Health Capacity Research Articles

Development and validation of a broadly applicable instrument to measure patients' health promotion and empowerment process in chronic disease.

This study aimed to develop and validate a generic, non-disease-specific, self-assessment measure that recognizes patients' health capacities and their empowering process of health promotion in chronic illness by using Bodyknowledging as the theoretical frame. Item generation and expert content validity analysis were the first steps in instrument development. Potential items were then validated in focus group interviews with six patients diagnosed with various chronic diseases. The research team reviewed the resulting items and undertook item reduction. A sample of adults (n = 357) with chronic disease surveyed the instrument items. Exploratory factor analysis with Oblimin rotation was conducted. A 3-factor solution was identified: nine items on the regaining health and wellness subscale, seven items on the uncertainty and bereavement subscale, and eight items on the loss of control and distancing subscale. Cronbach alpha for the scale was .92. The final 24-item instrument is non-disease-specific and broadly applicable for use in health promotion within the context of chronic disease. The instrument demonstrates high internal consistency reliability with initial face and construct validity. The new instrument has the potential for measuring patients' empowering process of health promotion in chronic disease and the outcomes of person-centered interventions and may guide clinicians in tailoring individual support.

Two-dimensional health state map to define metabolic health using separated static and dynamic homeostasis features: a proof-of-concept study

Abstract Defining metabolic health is critical for earlier reversing metabolic dysfunction and disease, and fasting-based diagnosis may not adequately assess individual's metabolic adaptivity under stress. We constructed a novel Health State Map (HSM) comprising Health Phenotype Score (HPS) with fasting features alone and Homeostatic Resilience Score (HRS) with a 5-time point features only (t = 30, 60, 90, 180, 240 min) following a standardized mixed macronutrient tolerance test (MMTT). Among 111 adult Chinese, the mixed-score, using the same set of fasting and post-MMTT data as HSM, was highly correlated with HPS. HRS was significantly associated with metabolic syndrome prevalence, independent of HPS (OR [95% CI]: 0.41 [0.18, 0.92]) and the mixed-score (0.34 [0.15, 0.69]). Moreover, HRS could discriminate metabolic characteristics unseparated by HPS and the mixed-score. Participants with higher HRS had better metabolic traits than those with lower HRS. Large interpersonal variations were also evidenced by evaluating postprandial homeostatic resiliencies for glucose, lipids, and amino acids, when participants had similar overall HRS. Additionally, HRS was positively associated with physical activity level and specific gut microbiome structure. Collectively, our HSM model might offer a novel approach to precisely define an individual's metabolic health and nutritional capacity.

Biodiversity of urban green spaces and human health: a systematic review of recent research

Although recent studies have explored links between landscape biodiversity and human health, the exact effects of specific types of biodiversity—such as the variety of species or genera—on health outcomes are still uncertain. In this review, we evaluate our current knowledge of how landscape biodiversity influences human health in different cultural contexts. We systematically assessed peer-reviewed literature to: 1) summarize the links between biodiversity variability and human health outcomes; 2) describe the pathways used to examine these links; 3) compare subjective perceptions of biodiversity with objective measures; and 4) describe any known connections between perceived biodiversity and health outcomes. We analyzed 41 studies published between 2018 and 2023, covering research from 15 countries on five continents. A key finding was the lack of significant links between biodiversity variability, like species richness, and health outcomes; only one-third of studies reported positive health effects. We identified two main pathways: restoring health capacities (mental health) and building health capacities (physical health). The public could identify different biodiversity levels, with perceived biodiversity correlating with health. Future research should explore varied mechanisms, physical health outcomes, causal relationships, and effects across diverse populations and regions.

Using wearable technology to objectively investigate physical behaviour and determine health outcomes of a physical activity intervention in patients with psoriasis.

Sedentary behaviour has a detrimental effect on health independent of the amount of physical activity undertaken. Despite the association of cardiometabolic and psychosocial comorbidities with psoriasis, how physical behaviour influences health outcomes in patients with psoriasis is poorly understood. We hypothesized that objective measurement of physical behaviour, using wearable digital technology, would have utility in understanding the clinical impact of an exercise intervention designed in partnership with patients with psoriasis. Fourteen patients with psoriasis completed a 20-week study. During weeks 1-10, participants followed an incrementally progressive, exercise intervention, followed by independent activities during weeks 11-20. Accelerometers (GENEActiv Original) and pedometers recorded physical behaviour. Evaluation at week-0, -10, and -20 included assessment of psoriasis, cardiometabolic disease/risk, psychological health and functional capacity. Our intervention supported significantly increased physical activity, including moderate-vigorous physical activity (p=0.04) and step count (p=0.04). We also observed a significant association between physical activity and psoriasis area and severity index (PASI)-50 response (p=0.01) and psychosocial functioning (p=0.029) together with a significant negative correlation between step count and psoriasis severity (p=0.012). We observed no change in total waking hour sedentary behaviour. Objective measurement of physical behaviour, using wearable digital technologies, offers a mechanism to further understand the clinical impact of lifestyle behaviour interventions. Crucially, despite increased levels of physical activity, we observed no change in total waking hour sedentary time. Further investigation is required to establish how modification of physical behaviour could offer an adjuvant management strategy for patients with psoriasis.

Resilience Promoting Happiness: An Attempt to Explore Interdependence

The focus of the paper was to evaluate the elements that foster resilience and also to investigate its relationship with happiness. The review of the literature was conducted using terms “resilience concepts” OR “promoting resilience “OR “promoting resiliency” andresilience and happiness.” .The literature search was conducted through online databases (Google Scholar, Research Gate and Shodhganga), keeping in consideration the inclusion and exclusion criteria. A total of 1283 studies were reviewed and finally 57 studies were included in the systematic review after fulfilling the inclusion criteria. The existing research highlights the concept of resilience and the significance of resilience and happiness, which are essential components of positive psychology, in enhancing an individual's overall well-being. The review highlights how resilience can serve as a mediator in the attainment of sustained happiness, while happiness can bolster resilience through its impact on mental health and adaptive capacities. The findings indicate a positive correlation between the two variables. The paper also put forth many limitations while analyzing the existing literature, like use of self-made measuring scales, shortage of longitudinal studies, publication bias, etc. Furthermore, it also suggests future studies in the said areas, keeping in mind the existing limitations

Voices from the ground: Qualitative perspectives on Ugandan national mental health system strengths, challenges, and recommendations

Mental health capacity building is a growing priority in Ugandan healthcare systems. Despite increased governmental attention to community mental health and mental healthcare needs, no empirical assessments document qualitative perspectives from stakeholders in the Ugandan mental health system. The goal of the current needs assessment study was to systematically explore stakeholders’ perceptions of strengths, challenges, and recommendations for enhancing capacity in the national mental health system in Uganda. Using ethnographic research methods, data were collected from 15 key informant interviews and four community focus groups with a total of 44 stakeholders involved in mental healthcare in Uganda. Thematic analyses of data yielded several themes in each domain, including 1) system strengths reflected in the existing policy and action plan, free medications, growing private sector, and partnerships and collaborations; 2) system challenges including socioeconomic constraints, stigma, and limited family engagement; and 3) recommendations surrounding enhanced education and training, integrating systemic approaches, and policy advocacy. We describe clinical, research, and policy implications that can inform systemic mental health efforts in Uganda and comparable global settings.

The Profiles of Health Aging in Older Ethiopian Adults within the WHO Healthy Aging Framework

AbstractThe World Health Organisation’s (WHO) Healthy Aging framework describes healthy aging as the maintenance of functional capacity in older adults. However, aging is a heterogeneous process influenced by genetics, lifestyle, and environmental factors, leading to variations in experiences of functional capacity among adults. In this study, Latent Class Analysis (LCA) classified groups of individuals based on their health and functional capacities. Adults from Northwest Ethiopia (n = 845) aged ≥ 60 years old, were interviewed about their cognition, mental health, social support, independence, and sensory functioning. LCA identified three groups, reflecting “high-“ (47.5%); "moderate-" (37.3%); and "low-functioning" (15.2%) participants. Compared to low-functioning individuals, high-functioning individuals were less likely to be aged 80+ (RR = 0.61; 95% CI: 0.46, 0.80), lonely (RR = 2.34; 95% CI: 1.72, 3.18), but more likely to report normal nutritional status (RR = 2.05; 95% CI: 1.47, 2.86), no multimorbidity (RR = 1.18; 95% CI: 1.06, 1.32), living in an urban area (RR = 1.12; 95% CI: 1.03, 1.22), and financially independent (RR = 1.24; 95% CI: 1.03, 1.49). Notably, almost half of the sample was classified as high functioning, comparable to findings from other developing countries. Those individuals in the high-functioning group who did not meet the WHO criteria for functional capacity across all domains did not differ from those individuals who did meet all the WHO criteria. This positively demonstrates that older adults do not need to be functional across all dimensions to experience healthy aging.

Space for Self-Care? Adolescents’ Rationales for Being Physically Active

Guided by Foucault’s theorization of power, self and strategies for self-care, the study aimed to characterize adolescents’ rationales for being physically active as the outcome of their negotiations with dominant discourses. Using stratified random sampling method, a sample of 291 adolescents (female = 161, age 11–14) was selected from 24 middle schools. With the Free and Reduced Meals (FARMS) rates ranging from 22% to 78%, the schools were drawn from six school districts that served urban, suburban, and rural communities. Photo-elicited semi-structured interviews were conducted. Discourse analyses were performed on the interview transcripts. Students identified health, body image, and physical capacities, in this order of significance, as leading rationales for physical activity participation. The finding indicates that students had been heavily influenced by dominant discourses, especially healthism, discourse on body image, and athleticism/ablism. Nevertheless, most students’ rationales for physical activities did not contain stereotypical and judgmental binary ideals based on which these dominant discourses were constructed. A small number of students demonstrated the potential of engaging self-care practices—reflectively and flexibly adopting discourses for their own needs. The findings suggest educators and practitioners help adolescents to disrupt the discourses of binaries for self-care.

THE IMPACT OF USING SMART WATCHES ON STUDENTS’ EFFORT CAPACITY: A COMPARATIVE STUDY

The increasing use of smartwatch technology among university students has raised questions about its potential impact on physical health and effort capacity. This study aims to evaluate the influence of smartwatch usage on the physical performance and effort capacity of students, focusing on those who utilize these devices for monitoring physical activity and health functions. In this comparative study, we employed a questionnaire to assess the adoption and usage patterns of smartwatches among students. The research sample was divided into two groups: a control group and an experimental group. Both groups participated in weekly aerobic gymnastics classes. However, the experimental group, equipped with smartwatches, was tasked with achieving a daily goal of 13,000-15,000 steps or expending 600 kcal. At the conclusion of the experiment, we evaluated the exercise capacity of all students using the Ruffier and Harvard tests. The results revealed significant differences between the two groups, with the experimental group demonstrating notably higher effort capacity. This suggests that the regular use of smartwatches, combined with specific fitness targets, can enhance physical performance and overall health among students. Our findings underscore the potential benefits of integrating wearable technology into student lifestyles, particularly in promoting physical activity and improving exercise capacity. This study contributes to the growing body of literature on the impact of smartwatches on health and fitness, highlighting their role as valuable tools for monitoring and enhancing physical performance in an academic setting. In conclusion, smartwatches can be useful tools for students, but they must be used with discernment. It is important to strike a balance between the benefits and distractions these devices bring. Students' effort capacity may be influenced by how they integrate smartwatches into their daily routine.

Mapping the Public Health and Health Promotion Capacity in Oman

Abstract Background An essential condition to enabling people to increase control over their health is to have sufficient capacity for public health (PH) and health promotion (HP). Despite the recognition of its importance, a comprehensive view of the PH and HP capacity in the sultanate of Oman is not yet available. This study provides a mapping of the country’s PH and HP capacity at national, governorate and district levels. Methods An online quantitative survey was performed amongst 70 health policy maker and experts in PH and HP using a questionnaire based on the PH capacity framework of Aluttis et al., yielding data on the country specific context with relevance for PH and 6 PH capacity domains, each divided in subdomains: leadership and governance; organizational structures, workforce, financial resources, partnerships, and knowledge development. Internal consistencies of the scales measuring the capacity subdomains ranged from .75 to .99. Results The survey revealed relatively low scores, representing partial development of capacities, for most of the public health capacity domains. The highest levels of capacity were observed for knowledge development (health information and monitoring systems, reporting systems and knowledge infrastructure), organizational structures (institutional capacity, program delivery structures, PH within health services, and response emergencies) and partnerships (formal consortia, informal partnerships and multisectoral coordination). In contrast, leadership and governance, workforce development, and financial resources score lower. Conclusions Mapping the strengths and weaknesses of PH and HP capacity in Oman allows to make recommendations for improving population health. Whereas all domains of PH and HP capacity are partially developed, there is a need to further improve capacity in all domains. Key messages • PH and HP capacities are partially developed in Oman. • Mapping the PH and HP capacity allows to identify strengths and weaknesses and make recommendations for improving public health.

Artificial intelligence – NPHIs’ role in utilizing its opportunities and addressing the risks

Abstract Issue & Problem National Public Health Institutes (NPHIs) in many countries are at the forefront of action to mitigate the impact of current and future threats to health as well as improving population health and wellbeing. Through research, collaboration, and support, NPHIs can approach these new realities together. One of the many emerging realities that NPHIs will need to engage in is how NPHIs best can utilise the powers of artificial intelligence and deal with the ethical and legal issues that come with it. Methods In preparation of IANPHI’s (International Association of National Public Health Institutes) Europe Regional network meeting in April 2024 a survey was conducted among the 42 members. 16 countries replied to questions, around e.g., 1) current applications of (generative) artificial intelligence (AI) in the work of institutes, 2) which experiences were made and 3) which measures NPHIs take to best utilize the possibilities and overcome challenges of AI technologies. Within four weeks 16 replies were shared. Lessons & Conclusions Some institutes have not yet adopted AI, while others report multiple applications but the primary areas of application vary considerably among Europe. Applications include summarizing and reformatting text; translation; transcribing and documenting meetings; search information in documents or databases; coding; creating visuals; literature review; surveillance of infectious diseases; disease forecasting; analysis of transmission dynamics; vaccine efficacy assessment and development; image recognition; diagnosis and prediction of diseases from medical datasets; text mining; symptom extraction; social listening; prediction of nitrate concentration in groundwater; drug analysis and measuring psychological resilience in social crisis. Key messages • AI poses opportunities and risks for public health and work of national public health institutes and capacity building initiatives are essential. • IANPHI decided to develop a joint framework for the use of AI in its member organisations with a focus on research and responsible use.

Strengthening youth mental health capacities in Albania: Training primary healthcare professionals

Abstract Background Addressing mental health issues among children and adolescents globally is crucial, necessitating interventions at the primary healthcare (PHC) level. The training programme in Albania equipped PHC professionals with skills for early identification, support, and referral for youth mental health issues. Given the global prevalence of such challenges, our intervention serves as a valuable model for enhancing mental health services in communities. Objectives The training aimed to develop the capacities of Albanian PHC professionals in improving mental health and psychosocial wellbeing among youth. Through innovative training sessions using participatory action methods, it was sought to answer key questions: How can Albanian PHC professionals better identify and support youth mental health issues? What innovative approaches can enhance mental health training for Albanian healthcare personnel? How can community engagement be strengthened to support youth mental health initiatives in Albania? Results Following the programme, 525 healthcare professionals in Albania received training, showing improved knowledge and skills in youth mental health support. They emphasized the importance of community engagement, standardized documentation, and specialized mental health services. Preliminary results indicate increased awareness and readiness among Albanian PHC professionals to address youth mental health needs. Conclusions The programme underscores the significance of equipping Albanian PHC professionals with comprehensive skills to tackle youth mental health challenges. Lessons learned have broader implications for strengthening mental health services globally, emphasizing collaboration, standardized protocols, and targeted interventions. Key messages • Strengthening PHC capacity in Albania improves early identification and support for youth mental health, enhancing overall wellbeing. • Tailored training and community engagement are vital for effective mental health interventions at the grassroots level in Albania.

Capacity mapping of comprehensive sexuality education in Gabon: A qualitative analysis

Abstract Background Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy. Methods Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE. Results The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient. Conclusions Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon. Key messages • CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps. • Evaluation and evidence mobilization deficits limit effectiveness.

Self-Attitude Parameters as Predictors of Psychological Well-Being in Students with Limited Health Capacities.

Psychological well-being is a system of optimal psychological qualities and states manifested as life strategy and a system of personal attitude to the world and oneself. Self-attitude is an intrapersonal phenomenon of individual projections in the field of self-awareness. In assessing psychological well-being, it acts as a guiding vector for self-development and self-actualization. In case of people with disabilities, psychological well-being largely depends on self-attitude as a predictor. This study featured the effect of self-attitude on psychological well-being in university students with limited health capacities. The study involved 60 students aged 18–25. The list of methodological tools involved Sentence Completion (J. M. Sacks, S. Levy), Subjective Well-Being Scale (adapted by M. V. Sokolova), and Personal Self-Attitude (V. V. Stolin, S. R. Pantileev). The study established differences in the assessment of psychological well-being by students with and without disabilities. Physically challenged students tended to demonstrate low self-esteem, associated with negative emotional and health experience. They also had specific parameters of self-attitude with a vector of positivity and trends towards personal growth. These parameters are a motivating component of social behavior that determines the general perception of psychological well-being by students with disabilities.

Taurine enhances growth performance by improving intestinal integrity and antioxidant capacity of weaned piglets.

Taurine is an amino acid that has been considered by animal husbandry as a feed additive due to its abundant biological functions. However, the effective dose of taurine added to feed is unknown. The aim of current study was to determine the optimal taurine supplementation level by investigating its effects on growth performance, diarrhea index, intestinal health and antioxidant capacity of weaned piglets. A total of 160 crossbred piglets (Landrace × Yorkshire, initially 8.39 ±0.11kg) were assigned to 4 groups (10 pigs/pen and 4 replicates/group). Basal diets containing 0 (control, CON), 0.1%, 0.3%, and 0.5% taurine were respectively provided to the piglets for a duration of 28 days. Six piglets from each group were selected for euthanasia and subsequent sample collection on day 29. The results showed that dietary 0.3% or 0.5% taurine supplementation increased average daily gain (P < 0.05), feed to gain ratio (P < 0.01), and serum albumin (P < 0.05), and decreased diarrhea index (P < 0.01) and diamine oxidase (DAO) level in the serum (P < 0.05). The greater expression of tight junction-related genes, including ZO-1 (P < 0.05) and Claudin-1 (P < 0.01), were observed in the duodenum after supplementation with 0.5% taurine. The supplementation of 0.3% or 0.5% taurine resulted in a significant reduction of crypt depth (P < 0.01) and an increase of villus height-to-crypt depth ratio (P < 0.01) in the duodenum. A greater abundance of goblet cells was detected in the duodenum and jejunum of piglets fed 0.5% taurine (P < 0.05). In addition, serum superoxide dismutase (SOD) level, liver catalase (CAT) level and liver total antioxidant capacity level were all significantly (P < 0.05) increased with 0.1%, 0.3% or 0.5% dietary taurine supplementation. On the whole, dietary supplementation with 0.3% or 0.5% taurine has the potential to significantly enhance the growth performance of piglets by improving the integrity of the intestinal barrier and boosting their antioxidant capacity.

The Role of NGOs in Health Capacity Building for Organizational Staff and Volunteers in Myanmar

The role of non-governmental organizations (NGOs) in health capacity building for trained community volunteers in Myanmar, a Least Developed Country (LDC) is significantly noteworthy. The study highlights the training programs and initiatives conducted by NGOs in areas such as sexual and reproductive health and rights (SRHR) and Gender-Based Violence (GBV) prevention, addressing critical needs in family planning, maternal health, GBV prevention, and the prevention of TB, HIV/AIDS, and other infectious diseases. The training programs and packages are designed to equip healthcare providers and community volunteers with fundamental skills, thereby enabling them to effectively address the health issues facing by the community especially among the vulnerable population. The study also points to the effective use of participatory learning methods by NGOs, such as interactive workshops, role-plays, case studies, and group discussions, which actively engage participants and promote an environment conducive to collective learning and knowledge sharing. Furthermore, through FGD, it was found that NGO interventions contribute to positive changes in health behaviors, such as increased awareness of preventive measures and adoption of healthier lifestyles.

A demand-driven climate services for health implementation framework: A case study for climate-sensitive diseases in Caribbean Small Island Developing States

Here we introduce a demand-driven framework designed to implement climate services in the health sector, with a particular focus on the Caribbean region. Climate services are essential for supporting informed decision-making and response strategies in relation to climate-related health risks. Through collaborative efforts, we are co-producing a climate-driven dengue early warning system (EWS) to target vector-borne diseases effectively. While challenges exist in implementing such systems, EWSs provide valuable tools for managing epidemic risks by predicting potential disease outbreaks in advance. The scarcity of operational climate tools in the health sector underscores the need for increased investment and strategic implementation practices. To address these challenges, a demand-driven framework is proposed, emphasizing strategic planning focused on health intervention development, partnership building, data, communication, human resources, capacity building, and sustainable funding. This framework aims to integrate climate services seamlessly into health systems, thereby enhancing public health resilience and facilitating well-informed decision-making to effectively address climate-sensitive diseases.

Роль высшего учебного заведения в социальной абилитации школьников с ограниченными возможностями здоровья

The article deals with one of the most important aspects of inclusion development, that is sectoral cooperation of educational establishments of different levels to solve the tasks of development of inclusive society. The author underlines that institutes of higher education have a lot of opportunities both to form an inclusive competence of their students and to provide help in development, training, education, career guidance, various events management and other forms of social rehabilitation of children with limited health capacities, who attend learning disability schools. The author also shares her real-life experience of cooperation of the kind by using interactive excursions management for school students with limited health capacities as an example. These interactive excursions are the result of social project that has demonstrated the efficiency of the sectoral cooperation of educational establishments of different levels for all the participants of inclusive approach.

Strengthening Health Security at Ground Border Crossings: Key Components for Improved Emergency Preparedness and Response-A Scoping Review.

Background: Ground crossing borders are considered a threat to health security due to their complex and challenging environments. The objective of this scoping review is to identify the main themes crucial for implementing effective health management at ground crossing borders to maintain health security. Methods: This scoping study was conducted following the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Documents published from January 2005 to December 2023 were searched for using PubMed, Scopus, Web of Science, and UN databases. Two reviewers screened and reviewed eligible studies in three stages: duplicate identification and elimination, title and abstract screening, and full-text assessment. Data were charted and grouped into themes, the frequency of each theme and its percentage was calculated, and then thematic analysis was conducted. Results: Forty-five studies met the inclusion criteria. Areas of research were grouped into eight themes: "Infection Prevention and Control measures (IPC) (17%)", "Collaboration, Coordination, and Partnership (17%)", "Research and Data Sharing (15%)", "Build Border Health Capacity (13.5%)", "Planning (13.5%)", "Communication (13%)", "Legislations and Frameworks (7%)", and "Services and Assistance for At-Risk Groups (4%)". Through this scoping review, we found that the eight themes are interconnected, and are crucial for implementing effective health management at the ground crossing borders and for better emergency preparedness responses among countries.

Pulmonary Vascular Structure and Function Are Related to Exercise Capacity in Health and COPD

Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function is associated with higher exercise capacity (VO2peak). Is there a cross-sectional association between the pulmonary vasculature and VO2peak? We hypothesized that those with higher computed tomography (CT) blood vessel volumes, and pulmonary diffusing capacity for carbon monoxide (DLCO) would have higher VO2peak, independent of airflow limitation. Participants from the CanCOLD study were categorized as: never-smokers with normal spirometry (n=263); ever-smokers with normal spirometry (n=407); and chronic obstructive pulmonary disease (COPD): individuals with spirometric airflow obstruction (n=334). Total vessel volume (TVV), the volume for all vessels with a cross-sectional area ≤5 mm2 (BV5), and between 5-10 mm2 (BV5-10) were generated from CT scans and used as indices of pulmonary vascular structure. DLCO was used as an index of pulmonary microvascular function. VO2peak was evaluated via incremental cardiopulmonary exercise testing. General linear regression models revealed that even after controlling for FEV1, emphysema severity and body morphology, DLCO, TVV, BV5 and BV5-10, were independently associated with VO2peak. Interaction effects were observed between COPD and TVV, BV5, and BV5-10 indicating a weaker association between pulmonary vascular volumes and VO2peak in COPD. Our results suggest that pulmonary vascular structure and DLCO is independently associated with VO2peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD.