Negative Exercise Research Articles

Affective experiences from school physical education in children and adolescents

Affective exercise experiences comprise a spectrum of memories, capturing both unpleasant and pleasant episodes. These can be assessed using the Affective Exercise Experience Questionnaire (AFFEXX, Ekkekakis et al., 2021), which examines three separate aspects: 1) antecedent cognitive appraisals (e.g., “incompetence vs. competence”), 2) core affective exercise experiences (e.g., “displeasure vs. pleasure”), and 3) the hedonistic motivation (“antipathy vs. attraction”) to engage in exercise. A German version, AFFEXX-PEG, designed to assess the affective exercise experiences from physical education (PE) in school-aged students, was used to investigate the correlations with PE school grades (as reported by the participants) and extracurricular sports participation (self-reported as the number of days per week spent engaging in at least 60 minutes of sports activities). This study analysed data from 569 individuals (Mage = 14.62, SD ± 1.84; 52% female) across grades 5 to 13. Nearly one-third (29%) of students reported unpleasant core affective experiences from PE in school, and negative experiences correlated with lower PE grades, r(517) = .52, p < 0.001, 95% CI [.45, .58]. Less attraction or antipathy toward PE was associated with fewer days of sports outside of school, r(559) = .38, p < 0.001, 95% CI [.31, .45]. Multiple regression analysis with negative core affective experiences from PE as the criterion and the six cognitive appraisals as predictors, showed that these experiences were primarily influenced by students’ perceived incompetence (b = .49, p < 0.001; R² = .84, F(6, 500) = 436.52, p < 0.001) in PE. Given the empirical evidence on the correlation between affective experiences and exercise behaviours in adults (Rhodes & Kates, 2015), these findings highlight the potential role of fostering positive affective PE experiences. Such experiences may influence lifelong exercise behaviours, and early intervention may prevent the onset of an inactive lifestyle. A new study focuses on children’s (8-12 years) affective experiences from exercise and parent-child interactions, examining the influences of socioeconomic status, parental exercise involvement, and children’s self-perceived body esteem. Elementary school children will report their affective experiences on another, simplified version of the AFFEXX, while their parents will complete a survey on, for example, socioeconomic status and parental involvement in physical activity. By matching data from both surveys, the analysis will explore the relationships between household factors and children’s affective exercise experiences. The goal is to understand early negative affective exercise experiences, assess the impact of family structures, and offer strategies to promote exercise beyond regular school programs.

Aortic valve replacement versus conservative treatment in asymptomatic severe aortic stenosis: long-term follow-up of the AVATAR trial.

The question of when and how to treat truly asymptomatic patients with severe aortic stenosis (AS) and normal left ventricular (LV) systolic function is still subject to debate and ongoing research. Here, the results of extended follow-up of the AVATAR trial are reported (NCT02436655, clinical trials.gov). The AVATAR trial randomly assigned patients with severe, asymptomatic AS and LV ejection fraction ≥50% to undergo either early surgical aortic valve replacement (AVR) or conservative treatment with watchful waiting strategy. All patients had negative exercise stress testing. The primary hypothesis was that early AVR will reduce a primary composite endpoint comprising all-cause death, acute myocardial infarction, stroke or unplanned hospitalization for heart failure (HF), as compared to conservative treatment strategy. A total of 157 low-risk patients (mean age 67 years, 57% men, mean Society of Thoracic Surgeons score 1.7%) were randomly allocated to either early AVR group (n=78) or conservative treatment group (n=79). In an intention-to-treat analysis, after a median follow-up of 63 months, the primary composite endpoint outcome event occurred in 18/78 patients (23.1%) in the early surgery group and in 37/79 patients (46.8%) in the conservative treatment group (hazard ratio [HR] early surgery vs. conservative treatment 0.42; 95% confidence interval [CI] 0.24-0.73, p=0.002). The Kaplan-Meier estimates for individual endpoints of all-cause death and HF hospitalization were significantly lower in the early surgery compared with the conservative group (HR 0.44; 95% CI 0.23-0.85, p=0.012 for all-cause death, and HR 0.21; 95% CI 0.06-0.73, p=0.007 for HF hospitalizations). The extended follow-up of the AVATAR trial demonstrates better clinical outcomes with early surgical AVR in truly asymptomatic patients with severe AS and normal LV ejection fraction compared with patients treated with conservative management on watchful waiting. NCT02436655 (ClinicalTrials.gov).

Self-Generated Lower Body Negative Pressure Exercise: A Low Power Countermeasure for Acute Space Missions.

Microgravity in spaceflight produces headward fluid shifts which probably contribute to Spaceflight-Associated Neuro-Ocular Syndrome (SANS). Developing new methods to mitigate these shifts is crucial for preventing SANS. One possible strategy is the use of self-generated lower body negative pressure (LBNP). This study evaluates biological or physiological effects induced by bed rest to simulate adaptations to microgravity. Participants were tested during powered LBNP and dynamic self-generated (SELF) LBNP at 25 mmHg for 15 min. The results were compared to the physiologic responses observed in seated upright and supine positions without LBNP, which served as controls for normal gravitational effects on fluid dynamics. Eleven participants' (five male, six female) heart rates, blood pressures, and cross-sectional areas (CSA) of left and right internal jugular veins (IJV) were monitored. Self-generated LBNP, which requires mild to moderate physical activity, significantly elevated heart rate and blood pressure (p < 0.01). Self-generated LBNP also significantly reduced right IJV CSA compared to supine position (p = 0.005), though changes on the left side were not significant (p = 0.365). While the effects of SELF and traditional LBNP on IJV CSA were largely similar, traditional LBNP significantly reduced IJV CSA on both sides. Given its low mass, volume, and power requirements, SELF LBNP is a promising countermeasure against SANS. Results from this study warrant longer-term studies of SELF LBNP under simulated spaceflight conditions.

Epidemiological, Angiographic and Cardiovascular Outcomes of Patients Diagnosed with Myocardial Bridge

Background: Myocardial bridging (MB) is a congenital coronary anomaly that can lead to harmful cardiac consequences if not diagnosed and treated. Objectives: This study aims to evaluate the Epidemiological, angiographic, and cardiovascular outcomes of patients diagnosed with myocardial bridge. Methods: The current research was conducted as a retrospective study in which 151 patients who underwent angiography participated. These patients were admitted between May 2014 and May 2016 at Heshmat and Aria hospitals in Rasht. The collected information in the present study included age, gender, blood pressure history, diabetes mellitus, blood lipid disorders, ischemic changes in ECG, ischemic changes in heart scan, output fraction, ischemic changes in exercise test, number of bridges, name of vessel, length of muscle bridge, and distance from the opening. To analyze the variables, the Chi-square test and independent t-test were used. Results: As a result, we found that myocardial bridging was present in 57 patients, and 95.08% of the bridges were located above LAD. According to this study, there is no significant relationship between the length of the bridge and the distance of the bridge from the vessel opening with the occurrence of ischemic changes in ECG and myocardial perfusion scan (P &gt; 0.05). However, the average distance of the bridge from the vessel opening in patients who had a positive exercise test was lower compared to the patients who had a negative test. They had a negative exercise test, and this difference was statistically significant (P &lt; 0.05). Conclusions: Furthermore, in patients diagnosed with an MB by CAG, the most MB located in the LAD, and this issue can help to better understand the outcome and how to manage these patients.

Association of temperature and absolute humidity with incidence of exercise-induced bronchoconstriction in children.

Exercise test outdoors is widely used to diagnose asthma in children, but it is unclear how much outdoor air factors affect the results. We analysed 321 outdoor exercise challenge tests with spirometry in children 6-16 years conducted due to suspicion of asthma or for assessing the effect of medication on asthma. We studied the association of FEV1 decrease and incidence of exercise-induced bronchoconstriction (EIB) with temperature, relative humidity (RH) and absolute humidity (AH). Asthma was diagnosed in 57% of the subjects. AH ≥5 g/m3, but not RH or temperature, was associated with the EIB incidence (p = 0.035). In multivariable logistic regression, AH ≥5 g/m3 was negatively associated (OR = 0.51, 95% CI [0.28─0.92], p = 0.026) while obstruction before exercise (OR = 2.11, 95% CI [1.16─3.86], p = 0.015) and IgE-mediated sensitisation were positively associated with EIB (OR = 2.24, 95% CI [1.11─4.51], p = 0.025). AH (r = -0.12, p = 0.028) and temperature (r = -0.13, p = 0.023) correlated with decrease in FEV1. In multivariable linear regression, only AH was associated with FEV1 decrease (coefficient = -0.044, 95% CI [-0.085 to -0.004], p = 0.033). AH of outdoor air associates with occurrence and severity of EIB in outdoor exercise tests in children. Care should be taken when interpreting negative outdoor exercise test results if AH of air is high.

Activating cancer communities through an exercise strategy for survivors: an effectiveness-implementation trial

IntroductionStrong evidence supports the recommendation that individuals living with or beyond cancer (LWBC) should be physically active and engage in physical exercise to enhance health and improve cancer-related outcomes. Many individuals LWBC are not achieving these benefits, partly due to a lack of resources. To address this, Activating Cancer Communities through an Exercise Strategy for Survivors (ACCESS) was developed to provide exercise programming and investigate exercise strategies and barriers for those LWBC.MethodsUsing an effectiveness-implementation design, adults LWBC joined ACCESS by healthcare provider or self-referral. A clinical exercise physiologist triaged participants to either a hospital-based site or one of two community-based sites to complete a 12-week, 24-session multimodal individualized exercise program. Physical fitness and multiple patient-reported outcomes were measured pre- and post-intervention.ResultsBetween January 2018 and March 2020, there were 332 referrals. Of these, 122 participants consented and completed the study. Completing ACCESS was associated with improvements in physical fitness and participant-reported outcomes, including general wellbeing, fatigue, negative emotional states, sleep quality, and exercise self-efficacy. The program was well-received by participants and was deemed feasible and acceptable from an implementation perspective.DiscussionThe ACCESS program demonstrably improved several health outcomes for individuals LWBC. Implementation outcomes have and continue to guide ongoing efforts to improve accessibility to ACCESS and work with the regional health authority and cancer care program to support the adoption of exercise into standard oncology care.Clinical trial registrationclinicaltrials.gov, identifier [NCT03599843].

Exercise dependence in endurance sports: Relation to emotional regulation and negative affectivity

The copious and uncontrolled practice of exercise can generate psychological dependence and mood changes. Emotional regulation and negative affectivity are relevant processes for the development of addictive patterns. This study analysed the differences in negative affectivity and emotional regulation based on the practice profile of exercise; the relationship between exercise dependence, emotional regulation, and negative affectivity; and the mediating role of emotional regulation in such relationship. 375 endurance sports practitioners participated. The differences in the physical exercise practice profiles were significant in all the study variables. Exercise dependence correlated positively and significantly with emotional regulation difficulties and with negative affectivity. Emotional regulation difficulties were predictors of exercise dependence. There was a mediating effect of emotional regulation difficulties between negative affect and exercise dependence. Improving emotional regulation skills could prevent the onset of exercise dependence.

Prognostic Impact of a Routine Six-Month Exercise Stress Test after Complex Left Main Bifurcation Percutaneous Intervention.

The prognostic value of exercise stress test after complex left main (LM) coronary artery bifurcation (LM) stenting has been poorly investigated. To partially fill this gap in knowledge, we retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for complex LM bifurcation disease between January 2008 and May 2018 who were treated using either single- or dual-stenting techniques. The prognostic impact of an exercise stress test, performed 6 months after the coronary intervention, was evaluated in 502 patients (316 males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3). At follow up after a mean of 37.1 ± 10.8 months (range 22.1-47.3 months), the target lesion failure (TLF) rate was 10.1% while stent thrombosis and cardiovascular mortality were 1.2 and 3.6%, respectively. A positive exercise stress test was detected at 6-month follow up in 42 out of 502 patients (8.4%); the incidence of a significant restenosis was 7.6% (n = 38). Patients with a negative exercise stress test at 6-month follow up had higher freedom from TLF and improved survival compared to those with a positive exercise stress test.

What I see and what I feel: the influence of deceptive visual cues and interoceptive accuracy on affective valence and sense of effort during virtual reality cycling.

How we feel during exercise is influenced by exteroceptive (e.g., vision) and interoceptive (i.e., internal body signals) sensory information, and by our prior experiences and expectations. Deceptive visual cues about one's performance during exercise can increase work rate, without negatively impacting affective valence (good/bad responses) or perceived exertion. However, what is less understood is whether the perception of the exercise experience itself can be shifted, if work rate is held constant. Here we aimed to investigate whether deceptive vision-via illusory hills in a virtual reality (VR) cycling experience-alters affective valence and perceived exertion when physical effort is controlled. We also evaluated whether the accuracy with which one detects interoceptive cues influences the extent to which deceptive visual information can shift exercise experiences. A total of 20 participants (10 female; 30.2 ±11.2yrs) completed three VR cycling conditions each of 10-min duration, in a randomised, counterbalanced order. Pedal resistance/cadence were individualised (to exercise intensity around ventilatory threshold) and held constant across conditions; only visual cues varied. Two conditions provided deceptive visual cues about the terrain (illusory uphill, illusory downhill; resistance did not change); one condition provided accurate visual cues (flat terrain). Ratings of affective valence (Feeling Scale) and of perceived exertion (Borg's RPE) were obtained at standardised timepoints in each VR condition. Interoceptive accuracy was measured via a heartbeat detection test. Linear mixed effects models revealed that deceptive visual cues altered affective valence (f2 = 0.0198). Relative to flat terrain, illusory downhill reduced affective valence (Est = -0.21, p=0.003), but illusory uphill did not significantly improve affective valence (Est = 0.107, p=0.14). Deceptive visual cues altered perceived exertion, and this was moderated by the level of interoceptive accuracy (Condition-Interoception interaction, p=0.00000024, f2 = 0.0307). Higher levels of interoceptive accuracy resulted in higher perceived exertion in the illusory downhill condition (vs flat), while lower interoceptive accuracy resulted in lower perceived exertion in both illusory hill conditions (vs flat) and shifts of greater magnitude. Deceptive visual cues influence perceptual responses during exercise when physical effort does not vary, and for perceived exertion, the weighting given to visual exteroceptive cues is determined by accuracy with which interoceptive cues are detected. Contrary to our hypotheses, deceptive visual cues did not improve affective valence. Our findings suggest that those with lower levels of interoceptive accuracy experience most benefit from deceptive visual cues, providing preliminary insight into individualised exercise prescription to promote positive (and avoid negative) exercise experiences.

Correlation between negative life events and suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture

ObjectiveTo investigate the incidence of suicide attempts among adolescents with HIV/AIDS in Liangshan Prefecture, Sichuan Province, as well as the correlation between negative life events, sleep, exercise, drug therapy and suicide attempts.MethodsA total of 180 Yi adolescents aged 11–19 years with HIV/AIDS in a county of Liangshan Prefecture, Sichuan Province, China, were investigated by census. The main outcome indicators included the incidence of suicide attempts and whether negative life events, sleep, exercise, drug therapy and other factors were related to suicide attempts.ResultsWe found that the incidence rate of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture was 13.9%. Negative life events were a risk factor for suicide attempts (OR = 1.047, p < 0.001, 95% CI 1.027–1.067). In the factors of negative life events, adaptation was a risk factor for suicide attempts (OR = 1.203, p = 0.026, 95% CI 1.022–1.416), and academic pressure showed a tendency to be a risk factor for suicide attempts (OR = 1.149, p = 0.077, 95% CI 0.985–1.339). However, the punishment factor, interpersonal stress factor and loss factor had no significant correlation with suicide attempts. There was no significant correlation between sleep, exercise, drug therapy and suicide attempts.ConclusionThe proportion of suicide attempts among Yi adolescents with HIV/AIDS in Liangshan Prefecture is high and should be considered. Negative life events are independent risk factors for suicide attempts, and it is necessary to strengthen the screening and early intervention for suicide attempts in HIV/AIDS adolescents with definite negative life events.

Heart Rate Recovery as a Predictor of Long-Term Adverse Events after Negative Exercise Testing in Patients with Chest Pain and Pre-Test Probability of Coronary Artery Disease from 15% to 65.

The prognosis of patients with chest pain after a negative exercise test is good, but some adverse events occur in this low-risk group. The aim of our study was to identify predictors of long-term adverse events after a negative exercise test in patients with chest pain and a lower intermediate (15-65%) pre-test probability of coronary artery disease (CAD) and to assess the prognostic value of exercise electrocardiography and exercise stress echocardiography in this group of patients. We identified from our stress test laboratory database 862 patients with chest pain without previously known CAD and with a pre-test probability of CAD ranging from 15 to 65% (mean 41 ± 14%) who underwent exercise testing. Patients were followed for the occurrence of death, non-fatal myocardial infarction (MI) and clinically guided revascularization. During the median follow-up of 94 months, 87 patients (10.1%) had an adverse event (AE). A total of 30 patients died (3.5%), 23 patients suffered non-fatal MI (2.7%) and 34 patients (3.9%) had clinically guided revascularization (20 patients percutaneous and 14 patients surgical revascularizations). Male gender, age, the presence of diabetes and a slow heart rate recovery (HRR) in the first minute after exercise were independently related to the occurrence of AEs. Adverse events occurred in 10.3% of patients who were tested by exercise stress echocardiography and in 10.0% of those who underwent stress electrocardiography (p = 0.888). The risk of AEs after negative exercise testing in patients with a pre-test probability of CAD of 15-65% is low. Male patients with a history of diabetes and slow HRR in the first minute after exercise have an increased risk of an adverse outcome.

A latent profile analysis of subjective exercise experiences among physically vulnerable college students and psychiatric symptoms correlates during three phases of the COVID-19 pandemic in Wuhan, China.

Physical activity among college students since the COVID-19 pandemic was well studied; however, subjective exercise experience and the emotional response toward physical exercise received less attention. The present study used latent profile analysis (LPA) to explore the latent class of subjective exercise experience among physically vulnerable college students who scored 59 points or less in tests under the National Student Physical Health Standard. Three non-duplicated samples at different stages of the COVID-19 pandemic were collected in March 2020 (N = 127), March 2021 (N = 118), and November 2021 (N = 206) respectively. Psychometrically validated scales, namely, Subjective Exercise Experiences Scale (SEES), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9) were used to measure subjective exercise experience, anxiety symptoms, and depressive symptoms. LPA revealed a 3-class solution for the subjective exercise experience of physically unfit students, namely, the "negative experience group" (30.82%), the "fatigue group" (41.91%), and the "positive experience group" (27.27%). Multinomial regression showed that probable anxiety [odds ratio (OR) = 0.12] was associated with the overall negative exercise experience while probable depression (OR = 0.19) was associated with psychological fatigue. Women (OR = 0.496) were more likely to experience overall negative exercise experience, and the outbreak of the COVID- 19 (OR = 2.14) pandemic influenced the psychological distress of the subjective exercise experience compared with the other two phases in the post-COVID- 19 era. Our findings provided significant implications for physical education targeting university students that interventions should be tailored differently for three profiles of the subjective exercise experience.

Early detection of myocardial ischemia in resting ECG: analysis by HHT

BackgroundExercise electrocardiography (ECG) is a noninvasive test aiming at producing ischemic changes. However, resting ECG cannot be adopted in diagnosing myocardial ischemia till ST-segment depressions. Therefore, this study aimed to detect myocardial energy defects in resting ECG using the Hilbert–Huang transformation (HHT) in patients with angina pectoris.MethodsElectrocardiographic recordings of positive exercise ECG by performing coronary imaging test (n = 26) and negative exercise ECG (n = 47) were collected. Based on the coronary stenoses severity, patients were divided into three categories: normal, < 50%, and ≥ 50%. During the resting phase of the exercise ECG, all 10-s ECG signals are decomposed by HHT. The RT intensity index, composed of the power spectral density of the P, QRS, and T components, is used to estimate the myocardial energy defect.ResultsAfter analyzing the resting ECG using HHT, the RT intensity index was significantly higher in patients with positive exercise ECG (27.96%) than in those with negative exercise ECG (22.30%) (p < 0.001). In patients with positive exercise ECG, the RT intensity index was gradually increasing with the severity of coronary stenoses: 25.25% (normal, n = 4), 27.14% (stenoses < 50%, n = 14), and 30.75% (stenoses ≥ 50%, n = 8). The RT intensity index of different coronary stenoses was significantly higher in patients with negative exercise ECG, except for the normal coronary imaging test.ConclusionsPatients with coronary stenoses had a higher RT index at the resting stage of exercise ECG. Resting ECG analyzed using HHT could be a method for the early detection of myocardial ischemia.

The Subjective Will and Psychological Experience of Home-Based Exercise in Lung Cancer Patients During Interval of Chemotherapy: A Qualitative Study.

This qualitative study explores the subjective will and psychological experience of home exercise in patients with lung cancer during the interval of chemotherapy. Semi-structured interviews were conducted with 15 lung cancer patients undergoing chemotherapy. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected and described in detail, and the authenticity of the theme was verified. The analysis revealed the home-based exercise experience of patients' in the interval period of chemotherapy, and identified three themes: 1) the perception experience of home-based exercise (beneficial home-based exercise experience, negative home-based exercise experience); 2) the influencing factors of home-based exercise (exercise rehabilitation knowledge, disease symptoms and adverse effects of chemotherapy, exercise history, exercise self-efficacy, social support, restrictions on objective conditions); 3) Patients with lung cancer expected to get professional guidance about home-based exercise rehabilitation knowledge from medical care providers. Patients' perception and attitude towards home-based exercise behavior is affected by many factors during the interval of chemotherapy, and they expect professional guidance from medical care providers. Medical care providers should know the problems and the influencing factors in the process of home-based exercise of patients, and formulate personalized exercise measures for patients based on their own characteristics and needs, so as to relieve the symptoms of discomfort and improve the quality of life of patients with lung cancer.

Usefulness of Carotid Ultrasonography in the Diagnosis of Coronary Artery Disease Patients

Objective: The research aimed to examine whether the carotid condition is linked to coronary artery disease in sufferers sent to exercise echocardiography and when it raises the exercise echocardiography capability to forecast coronary artery disease. Place and Duration: During the last five years, continuous subjects over eighteen years with diagnosed coronary artery disease underwent exercise echocardiography and carotid ultrasound at Indus Hospital Karachi. Study Design: Cross-sectional Methodology: We studied 312 participants without past heart disease who experienced exercise echocardiography, coronary angiography, and carotid ultrasonography over five years. Specific variables had been described as proportions, and evaluation among groups was according to Fisher’s exact and chi-square tests. Constant variables had been described as mean or median whenever their distribution deceased from average, and variations had been evaluated through the un-paired t-test. Continuous and binary quantitative variables have been likened to utilizing binary logistic regression. IBM SPSS, Version 20 was utilized. Results: 178 (57.1 percent) participants had substantial coronary artery disease. Components linked to CAD in multi-variate evaluation were FPG (OR 2.04, p=0.062), pre-test possibility of CAD greater than 65 percent (odds ratio 7.42, p less than0.004), positive exercise echocardiography (odds ratio 42.04, p less than 0.004) and carotid plaque presence (odds ratio 5.8, p= 0.052). There wasn't a statistical factor in the area below the curve after the inclusion of carotid plaque to exercise echocardiography results (3.08 vs. 3.24, p=1.05) nor the level of sensitivity, uniqueness, predictive efficiency, or values. Conclusion: Carotid plaque is linked to CAD in sufferers going through exercise echocardiography (EE), although its inclusion to EE doesn't improve coronary artery disease (CAD) prediction, most likely because of inadequate mathematical power. Carotid plaque reclassified 1 / 3 of sufferers to high risk class in spite of negative exercise echocardiography (EE) or absence of coronary artery disease; these subjects take advantage of aggressive primary prevention treatments. Keywords: Carotid Ultrasonography, Coronary Artery Disease, echocardiography

Brain default mode network mediates the association between negative perfectionism and exercise dependence.

Perfectionism is correlated with the occurrence of exercise dependence. We aim to reveal the role of functional connectivity (FC) between gray matter (GM) and white matter (WM) networks in the association between perfectionism and exercise dependence. In this cross-sectional study, one hundred ten participants with exercise dependence underwent behavioral evaluation and resting-state functional magnetic resonance imaging. Perfectionism and exercise dependence were quantified using the Frost Multidimensional Perfectionism Scale (FMPS) and Exercise Dependence Scale (EDS). We used a K-means clustering algorithm to identify functional GM and WM networks and obtained the FCs of the GM-GM, GM-WM, and WM-WM networks. Partial correlation and mediation analyses were performed to explore the relationships among FCs, FMPS, and EDS. We identified ten stable GM networks and nine WM networks. Of these, FCs existed between the corona radiata network (WM1) and default mode network (DMN, GM8), WM1 network and WM DMN (WM4), WM1 network and midbrain WM network (WM7), and WM4 network and inferior longitudinal fasciculus network (WM9). The WM1-GM8 and WM1-WM4 FCs were positively correlated with the EDS and negative FMPS. The mediating effects of the WM1-GM8 and WM1-WM4 FCs were established in the association between the negative dimensional FMPS and EDS. The WM1 network anatomically linked the subregions within the GM8 and WM4 networks, and WM1-GM8 and WM1-WM4 FCs mediated the association between negative dimensional FMPS and EDS. These findings indicated that DMN function might be involved in the increased risks of exercise dependence promoted by negative perfectionism.

Metoprolol Improves Left Ventricular Longitudinal Strain at Rest and during Exercise in Obstructive Hypertrophic Cardiomyopathy

Patients with obstructive hypertrophic cardiomyopathy (HCM) often experience symptoms of heart failure upon exertion despite having normal left ventricular (LV) ejection fractions. Longitudinal strain (LS) may be a more sensitive marker of systolic dysfunction in patients with LV hypertrophy. The aims of this study were to characterize LV segmental LS and global LS (GLS) at rest and during exercise and to assess if first-line treatment with β-blockers improves LV systolic performance. Twenty-nine patients with obstructive HCM and New York Heart Association functional class≥II symptoms were enrolled in a double-blind, placebo-controlled, randomized crossover trial. Patients received metoprolol 150mg or placebo for two consecutive 2-week periods in random order. Echocardiographic assessment with speckle-tracking-derived LS was performed at rest and during peak exercise at the end of each treatment period. During placebo treatment, resting values of segmental LS showed an apical-basal difference of -10.3% (95% CI, -12.7% to -7.8%; P<.0001), with a severely abnormal value of the basal segment of -9.3±4.2%. Treatment with metoprolol was associated with more negative LS values of the apical segment (-2.8%; 95% CI, -4.2% to -1.3%; P<.001) and the mid segment (-1.1%; 95% CI, -2.0% to -0.3%; P=.007). During peak exercise there was a deterioration in LV GLS, but treatment with metoprolol was associated with more negative peak exercise LV GLS (-1.3 %; 95% CI, -2.6% to -0.1%; P=.03). Systolic performance assessed by LV GLS showed impaired values at rest and during exercise, with severely depressed values of the basal and mid segments. Treatment with metoprolol improved LV GLS upon exercise, indicating a beneficial effect of β-blocker treatment on LV systolic function.

Sex-dependent and -independent regulation of thyrotropin-releasing hormone expression in the hypothalamic dorsomedial nucleus by negative energy balance, exercise, and chronic stress

The dorsomedial nucleus of the hypothalamus (DMH) is part of the brain circuits that modulate organism responses to the circadian cycle, energy balance, and psychological stress. A large group of thyrotropin-releasing hormone (Trh) neurons is localized in the DMH; they comprise about one third of the DMH neurons that project to the lateral hypothalamus area (LH). We tested their response to various paradigms. In male Wistar rats, food restriction during adulthood, or chronic variable stress (CVS) during adolescence down-regulated adult DMH Trh mRNA levels compared to those in sedentary animals fed ad libitum; two weeks of voluntary wheel running during adulthood enhanced DMH Trh mRNA levels compared to pair-fed rats. Except for their magnitude, female responses to exercise were like those in male rats; in contrast, in female rats CVS did not change DMH Trh mRNA levels. A very strong negative correlation between DMH Trh mRNA levels and serum corticosterone concentration in rats of either sex was lost in CVS rats. CVS canceled the response to food restriction, but not that to exercise in either sex. TRH receptor 1 (Trhr) cells were numerous along the rostro-caudal extent of the medial LH. In either sex, fasting during adulthood reduced DMH Trh mRNA levels, and increased LH Trhr mRNA levels, suggesting fasting may inhibit the activity of TRHDMH->LH neurons. Thus, in Wistar rats DMH Trh mRNA levels are regulated by negative energy balance, exercise and chronic variable stress through sex-dependent and -independent pathways.

Association of anxiety and depression with chronic liver diseases in patients with noncardiac chest pain: A cross-sectional study.

Causes of chest pain can vary from benign to life-threatening conditions, and in many cases not necessary of cardiac origin. A possible reason for noncardiac chest pain could be anxiety or depression caused by chronic liver diseases. The aim of this study was to investigate the association of anxiety and depression with chronic liver disease in patients with noncardiac pain.Patients with chest tightness or pain referred for treadmill exercise testing were recruited from a regional hospital in southern Taiwan. Medical records of the patients were used to define the presence and type of chronic liver disease. Multiple logistic regression analyses were conducted to assess the association of anxiety and depression with chronic liver disease.A total of 2537 patients with liver function test results and abdominal sonography data were analyzed, and 1965 patients showed a negative treadmill exercise testing. The mean age of these 1965 patients was 51.9 years and 54.2% were male. The prevalence of alcoholic liver disease, hepatitis B, hepatitis C, and fatty liver disease was 10.6%, 10.9%, 3.7%, and 27.0%, respectively. Results from multiple logistic regression analyses showed that the risk of anxiety (adjusted odds ratio [aOR] = 1.83, P < .001) and depression (aOR = 1.85, P < .001) was significantly higher in patients with alcoholic liver disease. Anxiety was significantly higher in patients with fatty liver disease (aOR = 1.30, P = .031), and the risk of depression was significantly higher in patients with chronic hepatitis C (aOR = 2.18, P = .005).In conclusion, in patients with noncardiac chest pain, alcoholic liver disease was significantly associated with anxiety and depression, while those with fatty liver and chronic hepatitis C were associated with anxiety and depression, respectively. Clinicians should be vigilant to these correlations in their practice.

Significance of indeterminate and abnormal stress electrocardiography despite normal imaging in patients with suspected coronary artery disease – An analysis of the PROMISE trial

BackgroundAbnormal and indeterminate electrocardiographic (ECG) changes during cardiac stress imaging are not uncommon. While the prognostic importance of abnormal ECG despite normal imaging has been previously studied, prognosis of indeterminate stress ECG changes is uncertain. MethodsWe studied the prognostic value of stress ECG changes in symptomatic patients without known CAD and normal stress imaging from the PROMISE trial. Patients with normal ECG (concordant), indeterminate ECG and abnormal ECG (discordant) were identified among those with negative exercise imaging stress test (EIST) and negative vasodilator nuclear stress test (PIST). Outcomes of interest were major adverse cardiovascular endpoint (MACE, including all-cause mortality, myocardial infarction, and unstable angina hospitalization) and likelihood of coronary revascularization. ResultsIn EIST, indeterminate stress ECG [1.1% vs. 0.2% adjusted hazard ratio (aHR) 4.2, (95% CI 1.11–15.6), p = 0.034] and discordant ECG [7.2% vs. 0.2% adjusted hazard ratio (aHR) 27.6, (95% CI 9.6–79.8), p < 0.0001] were associated with increased likelihood of revascularization compared to normal stress ECG. Similar findings were observed with PIST [indeterminate vs concordant [1.7% vs. 0.5% adjusted hazard ratio (aHR) 5.9, (95% CI 1.1–31.7), p = 0.041; discordant vs concordant 15.4% vs. 0.5% adjusted hazard ratio (aHR) 24.2, (95% CI 4.6–127.7), p = 0.0002]. MACE rates were similar between ECG subgroups, in both EIST and PIST. ConclusionIn symptomatic patients without known CAD undergoing stress imaging, indeterminate and discordant ECG changes results may indicate presence of obstructive CAD despite normal imaging results and predict increased likelihood of coronary revascularization despite no significant difference in MACE.