Differences In Cardiorespiratory Fitness Research Articles

Abstract 4132657: Age-related Differences in Peak Oxygen Uptake in Patients with Multimorbidity Undergoing Cardiac Rehabilitation

Background: Cardiac rehabilitation (CR) patients demonstrate a high burden of chronic conditions (CC). Both multimorbidity (MM; ≥2 coexisting CC) and aging negatively impact functional capacity, whereas CR improves performance. Age-related difference in cardiorespiratory fitness (CRF, peak oxygen uptake (VO 2 )) in CR patients with MM has not been studied. Hypothesis: We hypothesized improvement in CRF will be attenuated by MM with increasing age in CR patients. Aims: We aimed to identify age-related differences in CRF improvement in CR patients with MM. Methods: Patients ≥18 yrs old who attended ≥1 CR sessions from 1999-2017 and completed cardiopulmonary exercise stress test before and after CR were included. The prevalence of CC was assessed using Rochester Epidemiology Project records-linkage system. Age categories included: Younger (18-49 yrs), Midlife (50-64 yrs) and Older (≥65 yrs). CRF categories included: <0%, 0-8% and >8%. Analysis included Kruskal-Wallis and Chi-squared. Results: Of 622 patients, 75.4% were male. Mean age: 62.9±11.2 yrs; Younger (n=70) age: 42.7±6.8 yrs, 67.1% male; Midlife (n=283) age: 58.3±4.3 yrs, 78.8% male; Older (n=269) age: 73.0±5.2 yrs, 74.0% male. BMI was 29.9±5.4 kg/m 2 (Younger: 30.0±6.7, Midlife: 30.4±5.6, Older: 29.3±4.7; p<.05). Median (Q1, Q3) no. of CR sessions attended was 33(22, 35), with lower attendance in the Younger group: 25(16,34) vs Midlife: 33(20,35) and Older: 34 (29,35), p<.05. Overall, percent change in peak VO 2 was 11.5±21.6% (Younger: 18.8±22.8%, Midlife: 11.6±19.5%, Older: 9.4±23.1%; p<.01). The median number of CC was 7(5,8) with significant differences across groups: Younger: 5(3,7), Midlife: 6(5,8), Older: 7(6,9), p<.01. Number of CC increased with age across all CRF categories (p<.01, Fig. 1). However, there was no difference in number of CC within age groups across categories of CRF, Table 1. Conclusions: Our results suggest that MM increases with age in patients attending CR; however, within a given age group, improvement in CRF does not appear dependent on MM. The impact of age appears to have a greater impact than MM on CRF improvement. Individualized treatment plans should focus on the impact of age-related disparities on CRF improvement among CR patients with MM.

Baseline differences in cardiorespiratory fitness by gonadotropin releasing hormone agonist treatment converge after testosterone in transgender adolescents.

There are known sex differences in cardiorespiratory fitness (CRF). Little is known about the impact of pubertal blockade with a gonadotropin releasing hormone agonist (GnRHa) followed by hormone therapy on CRF for transgender adolescents. We aimed to (1) determine the effect of GnRHa monotherapy on CRF and mitochondrial function and associations with metabolomic profiles, and (2) evaluate for changes after 1 and 12 months of testosterone therapy among transgender adolescents . Participants assigned female at birth (n=19, baseline age 15.0+1.0 years) from two groups: GnRHa+ (n=8) and GnRHa- (n=11) were examined at baseline and 1- and 12-months post-testosterone therapy in a longitudinal observational study to assess cardiorespiratory fitness, mitochondrial respiration and metabolic profile. Fasted morning labs including assessment of metabolomics and peripheral blood mononuclear cell mitochondrial respiration and degree of mitochondrial coupling (respiratory control ratio, RCR). A graded cycle ergometer test was performed. Baseline differences were evaluated between groups. Changes were compared with mixed linear regression models evaluating time (baseline, 1 and 12 months), group (GnRHa treatment yes/no), and their interaction. At baseline GnRHa+ individuals had higher relative VO2peak (30.1+4.83 vs. 25.24+4.47 ml/kg/min, p=0.042) than GnRHa- individuals. In regression models, GnRHa+ individuals had a significant increase in peak watts (p=0.011) and total exercise time (p=0.005)after 12 months of testosterone (p=0.012), but not GnRHa- individuals. GnRHa+ individuals have significantly higher RCR under carbohydrate (p=0.0007) and lipid (p=0.0002) conditions than GnRHa+ individuals. Pretreatment with GnRHa positively influences peak CRF and mitochondrial respiration in adolescent transgender males undergoing testosterone therapy.

Physical Activity Levels, Cardiorespiratory Fitness, and Physical Literacy in Children With a Chronic Medical Condition.

This study investigated differences in cardiorespiratory fitness (CRF) and other physical literacy domains between children with a chronic medical condition (CMC) who adhered to with the physical activity guideline and those who did not. Forty children with a CMC (7-12years) wore an accelerometer for 7days to measure moderate-to-vigorous physical activity. CRF and muscle power were assessed with a maximal cardiopulmonary exercise test, and motor performance was measured with an exercise course. Motivation, confidence, knowledge, and understanding were assessed with a questionnaire. Children who adhered to the PA guideline (n =13) scored significantly higher for CRF, muscle power, motivation and confidence than children who did not adhere to the PA guideline (n =27). No significant differences were found for motor performance, knowledge and understanding. Future research should investigate the effect of paying specific attention to motivation and confidence in children with a CMC to stimulate their adherence to the PA guideline.

As We Were and As We Should Be, Combined Exercise Training in Adults With Schizophrenia: CORTEX-SP Study Part II.

To determine the changes in health-related quality of life (HRQoL) and sleep quality following a supervised combined exercise (EX) program compared to a Treatment-As-Usual (TAU) and to analyze the relationship between the differences in cardiorespiratory fitness (CRF) and HRQoL domains in people with schizophrenia (SZ). The SZ (n = 112, 41.3 ± 10.4 year) was randomly assigned into a TAU control group (n = 53) or EX-group (n = 59, 3 days/week). The 36-item Short-Form Health Survey questionnaire assessed HRQoL and the sleep quality analysis (accelerometry). After the intervention (20 weeks), physical functioning (∆ = 12.9%), general health (∆ = 15.3%), mental health (∆ = 8.3%), physical component summary (PCS) (∆ = 5.1%), and sleep efficiency (∆ = 1.9%) increased (p < 0.05) in the EX, with no significant changes in the TAU for any domains studied. There were significant differences between groups whose EX showed improvements (p < 0.05) compared to TAU in physical functioning, general health, PCS, and sleep efficiency. A greater CRF was associated with better values in physical functioning, role-physical, bodily pain, general health, vitality, and PCS after the exercise program in SZ. A 20-week supervised combined exercise intervention program for SZ increased sleep efficiency and physical functioning, general and mental health, and PCS scores. This could lead to a critical HRQoL change from how they were to how they should be. ClinicalTrials.gov identifier: NCT03509597.

Racial and Gender Differences in Cardiorespiratory Fitness and Atrial Fibrillation.

The expanding field of cardiorespiratory fitness (CRF) in individuals with and without atrial fibrillation (AF) presents a complex landscape, demanding careful interpretation of the existing research. AF, characterized by significant mortality and morbidity, prompts the exploration of strategies to mitigate its impact. Increasing physical activity (PA) levels emerges as a promising avenue to address AF risk factors, such as obesity, hypertension, and diabetes mellitus, through mechanisms of reduced vasoconstriction, endothelin-1 modulation, and improved insulin sensitivity. However, caution is warranted, as recent investigations suggest a heightened incidence of AF, particularly in athletes engaged in high-intensity exercise, due to the formation of ectopic foci and changes in cardiac anatomy. Accordingly, patients should adhere to guideline-recommended amounts of low-to-moderate PA to balance benefits and minimize adverse effects. When looking closer at the current evidence, gender-specific differences have been observed and challenged conventional understanding, with women demonstrating decreased AF risk even at extreme exercise levels. This phenomenon may be rooted in divergent hemodynamic and structural responses to exercise between men and women. Existing research is predominantly observational and limited to racially homogenous populations, which underscores the need for comprehensive studies encompassing diverse, non-White ethnic groups in athlete and non-athlete populations. These individuals exhibit a disproportionately high burden of AF risk factors that could be addressed through improved CRF. Despite the limitations, randomized control trials offer promising evidence for the efficacy of CRF interventions in patients with preexisting AF, showcasing improvements in clinically significant AF outcomes and patient quality of life. The potential of CRF as a countermeasure to the consequences of AF remains an area of great promise, urging future research to delve deeper to explore its role within specific racial and gender contexts. This comprehensive understanding will contribute to the development of tailored strategies for optimizing cardiovascular health and AF prevention in all those who are affected.

Serial cardiopulmonary exercise testing in young patients after one-and-half ventricle repair and Fontan procedure: a comparative study.

The Fontan procedure is the palliative surgical treatment for different congenital heart diseases (CHD) with a univentricular heart, but it has been associated with decreased exercise capacity, cardiovascular morbidity, and premature mortality. The one-and-half ventricle repair (1.5VR) was introduced as an alternative to the Fontan procedure, specifically for selected patients with borderline hypoplastic right ventricle (HRV), aiming for a more physiological circulation. Despite these efforts, the benefit of 1.5VR over Fontan circulation comparison on clinical and functional outcomes remains unclear. The aim of this study was to investigate and compare young patients with HRV after 1.5VR with those with functional single right or left ventricles (FSRV or FSLV) after Fontan palliation over a 10-year follow-up period. In this retrospective observational study, serial cardiopulmonary exercise tests (CPETs) performed in patients with 1.5VR and Fontan circulation between September 2002 and March 2024 have been analyzed. Only patients with at least 10 years of follow-up were considered. A total of 41 patients were included (age at baseline 8.6±2.6 years): 21 with FSLV, 12 with FSRV, and 10 with 1.5VR. No differences in cardiorespiratory fitness and efficiency were shown at the first CPET assessment among the three groups. At 10-year follow-up, 1.5VR had higher cardiorespiratory fitness and efficiency compared to FSLV and FSRV patients. These findings suggest that the 1.5VR may provide superior long-term functional outcomes than the Fontan procedure in patients with borderline HRV. Further studies are needed to evaluate the impact on hard clinical endpoints.

#1555 The effects of different interdialytic intervals on cardiorespiratory fitness assessed with CPET in hemodialysis patients

Abstract Background and Aims Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Method A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak (ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak (ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24 ± 4.18 vs 13.64 ± 2.76; p &amp;lt; 0.001); similar were the results for VO2peak (ml/min) (1188 ± 257 vs 1074 ± 224; p &amp;lt; 0.001) and VO2peak (%predicted) (58.9 ± 9.2 vs 52.3 ± 8.6; p &amp;lt; 0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1 ± 23.2 vs 79.3 ± 25.1; p &amp;lt; 0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak (ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak (ml/kg/min). Conclusion The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

THE EFFECTS OF DIFFERENT INTERDIALYTIC INTERVALS ON CARDIORESPIRATORY FITNESS ASSESSED WITH CARDIOPULMONARY EXERCISE TESTING IN HEMODIALYSIS PATIENTS

Objective: Long interdialytic interval in thrice-weekly hemodialysis is associated with excess cardiovascular and all-cause mortality risk. Impaired cardiorespiratory fitness is a strong predictor of mortality in hemodialysis. This study investigated differences in cardiorespiratory fitness assessed with cardiopulmonary exercise testing (CPET) between the end of the 2-day and the 3-day interdialytic interval. Design and method: A total of 28 hemodialysis patients, randomized in two different sequences of evaluation underwent CPET and spirometry examination at the end of the 2-day and the 3-day intervals. The primary outcome was the difference in oxygen uptake at peak exercise [VO2peak(ml/kg/min)] assessed with CPET. Volume status was assessed with interdialytic-weight-gain (IDWG), lung ultrasound, bioimpedance spectroscopy (BIS), and inferior vena cava measurements. A total of 14 age- and sex-matched controls were also evaluated. Results: Hemodialysis patients at the end of both 2-day and 3-day intervals presented lower values in all major CPET parameters than controls. VO2peak(ml/kg/min) was significantly higher at the end of the 2-day than the 3-day interval (15.24±4.18 vs 13.64±2.76;p&lt;0.001); similar were the results for VO2peak(ml/min) (1188±257 vs 1074±224;p&lt;0.001) and VO2peak(%predicted) (58.9±9.2 vs 52.3±8.6;p&lt;0.001). Numerical but no statistically significant differences were detected in VO2-anaerobic-threshold(ml/kg/min) and VO2-anaerobic-threshold(ml/min) between the two time-points. Maximal work load (90.1±23.2 vs 79.3±25.1;p&lt;0.001), exercise duration, HR at peak exercise and oxygen pulse also showed lower values at the end of the 3-day interval. FEV1 levels were similar between the two evaluations. Generalized-linear-mixed-model analysis including IDWG as random covariate attenuated the observed differences in VO2peak(ml/kg/min). Changes in BIS-derived overhydration indexes were moderately correlated with changes of VO2peak(ml/kg/min). Conclusions: The 3-day interval was associated with further impairment of VO2 at peak exercise. This effect was predominantly driven by excess fluid accumulation during the extra interdialytic day.

Effects on physical activity, physical fitness and well-being in a 36-months randomized controlled study, comparing a multimodal hospital-based intervention programme for primary cardiovascular prevention with usual care

BackgroundCardiovascular disease is a major cause of mortality and morbidity worldwide, and primary prevention efforts are poorly developed in people at high cardiovascular risk. On this background, we performed the Hjerteløftet Study and demonstrated that participation over 36 months in a multimodal primary prevention programme, significantly reduced validated cardiovascular risk scores. In the current substudy we aimed to further explore several elements and effects following the intervention programme.MethodsA random sample from the original Hjerteløftet Study was included for further examinations (n = 255, 40% women), and these patients were already randomized to an intervention group (IG) (n = 127), or a control group (CG) (n = 128). We compared changes from baseline to 36-months follow-up in physical activity, cardiorespiratory fitness, psychological well-being (WHO-5), cardiovascular medication use, smoking habits, and cardiometabolic risk factors (blood pressure, lipids, blood glucose, HbA1c, Apolipoprotein A-I, Apolipoprotein B and high-sensitive C-reactive protein).ResultsSelf-reported physical activity increased significantly with absolute difference in mean delta Physical Activity Index score in the IG compared to the CG: 0.90, 95% CI: 0.10 to 1.70, p = 0.028 (ANCOVA). There were no corresponding differences in cardiorespiratory fitness. The participation resulted in psychological well-being improvement in both groups with a larger increase in the IG compared to the CG. The mean difference in delta WHO-5 score was 5.06, 95% CI: 0.68 to 9.45, p = 0.024, and 3.28, 95% CI: -0.69 to 5.25, p = 0.104 when controlled for baseline values (ANCOVA). The use of antihypertensive medication increased significantly more in the CG (p = 0.044). Only minor, nonsignificant changes were observed for traditional risk factors and cardiometabolic variables.ConclusionsParticipation in the Hjerteløftet Study intervention programme resulted in an improved physical activity level, but without changing cardiorespiratory fitness. Participation in the programme also tended to improve psychological well-being, possibly related to increased physical activity, less smoking and less use of cardiovascular medication. Concerning the metabolic status, no major differences were observed, but minor changes may have been concealed by a larger increase in cardiovascular medication use in the control group.Trial registrationClinicalTrials.gov (NCT01741428), 04/12/2012.

Role of Cardiorespiratory Fitness and Mitochondrial Oxidative Capacity in Reduced Walk Speed of Older Adults With Diabetes.

Cardiorespiratory fitness and mitochondrial oxidative capacity are associated with reduced walking speed in older adults. The impact of cardiorespiratory fitness and mitochondrial oxidative capacity on walking speed in older adults with diabetes has not been clearly defined. We examined differences in cardiorespiratory fitness and skeletal muscle mitochondrial oxidative capacity between older adults with and without diabetes as well as determine their relative contribution to slower walking speed in older adults with diabetes. Participants with diabetes (n=159) had lower cardiorespiratory fitness and mitochondrial respiration in permeabilized fiber bundles when compared to those without diabetes (n=717), following adjustments for covariates including BMI, chronic comorbid health conditions, and physical activity. 4-m and 400-m walking speeds were slower in those with diabetes. Mitochondrial oxidative capacity alone or combined with cardiorespiratory fitness mediated ∼20-70% of the difference in walk speed between older adults with and without diabetes. Additional adjustments with BMI and co-morbidities further explained the group differences in walk speed. Cardiorespiratory fitness and skeletal muscle mitochondrial oxidative capacity contribute to slower walking speeds in older adults with diabetes.

Cardiorespiratory Performance in Kidney and Liver Transplant Recipients: The Dilemma to Combine Lifestyle and Fitness.

It is widely demonstrated that moderate-intensity exercise is associated with improved fitness in non-communicable chronic diseases. However, there are no specific guidelines available for transplant recipients. Body composition is closely linked to exercise capacity, typically estimated by cardiopulmonary testing, but its potential correlation with cardiovascular health outcomes has not been investigated yet. This study aims to evaluate and compare cardiorespiratory performance and body composition in two groups of liver and kidney transplant recipients. A mixed group of transplant recipients (10 kidney and 15 liver) participating in a lifestyle reconditioning program through unsupervised physical exercise prescription was examined. Both groups were assessed using bioimpedance analysis (BIA), lifestyle, and physical activity levels by IPAQ questionnaire and cardiopulmonary testing (CPET). The two groups differed by IPAQ examination: liver transplant patients practiced more physical activity. Statistically significant differences were found in peak VO2/HR (oxygen pulse), which was higher in the kidney group compared to the liver group (15.63 vs. 12.49 with p < 0.05). Body composition did not show significant differences in BMI and the percentage of FM/FFM (FFM: 78.04 ± 7.7 in Kidney T vs. 77.78 ± 7.2 in Liver T). Systolic pressure measured at the peak was significantly higher in the liver group (162.6 vs. 134 with p < 0.01). The correlation between the CPET and BIA parameters showed a positive VO2 max and FFM mass trend. The results suggest differences in cardiorespiratory fitness between the two populations of solid organ transplant recipients despite not being related to the physical activity level. The data support the importance of body composition analysis in sports medicine and the prescription of physical exercise, especially considering the potential correlation with VO2 max, even though home-based exercise does not seem to alter it substantially. BMI does not appear to be a determinant of cardiovascular performance. Other determinants should be investigated to understand the differences observed.

Metabolically healthy versus unhealthy obesity in adolescents: is there a difference in cardiorespiratory fitness, physical activity, and active commuting?

Metabolically healthy versus unhealthy obesity in adolescents: is there a difference in cardiorespiratory fitness, physical activity, and active commuting?

Home-based high-intensity interval training improves cardiorespiratory fitness: a systematic review and meta-analysis

BackgroundHigh-intensity interval training (HIIT) is an effective methods to improve maximal oxygen uptake. However, there is no definitive conclusion about the specific effectiveness of home-based HIIT. This review investigated the effects of home-based HIIT on cardiorespiratory fitness in a systematic review and meta-analysis.MethodsFour electronic databases were searched (PubMed, Cochran database, Web of Science, Igaku Chuo Zasshi) for studies through March 25, 2023. Eligibility criteria include randomized controlled trials of home-based HIIT in adult people regardless disease or handicaped. Comparisons were made between non-exercise controls, laboratory-based HIIT, and moderate-intensity continuous training (MICT). The primary outcome was defined as cardiorespiratory fitness and the secondary outcome was defined as patient-reported outcomes. The standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated for quantitative indices. The random-effect model was used as the pooling method.ResultsTwo hundred seven studies were identified, and 15 satisfied the inclusion criteria. The meta-analysis for cardiorespiratory fitness showed superiority of home-based HIIT to non-exercise controls (SMD 0.61, 95% CI: 0.21, 1.02). However, no significant difference in cardiorespiratory fitness was observed between home-based HIIT and lab-based HIIT (SMD: -0.35, 95%CI: -0.73, 0.03). Also, no significant difference was observed between the home-based HIIT and MICT (SMD 0.34, 95% CI: -0.05, 0.73).ConclusionThese results indicated that home-based HIIT was an effective intervention for improving cardiorespiratory fitness in healthy adults and patients. Importantly, this review found no significant differences in cardiorespiratory fitness between home-based HIIT and the group of laboratory HIIT and MICT, highlighting its comparable effectiveness and potential as a practical and valuable exercise intervention.

Differences in Cardiorespiratory Fitness and Normal Weight Obesity Based on NHANES 1999-2004 Surveys - A Cross Sectional Study

Differences in Cardiorespiratory Fitness and Normal Weight Obesity Based on NHANES 1999-2004 Surveys - A Cross Sectional Study

The association of increased body mass index on cardiorespiratory fitness, physical activity, and cognition in adults with down syndrome

BackgroundObesity is a significant risk factor for Alzheimer's disease; however, this association has not been explored in adults with Down syndrome. ObjectiveTo examine the association of obesity, assessed by body mass index (BMI), with factors related to Alzheimer's disease risk including cardiorespiratory fitness, physical activity, and cognition in adults with Down syndrome. MethodsAdults with Down syndrome attended a laboratory visit where BMI, cardiorespiratory fitness (VO2 peak), and cognitive function (CANTAB® DS Battery) were obtained. Physical activity (accelerometer) was collected over the week following the laboratory visit. Wilcoxon rank sum tests were used to evaluate differences in cardiorespiratory fitness, sedentary time, moderate-to-vigorous physical activity (MVPA), and cognition between adults with obesity (BMI≥ 30 kg/m2) and those with healthy weight or overweight (BMI <30 kg/m2). Spearman correlations and linear regressions were used to measure the impact of BMI on cardiorespiratory fitness, MVPA, sedentary time, and cognition. ResultsData was collected for 79 adults with Down syndrome (26.7 ± 9.0 years of age, 54% female, 54% with obesity). VO2 peak was significantly lower in participants with obesity (18.4 ± 2.5 ml/kg/min) compared to those with healthy weight or overweight (22.9 ± 4.0 ml/kg/min, p < 0.001). BMI was negatively associated with cardiorespiratory fitness (rho = −0.614, p < 0.001). No associations were observed between BMI and physical activity or cognition. ConclusionsLower BMI was associated with improved cardiorespiratory fitness. However, no associations were observed between BMI and cognition or physical activity. Nct registrationNCT04048759.

Application of european society of cardiology guidelines 2020 on competitive sports eligibility in a large population of subjects with surgically corrected congenital heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Congenital heart disease (CHD) affects approximately 0.5-1% of the general population. Thanks to the improvement of medical and surgical techniques, in developed countries 90% of individuals with CHD reach adulthood and, consequently, the demand for participation in sporting activities also increases. Recently, the European Society of Cardiology have given recommendations on participation in recreational and competitive sports (ESC 2020) based on a clinical and functional algorithm. Purpose To show the prevalence of the eligibility for competitive sports proposed by ESC 2020 in a real CHD population and the prevalence of real engagement in physical activity (both competitive and non-competitive). Also, to evaluate the difference in cardiorespiratory fitness (CRF) and the impact of training among different sport eligibility classes. Methods Retrospective study of 401 patients with surgically corrected CHD and followed up with cardiopulmonary exercise test (CPET) performed on treadmill or cycle ergometer until patients’ exhaustion. Subjects were divided in 4 classes according with ESC 2020 guidelines and corresponding to the eligibility for all competitive sport (A), all except endurance specialties (B), only for skill disciplines (C) or not eligible (D). Results Median (IQR) age was 18.0(13.0; 21.5) years; 266 patients (66.3%) were males. 34% were in class D, 13% in class B, 25% in class C and 28% in class A. Within the entire population, 179 subjects (44.6%) carried out structured exercise training, corresponding to 60.7% of subjects in class A, 45.1% of those in class B, 41.7% of those in class C and 41.1% of those in class D. VO2peak/Kg was similar between class A [39.2 (33.6-44.4) mL/Kg/min] and B [37.9 (30.6-42.6) mL/Kg/min], but significantly different between class A vs. class C [33.3 (28.3-41.4) mL/Kg/min p&amp;lt;.0001] and class D [32.2 (27.6-39.3) mL/Kg/min p&amp;lt;.0001]. Also, functional impairment, defined as &amp;lt;85% of the predicted for age and sex, resulted significantly higher in patients in the lower classes of sport eligibility (C and D) than in the higher ones, with a prevalence of impaired CRF of 22.5% in class A, 42.5% in class B, 55.1% in class C and 57.0% in class D (p &amp;lt;.0001). Paired comparison showed significant differences in CRF (VO2peak/Kg) between trained and untrained subjects both within and across ESC 2020 classes, while there was no significant difference between paired groups of different classes who presented the same level of physical activity (Figure 1). Conclusions Subjects in class A had better functional capacity than those in C and D classes, but exercise training (competitive or non-competitive) can have a significant impact on CRF level. Figure 1 shows that trained people in D class had higher CRF than untrained in A class, supporting that functional evaluation and an individualized exercise prescription may recruit functional "reserve" by improving the VO2peak as key prognostic component.

Train Smart Study: protocol for a randomised trial investigating the role of exercise training dose on markers of brain health in sedentary middle-aged adults

IntroductionRegular aerobic exercise is associated with improved cognitive function, implicating it as a strategy to reduce dementia risk. This is reinforced by the association between greater cardiorespiratory fitness and larger...

Assessing cardiorespiratory fitness relative to sex improves surgical risk stratification.

To what extent sex-related differences in cardiorespiratory fitness (CRF) impact postoperative patient mortality and corresponding implications for surgical risk stratification remains to be established. To examine this, we recruited 640 patients (366 males vs. 274 females) who underwent cardiopulmonary exercise testing prior to elective colorectal surgery. Patients were defined high risk if peak oxygen uptake was <14.3mL kg-1 min-1 and ventilatory equivalent for carbon dioxide at 'anaerobic threshold' >34. Between-sex CRF and mortality was assessed, and sex-specific CRF thresholds predictive of mortality was calculated. Seventeen percent of deaths were attributed to sub-threshold CRF, which was higher than established risk factors for cardiovascular disease (CVD). The group (independent of sex) exhibited a 5-fold higher mortality (high vs. low risk patients hazard ratio=4.80, 95% confidence interval 2.73-8.45, p < 0.001). Females exhibited 39% lower CRF (p < 0.001) with more classified high risk than males (36 vs. 23%, p=0.001), yet mortality was not different (p=0.544). Upon reformulation of sex-specific CRF thresholds, lower cut-offs for mortality were observed in females, and consequently, fewer (20%) were stratified with sub-threshold CRF compared to the original 36% (p < 0.001). Low CRF accounted for more deaths than traditional CVD risk factors, and when CRF was considered relative to sex, the disproportionate number of females stratified unfit was corrected. These findings support clinical consideration of 'sex-specific' CRF thresholds to better inform postoperative mortality and improve surgical risk stratification.

Macroregional Differences in Cardiorespiratory Fitness in Croatian Primary School Children

Purpose: Cardiorespiratory fitness (CRF) is an important indicator of health. Previous studies have shown that regional affiliation and the socioeconomic development of the area significantly influence the development of CRF. The aim of this research was to identify whether there are any differences in CRF among primary school children based on the macroregion in which they live. Methods: The study in-cluded 651 fourth-grade students from primary schools in the Republic of Croatia, aged 10.30±0.47 years. The sample of children was divided into three macro-regions of the Republic of Croatia (Continental, City of Zagreb, Adriatic). The CRF was assessed using the 20-meter shuttle run test. Results: The results indicate that children living in the region encompassing the city of Zagreb have significantly better results (45.77) in terms of maximal oxygen uptake (VO2max), which is used to assess CRF, compared to students coming from the Continental region (44.31). Students from the Adriatic macro-region have significantly better results (45.34) compared to those from the Conti-nental macro-region. There was no statistically significant difference observed between students from the city of Zagreb and the Adriatic macro-region. Conclusions: There is a great need to introduce physical exercise programs that affect the development of cardiorespiratory capacity in the Continental part of the Republic of Croatia, where it has been observed that students have a significantly lower level of cardiorespiratory fitness. There is a need to continue research that evaluates aerobic capacity in children and young people, and it should be based on direct measurements of aerobic capacity, by means of which more relevant data would be obtained, primarily on the values of maximum oxygen intake. Keywords: exercise physiology; physical fitness; relative age effects; students; young people.

Korean vs. Western Exercise Capacity Nomograms for Korean Patients With Cardiovascular Disease.

Exercise capacity is known to be an independent predictor of cardiovascular events and mortality. However, most previous studies were based on Western populations. Further study is warranted for Asian patients according to ethnic or national standards. We aimed to compare prognostic values of Korean and Western nomograms for exercise capacity in Korean patients with cardiovascular disease (CVD). In this retrospective cohort study, we enrolled 1,178 patients (62 ± 11 years; 78% male) between June 2015 and May 2020, who were referred for cardiopulmonary exercise testing in our cardiac rehabilitation program. The median follow-up period was 1.6 years. Exercise capacity was measured in metabolic equivalents by direct gas exchange method during the treadmill test. The nomogram for exercise capacity from healthy Korean individuals and a previous landmark Western study was used to determine the percentage of predicted exercise capacity. The primary endpoint was the composite of major adverse cardiovascular events (MACE; all-cause death, myocardial infarction, repeat revascularization, stroke and hospitalization for heart failure). A multivariate analysis showed that the risk of primary endpoint was more than double (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.10-4.40) in the patients with lower exercise capacity (< 85% of predicted) by Korean nomogram. The lower exercise capacity was one of the strong independent predictors along with left ventricular ejection fraction, age, and level of hemoglobin. However, the lower exercise capacity by Western nomogram could not predict the primary endpoint (HR, 1.33; 95% CI, 0.85-2.10). Korean patients with CVD with lower exercise capacity have higher risk of MACE. Considering inter-ethnic differences in cardiorespiratory fitness, the Korean nomogram provides more suitable reference values than the Western nomogram to determine lower exercise capacity and predict cardiovascular events in Korean patients with CVD.