemic left ventricular scar (subepicardial) into the mid-basal segment of the posterior wall. Echocardiography is a first-line, economic, and accessible diagnostic test for athletes and it can be useful, when abnormalities are detected, to indicate further investigations, such as CMR. Although non-ischemic left ventricular scarring is difficult to detect on echocardiography, this event is sometimes possible and require further investigation when observed.

The Responsiveness of Exercise Tests in COPD: A Randomized Controlled Trial

BackgroundChronic obstructive pulmonary disease (COPD) is characterised by reduced exercise tolerance and improving physical performance is an important therapeutic goal. A variety of exercise tests are commonly used to assess exercise tolerance, including laboratory and field-based tests. The responsiveness of these tests to common COPD interventions is yet to be compared, but may inform test selection in clinical and research settings. Research QuestionWhat exercise test possesses the greatest sensitivity to change pre- to post-intervention in patients with COPD? Study Design and Methods154 patients with symptomatic COPD were recruited and randomised (2:1:1) to six weeks of long-acting muscarinic antagonist (LAMA), pulmonary rehabilitation (PR), or usual care (UC). Pre- and post-intervention, participants performed a ramp-incremental and constant work rate cycle ergometer exercise test (ICET and CWRCT), incremental and endurance shuttle walk test (ISWT and ESWT), six-minute walk test (6MWT), and a four metre gait speed test (4MGS). Results103 participants (67 ± 8 y; 75 [73%] males; FEV1: 50.6 ± 16.8 % predicted) completed the study. Significant improvements in the ICET, CWRCT, ISWT, ESWT, and 6MWT were observed following PR (p<0.05), with the greatest improvements seen in the constant work rate protocols (% change: CWRCT: 42%; ESWT: 41%). InterpretationThe ESWT and CWRCT appeared to be the most responsive exercise test protocols to LAMA and PR. The magnitude of change was much greater after a programme of rehabilitation compared to bronchodilator therapy.

Characterizing Heart Rate Variability Response to Maximal Exercise Testing in People with Huntington's Disease.

Huntington's disease (HD) is an autosomal dominant, neurodegenerative disease that involves dysfunction in the autonomic nervous system (ANS). Heart rate variability (HRV) is a valid and noninvasive measure for ANS dysfunction, yet no study has characterized HRV response to exercise in people with HD. Characterize HRV response to exercise in individuals with HD and explore its implications for exercise prescription and cardiac dysautonomia mechanisms. 19 participants with HD were recruited as part of a cohort of individuals enrolled in the Physical Activity and Exercise Outcomes in Huntington's Disease (PACE-HD) study at Teachers College, Columbia University (TC). 13 non-HD age- and gender-matched control participants were also recruited from TC. HRV was recorded with a Polar H10 heart rate (HR) monitor before, during, and after a ramp cycle-ergometer exercise test. Participants with HD showed reduced HR peak (p < 0.01) and HR reserve (p < 0.001) compared with controls. Participants with HD demonstrated reduced root mean square of successive differences between normal-to-normal intervals (RMSSD) and successive differences of normal-to-normal intervals (SDSD) at rest (p < 0.001). Participants with HD also showed differences for low frequency (LF) power (p < 0.01), high frequency (HF) normalized units (nu) (p < 0.05), LF (nu) (p < 0.001), and HF/LF ratio (p < 0.05) compared with controls. We found reduced aerobic exercise capacity and sympathovagal dysautonomia both at rest and during post-exercise recovery in people with HD, suggesting modified exercise prescription may be required for people with HD. Further investigations focusing on cardiac dysautonomia and underlying mechanisms of sympathovagal dysautonomia in people with HD are warranted.

FEASIBILITY OF AEROBIC FITNESS TESTING IN AMNESTIC MILD COGNITIVE IMPAIRMENT FROM THE ACT TRIAL

Abstract Aerobic fitness has been postulated as a physiological mechanism of action for aerobic exercise to modify Alzheimer’s disease, but it has not been adequately studied in older adults with (MCI). The purpose of this study is to evaluate the feasibility of a gold-standard, laboratory-based, symptom-limited cycle-ergometer exercise testing (GXT) in older adults with amnestic mild cognitive impairment (aMCI) to assess peak oxygen consumption (VO2max [ml/kg/min]) using baseline data from the ACT Trial. The test was categorized as a submax, near-max, and max test based on if 0, 1, and ≥2 of the American College of Sports Medicine criteria was met: &amp;gt;90% of age-predicted maximum heart rate, plateau in VO2Peak, respiratory exchange ratio &amp;gt;1.10, and rating of perceived exertion &amp;gt;17. VO2max was predicted as 3.5*maximal metabolic equivalents (METs). Among 146 enrolled participants (73.8±5.7 years old with 16.9±2.9 years of education, 51.4% men, and 91.8% Caucasian), 145 completed GXTs. Sixteen GXTs (11.0%) were submax (VO2Peak 13.5±4.4), 53 (36.6%) were near-max (VO2Peak 16.5±4.1), and 76 (52.4%) were max (VO2Peak 18.4±5.1). Predicted VO2max were 21.6±6.8, 28.7±26.3, and 30.0±20.5 from submax, near-max, and max tests, respectively. Among max GXTs, VO2max was 19.5±4.9 in men (n=37) and 17.4±5.1 in women (n=39). In conclusion, GXTs was feasible for ~52% of the participants. METs-based prediction overly inflates VO2max estimates, in comparison to VO2max obtained from max GXTs. VO2max levels are substantially lower in older adults with aMCI than peers (23.1±6.3 in men and 21.1±3.4 in women), suggesting aerobic exercise as an important intervention for this population.

Long-term effects of a home exercise program in patients with acute myocardial infarction and percutaneous coronary intervention: prospective observational study

OBJECTIVE: Our aim was to evaluate the effects of home physical training (HPT) in patients with acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in 1 year and the long-term period.&#x0D; MATERIALS AND METHODS: A prospective observational study was conducted. Ninety-seven patients after AMI and PCI were included: Group 1 (n=51) patients exercising at home for the next year after PCI (HPT+), and Group 2 (n=46) no exercises (HPT). The evaluation was performed at baseline, in 1 year, and 8.90.9 years. The long-term response rate was 42 patients (82.4%) in the HPT+ group and 36 (78.3%) in the HPT- group.&#x0D; RESULTS: Patients in the HPT+ group had significantly higher physical performance at the cycle ergometer exercise test in 1 and 8.90.9 years: exercise time increased by 31.4% (p 0.001) and 40% (p 0.001), respectively, and the load increased by 15.6% (p 0.001) and 32.2% (p 0.001), whereas these indicators did not change significantly in HPT- group. Daily physical activity (PA) increased by 21.9% (p 0.01) in 1 year and 19.6% (p 0.01) in 8.90.9 years in the HPT+ group. PA did not change in the HPT- group in 1 year and decreased by 23.1% (p 0.001) in 8.90.9 years to a low level. The left ventricle ejection fraction in the HPT+ group increased by 2.4% (p 0.05) in 1 year and 6.8% (p 0.05) in 8.90.9 years with no changes in HPT- group. Quality of life increased more significantly in the HPT+ group by 50.6% (p 0.05) in 1 year and 71.6% (p 0.01) in 8.90.9 years versus 25.4% (p 0.05) and 46.9% (p 0.05), respectively, in the HPT- group. In the long-term period, the HPT+ group had fewer adverse clinical outcomes, with 22 patients compared with 28 (52.4 vs 77.8%, p 0.05).&#x0D; CONCLUSION: Patients with AMI and PCI who participated in a one-year HPT program had positively affected exercise tolerance, myocardial contractility, QoL, and adverse events in the long-term follow-up period.

The Effects of Type of Exercise on Ventilatory Efficiency (VE/VCO2) in 11-16-Year-Old Healthy Individuals: A Randomized Clinical Trial

Background: The ventilatory equivalent for CO2 (VE/VCO2 ) is the simplest way to predict ventilatory efficiency. This study aimed to investigate the impact of treadmill and cycle ergometer exercise tests on ventilatory outcomes in healthy adolescents. Methods: In this clinical trial with cross-over design, 52 adolescents aged 11-16 years old (age: 13.8±0.17 years, height: 157.4±0.95 cm, weight: 51.73±1.24 kg, represented as mean±standard error), went through treadmill and cycle ergometer exercise tests with a 6-day wash-out during July-August 2019, Tehran, Iran. Through a RAMP (raise, activate, mobilise, and potentiate) protocol, participants were asked to perform the maximal treadmill or cycle ergometer exercise and continue the test until exhaustion. Gas exchange and heart rate (HR) were obtained breath by breath during the test. Time, HR, VE/VCO2, minute ventilation) VE), end-tidal carbon dioxide pressure (PetCO2), and dead space (VD) to tidal volume (VT) ratios (VD/VT) were transferred to the computer and recorded. All data were reported at two-time points: Anaerobic threshold (AT) V-slop method and peak. Independent t-test was then performed to compare the two types of exercises using SPSS 16, and P˂0.05 was considered significant. Results: The results showed a significant difference in two points regarding the type of exercise for Time and VE/VCO2, but for HR (P=0.004), VE (P=0.0001), PetCO2 (P=0.008), and VD/VT (P=0.004), a significant difference was only observed in AT point. Conclusion: Several physiological mechanisms that occurred during the development stage could affect individuals’ respiratory parameters; however, in general, the type of exercise test affected VE/VCO2.

Prognostic value of peak work rate indexed by left ventricular diameter

Left ventricular diameter (LVEDD) increases with systematic endurance training but also in various cardiac diseases. High exercise capacity associates with favorable outcomes. We hypothesized that peak work rate (Wpeak) indexed to LVEDD would carry prognostic information and aimed to evaluate the association between Wpeak/LVEDDrest and cardiovascular mortality. Wpeak/LVEDDrest (W/mm) was calculated in patients with an echocardiographic examination within 3 months of a maximal cycle ergometer exercise test. Low Wpeak/LVEDDrest was defined as a value below the sex- and age-specific 5th percentile among lower-risk subjects. The association with cardiovascular mortality was evaluated using Cox regression. In total, 3083 patients were included (8.0 [5.4–11.1] years of follow-up, 249 (8%) cardiovascular deaths). Wpeak/LVEDDrest (W/mm) was associated with cardiovascular mortality (adjusted hazard ratio (HR) 0.28 [0.22–0.36]), similar to Wpeak in % of predicted, with identical prognostic strength when adjusted for age and sex (C-statistics 0.87 for both). A combination of low Wpeak/LVEDDrest and low Wpeak was associated with a particularly poor prognosis (adjusted HR 6.4 [4.0–10.3]). Wpeak/LVEDDrest was associated with cardiovascular mortality but did not provide incremental prognostic value to Wpeak alone. The combination of a low Wpeak/LVEDDrest and low Wpeak was associated with a particularly poor prognosis.

Exercise systolic blood pressure indexed to work rate predicts future risk of incident stroke

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): 1) The CircM network, Linköping University 2) The Swedish Stroke Association. Background Hypertension is a major risk factor for stroke. Exaggerated peak systolic blood pressure (SBP) during exercise is associated with increased risk of hypertension in normotensive subjects, whereas low, rather than high, peak exercise SBP predicts cardiovascular and all-cause mortality. Purpose We aimed to study the risk of incident fatal and non-fatal stroke in relation to absolute and work rate indexed exercise SBP, in patients referred for exercise testing. Methods We cross-linked clinical data from 14,428 bicycle ergometer exercise tests with data from the National Patient Registry and the Registry of Prescribed Medications up until December 2019. Subjects with a history of cerebrovascular disease were excluded, as well as subjects with submaximal tests, a drop in SBP during exercise, or with missing SBP data at the end of exercise. Baseline comorbidity was defined as diagnosis of, or treatment for, hypertension, diabetes, hyperlipidemia, and coronary artery disease (CAD). Work rate indexed SBP response (SBP/Watt-slope) was calculated as the increase in SBP during exercise divided by the increase in work rate. We applied Cox regression to calculate hazard ratios (HR) with 95% confidence intervals (95% CI) for the risk of incident stroke in association to peak SBP and the SBP/Watt-slope. We used absolute values as well the upper limit of normal (≥2 Z scores) of a recently published reference population, with reference equation including age, sex, SBP at rest, Wmax (for SBP peak only) and height (for SBP/W-slope only). Analyses were adjusted for age, sex, and baseline comorbidity. Results In total, 7,946 subjects (54% male, age 55±13 years) were included, with baseline comorbidity of hypertension (28%), diabetes (7%), hyperlipidemia (16%), and CAD (13%). During a median follow-up of 8.4 years (inter quartile range 5.8-11.5), 3.1% developed ischemic (2.2%) or hemorrhagic (1.0%) stroke. There were positive associations to future stroke with absolute peak exercise SBP (HR: 1.08 [1.03 – 1.13] per 10 mmHg increase) and with SBP/Watt-slope (HR: 1.09 [1.05 – 1.14] per 1 mmHg/10 Watt increase), but not after adjustment for sex, age and baseline comorbidity. However, having a SBP/Watt-slope ≥2 Z scores was associated with an increased risk for stroke (HR: 1.56 [1.08 – 2.25)] after adjustment for baseline comorbidity, whereas an adjusted SBP peak ≥2 Z scores was not (HR: 0.62 [0.32 – 1.21]). Conclusion A workload-indexed SBP response (SBP/Watt-slope) above the upper limit of normal may help to identify subjects with no history of cerebrovascular disease at risk of future stroke. In contrast, the absolute exercise SBP response to exercise does not add substantial information to the risk estimation above age, sex, and baseline comorbidity.

Retrospective cohort study at two centers, systolic blood pressure response during exercise testing

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Palacky University Olomouc Faculty of Medicine Czechia. Introduction Measurement of blood pressure (BP) is a standard part of the exercise testing protocol in the general population and in athletes, however, we do not have a sufficient definition of normal and abnormal blood pressure response to exercise and we don´t know the prognostic impact of exercise systolic blood pressure. Purpose To present systolic blood pressure values during exercise in athletes examined by an exercise test. Methods Retrospective analysis of blood pressure response to exercise in a selected cohort of athletes who performed a bicycle ergometer exercise test at two centers. We excluded individuals with prevalent cardiovascular disease. An individual ramp protocol to maximum was used and blood pressure was measured by auscultation method. Resting BP and the highest systolic blood pressure during exercise (SPBmax), maximum heart rate (TF), and maximum workload were recorded for each individual. The SBP/Watt-slope and the SBP/Watt-ratio at peak exercise were calculated. The SBP/Watt-slope was calculated as the ratio of the difference in the rest SPB and peak SPB measurement over the increment of workload. The SBP/Watt-ratio at peak exercise was calculated as the ratio of peak SBD over the peak workload. Sex-specific mean values, standard deviations, and 5th, 25th, 75th and 95th percentiles were determined. Results Between the years 2015 and 2021, 14 702 individuals – 3821 females (27,2 %) and 10 251 males (72,8 %) – underwent the exercise test, with an average age of 19 years (±14). The average Body Mass Index (BMI) was 21,1. The average maximum heart rate achieved was 183/min (±16) and the average peak workload achieved was 3,9 W/kg regardless of gender. The following values were calculated for the whole cohort: peak SBP/Watt-ratio and SBP/Watt-slope. More detailed results are in Table 1. Sex-specific values can be seen in Table 2. Conclusion The values of BP response during exercise testing in our cohort are comparable to recently published data. These data can change the interpretation of SPB response to exercise in the future. There is also a strong need for further research-the multivariate analysis of factors associated with a higher blood pressure response to exercise and determination of sex and age-specific values.

Heart Rate Responses at Rest, during Exercise and after Exercise Periods in Relation to Adiposity Levels among Young Nigerian Adults.

There is a dearth of comparative studies on heart rate (HR) abnormalities at rest, chronotropic responses during submaximal exercise, and such responses during recovery from submaximal exercise between healthy-weight and overweight/obese young adults. Eighty healthy young adults (30 men and 50 women) aged 19 to 33 years participated in the present study. A symptom-limited, submaximal, cycle ergometer exercise test of intensity targeted at 60% to 70% of the subject's age-predicted maximum HR was performed. The HR, blood pressure, and minute ventilation were measured at rest and during exercise. Post-exercise, HR was first measured at 1 minute of recovery and then every 2 minutes until the 5th minute. Our results showed significantly higher resting HR (P<0.001), lower percentage HR reserve during exercise (P<0.001), and slower HR recovery after exercise (P<0.05, P<0.01, or P<0.001) in overweight/obese men and women than in the non-overweight/obese controls. The prevalence of high resting HR, submaximal chronotropic incompetence, and blunted HR recovery were more common in the overweight/obese individuals than in the healthy-weight controls. Peak VO2 and ventilatory equivalent for oxygen were associated with resting HR, exercise HR parameters, and post-exercise HR recovery indices in both men and women. High resting HR, submaximal chronotropic incompetence, and blunted HR recovery in overweight/obese individuals in this study may be attributed to poor cardiorespiratory fitness and low respiratory efficiency.

Association of Gestation and Fetal Growth Restriction on Cardiovascular Health in Preterm-Born Children

To prospectively evaluate the associations of early and current life factors, including gestational age and fetal growth restriction in preterm-born subjects, on cardiovascular health including measures of central and peripheral blood pressure and arterial stiffness and assess cardiovascular changes before and after acute exercise in preterm- and term-born school-aged children. From 240 children, aged 7-12years, 204 (141 preterm-born and 63 term-born) had satisfactory data. An oscillometric device recorded cardiovascular measures before and after cycle ergometer exercise testing. Data were analyzed with multivariable linear regression and mediation. Central systolic blood pressure (SBP) was 6.4mmHg (95% CI, 1.2, 11.6) higher in preterm-born children with fetal growth restriction and 3.4mmHg (0.02, 6.8) higher in those without fetal growth restriction when compared with term controls. Augmentation index was 4.1% (0.7, 7.4) higher in the preterm fetal growth restriction group when compared with those without fetal growth restriction but was similar between the latter group and term controls. Regression modelling showed gestational age, female sex, and antenatal smoking, but not fetal growth restriction, were significantly associated with SBP. In contrast, fetal growth restriction and fat mass index, but not gestation, were significantly associated with augmentation index. Cardiovascular exercise responses were similar between all 3 groups studied. Our data show the differential associations of prematurity and fetal growth restriction on centralSBP and augmentation index. Cardiovascular responses to exercise were similar in all 3 groups. Preterm-born children with and without fetal growth restriction are at an increased risk of cardiovascular disease in adult life. URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-003712-20/GB: RHiNO, EudraCT: 2015-003712-20.

Changes in right ventricular two-dimensional echocardiographic speckle-tracking indices in adult LVAD population: a prospective clinical study

Abstract Objective Preserved right ventricular (RV) function is crucial in patients supported with left ventricular assist devices (LVAD). The use of strain derived from speckle tracking echocardiography (STE) is recommended by recent guidelines to evaluate intricate RV contractility. The data regarding long-term RV observation in LVAD patients using STE are limited. Thus, the study aimed to determine RV systolic function by STE in the remote period after LVAD implantation. Methods Patients with implanted third-generation LVADs with hydrodynamic bearing were prospectively enrolled (NCT05063006). The RV STE indices were analyzed before and after LVAD implantation, both at rest and during the cycle ergometer exercise test. Results We included 22 patients, the mean age was 58.4±7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. Stress tests were conducted 7 months postoperatively. The RV strain analysis was feasible in all subjects both in rest and exercise. The RV free wall strain (RVFWS) worsened from −13% (IQR, −17.3 to −10.9) to −11.3% (IQR, −12.9 to −6; p=0.033) after LVAD implantation with the particular decline in the apical RV segment [−11.3% (IQR, −16.4 to −6.2) vs −7.8% (IQR, −11.7 to −3.9; p=0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [−8.5% (IQR, −10.8 to −6.9) vs −7.3% (IQR, −9.8 to −4.7; p=0.184)]. Neither RVFWS (−11.3% (IQR, −12.9 to −6) vs −9.9% (IQR, −13.5 to −7.5; p=0.077) nor RV4CSL [−7.3% (IQR, −9.8 to −4.7) vs −7.9% (IQR, −9.8 to −6.3; p=0.548)] changed during cycle ergometer stress test. Conclusion The RVFWS worsens after LVAD implantation presumably due to impaired apical contractility. In LVAD-supported patients during the cycle ergometer stress test, the detailed RV strain analysis is feasible and its indices remain unchanged. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): 1. Cor Aegrum Foundation of Cardiac Surgery Development in Cracow2. Medtronic Poland sp. z o.o.

Continuous hands-free monitoring of echocardiographic exercise test using probe fixation device.

Stress echocardiography has been widely used in clinical practice for decades and has recently gained even more importance in diagnostic approaches to ischemic heart disease. However, it still has numerous limitations. Despite advantages of physical exercise as most physiologic stressor, it is impossible to continuously monitor the cardiac function during treadmill test and difficult to maintain an optimal acoustic window during cycle ergometer exercise tests. The aim herein, is to assess the feasibility of probe fixation for use during exercise echocardiography. Forty-eight subjects (47 men, mean age 42 ± 17 years, 25 healthy volunteers, 23 patients with suspected coronary artery disease) were included in this study. All subjects underwent exercise stress test on treadmill (32 cases) or cycle ergometer (16 cases). Both sector and matrix probes were used (in 17 and 31 tests, respectively). The semi-quantitative quality of acquired apical views were assessed at each stage using a four-point grading system. The mean time required for probe fixation was 9 ± 2 min. At baseline, 10 patients had at least one apical window of quality precluding reliable analysis. Twenty-five patients required probe repositioning during exercise (more often on a treadmill). During peak exercise quality of images in all views declined, but for diagnostic purposes it remained sufficient in 29 patients. Thus, 76% of performed tests (60% study population) had sufficient image quality. Probe fixation offers the possibility of continuous acquisition of echocardiographic images during physical exercise. The device is suitable almost exclusively for male patients and in some patients requires repositioning.

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

High fitness levels attenuate the increased risk of heart failure due to low socioeconomic status: A cohort study

Prediction of males' physical work capacity in various simulated altitudes using an incremental cycle ergometer exercise test at sea level

Standard approach to predict the decrease in physical fitness that will occur following a transition to a higher altitude is unavailable. Therefore, the study aimed to design simple mathematical models to predict submaximal exercise performance in various altitude environments, using a simple physical work capacity test conducted at sea level involving &gt;200 subjects. After splitting the subjects’ data in a ratio of 7:3, we used 70%of the data for regression model development and employed 30% for cross-validation testing. All subjects performed submaximal exercise tests using a cycle ergometer at artificial altitudes of 2000 m, 3000 m, 4000 m, 5000 m, and at sea level. We applied simple regression analysis to create a predictive model with the statistical significance set at the level of &lt;5%. There were 233 subjects involved in this study. The coefficient of determination of our regression model was 40–58%, and the standard error of estimation was 14.96–17.27 watts. The cross-validation of our regression model was 8–10%. Among the regression models developed, the one applied to an artificial altitude of 5000 m was 17%, and the regression model applied to an artificial altitude below 4000 m had no issues in generalization since the cross-validation was less than 10%. However, the regression model applied to an artificial altitude of 5000 m had a cross-validity of 17%; therefore, it should be used with caution.

Association between cardiorespiratory fitness and metabolic health in overweight and obese adults.

Cardiorespiratory fitness (CRF) has been inversely associated with insulin resistance and clustering of cardiometabolic risk factors among overweight and obese individuals. However, most previous studies have scaled CRF by body mass (BM) possibly inflating the association between CRF and cardiometabolic health. We investigated the associations of peak oxygen uptake (V̇O<inf>2peak</inf>) and peak power output (W<inf>peak</inf>) scaled either by BM-1, fat free mass (FFM-1), or by allometric methods with individual cardiometabolic risk factors and clustering of cardiometabolic risk factors in 55 overweight or obese adults with metabolic syndrome. V̇O<inf>2peak</inf> and W<inf>peak</inf> were assessed by a maximal cycle ergometer exercise test. FFM was measured by air displacement plethysmograph and glucose, insulin, HbA1c, triglycerides, and total, LDL, and HDL cholesterol from fasting blood samples. HOMA-IR and metabolic syndrome score (MetS) were computed. V̇O<inf>2peak</inf> and W<inf>peak</inf> scaled by BM-1 were inversely associated with insulin (β=-0.404 to -0.372, 95% CI: -0.704 to -0.048), HOMA-IR (β=-0.442 to -0.440, 95% CI: -0.762 to -0.117), and MetS (β=-0.474 to -0.463, 95% CI: -0.798 to -0.127). Other measures of CRF were not associated with cardiometabolic risk factors. Our results suggest that using BM-1 as a scaling factor confounds the associations between CRF and cardiometabolic risk in overweight/obese adults with the metabolic syndrome.

Observational study of an inpatient program for musculoskeletal disorders: The effects of gender and physical activity.

A new inpatient secondary preventive program for patients with musculoskeletal health problems was introduced throughout Austria. The aim of the current work was to evaluate this “Health Prevention Active” program and its possible influences on the quality of medical results upon hospital discharge.This observational study presents monocentric data for 7448 patients (48.99 ± 6.15 years; 53.7% women) with chronic musculoskeletal disorders who completed a 3-week health program. The focus was placed on measuring medical quality outcomes such as BMI, blood pressure, heart rate, pain, subjective ratings, and achieved power output in cycle ergometer exercise testing. We describe pre-post changes before and after the inpatient program and the results of a follow-up survey conducted after 1 year to identify moderating factors related to health outcomes.The medical baseline showed obvious deficits regarding obesity, hypertension, and subjective symptoms. Of all patients, 36.5% were completely inactive. The patient's gender and physical activity had a high impact on the medical baseline status. In total, the majority of patients (86.2%; SMD = –0.78 ± 0.59) responded well to the health prevention program, independent of their ages and lifestyles.Requirements for secondary prevention programs are high. The results of the study reflect the general problems presented by inactivity, obesity, and subjective symptoms like pain. Physical activity was specifically identified as a major factor for the observed medical baseline status.

Exercise stress echocardiography with probe fixated on patient's chest

Abstract Background Stress echocardiography (SE) has been widely used in clinical practice for decades and recently has gained even more importance in diagnostic approach to ischemic heart disease. However, it still has numerous limitations. Despite advantages of physical exercise as most physiologic stressor, it is impossible to continuously monitor the cardiac function during treadmill test and difficult to maintain an optimal acoustic window during cycle ergometer exercise test. We aimed to assess the feasibility of probe fixation for the use during exercise echocardiography. Methods 48 subjects (47 men, mean age 42±17 years, 25 healthy volunteers, 23 patients with suspected coronary artery disease) were included in this study. All subjects underwent exercise stress test on treadmill (32 cases) or cycle ergometer (16 cases). Both sector and matrix probes were used (in 17 and 31 tests, respectively). We assessed semi-quantitatively the quality of acquired apical views at each stage using four-point grading system (0 = poor, 1 = suboptimal, 2 = acceptable, 3 = optimal). Results The mean time required for probe fixation was 9±2 min. At baseline, 10 patients had at least one apical window of quality precluding reliable analysis. 25 patients probe repositioning during exercise (more often on treadmill). During peak exercise quality of images in all views declined, but it remained sufficient in 29 patients for diagnostic purposes. Thus, 76% of performed tests (60% for all study population) were of sufficient image quality. Conclusion Probe fixation offers the possibility of continuous acquisition of echocardiographic images during physical exercise. However the device is suitable almost exclusively for male patients. Moreover, in some patients it requires repositioning. Funding Acknowledgement Type of funding sources: None.

Acute effects of expiratory positive airway pressure on exercise tolerance in patients with COPD

ABSTRACT Objective: To evaluate the acute effects of expiratory positive airway pressure (EPAP) on exercise tolerance, dyspnea, leg discomfort, and breathing pattern in patients with COPD. Methods: Fifteen patients with COPD were assessed with the following three different protocols: EPAP of 7.5 cmH2O used during a constant cycle ergometer exercise test (Protocol-1); EPAP of 7.5 cmH2O used for 15 minutes before the test (Protocol-2); and a sham system without pressure used for 15 minutes before the test (Protocol-3). Dyspnea and leg discomfort were assessed using Borg scale, whereas breathing pattern by optoelectronic plethysmography. Statistical analyses were performed using generalized estimating equations and Bonferroni tests (α = 5%), considering the protocols (1, 2, and 3) and moment (resting and the end of exercise). Results: Exercise tolerance was lower in protocol 1: 108 ± 45 seconds compared to protocols 2: 187 ± 99 seconds (p= .011) and 3: 183 ± 101 seconds (p= .021). No difference was observed between protocols 2 and 3 (p> .999). Dyspnea in protocol 1: 7.0 ± 2.08 was higher than protocols 2: 4.10 ± 2.45 (p= .001) and 3: 3.90 ± 2.21 (p< .001), but no differences were observed between protocols 2 and 3 (p> .999). No significant difference was observed for leg discomfort among the protocols (p= .137). There were no statistically significant differences for most variables of breathing pattern among the protocols. Conclusion: A reduction on exercise tolerance and an increase in dyspnea were found with EPAP of 7.5 cm H2O during a constant cycle ergometer exercise test in patients with COPD.

Relationship between anthropometric characteristics and aerobic fitness among Malaysian men and women.

This cross-sectional study evaluated the relationships between anthropometric and aerobic fitness (rate of perceived exertion [RPE] and predicted maximal oxygen uptake [VO2max]) among 228 participants (age: 23.78±4.42 years). RPE and predicted VO2max were determined during the cycle ergometer exercise test. Data were also obtained for height, weight, body mass index (BMI), hip and waist (WC) circumferences. Data analysis revealed VO2max is correlated with WC (r=−0.571), weight (r=−0.521), waist-to-height ratio (WHtR) (r=−0.516), waist-to-hip ratio (WHR) (r=−0.487), and BMI (r=−0.47) in men, while, in women with WC (r=−0.581), weight (r=−0.571), WHtR (r=−0.545), BMI (r=−0.545), WHR (r=−0.473), and height (r=−0.287) (all P<0.05). Regression analysis showed WC was a significant predictor for VO2max in men and women (r 2=32.6% vs. 33.7%). The receiver operating characteristic curve of WC showed 0.786 and 0.831 for men and women, respectively. WC or abdominal obesity is the strongest predictor for VO2max, which is an indicator of aerobic fitness in Malaysian adults.