Investigation of factors associated with autonomic nervous system function in patients with rheumatoid arthritis

Rheumatoid Arthritis (RA) patients have high risk for cardiovascular diseases (CVD). Poor autonomic nervous system (ANS) function, (increased sympathetic and reduced parasympathetic activity) is a factor contributing to the risk for CVD in RA. The first experimental chapter includes a cross-sectional study in which the association between a measure of myocardial ischemia during an exercise tolerance test (ETT) and resting heart rate variability (HRV) was explored in 96 RA patients. Myocardial ischemia was associated with reduced HRV. The second chapter examined the parasympathetic reactivation using heart rate recovery (HRR) following ETT, and multiple factors association with HRR. Multivariate analyses revealed no factor was independently associated with HRR, but it was the overall CVD risk and disease related burden that contributed to variability in HRR. In the third chapter, the effects of a three-month exercise intervention on HRR, CVD risks, inflammation, and measures of wellbeing were investigated in 62 RA patients. Exercise reduced some CVD risk factors and improved some measures of wellbeing, however, HRR and cardiorespiratory fitness did not improve. In the last chapter, a cross-sectional study compared HRR between age-and sex-matched RA (N=43) and diabetes mellitus (N=26) patients as well as inflammatory markers, CVD risk factors, and measures of wellbeing. There was no difference in HRR or inflammation between the two groups. A sub-analysis found that cardiorespiratory fitness was an independent predictor of HRR. These findings suggest that parasympathetic activity in RA associate with several CVD risk factors, and cardiorespiratory fitness is an important factor associated with it

Falls and potential therapeutic interventions among elderly and older adult patients with cancer: a systematic review

Objectives: The aim of this study was to perform a systematic review for previous publications that have assessed the incidence, risk factors, and favorable procedures to prevent and manage falls among cancer survivors of elderly and older adults. Materials: This systematic review was undertook using PubMed, SCOPUS, Web of Science, Medline, and Cochrane Database of clinical studies and systematic reviews to determine the incidence, risk factors, favorable inpatient and outpatient management, and non-pharmacological interventions for falls among elderly and older adult patients with cancer from 2010 to October, 2020. Results: After the comprehensive screening, clinical studies, meta-analysis, systematic reviews, and established guidelines were included in this review. Only 5 clinical studies (3 randomized and 2 single-arm studies), 5 systematic reviews, and 6 established guidelines were considered eligible. The five systematic reviews provide risk factors of falls and the 6 guidelines provide assessment & prevention modalities of falls, however, the 6 clinical studies provide the non-pharmacological intervention for falling among cancer survivors. Many factors associated are demonstrated among wide range of elderly individuals.Earlier falls were reliably listed as an important risk factor of falls in the two inpatient and outpatient environments including both general older people and geriatric cancer populations. Conclusions: This review concludes that the assessment of falls among older individuals with cancer is the most important way for determining who could need additional observation and treatment program. Health professions involving physical therapy and occupational therapy have an important function for promoting health well-being in elderly and older adults with cancer. Keywords: Cancer; falls; elderly; older adults, risk factors, intervention

Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study

Background Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. Methods Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. Results Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. Conclusion Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA

data for analysis.xlsx

Data include information about metabolic requirements for incremental shuttle walking tests and the same protocol performed on a treadmill walking test.</p

Cardiopulmonary response during incremental shuttle walking test in a hallway versus on treadmill in Phase IV cardiac rehabilitation: a cross-sectional study

Abstract There is widespread use of incremental shuttle walking test (ISWT) to measure functional capacity in cardiac rehabilitation patients. Due to occasional physical space limitations, an incremental shuttle walking test on a treadmill (ISWT-T) was suggested as an alternative. Knowledge about the cardiopulmonary response between the two tests and the factors associated with the distance achieved in Phase IV cardiac rehabilitation is limited. Thus, the study aims to compare the cardiopulmonary response between ISWT and ISWT-T and investigate the factors associated with distance achieved in both tests. Thirteen participants (66.3 ± 7.3 years, 84.6% males) attending phase IV cardiac rehabilitation participated in repeated measures counterbalanced trials. Each participant performed one ISWT and one ISWT-T separated by seven days. Main outcome measures included peak heart rate (HR), systolic and diastolic blood pressure post-test, distance achieved, respiratory frequency, tidal volume (VT), minute ventilation, respiratory exchange ratio, peak oxygen uptake (VO2PEAK), and secondary outcome measures included height, weight, waist circumference (WC) leg length (LL). There were no significant differences in the cardiopulmonary responses between ISWT and ISWT-T except for VO2PEAK (25.4 ± 5.8 vs 23.7 ± 5.1, p = 0.05, respectively). Age and height were significantly correlated with distance achieved during ISWT, and ISWT-T [age (r = − 0.72, vs. r = − 0.73, p ≤ 0.05, respectively)], [height (r = 0.68, vs. r = 0.68, p ≤ 0.05, respectively)]. LL was only correlated with distance achieved on ISWT-T (r = 0.59, p ≤ 0.05). These findings suggest a similar cardiopulmonary response between the two tests, but doing ISWT in the hallway evoked a higher metabolic demand than doing it on a treadmill. Additionally, distance achieved on both tests was related to height and inversely to age

The Association between Cardiorespiratory Fitness and Reported Physical Activity with Sleep Quality in Apparently Healthy Adults: A Cross-Sectional Study

Background: Recently, poor cardiorespiratory fitness (CRF) has been postulated as an adverse health outcome related to poor sleep quality. However, studies investigating the relationship between CRF and a subjective sleep quality index are scarce. Thus, the current study aimed to investigate the association between CRF and the Pittsburgh Sleep Quality Index (PSQI) in apparently healthy people. The secondary aim was to investigate the association between reported physical activity (PA) and PSQI. Methods: Thirty-three healthy male participants volunteered to participate. CRF (VO2PEAK) was measured via cardiopulmonary exercise testing on a treadmill. A short form of the International Physical Activity Questionnaire (IPAQ) was used to measure PA, and PSQI was used for the sleep quality index. Results: There was no correlation between CRF and PSQI total score or any component of the PSQI. There was a significant inverse correlation between IPAQ and PSQI total score (r = −0.36, p = 0.04). Categorical data analysis of the two questionnaires revealed that 42.4% of the participants who reported low physical activity also had poor sleep quality. Conclusions: The current study showed no association between CRF and the subjective sleep quality index but demonstrated a moderate inverse association between reported PA and subjective sleep quality index. The findings suggest that the more reported PA, the better the overall sleep quality