Clinical Perspectives on Incorporating Cardiorespiratory Fitness in Clinical Practice

Cardiorespiratory fitness (CRF) has been documented as a strong, independent predictor of non-communicable disease and mortality in both clinical and apparently healthy populations. This well-established relationship has impelled organizations, including the American Heart Association, to release scientific statements highlighting the importance of accurate quantification of CRF. Current knowledge of the relationship between CRF and mortality is predominantly based on estimated CRF obtained from varying indirect methods. Cardiopulmonary exercise testing (CPX), the gold standard method of CRF measurement, provides a more accurate and reliable quantification of CRF compared to estimated methods. This review provides support for the diagnostic and prognostic use of CRF based on the current literature and makes a case for the use of CPX when available, as well as the need for standardization of normative values defining CRF levels to increase the efficacy of the risk assessment. Further, clinical applications of CPX-derived CRF are discussed, providing clinicians with recommendations on how to use and interpret this measure in practice to guide clinical decisions and improve patient outcomes

Examination of Resistance Settings Based on Body Weight for the 3-Minute All-Out Critical Power Test

International Journal of Exercise Science 11(4): 585-597, 2018. There are conflicting suggestions regarding the most valid resistance (3-5% of body weight) to use for the critical power (CP) 3-min all-out (CP3min) test to estimate CP and anaerobic work capacity (AWC). The purpose of this study was to determine if the CP and AWC estimates from the CP3min test were affected by the percentage of body weight used to set the resistance on a Monark cycle ergometer. Ten recreationally trained participants (mean ± SD: Age: 22.2 ± 2.2 yrs.) completed the CP3min test at resistances of 4.5% (CP4.5%) and 3% (CP3%) of body weight to determine the CP and AWC. There were no significant differences between the CP4.5% (167 ± 34 W) and CP3% (156 ± 36 W) estimates. The AWC3% (5.6 ± 2.5 kJ) estimates were significantly lower than the AWC4.5% (9.0 ± 4.0 kJ).The CP and AWC estimates from the CP4.5% were consistent with values reported in the literature, however, the AWC estimate from the CP3% was lower than typically reported. These findings suggested that a resistance set at 3% of body weight for the CP3min test may be too low to accurately estimate AWC, but 3% and 4.5% resulted in the same estimation of CP. Thus, the principal finding of this study was that a resistance of 4.5% of body weight for CP3-min in recreationally trained participants resulted in more accurate estimates of AWC, compared to a resistance of 3%, and supports the use of 4.5% body weight resistance to measure both CP and AWC

Predictors of Arterial Stiffness in Law Enforcement Officers

Background: Compare arterial stiffness among law enforcement officers (LEOs) versus general population normative values and identify predictors of arterial stiffness in LEOs. Methods: Seventy male LEOs (age: 24–54 years) completed body composition, blood pressures, physical activity level, and carotid-femoral pulse wave velocity (cfPWV) measurements. T-tests and regression analyses were utilized to compare LEO data to normative data and predict cfPWV, respectively. Results: Compared to similar age strata within the general population, cfPWV was lower among LEO’s under 30-years (mean difference = −0.6 m·s−1), but higher among LEOs 50–55-years (mean difference = 1.1 m·s−1). Utilizing regression, age, relative body fat, and diastolic blood pressure explained the greatest variance in LEO’s cfPWV (adj. R2 = 0.56, p \u3c 0.001). Conclusion: This investigation demonstrated that arterial stiffness may progress more rapidly in LEOs and LEOs’ relative body fat and blood pressure may primarily affect arterial stiffness and risk of CVD

Superoxide Signaling in Perivascular Adipose Tissue Promotes Age-Related Artery Stiffness

We tested the hypothesis that superoxide signaling within aortic perivascular adipose tissue (PVAT) contributes to large elastic artery stiffening in old mice. Young (4-6 months), old (26-28 months), and old treated with 4-Hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (TEMPOL), a superoxide scavenger (1 mm in drinking water for 3 weeks), male C57BL6/N mice were studied. Compared with young, old had greater large artery stiffness assessed by aortic pulse wave velocity (aPWV, 436 ± 9 vs. 344 ± 5 cm s(-1)) and intrinsic mechanical testing (3821 ± 427 vs. 1925 ± 271 kPa) (both P \u3c 0.05). TEMPOL treatment in old reversed both measures of arterial stiffness. Aortic PVAT superoxide production was greater in old (P \u3c 0.05 vs. Y), which was normalized with TEMPOL. Compared with young, old controls had greater pro-inflammatory proteins in PVAT-conditioned media (P \u3c 0.05). Young recipient mice transplanted with PVAT from old compared with young donors for 8 weeks had greater aPWV (409 ± 7 vs. 342 ± 8 cm s(-1)) and intrinsic mechanical properties (3197 ± 647 vs. 1889 ± 520 kPa) (both P \u3c 0.05), which was abolished with TEMPOL supplementation in old donors. Tissue-cultured aortic segments from old in the presence of PVAT had greater mechanical stiffening compared with old cultured in the absence of PVAT and old with PVAT and TEMPOL (both, P \u3c 0.05). In addition, PVAT-derived superoxide was associated with arterial wall hypertrophy and greater adventitial collagen I expression with aging that was attenuated by TEMPOL. Aging or TEMPOL treatment did not affect blood pressure. Our findings provide evidence for greater age-related superoxide production and pro-inflammatory proteins in PVAT, and directly link superoxide signaling in PVAT to large elastic artery stiffness

Examination of Curcumin and Fenugreek Soluble Fiber Supplementation on Submaximal and Maximal Aerobic Performance Indices

This study examined the effects of curcumin and fenugreek soluble fiber supplementation on the ventilatory threshold (VT) and peak oxygen consumption (VO2 peak). Methods: Forty-five untrained men and women were randomly assigned to one of three supplementation groups: placebo (PLA, n = 13), 500 mg·day−1 CurQfen® (CUR, n = 14), or 300 mg·day−1 fenugreek soluble fiber (FEN, n = 18). Participants completed a maximal graded exercise test on a cycle ergometer to determine the VT and VO2 peak before (PRE) and after (POST) 28 days of daily supplementation. Separate, one-way analyses of covariance (ANCOVAs) were used to examine the between-group differences for adjusted POST VT and VO2 peak values, covaried for the respective PRE-test values. Results: The adjusted POST VT VO2 values for the CUR (mean SD = 1.593 0.157 L·min−1) and FEN (1.597 0.157 L·min−1) groups were greater than (p = 0.039 and p = 0.025, respectively) the PLA (1.465 0.155 L·min−1) group, but the FEN and CUR groups were not different (p = 0.943). There were no differences in the adjusted VO2 peak values (F = 0.613, p = 0.547) among groups. Conclusion: These findings indicated that fenugreek soluble fiber was responsible for the improvements in the submaximal performance index for both CUR and FEN groups

Coconut Inflorescence Sap Enhances Exercise Performance and Plasma Antioxidant Status in Young Active Men

Purpose Nutrition has been increasingly recognized as a key component to optimal sports performance. Though several botanical agents have been reported to possess ergogenic potential, there exists a great interest for tasty and safe natural substances as performance boosters. In the present contribution, the ergogenic potential of a novel powder form of coconut inflorescence sap (CSP) was investigated for the first time. Method Out of the fourteen participants recruited, twelve recreationally active men completed the single-blinded, placebo-controlled, crossover study for 8 weeks. Running based anaerobic sprint test (RAST) and 2.4 km running test were performed as anaerobic and aerobic tests, respectively. In arm 1, the participants were received with either placebo (200 mL water containing 400 mg aspartame/day) or CSP (3 g in 200 mL water/day) for 21 days. After the washout period, arm 2 was performed with a reversed treatment regime. VO2 max was estimated using a predictive formula. Results The primary outcome showed a significant enhancement in peak power and mean power (peak power from 3.67 W/kg b. wt. to 5.38 W/kg b. wt.; mean power from 3.47 W/kg b. wt. to 5.06 W/kg b. wt.). A significant (p \u3c 0.001) increase in VO2 max among CSP condition compared to the placebo was observed (from 59.38 ± 2.15 mL/kg/min to 62.56 ± 0.52 mL/kg/min). Further, serum analysis revealed enhanced antioxidant status and reduced lactate dehydrogenase (p \u3c 0.01) levels without any significant changes (p \u3e 0.05) in safety parameters. Conclusion It was concluded that CSP possesses significant ergogenic effect and may find wide application as a natural ingredient for sports nutrition and energy drinks. Trial Registration The study was registered in Clinical Trial Registry of India (Reg No.: CTRI/2018/03/012551 dated 13/03/2018)

The Association between the Change in Directly Measured Cardiorespiratory Fitness across Time and Mortality Risk

Background The relationship between cardiorespiratory fitness (CRF) and mortality risk has typically been assessed using a single measurement, though some evidence suggests the change in CRF over time influences risk. This evidence is predominantly based on studies using estimated CRF (CRFe). The strength of this relationship using change in directly measured CRF over time in apparently healthy men and women is not well understood. Purpose To examine the association of change in CRF over time, measured using cardiopulmonary exercise testing (CPX), with all-cause and disease-specific mortality and to compare baseline and subsequent CRF measurements as predictors of all-cause mortality. Methods Participants included 833 apparently healthy men and women (42.9 ± 10.8 years) who underwent two maximal CPXs, the second CPX being ≥1 year following the baseline assessment (mean 8.6 years, range 1.0 to 40.3 years). Participants were followed for up to 17.7 (SD 11.8) years for all-cause-, cardiovascular disease- (CVD), and cancer mortality. Cox-proportional hazard models were performed to determine the association between the change in CRF, computed as visit 1 (CPX1) peak oxygen consumption (VO2peak [mL·kg−1·min−1]) – visit 2 (CPX2) VO2peak, and mortality outcomes. A Wald-Chi square test of equality was used to compare the strength of CPX1 to CPX2 VO2peak in predicting mortality. Results During follow-up, 172 participants died. Overall, the change in CPX-CRF was inversely related to all-cause, CVD, and cancer mortality (p < 0.05). Each 1 mL·kg−1·min−1 increase was associated with a ~11, 15, and 16% (all p < 0.001) reduction in all-cause, CVD, and cancer mortality, respectively. The inverse relationship between CRF and all-cause mortality was significant (p < 0.05) when men and women were examined independently, after adjusting for years since first CPX, baseline VO2peak, and age. Further, the Wald Chi-square test of equality found CPX2 VO2peak to be a significantly stronger predictor of all-cause mortality than CPX1 VO2peak (p < 0.05). Conclusion The change in CRF over time was inversely related to mortality outcomes, and mortality was better predicted by CRF measured at subsequent test than CPX1 CRF. These findings emphasize the importance of adopting lifestyle behaviors that promote CRF, as well as support the need for routine assessment of CRF in clinical practice to better assess risk

Cardiorespiratory Fitness Normalized to Fat-Free Mass and Mortality Risk

Cardiorespiratory Fitness Normalized to Fat-Free Mass and Mortality Risk. Med. Sci. Sports Exerc., Vol. 52, No. 7, pp. 1532–1537, 2020. Purpose: Cardiorespiratory fitness (CRF) is known to be directly related to fat-free mass (FFM), therefore, it has been suggested that normalizing CRF to FFM (V˙O2peakFFM) may be the most accurate expression of CRF as related to exercise performance and cardiorespiratory function. However, the influence of ˙O2peakFFM (mL·kg FFM−1·min−1) on predicting mortality has been largely unexplored. This study aimeVd to primarily assess the relationship between V˙O2peakFFM and all-cause and disease-specific mortality risk in apparently healthy adults. Further, this study sought to compare the predictive ability of V˙O2peakFFM to V˙O2peak normalized to total body weight (V˙ O2peakTBW) for mortality out-comes. Methods: Participants included 2905 adults (1555 men, 1350 women) who completed a cardiopulmonary exercise test between 1970 and 2016 to determine CRF. Body composition was assessed using the skinfold method to estimate FFM. Cardiorespiratory fitness was expressed as V˙ O2peakTBW and V˙O2peakFFM. Participants were followed for 19.0 ± 11.7 yr after their cardiopulmonary exercise test for mortality outcomes. Cox-proportional hazard models were performed to determine the relationship of V˙O2peakFFM with mortality outcomes. Parameter estimates were assessed to compare the predictive ability of CRF expressed as V˙O2peakTBW and V˙O2peakFFM. Results: Overall, VO2peakFFM was inversely related to all-cause, cardiovascular disease, and cancer mortality, with a 16.2%, 8.4%, and 8.0% lower risk per 1 mL·kg FFM−1·min−1 improvement, respectively (P \u3c 0.01). Further, assessment of the parameter estimates showed V˙O2peakFFM to be a significantly stronger predictor of all-cause mortality than V˙ O2peakTBW (parameter estimates, −0.49 vs −0.16). Conclusions: Body composition is an important factor when considering the relationship between CRF and mortality risk. Clinicians should consider normalizing CRF to FFM when feasible, because it will strengthen the predictive power of the measure

The Influence of Change in Cardiorespiratory Fitness With Short-Term Exercise Training on Mortality Risk From The Ball State Adult Fitness Longitudinal Lifestyle Study

Objective To assess the influence of changes in cardiorespiratory fitness (CRF) after exercise training on mortality risk in a cohort of self-referred, apparently healthy adults. Patients and Methods A total of 683 participants (404 men, 279 women; mean age: 42.7±11.0 y) underwent two maximal cardiopulmonary exercise tests (CPX) between March 20, 1970, and December 11, 2012, to assess CRF at baseline (CPX1) and post-exercise training (CPX2). Participants were followed for an average of 29.8±10.7 years after their CPX2. Cox proportional hazards models were performed to determine the relationship of CRF change with mortality, with change in CRF as a continuous variable, as well as a categorical variable. A Wald chi-square test was used to compare the coefficients estimating the relationship of peak oxygen consumption (VO2peak) at CPX1 with VO2peak measured at CPX2 with time until death for all-cause mortality. Results During the follow-up period there were 180 deaths. When assessed independently, there were 20% (95% CI, 10–49%) and 38% (95% CI, 7–66%) lower mortality risks per 1 metabolic equivalent improvement in CRF (P\u3c.01) in men and women, respectively, after multivariable adjustment. Those that remained unfit had ∼2-fold higher risk for all-cause mortality compared with those that remained fit and CRF at CPX2 was a stronger predictor of all-cause mortality than at CPX1 (P=.02). Conclusion Improving CRF through exercise training lowers mortality risk. Clinicians should encourage individuals to participate in exercise training to improve CRF to lower risk of mortality

Normalizing Cardiorespiratory Fitness To Fat-free Mass Improves Mortality Risk Prediction In Overweight Adults From The Ball St Cohort: 2361 Board #280 May 28 3:00 PM - 4:30 PM

Cardiorespiratory fitness(CRF) is a significant predictor of mortality outcomes in various populations, including overweight and obese adults. However, CRF is commonly expressed normalized to total body weight (VO2peakTBW) which may weaken the relationship in obese adults as fat-free mass (FFM) is directly related to CRF, and increased body fat is associated with lower CRF in adults. Therefore, this study aimed to assess the relationship between CRF normalized for FFM(VO2peakFFM) and all-cause mortality, as well as compare the predictive ability of VO2peakFFM and VO2peakTBW in a cohort of self-referred overweight and obese adults