Exercise therapy and cardiac, autonomic and systemic function in patients with chronic heart failure

Background Exercise training is now accepted as a safe, adjunct therapy in stable heart failure patients. Acceptance of exercise training or therapy within this population is due to the benefits that have been demonstrated over the past three decades in trials and data syntheses presented in systematic reviews and meta-analyses. As new concepts emerge and with an increase in the number of trials comes the challenge of keeping up-to date with all the information, deciphering what's relevant, deciding how to interpret and apply the findings and what should happen next. Fortunately, the research methodologies of systematic review and meta-analysis provide a suitable platform for collecting, analysing and critically appraising studies. Methods An initial evidence mapping exercise identified the current level of research activity in regard to the synthesis of evidence focusing on the broad question of the benefits and/or effects of exercise training in heart failure patients. The objective of the exercise was to identify gaps in research synthesis and areas in which research synthesis would be valuable. A series of research syntheses were then conducted based on the identified gaps, using systematic reviews as the research methodology, and applying the statistical technique of meta-analysis where possible. Results While some of the effects of exercise training are now well established, e.g., improved functional capacity and quality of life, new trials and new concepts continue to emerge. Evidencing mapping highlighted a number of areas in which research synthesis was limited or out dated. The identified areas addressed the effect of exercise training on specific areas of cardiac, autonomic and systemic inflammatory markers in chronic heart failure patients; all associated with the pathogenesis and progression of heart failure. Evidence from systematic reviews and meta-analyses demonstrated that exercise training/therapy resulted in statistically significant improvements in: 1) endothelial function (FMD and EPCs), 2) direct (MSNA) and indirect (HRR, HRV) measures of autonomic function, 3) cardiac biomarkers (BNP, NT-proBNP) and 4) diastolic function, measured as E/E’. However, the evidence for improvements in a number of inflammatory markers was inconclusive, and limited evidence is currently available to allow for any conclusion to be drawn on the effect of exercise on emerging heart failure biomarkers. Conclusion This thesis utilised systematic reviews and meta-analyses as the research methodology to answer questions in relation to exercise training in heart failure patients. This work adds to the current evidence base by providing a robust synthesis of data in regard to effects of exercise training and therapy on endothelial function, autonomic function, inflammatory markers, biomarkers and diastolic function in heart failure patients

An Exploration of the Experiences of Adults that were Raised without Routine Childhood Vaccinations

This thesis explores the experiences of adults raised without routine childhood vaccinations. This is a highly contentious topic and despite the substantial number of children that are raised in this way, there is a paucity of literature exploring this group of people and the outcomes of such health care decisions. This study's theoretical framework is constructed from a phenomenological perspective. A phenomenological methodology guiding this study allowed the researcher to hear the participants' voices as they had experienced this phenomenon. Using a mixed method of data collection enabled the researcher to gain a breadth and depth of the phenomenon in question. Sixty-seven participants completed the open-ended online survey questionnaire and thirteen participants participated in the in-depth interviews. The data was collected from the survey questionnaire, which then informed the in-depth interviews that followed. Participants were found to have a high regard for their health and displayed proactive health conscious behaviours. A high level of contentment was found amongst participants in regards to the vaccine decision that was made on their behalf, with a great majority of participants found to have made the same non-vaccination decision for their own children. This thesis revealed the existence of a significant gap between the lived experience of individual's and the vaccine imperative placed upon the populace. Contributing to the literature, this study gleaned intergenerational insights, directly related to asking participants about vaccine decision-making regarding their own children. In addition, the project elucidated the way in which participants navigated between heterodox and orthodox medicine, in an attempt to meet their health care needs and preferences

Contact Tools in Japanese Acupuncture: An Ethnography of Acupuncture Practitioners in Japan

This study aimed to identify procedural elements of Japanese acupuncture, describe these elements in detail, and explain them in terms of the key thematic category of treatment principles. Between August 2012 and December 2016, ethnographic fieldwork was conducted in Japan. In total, 38 participants were recruited by chain referral and emergent sampling. Data was collected through participant observation, interviews, and by analyzing documents. A total of 22 participants agreed to clinical observation; 221 treatments were observed with 172 patients. Seventeen consented to formal interviews and 28 to informal interviews. Thematic analysis was used to critically evaluate data. One especially interesting theme was interpreted from the data: a variety of contact tools were applied in treatment and these were manipulated by adjusting elements of form, speed, repetition, and pressure. Tapping, holding, pressing/pushing, and stroking were the most important ways contact tools were used on patients. Contact tools are noninvasive, painless, can be applied in almost any environment, and may be easily accepted by patients worldwide. Contact tool theory and practice may be successfully integrated into acupuncture curricula outside of Japan, used to inform clinical trials, and contribute to an expanded repertoire of methods for practitioners to benefit individual patients in international contexts

An evidence-based guide to the efficacy and safety of isometric resistance training in hypertension and clinical implications

More than 30 randomized controlled trials, supported by individual patient-level and group-level meta-analyses and a Delphi analysis of expert opinion, unequivocally show isometric resistance training (IRT) elicits antihypertensive benefits in healthy people and those with chronic illness. We aim to provide efficacy and safety evidence, and a guide for IRT prescription and delivery. Recommendations are made for the use of IRT in specific patient populations and appropriate methods for IRT delivery. Published data suggest IRT consistently elicits mean blood pressure reductions of 7.4/3.3 mmHg systolic blood pressure/diastolic blood pressure, equivalent to antihypertensive medication monotherapy. Blood pressure reductions of this size are associated with an approximate 13% to 22% reduction in major cardiovascular events. Moreover, IRT is safe in a range of patient populations. We suggest that IRT has the greatest potential benefit when used as an antihypertensive therapy in individuals unwilling and/or unable to complete aerobic exercise, or who have had limited adherence or success with it; individuals with resistant or uncontrolled hypertension, already taking at least two pharmacological antihypertensive agents; and healthy or clinical populations, as an adjunct to aerobic exercise and dietary intervention in those who have not yet attained control of their hypertension. IRT is efficacious and produces clinically meaningful blood pressure reductions (systolic blood pressure, 7 mmHg; diastolic blood pressure, 3 mmHg). IRT is safe and typical program delivery requires only about 17 min weekly. IRT should be used as an adjunct to other exercise modalities, in people unable to complete other types of exercise, or in resistant hypertension

Action of the Crustacean Hyperglycemic Hormone (CHH) on Adenylate Cyclase and Phosphodiesterase in Crayfish Abdominal Muscle

Investigations on the mode of action of the crustacean hyperglycemic hormone (CHH) revealed an increase of CAMP and cGMP concentrations in the abdominal muscle after the application of this hormone, indicating a second messenger mechanism comparable to the mechanism already known for vertebrate peptide hormones. A maximal stimulation of CAMP was shown 10 min after the injection of the hormone, whereas in cGMP, a constant increase up to 20 min was demonstrated. It should be expected that this elevation is due to an activation of adenylate and guanylate cyclase, but we cannot rule out the possibility of an inhibition of the phosphodiesterases caused by the hormone, which would also result in an increase of the cyclic nucleotides. The time course of the adenylate cyclase activity after hormone injection shows a pattern similar to the one we know for the CAMP concentrations. As one should expect, there is a little time delay between the action of the adenylate cyclase and the increase of CAMP. CAMP phosphodiesterase shows changes in activity comparable to CAMP increase. This increase obviously is due to the elevated CAMP concentrations and not to an immediate action of the hormone on phosphodiesterase. cGMP phosphodiesterase follows more or less the same pattern, an observation which coincides with the cGMP elevation curve. Guanylate cyclase was not measured. From these results, it seems clear that the increase in cyclic nucleotides after hormone injection is due to the action of cyclases and not to an inhibition of phosphodiesterases

Properties of crayfish abdominal muscle adenylate cyclase

1. Properties of a hyperglycemic-hormone sensitive adenylate cyclase of the crayfish abdominal muscle were determined. 2. The enzyme was maximally stimulated by 15 mM Mg²+ or 500 μM Mn²+. 3. A Km for ATP of 26 μM was calculated. 4. NaF-stimulation was highest with 3 mM. 5. In contrary to Gpp(NH)p, GTP had no activating effect on the enzyme

Crayfish abdominal muscle adenylate cyclase: Studies on the stimulation by a Ca²+-binding protein

A plasma-membrane preparation of crayfish muscle showed an adenylate cyclase activity which is inhibited to about 80% of its original activity by 100 μM-EGTA. Measurements of the enzyme activity in the presence of 100 μM-EGTA and various concentrations of Ca²+ revealed an increase in enzyme activity of about 400%, indicating an adenylate cyclase which is dependent on Ca²+ for activity. Fluphenazine (1 mM), a blocker of the Ca²+-binding protein calmodulin, decreased enzyme activity to zero. The enzyme can be re-activated by the addition of certain concentrations of calmodulin to the assay medium. This suggests that crayfish muscle adenylate cyclase is dependent on Ca²+ and calmodulin for activity