Exercise Time Research Articles

Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study.

Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost. This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement. This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment. In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program. The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial. ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462. RR2-10.2196/42651.

Physical Exercise and Health, 3: The Health Care Professional and Patient's Guide to Understanding What to Do, How, and Why-Part 1.

Physical activity and exercise are associated with important short- and long-term health benefits. It does not take much effort to reap these benefits; every little bit of activity counts, including activities that are performed as part of daily life. Everybody can exercise, even those with existing medical conditions, and even those with existing cardiac or orthopedic conditions; all that is necessary is to tailor the exercise to individual capacity with appropriate dos and don'ts. This article, addressed to health care professionals, their patients, and the general public, provides practical guidance on exercise, mostly in the form of points and short paragraphs, so that the reader can easily understand and assimilate what to do, how, and why. The article explains what the health benefits of exercise are; how much exercise one ideally needs to perform for optimal health outcomes; what targets to set for exercise; what effects exercise has on muscles, bones, and the heart; and how these effects are beneficial. The article offers suggestions on how to create time and opportunity for exercise, how to motivate oneself for exercise, and how to avoid boredom and discouragement. Most important of all, this article provides a detailed discussion on exercise-related risks, especially orthopedic risks, and how to avoid these risks. Protecting the knee joint from injury receives particular attention. Practical guidance on what to actually do appears in the next article in the series.

A Mindful Alternative to Screen Time: The Short-Term Effects of a Breath-Focused Mindfulness Exercise vs. Unstructured Smartphone Screen Time on Heart Rate Variability and Relaxation

Introduction: Many smartphone users spend hours daily on unstructured screen time leisure activities including social media, games, and videos. Given that many users express a desire to cut back on this habit, it is important to test the relative physiological and emotional benefits of alternative activities, such as mindfulness meditation, as daily practices for relaxation and restoration. Methods: This study tests the immediate effects of unstructured mobile phone screen time vs. practice of a brief mindful breathing meditation exercise on heart rate variability (HRV, a common measure of healthy resting physiological activity) and self-reported states of relaxation. Participants (171 female university students) were randomly assigned to 15 minutes of unstructured screen time (i.e., use phones in a manner consistent with typical daily use) or a mindfulness induction (i.e., a guided meditation recording focused on mindfulness of breathing). Results: Consistent with hypotheses, HRV showed greater increases relative to baseline in the mindfulness condition than the screen time condition (High-frequency HRV, partial η2 = .14, p < .001; Root Mean Square of Successive Differences, partial η2 = .053, p = .002). Subjective relaxation increased in both conditions (partial η2 = .47, p < .001); however, mindfulness produced greater increases in relaxation over time than unstructured screen time (partial η2 = .089, p < .001). Conclusions: Mindfulness was superior to unstructured screen time at increasing physiological and subjective markers of relaxation. Results suggest that repurposing smartphones to facilitate mindfulness practice though guided meditation apps may be a more effective method of promoting physiological and emotional well-being than more ubiquitous unstructured smartphone use.

Current status of exercise and its impact on quality of life in patients undergoing peritoneal dialysis in the post-COVID-19 period.

The aims of this study were to investigate the current status and the influence factors of exercise, and to explore the impact of exercise on the quality of life (QoL) in peritoneal dialysis (PD) patients in the post-COVID-19 period. Those PD patients who were followed up between September 2020 and August 2021 were enrolled. The collected data included demographic information, clinical data, exercise data, and QoL. In total, 339 PD patients were included in this cross-sectional study. The mean age was 44.0 ± 13.0 years, with a median PD duration of 6.7 (1.7 - 41.9) months. The primary renal disease was glomerulonephritis (68.4%). 277 (81.7%) PD patients performed exercise, with median exercise time 5.0 (3.5 - 7.8) hours per week. The main type of exercise was slow walking. Pain (odds ratio (OR) = 0.311, p = 0.002) and lower hemoglobin level (OR = 1.016, p = 0.033) were independent risk factors for exercise. Moreover, male sex (B = 2.803, p < 0.001) was an independent protective factor, while advanced age (B = -0.097, p < 0.001), higher body mass index (B = -0.154, p < 0.001), and pain (B = -0.643, p = 0.023) were independent risk factors for exercise intensity. After adjustment for other confounders, exercise (B = 5.787, p = 0.037) was an independent protective factor for total score of QoL in PD patients. In the current study, 81.7% of PD patients performed exercise in the post-COVID-19 period. Pain and anemia were independent risk factors for exercise in PD patients. Advanced age, female sex, higher body mass index, and pain were independently associated with lower exercise capacity in PD patients. PD patients undergoing exercise had better QoL.

복합운동과 저염식 교육이 여성노인의 대사증후군 위험인자, 맥파속도 및 영양소 섭취 상태에 미치는 영향

The purpose of this study was to analyze the effect of combined exercise program and low-sodium diet education on metabolic syndrome risk factors, pulse wave velocity and nutrient intakes status in the elderly women for 12 weeks. The subjects were conducted twice a week and each time for 60 minutes of exercise time for elderly women consisting. combined exercise program low-sodium diet education group (n=8), combined exercise program group (n=8), low-sodium diet education group (n=8), control group (n=8). Data processing calculated the average value(M) and standard deviation(SD) for each measurement item, and paired t-test was performed in each group, and using one-way ANOVA and the post-verification Duncan were set to .05. As a result, metabolic syndrome risk factors, pulse wave velocity all showed positive effects in the combined exercise program low-sodium diet education group. In the low-sodium diet education group, SBP, DBP(p&lt;.05) were significantly reduced, and HDL-C(p&lt;.05) was significantly increased. Therefore, aerobic exercise and bare-handed muscle resistance exercise, have been shown to affect metabolic syndrome and pulse wave velocity through regular physical activity and changes in eating habits through low-sodium diet education, and are expected to help prevent various diseases including cardiovascular disease.

Association of accelerometer-measured physical activity intensity, sedentary time, and exercise time with incident Parkinson’s disease

Evidence regarding the association between physical activity and Parkinson’s disease (PD) risk is generally limited due to the use of self-report questionnaires. We aimed to quantify the separate and combined effects of accelerometer-measured light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time and exercise timing with incident PD. 96,422 participants without prior PD and with usable accelerometer data were included from UK Biobank. Time spent in sedentary activity, LPA, MVPA, and exercise timing were estimated using machine learning models. The study outcome was incident PD. Over a median follow-up duration of 6.8 years, 313 participants developed PD. There was a L-shaped association for LPA and MVPA, and a reversed L-shaped association for sedentary time, with the risk of incident PD (all P for nonlinearity < 0.001). Similar trends were found across three time-windows (morning, midday-afternoon, and evening). Compared with those with both low LPA (<3.89 h/day) and low MVPA (<0.27 h/day), the adjusted HR (95% CI) of PD risk was 0.49 (0.36–0.66), 0.19 (0.36–0.66) and 0.13 (0.09–0.18), respectively, for participants with high MVPA only, high LPA only, and both high LPA and high MVPA. Moreover, participants with both low LPA and high sedentary time (≥9.41 h/day) (adjusted HR, 5.59; 95% CI: 4.10–7.61), and those with both low MVPA and high sedentary time (adjusted HR, 3.93; 95% CI: 2.82–5.49) had the highest risk of incident PD. In conclusion, regardless of exercise timing (morning, midday-afternoon, and evening), there was an inverse association for accelerometer-measured MVPA and LPA, and a positive association for sedentary time, with incident PD.

Optimal exercise combinations for patients with diabetes.

Exercise is a key way to control the blood glucose, which can improve blood lipids and blood pressure, reduce glycated hemoglobin levels, and increase insulin sensitivity. It is of great significance for maintaining blood glucose homeostasis. This study aims to explore the optimal exercise combinations suitable for diabetic patients, and to provide scientific and effective personalized exercise guidance for diabetic patients. The physical examination data and questionnaire results of were collected from the Third Xiangya Hospital of Central South University. The study was involved in 3 867 diabetes from January, 2020 to December, 2021. The basic information and living habits were obtained through questionnaires. The fasting blood samples were collected to measure the levels of total cholesterol (TCh), triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose. Physical measurements included height, weight, waistline, hipline, and blood pressure. Categorical variables were tested using chi-square tests, and continuous variables were tested using non-parametric Kruskal-Wallis test. Multiple linear regression model was used to analyze the relationship between exercise behaviors (frequency, duration, and intensity), years of exercise, diet habits, medicine, and fasting blood glucose. The relationship between different exercise behaviors and various indexes (BMI, blood pressure, blood lipids, blood glucose) was analyzed by multiple rising sun rose plots. The polar thermal diagram showed the relationship of exercise behaviors with the best expected effect. Non-parametric Kruskal-Wallis test showed that there were significant differences in other indexes except LDL-C (P=0.681) among groups with different exercise behaviors (all P<0.01). The multiple rising sun rose plots showed that diabetic patients who did moderate to high intensity exercise more than 5 times a week for more than 30 min each time had a healthier BMI, blood lipid levels, blood glucose levels, and blood pressure. Polar thermal diagram showed that low-intensity exercise once or twice a week requires 30 to 60 min or more of exercise to achieve the desired results. Multiple linear regression analysis showed that frequency (β=-0.208, 95% CI -0.356 to -0.059, P=0.006), duration (β=-0.227, 95% CI -0.387 to -0.066, P=0.006), intensity of exercise (β=-0.110, 95% CI -0.218 to -0.002, P=0.046), diet habits (β=0.462, 95% CI 0.295 to 0.556, P<0.001) and medicine (β=-0.520, 95% CI -0.720 to -0.312, P<0.001) were correlated with fasting blood glucose. Moderate to high intensity exercise for more than 30 min and 5 times a week is the most beneficial combination for diabetes. Low exercise intensity should be combined with higher exercise frequency and longer exercise time to achieve the desired effect. With the increase of exercise intensity, the relationship between low exercise frequency and long exercise time is weakened.

Efficacy of morning versus afternoon aerobic exercise training on reducing metabolic syndrome components: A randomized controlled trial.

A supervised intense aerobic exercise program improves the health of individuals with metabolic syndrome (MetS). However, it is unclear whether the timing of training within the 24h day would influence those health benefits. The present study aimed to determine the influence of morning vs. afternoon exercise on body composition, cardiometabolic health and components of MetS. One hundred thirty-nine individuals with MetS were block randomized into morning (AMEX; n=42) or afternoon (PMEX; n=59) exercise training groups, or a non-training control group (Control; n=38). Exercise training was comprised of 48supervised high-intensity interval sessions distributed over 16weeks. Body composition, cardiorespiratory fitness (assessed by ), maximal fat oxidation (FOmax ), blood pressure and blood metabolites were assessed before and after the intervention. Compared with the non-training Control, both exercise groups improved similarly body composition (-0.7% fat loss; P=0.002), waist circumference (-2.1 cm; P<0.001), diastolic blood pressure (-3.8mmHg; P=0.004) and (3.5mLkg-1 min-1 ; P<0.001) with no differences between training groups. AMEX, in comparison with PMEX, reduced systolic blood pressure (-4% vs. -1%; P=0.019), plasma fasting insulin concentration (-12% vs. -5%; P=0.001) and insulin resistance (-14% vs. -4%; P=0.006). Furthermore, MetS Zscore was further reduced in the AMEX compared to PMEX (-52% vs. -19%; P=0.021) after training. In summary, high-intensity aerobic exercise training in the morning in comparison to training in the afternoon is somewhat more efficient at reducing cardiometabolic risk factors (i.e. systolic blood pressure and insulin sensitivity). KEY POINTS: The effect of exercise time of day on health promotion is an area that has gained interest in recent years; however, large-scale, randomized-control studies are scarce. People with metabolic syndrome (MetS) are at risk of developing cardiometabolic diseases and reductions in this risk with exercise training can be precisely gauged using a compound score sensitive to subtle evolution in each MetS component (i.e. Z score). Supervised aerobic exercise for 16weeks (morning and afternoon), without dietary restriction, improved cardiorespiratory and metabolic fitness, body composition and mean arterial pressure compared to a non-exercise control group. However, training in the morning, without changes in exercise dose or intensity, reduced systolic blood pressure and insulin resistance further compared to when training in the afternoon. Thus, high-intensity aerobic exercise training in the morning is somewhat more efficient in improving the health of individuals with metabolic syndrome.

Ansietas dan Kualitas Tidur Lanjut Usia

Sleep disorders in the elderly continue to increase. About 50% of the elderly complain of difficulty sleeping. One of the causes is anxiety. Deterioration of mental condition in the elderly is the most visible result of lack of sleep. To improve the quality of sleep of the elderly can be done by controlling the time of elderly naps, light exercise, and relaxation therapy. The purpose of this study is to analyze the relationship between anxiety and sleep quality of the elderly in the work area of UPTD Muara Kumpeh Health Center. The independent variable is anxiety and the dependent variable is sleep quality. The research location is in the working area of UPTD Muara Kumpeh Health Center, starting from September 2022-April 2023. There were 106 samples using the Proportionate Stratified Random Sampling method. The data collection instruments used were the ZSAS (Zung-Self Anxiety Rate Scale) questionnaire and the PSQI (Pittsburgh Sleep Quality Index) questionnaire using the Kendall tau statistical test. There was a statistically significant relationship between anxiety and sleep quality of the elderly with a value of p = 0.000 (p &lt; 0.05). The role of puskesmas officers in providing health promotion such as providing motivation and encouragement, as well as teaching relaxation therapy is needed to overcome anxiety and improve the quality of sleep of the elderly.

The Longitudinal Mediating Effect of Smartphone Dependency on the Relationship between Exercise Time and Subjective Happiness in Adolescents.

The phenomenon of adolescents engaging in less physical activity as they age raises several concerns. Among these, we hypothesized that this trend may negatively impact their mental health and smartphone dependency. Thus, the aim of this study was to longitudinally examine the mediating effect of smartphone dependency in the relationship between adolescents' exercise time and subjective well-being. For analysis, publicly available data from the 2018 Korean Children and Youth Panel Survey were utilized, with a total of 2,242 participants' data included in the analysis. Latent growth modeling results revealed a significant linear decrease in adolescents' exercise time and subjective well-being each year, while smartphone dependency exhibited an increasing trend. Furthermore, the significance tests of indirect effects indicated that the mediating effect of the changing trend in smartphone dependency between the changing trends in exercise time and subjective happiness in adolescents was statistically significant. These findings suggest that as grade levels increase, reducing exercise time can lead to higher smartphone dependency among adolescents, ultimately resulting in decreased subjective well-being.

Factors Contribute to Job Stress among Indonesian Lecturers Working from Home During Pandemic

Introduction: Amidst the COVID-19 pandemic, nearly all non-critical sectors require their workers to work remotely, including lecturers. All teaching and learning activities are carried out online. During this period, the problem of psychosocial disorders is of particular concern. Therefore, a study is deemed necessary to analyze what factors contribute to job stress in lecturers working from home during the pandemic. Methods: A cross-sectional study was conducted with a total 0f 111 respondents. This study was conducted through an online survey. The population of this study was lecturers. All data were collected in 2021. Variables in this study were sex, age, working time per day, break time per day, sleep time per day, workout time per week, circadian rhythm, insomnia and work stress. Results: The results of this study indicate that there is no relationship between sex and job stress also a very weak relationship strength between age, sleep time per day, workout time per week, circadian rhythm, insomnia and job stress. Furthermore, there is a strong, unidirectional relationship between working time and job stress level and a weak relationship between break time per day and job stress level. Conclusion: The conclusion is that all variables except sex have a relationship with job stress but with varying degrees. Further research on this study in different population and different methods is suggested.

EFFECTS OF TAI CHI EXERCISES ON PHYSICAL ACTIVITY AND PULMONARY FUNCTION IN PATIENTS WITH CORONARY ARTERY BYPASS GRAFTING

Objective: To determine the effects of Tai Chi exercises on physical activity, pulmonary function, and rate of perceived exertion in post-coronary artery bypass grafting patients. Material and Methods: A Randomized control trial was conducted in the Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan from January 2018 - July 2018. 50 post-coronary artery bypass grafting patients were calculated by the open epi tool and randomly allocated into two groups in equal halves through non-probability purposive sampling with the toss the coin method. 40-60 years males and females with &gt;40% ejection fraction were included while vitally unstable patients were excluded. The experimental group was given Tai Chi exercises while the control group was given a bicycle. Levels of physical activity and pulmonary functions were assessed at baseline, 4thand 6th week of training. Results: Out of the total sample size only 39 were analyzed 11 were dropped off due to not following proper follow-up, and there was no statistical difference in heart rate P=0.095. Oxygen saturation shows a significant difference with P&lt;0.001, Physical activity was low at baseline but after exercise training, the Tai Chi group showed great improvement P&lt; 0.01. Pulmonary functions showed statistically insignificant results P=0.865. The rate of perceived exertion was high in 2nd week and gradually decreased with the mean of 3.20 and 3.37 while the time of exercise was improved with P&lt;0.01. Conclusion: Tai Chi exercises have better improvement in pulmonary function, rate of perceived exertion, time of exercise, and physical activity in post-coronary artery bypass grafting patients. Keywords: Coronary artery bypass grafting, pulmonary functions, physical activity, rate of perceived exertion, Tai Chi

A comparison of aerobic- and resistance-emphasised exercise on cardiometabolic health and quality of life in men receiving androgen deprivation therapy for prostate cancer: Protocol for a feasibility trial

BackgroundThose with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes. MethodsThis is a 6-month randomised two-armed feasibility trial. Prostate cancer patients undergoing ADT and radiotherapy will be recruited (n = 24) and randomised to either a resistance- or aerobic-emphasised group. Participants will attend twice-weekly supervised individual or small group sessions, with 75% of exercise time in the primary exercise modality. The primary outcome will be feasibility, determined via assessment of recruitment, retention, adherence, safety, and acceptability. Secondary outcomes will include quality of life, body composition, vascular indices, aerobic and muscular fitness and cardiometabolic health blood biomarkers. ConclusionIt is envisaged that the trial will provide valuable information and preliminary difference data that will aid in the design of an efficacious larger trial that will adopt a major and minor emphasis approach to the scheduling of resistance and aerobic exercise.

Effects of a Forest Therapy Program on Physical Health, Mental Health, and Health Behaviors

(1) Background: Although interest in the health-promoting effects of forest therapy is increasing, few researchers have investigated the mid-long-term impact of such therapy on health indicators or exercise behaviors. We explored changes in physical health, mental health, and exercise behaviors 1, 2, and 4 weeks after a forest therapy program concluded. We sought to establish a solid foundation for such programs and a standardized evaluation system. (2) Method: We measured the blood pressure and heart rate variability of 99 adults before and after participation in a forest therapy program. We used the State-Trait Anxiety Inventory to assess anxiety, the Beck Depression Inventory to evaluate both anxiety and depression, the Profile of Mood States to explore mood, the Euro-Quality of Life-5 Dimension scale to assess the overall quality of life, and the Positive and Negative Effect Schedule to measure positive and negative mood. We employed the Global Physical Activity Questionnaire to determine exercise time, intensity, and changes in exercise type before the program and 1–4 weeks after program completion. (3) Results: Anxiety, depression, mood, quality of life, heart rate, and blood pressure control improved significantly after the program. The reduced depression and increased medium-intensity exercise time persisted for 1, 2, and 4 weeks after the end of the program. (4) Conclusions: We tracked various health indicators and clearly distinguished those that were useful in the short term from those more appropriate for evaluation in the long term. This is the first report to show that a forest therapy program affects exercise behavior; this suggests that health behaviors should be continuously tracked.

Cross-sectional associations of weekly time, social context, and motivation of exercise with mental health among workers.

Exercise is considered a strategy to promote mental health among workers. However, the optimal exercise conditions that promote mental health benefits for workers are still unclear. This study examined the cross-sectional associations of weekly exercise time duration, social context of exercise, and exercise motivation levels with the mental health among Japanese workers. A web-based cross-sectional questionnairesurvey was conducted among 18,902 workers, aged 20-59 years. The mental health variables (psychological distress, psychological stress reaction, physical stress reaction, job satisfaction, and work engagement), exercise participation (non-exercisers, exercisers), and demographic factors of all responders were measured. Weekly exercise time, social context of exercise (alone only, with others only, both alone and with others), and exercise motivation (non-regulation, external/introjected regulation, identified regulation, integrated regulation, and internal regulation) were also measured amongst exercisers. After adjusting for demographic factors, multiple regression analyses were conducted. Exercisers had significantly lower psychological distress, lower psychological and physical stress reactions, higher job satisfaction, and higher work engagement than non-exercisers. Among exercisers, while weekly exercise time duration and social context of exercise were not clearly and robustly associated with mental health variables, respondents with intrinsic regulation had significantly lower psychological distress, lower psychological and physical stress reaction, higher job satisfaction, and higher work engagement than those with lower self-determined motivations. This study found that more self-determined exercise motivation is closely associated with advantageous mental health variables, than the duration or the social context of exercise among Japanese workers.

Coronary flow reserve predicts response to anti-ischaemic therapy in patients with angina with non-obstructive coronary arteries

Abstract Background Half of all patients with angina have non-obstructive coronary arteries (ANOCA) and therapy is often empirical. The CorMicA trial showed improved symptom scores with a physiology-guided approach but the mechanistic relationship between physiological classification and outcome remains unclear. Purpose To assess if invasively assessed coronary flow reserve (CFR) can predict change in exercise time (ET) and angina-specific quality of life (QOL) in response to anti-ischaemic therapy in patients with ANOCA. Methods Prospective, randomised, crossover trial of consecutively evaluated patients with ANOCA. Inclusion criteria: (i) typical and limiting angina; (ii) non-obstructive coronary arteries (fractional flow reserve &amp;gt;0.80); (iii) normal left ventricular systolic function. Coronary physiological assessment was performed using a pressure and Doppler dual sensor-tipped wire in the left anterior descending artery and microvascular dysfunction defined a priori as CFR&amp;lt;2.5 in response to intravenous Adenosine. Patients, clinicians, and researchers were blinded to coronary physiology data. All patients were then sequentially treated with Amlodipine and Ranolazine (in a randomised order), in 4 week blocks with 1 week washout (Figure 1). The outcome measures are 1) Primary (objective): change in ET on exercise stress testing and 2) Secondary (subjective): change in angina-specific QOL on Seattle Angina Questionnaire (SAQ). Data are presented as mean±SD or median (IQR). Results Sixty-six patients with ANOCA were enrolled into the study [62±8 years, 64% females, CCS 3 (2, 3)]; eight patients were excluded. Forty patients had an impaired CFR (2.0±0.3), whilst 18 patients had normal CFR (3.1±0.6), with similar baseline ET (324±133 vs 321±136 seconds, respectively; p=0.94). Patients with an impaired CFR improved their exercise capacity with Ranolazine (ΔET 70±108 seconds; p&amp;lt;0.01) and Amlodipine (ΔET 70±82 seconds; p&amp;lt;0.01). However, there was no such improvement in patients with normal CFR, with either Ranolazine (ΔET 16±88 seconds; p=0.49) or Amlodipine (ΔET 21±59 seconds; p=0.18) (Figure 2). There was no evidence of a training effect (ΔET between visit 1 and visit 4 was 15±112 seconds; p=0.57). Angina-specific QOL improved in patients with impaired CFR [Ranolazine ΔSAQ 12±18 (p&amp;lt;0.01) and Amlodipine ΔSAQ 8±13 (p&amp;lt;0.01)]; the change in SAQ was less marked in patients with normal CFR [Ranolazine ΔSAQ 7±14 (p=0.07) and Amlodipine ΔSAQ 6±10 (p=0.03)]. Conclusion Patients with impaired CFR demonstrated an improved exercise capacity, whereas patients with normal CFR did not. CFR-guided management of ANOCA is likely to be superior to an empirical strategy. This type of physiology-blinded study design could act as a template for future therapy trials in patients with stable angina.Study design for therapeutic trialResponse to anti-ischaemic therapy

Biventricular dysfunction and lung congestion in post-COVID patients: a speckle tracking and stress lung echocardiography analysis

Abstract Background Cardiovascular abnormalities have been observed in half of all COVID-19 patients in the acute phase of the infection. Additionally, 10-35% of these patients have various long-term symptoms diagnosed with post-acute sequelae of COVID-19 (PASC). Aim of this study was to evaluate the role of exercise stress echocardiography (ESE) with an integrated approach, inclusive of Speckle-Tracking Echocardiography (STE) with Myocardial Work (MW) analysis in the evaluation of patients after COVID infection. Methods We prospectively recruited a population of 370 post-COVID 19 patients (Group 1) (225 males; 55.8 ±8.3 years), and of 250 age- and sex-comparable healthy controls (Group 2). In Standard Doppler echocardiography, STE and MW analyses and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Results Left ventricular (LV) wall thickness, diameters and mass index were comparable between the two groups. Both LV ejection fraction (EF) and right ventricular (RV) functional indexes (TAPSE and Tissue Doppler S’ wave) at rest did not show differences between the two groups. Conversely, baseline LV GLS (-16.2±2.8 vs. –20.4±3.3 %; p&amp;lt;0.01), MW efficiency (88.8±3.2 vs. 93.2±3.3 %; p&amp;lt;0.001), and RV strain (-16.4±2.8 vs. –20.4±4.3 %; p&amp;lt;0.01), were significantly reduced in Group 1. Also pulmonary artery systolic pressures (PASP) (33.5±3.8 vs. 24.6±3.1 mmHg; p&amp;lt;0.001), and LV E/e’ ratio were significantly increased in COVID group, while B-lines ( ≥ 2) at rest were found in 25.3% of Group 1 and 5.1% of Group 2 (p &amp;lt; 0.001). During effort, COVID patients showed reduced exercise time and exercise capacity (&amp;lt;0.001). Values of LVEF, RV strain and LV GLS (all with p value &amp;lt;0.01) and MWE (p&amp;lt;0001) were much lower in COVID patients when compared to Group 2. Additionally, COVID patients showed at peak effort an increased LV E/e’ ratio, pulmonary pressures and B-lines by lung ultrasound (all p &amp;lt;0.001). Multivariable analysis detected independent associations of baseline GLS and MWE with maximal workload (watts reached), LV E/e’ ratio and B-lines during effort (p&amp;lt;0.001), stronger than the association of LVEF with the same functional parameters (p&amp;lt;0.01). What’s more, RV strain (p&amp;lt;0.001) was significantly associated with PASP levels at peak effort. Conclusions In post-COVID patients, biventricular involvement with impairment of LV and RV systolic function is frequent, missed by conventional indices such as EF or TAPSE, and detected by more sensitive STE indices such as LV-GLS, ME, and RV-strain. These alterations are functionally significant and associated with shorter exercise -time, more pulmonary hypertension, and greater pulmonary congestion during stress.

Rethinking the false positive exercise stress test in the context of coronary microvascular dysfunction

Abstract Background Exercise stress testing (EST) was the traditional tool to detect myocardial ischaemia, but its use has declined due to its perceived high false positive rate. However, EST was historically validated against the reference standard of obstructive coronary artery disease (CAD). It is now well recognised that myocardial ischaemia can occur in the absence of CAD and this cohort, termed angina with non-obstructive coronary arteries (ANOCA), comprises nearly 50% of all patients presenting with stable angina. Purpose Our study assesses the accuracy of EST in detecting a substrate for myocardial ischaemia, with the reference standard being comprehensive coronary physiology assessment in patients with ANOCA. Methods Patients with typical angina and non-obstructive coronary arteries underwent physiological characterisation of the coronary circulation using a dual sensor-tipped intracoronary guidewire in the left anterior descending artery. The epicardial vessel was assessed by Fractional Flow Reserve (FFR) and the microcirculation by both endothelium-independent function (coronary flow reserve, CFR, using intravenous adenosine) and endothelium-dependent function (acetylcholine flow reserve, AChFR, using intracoronary acetylcholine infusion). Those with FFR≤0.80 were excluded per protocol. Coronary microvascular dysfunction was defined a priori as impaired CFR (&amp;lt;2.5) or impaired AChFR (≤1.5). All patients underwent a treadmill EST, using a standard Bruce protocol, with ischaemic electrocardiographic (ECG) changes defined as the appearance of 0.1mV ST-segment depression 80 milliseconds from the J-point. Patients, physiologists, and researchers were all blinded to the coronary physiology data. All data are presented as mean±SD or median (IQR). Results Ninety-one patients [67% female, 62±9 years, CCS 3 (2 to 3)] were recruited into this study. EST was performed 27 (15 to 139) days after angiography. Twenty-seven patients (30%) developed ischaemic ECG changes during their EST (Ischaemic group), whereas 64 patients (70%) did not (Control group). Both groups were phenotypically similar for demographics, risk factors, exercise time and FFR (Figure 1). 100% of the Ischaemic group and 69% of the control group had CMD. Conversely, 38% of patients with CMD developed ischaemic ECG changes on exercise but none (0%) of those with normal microvascular function did (p=0.001) (Figure 2A). The false positive rates with progressively granular reference standards are depicted in Figure 2B; there were no false positive ESTs using a comprehensive physiological reference standard. Angina reported during EST was less specific for CMD than induced ECG changes (70% vs 100%, p&amp;lt;0.001). Conclusions In patients with ANOCA a positive EST is always indicative of CMD. The potential utility of EST as a rule-in test for CMD makes it an attractive non-invasive widely available test that could be re-integrated into clinical pathways for assessing new onset angina.Patient characteristicsEST versus coronary physiology

Clinical efficacy of permanent internal mammary artery occlusion in chronic coronary artery disease: a double-blind, randomized, sham-controlled trial

Abstract Introduction Natural internal mammary artery (IMA) bypasses to the coronary circulation have been shown to act as extracardiac sources of myocardial blood supply, which has been found augmented by right IMA device occlusion. The goal of this randomized, sham-controlled trial was to test the efficacy of permanent right or left IMA device occlusion on symptoms of chronic coronary artery disease (CAD), on coronary artery occlusive blood supply, as well as on myocardial ischemia. Methods This was a prospective superiority trial in 100 patients with chronic CAD randomly allocated (1:1) to IMA permanent vascular device occlusion (verum group) or to IMA sham intervention (placebo group). The primary study endpoint was the change in treadmill exercise time (DET in seconds, s) during 6 weeks of follow-up after trial intervention. Secondary study endpoints were the changes in simultaneously obtained collateral flow index (CFI), and angina pectoris during a 1-minute proximal balloon occlusion of the coronary artery of interest. CFI is the ratio between simultaneous mean coronary occlusive divided by mean aortic pressure both subtracted by central venous pressure. Results In the verum and placebo group, exercise time changed from 398±176s to from 421±198s in the verum group (p=0.1745), and from 426±162s to 430±166s in the placebo group (p=0.55); DET was +23±116s and +4±120s, respectively (p=0.44). CFI change during follow-up was +0.022±0.061 in the verum and -0.039±0.072 in the placebo group (p&amp;lt;0.0001). Angina pectoris at follow-up during the coronary balloon occlusion for CFI measurement had decreased or disappeared in 20/48 patients of the verum group, and in 10/47 patients of the placebo group (p=0.0336). Conclusion Permanent IMA device occlusion tends to augment treadmill exercise time in response to heightened coronary artery occlusive blood supply, the fact of which is reflected by mitigated signs of myocardial ischemia.

The “Digital Disconnect” on the Back of Occupational Health and Safety

The importance of digital disconnection in the workplace cannot be overstated, as it plays a crucial role in preserving the physical and mental well-being of employees. In today's hyper-connected world, the constant use of digital devices and online communication has blurred the boundaries between work and personal life. This continuous connectivity can lead to a range of health issues. Physically, excessive screen time and sedentary work can result in eye strain, headaches, and musculoskeletal problems. Additionally, a lack of time for relaxation and exercise can contribute to a host of chronic health conditions. Mentally, the relentless notifications and information overload can lead to burnout, stress, and anxiety. Continuous work-related communication, even after office hours, disrupts personal lives and makes it challenging for individuals to recharge and spend quality time with loved ones. Promoting digital disconnection by setting boundaries, encouraging regular breaks, and respecting off-hours can help employees maintain a healthier work-life balance. Ultimately, these practices enhance physical and mental health, leading to happier and more productive workers. Employers and employees must recognize the significance of this disconnect to create a sustainable and healthy work environment.