Diagnositic value of pelvic enthesitis on MRI of the sacroiliac joints in enthesitis related arthritis

Background: To determine the prevalence and diagnostic value of pelvic enthesitis on MRI of the sacroiliac (SI) joints in enthesitis related arthritis (ERA). Methods: We retrospectively studied 143 patients aged 6-18 years old who underwent MRI of the SI joints for clinically suspected sacroiliitis between 2006-2014. Patients were diagnosed with ERA according to the International League of Associations for Rheumatology (ILAR) criteria. All MRI studies were reassessed for the presence of pelvic enthesitis, which was correlated to the presence of sacroiliitis on MRI and to the final clinical diagnosis. The added value for detection of pelvic enthesitis and fulfilment of criteria for the diagnosis of ERA was studied. Results: Pelvic enthesitis was seen in 23 of 143 (16 %) patients. The most commonly affected sites were the entheses around the hip (35 % of affected entheses) and the retroarticular interosseous ligaments (32 % of affected entheses). MRI showed pelvic enthesitis in 21 % of patients with ERA and in 13 % of patients without ERA. Pelvic enthesitis was seen on MRI in 7/51 (14 %) patients with clinically evident enthesitis, and 16/92 (17 %) patients without clinically evident enthesitis. In 7 of 11 ERA-negative patients without clinical enthesitis but with pelvic enthesitis on MRI, the ILAR criteria could have been fulfilled, if pelvic enthesitis on MRI was included in the criteria. There is a high correlation between pelvic enthesitis and sacroiliitis, with sacroiliitis present in 17/23 (74 %) patients with pelvic enthesitis. Conclusions: Pelvic enthesitis may be present in children with or without clinically evident peripheral enthesitis. There is a high correlation between pelvic enthesitis and sacroiliitis on MRI of the sacroiliac joints in children. As pelvic enthesitis indicates active inflammation, it may play a role in assessment of the inflammatory status. Therefore, it should be carefully sought and noted by radiologists examining MRI of the sacroiliac joints in children

A Multi-Center Comparison of VO2peak Trainability Between Interval Training and Moderate Intensity Continuous Training

There is heterogeneity in the observed VO2peak response to similar exercise training, and different exercise approaches produce variable degrees of exercise response (trainability). The aim of this study was to combine data from different laboratories to compare VO2peak trainability between various volumes of interval training and Moderate Intensity Continuous Training (MICT). For interval training, volumes were classified by the duration of total interval time. High-volume High Intensity Interval Training (HIIT) included studies that had participants complete more than 15 min of high intensity efforts per session. Low-volume HIIT/Sprint Interval Training (SIT) included studies using less than 15 min of high intensity efforts per session. In total, 677 participants across 18 aerobic exercise training interventions from eight different universities in five countries were included in the analysis. Participants had completed 3 weeks or more of either high-volume HIIT (n = 299), low-volume HIIT/SIT (n = 116), or MICT (n = 262) and were predominately men (n = 495) with a mix of healthy, elderly and clinical populations. Each training intervention improved mean VO2peak at the group level (P \u3c 0.001). After adjusting for covariates, high-volume HIIT had a significantly greater (P \u3c 0.05) absolute VO2peak increase (0.29 L/min) compared to MICT (0.20 L/min) and low-volume HIIT/SIT (0.18 L/min). Adjusted relative VO2peak increase was also significantly greater (P \u3c 0.01) in high-volume HIIT (3.3 ml/kg/min) than MICT (2.4 ml/kg/min) and insignificantly greater (P = 0.09) than low-volume HIIT/SIT (2.5 mL/kg/min). Based on a high threshold for a likely response (technical error of measurement plus the minimal clinically important difference), high-volume HIIT had significantly more (P \u3c 0.01) likely responders (31%) compared to low-volume HIIT/SIT (16%) and MICT (21%). Covariates such as age, sex, the individual study, population group, sessions per week, study duration and the average between pre and post VO2peak explained only 17.3% of the variance in VO2peak trainability. In conclusion, high-volume HIIT had more likely responders to improvements in VO2peak compared to low-volume HIIT/SIT and MICT

Aerobic interval training versus continuous training in patients with coronary artery disease

Coronary artery disease (CAD) is the progressive narrowing of the arteries supplying the heart muscle from oxygen and other nutrients. It is the main cause of death in Europe and worldwide, accounting for 20% of all deaths. This progressive narrowing can lead to an acute myocardial infarction. Coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are frequently used procedures in severe CAD. Patients with CAD receive a multidisciplinary treatment including medication, education, psychological support, dietary changes and smoking cessation. However, the core component in their treatment is structured exercise training, since exercise-based cardiac rehabilitation decreases all-cause (20%) and cardiovascular mortality (26%) substantially compared to conventional treatment. These improved survival rates are mediated through training-related increases in maximal exercise capacity (peak oxygen uptake; peak VO2). An increase of 1 ml/kg/min in peak VO2 is associated with a 15% decrease in mortality. The main purpose of exercise-based cardiac rehabilitation is therefore to optimally increase the peak VO2. Even though current programs seem to be effective, the search for the most optimal exercise characteristics (duration, frequency, intensity, mode) is still ongoing. Current practice includes continuous endurance training (20-45 minutes) at moderate intensity (40-80% of peak VO2). However, there’s evidence that higher intensities (80-90% of peak VO2) are more effective to increase peak VO2. Yet, these high intensities cannot be sustained for a long duration and thus require an interval structure in which high intensity bouts (30 seconds – 4 minutes) are alternated by periods of relative rest (30 seconds – 3 minutes). In 2004, aerobic interval training at high intensities (AIT) was introduced in cardiac rehabilitation for CAD patients. Small single-centre studies comparing this AIT with continuous training at moderate intensity (MCT) showed more favourable results after AIT, or equal effects after both interventions. Therefore, the main goal of this doctoral research was to investigate the short- and long-term effects of AIT and MCT in patients with CAD, using meta-analytic statistics (summarizing existing literature) and by designing a large multicentre interventional study (SAINTEX-CAD = Study on Aerobic INTerval EXercise in Coronary Artery Disease patients). From our meta-analysis including 9 studies, we could conclude that AIT was more effective compared to MCT in increasing peak VO2; a mean difference of 1.60 ml/kg/min was found, which is clinically relevant. Mean increases were 20.5% after AIT (100 patients) and 12.8% after MCT (106 patients), the latter being low compared to existing literature. In contrast, our intervention study, in which 200 patients performed 3 weekly AIT or MCT cycling sessions during 12 weeks, resulted in similar improvements after both training interventions (AIT +22.7%, MCT +20.3%). To clarify this inconvenience, a final study was set up in which we objectively measured the energy expenditure of frequently used AIT and MCT protocols, including those of the SAINTEX-CAD study. We could conclude that AIT is more efficient than MCT to increase peak VO2, since a lower energy expenditure and a shorter duration are needed for similar improvements in peak VO2. On the other hand, energy expenditure is not a main goal of exercise-based cardiac rehabilitation, making it worth saying that MCT is equally effective when intensity is sufficiently high and duration is prolonged (intensity x duration = energy expenditure). Patients’ preferences should be met, in order to increase the intrinsic motivation to ensure a lifelong physical activity behaviour. In the SAINTEX-CAD study we observed that patients preserved a satisfactory physical activity level, with more than 90% of all patients meeting the guidelines of the World Health Organization to be physically active for at least 150 minutes per week at moderate intensity. This resulted in a sustained peak VO2 nine months after finishing the centre-based AIT or ACT intervention, which is good for the prognosis of the CAD patients.status: publishe

A comparison of aerobic interval training and moderate continuous training in coronary artery disease patients: the SAINTEX-CAD study

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Aerobic interval training versus continuous training in patients with coronary artery disease or heart failure: an updated meta-analysis with focus on secondary outcomes

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Hoog intensieve intervaltraining voor patiënten met coronair hartlijden, de moeite waard

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Aerobic Interval vs. Continuous Training in Patients with Coronary Artery Disease or Heart Failure: An Updated Systematic Review and Meta-Analysis with a Focus on Secondary Outcomes

BACKGROUND: In a previous meta-analysis including nine trials comparing aerobic interval training with aerobic continuous training in patients with coronary artery disease, we found a significant difference in peak oxygen uptake favoring aerobic interval training. OBJECTIVE: The objective of this study was to (1) update the original meta-analysis focussing on peak oxygen uptake and (2) evaluate the effect on secondary outcomes. METHODS: We conducted a systematic review with a meta-analysis by searching PubMed and SPORTDiscus databases up to March 2017. We included randomized trials comparing aerobic interval training and aerobic continuous training in patients with coronary artery disease or chronic heart failure. The primary outcome was change in peak oxygen uptake. Secondary outcomes included cardiorespiratory parameters, cardiovascular risk factors, cardiac and vascular function, and quality of life. RESULTS: Twenty-four papers were identified (n = 1080; mean age 60.7 ± 10.7 years). Aerobic interval training resulted in a higher increase in peak oxygen uptake compared with aerobic continuous training in all patients (1.40 mL/kg/min; p < 0.001), and in the subgroups of patients with coronary artery disease (1.25 mL/kg/min; p = 0.001) and patients with chronic heart failure with reduced ejection fraction (1.46 mL/kg/min; p = 0.03). Moreover, a larger increase of the first ventilatory threshold and peak heart rate was observed after aerobic interval training in all patients. Other cardiorespiratory parameters, cardiovascular risk factors, and quality of life were equally affected. CONCLUSION: This meta-analysis adds further evidence to the clinically significant larger increase in peak oxygen uptake following aerobic interval training vs. aerobic continuous training in patients with coronary artery disease and chronic heart failure. More well-designed randomized controlled trials are needed to establish the safety of aerobic interval training and the sustainability of the training response over longer periods.status: publishe

High intensity interval training in coronary artery disease patients, is it worth the effort?

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High intensity interval training in coronary artery disease patients, is it worth the effort?

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The effect of exercise and diet, alone or combined, on body composition: a meta-analysis of randomized controlled trials

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