Insuficiència cardíaca diastòlica: valoració i exercici físic

Pacients amb insuficiència cardíaca diastòlica (ICD) mostren símptomes d'insuficiència cardíaca clàssica, per bé que tenen una funció sistòlica normal. La intolerància a l'exercici en ICD s'ha d'avaluar amb mesuraments que han demostrat prognosi, com a consum d'oxigen pic (VO2pic), llindar ventilatori (VT) i relació entre ventilació minut i producció de diòxid de carboni (pendent VE/VCO2). La prova de 6 minuts caminant presenta una gran variabilitat i només una correlació modesta amb VO2pic, i resulta inacceptable quan calen valors exactes per a l'estratificació de pacients. Semblantment, els pacients amb insuficiència cardíaca sistòlica, pacients ICD, presenten valors marcadament reduïts de VO2pic i VT, i elevat pendent VE/VCO2. Pacients ICD han mostrat adaptacions a l'entrenament, incloent-hi millores en la tolerància a l'exercici, VO2pic i VT, la qual cosa indica que les teràpies exitoses en insuficiència cardíaca sistòlica podrien tenir el seu paper en ICD

Insuficiencia cardíaca diastólica: valoración y ejercicio físico

Pacientes con insuficiencia cardíaca diastólica (ICD) muestran síntomas de insuficiencia cardíaca clásica, sin embargo tienen una función sistólica normal. La intolerancia al ejercicio en ICD debe evaluarse con mediciones que han demostrado prognosis, como consumo de oxígeno pico (VO2pico), umbral ventilatorio (VT), y relación entre ventilación minuto y producción de dióxido de carbono (pendiente VE/VCO2). La prueba de 6 min andando presenta una gran variabilidad y sólo una correlación modesta con VO2pico, y resulta inaceptable cuando son necesarios valores exactos para la estratificación de pacientes. De forma similar a los pacientes con insuficiencia cardíaca sistólica, pacientes ICD presentan valores marcadamente reducidos de VO2pico y VT, y elevada pendiente VE/VCO2. Pacientes ICD han mostrado adaptaciones al entrenamiento incluyendo mejoras en la tolerancia al ejercicio, VO2pico y VT, lo que indica que las terapias que han sido exitosas en insuficiencia cardíaca sistólica podrían tener su papel en ICD

Physical activity on cardiorespiratory fitness and cardiovascular risk in premenopausal and postmenopausal women: a systematic review of randomized controlled trials

Importance: The apparent cardioprotective effects of endogenous estrogens to prevent cardiovascular disease in premenopausal women are reduced with the loss of estrogen post-menopause. Cardiorespiratory fitness and cardiovascular risk factors are closely related to physical activity levels. Objective: This study conducted a critical assessment of studies for health prevention that analyze the effects of physical activity programs on cardiorespiratory fitness and cardiovascular risk factors in women, comparing premenopausal and postmenopausal states, through a systematic review of randomized controlled trials. Evidence review: A computerized literature search was performed to include articles up until December 2021 in the following online databases: PubMed, Cochrane, Scopus, SportDiscus, and Web of Science. Regarding physical activity intervention, women of all ages were engaged. The PEDro scale and Oxford's evidence levels were used for the assessment of the risk of bias in the included articles. Findings: Fourteen scientific articles met the inclusion criteria. Great variability was found in physical activity variables. All the studies found an improvement in at least one variable. The risk of bias was high, with all the articles obtaining a low methodological quality, except two with high methodological quality. Only one article considered the differences in the menopausal state observing the effects of physical activity intervention and highlighting the importance of physical activity in both states. Conclusions and relevance: To strengthen the evidence for the benefits of physical activity programs in women and to observe the effects depending on their menopausal state, there is an ongoing need for more rigorous randomized controlled trials of appropriate length and dose, with individualized exercise intensity

Influence of the Position on the Bicycle on the Frontal Area in Road Cyclists

The aims of the present study were to determine whether the estimations of the frontal area of the combined cyclist-bicycle (APCB) obtained with the Heil’s non-logarithmic prediction equations (NPE) in the stem position (SP), brake hoods position (BHP) and drops position (DP) are comparable to the measured APCB with the computerized planimetry (CP) method, and to analyse with the CPmethod and the NPE the influence of the body position on the APCB. Nineteen participants competing in the Spanish Road Cycling First division took part in the study. The NPE overestimated the APCB in the BHP and in the DP compared with the measured APCB with the CP method (6.9% and 5.1%, respectively; p<0.05). Significant differences among the three positions were obtained with the CP method. The overestimation of the APCB with the NPE in the BHP and in the DP, and the less sensitivity of the NPE to show significant differences between the SP and DP suggest that the NPE are not appropriate to accurately predict the APCB

Tabako-ohitura eta bihotz-biriketako gaitasuna, hipertentsioa, gehiegizko pisua, bizimodu sedentarioa eta ez-aktiboa duten pertsonengan

Tabako-ohiturak gaixotasun kroniko gehienak pairatzeko arriskua areagotu dezakeen ohitura zabaldua da. Haien artean, hipertentsioaren eragilea izan daitekeela behatu da. Horrez gain, jarduera fisikoarekiko (JF) tolerantzian eta bihotz-biriketako funtzioan eragin kaltegarria izan dezake. Izan ere, JF-ak arrisku hauen garapena murriztu ditzake, eta bihotz-birika gaitasunean (BBG) hobekuntzak eragin. Hortaz, ikerketa honen helburua da hipertentsioa, gehiegizko pisua, bizimodu sedentarioak eta ez-aktiboak dituzten pertsonen BBG-an tabako-ohiturak izan ditzakeen eraginak aztertzea eta JF interbentzio ondorengo egokitzapen-ezberdintasunak aztertzea. EXERDIET- HTA ikerkuntzan 222 parte-hartzailek (53,8 ± 7,9 urte) parte hartu zuten. Hamasei asteko ariketa fisiko gainbegiratuarekin interbentzioa egin zitzaien (astean bi egun), bi talde ezberdinetan banatuz erretzaileen taldea (ERT) eta ez-erretzaileen taldea (EERT). Proba guztiak interbentzioaren aurretik eta ondoren errepikatu zitzaien. Interbentzio aurreko taldeen konparaketan, ERT-ak, EERT-rekin konparatuz, gorputzeko masa totalean, gorputz-masa indizean, eta gantz-masan (GM) balioetan altuagoak (p 0,05) behatu. Interbentzioaren amaieran bi taldeek balio guztietan hobekuntza esanguratsuak azaldu zituzten aurre vs. ondoko balioak aztertuz, bai gorputzeko konposizioan, bai BBG-balioetan. Bestalde, ERT-aren eta EERT-aren hobekuntzen aldaketa-deltari dagokionez, GM eta gantz gabeko masan parametroetan ezberdintasun esanguratsuak behatu ziren ERT-an hobekuntza altuagoak (p 0.05) were observed in the CRF variables (peak oxygen consumption and metabolic equivalent). At the end of the intervention, both groups reported significant improvements in body composition and CRF values. On the other hand, concerning the delta change, significant differences were observed in fat mass and fat-free mass parameters with greater improvements observed in SG (p'0.05). Therefore, regardless of smoking (SG vs. NSG), exercise intervention had beneficial effects on CRF in hypertensive, overweight, sedentary, and inactive individuals. The results of this study may help to spread the anti-smoking message of health professionals in society and to disseminate healthier lifestyles

A Metabolically Healthy Profile Is a Transient Stage When Exercise and Diet Are Not Supervised: Long-Term Effects in the EXERDIET-HTA Study

Metabolically unhealthy obesity (MUO) is a regular state in people with primary hypertension (HTN), obesity, and who are physically inactive. To achieve and maintain a metabolically healthy overweight/obese (MHO) state should be a main treatment goal. The aims of the study were (1) to determine differences in metabolic profiles of overweight/obese, physically inactive individuals with HTN following a 16-week (POST) supervised aerobic exercise training (SupExT) intervention with an attentional control (AC) group, and (2) to determine whether the changes observed were maintained following six months (6 M) of unsupervised time. Participants (n = 219) were randomly assigned into AC or SupExT groups. All participants underwent a hypocaloric diet. At POST, all participants received diet and physical activity advice for the following 6 M, with no supervision. All measurements were assessed pre-intervention (PRE), POST, and after 6 M. From PRE to POST, MUO participants became MHO with improved (p < 0.05) total cholesterol (TC, ∆ = −12.1 mg/dL), alanine aminotransferase (∆ = −8.3 U/L), glucose (∆ = −5.5 mg/dL), C-reactive protein (∆ = −1.4 mg/dL), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) compared to unhealthy optimal cut-off values. However, after 6 M, TC, glucose, and SBP returned to unhealthy values (p < 0.05). In a non-physically active population with obesity and HTN, a 16-week SupExT and diet intervention significantly improves cardiometabolic profile from MUO to MHO. However, after 6 M of no supervision, participants returned to MUO. The findings of this study highlight the need for regular, systematic, and supervised diet and exercise programs to avoid subsequent declines in cardiometabolic health.P.C., A.M.A.-B., and I.G.-A. were supported by the Basque Government with predoctoral grants. This study was supported by the University of the Basque Country (EHU14/08, PPGA18/15)

Low-Volume and High-Intensity Aerobic Interval Training May Attenuate Dysfunctional Ventricular Remodeling after Myocardial Infarction: Data from the INTERFARCT Study

Background: Aerobic high-intensity interval training (HIIT) has demonstrated benefits for ventricular remodeling after myocardial infarction (MI) through various mechanisms. Despite this, the optimal training volume is not well known. The present study aimed to assess the effects of different (low vs. high volume) aerobic HIIT compared to an attentional control (AC) group on echocardiographic and biochemical indicators of left ventricular (LV) remodeling in adults after MI. Methods: Randomized clinical trial conducted on post-MI patients with preserved ventricular function. Participants were assigned to three study groups. Two groups performed HIIT 2 d/week, one group with low-volume HIIT (20 min, n = 28) and another with high-volume HIIT (40 min, n = 28). A third group was assigned to AC (n = 24) with recommendations for unsupervised aerobic training. Left ventricular echocardiographic parameters and cardiac biomarker levels (N-terminal pro-b-type natriuretic peptide, NT-proBNP; soluble growth stimulation expressed gene 2, ST2; troponin T; and creatine kinase) were assessed at baseline and after the intervention (16 weeks). Results: Eighty participants (58.4 ± 8.3 yrs, 82.5% male) were included. Both low- and high-volume HIIT showed increases (p < 0.05) in left ventricular end-diastolic diameter (1.2%, 2.6%), and volume (1.1%, 1.3%), respectively. Interventricular septal and posterior walls maintained their thickness (p = 0.36) concerning the AC. Significant (p < 0.05) gain in diastolic function was shown with the improvements in E (–2.1%, –3.3%), e’ waves (2.2%, 5.5%), and the deceleration time (2.1%, 2.9%), and in systolic function with a reduction in global longitudinal strain (–3.2%, –4.7%), respectively. Significant (p < 0.05) reductions of N-terminal pro-B-type natriuretic peptide (NT-proBNP) (–4.8%, –11.1%) and of ST2 (–21.7%, –16.7%)were found in both HIIT groups respectively compared to the AC group. Creatine kinase elevation was shown only in high-volume HIIT (19.3%, p < 0.01). Conclusions: Low-volume HIIT is proposed as a clinically time-efficient and safer strategy to attenuate dysfunctional remodeling by preventing wall thinning and improving LV function in post-MI patients.This study has been carried out receiving funds from the Santiago Apostol Hospital (Miranda de Ebro, Spain) and the Department of Physical Education and Sport, University of the Basque Country (UPV/EHU)

Physical activity, sedentary behavior, and sleep quality in adults with primary hypertension and obesity before and after an aerobic exercise program: Exerdiet-hta study

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Background: The purposes of the study were to: analyze, by objective (accelerometry) and subjective (International Physical Activity Questionnaire, IPAQ) methodologies, the physical activity (PA) and sedentary behavior (SB) in healthy adults (HEALTHY, n = 30) and individuals with primary hypertension (HTN) and overweight/obesity (n = 218); assess the effects of an aerobic exercise intervention on physical activity (PA), sedentary behavior (SB), and sleep quality in the HTN group; and evaluate the relationship between objectively measured and subjectively reported PA and SB. Methods: The measurements were performed before a 16-week exercise intervention period in both HEALTHY and HTN groups and after the intervention period only in the HTN group, randomized to attention control or exercise training (ExT) subgroups. Results: The HEALTHY group showed more moderate-to-vigorous PA (p \u3c 0.05) and better sleep quality (p \u3c 0.05) than the HTN group, but no difference in SB. After the intervention, HTN participants’ PA and SB, objectively measured by accelerometry, were unchanged, but increased PA and decreased SB (p \u3c 0.05) were observed through IPAQ in ExT. The intervention was effective in improving sleep quality in HTN participants. Conclusions: The differences in moderate-to-vigorous PA and SB may be useful in defining the health profile of a population. The supervised aerobic exercise program was effective in increasing PA, reducing SB, and improving sleep quality in overweight/obese adults with HTN. Accelerometer-measured and self-reported data were not comparable, but complementary

Impact on Health-Related Quality of Life after Different Aerobic Exercise Programs in Physically Inactive Adults with Overweight/Obesity and Primary Hypertension: Data from the EXERDIET-HTA Study

Primary hypertension (HTN) and obesity are associated with a worse health-related quality of life (QoL). This research was carried out to analyze the health-related QoL measurements in a physically inactive and obese population with HTN (n = 253) in comparison to a HEALTHY sample (n = 30), to determine the HTN sample changes in QoL following different (high-volume moderate-intensity continuous training, high-volume high-intensity interval training (HIIT), low-volume HIIT) 16-week supervised aerobic exercise training (ExT) programs compared to attention control, and to assess the differences in QoL variables between the different ExT programs. The SF-36 questionnaire was used to assess health-related QoL. At baseline, HTN showed lower scores (p < 0.05) in physical function (88.6 vs. 99.2), general health (63.3 vs. 82.4), vitality (58.2 vs. 68.7), social functioning (88.5 vs. 95.2), and mental health (76.1 vs. 81.8) compared to HEALTHY. Following intervention, all HTN subgroups showed higher (p < 0.05) vitality, but physical functioning and general health significantly improved only in the ExT groups, with even better values in general health for both HIIT subgroups. Only the low-volume HIIT showed positive changes (p < 0.05) in social functioning (∆ = 6.9%) and mental health (∆ = 6.4%) domains after the intervention. These results highlight the important role of supervised exercise in improving physical and psychological health.This study was supported by the University of the Basque Country (EHU14/08, PPGA18/15). MTE was supported by the University of the Basque Country (UPV/EHU). IGA, PC, and AMAB were supported by the Basque Government with predoctoral grants

Physical Activity, Sedentary Behavior, and Sleep Quality in Adults with Primary Hypertension and Obesity before and after an Aerobic Exercise Program: EXERDIET-HTA Study

Background: The purposes of the study were to: analyze, by objective (accelerometry) and subjective (International Physical Activity Questionnaire, IPAQ) methodologies, the physical activity (PA) and sedentary behavior (SB) in healthy adults (HEALTHY, n = 30) and individuals with primary hypertension (HTN) and overweight/obesity (n = 218); assess the effects of an aerobic exercise intervention on physical activity (PA), sedentary behavior (SB), and sleep quality in the HTN group; and evaluate the relationship between objectively measured and subjectively reported PA and SB. Methods: The measurements were performed before a 16-week exercise intervention period in both HEALTHY and HTN groups and after the intervention period only in the HTN group, randomized to attention control or exercise training (ExT) subgroups. Results: The HEALTHY group showed more moderate-to-vigorous PA (p < 0.05) and better sleep quality (p < 0.05) than the HTN group, but no difference in SB. After the intervention, HTN participants’ PA and SB, objectively measured by accelerometry, were unchanged, but increased PA and decreased SB (p < 0.05) were observed through IPAQ in ExT. The intervention was effective in improving sleep quality in HTN participants. Conclusions: The differences in moderate-to-vigorous PA and SB may be useful in defining the health profile of a population. The supervised aerobic exercise program was effective in increasing PA, reducing SB, and improving sleep quality in overweight/obese adults with HTN. Accelerometer-measured and self-reported data were not comparable, but complementary.A.M.A.-B., P.C. and I.G.-A. were supported by the Basque Government with predoctoral grants. This study was supported by the University of the Basque Country (EHU14/08, PPGA18/15)