Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation

The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI).  This respitory contains interviews (in dutch) conducted for the study: "Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation." DOI: 10.1007/s41999-023-00774-1 Because of the sensitive nature of the data, the data is confidential and will be shared only under strict conditions. For more information contact: Dennis van Erck, [email protected], Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. </p

Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation

The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI).  This respitory contains interviews (in dutch) conducted for the study: "Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation." DOI: 10.1007/s41999-023-00774-1 Because of the sensitive nature of the data, the data is confidential and will be shared only under strict conditions. For more information contact: Dennis van Erck, [email protected], Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. </p

Cycling at Altitude: Lower Absolute Power Output as the Main Cause of Lower Gross Efficiency

Background: Although cyclists often compete at altitude, the effect of altitude on gross efficiency (GE) remains inconclusive. Purpose: To investigate the effect of altitude on GE at the same relative exercise intensity and at the same absolute power output (PO) and to determine the effect of altitude on the change in GE during high-intensity exercise. Methods: Twenty-one trained men performed 3 maximal incremental tests and 5 GE tests at sea level, 1500 m, and 2500 m of acute simulated altitude. The GE tests at altitude were performed once at the same relative exercise intensity and once at the same absolute PO as at sea level. Results: Altitude resulted in an unclear effect at 1500 m (−3.8%; ±3.3% [90% confidence limit]) and most likely negative effect at 2500 m (−6.3%; ±1.7%) on pre-GE, when determined at the same relative exercise intensity. When pre-GE was determined at the same absolute PO, unclear differences in GE were found (−1.5%; ±2.6% at 1500 m; −1.7%; ±2.4% at 2500 m). The effect of altitude on the decrease in GE during high-intensity exercise was unclear when determined at the same relative exercise intensity (−0.4%; ±2.8% at 1500 m; −0.7%; ±1.9% at 2500 m). When GE was determined at the same absolute PO, altitude resulted in a substantially smaller decrease in GE (2.8%; ±2.4% at 1500 m; 5.5%; ±2.9% at 2500 m). Conclusion: The lower GE found at altitude when exercise is performed at the same relative exercise intensity is mainly caused by the lower PO at which cyclists exercis

Cycling at altitude: Lower absolute power output as the main cause of lower gross efficiency

Background: Although cyclists often compete at altitude, the effect of altitude on gross efficiency (GE) remains inconclusive. Purpose: To investigate the effect of altitude on GE at the same relative exercise intensity and at the same absolute power output (PO) and to determine the effect of altitude on the change in GE during high-intensity exercise. Methods: Twenty-one trained men performed 3 maximal incremental tests and 5 GE tests at sea level, 1500 m, and 2500 m of acute simulated altitude. The GE tests at altitude were performed once at the same relative exercise intensity and once at the same absolute PO as at sea level. Results: Altitude resulted in an unclear effect at 1500 m (−3.8%; ±3.3% [90% confidence limit]) and most likely negative effect at 2500 m (−6.3%; ±1.7%) on pre-GE, when determined at the same relative exercise intensity. When pre-GE was determined at the same absolute PO, unclear differences in GE were found (−1.5%; ±2.6% at 1500 m; −1.7%; ±2.4% at 2500 m). The effect of altitude on the decrease in GE during high-intensity exercise was unclear when determined at the same relative exercise intensity (−0.4%; ±2.8% at 1500 m; −0.7%; ±1.9% at 2500 m). When GE was determined at the same absolute PO, altitude resulted in a substantially smaller decrease in GE (2.8%; ±2.4% at 1500 m; 5.5%; ±2.9% at 2500 m). Conclusion: The lower GE found at altitude when exercise is performed at the same relative exercise intensity is mainly caused by the lower PO at which cyclists exercise

Exploring barriers and facilitators of behavioural changes in dietary intake and physical activity: a qualitative study in older adults undergoing transcatheter aortic valve implantation

Purpose The majority of older patients, scheduled for a cardiac procedure, do not adhere to international dietary intake and physical activity guidelines. The purpose of this study was to explore barriers and facilitators regarding dietary intake and physical activity behaviour change in older patients undergoing transcatheter aortic valve implantation (TAVI). Methods We conducted a qualitative study using semi-structured interviews with patients undergoing TAVI. Interviews were analysed by two independent researchers using thematic analysis, the capability, opportunity and motivation behaviour model was used as a framework. Results The study included 13 patients (82 ± 6 years old, 6 females) until data saturation was reached. Six themes were identified, which were all applicable to both dietary intake and physical activity. Three following themes were identified as barriers: (1) low physical capability, (2) healthy dietary intake and physical activity are not a priority at an older age and (3) ingrained habits and preferences. Three following themes were identified as facilitators: (1) knowledge that dietary intake and physical activity are important for maintaining health, (2) norms set by family, friends and caregivers and (3) support from the social environment. Conclusion Our study found that older patients had mixed feelings about changing their behaviour. The majority initially stated that dietary intake and physical activity were not a priority at older age. However, with knowledge that behaviour could improve health, patients also stated willingness to change, leading to a state of ambivalence. Healthcare professionals may consider motivational interviewing techniques to address this ambivalence

Preprocedural muscle strength and physical performance and the association with functional decline or mortality in frail older patients after transcatheter aortic valve implementation: a systematic review and meta-analysis

BACKGROUND: A significant number of older patients planned for transcatheter aortic valve implantation (TAVI) experience a decline in physical functioning and death, despite a successful procedure. OBJECTIVE: To systematically review the literature on the association of preprocedural muscle strength and physical performance with functional decline or long-term mortality after TAVI. METHODS: We followed the PRISMA guidelines and pre-registered this review at PROSPERO (CRD42020208032). A systematic search was conducted in MEDLINE and EMBASE from inception to 10 December 2021. Studies reporting on the association of preprocedural muscle strength or physical performance with functional decline or long-term (>6 months) mortality after the TAVI procedure were included. For outcomes reported by three or more studies, a meta-analysis was performed. RESULTS: In total, two studies reporting on functional decline and 29 studies reporting on mortality were included. The association with functional decline was inconclusive. For mortality, meta-analysis showed that low handgrip strength (hazard ratio (HR) 1.80 [95% confidence interval (CI): 1.22-2.63]), lower distance on the 6-minute walk test (HR 1.15 [95% CI: 1.09-1.21] per 50 m decrease), low performance on the timed up and go test (>20 s) (HR 2.77 [95% CI: 1.79-4.30]) and slow gait speed (<0.83 m/s) (HR 2.24 [95% CI: 1.32-3.81]) were associated with higher long-term mortality. CONCLUSIONS: Low muscle strength and physical performance are associated with higher mortality after TAVI, while the association with functional decline stays inconclusive. Future research should focus on interventions to increase muscle strength and physical performance in older cardiac patients

The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11–14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure

The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11–14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure

The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11–14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure

The trajectory of nutritional Status and physical activity before and after transcatheter aortic valve implantation

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment-short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11-14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (&gt;7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI -0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI -47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure