Quantificazione degli adattamenti muscolari metabolici attraverso spettroscopia a raggi infrarossi e risposta emodinamica a seguito di un programma riabilitativo di cammino alla massima velocità libera dal dolore nell’arteriopatia periferica

Background: exercise training reduces walking disability in peripheral arterial disease (PAD). Metabolic adaptations induced by rehabilitation programs have been documented by invasive methods. Near infrared spectroscopy (NIRS), potentially useful for the study of non-invasive static and dynamic muscle metabolism, has not yet been used to assess the effects of exercise in PAD. The aim of the present study is to document hemodynamic and metabolic adaptations, by NIRS technique, associated with variations in performance recorded at the end of a program of exercise therapy in PAD prescribed at hospital and carried out at home (Ti.To). Method: 55 PAD patients with claudicatio intermittens (group E) and 15 healthy subject (group C) were enrolled. Evaluation were carried out upon entry (T0) and at 7±2 month (T9). Ankle-brachial index (ABI) and muscle VO2 consumption (mVO2 ) in the gastrocnemius by NIRS, were determined at rest. Participants than performed an incremental treadmill test for determination of pain threshold speed (PTS). Cardiovascular response (dFc), and rate of muscle oxygenation, were determined in a predetermined speed range (1,7-3 km/h) by NIRS, through quantification of variation in oxygenated (O2Hb), deoxygenated (HHb), total (tHb) and differential (dHb) haemoglobin. Group E performed a rehabilitation program (Ti-To) based on 2 daily 10-min home walking session at maximal asymptomatic speed and the patients attending monthly check-ups at hospital. Group C continued to carry out normal daily activities. Results: 42 patients and 15 healthy subjects were studied. All subject in group E completed the Ti- To program. Group C showed no significant changes in hemodynamic and metabolic parameters at the end of the study. At the end of the rehabilitation program group E, while continuing to show different values of outcome parameters than the group C, showed a trend to normalization with a) significantly changes in PTS (p<0.0001) compared with significantly higher values of ABI (p<0.0001) and mVO2 (p=0.0011), b) lower muscle perfusion deficit in dynamic phase for increase of O2HbAUC (p=0.0010) and c) concomitant reduction of cardiovascular response (p=0.0293). At the end of rehabilitation program, compared to the group with significant ABI increase, patient without favorable hemodynamic changes in worse limb showed a dramatic increase in mVO2 and similar functional changes. Conclusion: Ti-To program in PAD leads to functional improvements by means of peripheral adaptations, hemodynamic or muscles, otherwise combined together, with reduction of compensatory cardiovascular response. NIRS measurement, allows to non-invasive study of muscle metabolic useful to evaluate the effects of different rehabilitative training program in PAD

Age at Menarche, Growth Velocity, and Adiposity Indices in Italian Girls Aged 10 to 14

Age at menarche (AAM) is an effective marker of puberty timing but its onset could be influenced by several intrinsic and extrinsic factors. This study aimed to assess the AAM in a sample of Italian adolescents and to investigate its association with anthropometric variables. Considering the rise in overweight/obesity worldwide, special attention was paid to a possible decrease in AAM as adiposity indices increase. A longitudinal study was carried out on 117 middle school girls in Northern Italy. Data concerning menarche and anthropometric traits (standing and sitting height, weight, waist circumference, and skinfold thicknesses) were directly collected. Lower limb length and indices of adiposity and growth were calculated. The median AAM was 11.66 (95% IC: 11.31-11.68). Age-adjusted ANCOVA between mature and non-mature girls showed significant differences in growth-related traits and WHtR. No preponderance of overweight/obesity among mature participants was found. AAM was not significantly associated with weight or the growth velocity of adiposity indices in a subsample of maturers. Moreover, the median AAM of our sample was similar to that found in women born about 60 years ago in the same region. In conclusion, in addition to a stabilization of AAM since the 1960s, our results suggest that there is no significant correlation between increased adiposity and early AAM

Assessing the Impact of COVID-19 Prevention Measures on Adolescent Growth in Italy

COVID-19 infection has caused increased morbidity and mortality worldwide. Several strategies have been adopted around the world to prevent its spread. Italy underwent a long lockdown for face-to-face educational activities, which were replaced with online classes. This longitudinal study aimed to analyze the effects of COVID-19 prevention measures on physical growth and body image perception in a sample of Italian adolescents who experienced the pandemic-induced lockdown in 2020. In particular, we wished to ascertain how lifestyle changes had affected their growth rates and health. Special attention was paid to increases in adiposity indicators (BMI, waist circumference, waist-to-height ratio) and weight caused by reduced physical activity, and consequent possible dissatisfaction with body image. We assessed the impact of school closures by comparing the annual growth rate and body image perception changes of adolescents (n = 60; age = 11.3 &amp; PLUSMN; 0.4 years) who experienced this isolation with those in the following years who did not experience these restrictions (n = 68; age = 11.4 &amp; PLUSMN; 0.3 years). As a consequence of the lockdown, our results indicate a greater annual growth rate in weight and other indices of adiposity (p &lt; 0.05). As the virus is continuing to evolve and propagate, larger population studies can verify and confirm our findings. In promoting health policy to prevent the ongoing prevalence of obesity in adolescents, an accurate assessment of whether the increase in obesity rates during the pandemic is to be considered a temporary trend is highly recommended

A Moderate Walking Test Predicts Survival in Women With Cardiovascular Disease

Introduction: Cardiovascular disease (CVD) is the principal cause of death in U.S. women. Peak oxygen uptake is strongly related to mortality and CVD. This study aimed to investigate the association between estimated peak oxygen uptake, determined using a moderate 1-km walking test, and all-cause mortality in female patients with stable CVD. Methods: Of the 482 women in our registry between 1997 and 2020, we included 430 participants in the analysis (aged 67 [34-88] years). A Cox proportional hazard model was used to determine the variables significantly associated with mortality. On the basis of the peak oxygen uptake estimated using the 1-km walking test, the sample was subdivided into tertiles, and mortality risk was calculated. The discriminatory accuracy of peak oxygen uptake in estimating survival was assessed by receiver operating characteristic curves. All results were adjusted for demographic and clinical covariates. Results: A total of 135 deaths from any cause occurred over a median of 10.4 years (IQR=4.4-16.4), with an average annual mortality of 4.2%. Estimated peak oxygen uptake was a stronger predictor of all-cause mortality than demographic and clinical variables (c-statistic-0.767; 95% CI=0.72, 0.81; p&lt;0.0001). The survival rate decreased from the highest tertile of fitness to the lowest. Compared with the lowest group, hazard ratios (95% CIs) for the second and third tertiles were 0.55 (0.37, 0.83) and 0.29 (0.16, 0.51), respectively (p for trend &lt;0.0001). Conclusions: Higher peak oxygen uptake levels were associated with a lower risk of all-cause mortality. The indirect estimation of peak oxygen uptake using the 1-km walking test is feasible and can be applied for risk stratification among female patients undergoing secondary prevention programs

Impact of Improvement in Walking Speed on Hospitalization and Mortality in Females with Cardiovascular Disease

Cardiovascular disease (CVD) is the principal cause of death in women. Walking speed (WS) is strongly related with mortality and CVD. The rate of all-cause hospitalization or death was assessed in 290 female outpatients with CVD after participation in a cardiac rehabilitation/secondary prevention program (CR/SP) and associated with the WS maintained during a moderate 1 km treadmill-walk. Three-year mortality rates were 57%, 44%, and 29% for the slow (2.1 ± 0.4 km/h), moderate (3.1 ± 0.3 km/h), and fast (4.3 ± 0.6 km/h) walkers, respectively, with adjusted hazard ratios (HRs) of 0.78 (p = 0.24) and 0.55 (p = 0.03) for moderate and fast walkers compared to the slow walkers. In addition, hospitalization or death was examined four to six years after enrollment as a function of the change in the WS of 176 patients re-assessed during the third year after baseline. The rates of hospitalization or death were higher across tertiles of reduced WS, with 35%, 50%, and 53% for the high (1.5 ± 0.3 km/h), intermediate (0.7 ± 0.2 km/h), and low tertiles (0.2 ± 0.2 km/h). Adjusted HRs were 0.79 (p = 0.38) for the intermediate and 0.47 (p = 0.02) for the high tertile compared to the low improvement tertile. Improved walking speed was associated with a graded decrease in hospitalization or death from any cause in women undergoing CR/SP

Impact of COVID-19 Pandemic on Physical Activity in Patients With Implantable Cardioverter-Defibrillators

Purpose: The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death. Methods: Daily PA of 24 patients was estimated by processing recorded data from ICD-embedded accelerometric sensors used by the rate-responsive pacing systems. Results: During the forced 40-d in-home confinement, a mean 25% reduction of PA was observed as compared with the 40-d confinement-free period (1.2 ± 0.3 vs 1.6 ± 0.5 hr/d, respectively, P =.0001). Conclusions: This objective quantification of the impact of the COVID-19 pandemic on PA determined by an ICD device showed an abrupt and statistically significant reduction of PA in primary prevention ICD patients, during the in-home confinement quarantine. To counteract the deleterious effects of physical inactivity during the COVID-19 outbreak, patients should be encouraged to perform indoor exercise-based personalized rehabilitative programs

Guided walking is more effective than suggested walking in reducing the blood pressure of hypertensive sedentary subjects and in modifying their lifestyle

Objective The study has compared the effects of a program of guided walking (GW) and of a program of suggested walking (SW) on the blood pressure and on the lifestyle of sedentary hypertensive subjects. Methods Participants were sedentary and had a systolic pressure ≥ 140 mmHg. They were divided in a group of GW (n = 93) and of SW (n = 99). Blood pressure, weight, BMI, waist circumference and walking speed were assessed at enrollment and after 6 months. Sixteen months after the end of the project, the subjects were contacted to check if they were maintaining the walking activity. Results During the 6 months, the weekly walking time was 300 min in the GW group and 120 in the SW group. Seventy subjects of the GW group and 88 of the SW group completed the program. Significantly decrease in weight, BMI and waist circumference was observed in both groups. Systolic and diastolic pressure decreased by 7.5 and 1.9 mmHg in the GW group and by 4.1 and 2.1 mmHg in the WS. The decrease in systolic pressure was significantly higher in the subjects of GW group. Sixteen months after the end of the study, 54 subjects of the WG and 30 of the SG declared to maintain a walking habit. Conclusion Both programs resulted in significant reductions of systolic and diastolic pressure. The reduction of systolic pressure was significantly higher in the subjects who followed the GW program. The GW program was also more effective than the SW program in modifying the lifestyle of the participants

Guided walking reduces blood pressure in hypertensive sedentary subjects including those with resistant hypertension

Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P &lt; 0.0001) of systolic pressure was observed in both groups. The decrease was significantly higher (P &lt; 0.0001) in the subjects under therapy. The decrease of systolic pressure was directly proportional to baseline values. Diastolic blood pressure decreased significantly in both groups. In conclusion, habitual walking may lead to clinically significant reductions of blood pressure in therapy resistant hypertensive subjects

Reduction of risk factors for cardiovascular diseases and long lasting walking habit in sedentary male and female subjects following one year of guided walking

Aims To analyze the change in risk factors for cardiovascular diseases in sedentary subjects following 1 year of guided walking and check the maintenance of the walking habit 16 months after the end of the project. Methods A total of 650 sedentary subjects (442 women, 208 men) were admitted to the project. Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, and walking speed were determined at enrollment and redetermined after 1 year in the subjects completing the project. Daily groups of guided walking were organized. Results In the 326 subjects completing the project, highly significant reduction in body weight, BMI, waist circumference, systolic and diastolic blood pressure and increase in walking speed were documented. Out of the 326 finishers, 266 answered a questionnaire on the minutes of walking they were doing each week, 16 months after the end of the project: 258 declared 170 ± 110 min while eight declared to be back to inactivity. Conclusion Guided walking was followed by highly significant reduction in risk factors for cardiovascular diseases and improved walking speed. Seventy-seven percent of the finishers were maintaining the walking practice 16 months after the end of the project, indicating that guided walking programs can be effective in permanently modifying the lifestyle of sedentary subjects