Tracking Cardiovascular Responses To Anticipation Of An Exercise Test In Cardiac Rehabilitation: A Preliminary Test

Cardiovascular reactivity (CVR) refers to relatively high heart rate (HR) and blood pressure (BP) increases in the face of a mental stressor. CVR may be a concern for heart patients since it may precede ischemic events and CVR may be an indicator of relatively poor prognosis. Anticipation of an exercise tolerance test (ETT) results in rapid increases in HR and BP and has been used as a stressor in heart patient to study CVR. However, it is not clear how CVR changes associated with an ETT change after a course of cardiac rehabilitation (CR). PURPOSE: To examine CVR, specifically HR and systolic (SBP) and diastolic blood pressure (DBP) responses, to anticipation of an exercise tolerance test before and after a course of CR. METHODS: CVR was recorded for 76 patients at baseline and for a subsample of 23 patients who completed 6 weeks of CR. Identical procedures were used for baseline and post-CR data collection. Resting HR and BP were measured 3 times, 1 minute apart, by an automated oscillometric BP monitor after the patient had been seated quietly and alone for 5 minutes. The patient was then prepped for an ETT and met in the exercise stress testing lab by the researcher. Standing HR and BP measures were taken by the same automated BP device after 1 and 3 minutes of standing on the treadmill immediately prior to beginning exercise. The mean of the 3 seated measures was considered the resting BP and HR. Peak BP and HR standing were used to calculate the cardiovascular response to anticipation of exercise. CVR was defined as peak BP and HR minus resting BP and HR, respectively. RESULTS: Anticipation of exercise resulted in significant increases (all p’s < .002) in CV parameters with an average CVR at baseline for HR, SBP and DBP of 4.0 bpm, 16.6 mmHg, and 13.5 mmHg, respectively. CVR after a course of CR for HR, SBP and DBP were 4.3 bmp, 15.9 mmHg, and 9.2 mmHg (ps < .001). Differences between baseline and post-CR CVR was significant only for the change in DBP (p = .05). CONCLUSION: Patients responded with a predictable increase in HR and BP in anticipation of an ETT before and after a course of CR. After CR, DBP increases in anticipation of an ETT were lower in magnitude than before CR. Future research should investigate specific components of CR that may help reduce CVR

Examining the psychometric properties of the Behavioral Regulation in Exercise Questionnaire

The purpose of this study was to examine select psychometric properties of the Behavioral Regulation in Exercise Questionnaire (BREQ; Mullen, Markland, & Ingledew, 1997). To accomplish this aim, data were gathered in 2 phases to evaluate the BREQ’s factorial composition and structure and the relation between the BREQ, need satisfaction, exercise behavior, and relevant motivational constructs. Participants completed measures assessing psychological need satisfaction, optimism, perceived behavioral control, exercise behavior, and the BREQ. Phase 1 results supported the original 4-factor measurement model and a simplex model of structural relations between latentBREQconstructs suggested within self-determination theory (Deci & Ryan, 1985), and results supported the positive relations between more self-determined motives and greater psychological need satisfaction and frequent exercise behavior. Phase 2 results provided further construct validity evidence for the BREQ by linking subscale scores with greater perceived behavioral control in a manner consistent with theory (Deci & Ryan, 1985). Collectively, these results further support the construct validity of the BREQ and lend credence to the notion of measuring exercise motivation from a multidimensional perspective using self-determination theory as a guiding framework in the exercise domain

Physical trauma and risk of multiple sclerosis: A systematic review and meta-analysis of observational studies

AbstractBackgroundWe aimed to examine physical trauma as a risk factor for the subsequent diagnosis of MS.MethodsWe searched for observational studies that evaluated the risk for developing MS after physical trauma that occurred in childhood (≤20years) or “premorbid” (>20years). We performed a meta-analysis using a random effects model.ResultsWe identified 1362 individual studies, of which 36 case–control studies and 4 cohort studies met the inclusion criteria for the review. In high quality case–control studies, there were statistically significant associations between those sustaining head trauma in childhood (OR=1.27; 95% CI, 1.12–1.44; p<0.001), premorbid head trauma (OR=1.40; 95% CI, 1.08–1.81; p=0.01), and other traumas during childhood (OR=2.31; 95% CI, 1.06–5.04; p=0.04) and the risk of being diagnosed with MS. In lesser quality studies, there was a statistical association between “other traumas” premorbid and spinal injury premorbid. No association was found between spinal injury during childhood, or fractures and burns at any age and the diagnosis of MS. The pooled OR of four cohort studies looking at premorbid head trauma was not statistically significant.ConclusionsThe result of the meta-analyses of high quality case–control studies suggests a statistically significant association between premorbid head trauma and the risk for developing MS. However, cohort studies did not. Future prospective studies that define trauma based on validated instruments, and include frequency of traumas per study participant, are needed

Does participation in cardiac rehabilitation affect health outcomes and health care utilization and costs?

Exercise based cardiac rehabilitation (CR) programs have been shown to be efficacious in the reduction of recurrent cardiovascular events and increased physical and psychological function. However, in North America only about 10-40% of eligible CVD patients are referred to CR. One reason for poor CR referral may be a lack of information on the costs and health care utilization associated with CR. Thus, the purpose of this project was to explore differences in health care utilization and costs among patients who attended and did not attend cardiac rehabilitation

Adolescent Weight Status and Related Behavioural Factors: Web Survey of Physical Activity and Nutrition

Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents

Adolescent Weight Status and Related Behavioural Factors: Web Survey of Physical Activity and Nutrition

Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents

Whole Genome Sequence Analysis of Cryptococcus gattii from the Pacific Northwest Reveals Unexpected Diversity

A recent emergence of Cryptococcus gattii in the Pacific Northwest involves strains that fall into three primarily clonal molecular subtypes: VGIIa, VGIIb and VGIIc. Multilocus sequence typing (MLST) and variable number tandem repeat analysis appear to identify little diversity within these molecular subtypes. Given the apparent expansion of these subtypes into new geographic areas and their ability to cause disease in immunocompetent individuals, differentiation of isolates belonging to these subtypes could be very important from a public health perspective. We used whole genome sequence typing (WGST) to perform fine-scale phylogenetic analysis on 20 C. gattii isolates, 18 of which are from the VGII molecular type largely responsible for the Pacific Northwest emergence. Analysis both including and excluding (289,586 SNPs and 56,845 SNPs, respectively) molecular types VGI and VGIII isolates resulted in phylogenetic reconstructions consistent, for the most part, with MLST analysis but with far greater resolution among isolates. The WGST analysis presented here resulted in identification of over 100 SNPs among eight VGIIc isolates as well as unique genotypes for each of the VGIIa, VGIIb and VGIIc isolates. Similar levels of genetic diversity were found within each of the molecular subtype isolates, despite the fact that the VGIIb clade is thought to have emerged much earlier. The analysis presented here is the first multi-genome WGST study to focus on the C. gattii molecular subtypes involved in the Pacific Northwest emergence and describes the tools that will further our understanding of this emerging pathogen

Fatal Disseminated Cryptococcus gattii Infection in New Mexico

We report a case of fatal disseminated infection with Cryptococcus gattii in a patient from New Mexico. The patient had no history of recent travel to known C. gattii-endemic areas. Multilocus sequence typing revealed that the isolate belonged to the major molecular type VGIII. Virulence studies in a mouse pulmonary model of infection demonstrated that the strain was less virulent than other C. gattii strains. This represents the first documented case of C. gattii likely acquired in New Mexico