Cardiorespiratory Exercise Testing Research Articles

Возрастные особенности аэробных возможностей организма у спортсменов с разной направленностью физических нагрузок

The purpose of this study was to identify age-related features of aerobic capacity in athletes working on their endurance or speed-strength qualities. Materials and methods. The research involved 103 male athletes, who were divided into groups according to the type of physical activity (endurance (n = 58) and strength-speed (n = 45)) and age (12–15, 16–18 and 19–26 years). Their aerobic capacity was determined using cardiorespiratory exercise testing. Results. It was shown that the increase in relative peak oxygen consumption (VO2peak) was influenced not so much by age as by the type of physical activity (ANOVA: F = 18.1, p = 0.00004). At the same time, respiratory coefficient (F = 5.6, p = 0.007), heart rate at anaerobic threshold (F = 4.9, p = 0.009), tidal volume (F = 7.5, p = 0.01) and minute ventilation (F = 6.6, p = 0.002) were influenced mainly by age. In athletes aged 12–15 years, factor analysis established a negative correlation of type of physical activity with oxygen pulse, while physical working capacity was positively correlated with breathing parameters. Subjects aged 16–18 years showed no significant correlations between the variables and type of physical activity; at the same time, the number of correlations between ergometry parameters and physical working capacity factor increased with age. In athletes aged 19–26, the variables correlated strongly with the type of physical activity; the contribution of VO2peak to the physical working capacity factor is clearly demonstrated. The development of aerobic capacity is mainly influenced by the type of physical activity. However, in athletes aged 12–15 years, aerobic loads do not lead to a significant increase in VO2peak. The greatest increase in VO2peak is observed in 16–18-year-olds, while after 18 years of age, its growth halts.

The First Season After the COVID-19 Pandemic Cardiorespiratory and Statistics’ Performance in Czech Ice Hockey Players

The study describes the cardiorespiratory and statistics performance of ice hockey players during the season of 2020 after the COVID-19 lockdown’. Eight elite Czech male players (4 non-COVID-19 and 4 COVID-19 groups) were evaluated before and after the competition season. Players performed a cardiorespiratory exercise test and the maximal oxygen consumption, ventilatory threshold, respiratory compensation point, maximal heart rate and test time were measured. The number of matches, goals and plus/minus statistics were retained. No significant differences between groups before and after the season for all cardiorespiratory responses were found, and the no-COVID-19 group played more games. The conclusion highlights that the cardiorespiratory performance place all players (with and without COVID-19 history) in similar conditions to be prepared for the next season. Due to a wide variation among players’ statistics, based on plus/minus parameters, cannot be established that the 2020 season impaired the players’ statistics.

Exercising with a Surgical Mask is Safe but Decreases Performance in Both Athletic and Non-Athletic Individuals

Introduction: Upper respiratory tract infections (URTI) are common medical problems in athletes. Many athletes with URTI continue to train at high-levels and even compete. Using a mask as an additional measure may be beneficial to prevent the spreading of infection among teammates. However, there are many concerns about the effects of mask use on exercise safety and performance. Although some studies have investigated the effects of masks on performance in healthy individuals, studies in athletes are even more limited. Thus, we aimed to evaluate the impact of surgical masks on performance and safety during a cardiorespiratory exercise test (CPET) test applied to both athletes and non-athletes. Patients and Methods: A cross-over, non-randomized study was designed. The study was conducted in two phases. In phase 1, the CPET was performed without using a surgical mask. In phase 2, CPET was performed with a surgical mask in addition to the spiro mask 48 hours after the first test. Thirty participants aged 18-35 were included in the study. They were further divided as athletes (n= 17) and non-athletes (n= 13) subgroups. Results: Significant decreases were observed in some parameters of submaximal exercise [VEan, BFan, VE/ VO2 , VE/VCO2 (p< 0.001)] and in maximal exercise [VEmax, BFmax, TVmax, VE/VO2 , VE/VCO2 (p< 0.001)]. There were also significant decreases in VO2 levels (VO2 an, VO2 max) when compared with and without a surgical mask in both submaximal and maximal exercise (p< 0.001). Additionally, PETO2 decreased, and PETCO2 increased in maximum exercise (p< 0.001), whereas no significant changes were detected at the submaximal level. In subgroup analysis, VEan, VEmax, VO2 an, VO2 max parameters were decreased in athletes compared to non-athletes in surgical masked tests. Conclusion: Surgical masks for athletes and non-athletes decrease performance but have no detrimental effect on cardiorespiratory parameters. Athletes should be aware of this negative effect when high-level performance is demanded.

Comparative study of the effects of left ventricular and biventricular pacing on indices of cardiac function and clinical status of heart failure patients: preliminary results of READAPT study

Abstract Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute, optimizing it by means of comparing relative activation delay between right and left ventricles (electrically – driven optimization). In the present study we evaluated the effects of a pLVP algorithm on 50 heart failure patients (all Caucasians, 49% male; 66 +/- 8 years old; 46% ischemic cardiomyopathy; 41% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status, as well as a self-reported quality of life questionnaire. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response. Results Significant comparative effects of LVP over optimized CRT were noted regarding RV systolic velocity in TDI even from 6-months from baseline (6% increase, p=0.01); while end-systolic diameter of left ventricle was increased by 4% in 6-months in CRT group (p=0.01), while no significant difference was observed in LVP group. At 12 months endsystolic volume was significantly decreased (16%, p=0.01) and left ventricular systolic longitudinal strain was improved in 12 months in LVP group compared to CRT group (p- for interaction =0.001). Additionally, in cardiorespiratory exercise test LVP group showed improved inotropic reserve compared to CRT group according to maximum SBP achieved (20% increase, p<0.01 for interaction); while all other cardiorespiratory indices shoed borderline significant changes at 12 -months. Minnesota score was significantly reduced in LV-P group by 70% at 6-months; whereas no significant change was observed in CRT group (p for interaction <0.01). Conclusions In the preliminary findings of READAPT study, it seems that LV pacing optimized by a standardized echocardiographic protocol in patients with preserved AV conduction, LBBB, can achieve a higher percentage of synchronized LV pacing associated with improved patient quality of life; right ventricular function and endsystolic volume at 6 and 12-months of follow-up, over echo-optimized CRT pacing.

Description of the menstrual cycle status, energy availability, eating behavior and physical performance in a youth female soccer team

The aim of the study was to describe the menstrual status and perception, risk of low energy availability (LEA) and the presence of orthorexia nervosa (ON) in youth female from a soccer team. Also, verify the possible effect of LEA and ON on physical performance. Data from 19 female players (14.6 ± 1.42 yr) belonging to a soccer team from Cyprus was taken during pre-season. The menstrual cycle status was evaluated by specific questions, LEA by the Low Energy Availability in Females Questionnaire (LEAF-Q), ON by the ORTO-R questionnaire and physical performance by jump, handgrip and cardiorespiratory exercise tests. Players were separated into the risk of LEA and ON. Comparison and correlation tests were performed with a significance set at p < 0.05. As the main results, 66.7% of players perceived that the menstrual period affects their performance in the game, 83.3% did not communicate with coaches about their menstrual cycle; the prevalence of risk of LEA was 26.3%; players with risk of LEA also presented higher scores ON; neither LEA nor ON presented a significant association with players performance. The findings highlighted that youth players perceived an impact of the menstrual period on performance, but did not communicate with the coach about it. Players with the risk of LEA and high values of ON seem not to be associated with a decrease in physical performance during the pre-season evaluation. Attention is required as the players were assessed once. Monitoring these parameters throughout the sports season is recommended to obtain better clarification about the topic.

#5764 STUDY OF THE INFLUENCE OF PHYSICAL ACTIVITY ON THE FUNCTION OF EXTERNAL RESPIRATION IN PATIENTS WITH CKD IN THE PROCESS OF REHABILITATION

Abstract Background and Aims Chronic kidney disease is a global health problem in which patients performance decreases as renal dysfunction progresses. The aim was to study of the function of external respiration in patients with CKD in the dynamics of a 12-week rehabilitation program. Method The study included 130 patients with CKD stages 2-3, aged 45 to 65 years, whose average age was 58.7 ± 0.73 years, and the proportion of women in the sample was 47.7%. All patients were examined of urea, serum creatinine, hemoglobin level. To determine exercise tolerance, a cardiorespiratory exercise test and spirogram were performed. Patients of the main group, depending on the initial CRET parameters, were divided into 2 subgroups: 1 subgroup - 67 patients who performed light intensity exercises; 2 subgroups - 33 patients who performed medium-intensity exercises for 12 weeks 3 times a week. The choice of training intensity was made according to the level of individual or subjective perception of the load and was calculated using the approximate heart rate. The control group consisted of patients with CKD stages 2-3 who did not perform physical training. Results An analysis of the spinographic parameters of patients with CKD revealed that the FEV1 and FVC indicators are of great importance in assessing the results of rehabilitation measures. There were positive results of 12 weeks of physical training with a more pronounced increase in FEV1. Patients in the light intensity training group achieved 35-45% of maximum heart rate or 40% of peakO2 consumption, and in the moderate intensity training group, 45-55% of maximum heart rate and 50-60% of peakO2 were achieved. The index (FEV1/FVC, in %) showed significant differences both in the initial indicators and in the dynamics. Conclusion In patients with pre-dialysis stages of CKD, a significant effect was revealed with the combined use of standard therapy and physical activity of light and moderate intensity, which ensures the preservation of positive dynamics in terms of the degree of increase in diastolic blood pressure at the time of exercise and respiratory parameters (FEV-1 and FVC, p&amp;lt;0.05).

EFFECTS OF SARS-COV-2 INFECTION ON THE CARDIORESPIRATORY PERFORMANCE BY HYPERTENSION STATUS

Objective: Few data have been published regarding the holistic approach of patients with history of arterial hypertension after Sars-Cov-2 infection. The purpose of our study was to examine the impact of Covid-19 in the cardiopulmonary status of hypertensive patients 3 months after the first day of infection. Design and method: All participants who recovered Covid-19 infection underwent cardiorespiratory exercise test using either Bruce or modified Bruce protocol and transthoracic echocardiogram where all parameters were evaluated. The population was separated into two groups based on history of hypertension. Group I included 62hypertensives and Group II included 134normotensive subjects. Results: A total of 198 patients (51±15 years, 44.4% males, 6.6% history of coronary heart disease) were assessed. Hypertensives had higher BMI (30.47±4.68 vs. 26.20 ±5.36 kg/m2, p&lt;0.001) and BSA (2.03±0.24 vs. 1.91±0.45, p&lt;0.001). They were hospitalized in higher percentage comparing to normotensives(54.8% vs. 35.8%, p&lt;0.01). Out of echocardiographic parameters, diastolic dysfunction parameters including left atrial diameter(40 ±6 vs. 35±5mm, p&lt;0.001) and E/A ratio (0.95±0.34 vs. 1.22±0.43, p&lt;0.001) differed significantly between two groups. LVEF(%) was also significantly impaired (56±10% vs. 58±9%, p:0.04) in hypertensives. This finding was depicted in lower oxygen consumption (VO2 (ml/kg/min)) both maximum (22±4 vs.28±7, p&lt;0.001) and during the 1st minute of recovery (19±18 vs.21±23, p&lt;0.006), metabolic equivalents (METS) at peak, 10±13 vs. 10±3, p&lt;0.001) and HR1st minute recovery (124±23 vs. 138±21 bpm, p&lt; 0.001) comparing to normotensives. Systolic blood pressure(mmHg) at rest (132±13 vs. 125±16, p: 0.002), maximum (189±28 vs. 177±26, p: 0.01) and during the 1st minute of recovery (179±29 vs. 162±25, p: 0.001) was higher while the exercise duration was significantly lower (8±3 vs. 9±3 min, p&lt;0.001) in patients with hypertension. Finally, hypertensive subjects reported higher scores in Borg scale for dyspnea (7±2 vs. 6±2, p:0.02) comparing to normotensives. Conclusions: Current study highlighted the negative impact of Sars-Cov-2 infection in the ability of patients with hypertension to exercise. Therefore, the need for a more comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity in post-covid patients is mandatory

A single exercise exertion initiates antioxidant and vascular-protective mechanisms in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK (German Centre for Cardiovascular Research). Background Increased systemic inflammation and metabolic dysfunction at rest are observed in heart failure with reduced ejection fraction (HFrEF). Regular (endurance) exercise training can alleviate both. On the other hand, cardiorespiratory exercise testing (CPET) exerts a physical challenge thereby initiating the acute activation of the immune system and several metabolic pathways. Aim To characterize the differences and similarities acute inflammatory and metabolic activation in response to an acute exercise challenge, and their resolution after 2 hours of rest in patients with HFrEF as compared to controls. Methods Participants with HFrEF (n = 16) as well as age and sex matched controls (CON, n = 13) were investigated at baseline (T1), immediately after CPET (T2), and after 2 hours of resting post-CPET (T3). Clinical and physiological parameters, leukocyte profile, plasma cytokines and metabolites were assessed along with inflammatory and metabolic parameters at all three time points. Results and Discussion Cardiovascular risk profile as well as leukocyte, cytokine and metabolic parameters at T1 was similar in CON and HFrEF. Immediately after CPET, lactate, natural killer (NK) and NK-T cell blood counts, among others, were significantly increased in both groups. In HFrEF specifically, platelet aggregates with NK cells, CD8+ cytotoxic T cells and "classical" CD14++CD16-monocytes as well as phosphatidylcholines and triglycerides were increased. After 2h of rest post-CPET, almost all altered parameters returned to baseline in CON. In HFrEF, blood counts and morphological markers of inflammatory effector cell types, including CD8+ T cells and neutrophils remained elevated. Blood levels of inflammatory cytokines were associated to elevated levels of various phosphatidycholines in HFrEF, but not in CON, potentially pointing towards a link to cell death. Blood levels of methionine sulfoxide-to-methionine, declined at T3 versus T1 in both groups, potentially indicating activation of anti-oxidant methionine sulfoxide reductases. In addition, trigonelline, an inhibitor of trimethylamine N-oxide (TMAO) synthesis from choline was elevated by CPET in both groups and this increase correlated inversely with TMAO-to-choline ratio. This might indicate a so far unexplored exercise-induced vascular-protective mechanism by limiting the pro-atherogenic effects of TMAO. Conclusion CPET induced a complex acute immuno-metabolic response, whose restitution to baseline levels differed between HFrEF and healthy controls. Despite longer persistence of pro-inflammatory and metabolic mediators present in the circulation after the end of an acute exercise session, novel anti-oxidant and vascular protective mechanisms of exercise have been identified and appear to be still active in patients with HFrEF.

P310 CARDIOPULMONARY EXERCISE TEST IN THE EVALUATION OF A PATIENT WITH HFREF: THE IMPORTANCE IN THE ANALYSIS OF GAS KINETICS

Abstract Introduction exertional dyspnea is a symptom present in several diseases, identifying the origin is of fundamental diagnostic and therapeutic importance. Cardiorespiratory exercise testing (CPET) is a valuable tool not only to assess functional capacity but also for diagnostic and prognostic purposes. Clinical case 55–year–old patient with a history of episode of acute pulmonary edema. Echocardiogram showed FE 35% with diffuse left ventricular (LV) hypokinesis and mild–to–moderate mitral insufficiency (MI). Diagnostic coronarography showed lesion–free coronary tree. An interrupted CPET at 140W showed peak O2 consumption of 23.6 mL/kg/min that excluded indication for cardiac transplantation. An echocardiogram from us confirmed dilated cardiomyopathy (CMPD) with FE=32%, diffuse VS hypokinesia and mild–to–moderate functional MI. CPET was repeated, maximal for respiratory quotient (1.42) interrupted due to muscle exhaustion, indicative of moderate reduction in functional capacity with peak VO2 at 64% of predicted, preserved anaerobic threshold at 51% of VO2 max and reduced VO2/W and Pulse Oxygen Ratio (VO2/HR) values from cardiogenic limitation. Also evident drop in VO2/HR during the final stages of the test and associated change in slope of the VO2/Work relationship a sign of decline in stroke volume and cardiogenic efficiency. Absent signs of ventilatory limitation, pulmonary vascular (Ve/VCO2=20.8 in normal range), or exercise desaturation. In the final phase of the test increase in VCO2 and Ve/VCO2 and Ve/VO2 equivalents. In order to find the explanation to the data collected by CPET, exercise echocardiogram was performed, which revealed the development of severe mitral valvular insufficiency and subsequent pulmonary hypertension justifying the behavior of the parameters collected by CPET. Discussion The oxygen pulse represents a metabolic surrogate for stroke volume. Normally during the active phases of exertion there is a progressive increase followed by a plateau. The evident flattening of the VO2/Work curve during the final phases of exercise and the concomitant decrease in oxygen pulse denote inadequate cardiac performance relative to the increased energy demands during exercise. Conclusions CPET proves to be a valuable clinical tool to guide the diagnostic–therapeutic pathway, particularly in the presence of complex heart disease (CMPD or IM).

Apelin as a Potential Regulator of Peak Athletic Performance

Apelin, as a cardiokine/myokine, is emerging as an important regulator of cardiac and skeletal muscle homeostasis. Loss of apelin signaling results in premature cardiac aging and sarcopenia. However, the contribution of apelin to peak athletic performance remains largely elusive. In this paper, we assessed the impact of maximal cardiorespiratory exercise testing on the plasma apelin levels of 58 male professional soccer players. Circulating apelin-13 and apelin-36, on average, increased transiently after a single bout of treadmill exercise; however, apelin responses (Δapelin = peak - baseline values) showed a striking interindividual variability. Baseline apelin-13 levels were inversely correlated with those of Δapelin-13 and Δapelin-36. Δapelin-13 showed a positive correlation with the maximal metabolic equivalent, relative maximal O2 consumption, and peak circulatory power, whereas such an association in the case of Δapelin-36 could not be detected. In conclusion, we observed a pronounced individual-to-individual variation in exercise-induced changes in the plasma levels of apelin-13 and apelin-36. Since changes in plasma apelin-13 levels correlated with the indicators of physical performance, whole-body oxygen consumption and pumping capability of the heart, apelin, as a novel exerkine, may be a determinant of peak athletic performance.

Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction.

Chronic kidney disease (CKD) is common in heart failure (HF). Chronic kidney disease often worsens the prognosis and impairs the management of patients with HF. Chronic kidney disease is frequently accompanied by sarcopenia, which limits the benefits of cardiac rehabilitation (CR). The aim of this study was to evaluate the impact of CR on cardiorespiratory fitness in HF patients with reduced ejection fraction (HFrEF) according to the CKD stage. We conducted a retrospective study including 567 consecutive patients with HFrEF, who underwent a 4-wk CR program, and who were evaluated by cardiorespiratory exercise test before and after the program. Patients were stratified according to their estimated glomerular filtration rate (eGFR). We performed multivariate analysis looking for factors associated with an improvement of 10% in peak oxygen uptake (V˙ o2peak ). Thirty-eight percent of patients had eGFR <60 mL/min/1.73m². With decreasing eGFR, we observed deterioration in V˙ o2peak , first ventilatory threshold (VT1) and workload and an increase in brain natriuretic peptide levels at baseline. After CR, there was an improvement in V˙ O2peak (15.3 vs 17.8 mL/kg/min, P < .001), VT1 (10.5 vs 12.4 mL/kg/min, P < .001), workload (77 vs 94 W, P < .001), and brain natriuretic peptide (688 vs 488 pg/mL, P < .001). These improvements were statistically significant for all stages of CKD. In a multivariate analysis predicting factors associated with V˙ o2peak improvement, renal function did not interfere with results. Cardiac rehabilitation is beneficial in patients with HFrEF with CKD regardless of CKD stage. The presence of CKD should not prevent the prescription of CR in patients with HFrEF.

Performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask.

To investigate if a cloth facemask could affect physiological and perceptual responses to exercise at distinct exercise intensities in healthy young individuals. Nine participants (sex, female/male: 6/3; age: 13±1 years; VO2peak: 44.5±5.5 mL/kg/min) underwent a progressive square-wave test at four intensities: (1) 80% of ventilatory anaerobic threshold (VAT), (2) VAT, and (3) 40% between VAT and [Formula: see text] wearing a triple-layered cloth facemask or not. Participants then completed a final stage to exhaustion at a running speed equivalent to the maximum achieved during the cardio-respiratory exercise test (Peak). Physiological, metabolic, and perceptual measures were measured. Mask did not affect spirometry (forced vital capacity, peak expiratory flow, forced expiratory volume; all p≥0.27), respiratory (inspiratory capacity, end-expiratory volume [EELV] to functional vital capacity ratio, EELV, respiratory frequency [Rf], tidal volume [VT], Rf/VT, end-tidal carbo dioxide pressure, ventilatory equivalent to carbon dioxide ratio; all p≥0.196), hemodynamic (heart rate, systolic and diastolic blood pressure; all p>0.41), ratings of perceived exertion (p = 0.04) or metabolic measures (lactate; p = 0.78) at rest or at any exercise intensity. This study shows that performing moderate to severe activity is safe and tolerable for healthy youth while wearing a cloth facemask. ClinicalTrials.gov: NCT04887714.

Cardiorespiratory Coordination in Collegiate Rowing: A Network Approach to Cardiorespiratory Exercise Testing.

Collegiate rowing performance is often assessed by a cardiopulmonary exercise test (CPET). Rowers’ on-water performance involves non-linear dynamic interactions and synergetic reconfigurations of the cardiorespiratory system. Cardiorespiratory coordination (CRC) method measures the co-variation among cardiorespiratory variables. Novice (n = 9) vs. Intermediate (n = 9) rowers’ CRC (H0: Novice CRC = Intermediate CRC; HA: Novice CRC < Intermediate CRC) was evaluated through principal components analysis (PCA). A female NCAA Division II team (N = 18) grouped based on their off-water performance on 6000 m time trial. Rowers completed a customized CPET to exhaustion and a variety of cardiorespiratory values were recorded. The number of principal components (PCs) and respective PC eigenvalues per group were computed on SPSS vs28. Intermediate (77%) and Novice (33%) groups showed one PC1. Novice group formed an added PC2 due to the shift of expired fraction of oxygen or, alternatively, heart rate/ventilation, from the PC1 cluster of examined variables. Intermediate rowers presented a higher degree of CRC, possible due to their increased ability to utilize the bicarbonate buffering system during the CPET. CRC may be an alternative measure to assess aerobic fitness providing insights to the complex cardiorespiratory interactions involved in rowing during a CPET.

NK cells are associated with immunometabolic response to a single exercise exertion in heart failure patients

Abstract Background Increased systemic inflammation and metabolic dysfunction are observed in heart failure with reduced ejection fraction (HFrEF). On the other hand, cardiorespiratory exercise testing (CPET) exerts a physical challenge and initiates the activation of the immune system, including acute release of natural killer (NK) cells into the circulation, and several metabolic pathways. Aim To characterize the inflammatory and metabolic alterations of HFrEF patients in response to an acute exercise challenge, and after 2 hours of recovery. Methods Participants with HFrEF (n=16), age and sex matched controls (CON, n=13) were investigated at baseline, immediately after and 2 hours after CPET. Clinical and physiological parameters, leukocyte profile, plasma cytokines and metabolites were assessed along with inflammatory and metabolic parameters at all three time points. NK cell counts and morphological/activation parameters in different contexts were examined. Further, the time-dependent coordination of NK cell numbers post-exercise with tryptophan metabolism and plasma triglycerides were assessed. NK cells were isolated from blood of healthy donors for ex vivo proof-of-principle experiments, including phenotype polarization and NK cell specific tryptophan metabolism. Results Cardiovascular risk profiles as well as leukocyte, cytokine and metabolic parameters at baseline were similar in CON and HFrEF. Immediately after CPET, lactate, and NK T cell blood counts were significantly increased in both groups. In HFrEF but not CON, platelet aggregates with NK cells, CD8+ cytotoxic T cells and “classical” CD14++CD16-monocytes, phosphatidylcholines and triglycerides were increased. After 2h of recovery, almost all altered parameters returned to baseline in CON. In contrast, blood counts and morphological markers of inflammatory effector cell types, including CD8+ T cells and neutrophils remained elevated in HFrEF. NK cells remained elevated after the recovery period and correlated with levels of various triglyceride species in the HFrEF patients. Tryptophan levels in plasma were reduced by acute exercise and the kynurenine to tryptophan ratio was increased and correlated with increase in NK and NK-T cell counts, as well as IL-12 plasma levels. Treatment with IL-12 led to increased synthesis of kynurenine from tryptophan, expression of indoleamine 2,3-dioxygenase and abundance of regulatory CD56bri NK cell phenotypes ex vivo. Secretome of untreated NK cells impaired cellular respiration, increased glycolysis/oxidation ratio in skeletal muscle cells, and increased the release of triglycerides from hepatocarcinoma cells. Conclusion CPET induced a complex acute immunometabolic response, whose restitution to baseline levels differed between HFrEF and healthy controls. Exercise-induced changes in NK cell metabolism and phenotype shift might modulate cellular respiration in myocytes and release of triglycerides by hepatocytes in HFrEF and in CON. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK (German Centre for Cardiovascular Research)

The Effect Of Adipose Tissue Distribution On Aerobic Capacity In Male Overweight Subjects

It has been demonstrated that the predominantly abdominal fat distribution compared withperipheral fat mass decrease the lipids oxidation rates during exercise in normal weight and obese woman. PURPOSE: The aim of this study was to investigate the impact of a low vs high ratio of android to gynoid body fat mass on: 1) cardiorespiratory functional capacity (CFC) and 2) ventilatory thresholds in overweight male subjects (OMS). METHODS: Forty two recreationallyactive men (between 2 - 6 h/week of physical activiy) with a mean age of 34.0 + 6.3 wereallocated in two groups: lower android to gynoid L(A/G) ratio (n=19; A/G ratio= 0.85+ 0.14);and the other group with higher H(A/G) ratio (n=23; A/G ratio=1.16+ 0.13). The maximal cardiorespiratory exercise test (Cortex, Metalyzer IIIB, Lipizieg, Germany) was performed on a treadmill using a ramp protocol with workoload (1 km/h) increment every 1 minute in order to determine maximal oxygen consumption (VO2 max), ventilatory anaerobic threshold (VAT), and respiratory compensation point (RCP). A dual X-ray absorptiometry (DXA) was used (GEMedical Systems Lunar, Madison, USA) to measure body composition: total mass, fat mass and skeletal muscle index. Android and gynoid fat were measured, and the ratio between them was calculated (A/G ratio). RESULTS: Regarding body composition the L-A/G showed lower values than H- A/G group for android to gynoid ratio (0.85 + 0.14 vs. 1.16 + 0.13, respectively, p=0.01).In addition, the L-A/G group showed lower values to fat mass index (6.6 + 2.8 vs. 8.5 + 2.4 Kg/m2respectively, p=0.04). No differences (p>0.05) were observed between L-A/G than H-A/G to skeletal muscle index (20.2 + 2.5 vs.18.9 + 1.3 Kg/m2, respectively) and body mass index (27.6+ 2.3 vs. 28.6 + 1.4 Kg/m2 respectively, p=0.13). Regarding CFC, the L-A/G showed greater values to VO2 max (44.4 + 5.4 vs. 37.9 + 5.8 ml/kg/min, respectively, p=0.001). In addition, the L-A/G presented greater values to VO2 at VAT (27.7 + 5.3 vs. 23.5 + 6.1 ml/kg/min, p=0.03) and RCP (40.0 + 7.7 vs. 33.5 + 6.5 ml/kg/min, p=0.01) compared to H-A/G. CONCLUSION: Our findings indicate that body fat distribution with predominantly android fat mass reduces aerobic capacity in OMS. Furthermore, these results suggest that OMS with lower A/G ratio show greater skeletal muscle oxidative capacity during exercise.

Is the Combination of Aerobic Exercise with Mat Pilates Better than Mat Pilates Training Alone on Autonomic Modulation Related to Functional Outcomes in Hypertensive Women? Secondary Analysis of a Randomized Controlled Trial.

Background: Although mat Pilates (MP) has become popular, the effects of MP in hypertensive women (HW) are not entirely clear. Here, we investigated the effects of 16 weeks of MP training contrasted with MP supplemented with aerobic exercise (MP+AE) and compared with a non-intervention group on autonomic modulation, cardiorespiratory fitness, strength, flexibility, performance of functional tasks, QOL, anthropometric variables, clinical BP, and heart rate. Methods: This is a three-arm, secondary analysis of an RCT. Sixty HW, aged 30 to 59 years, were allocated into: MP only (MP), MP+AE on a treadmill (MP+AE), and Control Group, without exercises. Assessments were performed before and after 16 weeks of training. Results: The ANOVA shows differences in between-group comparisons in the SDNN, rMSSD, and SD1 in the heart rate variability analysis, with increases in rMSSD, SDNN, and SD1 only in the MP, and this result was not found in the MP+AE group (p < 0.05). Differences were observed in the between-group comparisons in time in the cardiorespiratory exercise test (CPX), flexibility, and the waist-to-hip ratio, with changes in the MP+AE, differences in QOL, and increments in the MP and MP+AE (p < 0.05). Conclusions: MP increased the indices that reflect vagal and global cardiac autonomic modulation. MP+AE improved the CPX performance, flexibility, QOL, and anthropometric variables. These results suggest that MP supplemented or not with AE has promising effects in HW.

Normal References of Peak Oxygen Uptake for Cardiorespiratory Fitness Measured with Cardiopulmonary Exercise Testing in Chinese Adults.

Introduction: This study aims to establish normal reference values of peak oxygen uptake (VO2peak) for cardiorespiratory fitness (CRF) in Chinese adults using cardiorespiratory exercise testing (CPET). Methods: A cross-sectional study was done in four communities, two in the North (Beijing) and two in the South (Hezhou, Guangxi) of China from 1 January 2017 to 31 December 2018, with one urban and one rural in each region. Out of 1642 participants screened, 1114 were eligible and completed CPET using a cycle ergometer (Ergosana320F) without abnormal ECG and were included in the analysis. The 2nd and 98th percentiles of O2peak were used as the lower and upper limits of the normal reference values. Results: Significant difference in mean O2peak was shown between men (27.0 mL·min−1·kg−1) and women (23.7 mL·min−1·kg−1). The mean O2peak decreased with age in both sexes, from 35.8 mL·min−1·kg−1 in age 20–29 years to 20.5 mL·min−1·kg−1 in 70–79 years in men and from 29.2 mL·min−1·kg−1 to 17.0 mL·min−1·kg−1 in women. Thus, the age- and sex-specific normal reference values of O2peak were presented for each 10-year age group by men and women separately. Conclusions: This first community-based study in China provides age- and sex-specific normal references of O2peak as a measure of CRF in Chinese adults, which differed significantly from those established in Western populations. Future studies with national representative samples should be warranted.

Prescribing or co-designing exercise in healthy adults? Effects on mental health and interoceptive awareness.

Universal exercise recommendations for adults neglect individual preferences, changing constraints, and their potential impact on associated health benefits. A recent proposal suggests replacing the standardized World Health Organisation (WHO) exercise recommendations for healthy adults by co-designed interventions where individuals participate actively in the decisions about the selected physical activities and the effort regulation. This study contrasts the effects on mental health and interoceptive awareness of a co-designed and co-adapted exercise intervention with an exercise program based on the WHO recommendations for healthy adults. Twenty healthy adults (10 men and 10 women, 40–55 y.o.) participated voluntarily in the research. They were randomly assigned to a co-designed exercise intervention (CoD group) and a prescribed exercise program (WHO group). Supervised online by specialized personal trainers, both programs lasted 9 weeks and were equivalent in volume and intensity. The effects of the exercise intervention were tested through personal interviews, questionnaires (DASS-21 and MAIA) and a cardiorespiratory exercise test. Intragroup differences (pre-post) were assessed using the Mann-Whitney Wilcoxon test and intergroup differences through Student’s t-tests. Effect sizes were calculated through Cohen’s d. Interviews were analyzed through thematic analysis. Eleven participants completed the intervention (CoD = 8, WHO = 5). Both groups improved, but non significantly, their cardiorespiratory testing results, and no differences were found between them post-intervention. Mental health was only enhanced in the CoD group (p < 0.001), and interoceptive awareness improved in seven of the eight scales in the CoD group (p < 0.001) and only in 3 scales in the WHO group (p < 0.01). In conclusion, the co-designed intervention was more effective for developing mental health, interoceptive awareness, autonomy, and exercise self-regulation than the WHO-based exercise program.

The AktiWeb study: feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis

BackgroundPatient organisations may be an under-utilised resource in follow-up of patients requiring long-term exercise as part of their disease management. The purpose of this study was to explore the feasibility of a web-based exercise program delivered by a patient organisation to patients with hip and/or knee osteoarthritis (OA).MethodsIn this pre–post feasibility study, patients aged 40–80 years with hip and/or knee OA were recruited from Diakonhjemmet Hospital. The 12-week intervention was delivered through a patient organisation’s digital platform. Feasibility was evaluated by proportion of eligible patients enrolled, proportion of enrolled patients who provided valid accelerometer data at baseline, and proportion completing the cardiorespiratory exercise test according to protocol at baseline and completed follow-up assessments. Patient acceptability was evaluated for website usability, satisfaction with the initial exercise level and comprehensibility of the exercise program. Change in clinical outcomes were assessed for physical activity, cardiorespiratory fitness and patient-reported variables.ResultsIn total, 49 eligible patients were identified and 35 were enrolled. Thirty (86%) of these attended baseline assessments and provided valid accelerometer data and 18 (51%) completed the maximal cardiorespiratory exercise test according to protocol. Twenty-two (63%) patients completed the follow-up questionnaire, and they rated the website usability as ‘acceptable’ [median 77.5 out of 100 (IQR 56.9, 85.6)], 19 (86%) reported that the initial exercise level was ‘just right’ and 18 (82%) that the exercise program was ‘very easy’ or ’quite easy’ to comprehend. Improvement in both moderate to vigorous physical activity (mean change 16.4 min/day; 95% CI 6.9 to 25.9) and cardiorespiratory fitness, VO2peak (mean change 1.83 ml/kg/min; 95% CI 0.29 to 3.36) were found in a subgroup of 8 patients completing these tests. Across all patient-reported outcomes 24–52% of the patients had a meaningful improvement (n = 22).ConclusionA web-based exercise program delivered by a patient organisation was found to be feasible and acceptable in patients with hip and/or knee OA.Trial registrationClinicalTrials.gov, NCT04084834 (registered 10 September 2019). The Regional Committee for Medical and Health Research Ethics south-east, 2018/2198. URL: Prosjekt #632074 - Aktiv med web-basert støtte. - Cristin (registered 7 June 2019).

Cardiorespiratory fitness assessment on active patients who kept attending their phase III exercise-based cardiac rehabilitation during the COVID-19 era

Funding AcknowledgementsType of funding sources: None.BackgroundCardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown.PurposeAssess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic.MethodsA cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session.A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021).ResultsA total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction.There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period.When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001).ConclusionIn spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF.