Increase In VO2peak Research Articles

Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study

We included 52 participants with HFrEF with a left ventricular ejection fraction <40% to receive either sacubitril/valsartan (target dose of 400 mg daily) or enalapril (target dose of 40 mg daily). Peak VO2 was measured by using cardiopulmonary exercise testing. Six-minute walk test was also performed. At 12 weeks, the sacubitril/valsartan (mean dose 382.6 ± 57.6 mg daily) group had increased peak VO2 of 13.1% (19.35 ± 0.99 to 21.89 ± 1.04 mL/kg/min) and enalapril (mean dose 34.4 ± 9.2 mg daily) 5.6% (18.58 ± 1.19 to 19.62 ± 1.25 mL/kg/min). However, no difference was found between groups (P=.332 interaction). At 24 weeks, peak VO2 increased 13.5% (19.35 ± 0.99 to 21.96 ± 0.98 mL/kg/min) and 12.0% (18.58 ± 1.19 to 20.82 ± 1.18 mL/kg/min) in sacubitril/valsartan (mean dose 400 ± 0 mg daily) and enalapril (mean dose 32.7 ± 11.0 mg daily), respectively. However, no differences were found between groups (P= .332 interaction). At 12 weeks, 6-MWT increased in both groups (sacubitril/valsartan: 459 ± 18 to 488 ± 17 meters [6.3%] and enalapril: 443 ± 22 to 477 ± 21 meters [7.7%]). At 24 weeks, sacubitril/valsartan increased 18.3% from baseline (543 ± 26 meters) and enalapril decreased slightly to 6.8% (473 ± 31 meters), but no differences existed between groups (P= .257 interaction). Compared to enalapril, sacubitril/valsartan did not substantially improve peak VO2 or 6-MWT after 12 or 24 weeks in participants with HFrEF. (NEPRIExTol-HF Trial, ClinicalTrials.gov number, NCT03190304).

Graded aerobic exercise (GAEx): An effective exercise regimen to improve cardio-respiratory fitness and physical and psychosocial functioning in children with burn sequelae of the chest

PurposeThe cardio-respiratory function is compromised in children recovering from burns, particularly, those who sustain a burn injury across the chest, which leads to further prejudicial effects on physical and psychosocial health. This study endeavored to explore the efficacy of 12 weeks of graded aerobic exercise (GAEx) on the cardiorespiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. MethodsThirty-six burn-injured children aged 10–18 years (%TBSA: 24.2 ± 4.9, and 38.8 ± 12.9 months since injury) were randomly assigned to GAEx group (n = 18; undergone a 12-week intensity- and time-graded aerobic exercise program plus standard rehabilitation) or control group (n = 18; received the standard rehabilitation only). The cardio-respiratory fitness [marked by the peak oxygen uptake (VO2peak), minute ventilation (VE), ventilatory equivalent of inhaled oxygen (VEq/VO2), oxygen pulse (O2P), respiratory exchange ratio (RER), maximum heart rate (HRmax), and the heart rate recovery at one minute (HRR1)] and physical and psychosocial functioning were assessed pre- and post-intervention. ResultsChildren in the GAEx group showed significant increases in VO2peak (P = 0.013), VE (P = 0.026), O2P (P = 0.034), HRmax (P = 0.035), and HRR1 (P = 0.04) and declines in VEq/VO2 (P = 0.009) and RER (P = 0.011) as compared to the control group. Additionally, the GAEx group reported higher physical (P = 0.029) and psychosocial (P = 0.012) functioning. ConclusionTwelve weeks of GAEx has salutary effects on cardio-respiratory capacity and physical and psychosocial functioning in children with burn sequelae of the chest. These findings suggest that adding GAEx as a complementary therapy to the long-term rehabilitation protocol for this patient population is worthwhile.

4‐s Power Cycling Training Increases Maximal Anaerobic Power, Peak Oxygen Consumption and Total Blood Volume

Introduction High-intensity interval training (HIIT) is an effective tool to improve cardiovascular fitness and maximal anaerobic power. Different methods of HIIT have been studied but the effects of repeated maximal effort cycling with very short exercise time (i.e., 4-s) and short recovery time (15-30 s) might suit individuals with limited time to exercise. Purpose We examined the effects of training at near maximal anaerobic power during cycling (PC) on maximal anaerobic power, peak oxygen consumption (VO2peak), and total blood volume in 11 young healthy individuals (age: 21.3±0.5 y) (6 men, 5 women). Methods Participants trained three times a week for eight weeks performing a PC program consisting of 30 bouts of 4-s at an all-out intensity (i.e., 2 minutes of exercise per session). The cardiovascular stress progressively increased over the weeks by decreasing the recovery time between sprints (30 to 24 to 15-s) and thus total session time decreased from 17 to < 10 min. Results PC elicited a 13.2% increase in VO2peak (Pre: 2.86±0.18 L/min, Post: 3.24±0.21 L/min, (p=0.003)) and a 7.6% increase in total blood volume (Pre: 5,139±199 ml, Post: 5,529±342 ml, p<0.05). Concurrently, maximal anaerobic power increased by 17.2% (Pre: 860±53 watts, Post: 1,009±71 watts; p<0.001). Conclusion PC training program employing 30 bouts of 4-s for a total of 2 min of exercise, resulting in a total session time of less than 10 min in the last weeks, is effective for improving total blood volume, VO2peak and maximal anaerobic power in young healthy individuals over 8 weeks. These observations require reconsideration of the minimal amount of exercise needed to significantly increase both maximal aerobic and anaerobic power.

Aerobic exercise and inspiratory muscle training increase functional capacity in patients with univentricular physiology after Fontan operation: A randomized controlled trial

BackgroundThe effect of exercise training and its mechanisms on the functional capacity improvement in Fontan patients (FP) are virtually unknown. This trial evaluated four-month aerobic exercise training and inspiratory muscle training on functional capacity, pulmonary function, and autonomic control in patients after Fontan operation. MethodsA randomized controlled clinical trial with 42 FP aged 12 to 30 years and, at least, five years of Fontan completion. Twenty-seven were referred to a four-months supervised and personalized aerobic exercise training (AET) or an inspiratory muscle training (IMT). A group of non-exercise (NET) was used as control. The effects of the exercise training in peak VO2; pulmonary volumes and capacities, maximal inspiratory pressure (MIP); muscle sympathetic nerve activity (MSNA); forearm blood flow (FBF); handgrip strength and cross-sectional area of the thigh were analyzed. ResultsThe AET decreased MSNA (p = 0.042), increased FBF (p = 0.012) and handgrip strength (p = 0.017). No significant changes in autonomic control were found in IMT and NET groups. Both AET and IMT increased peak VO2, but the increase was higher in the AET group compared to IMT (23% vs. 9%). No difference was found in the NET group. IMT group showed a 58% increase in MIP (p = 0.008) in forced vital capacity (p = 0.011) and forced expiratory volume in the first second (p = 0.011). No difference in pulmonary function was found in the AET group. ConclusionsBoth aerobic exercise and inspiratory muscle training improved functional capacity. The AET group developed autonomic control, and handgrip strength, and the IMT increased inspiratory muscle strength and spirometry.Clinical Trial Registration:ClinicalTrials.gov Identifier: NCT02283255

Effect of Aerobic Exercise on Cardiopulmonary Responses and Predictors of Change in Individuals With Parkinson's Disease

ObjectiveTo determine the effect of aerobic exercise on maximal and submaximal cardiopulmonary responses and predictors of change in individuals with Parkinson's disease (PD). DesignSingle-center, parallel-group, rater-blind study. SettingResearch laboratory. ParticipantsIndividuals with mild to moderate PD (N=100). InterventionParticipants were enrolled in a trial evaluating the effect of cycling on PD and randomized to either voluntary exercise (VE), forced exercise (FE), or a no exercise control group. The exercise groups were time and intensity matched and exercised 3×/wk for 8 weeks on a stationary cycle. Main Outcome MeasuresCardiopulmonary responses were collected via gas analysis during a maximal graded exercise test at baseline and post intervention. ResultsExercise attendance was 97% and 93% for the FE and VE group, respectively. Average exercise heart rate reserve was 67%±11% for FE and 70%±10% for VE. No significant difference was present for change in peak oxygen consumption (VO2peak) post intervention, even though the FE group had a 5% increase in VO2peak. Both the FE and VE groups had significantly higher percentage oxygen consumption per unit time (V˙o2) at ventilator threshold (VT) than the control group compared with baseline values (P=.04). Mean V˙O2 at VT was 5% (95% CI, 0.1%-11%) higher in the FE group (P=.04) and 7% (2%, 12%) higher in VE group compared with controls. A stepwise linear regression model revealed that lower age, higher exercise cadence, and lower baseline VO2peak were most predictive of improved VO2peak. The overall model was found to be significant (P<.01). ConclusionsPeak and submaximal cardiopulmonary function may improve after aerobic exercise in individuals with PD. Lower age, higher exercise cadence, and lower baseline VO2peak were most predictive of improved VO2peak in this exercise cohort. The improvements observed in aerobic capacity were gained after a relatively short aerobic cycling intervention.

Effect of Aerobic Exercise and Dietary Intervention on Visceral and Subcutaneous Adipose tissue in Sedentary Overweight Adults: a Magnetic Resonance Imaging Study

The purpose of this study was to examine the effect of aerobic exercise and anti-atherosclerotic diet intervention on visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), lipid profiles and insulin (IN) concentration in overweight adults. Method: Thirty-six sedentary overweight adults, age 20 to 25 yr, volunteered as study subjects. Subjects were randomly assigned to: 1) exercise training with American Heart Association anti-atherosclerotic Step 1 (AHA-S1) diet (E+D, n=12), 2) exercise training alone (without the AHA-S1 diet) (EX, n=12), and 3) no-treatment control (CON, n=12). The E+D trained 45 min a day at 70% of VO2peak, 3 days/week and consumed the AHA-S1 diet for 12 weeks, while the EX trained at the identical exercise intensity, duration and frequency without the AHA-S1 diet for 12 weeks. The CON did not engage in exercise training and consumed preferred habitual diet for the same study duration. Study outcome measurements include a magnetic resonance imaging scan for visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), body weight (BW), VO2peak, insulin concentration (IN), and fasting lipids. Results: The E+D showed significant (p&lt;0.05) reduction in VAT, SAT, WT and IN as well as increase in VO2peak and HDL-cholesterol. The EX showed significant (p&lt;0.05) reduction in IN and increase in VO2peak and HDL-Cholesterol. Conclusion: E+D was effective in lowering SAT, VAT, WT and IN as well as enhancing VO2peak and HDL-cholesterol, while EX was effective in lowering IN and enhancing VO2peak and HDL-cholesterol in sedentary overweight adults. Keywords: Aerobic exercise, American Heart Association Step-One diet, MRI, Abdominal and visceral fat, VO2peak, LDL-cholesterol, HDL-cholesterol,

What Is the Relation between Aerobic Capacity and Physical Activity Level in Adults with Congenital Heart Disease?

Background: Aerobic capacity (AC) in adults with congenital heart disease (CHD) is often reduced, mainly due to low confidence levels towards physical activity (PA). The main objective of this study was to estimate the association between PA level and AC (measured as peak of oxygen consumption, VO2peak) in adults with CHD. Methods: A total of 183 individuals (83 women and 100 men; mean (SD) age 36.9 (11.0) years old) from Vall d’Hebron Hospital, Barcelona-Spain in 2019, participated in this cross-sectional study. The AC was assessed by cardiopulmonary exercise testing (CPET) using a treadmill ramp protocol. Considering values of metabolic equivalent of task (MET, MET-min·week-1 ) obtained by the short International Physical Activity Questionnaire (IPAQ), participants were divided into three categories of PA: health-enhancing PA (HEPA), minimally active, and inactive. Results: Median (SD) PA was 2737.2 (2835.7) MET-min·week-1 , with 60 participants (32.8%) reporting HEPA, 91 (49.7%) minimally active, and 32 (17.5%) inactivity. Participants demonstrated a mean VO2peak of 28.9 (8.8) mL·Kg-1 ·min-1 , showing AC values on average 13% lower than expected in a healthy population. Overall, PA and AC were positively associated. Adjusting for sex and age, an increase of 1000 MET-min·week-1 was associated with an increase in VO2peak of 0.8 units (95% CI 0.4–1.2; p < 0.001). There were no differences in the degree of increase between sexes (p = 0.427). Conclusion: These findings suggest that an increase in PA in patients with CHD significantly improves their AC, and hence, could be recommended when the goal is to improve their physical condition.

Changes in Liver Enzymes and Metabolic Profile in Adolescents with Fatty Liver following Exercise Interventions.

PurposeNonalcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver diseases in both adults and children with obesity. The aim of this study was to compare the changes in liver enzymes and metabolic profile in adolescents with fatty liver following selected school-based exercise (SBE) and high-intensity interval training (HIIT) interventions.MethodsIn a semi-experimental study, 34 obese male adolescents with clinically defined NAFLD were divided into the HIIT (n=11, age=12.81±1.02 years, body mass index [BMI]=26.68 ±2.32 kg/m2), selected SBE (n=11, age=13.39±0.95 years, BMI=26.47±1.74 kg/m2), and control (n=12, age=13.14±1.49 years, BMI=26.45±2.21 kg/m2) groups. The ultrasonography NAFLD grade, peak oxygen uptake (VO2peak), lipid profile, insulin resistance, and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels of the participants were measured before and after the exercise interventions.ResultsThe BMI, waist-to-hip ratio, and body fat percentage of the participants decreased, and a significant increase in VO2peak was observed after the intervention; however, the HIIT group showed a significant improvement compared with the SBE group (p<0.01). Significant reductions were observed in the levels of insulin resistance, triglyceride, total cholesterol, ALT, and AST in both groups, although high-density lipoprotein levels decreased only in the HIIT group (p<0.01). Further, a significant reduction in low-density lipoprotein level was observed in the training groups (p<0.01), but this decrease was not significant compared with the control group (p>0.01).ConclusionHIIT and SBE are equally effective in improving health parameters in obese children and adolescents.

Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease

<b>Background:</b> The purpose of this study was to investigate whether patients with adult congenital heart disease (ACHD) benefit from exercise-based cardiac rehabilitation (CR) short- and long-term with regard to improvement of cardiorespiratory fitness. <b>Methods:</b> Cardiopulmonary exercise tests (CPET) completed by ACHD patients between January 2000 and October 2019 were analysed retrospectively. Linear mixed models were performed for peak oxygen consumption (VO₂) with patients as random effect and age, sex, disease classification, preceding surgery (≤3 months) and preceding CR (≤4 weeks for short term and >4 weeks for long term) as fixed effects. <b>Results:</b> 1056 CPETs of 311 ACHD patients with simple (7), moderate (188) or great (116) complexity heart defects were analysed. The 59 patients who completed a CR (median age 27 yrs, 38% females) increased peak VO₂ from before to after CR by a median of 2.7 (IQR –0.6 to 5.5) ml/kg/min. However, in the multivariate mixed model, peak VO₂ was non-significantly increased short-term after CR (β 0.8, 95%CI –0.7 to 2.4), not maintained long-term after CR (β 0.0, 95%CI –1.7 to 1.6) but significantly reduced after surgery (β –5.1, 95%CI –7.1 to –3.1). The 20 CR patients after surgery increased their peak VO₂ by 6.2 (IQR 3.6–9.5) ml/kg/min, while the 39 CR patients without preceding surgery increased it by 0.9 (IQR –1.5 to 3.1) ml/kg/min. <b>Conclusions:</b> The increase in peak VO₂ with CR was mainly due to recovery from surgical intervention. The small independent benefit from CR was not maintained long-term, highlighting the potential to improve current CR concepts in ACHD populations.

Do socioeconomic status and ethnicity predict CR outcomes in coronary heart disease patients in Denmark?

Abstract Background Cardiac patients with low socioeconomic status and other ethnic background have worse prognosis and outcomes. Cardiac rehabilitation (CR) has the potential to diminish this socioeconomic and ethnical disparity, but evidence is lacking. Purpose To describe if socioeconomic status and ethnicity predicts CR outcomes in coronary heart disease (CHD) patients in Denmark. Methods The study is based “The Danish Cardiac rehabilitation database” (DHRD) which monitors quality of CR in Denmark. The study population are all patients with CHD (myocardial infarction or stable coronary artery disease with revascularization or medical treatment) participating in CR reported to the database from Aug 2015 to Mar 2018. The quality indicators (QI) were &amp;gt;80% participation in exercise sessions, &amp;gt;10% increase in VO2peak, smoking cessation, LDL &amp;lt;1.8mmol/L (or 50% reduction of baseline LDL), blood pressure &amp;lt;140/90, dietary consulting, screening for diabetes, screening for depression and medical treatment with acetylsalicylic acid, statins and beta-blockers at completion of CR. Educational level as a marker for socioeconomic status was divided into no-, basic-, medium- and high education, and ethnicity into Danish, Western and non-western origin. We compared QI across educational level and ethnicity using descriptive statistics. Results Analyses are based on 9000 patients. Age and gender differed significantly in the groups (all p&amp;lt;0.001). Medical treatment and achievement of LDL- and blood pressure control was overall good with no difference across socioeconomic strata or ethnicity. Despite similar participation rate, higher education was associated with greater improvements in VO2peak. Patients of non-western ethnicity were less often screened for depression and less often received dietary consulting. Conclusion In this nationwide quality database for CR, medical treatment and achievement of traditional risk factor goals was good across socioeconomic and ethnic strata. However, outcome in VO2peak and implementation of screening for depression and diabetes showed disparity across socioeconomic and ethnic groups. The effect on long-term outcomes remains to be addressed. Funding Acknowledgement Type of funding source: None

Increased oxygen uptake and utilization in the peripheral muscles, rather than cardiac function reserve, may be determinants of increased peak VO2 by cardiac rehabilitation in heart failure

Abstract Background Peak oxygen consumption (peak VO2) is a major prognostic parameter in heart failure (HF). Previous studies have shown a relationship between peak VO2 and impaired oxygen uptake and utilization in the peripheral muscles. The purpose of this study was to clarify the determinant of increased peak VO2 by cardiac rehabilitation (CR) in patients with HF. Methods We performed echocardiography during upright ramp bicycle cardiopulmonary exercise test in 30 HF patients (61±1 years of age, 80% male) before and 6 months after CR. HR reserve was determined as the change in HR from rest to peak exercise, expressed as a percentage of the predicted maximal HR reserve. Elastance index (EAI) and LV end-systolic elastance index (ELVI) were derived as the ratio of end-systolic pressure to stroke volume index and end-systolic volume index, respectively. End-systolic pressure was estimated from the equation 0.9 × brachial systolic blood pressure. Ventriculo-arterial coupling (VAC) was calculated as the quotient of EAI and ELVI. The ratio of LDEDVI to E/e' mean was used to evaluate LV diastolic compliance. Systemic vascular resistance index was calculated as mean arterial pressure divided by echocardiography calculated cardiac index and multiplied by 80. The arterial venous oxygen content difference (C (A-V) O2 gradient) was calculated by using the Fick equation as: VO2/echocardiography calculated cardiac output. Results Peak VO2 and C (A-V) O2 gradient were increased by CR. However, heart rate reserve, systolic reserve, VAC, diastolic reserve and vasodilation reserve were unchanged by CR (Table 1). Conclusions Increased oxygen uptake and utilization in the peripheral muscles, rather than cardiac function reserve, may be determinants of increased peak VO2 by CR in HF. Table 1 Funding Acknowledgement Type of funding source: None

Correlation Between Exercise-Induced Increases in VO2 Peak and Motor/Cognitive Ability in Sedentary Older Adults

To determine if post-intervention improvements in VO2 peak, an indicator of cardiovascular fitness, were correlated with changes in motor skills and cognitive abilities in older adults.

Feasibility and effects of high-intensity interval training in older adults living with HIV

ABSTRACT Adults with HIV on therapy can live a normal lifespan but exhibit advanced ageing which includes reduced cardiorespiratory fitness. Our objective was to determine the feasibility and effects of high-intensity interval training (HIIT) combined with resistance training (RT) in older adults with HIV. We conducted a cross-over pilot study within a randomized exercise trial in sedentary adults with HIV ≥50 years of age. First, participants were randomized to 4 months of continuous high-intensity aerobic exercise (AEX) and RT 3x/week or standard of care control. Then, the control group completed 4 months of HIIT + RT (3x/week). Among the 32 individuals enrolled, 26 eligible participants were randomized. Most participants were African American (63%) and male (95%) with a mean (SD) age of 61.5 (6.7) years and VO2peak of 24.5 (4.9) ml/kg/min. Attendance and adherence to both exercise training interventions were high. The clinically significant increases in VO2peak (ml/kg/min) after HIIT (3.09 ±1.04, p=0.02) and AEX (2.09 ±0.72, p=0.01) represented improvements of 17.1% and 7.7%, respectively. Both groups had improvements in exercise endurance (time on the treadmill) and strength (all p< 0.01). This pilot study supports HIIT as an efficient means to deliver high-intensity AEX to improve cardiorespiratory fitness toward the goal of attenuating the accelerated ageing process in adults with HIV.

Effects of detraining on cardiorespiratory fitness of individuals with chronic stroke

ABSTRACT Background Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. Objective To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. Methods A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg−1.min−1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg−1.min−1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). Results There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p< .001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p= .001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p= .12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). Conclusions Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life.

Effect of a 12-week training program on the anthropometric and physiological profiles of some participants registered in a fitness center in Douala, Cameroon.

Fitness centers are remarkably abundant in Cameroon. The aim of this work was to assess the effects of a 12-week training program on the anthropometric and physiological profiles of some participants in a fitness center. A total of 86 participants (40 from the experimental group and 46 from the control group) with age ranging from 17 to 53 years were subjected to pre- and posttraining assessments of, anthropometric parameters, physiological parameters, and performance. Anthropometric parameters (weight, height, body mass index [BMI], waist circumference [WC]) and blood pressure (diastolic blood pressure, systolic blood pressure [SBP]) were measured according to standard protocols. Heart rate was recorded using a heart rate monitor. Cardiorespiratory fitness (maximal oxygen uptake or VO2peak) was estimated by the 20-multistage shuttle run test. All the data was collected twice within 12 weeks. Weight, BMI, and WC did not show any significant variation (P>0.05) after a 12-week training program. VO2peak increase was insignificant (P>0.05) higher in men (7.5%, P=0.06), compared to women (5.4%, P=0.4). We noticed a significant reduction (P=0.002) in the SBP of men. Significant increase of HR max was found in women. There was an improvement of 13.7% in the VO2peak of the participants who did not consume alcohol. These results demonstrate the slight benefits of a 12-week training program on health. The weight characteristics of the participants and lifestyle may play an important role in these interactions.

Safety of exercise therapy after acute pulmonary embolism.

The role of exercise therapy after acute pulmonary embolism (PE) is unknown. Exercise therapy is safely used after myocardial infarction and chronic obstructive pulmonary disease. The aim of this study was to investigate the safety of exercise therapy after acute PE. We implemented a 3-month exercise program after acute PE. Outcomes were death, bleeding, readmissions, recurrent events, changes in peak VO2 and quality of life (QoL). A total of 23 patients were enrolled and received anticoagulation; no adverse events were reported during the exercise period. One death, 1 DVT and 5 readmissions were reported due to non-exercise related reasons. Functional capacity improved as evidenced by an increased peak VO2 at 3 months (+3.9 ± 5.6 mL/kg/min; p = 0.05). Improvement in QoL was observed at 6-months on the functional (+17.0 ± 22.6, p = 0.03) and physical health factor scales (+0.9 ± 4.6, p = 0.03). Exercise therapy is feasible and safe in appropriately anticoagulated patients after PE.

Long-term effects of high-intensity training vs moderate intensity training in heart transplant recipients: A 3-year follow-up study of the randomized-controlled HITTS study.

The randomized controlled High-Intensity Interval Training in De Novo Heart Transplant Recipients in Scandinavia (HITTS) study compared 9months of high-intensity interval training (HIT) with moderate intensity continuous training in de novo heart transplant recipients. In our 3-year follow-up study, we aimed to determine whether the effect of early initiation of HIT on peak oxygen consumption (VO2peak ) persisted for 2years postintervention. The study's primary end point was the change in VO2peak (mL/kg/min). The secondary end points were muscle strength, body composition, heart rate response, health-related quality of life, daily physical activity, biomarkers, and heart function. Of 78 patients who completed the 1-year HITTS trial, 65 entered our study and 62 completed the study tests. VO2peak increased from baseline to 1year and leveled off thereafter. During the intervention period, the increase in VO2peak was larger in the HIT arm; however, 2years later, there was no significant between-group difference in VO2peak . However, the mean change in the anaerobic threshold and extensor muscle endurance remained significantly higher in the HIT group. Early initiation of HIT after heart transplantation appears to have some sustainable long-term effects. Clinical trial registration number: NCT01796379.

63Effects of exercise-based cardiac rehabilitation and detraining on exercise capacity and cardiac function in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up

Abstract Introduction We aimed to determine whether maximal exercise capacity, left ventricular function, and quality of life (QoL) scores are sustained in patients with atrial fibrillation (AF) after termination of training following exercise-based cardiac rehabilitation (ECR). Methods In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an exercise training group for 12 months (ECR, n = 13), a group with 6-month detraining after a 6-month exercise training (DT, n = 15), and a medical treatment only group (MT, n = 30). For exercise training, cycling on a bicycle ergometer was performed in the DT and ECR groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warm-up at 60%–70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80%–90% of the HRpeak, with 3 minutes of active recovery at 60%–70% of the HRpeak between intervals, ending with a 5-minute cool-down period. Peak exercise oxygen consumption (Vo2), left ventricular function, plasma lipid level, N-terminal pro B-type natriuretic peptide level, and QoL score were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments. Results Six months of exercise training increased the peak Vo2 (ECR: 28.2 ± 7.0 ml/[kg·min] and DT: 28.0 ± 8.3 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p= 0.047) and QoL scores (36-Item Short-form Health Survey) and decreased the total cholesterol level (ECR: 146.8 ± 43.8 mg/dl and DT: 140.6 ± 22.4 vs. MT: 182 ± 44.2 mg/dl, p = 0.008). Detraining resulted in an increase in QoL score and a decrease in total cholesterol level (ECR: 142.8 ± 21.4 mg/dl and DT: 151.8 ± 39.8 vs. MT: 176.8 ± 34.2 mg/dl, p = 0.017). However, the exercise training-induced increase in peak Vo2 reverted to the baseline level after detraining (ECR: 27.1 ± 5.1 ml/kg/min vs. DT: 24.4 ± 7.2 ml/[kg·min] and MT: 21.5 ± 4.86 ml/[kg·min], p = 0.017). The resting left ventricular systolic and diastolic functions were not significantly different, with no inter-group difference after 6 months of training and 6 months of continuous training or detraining. Conclusions As the QoL scores are maintained despite peak Vo2 being lowered by detraining after an exercise training period in patients with AF, physicians should encourage patients’ participation in a continuous exercise program to sustain the improvement in both the QoL score and peak Vo2 with exercise training. Further studies with larger sample sizes are needed to observe the long-term effects of exercise training and detraining.

64effects of long-term exercise training and detraining on endothelial function and arterial stiffness in patients with atrial fibrillation: a randomized controlled trial with 1-year follow-up

Abstract Introduction Exercise training (ET) improves endothelial function and arterial stiffness in patients with cardiovascular disease. However, whether ET improves endothelial function and arterial stiffness in patients with atrial fibrillation (AF) is unclear. If it does, for how long the effects are sustained remains to be determined. Methods In a prospective study, 58 patients with AF (age, 62 ± 7 years) were randomized into an ET group for 12 months (CT, n = 13), a group with 6-month detraining after a 6-month ET (DT, n = 15), and a medical treatment only group (MT, n = 30). For ET, cycling on a bicycle ergometer was performed in the DT and CT groups 3 times a week for 6 and 12 months, respectively. Each session started with a 10-minute warmup at 60% to 70% of the maximal heart rate (HRpeak), followed by four 4-minute intervals at 80% to 90% of the HRpeak, with 3 minutes of active recovery at 60% to 70% of the HRpeak between intervals, ending with a 5-minute cooldown period. Peak exercise oxygen consumption (Vo2), intimal-medial thickness (IMT) of the carotid artery measured on high-resolution ultrasonography, and left ventricular function were measured at baseline, after 6 months of training, and after additional 6 months of continuous training or detraining follow-up assessments. In addition, plasma von Willebrand factor (vWF), endothelin-1, nitric oxide, tumour necrosis factor alpha, interleukin-1 beta, interleukin-6, and interleukin-10 levels were measured as indices of endothelial function. Results The 6-month ET increased peak Vo2 (CT: 29.0 ± 6.5 ml/[kg·min] and DT: 26.0 ± 8.2 ml/[kg·min] vs. MT: 23.0 ± 5.2 ml/[kg·min], p = 0.04) and decreased plasma vWF levels (CT: 103.7 ± 30.7 IU/dL and DT: 106.0 ± 31.2 IU/dL vs. MT: 145.0 ± 47.7 IU/dL, p = 0.01). Detraining significantly reduced the ET-induced increase in Vo2 and decreased the vWF to baseline level, although continuous ET maintained changes in Vo2 (CT: 28.1 ± 5.3 ml/[kg·min] and DT: 22.4 ± 6.6 ml/[kg·min] vs. MT: 21.5 ± 4.8 ml/[kg·min], p = 0.043) and in vWF (CT: 84.3 ± 39.1 IU/dL vs. DT: 122.2 ± 27.5 IU/dL and MT: 135.9 ± 50.4 IU/dL, p = 0.014). However, carotid arterial IMT, and resting left ventricular systolic and diastolic functions showed no significant changes, with no inter-group differences after 6 months of training and 6 months of continuous training or detraining. Conclusions The decreased vWF level suggested that ET can be a strong non-pharmacologic option to improve endothelial function in patients with AF. However, it can rapidly lose its effects after detraining. Therefore, physicians should encourage their patients to participate in a continuous exercise program to sustain its benefits in terms of improved exercise capacity and endothelial function in patients with AF.

Left ventricular diastolic function: Effects of high-intensity exercise after acute myocardial infarction.

Reduced left ventricular (LV) diastolic function indicates poor prognosis after acute myocardial infarction (AMI). Our aim was to study whether a twelve-week high-intensity interval training program could improve diastolic function in patients with a relatively recent AMI. Twenty-eight patients (mean age 56 (SD 8) years) with a recent AMI performed high-intensity interval training twice a week for 12weeks. Each training session consisted of four 4-minute bouts at 85%-95% of peak heart rate, separated by 4-minute active breaks. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO2peak ). Echocardiography was performed at rest and during an upright bicycle exercise test. There was a significant increase in mitral annulus early diastolic velocity (e') at peak exercise (75W) from baseline to follow-up (7.9 (1.5) vs. 8.4 (1.7) cm/s, P=.012), but no change in e' at rest (7.1 (1.9) vs. 7.3 (1.7) cm/s, P=.42). There was a significant increase in VO2peak (mean (SD), 35.2 (7.3) vs. 38.9 (7.4) ml/kg/min, P<.001). e' at peak exercise correlated with VO2peak both at baseline and follow-up (r=0.50, P=.007, and r=0.41, P=.032). The present study shows that LV diastolic function during exercise is related to VO2peak . We also found an improvement of diastolic function after exercise training, even in a population with a relatively well preserved systolic and diastolic function. The results demonstrate the importance of obtaining measurements during exercise when evaluating the effects of exercise interventions.