bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of home-based prehabilitation on objectively measured physical activity in patients undergoing elective major cardiac and non-cardiac surgery. Data from a randomized controlled trial
Authors: Vetsch T , Engel D , Beilstein C M , Wuethrich P Y , Eser P , Wilhelm M 
Published: June 2024

Abstract

Background
Low functional capacity in patients undergoing major elective surgery is associated with postoperative complications. Prehabilitation aims to increase functional capacity by increasing preoperative physical activity. Low functional capacity in patients eligible for major surgery is associated with high age and comorbid burden. In this population, center-based prehabilitation is a barrier for participation. Therefore, we developed a multimodal home-based prehabilitation intervention. Data regarding the effectiveness of a home-based prehabilitation intervention to increase physical activity before surgery is limited. We hypothesize that home-based prehabilitation leads to an increase in physical activity in patients undergoing major cardiac and non-cardiac surgery.

Methods
We included patients aged over 65 with a proven low functional capacity and/or ventilatory efficiency measured by preoperative cardiopulmonary exercise testing. Patients were randomized to either standard of care or intervention. The intervention group received a home-based prehabilitation intervention 2-4 weeks before surgery. As part of the multimodal intervention, patients were prescribed a walking regimen according to the physical activity guidelines published by the World Health Organization (WHO). Patients were followed-up with weekly telephone calls by a physiotherapist to increase adherence and motivation. All patients were provided a wrist-worn tri-axial accelerometer at the baseline visit. The accelerometer was collected at the ward once the patient entered the hospital for surgery. Physical activity was estimated by calculating the average Euclidean norm minus one (ENMO, milligravity [mg]) per day. Baseline characteristics were tested by Wilcoxon rank-sum test and a linear model for the primary outcome was performed to adjust for confounders. Data analysis was performed using R Studio.

Results
37 patients scheduled for cardiac and 62 for non-cardiac surgery were included (Table 1).
Mean group difference of daily physical activity levels in non-cardiac surgery patients was 3.01 mg (p = 0.03, 95% CI [0.3, 5.6]). Mean group difference of daily physical activity levels in cardiac surgery patients was 0.27 mg (p = 0.95, 95% CI [-4.1, 5.0]) (Figure 1). Patients undergoing cardiac surgery had higher overall activity levels compared to non-cardiac also when adjusted for age.

Conclusion
Home-based prehabilitation increases preoperative physical activity levels in patients undergoing major non-cardiac surgery, but not in patients undergoing major cardiac surgery. Higher activity levels in cardiac surgery patients was unexpected, but may be explained by previous inclusion of patients with cardiac diseases in exercise-based rehabilitation and physical activity recommendations at routine cardiac follow-up visits. Table 1 Figure 1
Effect of exercise training on cardiac reserve in heart failure with preserved ejection fraction: a substudy from OptimEx-CLIN
Authors: Gevaert A B , Winzer E B , Mueller S , De Schutter S , Beckers P J , Hommel J , Linke A , Wisloff U , Adams V , Pieske B , Halle M , Van Craenenbroeck E M , Van De Heyning C M 
Published: June 2024

Abstract

Aims
Supervised exercise training improves aerobic capacity (V̇O2peak) in patients with heart failure and preserved ejection fraction (HFpEF), but underlying mechanisms remain unclear. We aimed to evaluate whether exercise training could improve parameters of systolic and diastolic function assessed during exercise echocardiography.

Methods
This was a substudy of the multicentre Optimizing Exercise Training in HFpEF (OptimEx-Clin) trial, in which patients with HFpEF were randomized 1:1:1 to guideline control, moderate continuous training, or high intensity interval training. All patients included at 2 centres had exercise echocardiography at baseline and 3 months and were included (n=61).

Results
During baseline exercise echocardiography, E/e’ increased to 19.5 ±6.1 and systolic pulmonary artery pressure (PAPs) to 51 ±11 mmHg (both p&lt;.001). Right ventricular function failed to improve (maximal tricuspid annular plane systolic excursion [TAPSE] 24.7 ±4.0 mm, p=.051 vs baseline; maximal TAPSE/PAPs 0.49 ±0.14 mm/mmHg, p&lt;.001 for decrease vs baseline).
At 3 months, patients randomized to exercise training improved V̇O2peak, and demonstrated small but significant improvements in exercise E/e’ (control 21.7 ± 7.4, training 17.2 ±4.1, p-interaction=.044, Figure) and septal S’ reserve (control 27 ±22 % increase, training 36 ±38 % increase, p-interaction=.034). Echocardiographic changes were not significantly associated with V̇O2peak or training response.

Conclusions
In patients with HFpEF, exercise echocardiography reveals increases in filling pressures during exercise as well as impaired right ventricular reserve. After 3 months of exercise training, HFpEF patients demonstrate small improvements in diastolic reserve (exercise E/e’) and systolic reserve (exercise S’), but these do not explain the improved aerobic capacity. Figure
Long-term exercise program in cardiovascular patients: the impact on quality of life
Authors: Gregorio C , Cravo J , Abrantes A , Martins A M , Garcia A B , Azaredo Raposo M , Bartolo P , Pinto R , Borges M , Lemos Pires M , Sa G , Cunha N , Aguiar-Ricardo I , Pinto F J , Abreu A 
Published: June 2024

Abstract

Introduction
The benefits of Phase 2 cardiac rehabilitation is well-established in terms of improving functional capacity, quality of life, and even prognosis. The impact of a long-term exercise program is less established.

Purpose
To assess the impact of a maintenance exercise program after Phase 2 of cardiac rehabilitation on quality of life.

Methods
A single-center cohort study was conducted, involving patients (pts) who completed a phase 2 CR program at least 6 months prior to the study and answered the 36-Item Short Form Survey (SF-36) telephonically. The participants were categorized into 2 groups based on their progression to phase 3 programs: Group 1, comprising those who continued exercising in a specialized cardiac rehabilitation center or local gym, and Group 2, encompassing those engaging in any form of exercise. Scores were assigned to eight health domains, and overall scores were compared between the two groups.

Results
A total of 110 pts were included (78% male; mean age of 61.5 ± 11 years). They were initially referred for ischemic heart disease (86%). Regarding clinical data, 59% had hypertension, 10% were diabetic, 79% had dyslipidemia and 20% were smokers. Regarding progression to Phase 3 of CR, 51% of pts maintained physical exercise (group 1).
When analyzing each of the eight domains of health, the group 1 had a higher overall score on the following domains: functional capacity (90±14 vs 85±25, p=0.014); bodily pain (100±0 vs 100±25), p=0.026); vitality (68±15 vs 61±16, p=0.021) and mental health (88±12 vs 80±20, p=0.013). Additionally, we noted a tendency for higher scores in the remaining domains, although not statistically significant.
Subgroup analysis of ischemic pts showed similar results in functional capacity (p=0.017), bodily pain (p=0.009) and vitality (p=0.025). These results were independent of gender and body mass index.

Conclusion
Our study highlights the importance of maintaining a physical exercise program after phase 2 of cardiac rehabilitation in terms of quality of life, particularly in domains crucial to daily functioning and mental well-being.
Predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization
Authors: Tiksnadi B B , Marita I , Najiyah H H , Astuti A W , Sastradimaja S B 
Published: June 2024

Abstract

Background
Functional capacity improvement becomes a target therapy after cardiac rehabilitation (CR) program that may improve outcome beyond the quality of life. We aimed to assess the predictors of functional capacity improvement after CR program following coronary revascularization.

Methods
This was a retrospective cohort study included all revascularized CAD patients who underwent CR program phase II, 4-8 weeks (twice weekly), 6–12 sessions, moderate intensity aerobic exercises (ergocycle and/or treadmill) from January 2019–July 2023 in a tertiary hospital. The patient's functional capacity (METs) calculated at maximal stress test prior and after the program. Univariate and multivariate analysis was performed using chi-square and logistic regression analysis, respectively.

Results
A total of 377 patients enrolled, 132 patients completed CR program, 103 patients with complete data [mean age was 56.5±9.4, and 91.2% men] were included in this study. The mean METs prior and after procedure were 9.2±2.6 and 10.05±2.6, respectively. The mean improvement was 0.87±1.95. Of 103 participants, METs was improved in 80 patients (77,6%). Univariate analysis revealed that completeness of exercise program (80.58%), hypertension (40.77%), diabetes mellitus (DM) (31.06%), were significantly associated with METS improvement, while obesity (31.06%) and HFrEF(19.4%) had inversely associated. Other variables including age, sex, smoking, depression, and type of revascularization were not substantially linked. Multivariate analysis showed obesity [OR=0.261 (CI=0.081–0.841) ;p-value=0.024], completeness of exercise program [OR=5.223 (CI=1.472–18.53) ;p-value=0,011], DM [OR=4.98 (CI=1.13–21.90) ;p-value=0,033] and HFrEF [OR=0.234 (CI=0.063–0.87) ;p-value=0,03] were substantially linked with METS improvement.

Conclusion
Completeness of exercise program, obesity, DM and HFrEF were an independent predictors of functional capacity improvement after cardiac rehabilitation following coronary artery revascularization. Baseline Characteristics. Univariate and multivariate analysis.
Is cardiac rehabilitation useful in our older population?
Authors: Iglesias Colino E , Merchan Gomez S , De Tapia Majado B , Martin Herrero F , Oterino Manzanas A , Velasco Canedo M , Oreja Sanchez C , Gonzalez Abarquero E , Olazar Pardeiro M A , Braccho D , Sanchez Fernandez P L 
Published: June 2024

Abstract

Introduction
Cardiac rehabilitation programs (CRP) are recommended in patients with heart failure and ischemic heart disease with a class I indication. Nevertheless, we know only one third of these patients undertake them, mainly because it’s a limited resource and not available in all centers. In some centers, for this reason, it’s limited to younger patients, in which we could expect a greater benefit. Moreover, older age has been identified as an obstacle for patients to attend these programs.

Purpose
To compare the results of the senior patients (defined as 70 years old or older) in our center to our general results.

Methods
A retrospective analysis of our patients before and after cardiac rehabilitation program was made comparing both groups using SPSS Statistics v23.

Results
Both groups had similar characteristics before the program, except for active smoking, which was significantly more frequent in patients younger than 70, and arterial hypertension which was more frequent in patients over 70.
Several parameters were analyzed in our population before and after CRP in all patients, and in our patients aged 70 or older.
In the first analysis, significant differences were obtained in overweight, glycemic and lipid control, NTproBNP reduction and LVEF. Moreover, the was a significant improvement in functional capacity, quality of life (measured by SF-36 scale) and anxiety.
When analyzing only our senior patients, we observed improvement in most of anthropometric, functional and quality of live parameters, and lab results, even though, probably due to a lower sample, these were only significant in BMI, HbA1c, LDL, NTproBNP, LVEF, functional capacity and quality of life measured by SF-36.

Conclusions
CRP improves clinical, analytical, and functional parameters, and is clearly beneficial in patients of 70 years or more. Therefore, they should be offered to perform it with the same indications as younger patients. Unfortunately, these patients’ assistance is also limited by usually further from hospital residence (rural population) and a frequent caregiver role and might need a higher support in order to assure their enrollment in these programs.
Exercise-based cardiac rehabilitation for patients with atrial fibrillation receiving catheter ablation: associations with long-term clinical outcomes
Authors: Fitzhugh C , Jones H , Foweather L , Lip G Y H , Buckley B J R 
Published: June 2024

Abstract

Background
Catheter ablation is an effective treatment for symptomatic atrial fibrillation (AF) and has superiority over drug treatments. Emerging evidence suggests that exercise-based cardiac rehabilitation (ExCR) can improve the health outcomes of people with AF, but the long-term impact of ExCR on clinical endpoints for patients with AF following catheter ablation is unclear. We investigated 12-month all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction in patients with AF receiving catheter ablation and ExCR versus matched controls receiving catheter ablation only.

Methods and Results
A propensity-matched cohort study was conducted using electronic medical records from a global federated health research network. Patients with AF who received catheter ablation and ExCR were propensity-score matched for age, sex, ethnicity, comorbidities, cardiovascular procedures, and cardiovascular medication with patients with AF who received catheter ablation only.
Using logistic regression, 12-month incidence of all-cause mortality, hospitalisation, ischaemic stroke, and myocardial infarction were compared. In 6510 AF patients (mean age 66, SD; 11, 26.3% female) who had received catheter ablation, ExCR was associated with lower all-cause mortality (OR 0.73; 95% CI, 0.59-0.92) and hospitalisations (OR 0.77; 95% CI, 0.69-0.85) when compared with propensity-score matched controls. No significant associations were shown for ischaemic stroke (OR 0.88; 95% CI, 0.62-1.25) or myocardial infarction (OR 0.89; 95% CI, 0.67-1.20). Secondary analysis of AF progression from paroxysmal to sustained AF at 12-month follow-up demonstrated proportionally lower AF progression with 10% in the ExCR cohort compared to 15% in the catheter ablation cohort (OR 0.62, 95% CI: 0.56- 0.68).

Conclusions
ExCR in patients with AF who received catheter ablation associated with lower all-cause mortality and hospitalisation at 12-month follow-up compared to those who received catheter ablation alone, as well as less AF progression from paroxysmal to sustained AF at 12-month follow-up.
Direct measurement of peak oxygen uptake in cardiopulmonary exercise testing as a survival predictor in octogenarians
Authors: Braga F , Milani M , Fachetti A , Espinosa G , Moraes G , Milani J G P O , Mourilhe-Rocha R 
Published: June 2024

Abstract

Background
The direct measurement of peak oxygen uptake (VO2peak) through cardiopulmonary exercise testing (CPET) serves as the gold standard for assessing cardiorespiratory fitness. This measurement is a firmly established indicator of health and holds substantial prognostic value concerning all-cause mortality in both populations with and without cardiovascular diseases. However, due to the scarcity of older individuals in studies employing CPET, its significance in this phase of life is less explored. Existing data on octogenarians primarily relies on the indirect measurement of VO2peak through the estimation of peak metabolic equivalents achieved (MET). It is worth noting that indirect estimation is generally less precise compared to direct measurement through CPET. This gap raises questions about the enduring validity of VO2peak as a robust predictor of mortality and morbidity in this specific demographic, akin to its predictive efficacy among younger individuals.

Purpose
To analyse the role of VO2peak as a predictor of survival in octogenarians.

Methods
Patients aged 80 years or older who underwent CPET assessment at a single centre from Brazil were included in this study. The variable VO2peak was determined as the highest 30-second average sample obtained during the final minute of the effort. The measured value was subsequently compared to predicted values by the Wasserman algorithm to calculate the percent-predicted VO2peak achieved (%VO2peak). The optimal cut-off point for the %VO2peak was determined by receiver operating characteristic (ROC) curve analysis, and this value was used as a cut-off to categorise individuals with %VO2peak higher or lower. Then, Cox regression models were employed to evaluate this dichotomisation to predict survival outcomes.

Results
Among 188 patients assessed, 22 (11.7%) died during the median follow-up of 494 days, with non-survivors being older, having lower VO2peak, and lower %VO2peak (Figure 1). Figure 2A illustrates the ROC curve for mortality prediction by %VO2peak. The area under the ROC curve was 0.699 (95% CI: 0.627 to 0.764; p &lt; 0.001), and the optimal cut-off point was determined to be %pVO2 ≤ 80%. Cox regression models indicated associations between %VO2peak ≤ 80% and mortality: HR=3.19 (95% CI: 1.30 to 7.86, p=0.011) for the unadjusted model (Figure 2B); and HR=3.124 (95% CI: 1.26 to 7.74, p=0.013) for the model with inclusion of age as a covariate to evaluate the impact of %VO2peak while accounting for age-related effects.

Conclusion
Amidst the backdrop of a rapidly aging population, our study highlights the enduring significance of VO2peak as a survival predictor among the elderly. These findings hold profound implications for tailoring healthcare strategies to address the evolving demographic landscape.
Revisiting the peak breathing reserve &lt; 15% criterion to indicate ventilatory limitation to treadmill incremental cardiopulmonary exercise testing in men and women aged 20 to 80 years
Authors: Milani M , Milani J G P O M , Machado F V C , Cipriano G F B , Neder J A , Hansen D , Cipriano G 
Published: June 2024

Abstract

Background
The respiratory system is not the limiting step to humans’ tolerance to dynamic exercise in most physiological circumstances. For instance, minute ventilation at peak exercise (VEpeak) is appreciably lower than the maximal sustained ventilatory capacity (MSVC). Using the estimated (from forced expiratory volume in one second (FEV1)) maximal voluntary ventilation (MVVest) as a surrogate of the MSVC, a peak breathing reserve (BRpeak= [1-(VEpeak /MVVest)] x 100) &gt; 15% has been widely recommended as the decision node to rule out ventilatory limitation. Supportive evidence for this contention, however, stems from small samples tested on a cycle ergometer, an exercise modality associated with lower ventilatory demands than those elicited by treadmill - the commonest ergometer in cardiology.

Purpose
To determine the prevalence of ventilatory limitation to treadmill incremental cardiopulmonary exercise testing (CPET) based on BRpeak≤15% in a large sample of apparently healthy men and women showing a large age span.

Methods
We retrospectively analyzed treadmill CPET data from 3,544 apparently healthy individuals aged 20 to 80 years living in Midwest Brazil. As recommended by current guidelines(1-2), we multiplied FEV1 by 35 or 40. We established the prevalence of BRpeak≤15% in subjects stratified by sex and age (20-39, 40-59, and 60-80 years). Anticipating a high prevalence of low BRpeak using 35 or 40, we aimed to establish which coefficient should be used to multiplying FEV1 to decrease the prevalence of ventilatory limitation to ≤5% and ≤1% in each sex.

Results
BRpeak≤15% was found in 21.7% of women and 48.0% of men when FEV1 was multiplied by 35: corresponding values were 5.8% and 17.4% when the multiplying coefficient was 40, respectively (Figure 1). Regardless of sex, particularly high prevalence of BRpeak≤15% was found in the middle-aged group (Figure 2). Using 40.5 to multiply FEV1 in women and 45 in men resulted in ≤5% prevalence of ventilatory limitation. Further discriminative power (≤1% of BRpeak≤15%) required coefficients as high as 45 and 49 for women and men, respectively (Figure 2).

Conclusion
To avoid unacceptable high false positive rates for ventilatory limitation to incremental CPET on a treadmill (BRpeak≤15%), pre-exercise FEV1 should be multiplied by higher coefficients than those commonly recommended for cycle ergometer-based tests. This is particularly critical for men who reach high exercise intensities. Ever if appropriate coefficients are employed, BRpeak should be used with caution as the sole criterion to rule in or out a contribution of "the lungs" to exercise limitation in individual subjects(3).
Does peak exercise capacity correlate with aortic stiffness and atrial strain in children with Fontan circulation? - A case-control study
Authors: Tekerlek H , Saglam M , Selcuk S N , Aykan H H , Vardar-Yagli N , Karagoz T 
Published: June 2024

Abstract

Background/Introduction
It is well known that exercise capacity is reduced in Fontan patients. However, more information is needed on exercise capacity, atrial strain, and aortic stiffness in children with Fontan circulation compared to controls and on the relationship of aortic stiffness and atrial strain with exercise capacity.

Purpose
It was aimed to compare peak exercise capacity, aortic stiffness, and atrial strain with controls and to investigate the relationship between peak exercise capacity and aortic stiffness and atrial strain in children with Fontan circulation.

Methods
Demographic and clinical characteristics were recorded. Peak oxygen consumption (VO2peak) was measured using cardiopulmonary exercise test (CPET) with modified Bruce protocol on a treadmill and recorded as ml/min, ml/min/kg, %pred values according to Wasserman’s equations. Atrial strain with speckle tracking echocardiography (STE) and aortic stiffnes with pulse wave velocity (PWV) were assessed using Philips Healthcare EPIQ CVx. The dominant atrium strain was recorded for reservoir phase (εres), conduit phase (εcon), and contractile phase (εact) were recorded as %. Aortic pulse wave velocity (PWV) recorded as m/sec.

Results
Fifteen children with Fontan circulation (median= 12 years, 6 female) and 14 controls (median=12 years, 5 female) were included. VO2peak, εres, and εcon were lower; aortic PWV were higher in patients compared to controls (p&lt;0.05) (Table 1). VO2peak significantly associated with aortic PWV, εres, εcon, and εact in children with Fontan circulation (p&gt;0.05) (Table 2).

Conclusions
Decreased exercise capacity, increased aortic stiffness, and the impaired atrial strain was found in children with Fontan circulation compared to controls in this study.Furthermore, decreased exercise capacity associated with increased aortic stiffness and impaired atrial strain. Further studies with the increased number of participants can provide new insights into determinants of exercise intolerance in children with Fontan circulation.