Blood volume, hemoglobin mass, and peak oxygen uptake in older adults : The Generation 100 Study

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Feasibility of telerehabilitation for heart failure patients inaccessible for outpatient rehabilitation

Aims Despite strong recommendations, outpatient cardiac rehabilitation is underused in chronic heart failure (CHF) patients. Possible barriers are frailty, accessibility, and rural living, which may be overcome by telerehabilitation. We designed a randomized, controlled trial to evaluate the feasibility of a 3-month real-time, home-based telerehabilitation, high-intensity exercise programme for CHF patients who are either unable or unwilling to participate in standard outpatient cardiac rehabilitation and to explore outcomes of self-efficacy and physical fitness at 3 months post-intervention. Methods and results CHF patients with reduced (≤40%), mildly reduced (41–49%), or preserved ejection fraction (≥50%) (n = 61) were randomized 1:1 to telerehabilitation or control in a prospective controlled trial. The telerehabilitation group (n = 31) received real-time, home-based, high-intensity exercise for 3 months. Inclusion criteria were (i) ≥18 years, (ii) New York Heart Association class II-III, stable on optimized medical therapy for >4 weeks, and (iii) N-terminal pro-brain natriuretic peptide >300 ng/L. All participants participated in a 2-day ‘Living with heart failure’ course. No other intervention beyond standard care was provided for controls. Outcome measures were adherence, adverse events, self-reported outcome measures, the general perceived self-efficacy scale, peak oxygen uptake (VO2peak) and a 6-min walk test (6MWT). The mean age was 67.6 (11.3) years, and 18% were women. Most of the telerehabilitation group (80%) was adherent or partly adherent. No adverse events were reported during supervised exercise. Ninety-six per cent (26/27) reported that they felt safe during real-time, home-based telerehabilitation, high-intensity exercise, and 96% (24/25) reported that, after the home-based supervised telerehabilitation, they were motivated to participate in further exercise training. More than half the population (15/26) reported minor technical issues with the videoconferencing software. 6MWT distance increased significantly in the telerehabilitation group (19 m, P = 0.02), whereas a significant decrease in VO2peak ( 0.72 mL/kg/min, P = 0.03) was observed in the control group. There were no significant differences between the groups in general perceived self-efficacy scale, VO2peak, and 6MWT distance after intervention or at 3 months postintervention. Conclusions Home-based telerehabilitation was feasible in chronic heart failure patients inaccessible for outpatient cardiac rehabilitation. Most participants were adherent when given more time and felt safe exercising at home under supervision, and no adverse events occurred. The trial suggests that telerehabilitation can increase the use of cardiac rehabilitation, but the clinical benefit of telerehabilitation must be evaluated in larger trials

Quality of Life and rehabilitation at Beitostølen Helsesportssenter

Background: Quality of Life (QoL) is a difficult and therefore poorly defined term. There are different definitions used in questionnaires and by different actors in the field. The exercise at Beitostølen Helsesportsenter (BHSS) is not necessarily an optimization of function, as much as a thought of unity regarding the patient s life, using adapted physical activity (APA) and sports as a tool. Material and method: 4 informants admitted to rehabilitation stays, were in depth interviewed at two different periods of times; during and 3 months after their stay. These data were analyzed using qualitative method. Results: In accordance with earlier studies at BHSS, we found that QoL can be affected in a positive way by rehabilitation at BHSS. In addition we learned about several factors of importance concerning QoL, especially that they differ a lot among patients. The different informants emphasize widely different subjects affecting their QoL. A quantitative research using questionnaires would not intercept these differences. Interpretation: Patients are unique, with different preferences and different needs. This requires an open, individual, qualitative approach to patients. They are entitled to an adjusted offer at those areas that will enhance their QoL. Our claim is that the use of qualitative method will find different and more correct answers to what QoL is to patients

Helsesport og livskvalitet ved Beitostølen Helsesportsenter

Adapted physical activity and quality of life at Beitostølen Helsesportsenter Abstract Background: “Quality of Life” (QoL) is a difficult and therefore poorly defined term. There are different definitions used in questionnaires and by different actors in the field. The exercise at Beitostølen Helsesportsenter (BHSS) is not necessarily an optimization of function, as much as a thought of unity regarding the patient’s life, using adapted physical activity (APA) and sports as a tool. Material and method: 4 informants admitted to rehabilitation stays, were in depth interviewed at two different periods of times; during and 3 months after their stay. These data were analyzed using qualitative method. Results: In accordance with earlier studies at BHSS, we found that QoL can be affected in a positive way by rehabilitation at BHSS. In addition we learned about several factors of importance concerning QoL, especially that they differ a lot among patients. The different informants emphasize widely different subjects affecting their QoL. A quantitative research using questionnaires would not intercept these differences. Interpretation: Patients are unique, with different preferences and different needs. This requires an open, individual, qualitative approach to patients. They are entitled to an adjusted offer at those areas that will enhance their QoL. Our claim is that the use of qualitative method will find different and more correct answers to what QoL is to patients

Kraftig stigning i kreatinkinase etter intensiv trening

BAKGRUNN Treningsindusert rabdomyolyse er en stadig hyppigere årsak til innleggelse i sykehus og er mye omtalt i mediene. Den reelle forekomsten av tilstanden er ukjent. Vi ønsket å undersøke endring i kreatinkinase (CK) hos friske studenter etter intensiv trening og se etter korrelasjon mellom CK, smerte og treningsbakgrunn. METODE OG MATERIALE 24 friske studenter gjennomførte én intensiv treningsøkt og var sine egne kontrollpersoner med prøver før og etter treningen. RESULTATER Alle deltagerne fikk CK-stigning etter treningsøkten, 58 % til over 5 000 E/l. CK steg fra median 104 E/l (72–212) til median 6 071 E/l (2 815–12 275) på dag 4, p < 0,001. Frekvensen av styrketrening før forsøket hadde en negativ Spearmans rangkorrelasjon med CK-stigning, rho = -0,477 (p = 0,021). FORTOLKNING Kraftig CK-stigning er et normalfenomen etter intensiv trening, og graden henger sammen med treningsbakgrunnen. Nye studier bør se på om pasienter med treningsindusert rabdomyolyse skal behandles på samme måte som rabdomyolyse av andre årsaker

Favorable effects on arterial stiffness after renal sympathetic denervation for the treatment of resistant hypertension: a cardiovascular magnetic resonance study

Aims: Renal sympathetic denervation (RDN) has recently been suggested to be a novel treatment strategy for patients with treatment-resistant hypertension. However, the latest randomized studies have provided conflicting results and the influence of RDN on arterial stiffness remains unclear. Therefore, this study aimed to detect the effects of RDN on arterial stiffness as measured with aortic pulse wave velocity (PWV) and distensibility in addition to cardiac function and T1 mapping at baseline and at 6-month follow-up. Methods: RDN was performed in a total of 16 patients with treatment-resistant hypertension, and the procedures were conducted at two university hospitals using two different RDN devices. All patients and age-matched controls underwent a comprehensive clinical examination and cardiac magnetic resonance protocols both at baseline and at a 6-month follow-up. Results: In the treatment group, the systolic blood pressure (SBP) was found to be decreased at the follow-up visit (office SBP; 173±24 compared to 164±25 mmHg [P= 0.033]), the 24-hour ambulatory SBP had decreased (163±25 compared to 153±20 mmHg [P=0.057]), the aortic PWV had decreased from 8.24±3.34 to 6.54±1.31 m/s (P=0.053), and the aortic distensibility had increased from 2.33±1.34 to 3.96±3.05 10−3 mmHg−1 (P=0.013). The changes in aortic PWV and distensibility were independent of the observed reductions in SBP. Conclusion: The arterial stiffness, as assessed with aortic PWV, and distensibility were improved at 6 months after RDN. This improvement was independent of the reduction in SBP

Favorable effects on arterial stiffness after renal sympathetic denervation for the treatment of resistant hypertension: a cardiovascular magnetic resonance study

Aims: Renal sympathetic denervation (RDN) has recently been suggested to be a novel treatment strategy for patients with treatment-resistant hypertension. However, the latest randomized studies have provided conflicting results and the influence of RDN on arterial stiffness remains unclear. Therefore, this study aimed to detect the effects of RDN on arterial stiffness as measured with aortic pulse wave velocity (PWV) and distensibility in addition to cardiac function and T1 mapping at baseline and at 6-month follow-up. Methods: RDN was performed in a total of 16 patients with treatment-resistant hypertension, and the procedures were conducted at two university hospitals using two different RDN devices. All patients and age-matched controls underwent a comprehensive clinical examination and cardiac magnetic resonance protocols both at baseline and at a 6-month follow-up. Results: In the treatment group, the systolic blood pressure (SBP) was found to be decreased at the follow-up visit (office SBP; 173±24 compared to 164±25 mmHg [P= 0.033]), the 24-hour ambulatory SBP had decreased (163±25 compared to 153±20 mmHg [P=0.057]), the aortic PWV had decreased from 8.24±3.34 to 6.54±1.31 m/s (P=0.053), and the aortic distensibility had increased from 2.33±1.34 to 3.96±3.05 10−3 mmHg−1 (P=0.013). The changes in aortic PWV and distensibility were independent of the observed reductions in SBP. Conclusion: The arterial stiffness, as assessed with aortic PWV, and distensibility were improved at 6 months after RDN. This improvement was independent of the reduction in SBP

Physicians’ Recognition and Management of Kidney Disease: A Randomized Vignette Study Evaluating the Impact of the KDIGO 2012 CKD Classification System

Rationale & Objective The Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification systems published in 2002 and 2012, respectively, are recommended worldwide and based on strong epidemiologic data. However, their impact on CKD recognition and management is not well evaluated in clinical practice, and we therefore investigated whether they help physicians recognize and appropriately care for patients with CKD. Study Design Randomized vignette experiment with fractional factorial design based on 6 kidney-related scenarios and 3 laboratory presentation methods reflecting the CKD guidelines. Participants evaluated 1 of 3 subsets of the 18 vignettes (ie, 6 vignettes each with 4 answer alternatives). Setting & Participants 249 interns, general practitioners, and residents/fellows attending postgraduate meetings and courses in Norway and the United States. Intervention Kidney-related results (serum creatinine level and urinary albumin excretion) were presented as the “minimal data” (high/low levels), KDOQI-2002 (estimated glomerular filtration rate [eGFR] reported automatically), or KDIGO-2012 (eGFR + albuminuria categorization + risk for complications) laboratory report. Outcome CKD management choice by physicians. Results When kidney laboratory data were presented as the KDOQI-2002 report (automatic eGFR calculation), there was a significantly higher odds for correct patient management decisions compared with the minimal data report (OR, 1.57; P < 0.001). Additional significant improvement was obtained with the KDIGO-2012 report (OR, 2.28 for correct answer vs minimal data report [P < 0.001]; OR, 1.45 compared to KDOQI-2002 report [P = 0.005]). The KDIGO classification system improved physician management in 4 of the 6 clinical scenarios covering a wide range of kidney-related topics. Interaction analysis showed that general practitioners and those with 1 to 3 years of internal medicine experience had the greatest improvements with the new presentation techniques. Limitations Physicians’ management was evaluated by theoretical scenarios rather than direct patient care. Conclusions Automatic GFR estimation, albuminuria categorization, and notification of the associated risk for complications improve most physicians` recognition and management of a wide range of CKD clinical scenarios