Sudden Cardiac Death Risk in Downhill Skiers and Mountain Hikers and Specific Prevention Strategies

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8–379.1; p < 0.001) and systemic hypertension (9.0; 4.0–20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8–30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2–5.2; p < 0.001) and diabetes (7.4; 1.6–34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04–0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1–0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice

Patients' experiences and perspectives regarding the use of digital technology to support exercise-based cardiac rehabilitation: a qualitative interview study

IntroductionDespite the well-known benefits of exercise-based cardiac rehabilitation for the secondary prevention of cardiovascular disease, participation in cardiac rehabilitation programmes and adherence to secondary prevention recommendations remain limited. Digital technologies have the potential to address low participation and adherence but attempts at implementing digital health interventions in real-life clinical practice frequently encounter various barriers. Studies about patients' experiences and perspectives regarding the use of digital technology can assist developers, researchers and clinicians in addressing or pre-empting patient-related barriers. This study was therefore conducted to investigate the experiences and perspectives of cardiac rehabilitation patients in Austria with regard to using digital technology for physical activity and exercise.MethodsTwenty-five current and former cardiac rehabilitation patients (18 men and 7 women, age range 39 to 83) with various cardiac conditions were recruited from a clinical site in Salzburg, Austria. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. The analysis followed a descriptive phenomenological approach, applying the framework analysis method.ResultsThe sample was diverse, including interviewees who readily used digital devices to support their physical activity, exercise and health monitoring, and interviewees who did not. Simplicity, convenience and accessibility were highlighted as important facilitators for the use of digital technology, while annoyance with digital devices, concerns about becoming dependent on them, or simply a preference to not use digital technology were commonly stated reasons for non-use. Interviewees' views on data protection, data sharing and artificial intelligence revealed wide variations in individuals' prior knowledge and experience about these topics, and a need for greater accessibility and transparency of data protection regulation and data sharing arrangements.DiscussionThese findings support the importance that is attributed to user-centred design methodologies in the conceptualisation and design of digital health interventions, and the imperative to develop solutions that are simple, accessible and that can be personalised according to the preferences and capabilities of the individual patient. Regarding data protection, data sharing and artificial intelligence, the findings indicate opportunity for information and education, as well as the need to offer patients transparency and accountability in order to build trust in digital technology and digital health interventions

Neškodljivost i djelotvornost glogova ekstrakta WS 1442 i nordijskog hodanja na profil lipida i funkciju endotela: randomizirano, djelomice slijepo probno istraživanje u dobrovoljaca prekomjerne tjelesne težine

Overweight and physical inactivity adversely affect endothelial function and are risk factors for atherosclerosis and cardiovascular disease. Both Crataegus extract WS 1442 and physical exercise exert beneficial effects on endothelial function. We investigated whether WS 1442 and Nordic walking (NW) had comparable effects on endothelial function and lipid profile in overweight subjects. In this partially blinded pilot study, overweight, otherwise healthy volunteers aged 45-75 years were randomized into four groups as follows: WS 1442 2x450 mg/day (WS-standard), WS 1442 2x900 mg/day (WS-double), exercise 2x30 minutes/week (NW-low), and exercise 4x45 minutes/week (NW-high) for 12 weeks. Safety was assessed based on adverse events. Endothelial function testing (EndoPAT®), assessment of endothelial progenitor cells, lipid profiles, and treadmill testing were performed. Sixty subjects participated in the study. At baseline, subjects in WS-standard/-double groups had higher lipid levels and greater impairment of endothelial function. Subjects with impaired endothelial function showed improvement regardless of the type of intervention. Subjects in WS-standard and WS-double groups showed a trend towards modest decrease in triglycerides and modest increase in HDL-cholesterol; most changes were within the normal limits. In NW-low/-high groups, values also remained within the normal range. Exercise capacity improved in both NW groups. WS-double showed no additional benefits over WS-standard. All adverse events were unrelated or improbably related to treatment. In conclusion, WS 1442 and exercise training were safe and showed beneficial effects on endothelial function and lipid profile in overweight but otherwise healthy volunteers; exercise capacity improved only by Nordic walking.Prekomjerna težina i tjelesna neaktivnost štetno djeluju na funkciju endotela i predstavljaju rizične čimbenike za aterosklerozu i srčanožilne bolesti. Glogov ekstrakt WS 1442 i tjelesna aktivnost oboje utječu povoljno na endotelnu funkciju. Ispitivali smo imaju li WS 1442 i nordijsko hodanje (NH) usporedive učinke na endotelnu funkciju i profil lipida u osoba prekomjerne tjelesne težine. U ovom djelomice slijepom probnom istraživanju su inače zdravi dobrovoljci prekomjerne tjelesne težine u dobi od 45 do 75 godina nasumce podijeljeni u četiri skupine: WS 1442 2x450 mg/dan (standardna doza WS), WS 1442 2x900 mg/dan (dvostruka doza WS), tjelovježba 2x30 minuta na tjedan (niska razina NH) i tjelovježba 4x45 minuta na tjedan (visoka razina NH) kroz 12 tjedana. Neškodljivost se procjenjivala na osnovi štetnih događaja. Provedeno je testiranje endotelne funkcije (EndoPAT®), procjena endotelnih progenitorskih stanica, profila lipida te test opterećenja. U istraživanju je sudjelovalo 60 ispitanika. Ispitanici na standardnoj/dvostrukoj dozi WS imali su bazalno više razine lipida i veći poremećaj endotelne funkcije. Ispitanici s poremećenom endotelnom funkcijom pokazali su poboljšanje bez obzira na vrstu intervencije. Ispitanici na standardnoj i dvostrukoj dozi WS pokazivali su tendenciju ka skromnom sniženju triglicerida i skromnom porastu HDL-kolesterola; većina ovih promjena bila je unutar normalnih granica. Uz nisku/visoku razinu NH vrijednosti su također ostale unutar normalnog raspona. Sposobnost za tjelovježbu poboljšala se u objema skupinama NH. Dvostruka razina WS nije pokazala dodatnih koristi u usporedbi sa standardnom dozom WS. Svi štetni događaji bili su nevezani ili malo vjerojatno povezani s tretmanom. U zaključku, WS 1442 i tjelovježba pokazali su se neškodljivima i imali su povoljan učinak na funkciju endotela i profil lipida kod inače zdravih osoba prekomjerne tjelesne težine; sposobnost za tjelovježbu poboljšala se samo pomoću NH

The Last JITAI? The Unreasonable Effectiveness of Large Language Models in Issuing Just-in-Time Adaptive Interventions: Fostering Physical Activity in a Prospective Cardiac Rehabilitation Setting

We investigated the viability of using Large Language Models (LLMs) for triggering and personalizing content for Just-in-Time Adaptive Interventions (JITAIs) in digital health. JITAIs are being explored as a key mechanism for sustainable behavior change, adapting interventions to an individual's current context and needs. However, traditional rule-based and machine learning models for JITAI implementation face scalability and flexibility limitations, such as lack of personalization, difficulty in managing multi-parametric systems, and issues with data sparsity. To investigate JITAI implementation via LLMs, we tested the contemporary overall performance-leading model 'GPT-4' with examples grounded in the use case of fostering heart-healthy physical activity in outpatient cardiac rehabilitation. Three personas and five sets of context information per persona were used as a basis of triggering and personalizing JITAIs. Subsequently, we generated a total of 450 proposed JITAI decisions and message content, divided equally into JITAIs generated by 10 iterations with GPT-4, a baseline provided by 10 laypersons (LayPs), and a gold standard set by 10 healthcare professionals (HCPs). Ratings from 27 LayPs and 11 HCPs indicated that JITAIs generated by GPT-4 were superior to those by HCPs and LayPs over all assessed scales: i.e., appropriateness, engagement, effectiveness, and professionality. This study indicates that LLMs have significant potential for implementing JITAIs as a building block of personalized or "precision" health, offering scalability, effective personalization based on opportunistically sampled information, and good acceptability

Mobile technologies to promote physical activity during cardiac rehabilitation : a scoping review

Promoting regular physical activity (PA) and improving exercise capacity are the primary goals of cardiac rehabilitation (CR). Mobile technologies (mTechs) like smartphones, smartwatches, and fitness trackers might help patients in reaching these goals. This review aimed to scope current scientific literature on mTechs in CR to assess the impact on patients’ exercise capacity and to identify gaps and future directions for research. PubMed, CENTRAL, and CDSR were systematically searched for randomized controlled trials (RCTs). These RCTs had to utilize mTechs to objectively monitor and promote PA of patients during or following CR, aim at improvements in exercise capacity, and be published between December 2014 and December 2019. A total of 964 publications were identified, and 13 studies met all inclusion criteria. Home-based CR with mTechs vs. outpatient CR without mTechs and outpatient CR with mTechs vs. outpatient CR without mTechs did not lead to statistically significant differences in exercise capacity. In contrast, outpatient CR followed by home-based CR with mTechs led to significant improvement in exercise capacity as compared to outpatient CR without further formal CR. Supplying patients with mTechs may improve exercise capacity. To ensure that usage of and compliance with mTechs is optimal, a concentrated effort of CR staff has to be achieved. The COVID-19 pandemic has led to an unprecedented lack of patient support while away from institutional CR. Even though mTechs lend themselves as suitable assistants, evidence is lacking that they can fill this gap

Whole body vibration for chronic patellar tendinopathy: A randomized equivalence trial

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Purpose: Whole body vibration (WBV) triggers anabolic responses in various tissues, including tendons, without requiring high force production. In this waitlist-controlled equivalence trial, we tested its clinical effectiveness as an alternative treatment for patellar tendinopathy against conventional heavy slow resistance training (HSR). Methods: Thirty-nine patients were randomized to either 3 months of WBV training (n = 13), HSR training (n = 11), or a waitlist control (WLC) group (n = 15). In a partly cross-over design, 14 patients of the WLC group were redistributed to one of the two intervention groups (5 in WBV, 9 in HSR). Pre- and post-intervention testing included pain assessments (VAS), functional limitations (VISA-P), knee extension strength and tendon morphological, mechanical and material properties. Follow-up measurements (VAS, VISA-P) were performed in the WBV and HSR groups 6 months after the intervention. Results: Comparisons with the WLC group revealed significant improvements in VISA-P and VAS scores after HSR (41%, p = 003; 54%, p = 0.005) and WBV (22%, p = 0.022; 56%, p = 0.031) training. These improvements continued until follow-up (HSR: 43%, 56%; WBV: 24%, 37%). Pre-post improvements in VAS scores were equivalent between WBV and HSR groups but inconclusive for the VISA-P score and all pre-test to follow up comparisons. The mid-tendon cross-sectional area was significantly reduced after WBV (−5.7%, p = 0.004) and HSR (−3.0%, p = 0.004) training compared to WLC although the equivalence test between interventions was inconclusive. Conclusion: Whole body vibration improved symptoms typically associated with patellar tendinopathy. This type of intervention is as effective as HSR against maximum pain, although equivalence could not be confirmed for other variables. The beneficial responses to WBV and HSR treatments persisted for 6 months after the end of the intervention.publishedVersionInstitutt for fysisk prestasjonsevne / Department of Physical Performanc

International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD

The Impact of Exercise Training and Supplemental Oxygen on Peripheral Muscles in COPD: A Randomized Controlled Trial

Objective: Exercise training is a cornerstone of the treatment of COPD while the related inter-individual heterogeneity in skeletal muscle dysfunction and adaptations are not yet fully understood. We set out to investigate the effects of exercise training and supplemental oxygen on functional and structural peripheral muscle adaptation. Methods: In this prospective, randomized, controlled, double-blind study, 28 patients with non-hypoxemic COPD (FEV1 45.92 ± 9.06%) performed six-weeks of combined endurance and strength training, three times a week while breathing either supplemental oxygen or medical air. The impact on exercise capacity, muscle strength and quadriceps femoris muscle cross-sectional area (CSA), was assessed by maximal cardiopulmonary exercise testing, ten-repetition maximum strength test of knee extension, and magnetic resonance imaging, respectively. Results: After exercise training, patients demonstrated a significant increase of functional capacity, aerobic capacity, exercise tolerance, quadriceps muscle strength and bilateral CSA. Supplemental oxygen affected significantly the training impact on peak work rate when compared to medical air (+0.20 ± 0.03 vs +0.12 ± 0.03 Watt/kg, p = 0.047); a significant increase in CSA (+3.9 ± 1.3 cm2, p = 0.013) was only observed in the training group using oxygen. Supplemental oxygen and exercise induced peripheral desaturation were identified as significant opposing determinants of muscle gain during this exercise training intervention, which led to different adaptations of CSA between the respective subgroups. Conclusions: The heterogenous functional and structural muscle adaptations seem determined by supplemental oxygen and exercise induced hypoxia. Indeed, supplemental oxygen may facilitate muscular training adaptations, particularly in limb muscle dysfunction, thereby contributing to the enhanced training responses on maximal aerobic and functional capacity

A systematic review of cardiac rehabilitation registries

Introduction: Despite cardiac rehabilitation (CR) being recommended in clinical practice guidelines internationally these services are under-utilised, programs are not standardised and quality improvement methods and outcomes are rarely published. National registries are an important strategy to characterise service delivery, quality and outcomes, yet the number, type and components of national CR registries has not been reported. Aims: To identify and describe national and international CR registries internationally, and summarise their key features. Methods: The literature reporting on CR registries used to monitor the quality of CR at a national and international-level was systematically reviewed. A search of four databases was conducted in July 2016, with two reviewers independently screening title/abstracts and full-texts for inclusion. Data were extracted from included studies, independently checked by a second reviewer and synthesised qualitatively. Results: Eleven articles were included in the review comprising seven national registries and one international registry (of 12 European countries) for a total sample of 265,608 patients. Data were most commonly provided to the registry via a web-based application, and included individual-level data (i.e., sociodemographic characteristics, medical history, and clinical measurements). When reported, service-level data most commonly included wait times, program enrolment and completion. The overarching governance, funding modes (e.g., industry (n=2), government (n=1)), and incentives for registry participation (e.g., benchmarking, financial reimbursement, or mandatory requirement) varied widely. Conclusion: The use of national and international registries for characterising CR and providing a benchmark for quality improvement is in its early stages but shows promise for national and global benchmarking. Keywords: Acute coronary syndrome; cardiovascular disease, health information systems; quality Improvemen