Increased Exercise Tolerance Research Articles

ПРОДОЛЖАЮЩИЙСЯ СИМПТОМАТИЧЕСКИЙ COVID-19 – ВОЗМОЖНОСТИ ФАРМАКОТЕРАПИИ

Introduction. The medical community continues to search for modern methods of treating the ongoing symptomatic COVID-19 and post-COVID syndrome. Among all symptoms of ongoing symptomatic COVID-19, respiratory disorders are the most challenging and leading not only to impaired quality of life, but also to patient's disability. Thus, it seems relevant to study various options for the treatment of ongoing symptomatic COVID-19, including drugs with adaptogenic effects. Aim. The aim of the study was to seek the effects of the drug Trecresan on the recovery of patients who had COVID-19 (reduction of the severity of asthenia, restoration of lung function and other indicators) in comparison with standard (real practice) therapy of patients who incurred a new coronavirus infection COVID-19. To evaluate and conduct a comparative analysis of the safety of the treatment regimens used for "ongoing symptomatic COVID-19" with patients who have moderate and severe case of a new coronavirus infection. Material and methods. The study included 103 patients with ongoing symptomatic COVID-19 who were hospitalized in a pulmonology department. The first group included 53 patients who were treated with the drug Trecresan, the 2nd group included 50 patients. During the examination of patients, the following was performed: A comprehensive study of lung function, including the designation of the diffusion capacity of the lungs - DLCO, the level of SpO2 (saturation), a 6-minute walking test, an assessment asthenia severity on the MFI-20 (Multidimensional Fatigue Inventory) scale. The clinical efficiency of complex therapy was analyzed after 8-10 days of treatment. The endpoints necessary for subsequent analysis were the timing of COVID-19 symptoms resolution (severity of asthenia, performance, etc.) and adverse events developed during treatment. Results and discussion. The inclusion of the drug Trekrezan in the treatment of patients with ongoing symptomatic COVID-19 led to an improvement in overall well-being. There was a significant decrease in the severity of asthenia on the MFI-20 scale, a statistically significant decrease in the degree of shortness of breath and improvement in the patient’s quality of life were revealed, a decrease in the inpatient period was noted. Conclusion. It has been established that medium-term therapy using the adaptogen Trekrezan with patients with ongoing symptomatic COVID-19 and post-COVID syndrome reduces the severity of symptoms of the disease, increases exercise tolerance, reduces the severity of asthenia on the MFI-20 scale, reduces the inpatient period.

Effect of Cardiac Rehabilitaion in Percutaneous Transluminal Coronary Angioplasty (PTCA)

Introduction: Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronaryintervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowingunobstructed blood flow to the myocardium. Cardiac rehabilitation is important role for more successful PTCA.To increase cardiac efficiency, increase exercise tolerance or endurance and to get the effective and better results.Case presentation: 45 years male admitted in emergency department with chest pain during gym workout.Blood reports, ECG, ECHO, and angiography done in investigation. In angiography RCA 99% stenosis and in D1ostial 60% stenosis. PTCA procedure done with DES to RCA. Twelve days after surgery patient came for cardiacrehabilitation in physiotherapy department.Management and Outcome: warm-up, aerobic period, and cool-down, abdominal exercise, strengthening exerciseincluded in cardiac rehabilitation. Pulse rate, blood pressure, respiratory rate, Spo2, Rate of perceived exertionscale and 6-min walk test, distance, vo2 max calculated as an outcome.Discussion: Cardiac Rehabilitation is most important for faster recovery as well as better efficiency for cardiacendurance. Maximum oxygen uptake increased after cardiac rehabilitation protocol.Conclusion: Cardiac Rehabilitation is helpful for more successful PTCA.

Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome

To develop a new medical technology for the 3rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort. There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2. The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01). The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

Effects of caffeine on central and peripheral fatigue following closed- and open-loop cycling exercises.

We examined whether endurance performance and neuromuscular fatigue would be affected by caffeine ingestion during closed- and open-loop exercises. Nine cyclists performed a closed-loop (4,000-m cycling time trial) and an open-loop exercise (work rate fixed at mean power of the closed-loop trial) 60 min after ingesting caffeine (CAF, 5 mg/kg) or placebo (PLA, cellulose). Central and peripheral fatigue was quantified via pre- to post-exercise decrease in quadriceps voluntary activation and potentiated twitch force, respectively. Test sensitivity for detecting caffeine-induced improvements in exercise performance was calculated as the mean change in time divided by the error of measurement. Caffeine ingestion reduced the time of the closed-loop trial (PLA: 375.1±14.5 s vs CAF: 368.2±14.9 s, P=0.024) and increased exercise tolerance during the open-loop trial (PLA: 418.2±99.5 s vs CAF: 552.5±106.5 s, P=0.001), with similar calculated sensitivity indices (1.5, 90%CI: 0.7-2.9 vs 2.8, 90%CI: 1.9-5.1). The reduction in voluntary activation was more pronounced (P=0.019) in open- (-6.8±8.3%) than in closed-loop exercises (-1.9±4.4%), but there was no difference between open- and closed-loop exercises for the potentiated twitch force reduction (-25.6±12.8 vs -26.6±12.0%, P>0.05). Caffeine had no effect on central and peripheral fatigue development in either mode of exercise. In conclusion, caffeine improved endurance performance in both modes of exercise without influence on post-exercise central and peripheral fatigue, with the open-loop exercise imposing a greater challenge to central fatigue tolerance.

Benefits of Concurrent Aerobic-Resistance Interval Exercise in Patients with Chronic Obstructive Pulmonary Disease

Physical training of lower leg skeletal muscle has been shown to increase exercise tolerance in Chronic Obstructive Pulmonary Disease (COPD) patients. The objective of this study was to measure the effect of concurrent aerobic-resistance interval exercise on lower leg muscle function and local muscle tissue oxygenation in the vastus lateralis muscle (VLM) of COPD patients.

Комплексная оценка нагрузочного тестирования у женщин репродуктивного возраста с нормальной и избыточной массой тела в условиях прегравидарной подготовки

Relevance. The progressive development of new orientation in preventive medicine and obstetric practice – preconception and prenatal cares, requires the active development and implementation of effective comprehensive programs to optimize physical activity, increase the functional body capacity and dynamic control of blood pressure among women of reproductive age. Materials and methods. At the background of practical implementation for the algorithm of sequential increase in the level of physical activity (apps on Android and Apple platforms) by 1 percentile for 7 days during 5-7 weeks, stress testing by treadmill test according to the modified protocol (R. Bruce) was carried out among 133 patients 20-35 years old with normal body mass (70 women – group One) and body mass excess (63 women – group Two). The assessment is for the tolerability level, for dynamics of body mass and blood pressure by comparison with the source (original) data. Results. In comparison with initial data after preconception care using the author’s algorithm at the background of reaching the sub-maximal CCR (cardiac construction rate) on the treadmill test, unidirectional positive effects of increasing exercise tolerance in both groups were established, but with higher indicators of metabolic equivalent, maximum oxygen consumption chronotropic reserve and shorter recovery time among women with normal body mass by comparison with women with BMI. Conclusions. The reached level of tolerance to physical activity and weight loss were combined with the increase in the effectiveness of pregnancy among the with BMI up to 52,3%. A comparative analysis of the results for complex assessment of load testing in both groups allow for a consistent centile increase in the daily number of locomotions up to 10-12 weeks and an approximation of body weight to the upper limit of the regulatory corridor (75-90 cents) among women with BMI, taking into account their personal consent and under the control of the results of stress testing and blood pressure indicators.

Aerobic Physical Exercise Improves Exercise Tolerance and Fasting Glycemia Independent of Body Weight Change in Obese Females.

Obesity is associated with increased risk of several chronic diseases and the loss of disease-free years, which has increased the focus of much research for the discovery of therapy to combat it. Under healthy conditions, women tend to store more fat in subcutaneous deposits. However, this sexual dimorphism tends to be lost in the presence of comorbidities, such as type 2 diabetes mellitus (T2DM). Aerobic physical exercise (APE) has been applied in the management of obesity, however, is still necessary to better understand the effects of APE in obese female. Thus, we investigated the effect of APE on body weight, adiposity, exercise tolerance and glucose metabolism in female ob/ob mice. Eight-weeks-old female wild-type C57BL/6J and leptin-deficient ob/ob mice (Lepob) were distributed into three groups: wild-type sedentary group (Wt; n = 6), leptin-deficient sedentary group (LepobS; n = 5) and leptin-deficient trained group (LepobT; n = 8). The LepobT mice were subjected to 8 weeks of aerobic physical exercise (APE) at 60% of the maximum velocity achieved in the running capacity test. The APE had no effect in attenuating body weight gain, and did not reduce subcutaneous and retroperitoneal white adipose tissue (SC-WAT and RP-WAT, respectively) and interscapular brown adipose tissue (iBAT) weights. The APE neither improved glucose intolerance nor insulin resistance in the LepobT group. Also, the APE did not reduce the diameter or the area of RP-WAT adipocytes, but the APE reduced the diameter and the area of SC-WAT adipocytes, which was associated with lower fasting glycemia and islet/pancreas area ratio in the LepobT group. In addition, the APE increased exercise tolerance and this response was also associated with lower fasting glycemia in the LepobT group. In conclusion, starting APE at a later age with a more severe degree of obesity did not attenuate the excessive body weight gain, however the APE promoted benefits that can improve the female health, and for this reason it should be recommended as a non-pharmacological therapy for obesity.

Occupational therapy interventions in pulmonary rehabilitation – an update in the COVID-19 ERA

Background. As symptoms of COVID-19 infection are varying in severity and type, the long-term disability is yet to be established due to a short time-window since the pandemic started. Most survivors will have persistent pulmonary symptoms even after the infection, which raises the awareness of the importance of pulmonary rehabilitation in these patients, as they are mostly young, with severely diminished quality of life as they are unable to perform their basic activities of daily living as before. Occupational therapy is a form of rehabilitation treatment aimed at maximizing functionality and independence in performing activities of daily living, improvement of the patient’s autonomy and prevention of further functional decline. Objective. The purpose of the current work is to review the most important occupational therapy interventions applicable during a pulmonary rehabilitation program for chronic pulmonary pathologies, that can also be applied in COVID-19 survivors with persistent respiratory symptoms. Discussion. The main objectives of occupational therapy in pulmonary rehabilitation are training using breathing techniques at rest and during task performance, upper limbs training to increase exercise tolerance, programming and simplifying daily activities, informing patients of the importance of asking for help, planning the day/week, organizing the environment, educating the patient. All these objectives can be achieved in a simple way and at low-cost. Conclusions. Occupational therapy intervention during comprehensive pulmonary rehabilitation must be promoted to specifically evaluate and solve problems related to respiratory disability. Occupational tasks should be related to symptoms occurring during specific activities. Standardized protocols and definition of outcomes during occupational therapy intervention are lacking. Keywords: occupational therapy, pulmonary rehabilitation, COVID-19, activities of daily living, quality of life,

APPLICATION OF "L-BIOCOMPLEX" IN CHRONIC HEART FAILURE TREATMENT IN PATIENTS WITH METABOLIC SYNDROME

The combination of chronic heart failure and metabolic syndrome is a common clinical case. Patients with this pathology belong to the group of a high cardiovascular risk, which is explained by the higher frequency and severity of traditional cardiovascular factors. Of particular interest is the use of "L−BIOCOMPLEX (liposomal)" dietary supplement of "Biolik" company (Kharkiv, Ukraine), available in liposomal form as a set of L−carnitine + thioctic acid in cardiovascular pathology. To study its effect on treatment efficiency, 40 patients with chronic heart failure in combination with metabolic syndrome were examined. The treatment result for the patients whose complex treatment included "L−BIOCOMPLEX" at a dose of 5 ml of L−carnitine and 10 ml of thioctic acid once a day 30 minutes before meals for four weeks, and those receiving only basic therapy. It has been shown that L−BIOCOMPLEX as an additive to standard therapy improves the clinical and functional state of patients: reduces the functional class of chronic heart failure, increases exercise tolerance, enhances diastolic heart function and boosts the left ventricular ejection fraction in the left ventricle. The inclusion of "L−BIOCOMPLEX" in the traditional scheme of therapy helped to improve the quality of life of patients. As part of the combination therapy of the patients with chronic heart failure the "L−BIOCOMPLEX" positively affects lipid and carbohydrate metabolism, reduces atherogenic lipids, diminishes the severity of insulin resistance. Thus, "L−BIOCOMPLEX" has a positive influence on additional risk factors, affecting the cardiovascular prognosis and playing a significant role in the mechanisms of development and progression of heart failure. Key words: "L−BIOCOMPLEX", L−carnitine, thioctic acid, chronic heart failure, metabolic syndrome.

Determination of Specific IgG to Identify Possible Food Intolerance in Athletes Using ELISA

Nutrition is considered one of the foundations of athletic performance, and post-workout nutritional recommendations are fundamental to the effectiveness of the recovery and adaptive processes. Therefore, at present, new directions in dietetics are being formed, focused on the creation of personalized diets. To identify the probable risk of somatic and allergic reactions upon contact with food antigens, we used the method of enzyme-linked immunosorbent assay (ELISA) for the quantitative determination of IgG antibodies in the blood plasma of athletes against protein–peptide antigens accommodated in food. The study enrolled 40 athletes of boating and fighting sport disciplines. We found that the majority of the studied participants were characterized by an elevated IgG level against one or two food allergens (barley, almond, strawberry, etc.). Comparative analysis of the semiquantitative levels of IgG antibodies in athletes engaged in boating and fighting did not reveal significant differences between these groups. As a result, foods that are likely to cause the most pronounced immune response amongst the studied participants can be identified, which may indicate the presence of food intolerances. An athlete’s diet is influenced by both external and internal factors that can reduce or worsen the symptoms of a food intolerance/allergy associated with exercise. The range of foods is wide, and the effectiveness of a diet depends on the time, the place, and environmental factors. Therefore, during the recovery period (the post-competition period), athletes are advised to follow the instructions of doctors and nutritionists. An effective, comprehensive recovery strategy during the recovery period may enhance the adaptive response to fatigue, improving muscle function and increasing exercise tolerance. The data obtained may be useful for guiding the development of a new personalized approach and dietary recommendations covering the composition of athletes’ diet and the prevalence of food intolerance.

Effect of high-flow nasal cannula oxygen therapy on exercise tolerance in patients with idiopathic pulmonary fibrosis: A randomized crossover trial.

Exercise capacity in idiopathic pulmonary fibrosis (IPF) is limited by exercise-induced hypoxaemia. This study aimed to examine the effect of high-flow nasal cannula oxygen therapy (HFNC) on exercise tolerance in patients with IPF. We conducted a single-centre, open-label, randomized crossover trial to compare HFNC and Venturi mask (VM) therapy in terms of exercise tolerance. Patients underwent constant-load symptom-limited exercise testing at 80% peak work rate with HFNC or a VM in a randomized order. The settings were 60 L/min and a 50% fraction of inspired oxygen (FiO2 ) for HFNC and 12 L/min and 50% FiO2 for VM. The primary outcome was endurance time, and the secondary outcomes were heart rate (HR), percutaneous oxygen saturation (SpO2 ), dyspnoea and leg fatigue, as determined by the modified Borg Scale at the isotime and endpoint, and the level of comfort while using the devices. Twenty-four participants (75.0% men; age, median [interquartile range]: 77.5 [68.8-83.0] years) were enrolled. Compared with VM, HFNC significantly improved the endurance time (647.5s [454.0-1014.8] vs. 577.5 s [338.0-861.5]), minimum SpO2 (96.0% [95.0-98.0] vs. 94.0% [92.8-96.0]) and leg fatigue at the isotime (3.0 [1.6-4.0] vs. 5.0 [3.0-6.3]) and endpoint (4.0 [2.8-5.0] vs. 5.0 [3.8-6.3]). Differences in maximum HR, dyspnoea at the isotime and endpoint and comfort were non-significant between HFNC and VM therapy. HFNC increased exercise tolerance in patients with stable IPF experiencing exercise-induced hypoxaemia.

Assessment of sexual and physical activity of patients after implantation of left ventricular assist device (LVAD)

Abstract Background Patients with cardiovascular diseases also suffer from problems related to the sexual sphere, among others: reduction or loss of libido, avoiding sexual activity, impotence. They may result from depressive disorders and the fear of the appearance of health and life-threatening symptoms during sexual intercourse (dyspnea, angina, myocardial infarction, arrhythmias, sudden death). The aim of the study was to evaluate sexual and physical activity in patients after implantation of left ventricular assist device (LVAD). Methodology The study included 50 men aged 18–66, average 55 years, after LVAD implantation. Finally 20 patients did not complete the program and were excluded from the analysis. The subjects were assessed by a sexologist in terms of the quality of sexual life and erectile dysfunction. Sexological counselling and education (positions during intercourse, safety recommendations) and physical activity (training forms, frequency and duration of training) were conducted, 13 patients were qualified for pharmacological treatment of erectile dysfunction. The level of physical activity (according to International Physical Activity Questionnaire, IPAQ) and sexual satisfaction (questionnaire) as well as quality of sexual life (Mell-Krat Scale) were assessed before LVAD implantation and after 6 months. Additionally, exercise tolerance was evaluated with 6 minute walk test (6-MWT). The tests were repeated after 6 months. Results After the implementation of sexual and physical activity education, a significant improvement was observed in the results of the parameters tested: 6-MWT [m]: 355.5 (131.1) vs. 465.5 (93.8), p&amp;lt;0.001, IPAQ [met / min / week]: 1.411.5 (513.4, 2.465.2) vs. 3.870.0 (983.0, 5.274.0), p&amp;lt;0.002, sexual satisfaction: 26.5 (24.2, 28.0) vs. 28.5 (27.2, 29.0), p&amp;lt;0.01. The quality of sex life in the whole group significantly decreased after LVAD implantation compared to the period before onset of the disease, Mell-Krat Scale score: 50.0 (46.0, 51.8) vs. 26.0 (9.2, 48.5), p&amp;lt;0.001. In patients who received pharmacological treatment, the quality of sexual life assessed by the Mell-Krat Scale improved significantly: before treatment 10.0 (8.0, 13.0) vs. 34.0 (6.0, 37.0) after treatment, p&amp;lt;0.006, but did not return to pre-onset levels. A significant positive correlation was observed between the assessment of sexual satisfaction and the results of 6-MWT and IPAQ score. Conclusions Sexual health education significantly improves sexual satisfaction in patients following LVAD implantation. Increasing exercise tolerance and the level of daily activity has a positive effect on the subjective assessment of sexual satisfaction. However, the quality of sexual life significantly decreases after LVAD implantation and even after pharmacological treatment it does not return to the level from before the onset of the disease. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): STRATEGMED II - RH-ROT - NATIONAL RESEARCH AND DEVELOPMENT CENTER

Acute effect of oxygen therapy on exercise tolerance and dyspnea perception in ILD patients.

Ambulatory oxygen therapy (AOT) is commonly prescribed in interstitial lung disease (ILD) patients, with the aim of reducing dyspnea and increasing exercise tolerance. Despite its frequent use and a reasonable physiological rationale, there is a lack of evidence supporting the effect of AOT on improving dyspnea during exercise. Moreover, dyspnea encompasses distinct sensory (intensity, quality) and affective (anxiety, fear) components with different underlying neurophysiological mechanisms. The aim of this study was to evaluate the effect of oxygen supplementation on exercise tolerance and dyspnea in ILD patients with exercise induced hypoxia (EIH). Forty-seven ILD patients performed a six-minute walk test (6MWT) on room air (RA) and with oxygen supplementation (Ox). The 6MWT distance (6MWD) was significantly greater with oxygen supplementation (RA: 242±143 m vs Ox: 345±106 m p<0,01). With oxygen supplementation, the overall dyspnea and anxiety significantly decreased both at rest [1.1±1.4 Borg Unit (BU)] vs 0.4±0.9BU, p.<0.01, and 1.1±1.6BU vs 0.5±1.3 BU, p.<0.05, respectively) and at the end of exercise (5.1±2.6 BU vs 3.7±2.5 BU, p<0.001 and 3.4 ±2.9 vs 2.5±2.8, p.<0.01, respectively) despite a greater walked distance. In ILD patients with EIH, oxygen supplementation increases the exercise tolerance and reduces overall dyspnea perception and the anxiety component of breathlessness.

Impact of ranolazine on exercise tolerance and arrhythmias in patients with INOCA

The aim of the study to evaluate the effect of supplementation of basic therapy by ranolazine in patients with INOCA on exercise test parameters and Holter ECG monitoring.&#x0D; Materials and methods. 53 patients with stable coronary heart disease were examined, including 18 men (33.9 %) and 35 (66 %) women, the average age of patients was 57 (±9.68) years. According to the results of coronary angiography all patients had non-obstructive coronary arteries. In addition to physical and laboratory examination, bicycle ergometry, Holter ECG monitoring and echocardiography were included in the examination of patients. Patients were divided into 2 groups: group I - patients who in addition to standard therapy received ranolazine at a dose of 1000 mg twice a day for 6 months, and group II patients with standard coronary heart disease therapy. After 6 months from the beginning of the observation an objective examination, echocardiography, exercise test, Holter ECG monitoring were repeated.&#x0D; Results. The study found that patients receiving ranolazine in addition to standard therapy had a statistically significant increase in exercise duration after 6 months compared with baseline and group II. Before treatment in group I, the duration of the exercise test was 356.51±180.24s, and after treatment 414.32±142.10s (p=0.03). In group II, the duration of the test before treatment was 361.4±160.24 c, and after 380.5±152.2 s (p=0.15). It was also found that the duration of the test differed significantly in group I after treatment of patients from group II after treatment of patients with a standard treatment regimen (p=0.04). According to the results of Holter ECG monitoring in group I found a positive effect of ranolazine on the frequency of ventricular arrhythmias: before treatment n=1142 [30; 2012], after treatment n=729 [23; 1420], while in group II a significant difference between the number of extrasystoles before treatment and after not detected (n=1026 [17; 1920], n=985 [15; 1680], respectively) p=0.18.&#x0D; Conclusions. The addition of ranolazine to the basic therapy of patients with non-obstructive coronary arteries disease helps to increase exercise tolerance (according to the loading stress test) and contributes to a significant reduction in the number of ventricular arrhythmias (according to Holter-ECG) compared with both baseline and group II

September 2021 at a glance: focus on biomarkers, sex differences and adherence to medical treatment.

Biomarkers represent useful tools in the management of patients with heart failure (HF). 1-3 Antigen carbohydrate 125 (CA125) is a novel marker of congestion, inflammation and right-sided HF. It emerged as an affordable and widely available tool for tailoring HF therapies and prognostic stratification, since high serum levels are associated with an increased risk of death and HF hospitalization.4 The role of cardiac troponin in HF is well-established.5 In the Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced), increasing levels of high-sensitivity cardiac troponin T (hs-cTnT) were associated with higher rates of comorbidities (i.e. diabetes and atrial fibrillation), more advanced New York Heart Association functional class, decreased renal function, higher concentrations of natriuretic peptides and worse clinical course. However, empagliflozin reduced the primary endpoint of cardiovascular death or HF hospitalization, regardless of baseline hs-cTnT levels,6 confirming the role of sodium–glucose co-transporter 2 (SGLT2) inhibitors as an essential treatment for patients with HF with reduced ejection fraction (HFrEF).7-9 Sex-based differences exist among patients with HF.10, 11 In the Effects of High-Dose versus Low-Dose Losartan on Clinical Outcomes in Patients with Heart Failure (HEAAL) trial, women appeared to respond similarly to low and high doses of losartan, whereas men had more benefits with high doses. However, women were older compared with men and more frequently presented severe symptoms and renal dysfunction.12 Sex differences were also investigated in the Patient-centered Care Transitions in Heart Failure: A Pragmatic Cluster Randomized (PACT-HF) study, enrolling 986 patients with the aim to test the effect of a patient-centred transitional care model. Such model improved discharge preparedness, transition quality, and the health-related quality of life both at 6 weeks and 6 months, with no differences between men and women. Women had a lower quality of life score at discharge, but experienced more benefits from treatment compared with men.13 Dietary interventions are related to HF incidence and outcome.14, 15 A meta-analysis, including 122 randomized controlled trials and 176 097 participants, summarized and confirmed the impact of nutritional and dietary interventions on HF-related outcomes. In particular, coenzyme Q10 was associated with lower all-cause mortality, whereas Mediterranean diet was related with a lower risk of developing HF.16 Ergoreflex is a cardiorespiratory reflex activated during physical effort. HF patients often develop skeletal myopathy,17 which is associated with increasing ergoreflex sensitivity and dyspnoea on effort. Exercise training represents a valuable strategy to reduce such sensitivity and increase exercise tolerance.18 Among the quality of life measures tested in the PARALLAX trial (a randomized controlled trial of sacubitril/valsartan vs. individualized medical therapy in heart failure with mildly reduced and preserved ejection fraction), the Short Form Health Survey-36 physical functioning score was the most closely correlated with 6-min walk test (6MWT). A modest correlation was found between 6MWT and Kansas City Cardiomyopathy Questionnaire clinical summary score. Many factors were associated with worse values in both quality of life and exercise capacity (i.e. female sex, higher body mass index, higher levels of N-terminal pro-B-type natriuretic peptide and coronary artery disease).19 Adherence to guideline-directed medical therapy (GDMT) improves outcome in patients with HFrEF.20, 21 However, GDMT remains suboptimal in a large proportion of patients.22 A recent multinational observational study confirmed strong patterns of GDMT low-titration in HF patients. Target dose of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers, beta-blockers, and angiotensin receptor–neprilysin inhibitors, was achieved in 15%, 10%, 12%, and 30% of patients, respectively. An early discontinuation of therapy was frequently observed, with ACEi being the most withdrawn agent (55% at 12 months), followed by mineralocorticoid receptor antagonists (MRA) (40% at 12 months).23 Bhatt et al.24 evaluated the effects of both sacubitril/valsartan and enalapril on co-prescribed beta-blockers and MRA in the Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HH) trial. Sacubitril/valsartan did not influence beta-blocker treatment nor MRA initiation, but led to fewer MRA discontinuation compared to enalapril. The coronavirus disease 2019 (COVID-19) pandemic represented a great burden for the HF community.25-30 Management of heart transplant recipients require even tighter precautionary measures in this historical era.31 In a prospective single centre cohort study, including heart transplant recipients, short-term immunogenicity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine has been evaluated. Only 15% of patients displayed the presence of anti-spike IgG antibodies after the first dose, and a total of 49% responded to the full two-dose vaccine schedule. Older age and anti-metabolite-based immunosuppression were associated with lower immunogenicity.32

Practical Recommendations for High-Intensity Interval Training for Adults with Cardiovascular Disease

Apply It! • High-intensity interval training (HIIT) can be implemented safely in adults with cardiovascular disease (CVD) after a graded exercise test assessing exercise responses at a high intensity (e.g., to 85% heart rate peak [HRpeak] or a rating of perceived exertion [RPE] of 15). • Always involve the patient in the decision-making process for selecting the mode of exercise to perform HIIT to increase adherence, compliance, and enjoyment to the exercise program. • Given the low exercise tolerance that is typically experienced by patients with CVD, short duration high-intensity bouts (e.g., 30 seconds to 1 minute) may be necessary to increase exercise tolerance and self-efficacy. Active or passive recovery interspersed between high-intensity intervals should be equal to or greater than the duration of the high-intensity intervals. Passive recoveries should be avoided if a person experiences vasovagal symptoms/events.

Oxidative phenotype induced by aerobic physical training prevents the obesity-linked insulin resistance without changes in gastrocnemius muscle ACE2-Angiotensin(1-7)-Mas axis

BackgroundWe investigate the effect of aerobic physical training (APT) on muscle morphofunctional markers and Angiotensin Converting Enzyme 2/Angiotensin 1-7/Mas receptor (ACE2/Ang 1-7/Mas) axis in an obesity-linked insulin resistance (IR) animal model induced by cafeteria diet (CAF).MethodsMale C57BL/6J mice were assigned into groups CHOW-SED (chow diet, sedentary; n = 10), CHOW-TR (chow diet, trained; n = 10), CAF-SED (n = 10) and CAF-TR (n = 10). APT consisted in running sessions of 60 min at 60% of maximal speed, 5 days per week for 8 weeks.ResultsTrained groups had lower body weight and adiposity compared with sedentary groups. CAF-TR improved the glucose and insulin tolerance tests compared with CAF-SED group (AUC = 28.896 ± 1589 vs. 35.200 ± 1076 mg dL−1 120 min−1; kITT = 4.1 ± 0.27 vs. 2.5 ± 0.28% min−1, respectively). CHOW-TR and CAF-TR groups increased exercise tolerance, running intensity at which VO2 max was reached, the expression of p-AMPK, p-ACC and PGC1-α proteins compared with CHOW-SED and CAF-SED. Mithocondrial protein expression of Mfn1, Mfn2 and Drp1 did not change. Lipid deposition reduced in CAF-TR compared with CAF-SED group (3.71 vs. 5.53%/area), but fiber typing, glycogen content, ACE2 activity, Ang 1-7 concentration and Mas receptor expression did not change.ConclusionsThe APT prevents obesity-linked IR by modifying the skeletal muscle phenotype to one more oxidative independent of changes in the muscle ACE2/Ang 1-7/Mas axis.

Physical Training effectiveness and Tolerance in Patients after Myocardial Infraction, Depending on the Initial Physical activity Tolerance

Aim. To investigate exercise tolerance in patients undergoing acute coronary syndrome with outcome in myocardial infarction, dependingon physical activity tolerance. Material and methods. We studied 80 patients aged from 40 to 75 years old who were admitted from primary vascular centers for athree-week rehabilitation course to the department of medical rehabilitation for patients with somatic diseases of the clinic of the IvanovoState Medical University of the Ministry of Health of Russia, of which 61 were men (76,3%) and 19 women (23,7%). In accordancewith the aim of the study, a 6-minute walk test was performed in all patients before and after the completion of the rehabilitationcourse. Based on the test results, physical exercise tolerance was assessed and the functional class (FC) of coronary heart disease (CHD) was determined. The patients with I class coronary heart disease (CHD) in the number of 20 patients (25%) made up the 1st group, 21patients (26,3%) with II class – the 2nd group, 21 patients (26,3%) with III class – the 3rd group, and 18 patients (22,5%) with IV class– the 4th group. Results. Every third patient who was admitted to a 3-week cardiac rehabilitation course had short-term adverse reactionson loading during physical training on simulators. Most cases of inadequate reactions were noted in patients with III and IV IHDclass III (according to the 6-minute walk test) having, according to the International Classification of Functioning, Disability and Health(ICF), moderate and pronounced reduction of exercise tolerance function. Patients often had tachycardic and hypertensive reactionsin the porcess of prysical training on stimulators and some patients (more often those with the pronounced decrease in exercise tolerancefunction) had hypotensive reaction which is the most unfavorable type of response to the load. In the vast majority of patientswith I and II CHF with no impairment or mild decrease in exercise tolerance according to ICF, an adequate response of hemodynamicparameters to exercise was determined. Adverse reactions were observed only in every fifth-seventh patient and were manifested onlyin the form of tachycardic and hypertensive reactions to exercise. The study analyzed the effectiveness of rehabilitation measures inthe groups of patients with different levels of tolerance to physical activity. It was found out that all the patients with myocardial infarction,regardless of the initial level, had increased exercise tolerance after cardiac rehabilitation. Conclusion. The 6-minute walk test is insufficiently informative for patients with markedly reduced tolerance to physical activity. The«gold standard» of qualitative and quantitative assessment of reactions and interaction between cardiovascular and respiratory systems,as well as metabolic response of the body during physical activity for these patients is the spiroergometric study.

Evaluation of the effectiveness of low-frequency magnetotherapy in the rehabilitation of patients with pneumonia caused by the SARS-CoV-2 virus (the causative agent of COVID-19)

The study aimed to evaluate the effectiveness of the low-frequency magnetic therapy with a "running" magnetic field in medical rehabilitation after COVID-19 pneumonia. Materials and research methods: The study included 42 patients (24 men and 18 women) aged 40 to 65 years, who had pneumonia (J16.8) caused by the new coronavirus SARS-CoV-2. The first group included 22 patients who received standard drug therapy and starting from the 20th day after discharge from the hospital, this group of patients received low-frequency magnetotherapy with a “running” pulsed magnetic field of the ALMAG-02 apparatus. The second group included 20 patients who received the same treatment, except for magnetotherapy. Results: The course of rehabilitation measures carried out led to an increase in the functional capabilities of the cardio-respiratory system in patients of both groups, an increase in chest excursions, an increase in the vital capacity of the lungs, the normalization of the act of breathing and ventilation of the lungs, and an improvement in the psychosomatic status of patients. In the main group, these changes are more pronounced than in the control group, which is associated with the inclusion in the complex treatment of low-frequency magnetotherapy with a “running” pulsed magnetic field. Conclusion: The use of low-frequency magnetic therapy with a "running" pulsed magnetic field in the complex of rehabilitation measures for patients who have suffered from COVID-19 pneumonia significantly improves the somatic status of patients, increases exercise tolerance, and optimizes the function of external respiration. Keywords: magnetotherapy, COVID-19, pneumonia

A randomized placebo-control trial of the acute effects of oxygen supplementation on exercise hemodynamics, autonomic modulation, and brain oxygenation in patients with pulmonary hypertension

BackgroundThe integrative physiological effects of O2 treatment on patients with pulmonary hypertension (PH) during exercise, have not been fully investigated. We simultaneously evaluated, for the first time, the effect of oxygen supplementation on hemodynamic responses, autonomic modulation, tissue oxygenation, and exercise performance in patients with pulmonary arterial hypertension (PAH)/Chronic Thromboembolic PH(CTEPH). Material-methodsIn this randomized, cross-over, placebo-controlled trial, stable outpatients with PAH/CTEPH underwent maximal cardiopulmonary exercise testing, followed by two submaximal trials, during which they received supplementary oxygen (O2) or medical-air. Continuous, non-invasive hemodynamics were monitored via photophlythesmography. Cerebral and quadriceps muscle oxygenation were recorded via near-infrared spectroscopy. Autonomic function was assessed by heart rate variability; root mean square of successive differences (RMSSD) and standard-deviation-Poincare-plot (SD1) were used as indices of parasympathetic output. Baroreceptor sensitivity (BRS) was assessed throughout the protocols. ResultsNine patients (51.4 ± 9.4 years) were included. With O2-supplementation patients exercised for longer (p = 0.01), maintained higher cerebral oxygenated hemoglobin (O2Hb;p = 0.02) levels, exhibited an amelioration in cortical deoxygenation (HHb;p = 0.02), and had higher average cardiac output (CO) during exercise (p < 0.05), compared to medical air; with no differences in muscle oxygenation. With O2-supplementation patients exhibited higher BRS and sample-entropy throughout the protocol (p < 0.05) vs. medical air, and improved the blunted RMSSD, SD1 responses during exercise (p = 0.024). ConclusionWe show that O2 administration improves BRS and autonomic function during submaximal exercise in PAH/CTEPH, without significantly affecting muscle oxygenation. The improved autonomic function, along with enhancements in cardiovascular function and cerebral oxygenation, probably contributes to increased exercise tolerance with O2-supplementation in PH patients.