Mean Exercise Time Research Articles

Detection of ischemia in kidney transplant candidates: is pharmacological stress echocardiography essential?

Abstract Introduction and Objectives The increase in the average age of candidates for kidney transplantation (KT) implies a higher number of comorbidities and cardiovascular risk (CVR). Pharmacological stress echocardiography (SE) is frequently preferred over exercise to assess pre-surgical CVR in these patients. However, this preference is based on the assumption that they have poorer functional capacity, which is not sufficiently supported by scientific evidence. The objective of this study is to determine the cardiovascular risk profile of kidney transplant candidates and the utility of exercise echocardiography (EE) for risk stratification and predicting complications arising from the transplant. Methods Retrospective analysis of patients referred to Cardiology for pre-KT evaluation following our local protocol, between January 2021 and December 2023. EE was preferably performed if the patient had adequate ambulation capacity, using a treadmill with the Bruce protocol to maximum capacity, setting the target heart rate at 85% of the theoretical maximum heart rate (TMHR, 220-age). Functional capacity was measured in exercise time (ET) and metabolic equivalents (METs). SE was performed with dobutamine or dipyridamole. Results Forty-six patients with advanced renal failure were included, 63% on renal replacement therapy (RRT), with a mean age of 66± 11 years and 76.1% male. In 70% of the patients, EE was initially performed, with 13 studies (34%) being inconclusive due to TMHR criteria, of which 8 subsequently required SE (17% of the total). The mean exercise time was 6.11± 2.9 minutes. The mean functional capacity was 6.8 ± 2.3 METs, slightly lower than predicted for sex and age (7.5 METs), but this difference was not significant (p=0.23). Among the SEs (30%), one study was performed with dipyridamole, and the rest with dobutamine, with complications such as non-sustained ventricular arrhythmias and arterial hypotension recorded in 2 SEs. Only one study was positive for inducible ischemia, for which a coronary angiography was performed without significant lesions. A total of 11 patients (24%) received KT, with no cardiovascular complications recorded during the perioperative period. Conclusions Patients with advanced renal failure or on RRT who are candidates for KT, despite their high CVR, have a low incidence of inducible ischemia and acceptable functional capacity. EE is a test that allows for cardiovascular risk assessment prior to the intervention in most patients, with fewer complications than SE. Baseline characteristics

Assessing the Use of a Training Model Using Immersive Virtual Reality for Sacrospinous Fixation Surgery: A Pilot Study.

Sacrospinous fixation (SSF) is a surgical complex procedure for uterovaginal prolapse that may result in pudendal plexus and vascular damage. The objective was to evaluate a training model using virtual reality to perform SSF. We conducted a prospective single-center pilot study in the university's academic innovation department in November 2023. We recruited 20 participants, 10 gynecology resident surgeons (group 1) and 10 experienced gynecology surgeons (group 2). The mean age was 26.6 ± 0.6years in group 1 and 39.7 ± 3.1years in group 2. The satisfaction rate reached 90% in both groups. A scale from 1 to 4 (1 = not-at-all, 4 = completely) was used to assess participants' perceptions. The realism of the simulation was rated at 3.3 ± 0.1 in group 1 and 3.5 ± 0.2 in group 2 (p = 0.41), the haptic feedback was rated at 2.0 ± 0.3 and 1.8 ± 0.3 (p = 0.66), the mean exercise time was 6.4 ± 1.3min and 4.8 ± 0.7min (p = 0.58), and the mean success rate was 70.8 ± 3.2% and 83.5 ± 6.8% (p = 0.14). In group 2, left and right instruments were placed at 2.6 ± 0.8mm and 2.9 ± 0.7mm from the target respectively, and in group 1 at 4.8 ± 0.7mm and 3.8 ± 0.5mm respectively. Participants reported greater comfort in performing sacrospinous fixation after simulation training (3.0 ± 0.2 versus 2.3 ± 0.3, p = 0.17). Our virtual reality simulation model is feasible and accurate for SSF training for both residents and experienced surgeons with a high level of satisfaction. Virtual reality simulation improves technical skills and promotes surgical comfort.

Effects of native vitamin D supplementation on vitamin D status and body composition after sleeve gastrectomy: A retrospective study in Japanese patients

IntroductionThe effect of vitamin D status after bariatric surgery on postoperative skeletal muscle condition has not been adequately studied. MethodsClinical data from 83 patients (median age 44 years, BMI 40.4 kg/m2) who underwent sleeve gastrectomy (SG) were collected from medical records and analyzed retrospectively. Of the 83 patients, 37 who received continuous guidance on native vitamin D3 supplementation from before to 12 months after surgery were defined as the vitamin D supplementation (VDS) group, and 46 patients who did not receive such guidance as the control group. Native vitamin D3 supplement was provided by a dietitian at preoperative and postoperative visits. The supplementation dose was prescribed at 3000 IU/day after SG. ResultsIn VDS group, blood 25-hydroxyvitamin D (25OHD) level increased significantly from 18.5 at baseline to 29.7 ng/mL at 3 months after surgery and plateaued, while 25OHD level remained low in the control group. In the analysis that included both groups, change in 25OHD level from baseline to 12 months after surgery correlated significantly with mean vitamin D intake (r = 0.596, p < 0.001) and 12-month post-SG/baseline ratio of percent lower limb skeletal muscle mass (r = 0.469, p < 0.05). Multiple regression analysis identified change in 25OHD level and mean exercise time as significant factors independently associated with 12-month post-SG/baseline ratio of percent lower limb skeletal muscle mass. ConclusionVitamin D3 supplementation after SG is useful for improving vitamin D status that may be associated with prevention of postoperative lower limb skeletal muscle mass loss.

Feasibility and safety of exercise during chemotherapy in people with gastrointestinal cancers: a pilot study

PurposeSarcopenia is a poor prognostic factor in cancer patients, and exercise is one of the treatments to improve sarcopenia. However, there is currently insufficient evidence on whether exercise can improve sarcopenia in patients with advanced cancers. This study examined the feasibility of exercise in advanced gastrointestinal (GI) cancer patients treated with palliative chemotherapy.MethodsBetween 2020 and 2021, 30 patients were enrolled in a resistance and aerobic exercise program for six weeks. The exercise intervention program (EIP) consisted of low, moderate, and high intensity levels. Patients were asked to select the intensity level according to their ability. The primary endpoint was the feasibility of the EIP measured by compliance during the six weeks. A compliance of over 50% was considered acceptable. The secondary endpoints were changes in weight and muscle mass, safety, quality of life (QoL) and overall survival (OS).ResultsThe median age of the study’s participants was 60 (30–77). The total compliance to the EIP was 63.3% (19/30 patients). Sixteen (53.3%) patients had a compliance of over 80%. The attrition rate was 30.0% (9/30). The mean exercise time was 41.4 min, and the aerobic exercise was 92.3% and the resistant exercise was 73.7%, and both exercise was 66.5%. Most patients performed the moderate intensity level exercises at home or near their home. The mean skeletal muscle index (SMI) was 43.5 cm2/m2 pre-chemotherapy and 42.2 cm2/m2 after six weeks of chemotherapy, with a decrease of -1.2 ± 2.8 cm2/m2 (-3.0%) (p = 0.030). In the poor compliance group, the mean SMI decrease was -2.8 ± 3.0 cm2/m2 which was significantly different (p = 0.033); however, in the good compliance group, the mean SMI decrease was -0.5 ± 2.5 cm2/m2 which was maintained over the six weeks (p = 0.337). The good compliance group had a significantly longer median OS compared with the poor compliance group (25.3 months vs. 7.9 months, HR = 0.306, 95% CI = 0.120–0.784, p = 0.014). The QoL showed a better score for insomnia (p = 0.042). There were no serious adverse events.ConclusionsThe EIP during palliative chemotherapy in advanced GI cancer patients showed good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The EIP was safe, and the QoL was maintained. Based on this study, further research in exercise intervention in advanced cancer patients is needed.Clinical trial registrationThe clinical trial registration number is KCT 0005615 (CRIS, https://cris.nih.go.kr/cris/en/); registration date, 23rd Nov 2020.

The direct effect of exercise on the mental health of scientific and technological professionals and the mediating effects of stress, resilience, and social support.

High working pressure is one of the main causes of occupational sub-health problems in scientific and technological professionals. With the development of exercise psychology, an increasing number of scholars have begun to focus on the influence of exercise on mental health. However, a limited number of scholars have investigated the effects of exercise on mental health and related mechanisms among scientific and technological professionals. Thus, this study aimed to investigate the relationship between exercise and the mental health of scientific and technological professionals and the mediating roles of stress, resilience, and social support. The respondents in this study were recruited using snowball sampling techniques and finally collected a total of 1,248 valid responses. Questionnaires were distributed through "www.wjx.cn (An online questionnaire website in China, which provides similar functions with Amazon MTurk)" in Henan province from November to December 2021. Participants were asked to complete the Positive Mental Health Scale, the stress subscale of the Depression Anxiety and Stress Scale (21 items), the Connor-Davidson Resilience Scale, and the Perceived Social Support Scale. A total of 1,248 valid responses were obtained. The mean exercise time of males was longer than that of females (t = 3.65, p < 0.01). Exercise and mental health were significantly associated with differences in age (F = -8.57, F = -4.66, p < 0.01) and educational background (F = 12.86, F = 7.14, p < 0.01). There were significant correlations among exercise, mental health, stress, resilience, and social support (p < 0.01). The direct effects of exercise on mental health were significant (β = 0.271, t = 9.577, p < 0.001), and the mediating effects of stress, resilience, and social support were also significant (χ2/df = 4.72, CFI = 0.940, TLI = 0.935, SRMR = 0.048, RMSEA = 0.055). This study explored the effects of exercise on mental health and related mechanisms among scientific and technological professionals, which is beneficial to providing effective suggestions for managing and preventing the mental health of scientific and technological professionals. Future research should include a wider range of participants and adopt a longitudinal follow-up design to more deeply investigate the relationship between exercise and the mental health of scientific and technological professionals.

Effectiveness of Unsupervised Exercise Therapy After Endovascular Treatment for an Iliac Occlusive Lesion.

Exercise therapy has acceptable outcomes for patients with intermittent claudication (IC), but there are few reports on the results of continuous unsupervised exercise therapy after endovascular treatment (EVT) for an iliac lesion. The aim of this study is to analyze the long-term outcomes of unsupervised exercise therapy for patients after EVT. A retrospective analysis was performed in 76 patients (93 limbs) with IC who underwent iliac EVT from 2012 to 2020 at our hospital. Maintenance of unsupervised exercise therapy was evaluated at 6months after EVT. Long-term outcomes such as primary patency, clinically driven target lesion revascularization (CD-TLR), survival, and major adverse cardiovascular events (MACE) were compared between patients who continued (cET group) or discontinued (dET group) unsupervised exercise therapy. A total of 28 patients (37%) continued unsupervised exercise therapy until 6months after EVT for an iliac lesion. There were no differences in patient background and procedural details between the cET and dET groups. The follow-up rate was 96% in a median follow-up period of 35 [25 - 42]months. The mean exercise time in the cET group was 52 ± 18minutes daily, with a mean frequency of 5.8 ± 1.1days per week. The median step count in the cET group was 5559 ± 2908 steps daily. At 3years, the cET group had significantly higher rates for primary patency (97% vs 71%, P = .002), and freedom from CD-TLR (97% vs 79%, P = .007); and a tendency for higher survival (100% vs 94%, P = .074), and higher freedom from MACE (89% vs 73%, P = .12). The findings of this study suggested superior long-term outcomes, including primary patency, freedom from CD-TLR, survival, and freedom from MACE, in patients who maintained continuous unsupervised exercise therapy after EVT.

Effects of mixed-cooling strategies on executive functions in simulated tennis in hot and humid conditions.

This study aimed to investigate the effects of mixed-cooling strategies, which combines external (cooling vest + neck cooled collar) and internal cooling (cold sports drink ingestion) on measures of executive function during simulated tennis in hot/humid conditions. In a counterbalanced design (randomised order), eight males undertook two trials [one with the mixed-cooling strategy, (MCOOL condition) and another without (CON condition)] in a climate chamber (36.5°C, 50% relative humidity). All subjects completed an intermittent treadmill protocol simulating a three-set tennis match with a 90-second break during odd-numbered games and 120-second breaks between sets, in accordance with the activity profile and International Tennis Federation rules. The mixed-cooling strategies were adopted before test and break time during the simulated tennis match. Stroop task, 2-back task, More-odd shifting task, gastrointestinal temperature (Tgi), skin temperature, blood lactic acid (BLA), heart rate, urine specific gravity (USG), sweat rate (SR), thermal sensation (TS) and perceived exertion (RPE) were measured. Results showed that the mean exercise time was longer in the MCOOL condition than in the CON condition. The SR was greater in CON trial compared with that in MCOOL trial. Results of two-way analysis of variance with repeated measures revealed that time×condition interactions were significant in BLA, Stroop response time, and switch cost of the more-odd shifting task. There were main effects of condition for Tgi, HR, TS, RPE, BLA, Stroop response time, and switch cost of the more-odd shifting task. In a hot/wet environment, pre- and intermittent mixed-cooling strategies can significantly improve exercise time and measures of executive function of tennis players in a simulated tennis match.

Peak oxygen consumption is associated with the inotropic reserve in patients with heart failure with reduced ejection fraction undergoing cardiopulmonary testing

Abstract Background The role of cardiopulmonary exercise testing (CPET) in the prognostic evaluation of heart failure with reduced ejection fraction (HFrEF) is powerful and well-established. Nevertheless, the value of CPET in predicting left ventricular inotropic reserve in HFrEF remains unknown. Purpose The investigation of possible associations between CPET variables and left ventricular contractile reserve in patients with HFrEF. Methods Consecutive patients aged ≥18 years old with a diagnosis of heart failure and a left ventricular ejection fraction ≤40%, as assessed by echocardiography, were prospectively enrolled. Demographic and clinical data were recorded. All subject underwent CPET with either a Bruce or a modified Bruce protocol. Peak oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation to carbon dioxide production (VE/VCO2) slope, minute ventilation (VE), and VO2/heart rate (HR) values were calculated, while hemodynamic parameters during the test were also measured. Results In total, 191 patients with HFrEF were included in the analysis. The mean age was 58.8±11.8 years and 30 (15.7%) patients were women. Ischemic heart disease was the etiology of HFrEF in 101 (52.9%) patients, whereas 90 (47.1%) patients had a history of dilated cardiomyopathy. The mean exercise time was 7.6±.3 minutes. Mean peak VO2 and VE/VCO2 slope values were calculated at 19.1±6.1 ml kg–1 min–1 and 43.7±10.1, respectively. According to peak VO2 values, 70 patients (37.2%) were in Weber class A, 57 (29.8%) in class B, 48 (25.1%) in class C and 15 (7.9%) in class D. In univariate analysis, the change between rest and peak systolic blood pressure (ΔSBP), which is considered to reflect the left ventricular inotropic reserve, was positively correlated to the peak VO2 (p&amp;lt;0.001), the total pulmonary ventilation (VE) (p&amp;lt;0.001) and the peak heart rate during exercise (p=0.02). In multivariable analysis, peak VO2 was independently, linearly associated with the ΔSBP during CPET (Figure 1) (β=0.661, p=0.022). In Roc analysis, it was found that a cut-off value for peak VO2 of 16 ml kg–1 min–1 exhibits 64% sensitivity and 60% specificity in predicting a ΔSBP&amp;gt;40mmHg during exercise (area under the curve: 0.657, p&amp;lt;0.001 – Figure 2). Conclusion The peak oxygen consumption during cardiopulmonary testing represents an acceptable predictor of inotropic reserve in patients with HFrEF. Funding Acknowledgement Type of funding sources: None.

Prognostic value of exercise stress echocardiography in patients with known coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Exercise stress echocardiography (EE) is useful for diagnosis and risk stratification in patients (pts) with suspected coronary artery disease (CAD). Pts with known CAD carry a high risk of events. Our aim was to assess the utility of EE in predicting outcomes in this population. Methods Single center retrospective study of consecutive pts with known CAD who performed an EE between 2018 and 2019. The primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up. Results A total of 76 pts were included (mean age 59±9 years; 87% male). Fifty-nine (78%) pts had history of ACS, 51 (67%) of percutaneous coronary intervention (PCI) and 14 (18%) of coronary artery bypass graft. The majority of pts had 2 or more vessel disease (42 pts; 55%). The main reason for performing EE was new onset of chest pain (38 pts; 50%) followed by functional assessment of coronary stenoses after incomplete revascularization (29 pts; 38%). The majority of pts had a preserved left ventricular ejection fraction (67; 88%). The exam was performed under beta-blocker effect in 35 (46%) pts. The results of EE were positive for myocardial ischemia in 7 (9%) pts, negative in 37 (49%) pts and inconclusive in 32 (42%) pts. Mean exercise time was 8±3 minutes and mean METs achieved was 9.4±2.6. ST-segment depression fulfilling electrocardiographic criteria for ischemia occurred in 17 (22%) pts. Eleven (14%) pts complained of chest pain during the exam. During a median follow up of 22 months (IQR 15-26), the primary endpoint occurred in 9 pts (admission for ACS in 5 pts; revascularization for chronic coronary syndrome in 4 pts). No cardiovascular death occurred. The positive predictive value of EE for the primary endpoint was 57.1% and the negative predictive value (NPV) 97.3%. In a survival analysis, the predictors of the primary endpoint were lower exercise time, lower METs achieved, untreated significant coronary lesions and a positive EE (figure). After adjustment in a multivariate analysis, a positive EE was an independent predictor of the primary endpoint (HR 4.6, 95%CI: 1.1-16.7, p=.044). Conclusion In pts with known CAD, EE had a high NPV and a positive result was an independent predictor of future cardiovascular events.

Abstract P5-18-07: Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer

Abstract Background Targeting the activity of the estrogen receptor and/or estrogen synthesis is a standard primary treatment for eligible patients with estrogen receptor-positive breast cancer. Giredestrant is a highly potent, nonsteroidal oral selective estrogen receptor antagonist and degrader that achieves robust estrogen receptor occupancy. In animal models and early phase studies, giredestrant was associated with a dose-dependent reduction in heart rate. Therefore, we leveraged an ongoing nonrandomized, open-label, dose-escalation and -expansion phase Ia/b study (GO39932) to evaluate its cardiac safety. Methods Eligibility criteria for the main study are available at https://clinicaltrials.gov/ct2/show/NCT03332797. Additional relevant cardiac exclusion criteria included current treatment with medications known to decrease heart rate, e.g., beta blockers.100 mg giredestrant was given daily on Days 1-28 of each 28-day cycle (monotherapy for 14 days; patients then continued monotherapy or received combination treatment with 125 mg daily oral palbociclib for the study duration, per investigator decision). The 100 mg giredestrant dose for this arm (rather than the phase III 30 mg dose) was evaluated to increase the likelihood of observing relevant cardiac effects. Electrocardiograms were required on Day 1 of each cycle; 24-hour Holter data were collected and treadmill-exercise testing was completed at screening (prior to starting giredestrant), steady state (Day 8 [+3 days]), and as clinically indicated. Exercise testing evaluated baseline heart rate, exercise duration, maximal heart rate, and heart rate recovery. A standard Bruce protocol was followed. Results Clinical data cutoff was Apr 16, 2021. Twenty patients were enrolled and included in the current analysis; median age was 59 (range, 45-72); three patients (15%) had a history of hypertension at screening. During follow-up, no dysrhythmias were observed that required treatment or a change in study medication, and no patients were noted to have a resting heart rate of &amp;lt;50 beats per minute based on routine heart rate monitoring. Two Grade 1 bradycardia events (&amp;lt;60 beats per minute) were reported; both in patients receiving palbociclib. No other cardiac adverse events (AEs) were reported overall, nor any other serious AEs. Holter monitoring reports were available for 19 patients at screening and 20 on treatment. There were no episodes of second- or third-degree atrioventricular block. At screening, 2/19 patients (11%) had a paroxysmal supraventricular tachycardia event (SVT; ≤30 seconds). During the study, 4/20 patients (20%) had a paroxysmal SVT event and, of these, 1/4 had four episodes of an SVT event lasting &amp;gt;30 seconds and 1/4 also experienced one episode of non-sustained ventricular tachycardia. No patients required any cardiac treatment or dose modification. Twenty patients underwent exercise testing. Exercise time was similar among patients before and after starting giredestrant (mean exercise time 7 min 10 sec before; 7 min 44 sec after). Exercise intensity was similar before and after starting treatment (mean metabolic equivalents expenditure 7.52 [standard deviation 2.81] and 8.68 [2.78], respectively). One patient had an abnormal heart rate recovery on exercise testing at screening and again while on treatment. Conclusions In a thorough cardiac safety analysis, applying routine electrocardiograms, 24-hour Holter monitoring, and exercise testing, no clinically relevant cardiac effects were observed with 100 mg giredestrant (a higher dose than the phase III 30 mg dose). Citation Format: Tomas G Neilan, Rafael Villanueva-Vázquez, Meritxell Bellet, Elena López-Miranda, Laura García-Estévez, Peter Kabos, John Bond, Mary R Gates, Ching-Wei Chang, Valentina Boni. Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-07.

Prevalence and clinical impact of latent obstruction in hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Hypertrophic cardiomyopathy (HCM) is characterized by varying degrees of left ventricular outflow tract obstruction (LVOTobs). We aim to define the prevalence, clinical profile and impact of LVOTobs under physiological exercise in HCM patients (pts). METHODS Single center retrospective study of consecutive HCM pts without LVOTobs at rest (resting gradient &amp;lt;30mmHg), referred for exercise stress echocardiogram (ESE) between 2015 and 2019. Significative latent obstruction was defined as a LVOT gradient ≥50 mmHg during exercise or at early recuperation. RESULTS A total of 56 pts were included (64% men, mean age 57 ± 11 years, 61% septal HCM). The majority of pts (47; 84%) were in NYHA I functional class, 20 (36%) had history of syncope or pre-syncope (S/pS) and 7 (13%) had an implantable cardioverter defibrillator (ICD). Twelve (21%) pts had systolic anterior motion (SAM) of the mitral valve at rest. Thirty-five (63%) pts performed ESE under beta-blocker (BB) therapy. Mean exercise time was 8 ± 3 min. During ESE, 2 (4%) pts developed a LVOT gradient between 30 to 50 mmHg and 17 pts (30%) developed a significative LVOTobs gradient (mean 85 ± 18 mmHg). Pts with significative latent LVOTobs had more previous complaints of S/pS (59% vs 26%, p=.017), a tendency for a higher NYHA functional class (p=.082) and were more frequently on BB therapy (82% vs 18%, p=.043). Mean septum thickness was similar between groups (17 ± 0.7 vs 16 ± 0.6 mm, p=.536). The presence of SAM at rest was more frequent in the significative latent LVOTobs pts (p&amp;lt;.001). No differences were noted in exercise tolerance (p=.526). During a median follow-up of 43 (IQR 15-53) months, 7 (41%) pts with significative latent LVOTobs had a pre-syncope, 3 (18%) were diagnosed with atrial fibrillation and 2 (12%) had a cardiovascular admission . There was up-titration/initiation of BB therapy in 5 (29%) pts, referral for septal myectomy in 3 (18%) and ICD implantation for primary prevention in 3 (18%) pts. No proper ICD shocks, sustained ventricular arrythmias or deaths occurred. Comparing significative latent to non LVOTobs pts, the first ones had more ICD implantation (log rank p =.04) and performed a surgical myectomy more frequently (log rank p= .018) during the follow-up. CONCLUSION In our study, significative latent LVOTobs was observed in 30% of pts. Its presence can have clinical implications in HCM pts approach and should be suspected in more symptomatic pts and when SAM is present at rest.

Impact of an inconclusive exercise stress echocardiogram on cardiovascular outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Exercise stress echocardiography (ESE) is used for the assessment of suspected or known coronary artery disease (CAD); however, a certain percentage of ESE studies are inconclusive. We aim to evaluate the prognostic impact of an inconclusive ESE on cardiovascular outcomes. Methods Single-center retrospective study of consecutive patients (pts) who performed an ESE between 2018 and 2019 for diagnosis or stratification of CAD. All pts performed a symptom-limited Bruce protocol. ESE was considered inconclusive when 85% of age-predicted maximum HR was not reached. Primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up. Results A total of 141 pts were included (76% male; mean age 60 ± 9 years). ESE was inconclusive in 51 (36%) pts, positive in 11 (8%) and negative in 79 (56%). The mean exercise time of pts with inconclusive ESE was 7 ± 2 minutes and 76% had normal functional capacity. Fatigue (25 pts; 49%) and lower extremities pain (11 pts; 22%) were the main reasons for ESE stopping. Five pts (10%) complained of chest pain during exam. Pts with an inconclusive ESE were more diabetic (inconclusive 43%, positive 9%, negative 13%; p=.001), had more chronic obstructive pulmonary disease (COPD) (14%, 0%, 2.5%; p=.026), performed more frequently the exam under beta blocker (BB) therapy (59%, 27%, 18%; p=.041) and had less ST-segment depression fulfilling electrocardiographic criteria for ischemia (10%, 64%, 27%, p&amp;lt;.001). Their functional capacity was worse than negative ESE pts (p&amp;lt;.001). During a median follow up of 22 months (IQR 15-27), 13 (9.2%) pts had the primary endpoint, including 5 pts (3.5%) with ACS. Pts with an inconclusive ESE had a lower incidence of the primary outcome than pts with a positive ESE and a higher incidence of events than pts with negative results (figure). In multivariate analysis, after adjusting for functional capacity and electrocardiographic criteria for ischemia, an inconclusive ESE was an independent predictor of the primary endpoint (HR 9.7, IC95% 1.1-87,6 p= .042) Conclusions The frequency of inconclusive ESE is not negligible (36%). These pts had more diabetes and COPD and performed the exam under BB therapy more frequently, highlighting the importance of proper patient selection. An inconclusive ESE was associated to a higher risk of cardiovascular events compared to negative ESE. Abstract Figure.

Exercise Performance And Aerobic Capacity In Adults With Congenital Heart Disease: A Follow-up Study

In order to control de development of persons with congenital heart disease, it is important to follow their aerobic capacity (AC), especially when they exercise. PURPOSE: To study the progress of Exercise Performance (EP) and AC in the follow-up of adults with congenital heart disease (CHD). METHODS: A longitudinal study with 127 adults with a mean age of 33.77 years (11.57) (71 women; and 56 men) who have undergone two cardiopulmonary exercise test (CEPT) in at least one year between the first and the second test. The AC and EP were assessed by a CPET using a ramp protocol over a treadmill obtaining cardiovascular and metabolic data. Participants started walking at 3 km/h and 0% grade for two minutes, increasing the speed 0.3 km/h, and 1.4% grade every minute to a maximum of 12% until exhaustion. Descriptive for all variables were obtained, and an analysis of variance (ANOVA one way; post-hoc Bonferroni) to evaluate significant differences among the first and the second CPET in the VO2Peak, body weight, time of effort, maximal velocity and % grade was applied. RESULTS: A significant decrease of AC appeared, where the VO2Peak in the first CPET was 27.73 (0.68) ml/kg/min versus in the second CPET was 26.62 (0.69) (P = 0.015). A significant increase was observed in the body weigh 64.98 (1.13) versus 66.55 (1.17) (P = 0.001). No significant differences were observed in terms of EP. Comparing the first with the second CPET, the mean exercise time was 12.75 min (3.11) versus 12.46 min (2.62) (P = 0.420); the mean maximal velocity was 6.2 km/h (0.8) versus 6.1 km/h (0.8) (P = 0.114); and the maximum % grade was 11.45% (0.11) versus 11.62% (0.09) (P = 0.159). CONCLUSIONS: The results suggest that despite observed decline in VO2Peak and an increase in the body weight the EP (duration of exercise time, velocity and percentage of grade) has been maintained without a deterioration along the time, sign of favorable evolution of the CHD in adults. More research is needed to find the reason why the EP does not correspond to the AC. Supported by SUR of DEC Generalitat de Catalunya and European Union 2020FI_B200128.

Effect of a day-trip to altitude (2500 m) on exercise performance in pulmonary hypertension: randomised crossover trial

Question addressed by the studyTo investigate exercise performance and hypoxia-related health effects in patients with pulmonary hypertension (PH) during a high-altitude sojourn.Patients and methodsIn a randomised crossover trial in stable (same therapy for >4 weeks) patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with resting arterial oxygen tension (PaO2) ≥7.3 kPa, we compared symptom-limited constant work-rate exercise test (CWRET) cycling time during a day-trip to 2500 m versus 470 m. Further outcomes were symptoms, oxygenation and echocardiography. For safety, patients with sustained hypoxaemia at altitude (peripheral oxygen saturation <80% for >30 min or <75% for >15 min) received oxygen therapy.Results28 PAH/CTEPH patients (n=15/n=13); 13 females; mean±sd age 63±15 years were included. After >3 h at 2500 m versus 470 m, CWRET-time was reduced to 17±11 versus 24±9 min (mean difference −6, 95% CI −10 to −3), corresponding to −27.6% (−41.1 to −14.1; p<0.001), but similar Borg dyspnoea scale. At altitude, PaO2 was significantly lower (7.3±0.8 versus 10.4±1.5 kPa; mean difference −3.2 kPa, 95% CI −3.6 to −2.8 kPa), whereas heart rate and tricuspid regurgitation pressure gradient (TRPG) were higher (86±18 versus 71±16 beats·min−1, mean difference 15 beats·min−1, 95% CI 7 to 23 beats·min−1) and 56±25 versus 40±15 mmHg (mean difference 17 mmHg, 95% CI 9 to 24 mmHg), respectively, and remained so until end-exercise (all p<0.001). The TRPG/cardiac output slope during exercise was similar at both altitudes. Overall, three (11%) out of 28 patients received oxygen at 2500 m due to hypoxaemia.ConclusionThis randomised crossover study showed that the majority of PH patients tolerate a day-trip to 2500 m well. At high versus low altitude, the mean exercise time was reduced, albeit with a high interindividual variability, and pulmonary artery pressure at rest and during exercise increased, but pressure–flow slope and dyspnoea were unchanged.

Hemodynamic and Ventilatory Responses during Exercise in Pediatric Patients with Pulmonary Embolism

Background Pediatric patients with pulmonary embolism (PE) suffer from exercise intolerance and dyspnea on exertion, often without right heart dysfunction or pulmonary hypertension - at least at rest. The pathophysiology of the exercise limitation following pediatric PE therefore remains incompletely understood. Objectives To extend our understanding of exercise intolerance in pediatric patients with PE by examining ventilatory and hemodynamic responses to exercise. Methods To accomplish our goal, we instituted a standardized institutional protocol to systematically assess exercise capacity in pediatric PE patients in the first 3 months following diagnosis. Between February 2019- June 2020, 15 patients underwent resting pulmonary function tests and an incremental symptom-limited cardiopulmonary exercise testing (CPET) to obtain peak exercise in 8-12 minutes. All patients had received anticoagulation for at least 3 months. In all patients, right and left ventricular systolic and/or diastolic dysfunction at rest was ruled out by transthoracic echocardiography. Continuous measurements were made of minute ventilation (VE), oxygen uptake (VO2), carbon dioxide production (VCO2), heart rate (HR), and blood pressure. Predicted values for peak VO2 and work rate were generated from predictive equations. Patients with impaired exercise capacity, defined as &amp;lt;80% of age-, sex- and ideal lean body mass predicted, and dyspnea on exertion underwent further exercise cardiac magnetic resonance (exCMR) imaging using an MR compatible ergometer. Biventricular volumes and contractility, RV longitudinal strain, and RV to pulmonary artery coupling were assessed at rest and with exercise. Results Baseline, clinical characteristics, and CPET data are shown in Tables 1 and 2. Forced Vital Capacity was normal without signs of airway obstruction. Three patients failed to reach their predicted physiologic limits during exercise, and CPET was terminated by the patient prematurely (e.g., muscular exertion, fatigue, &amp; dyspnea, respectively). The mean exercise duration was 9.85 min. The mean ventilatory reserve was within normal limits (&amp;gt;15%) in all but 1 patient. VO2/work rate was normal with normal VO2 at the anaerobic threshold (mean 1541ml/kg/min, SD:731). Exercise capacity, as measured by peak VO2 was reduced, that is, &amp;lt;80% of predicted, in 5 out of the 15 patients (30%). Of these, three patients had echocardiography evidence of RV dysfunction at PE diagnosis, which had resolved at the time of CPET. There were no differences in the mean exercise time and maximal work rate achieved in those with low exercise capacity relative to normal capacity. The ventilatory equivalent for CO2 (VE/VCO2) at peak exercise was elevated (&amp;gt;35) in three of the five patients with decreased exercise capacity. The O2 pulse was attenuated in patients with decreased exercise capacity when compared to those with normal exercise capacity (7.5 mL.beat -1 vs. 12.9-1; p=0.037). Of the two patients who underwent exCMR; one showed reduced right ventricular ejection fraction (38%), abnormal RV strain (-11.3%), elevated right sided pressures signified by interventricular flattening upon inspiration during free breathing scan and an uncoupled RV to the pulmonary circulation. Conclusions Reduced exercise capacity is common after PE and not evident by resting evaluations. Pediatric PE patients with low exercise capacity and dyspnea seem to be characterized by either an abnormal pulmonary vascular response to exercise or decreased ventilatory efficiency. Larger studies are needed to better understand exercise pathophysiology after pediatric PE. Disclosures No relevant conflicts of interest to declare.

Increasing Exercise Is Not Associated With An Increase In Sedentary Time In Obese Adults

BACKGROUND: It is now established that sedentary time is an independent predictor of morbidity and mortality. Whether increasing exercise is associated with an increase in objectively measured sedentary time is unclear. PURPOSE: To determine if increasing exercise consistent with consensus recommendations is associated with corresponding increases in sedentary time in abdominally obese adults. METHODS: Participants were 98 sedentary adults (BMI 31.8 ±3.7 kg/m2, age 55 ±7.1 years) randomly assigned to one of the following 4 groups: i) no-exercise control (n=19), ii) low-amount, low-intensity exercise (LALI) (180 and 300 kcal/ session for women and men, respectively, at 50% of VO2peak, n=24), iii) high-amount, low-intensity exercise (HALI) (360 and 600 kcal/session, respectively, at 50% of VO2peak, n=36), iv) high-amount, high-intensity exercise (HAHI) (360 and 600 kcal/session, respectively, at 75% of VO2peak, n=24). All exercise sessions were supervised. Sedentary time was determined objectively by accelerometry measured at baseline, 8, 16 and 24 weeks using established cut-points. RESULTS: The mean exercise time for LALI, HALI and HAHI were 31.2 ± 6.7, 58.3 ±7.8 and 42.7 ±4.5 min/day respectively. Corresponding values for sedentary time were 10.6, 10.3, and 10.4 hrs/day respectively. No statistically significant differences in sedentary time at baseline was observed between exercise groups (p=0.81). Similarly, no significant difference in the change in sedentary time at 24 weeks was observed between exercise groups (p=.59). The mean value for change in sedentary time for the 3 exercise groups combined was -15 mins/day. CONCLUSIONS: Increasing exercise consistent with consensus recommendations is not associated with a corresponding change in sedentary time independent of exercise amount or intensity. These observations counter the suggestion that fatigue associated with the adoption of exercise in obese adults may lead to corresponding increase in sedentary time.

The effects of regular vigorous- and moderate-intensity aerobic exercise on serum BDNF level, aging- and lifestyle disease-related blood components in middle-aged women

Purpose The purpose of this study was to investigate the effects of regular vigorous- and moderate-intensity aerobic exercise on serum brain-derived neurotrophic factor (BDNF) level, aging- and lifestyle disease-related blood components in middle-aged women. Methods The participants were recruited from a total of 19 physically healthy people aged 50-59 years, and were randomly divided into vigorous-intensity aerobic exercise (VIAE, n = 10) and moderate-intensity aerobic exercise (MIAE, n = 9) group. The participants were performed vigorous- and moderate-intensity aerobic exercise three times a week for eight weeks, and body composition measurement, graded exercise test, blood collection were performed before and after. Results Mean exercise time was significantly longer in the MIAE group than in the VIAE group. The V̇O2max was significantly higher in the VIAE group than in the MIAE group. Body weight, BMI, and body fat percentage were significantly lower than pre both groups. The BDNF concentration was significantly higher in the VIAE group than in the MIAE group. The dehydroepiandrosterone sulfate (DHEA-s) and insulin-like growth factor-1 (IGF-1) concentration were significantly higher than pre both groups. The free fatty acid and triglyceride concentrations were significantly lower than pre both groups, and HDL-C concentrations were significantly higher than pre both groups. Conclusions Vigorous-intensity aerobic exercise not only increases maximal oxygen uptake and blood BDNF level in middle-aged women, but also induces positive changes in aging-related hormones and lifestyle-related blood variables.

Comparing the effect of group training and telemedicine on exercise during pregnancy: An application of the health belief model.

INTRODUCTION:Many women refuse to exercise during pregnancy due to lack of awareness and not receiving training. The aim of this study was to investigate and compare the effect of group and telemedicine education on exercise during pregnancy by using the health belief model (HBM).MATERIALS AND METHODS:This quasi-experimental study was carried out in 2019 in Zahedan, and a total of 135 pregnant women participated in it. Samples were randomly assigned to the following three groups: group training (n = 45), telemedicine (n = 45), and control (n = 45). Group training was presented in three sessions, and the telemedicine group received the educational content through mobile applications. The samples completed the HBM questionnaire before and 6 weeks after the intervention. In addition, within 6 weeks after the intervention, they completed the exercise activity schedule. SPSS software Ver. 16 (IBM Corp, Armonk, NY, USA) was used for analysis, and data were analyzed by ANOVA, Tukey's post-hoc test, Kruskal–Wallis test, and Mann–Whitney test.RESULTS:After intervention, the scores of HBM constructs and exercise levels in group training, telemedicine group, and control group, respectively, were as follows: perceived susceptibility 25.91 ± 3.24, 25.51 ± 1.97, and 22.55 ± 3.78; perceived severity 27.48 ± 2.27, 25.13 ± 2.29, and 22.51 ± 3.88; perceived benefits 27.28 ± 2.97, 25.68 ± 3, and 22.8 ± 3.05; perceived barriers 10.69 ± 2.69, 10.66 ± 3.19, and 14.17 ± 3.14; cues to action 24.71 ± 4.35, 23.9 ± 2.48, and 22.84 ± 3.02; self-efficacy 26.17 ± 3.05, 25.2 ± 2.82, and 22.51 ± 3.38; and exercise levels 70.99 ± 20.43, 56.51 ± 21.99, and 37.62 ± 29.66. Group training and telemedicine led to significant improvement in all HBM constructs and exercise levels (P < 0.05, P < 0.0001, and P = 0.003, respectively). Group training provided more improvement than telemedicine in the scores of perceived severity (P < 0.0001), perceived benefits (P = 0.001), cues to action (P = 0.02), and mean exercise time (P = 0.001).CONCLUSION:The results of this study showed that the HBM is a proper model for exercise education in pregnant women. It is recommended to use HBM as a group training and telehealth in promoting the rate of exercise in pregnant women.

Efficacy of Exercise Stress Echocardiography in Elderly Patients

Introduction: An exercise stress echocardiogram (ESE) is routinely used to exclude coronary artery disease. A diagnostic ESE requires the patient to reach target heart rate (85% of age predicted heart rate maximum). The purpose of this review was to determine if patient age affects the likelihood of a diagnostic ESE. Method: A retrospective analysis of ESEs performed at a tertiary referral centre between January 2016–June 2017 was undertaken. Results were retrieved from the McKesson Cardiology reporting system. Patient age, exercise duration and maximum heart rate were reviewed. Patients were divided into 4 groups based on age- <70 years, 70–74 years, 74–79 years and 80+ years. Results: A total of 880 ESEs were reviewed. Patients aged <70 years (n = 741) mean exercise time was 8 minutes 11 seconds, 15% (n = 112) of tests did not achieve target heart rate. Patients aged 70–74 years (n = 82) mean exercise time was 6 minutes 30 seconds, 17% (n = 14) of tests did not achieve target heart rate. Patients aged <75–79 years (n = 38) mean exercise time was 5 minutes 19 seconds, 31% (n = 12) of tests did not achieve target heart rate. Patients aged >80 years (n = 19) mean exercise time was 3 minutes 46 seconds, 47% (n = 9) of tests did not achieve target heart rate. Conclusion: As patient age increased the mean exercise time and likelihood of obtaining a diagnostic ESE decreased. There was a substantial difference in exercise time and percentage of diagnostic tests in patients aged 75–79 and 80+ years when compared to patients aged <65 years.

Relationship between exercise time and musculoskeletal problems in children.

Objectives: The purpose of this study was to evaluate the relationship between exercise time and musculoskeletal problems and to determine the appropriate amount of exercise for children in both lower- and higher-grade levels of elementary and junior high schools.Materials and Methods: Mark-sheet-type questionnaires were distributed to and collected from all elementary and junior high schools in two cities. We collected 22,494 questionnaires in total. The relationship between exercise time and musculoskeletal problems was analyzed. The χ2 test and multivariate logistic regression analysis were used for statistical analyses.Results: The mean exercise time in school, in addition to physical education time, was 3.1 hours per week. In 56% of the children, the exercise time was less than 2 hours per week, and in 13% of the children, the exercise time was more than 10 hours per week. Although the rate of sports injury increased with an increase in exercise time, the duration of one-leg stand (a test of balance and muscle strength) also increased with an increase in exercise time. The cut-off values for sports injuries in boys/girls were 2.9/2.9 hours, 4.0/2.9 hours, and 7.5/4.2 hours in lower grade elementary school, higher grade elementary school, and junior high school, respectively.Conclusions: Although an appropriate amount of exercise improves one’s physical health and ability, excessive exercise leads to musculoskeletal problems. Approximately 7 hours/week of exercise is recommended for junior high school students. In elementary school, the exercise time should be carefully decided as the musculoskeletal system of the students is still immature.