Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): Rationale and design of a randomized clinical trial

Background: Reduced physical performance and impaired mobility are common in elderly patients after acute coronary syndrome (ACS) and they represent independent risk factors for disability, morbidity, hospital readmission and mortality. Regular physical exercise represents a means for improving functional capacity. Nevertheless, its clinical benefit has been less investigated in elderly patients in the early phase after ACS. The HULK trial aims to investigate the clinical benefit of an early, tailored low-cost physical activity intervention in comparison to standard of care in elderly ACS patients with reduced physical performance. Design: HULK is an investigator-initiated, prospective multicenter randomized controlled trial (NCT03021044). After successful management of the ACS acute phase and uneventful first 1 month, elderly (≥70 years) patients showing reduced physical performance are randomized (1:1 ratio) to either standard of care or physical activity intervention. Reduced physical performance is defined as a short physical performance battery (SPPB) score of 4-9. The early, tailored, low-cost physical intervention includes 4 sessions of physical activity with a supervisor and an home-based program of physical exercise. The chosen primary endpoint is the 6-month SPPB value. Secondary endpoints briefly include quality of life, on-treatment platelet reactivity, some laboratory data and clinical adverse events. To demonstrate an increase of at least one SPPB point in the experimental arm, a sample size of 226 patients is needed. Conclusions: The HULK study will test the hypothesis that an early, tailored low-cost physical activity intervention improves physical performance, quality of life, frailty status and outcome in elderly ACS patients with reduced physical performance

Effects of combined strength and endurance training on exercise capacity in kidney transplant cyclists and runners

Introduction: After transplantation, engaging in regular physical activity (PA) or sport is recommended for health. Participation to competitive sports is increasingly common among kidney transplant recipients while little is known on how training affects the physical performance in transplanted athletes. Aim: The purpose of this case study was to assess the effects of a tailored training program on exercise parameters in kidney transplant cyclists (CKTRs) and runners (RKTRs). Methods: Twelve male transplanted athletes were enrolled. The workload at aerobic and anaerobic thresholds, the submaximal aerobic power (V'O2 stage) and rate of perceived exertion (RPE) during an incremental cycling or running test, and the peak instantaneous force (PIF) during a countermovement jump were assessed at baseline (T0) and after 6 months of tailored training (T6) consisting in strength and aerobic exercises. Exercise adherence, blood lipid profile and renal function were also investigated. Results: Eight CKTRs and 4 RKTRs completed the 6-month training period, with a significant increase of training volume (minutes/week). The exercise adherence was met by 90% in both groups. At T6, there were significant (p<0.05) improvements of maximum workload attained, the workload corresponding to the aerobic threshold and PIF, while workloads at anaerobic threshold, V'O2 stage and RPE were unchanged. Blood cholesterol significantly decreased (p<0.01), while the other blood parameters were unchanged. Conclusions: These findings indicate that the combined strength and endurance training is well tolerated and may improve exercise performance in this selected population of KTRs

Renal function and physical fitness after 12-mo supervised training in kidney transplant recipients

To evaluate the effect of a 12-mo supervised aerobic and resistance training, on renal function and exercise capacity compared to usual care recommendations

High Level Cycling Performance 10 Years after Cardiac Transplantation

Purpose: To describe cycling performance in a well-trained male a decade after Cardiac Transplantation (CTX). Case report: The patient was diagnosed with arrhythmo- genic right ventricular cardiomyopathy at 14 years of age and underwent CTX at 35 years. Exercise training began 3 weeks after CTX, and progressively increased in volume and intensity. Ten years after CTX he participated in twelve one-day cycling races over an eight-month period. Maximal cardiopulmonary exercise test was performed before the study. One race was monitored using a power meter. Results: VO2peak (47.2 mL/kg/min), maximal HR (161 bpm), and oxygen pulse (18.8 mL/bpm) were 113%, 92%, and 118% of age-predicted values respectively. HR, W, and relative VO2 at the ventilatory threshold and at the respira- tory compensation point were 128 bpm, 120 W, and 75% VO2peak, and 142 bpm, 155 W, and 86% VO2peak respec- tively. Cycling economy was ~80 W per liters per O2/min. The race was completed in 7 hours and 56 minutes, at an average of 141 bpm and 162 W, remaining between moder- ate-to-high intensity (4 h 2 min), and above high-to-severe intensity (2 h 19 min). Conclusion: Long-term aerobic training may result in a re- markable cycling performance a decade after CTX, likely because of cardiovascular adaptations

A Novel Quantitative Computer-Assisted Score Can Improve Repeatability in the Estimate of Vascular Calcifications at the Abdominal Aorta

In CKD and in the elderly, Vascular Calcifications (VC) are associated to cardiovascular events and bone fractures. VC scores at the abdominal aorta (AA) from lateral spine radiographs are widely applied (the 0–24 semiquantitative discrete visual score (SV) being the most used). We hypothesised that a novel continuum score based on quantitative computer-assisted tracking of calcifications (QC score) can improve the precision of the SV score. This study tested the repeatability and reproducibility of QC score and SV score. In forty-four patients with VC from an earlier study, five experts from four specialties evaluated the data twice using a dedicated software. Test–retest was performed on eight subjects. QC results were reported in a 0–24 scale to readily compare with SV. The QC score showed higher intra-operator repeatability: the 95% CI of Bland–Altman differences was almost halved in QC; intra-operator R2 improved from 0.67 for SV to 0.79 for QC. Inter-observer repeatability was higher for QC score in the first (Intraclass Correlation Coefficient 0.78 vs. 0.64), but not in the second evaluation (0.84 vs. 0.82), indicating a possible heavier learning artefact for SV. The Minimum Detectable Difference (MDD) was smaller for QC (2.98 vs. 4 for SV, in the 0–24 range). Both scores were insensitive to test–retest procedure. Notably, QC and SV scores were discordant: SV showed generally higher values, and an increasing trend of differences with VC severity. In summary, the new QC score improved the precision of lateral spine radiograph scores in estimating VC. We reported for the first time an estimate of MDD in VC assessment that was 25% lower for the new QC score with respect to the usual SV score. An ongoing study will determine whether this lower MDD may reduce follow-up times to check for VC progression

The Promotion of Pre- and Post-Transplant Physical Exercise in the Emilia-Romagna Region: The Network of the Program "Transplantation, Physical Activity, and Sport"

Introduction Following the positive experience of the national project "A transplant...and now it\u2019s time for Sport", the Transplant Reference Center of the Emilia-Romagna Region has pursued the promotion of pre- and post-transplant physical exercise by developing a network. Methods The path involved the Transplant Centers and Operative Units (UU.OO) who wanted to target transplant and waiting list patients, clinically stable, to perform personalized exercise through a program (supervised or not) prescribed by a specialist in sports medicine. With the collaboration of the Collective Prevention and Public Health Service the network was established, consisting of the Sports Medicine Centers and the Gyms that promote health (PS-AMA). To implement the network, training courses for all the professionals involved (doctors, nurses, exercise specialists) and operational meetings in the Transplant Centers-Nephrology Units with Patients\u2019 Associations have been organized. Results To date there are 14 transplant centers and UU.OO, 9 sports medicine centers and 45 PS-AMA involved in this network. Seven training courses were organized with the participation of 193 health professionals. From January 2016, there have been 65 transplanted patients and 5 patients on waiting list who practice prescribed exercise. Of these, 45 carry out supervised exercise in PS-AMA, 25 perform autonomous exercise. Each patient is monitored every 6 months. None problems related to the exercise performance were recorded. Conclusions The development of a network of professionals and associations is the key element to raise awareness on physical activity among transplanted and waiting for transplant patients, reducing the pathologies associated with a sedentary lifestyle

Additional file 2: of Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of a randomized clinical trial

Calisthenics exercises. (DOC 1084 kb

Additional file 1: of Physical activity intervention for elderly patients with reduced physical performance after acute coronary syndrome (HULK study): rationale and design of a randomized clinical trial

Brochure for patients at hospital discharge. (DOC 499 kb