Introduction to the research topic: the role of physical fitness on cardiovascular responses to stress

[EN] This e-book is the culmination of countless hours of meticulous work by global scientists. We would like to thank the researchers for their great contributions to this hot topic. The combination of these studies reflects the importance of the topic amongst researchers and practitioners and the wide interest from numer- ous laboratories around the world. The contributions include a variety of formats including five original investigations, three review articles, one opinion article and a hypothesis and the- ory article. Notably, these contributions included both human and animal models that encompassed a range of techniques from molecular mechanisms to real life interventions thus reinforcing the translational approach for the understanding of cardiovascu- lar responses to stress

Self-Rated Mental Stress and Exercise Training Response in Healthy Subjects

Purpose: Individual responses to aerobic training vary from almost none to a 40% increase in aerobic fitness in healthy subjects. We hypothesized that the baseline self-rated mental stress may influence to the training response. Methods: The study population included 44 healthy sedentary subjects (22 women) and 14 controls. The laboratory controlled training period was 2 weeks, including five sessions a week at an intensity of 75% of the maximum heart rate for 40 min/session. Self-rated mental stress was assessed by inquiry prior to the training period from 1 (low psychological resources and a lot of stressors in my life) to 10 (high psychological resources and no stressors in my life), respectively. Results: Mean peak oxygen uptake (VO2peak) increased from 34 ± 7 to 37 ± 7 ml kg−1 min−1 in training group (p < 0.001) and did not change in control group (from 34 ± 7 to 34 ± 7 ml kg−1 min−1). Among the training group, the self-rated stress at the baseline condition correlated with the change in fitness after training intervention, e.g., with the change in maximal power (r = 0.45, p = 0.002, W/kg) and with the change in VO2peak (r = 0.32, p = 0.039, ml kg−1 min−1). The self-rated stress at the baseline correlated with the change in fitness in both female and male, e.g., r = 0.44, p = 0.039 and r = 0.43, p = 0.045 for ΔW/kg in female and male, respectively. Conclusion: As a novel finding the baseline self-rated mental stress is associated with the individual training response among healthy females and males after highly controlled aerobic training intervention. The changes in fitness were very low or absent in the subjects who experience their psychological resources low and a lot of stressors in their life at the beginning of aerobic training intervention

Effects of bright light treatment on psychomotor speed in athletes

Purpose: A recent study suggests that transcranial brain targeted light treatment via ear canals may have physiological effects on brain function studied by functional magnetic resonance imaging (fMRI) techniques in humans. We tested the hypothesis that bright light treatment could improve psychomotor speed in professional ice hockey players. Methods: Psychomotor speed tests with audio and visual warning signals were administered to a Finnish National Ice Hockey League team before and after 24 days of transcranial bright light or sham treatment. The treatments were given during seasonal darkness in the Oulu region (latitude 65 degrees north) when the strain on the players was also very high (10 matches during 24 days). A daily 12-min dose of bright light or sham (n = 11 for both) treatment was given every morning between 8–12 am at home with a transcranial bright light device. Mean reaction time and motor time were analyzed separately for both psychomotor tests. Analysis of variance for repeated measures adjusted for age was performed. Results: Time x group interaction for motor time with a visual warning signal was p = 0.024 after adjustment for age. In Bonferroni post-hoc analysis, motor time with a visual warning signal decreased in the bright light treatment group from 127 ± 43 to 94 ± 26 ms (p = 0.024) but did not change significantly in the sham group 121 ± 23 vs. 110 ± 32 ms (p = 0.308). Reaction time with a visual signal did not change in either group. Reaction or motor time with an audio warning signal did not change in either the treatment or sham group. Conclusion: Psychomotor speed, particularly motor time with a visual warning signal, improves after transcranial bright light treatment in professional ice-hockey players during the competition season in the dark time of the year

Baroreflex sensitivity following acute upper-body exercise in the cold among stable coronary artery disease patients

Background: A cold environment and exercise separately affect the autonomic nervous system (ANS), baroreflex sensitivity (BRS), and blood pressure variability (BPV) but their combined effects on post-exercise recovery are not known. Our cross-over trial examined these responses following upper-body static and dynamic exercise performed in a cold and neutral environment in patients with coronary artery disease (CAD). Methods: 20 patients with stable coronary artery disease performed both graded static (10%–30% of maximal voluntary contraction) and dynamic (light, moderate and high perceived intensity) upper-body exercise at −15°C and +22°C for 30 min. Electrocardiogram and continuous blood pressure were measured to compute post-exercise (10 and 30 min after exercise) spectral powers of heart rate (HR), blood pressure variability and BRS at low (0.04–0.15 Hz) and high (0.15–0.4 Hz) frequencies. Results: Static upper-body exercise performed in a cold environment increased post-exercise high frequency (HF) spectral power of heart rate (HF RR) (p Conclusion: Static upper-body exercise in the cold increased post-exercise BRS and overall vagal activity but without reduced systolic blood pressure. Dynamic upper-body exercise in the cold reduced post-exercise vagal BRS but did not affect the other parameters. The influence of cold exposure on post-exercise autonomic and cardiovascular responses following static upper-body exercise require further studies. This information helps understanding why persons with cardiovascular diseases are vulnerable to low environmental temperature. ClinicalTrials.gov: NCT02855905 (04/08/2016)

Cardiovascular responses to dynamic and static upper-body exercise in a cold environment in coronary artery disease patients

Purpose - Upper-body exercise performed in a cold environment may increase cardiovascular strain, which could be detrimental to patients with coronary artery disease (CAD). This study compared cardiovascular responses of CAD patients during graded upper-body dynamic and static exercise in cold and neutral environments. Methods - 20 patients with stable CAD performed 30 min of progressive dynamic (light, moderate, and heavy rating of perceived exertion) and static (10, 15, 20, 25 and 30% of maximal voluntary contraction) upper body exercise in cold (− 15 °C) and neutral (+ 22 °C) environments. Heart rate (HR), blood pressure (BP) and electrocardiographic (ECG) responses were recorded and rate pressure product (RPP) calculated. Results - Dynamic-graded upper-body exercise in the cold increased HR by 2.3–4.8% (p = 0.002–0.040), MAP by 3.9–5.9% (p = 0.038–0.454) and RPP by 18.1–24.4% (p = 0.002–0.020) when compared to the neutral environment. Static graded upper-body exercise in the cold resulted in higher MAP (6.3–9.1%; p = 0.000–0.014), lower HR (4.1–7.2%; p = 0.009–0.033), but unaltered RPP compared to a neutral environment. Heavy dynamic exercise resulted in ST depression that was not related to temperature. Otherwise, ECG was largely unaltered during exercise in either thermal condition. Conclusions - Dynamic- and static-graded upper-body exercise in the cold involves higher cardiovascular strain compared with a neutral environment among patients with stable CAD. However, no marked changes in electric cardiac function were observed. The results support the use of upper-body exercise in the cold in patients with stable CAD

Heart Rate Dynamics after Exercise in Cardiac Patients with and without Type 2 Diabetes

Purpose: The incidence of cardiovascular events is higher in coronary artery disease patients with type 2 diabetes (CAD + T2D) than in CAD patients without T2D. There is increasing evidence that the recovery phase after exercise is a vulnerable phase for various cardiovascular events. We hypothesized that autonomic regulation differs in CAD patients with and without T2D during post-exercise condition. Methods: A symptom-limited maximal exercise test on a bicycle ergometer was performed for 68 CAD + T2D patients (age 61 ± 5 years, 78% males, ejection fraction (EF) 67 ± 8, 100% on β-blockade), and 64 CAD patients (age 62 ± 5 years, 80% males, EF 64 ± 8, 100% on β-blockade). Heart rate (HR) recovery after exercise was calculated as the slope of HR during the first 60 s after cessation of exercise (HRRslope). R–R intervals were measured before (5 min) and after exercise from 3 to 8 min, both in a supine position. R–R intervals were analyzed using time and frequency methods and a detrended fluctuation method (α1). Results: BMI was 30 ± 4 vs. 27 ± 3 kg m2 (p < 0.001); maximal exercise capacity, 6.5 ± 1.7 vs. 7.7 ± 1.9 METs (p < 0.001); maximal HR, 128 ± 19 vs. 132 ± 18 bpm (p = ns); and HRRslope, −0.53 ± 0.17 vs. −0.62 ± 0.15 beats/s (p = 0.004), for CAD patients with and without T2D, respectively. There was no differences between the groups in HRRslope after adjustment for METs, BMI, and medication (ANCOVA, p = 0.228 for T2D and, e.g., p = 0.030 for METs). CAD + T2D patients had a higher HR at rest than non-diabetic patients (57 ± 10 vs. 54 ± 6 bpm, p = 0.030), but no other differences were observed in HR dynamics at rest or in post-exercise condition. Conclusion: HR recovery is delayed in CAD + T2D patients, suggesting impairment of vagal activity and/or augmented sympathetic activity after exercise. Blunted HR recovery after exercise in diabetic patients compared with non-diabetic patients is more closely related to low exercise capacity and obesity than to T2D itself

Standing time and daily proportion of sedentary time are associated with pain-related disability in a one month accelerometer measurement in adults with overweight or obesity

ObjectivesThe association between the subjective experience of pain-related disability (PRD) and device-measured physical activity (PA) and sedentary behavior (SB) in overweight and obese adults is not well known. The aim of this study was to investigate the associations of pain markers with accelerometer-measured SB duration and different intensities of PA among physically inactive middle-aged adults with overweight or obesity.MethodsThis cross-sectional analysis included 72 subjects (27 men) with mean age of 57.9 (SD 6.7) years and mean BMI of 31.6 (SD 4.1) kg/m2. SB and standing time (ST), breaks in sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) were measured for four consecutive weeks (mean 25 days, SD 4) with a hip-worn triaxial accelerometer. Headache, musculoskeletal pain, back pain, and PRD were assessed by visual analog scales (VAS) and using the Oswestry disability index (ODI). RAND-36 questionnaire was applied to assess health-related quality of life. The associations were studied by linear models.ResultsST was positively and SB proportion was negatively associated with PRD when adjusted for age, sex, BMI, accelerometry duration, MVPA, pain medication use, and general health perceptions assessed by RAND-36. No associations were found between ST and back pain. SB or different PA intensities were not associated with pain experience at specific sites.ConclusionsLonger daily ST, but not LPA or MVPA is associated with higher level of PRD. Correspondingly, higher proportion of SB is associated with lower level of PRD. This suggests that individuals with PRD prefer to stand, possibly to cope with pain. These results may highlight the importance of habitual standing behaviors in coping with experienced PRD in adults with overweight or obesity.</p

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology

Aims: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature ofprogrammes, and to compare these by European region (geoscheme) and with other high-income countries.Methods: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engagedto facilitate programme identification. Density was computed using global burden of disease study ischaemic heartdisease incidence estimates. Four high-income countries were selected for comparison (N¼790 programmes) toEuropean data, and multilevel analyses were performed.Results: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8%country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey.Programme volumes (median 300) were greatest in western European countries, but overall were higher than inother high-income countries (

Nature of Cardiac Rehabilitation Around the Globe

BackgroundCardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.MethodsIn this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.Findings111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p