Cardiorespiratory fitness as a predictor of short‐term and lifetime estimated cardiovascular disease risk

Development of cardiovascular disease (CVD) remains a public health concern for young-to-middle-aged adults, now exacerbated by the increasing prevalence of obesity and sedentary lifestyles. Cardiorespiratory fitness (CRF) improves the reclassification of short-term (10-year) CVD risk, but has not been uniformly defined across studies. This study evaluated cross-sectional differences in short-term and lifetime CVD risk scores, across both absolute metabolic equivalent (MET), sex- and age-standardised CRF categories in 805 healthy apparently healthy young-to-middle aged adults (68% male; 47.4 ± 7.2 years). CVD risk factors were evaluated, and estimated cardiorespiratory fitness (CRF) measurements (METS and peak VO2) were derived from a submaximal Bruce treadmill test. CRF measures also included post-exercise heart rate recovery (HRR) data. Consistent trends showing more favorable risk factor profiles and lower short-term CVD (QRISK2), and CVD mortality (SCORE) scores, associated with higher levels of CRF were evident in both sexes. Lifetime CVD risk (Q-Lifetime) was highest in the lowest CRF categories. Peak VO2 and HRR following submaximal exercise testing contributed to the variability in short-term and lifetime CVD risk. Global CVD risk predictions were examined across different contemporary CRF classifications with inconsistent findings. Recommended absolute MET and sex- and age-standardised CRF categories were significantly associated with both short-term and lifetime risk of CVD outcomes. However, compared to internationally-derived normative CRF standards, cohort-specific CRF categories resulted in markedly different proportion of individuals classified in the “poor” CRF category at higher CVD risk

Exercise Intensity and Energy Expenditure of a Simulated-sport Exergame versus Real-world Sport

Despite the multitude of local and national health initiatives aimed at increasing physical activity levels in the United States, there remains a dire need to aid individuals and families in adopting regular physical activity regimens. This lack of activity necessitates the use of novel and innovative methods for encouraging regular physical activity, such as the use of simulated-sport exergames. However, it is unclear whether these games can generate comparable physiological states of exercise to those seen within the actual sports they are simulating. Using data taken from a larger study, the purpose of the current study was to objectively compare physiological measures of exercise intensity and energy expenditure for a simulated-sport exergame versus its respective real-world sport, using the sport of racquetball. Undergraduate students (n = 103) who did not regularly exercise were provided with twice weekly, 30-minute training sessions for a new sport (racquetball) and were randomized into three different conditions of introductory training (None, Exergame, and Traditional Training) over an eight week period. This introductory training took place during Weeks 1 – 4, then all groups were transitioned into playing the actual sport of racquetball. The exergame group required participants to play a racquetball exergame for introductory training, while the traditional training group played the sport of racquetball on a racquetball court. The third group served as a control and came to introductory training sessions at the university activity center, but was only required to read or study. All participants were fitted with accelerometers during participation in order to measure levels of activity (via accelerometer counts), exercise intensity, steps taken and calories burned. As expected, analyses revealed that the traditional training group showed greater levels of all outcomes than all other groups during Weeks 1-4. Contrary to expectations, the exergame group did not show greater activity levels or energy expenditure than the control group at any time. All groups showed similar levels of activity once transitioned into playing actual racquetball. These findings support previous literature suggesting that an actual sport can produce significantly greater activity levels than its exergame counterpart. These results also provide evidence that exergames produce levels of activity that fall well below those suggested by ACSM minimum exercise guidelines. Future interventions should use these results by limiting the use of exergames to the introductory phase of training

An In-Depth Program Evaluation: Weigh To Wellness, UNC Wellness Center at Meadowmont, 2010

The Centers for Disease Control and Prevention (CDC) characterize American society as “obesogenic”; a society characterized by environments that promote increased food intake, nonhealthful foods, and physical inactivity. (The Centers for Disease Control and Prevention: obesity statistics http://www.cdc.gov/obesity/index.html) Policy changes and environmental initiatives that promote healthy eating, physical activity and nutrition as well as making them accessible, affordable and easy are the best way to combat obesity and reduce the risk factors that are closely associated with it such as diabetes, heart disease and certain cancers. Successful weight loss programs must focus on lifestyle modification, not diet alone. There is some evidence to support that lifestyle modification programs are more successful than weight loss programs in that they promote healthy living, not just healthy eating. Lifestyle modification programs for weight loss generally include proper nutrition, proper exercise in terms of frequency, type, and duration; stress management, smoking cessation and even psychological assessment and/or treatment in order to create an environment of wellness both physically and environmentally. The overall goal of lifestyle modification programs is therefore lifestyle modification, not necessarily weight loss. However, while lifestyle modification and weight loss are different, they are not mutually exclusive. Weight loss programs are geared towards weight loss but should include lifestyle modification techniques so that the weight loss can be maintained. This is because losing weight as a product of dietary and exercise changes is often not the issue; making those changes a way of life is crucial to the maintenance of those changes. For example, if a person chooses to stop smoking but continues to spend time participating in the kinds of activities that were conducive to smoking for them, they are less likely to be able to continue with cessation. It is one thing to lose the weight and quite another tokeep it off over time. This paper will address the evaluation of the UNC Wellness Center program Weigh To Wellness. It is the goal of UNC Wellness Center to create a weight loss program that offers lifestyle modification techniques for weight loss that can be expanded beyond UNC Wellness Center and offered to UNC Hospital employees.Master of Public Healt

Cardiovascular training improves fitness in patients with ankylosing spondylitis

Objective: Several studies suggest that patients with ankylosing spondylitis (AS) have an increased risk of cardiovascular disease. This study aimed to evaluate the effects of a 12-week individually heart rate-monitored, moderately intensive cardiovascular training on cardiovascular fitness and perceived disease activity in AS patients. Methods: Patients diagnosed with AS according to modified New York criteria were to either 'cardiovascular training' or 'attention control'. The training group performed three cardiovascular trainings per week. All participants attended one weekly usual care flexibility training. Attention control contained regular discussion groups on coping strategies. Adherence was self-monitored. Assessments were performed at baseline and after the intervention period of 3 months. Physical fitness was the primary endpoint, measured in watts using a submaximal bicycle test following the PWC75% protocol. All analyses controlled for gender, age, body mass index, baseline fitness and physical activity levels, and BASDAI. Results: Of 106 AS patients enrolled, 40% were women, mean age was 49 (SD +/-12) years. 76.5% of the training group reported exercising at least three times a week. At 3 month follow-up, fitness level in the training group was significantly higher than in the control group (90.32 (SD 4.52) vs.109.84 (SD 4.72) respectively, p=0.001), independent of other covariates. Average BASDAI total score was 0.31 points lower (p = 0.31) in the training group, reaching significance for the 'peripheral pain' subscore (1.19; p=0.01), but not for 'back pain' or 'fatigue'. Conclusions: Cardiovascular training, in addition to flexibility exercise, increased fitness in AS patients and reduced their peripheral pain

Inspiratory muscle training at sea level improves the strength of inspiratory muscles during load carriage in cold-hypoxia

Inspiratory muscle training (IMT) and functional IMT (IMTF: exercise-specific IMT activities) has been unsuccessful in reducing respiratory muscle fatigue following load carriage. IMTF did not include load carriage specific exercises. Fifteen participants split into two groups (training and control) walked 6 km loaded (18.2 kg) at speeds representing ∼50%V̇O2max in cold-hypoxia. The walk was completed at baseline; post 4 weeks IMT and 4 weeks IMTF (five exercises engaging core muscles, three involved load). The training group completed IMT and IMTF at a higher maximal inspiratory pressure (Pimax) than controls. Improvements in Pimax were greater in the training group post-IMT (20.4%, p = .025) and post-IMTF (29.1%, p = .050) compared to controls. Respiratory muscle fatigue was unchanged (p = .643). No other physiological or subjective measures were improved by IMT or IMTF. Both IMT and IMTF increased the strength of respiratory muscles pre-and-post a 6 km loaded walk in cold-hypoxia. Practitioner Summary: To explore the interaction between inspiratory muscle training (IMT), load carriage and environment, this study investigated 4 weeks IMT and 4 weeks functional IMT on respiratory muscle strength and fatigue. Functional IMT improved inspiratory muscle strength pre-and-post a loaded walk in cold-hypoxia but had no more effect than IMT alone. Abbreviations: ANOVA: analysis of variance; BF: breathing frequency; CON: control group; EELV: end-expiratory lung volume; EXP: experimental group; FEV1: forced expiratory volume in one second; FiO2: fraction of inspired oxygen; FVC: forced vital capacity; HR: heart rate; IMT: inspiratory muscle training; IMTF: functional inspiratory muscle training; Pemax: maximal expiratory pressure; Pimax: maximal inspiratory pressure; RMF: respiratory muscle fatigue; RPE: rate of perceived exertion; RWU: respiratory muscle warm-up; SaO2: arterial oxygen saturation; SpO2: peripheral oxygen saturation; V̇E: minute ventilation; V̇O2: rate of oxygen uptake

Pilot investigation of the oxygen demands and metabolic cost of incremental shuttle walking and treadmill walking in patients with cardiovascular disease

Objective: To determine if the metabolic cost of the incremental shuttle-walking test protocol is the same as treadmill walking or predicted values of walking-speed equations. Setting: Primary care (community-based cardiac rehabilitation). Participants: Eight Caucasian cardiac rehabilitation patients (7 males) with a mean age of 67±5.2 years. Primary and secondary outcome measures: Oxygen consumption, metabolic power and energy cost of walking during treadmill and shuttle walking performed in a balanced order with 1 week between trials. Results: Average overall energy cost per metre was higher during treadmill walking (3.22±0.55 J kg/m) than during shuttle walking (3.00±0.41 J kg/m). There were significant post hoc effects at 0.67 m/s (p<0.004) and 0.84 m/s (p<0.001), where the energy cost of treadmill walking was significantly higher than that of shuttle walking. This pattern was reversed at walking speeds 1.52 m/s (p<0.042) and 1.69 m/s (p<0.007) where shuttle walking had a greater energy cost per metre than treadmill walking. At all walking speeds, the energy cost of shuttle walking was higher than that predicted using the American College of Sports Medicine walking equations. Conclusions: The energetic demands of shuttle walking were fundamentally different from those of treadmill walking and should not be directly compared. We warn against estimating the metabolic cost of the incremental shuttle-walking test using the current walking-speed equations

Protocol for: Sheffield Obesity Trial (SHOT): A randomised controlled trial of exercise therapy and mental health outcomes in obese adolescents [ISRCNT83888112]

Background While obesity is known to have many physiological consequences, the psychopathology of this condition has not featured prominently in the literature. Cross-sectional studies have indicated that obese children have increased odds of experiencing poor quality of life and mental health. However, very limited trial evidence has examined the efficacy of exercise therapy for enhancing mental health outcomes in obese children, and the Sheffield Obesity Trial (SHOT) will provide evidence of the efficacy of supervised exercise therapy in obese young people aged 11–16 years versus usual care and an attention-control intervention. Method/design SHOT is a randomised controlled trial where obese young people are randomised to receive; (1) exercise therapy, (2) attention-control intervention (involving body-conditioning exercises and games that do not involve aerobic activity), or (3) usual care. The exercise therapy and attention-control sessions will take place three times per week for eight weeks and a six-week home programme will follow this. Ninety adolescents aged between 11–16 years referred from a children's hospital for evaluation of obesity or via community advertisements will need to complete the study. Participants will be recruited according to the following criteria: (1) clinically obese and aged 11–16 years (Body Mass Index Centile > 98th UK standard) (2) no medical condition that would restrict ability to be active three times per week for eight weeks and (3) not diagnosed with insulin dependent diabetes or receiving oral steroids. Assessments of outcomes will take place at baseline, as well as four (intervention midpoint) and eight weeks (end of intervention) from baseline. Participants will be reassessed on outcome measures five and seven months from baseline. The primary endpoint is physical self-perceptions. Secondary outcomes include physical activity, self-perceptions, depression, affect, aerobic fitness and BMI