Therapy Of Cardiovascular Diseases Research Articles

Formulation and Evaluation of Logenzes for Anticoagulantion

Cardiovascular diseases represent a significant global health burden, necessitating effective prevention and treatment strategies to mitigate their impact. Anticoagulant therapy plays a crucial role in managing these diseases by preventing the formation of blood clots, which can lead to life-threatening complications such as heart attacks and strokes. However, conventional anticoagulants are associated with limitations, including the risk of bleeding complications and the need for frequent monitoring. In recent years, there has been increasing interest in exploring natural alternatives to conventional anticoagulants, with Cayenne pepper (Capsicum annuum) emerging as a potential candidate due to its bioactive compound, capsaicin. This paper aims to review the existing literature on the anticoagulant properties of Cayenne pepper lozenges. By examining the pharmacological mechanisms of capsaicin and summarizing preclinical and clinical studies, this paper evaluates the efficacy, safety, and therapeutic potential of Cayenne pepper as an alternative or adjunctive therapy for cardiovascular diseases. The findings suggest that Cayenne pepper lozenges may hold promise as a novel anticoagulant agent, offering potential benefits in terms of cardiovascular health and reducing the burden associated with conventional anticoagulant therapy

Role of Colchicine in Cardiovascular Disorders.

Inflammation has played a pivotal role in atherosclerosis and other cardiovascular disorders, prompting the exploration of anti-inflammatory therapies to improve cardiovascular outcomes. Colchicine, a well-established agent in conditions such as gout and familial Mediterranean fever, has emerged as a promising novel anti-inflammatory agent in the realm of cardiovascular diseases. Its ability to target both traditional risk factors and residual inflammatory risk marks a significant advancement in cardiovascular prevention strategies, indicating a new era in cardiovascular care. Landmark trials have supported the efficacy and safety of low-dose colchicine in reducing major adverse cardiovascular events when combined with standard therapies. In addition, its endorsement by major cardiovascular societies underscores its significance as the first targeted anti-inflammatory therapy for cardiovascular disease. However, careful monitoring for drug interactions and adverse effects, particularly on kidney and liver function, is essential for safe use. In this review, we aim to comprehensively summarize the mechanisms of action of colchicine, its molecular and biochemical targets in various cardiovascular conditions, and its pharmacokinetics, and delve deeply into the existing evidence on its safety and efficacy in the treatment of cardiovascular disorders, including coronary artery disease, pericarditis, atrial fibrillation, and heart failure.

Reinforcement Learning for Closed-loop Regulation of Cardiovascular System with Vagus Nerve Stimulation: A Computational Study.

(Objective). Vagus nerve stimulation (VNS) is being investigated as a potential therapy for cardiovascular diseases including heart failure, cardiac arrhythmia, and hypertension. The lack of a systematic approach for controlling and tuning the VNS parameters poses a significant challenge. Closed-loop VNS strategies combined with artificial intelligence (AI) approaches offer a framework for systematically learning and adapting the optimal stimulation parameters. In this study, we presented an interactive AI framework using reinforcement learning (RL) for automated data-driven design of closed-loop VNS control systems in a computational study. (Approach). Multiple simulation environments with a standard application programming interface were developed to facilitate the design and evaluation of the automated data-driven closed-loop VNS control systems. These environments simulate the hemodynamic response to multi-location VNS using biophysics-based computational models of healthy and hypertensive rat cardiovascular systems in resting and exercise states. We designed and implemented the RL-based closed-loop VNS control frameworks in the context of controlling the heart rate (HR) and the mean arterial pressure (MAP) for a set point tracking task. Our experimental design included two approaches; a general policy using deep RL algorithms and a sample-efficient adaptive policy using probabilistic inference for learning and control (PILCO). (Main results). Our simulation results demonstrated the capabilities of the closed-loop RL-based approaches to learn optimal VNS control policies and to adapt to variations in the target set points and the underlying dynamics of the cardiovascular system. Our findings highlighted the trade-off between sample-efficiency and generalizability, providing insights for proper algorithm selection. Finally, we demonstrated that transfer learning improves the sample efficiency of Deep RL algorithms allowing the development of more efficient and personalized closed-loop VNS systems. (Significance). We demonstrated the capability of RL-based closed-loop VNS systems. Our approach provided a systematic adaptable framework for learning control strategies without requiring prior knowledge about the underlying dynamics.

EFFECTS OF PTEROSTILBENE ON HEART AND LUNG OXIDATIVE STRESS PARAMETERS IN TWO EXPERIMENTAL MODELS OF CARDIOVASCULAR DISEASE: MYOCARDIAL INFARCTION AND PULMONARY ARTERIAL HYPERTENSION.

Myocardial infarction (MI) and pulmonary artery hypertension (PAH) are two prevalent cardiovascular diseases. In both conditions, oxidative stress is associated with a worse prognosis. Pterostilbene (PTE), an antioxidant compound, has been studied as a possible therapy for cardiovascular diseases. This study aims to evaluate the effect of PTE on oxidative stress in the hearts of animals with myocardial infarction and in the lungs of animals with PAH. Male Wistar rats were used in both models. In the MI model, the experimental groups were sham, MI, and MI+PTE. In PAH model, the experimental groups were control, PAH, and PAH+PTE. Animals were exposed to MI through surgical ligation of the left coronary artery, or to PAH, by administration of monocrotaline (60 mg/kg). Seven days after undergoing cardiac injury, the MI+PTE animals were treated with PTE (100 mg/kg day) for 8 days. After this, the heart was collected for molecular analysis. The PAH+PTE animals were treated with PTE (100 mg/kg day) for 14 days, beginning 7 days after PAH induction. After this, the lungs were collected for biochemical evaluation. We found that PTE administration attenuated the decrease in ejection fraction and improved LV end-systolic volume in infarcted animals. In the PAH model, PTE improved pulmonary artery flow and decreased ROS levels in the lung. PTE administration promoted protective effects in terms of oxidative stress in two experimental models of cardiac diseases: MI and PAH. PTE also improved cardiac function in infarcted rats and pulmonary artery flow in animals with PAH.

Advances in preclinical surgical therapy of cardiovascular diseases.

Cardiovascular disease is the most common cause of death worldwide, resulting in millions of deaths annually. Currently, there are still some deficiencies in the treatment of cardiovascular diseases. Innovative surgical treatments are currently being developed and tested in response to this situation. Large animal models, which are similar to humans in terms of anatomy, physiology, and genetics, play a crucial role in connecting basic research and clinical applications. This article reviews recent preclinical studies and the latest clinical advancements in cardiovascular disease based on large animal models, with a focus on targeted delivery, neural regulation, cardiac remodeling, and hemodynamic regulation. It provides new perspectives and ideas for clinical translation and offers new methods for clinical treatment.

Andrographis paniculata: A potential supplementary therapy for cardiovascular diseases - A systematic review of its effects and molecular actions

Andrographis paniculata: A potential supplementary therapy for cardiovascular diseases - A systematic review of its effects and molecular actions

Regulation of Myocardial Lipid Accumulation in the Development of Obesity

Energy metabolism is important in the development of heart disease, which is the leading cause of death worldwide. The importance of energy metabolism in disease is becoming even more clear with the rise in obesity, metabolic diseases, and the recognition that they all fit together as with the recent offcial report of a new syndrome named Cardiovascular-Kidney-Metabolic (CKM) Syndrome. A complete understanding of myocardial lipid storage and subsequent utilization of lipids is essential to understanding the impact of these metabolic diseases in the heart and on the development of cardiac dysfunction and hypertrophy. In this study we investigate how the heart controls fuel storage by taking advantage of the impact of the transcription factor peroxisome proliferator activated receptor α (PPARα) on 1) fatty acid metabolism and lipid accumulation, 2) its key role in sex differences in cardiac hypertrophy which we previously reported, and 3) the regulation of lipid droplets. It is controversial whether a decline in myocardial PPARα mediates cardiac hypertrophy and whether it increases or reduces lipid accumulation. Using our tamoxifen inducible cardiac-specific PPARα knockout mouse (cPPAR−/−) we see less cardiac lipid accumulation in response to a 5 week high fat diet. Our data indicate that this difference in triglyceride levels is present in both males and females. Importantly, this is not driven by a difference in fatty acid supply to these hearts. Serum fatty acid levels are not lower in cPPAR−/− vs Control mice fed a high fat diet. Further, we have not observed a difference in high fat diet induced body weight gain between cPPAR−/− and Control mice. We have begun to examine how these differences in high fat diet-induced lipid accumulation correlate with cardiac hypertrophy by looking at heart weight normalized to tibia length. While we did not expect 5 weeks of a high fat diet to induce cardiac hypertrophy, it is possible that the difference in cardiac lipid storage in the cPPAR−/− hearts could impact this. This measurement did not indicate a difference in cardiac hypertrophy between high fat diet fed cPPAR−/− and Control mice. We are utilizing this mouse as a model to investigate the regulation of lipid droplets and the lipid droplet proteome. So far, our results are indicating that the regulation of lipid droplet proteins is not affected in a uniform manner. For example, our data is suggesting that the expression of different members of the perilipin family are affected in distinct ways. Overall, these data indicate that a reduction in cardiac PPARα protects against obesity induced cardiac lipid accumulation. Going forward, it will be interesting to see how these changes occur in relation to the lipid droplet proteome and whether any changes that occur differentially in males vs female may be involved in sex differences in cardiac hypertrophy. Better understanding these factors will be essential for the development of safe and effective future therapies for CKM syndrome and other cardiovascular diseases. ND-EPSCoR. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Extracellular Vesicles in the Diagnosis and Treatment of Cardiovascular Disease. What's behind? What do we need to implement them into clinical practice?

Extracellular vesicles (EVs) represent a heterogeneous group of particles secreted by cells to transfer information from the cell of origin to recipient cells by carrying various bioactive molecules. Numerous PubMed records on EVs reveal a burgeoning interest in EV-research, with a notable subset focusing on the potential diagnostic and therapeutic applications of EVs for diverse diseases, including cardiovascular disease (CVD), currently a globally leading cause of mortality. However, this great diagnostic and clinical potential has not yet been translated into clinical practice. No EV-based biomarkers and EV-therapeutic products have been approved, and EV-based therapy for CVD has not yet been shown to be effective. Therefore, this paper aims to scrutinize available data and identify what is needed to translate the underlying potential of EVs into specific EV-biomarkers and EV-therapeutic tools applicable in clinical practice.

Beyond silence: evolving ultrasound strategies in the battle against cardiovascular thrombotic challenges.

Cardiovascular thrombotic events have long been a perplexing factor in clinical settings, influencing patient prognoses significantly. Ultrasound-mediated acoustic therapy, an innovative thrombolytic treatment method known for its high efficiency, non-invasiveness, safety, and convenience, has demonstrated promising potential for clinical applications and has gradually become a focal point in cardiovascular thrombotic disease research. The current challenge lies in the technical complexities of preparing ultrasound-responsive carriers with thrombus-targeting capabilities and high thrombolytic efficiency. Additionally, optimizing the corresponding acoustic treatment mode is crucial to markedly enhance the thrombolytic effectiveness of ultrasound-mediated acoustic therapy. In light of the current status, this article provides a comprehensive review of the research progress in innovative ultrasound-mediated acoustic therapy for cardiovascular thrombotic diseases. It explores the impact of technical methods, therapeutic mechanisms, and influencing factors on the thrombolytic efficiency and clinical potential of ultrasound-mediated acoustic therapy. The review places particular emphasis on identifying solutions and key considerations in addressing the challenges associated with this cutting-edge therapeutic approach.

International Migration and Cardiovascular Health: Unraveling the Disease Burden Among Migrants to North America and Europe.

Europe and North America are the 2largest recipients of international migrants from low-resource regions in the world. Here, large differences in cardiovascular disease (CVD) morbidity and death exist between migrants and the host populations. This review discusses the CVD burden and its most important contributors among the largest migrant groups in Europe and North America as well as the consequences of migration to high-income countries on CVD diagnosis and therapy. The available evidence indicates that migrants in Europe and North America generally have a higher CVD risk compared with the host populations. Cardiometabolic, behavioral, and psychosocial factors are important contributors to their increased CVD risk. However, despite these common denominators, there are important ethnic differences in the propensity to develop CVD that relate to pre- and postmigration factors, such as socioeconomic status, cultural factors, lifestyle, psychosocial stress, access to health care and health care usage. Some of these pre- and postmigration environmental factors may interact with genetic (epigenetics) and microbial factors, which further influence their CVD risk. The limited number of prospective cohorts and clinical trials in migrant populations remains an important culprit for better understanding pathophysiological mechanism driving health differences and for developing ethnic-specific CVD risk prediction and care. Only by improved understanding of the complex interaction among human biology, migration-related factors, and sociocultural determinants of health influencing CVD risk will we be able to mitigate these differences and truly make inclusive personalized treatment possible.

Aspirin hypersensitivity: a practical guide for cardiologists.

Aspirin has been known for a long time and currently stays as a cornerstone of antithrombotic therapy in cardiovascular disease. In patients with either acute or chronic coronary syndromes undergoing percutaneous coronary intervention aspirin is mandatory in a dual antiplatelet therapy regimen for prevention of stent thrombosis and/or new ischaemic events. Aspirin is also currently a first-option antithrombotic therapy after an aortic prosthetic valve replacement and is occasionally required in addition to oral anticoagulants after implantation of a mechanical valve. Presumed or demonstrated aspirin hypersensitivity is a main clinical problem, limiting the use of a life-saving medication. In the general population, aspirin hypersensitivity has a prevalence of 0.6%-2.5% and has a plethora of clinical presentations, ranging from aspirin-exacerbated respiratory disease to anaphylaxis. Although infrequent, when encountered in clinical practice aspirin hypersensitivity poses for cardiologists a clinical dilemma, which should never be trivialized, avoiding-as much as possible-omission of the drug. We here review the epidemiology of aspirin hypersensitivity, provide an outline of pathophysiological mechanisms and clinical presentations, and review management options, starting from a characterization of true aspirin allergy-in contrast to intolerance-to suggestion of desensitization protocols.

The Essence of Lipoproteins in Cardiovascular Health and Diseases Treated by Photodynamic Therapy.

Lipids, together with lipoprotein particles, are the cause of atherosclerosis, which is a pathology of the cardiovascular system. In addition, it affects inflammatory processes and affects the vessels and heart. In pharmaceutical answer to this, statins are considered a first-stage treatment method to block cholesterol synthesis. Many times, additional drugs are also used with this method to lower lipid concentrations in order to achieve certain values of low-density lipoprotein (LDL) cholesterol. Recent advances in photodynamic therapy (PDT) as a new cancer treatment have gained the therapy much attention as a minimally invasive and highly selective method. Photodynamic therapy has been proven more effective than chemotherapy, radiotherapy, and immunotherapy alone in numerous studies. Consequently, photodynamic therapy research has expanded in many fields of medicine due to its increased therapeutic effects and reduced side effects. Currently, PDT is the most commonly used therapy for treating age-related macular degeneration, as well as inflammatory diseases, and skin infections. The effectiveness of photodynamic therapy against a number of pathogens has also been demonstrated in various studies. Also, PDT has been used in the treatment of cardiovascular diseases, such as atherosclerosis and hyperplasia of the arterial intima. This review evaluates the effectiveness and usefulness of photodynamic therapy in cardiovascular diseases. According to the analysis, photodynamic therapy is a promising approach for treating cardiovascular diseases and may lead to new clinical trials and management standards. Our review addresses the used therapeutic strategies and also describes new therapeutic strategies to reduce the cardiovascular burden that is induced by lipids.

Cinnamon: A potent nutraceutical agent for the protection of the cardiovascular system

Diseases such as diabetes, atherosclerosis, and hypertension are risk factors for Cardiovascular Diseases (CVDs). About 17.3 million deaths worldwide were due to CVDs in 2013 and is anticipated to be 23.3 million by 2030. Common therapies for CVDs are associated with wide side effects. Thus, herbal medicines have been regarded more due to fewer side effects, availability, cultural beliefs, and being cheap. For thousands of years, herbal medicine has been used for bacterial infections, colds, coughs, and CVDs. Cinnamon bark contains phenolic compounds such as cinnamaldehyde and cinnamic acid with protective properties that can reduce the risk of cardiovascular diseases, cardiac ischemia and hypertrophy, and myocardial infarction. Furthermore, cinnamon has antioxidant and anti-inflammatory properties and exhibits beneficial effects on the complications of diabetes, obesity, hypercholesterolemia, and hypertension which cause CVDs. Although the protective effects of cinnamon on the heart have been reported in many studies, it needs more clinical studies to prove the pharmaceutical and therapeutic efficacy of cinnamon on risk factors of CVDs. This review explains the protective effects of bioactive compounds of cinnamon on the cardiovascular system.

Role of Herbal Active Compound in Cardiac Failure Treatment

The prevalence of cardiovascular diseases (CVDs) is constantly rising, making them a major health burden. In terms of global mortality and morbidity, they are still at the top. An alternate method of treating many illnesses, including CVDs, is the use of medicinal herbs. There is a current, unprecedented push to include herbal remedies into contemporary healthcare systems. The widespread conviction in their safety and the fact that they offer more effective treatment at a lower cost than conventional modern medicines are two of the main factors propelling this movement. However, there has not been enough testing of the purported safety of herbal remedies. As a result, people need to know that medical herbs can be toxic, have possibly fatal side effects, and can interact negatively with other drugs. Experimental evidence suggests that medicinal herbs may be useful in the treatment of cardiovascular diseases (CVDs) due to their ability to inhibit multiple risk factors for these conditions. So, in order to successfully use herbs in CVD therapy, there have been numerous initiatives to transition medicinal herb research from the lab to the clinic. Presented below are cardiovascular diseases (CVDs) and the variables that put people at risk for developing them. Next, we provide a synopsis of herbal medicine's role in the treatment of disease, with a focus on cardiovascular diseases. In addition, information is compiled and examined about the ethnopharmacological therapeutic possibilities and medicinal qualities against cardiovascular diseases of four commonly used plants: ginseng, gingko biloba, ganoderma lucidum, and gymnostemma pentaphyllum. The use of these four plants in the treatment of cardiovascular diseases (CVDs) including myocardial infarction, hypertension, peripheral vascular disorders, coronary heart disease, cardiomyopathies, and dyslipidemias has been well examined. We are also making an effort to describe the current in vitro and in vivo investigations that have attempted to examine the cellular and molecular underpinnings of the four plants' cardio-protective effects. Lastly, we highlighted the effectiveness, safety, and toxicity of these four medicinal herbs by reviewing and reporting the results of current clinical trials.
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Hierarchical Piezoelectric Composites for Noninvasive Continuous Cardiovascular Monitoring.

Continuous monitoring of blood pressure (BP) and multiparametric analysis of cardiac functions are crucial for the early diagnosis and therapy of cardiovascular diseases. However, existing monitoring approaches often suffer from bulky and intrusive apparatus, cumbersome testing procedures, and challenging data processing, hampering their applications in continuous monitoring. Here, a heterogeneously hierarchical piezoelectric composite is introduced for wearable continuous BP and cardiac function monitoring, overcoming the rigidity of ceramic and the insensitivity of polymer. By optimizing the hierarchical structure and components of the composite, the developed piezoelectric sensor delivers impressive performances, ensuring continuous and accurate monitoring of BP at Grade A level. Furthermore, the hemodynamic parameters are extracted from the detected signals, such as local pulse wave velocity, cardiac output, and stroke volume, all of which are in alignment with clinical results. Finally, the all-day tracking of cardiac function parameters validates the reliability and stability of the developed sensor, highlighting its potential for personalized healthcare systems, particularly in early diagnosis and timely intervention of cardiovascular disease.

Extracellular neutrophil traps in cardiovascular diseases: problems and prospects of research

One of the links in the pathogenesis of cardiovascular diseases is chronic low-intensity systemic inflammation. In 2004, a previously unknown process was discovered — the formation of extracellular neutrophil traps (NETs) — NETosis (n eutrophil extracellular traps). NETs play a role in antimicrobial immunity though in certain cases they become a factor in the development of pathology. This review presents data on the effect of extracellular neutrophil traps on individual pathologies of the cardiovascular system (atherosclerosis, atrial fibrillation, thrombosis). The authors describe the mechanisms of NET formation (vital NETosis, suicidal NETosis) and their role in thrombus formation (as a framework for thrombus formation, initiation of coagulation), in the development of endothelial dysfunction, and electrical heterogeneity of the atrial myocardium. Data are presented indicating the connection between atherosclerosis, thrombosis, and atrial fibrillation with the activity of NETosis. Most studies demonstrate existing correlations on laboratory models, while the determination of NETs in patients with cardiovascular pathology in real clinical practice is almost absent. At the same time, understanding the processes associated with NETosis can help to identify specific markers and further strategies for the therapy of cardiovascular diseases.

Cinnamon: a nutraceutical supplement for the cardiovascular system

Common therapies for cardiovascular diseases (CVDs) are associated with wide side effects. Thus, herbal medicines have been regarded due to fewer side effects, availability, cultural beliefs, and being cheap. For thousand years, herbal medicine has been used for bacterial infections, colds, coughs, and CVDs. Cinnamon bark contains phenolic compounds such as cinnamaldehyde and cinnamic acid with protective properties which can reduce the risk of cardiovascular diseases, cardiac ischemia and hypertrophy, and myocardial infarction. Furthermore, cinnamon has antioxidant and anti-inflammatory properties and exhibits beneficial effects on the complications of diabetes, obesity, hypercholesterolemia, and hypertension which cause CVDs. Although the protective effects of cinnamon on the heart have been reported in many studies, it needs more clinical studies to prove the pharmaceutical and therapeutic efficacy of cinnamon on risk factors of CVDs.

On viscoelastic blood in a locally narrow artery with magnetic field: application of distributed-order time fractional Maxwell model

Purpose. The study of hemorheology of heterogeneous vessels is of importance for the therapy of cardiovascular diseases. The present paper aims to investigate the effects of the height parameter of the stenosis, the Reynolds number, the relaxation time and the Hartmann number on the blood flow by applying distributed order time fractional Maxwell model. Methodology. Distributed order time fractional Maxwell constitutive fluid model is used to simulate viscoelastic blood flowing in a narrowing blood vessel with uniform magnetic field. The continuity and momentum equations are established in two-dimensional cylindrical coordinate system for calculation. With vorticity-stream function method, the finite difference technique, combined with the fractional derivative L1 interpolation approximation, is utilized to obtain numerical solutions of velocity and wall shear stress. The effectiveness of the numerical method is verified. Outcomes. It reveals the choice of relaxation time in the governing equation has an influence on the results. The numerical results show that an appropriate increase of Reynolds number can reduce the possibility of vessel damage. Furthermore, when the height parameter of the stenosis increases, the damage to the vessel wall is getting serious. Besides, the wall shear stress along the blood vessel increases with the increase of the magnetic field, but the wall shear stress in the narrowest part of the blood vessel changes little.

Kidney Renin-Angiotensin System: Lost in a RAS Cascade.

Renin was discovered more than a century ago. Since then, the functions of the renin-angiotensin system in the kidney have been the focus of intensive research revealing its importance in regulation of renal physiology and in the pathogenesis of heart, vascular, and kidney diseases. Inhibitors of renin-angiotensin system components are now foundational therapies for a range of kidney and cardiovascular diseases from hypertension to heart failure to diabetic nephropathy. Despite years of voluminous research, emerging studies continue to reveal new complexities of the regulation of the renin-angiotensin system within the kidney and identification of nonclassical components of the system like the prorenin receptor (PRR) and ACE2 (angiotensin-converting enzyme 2), with powerful renal effects that ultimately impact the broader cardiovascular system. With the emergence of a range of novel therapies for cardiovascular and kidney diseases, the importance of a detailed understanding of the renin-angiotensin system in the kidney will allow for the development of informed complementary approaches for combinations of treatments that will optimally promote health and longevity over the century ahead.

DETERMINANTS OF CHOOSING A PLACE FOR PHYSICAL ACTIVITY

Physical activity is one of the main components of leading a healthy lifestyle. It is recommended not only as a prevention of many diseases, but in the right form also as a form of therapy in most cardiovascular diseases. There are many places where you can practice various forms of physical activity. The aim of the study was to indicate the key factors determining the choice of a sports club as a place of physical activity. The study presents the results of the survey conducted in May 2021 using the CAWI method. 120 respondents took part in the survey. They were mainly students living in cities with over 200,000 inhabitants. The research focused in particular on the following aspects determining the choice of a sports club as a place of physical activity: preferred number of training units per week, duration of training units, preferred location and availability (hours, dates of operation) of the place where physical activity is practiced. In order to identify the factors determining the choice of a sports club as a place of physical activity, questionnaire data was explored using frequency analysis. It was found that the respondents prefer three training units per week, which last 60 minutes. An important factor determining the choice of a sports club as a place for physical activity is its location and accessibility.