Author Archives: Paul Older

The XIX (if you count Spain!) European Practicum held in Milan, Italy
October 26th – 29th 2016

The Practicum was very well attended and run in its entirety at Centro Cardiologico Monzino. This is a Hospital devoted entirely to patients with heart disease whether that be medical or surgical.
Milan is a large very old city with a host of exciting antiquities including the magnificent Cathedral and Castle. Professor Agostoni also found some very exciting and different restaurants.
The programme was the traditional European Practicum format with three days of lectures, tutorials and practical laboratory sessions. Several major players in the cardiopulmonary industry were represented; these included Carefusion, Cortex, Cosmed, Schiller and Geratherm.
The physiology lectures were given by Professor Susan Ward and despite having taken an interest in physiology over many years, I learn new information at every Practicum. It was very good to see that the lectures kept pace with current issues such as neoadjuvant therapy and the MECKI score.
An innovation this year was the introduction of three prizes to the best research papers presented to the Research session on the Saturday morning. The Board had decided to award each of the best three presenters a prize of US$1,500. The winners were, in no particular order, Stefania Paolillo, Felix Gerhardt and Roberto Badagliacca. It is hoped that these awards will be awarded each year.
It is gratifying to see registrants from so many countries and I noted the presence of registrants from mainland China.

Milan2016GroupPhoto

Not a good photo. Many of our registrants were in the shade!!

Effects of high-intensity interval training on central haemodynamics and skeletal muscle oxygenation during exercise in patients with chronic heart failure

Spee, Ruud F; Niemeijer, Victor M; Wijn,
Pieter F; Doevendans, Pieter A; Kemps, Hareld M.

European Journal of Preventive Cardiology, December 2016, Vol. 23 Issue: Number 18
p1943-1952, 10p

Abstract: Background
High-intensity interval training
(HIT) improves exercise capacity in patients with chronic heart failure
(CHF). Moreover, HIT was associated with improved resting cardiac
function. However, the extent to which these improvements actually
contribute to training-induced changes in exercise capacity remains to
be elucidated. Therefore, we evaluated the effects of HIT on exercising
central haemodynamics and skeletal muscle oxygenation.Methods
Twenty-six CHF patients were randomised to a 12-week 4 × 4 minute HIT
program at 85–95% of peak VO2or usual care. Patients performed maximal
and submaximal cardiopulmonary exercise testing with simultaneous
assessment of cardiac output and skeletal muscle oxygenation by near
infrared spectroscopy, using the amplitude of the tissue saturation
index (TSIamp).

Results  Peak workload increased by 11% after HIT
(pbetween group = 0.01) with a non-significant increase in peak
VO2(+7%, pbetween group = 0.19). Cardiac reserve increased by 37% after
HIT (p within group = 0.03, pbetween group = 0.08); this increase was
not related to improvements in peak workload. Oxygen uptake recovery
kinetics after submaximal exercise were accelerated by 20% (pbetween
group = 0.02); this improvement was related to a decrease in TSIamp
(r= 0.71, p= 0.03), but not to changes in cardiac output
kinetics.

Conclusion  HIT induced improvements in maximal exercise
capacity and exercising haemodynamics at peak exercise. Improvements in
recovery after submaximal exercise were associated with attenuated
skeletal muscle deoxygenation during submaximal exercise, but not with
changes in cardiac output kinetics, suggesting that the effect of HIT
on submaximal exercise capacity is mediated by improved microvascular
oxygen delivery-to-utilisation matching.; (AN 40419387)

Annual General Meeting

The Annual General Meeting
This will be held on Thursday 27th October 2016
at the Centro Cardiologico Monzino, Milan at 1 pm.
This will be followed by the Board Meeting.

Agenda.
1) Presidents Report
2) Executive Directors Report
3) The Abstract system
4) Any other business

Systematic review: pre‐ and post‐operative prognostic value of cardiopulmonary exercise testing in liver transplant candidates

Ney,  M.; Haykowsky, M. J.; Vandermeer, B.; Shah, A.; Ow, M.; Tandon, P..
Alimentary Pharmacology & Therapeutics, October 2016, Vol. 44 Issue:
Number 8 p796-806, 11p;

Abstract: Cardiopulmonary exercise testing
(CPET) is the gold standard for the objective assessment of functional
status. In many conditions, CPET outperforms the traditional variables
in predicting mortality. In patients with cirrhosis listed for liver
transplantation, our primary aim was to determine the prognostic value
of CPET for pre‐and post‐transplant mortality and, in particular,
whether CPET remained predictive after adjustment for liver disease
severity. A systematic literature review was conducted in databases
Medline, Scopus, Embase and PubMed. Where possible, data were pooled
for meta‐analyses using a DerSimonian and Laird random effects model. A
total of seven studies were retrieved, including 1107 patients with a
mean MELD of 14.2 (standard deviation 1.6) and peak baseline VO2of 17.4
mL/kg/min. In all of the studies in which multivariable analysis was
performed, CPET variables were independent predictors of pre‐transplant
mortality (three studies) and post‐transplant mortality (four studies).
In the three studies where we could aggregate post‐transplant mortality
data, post‐transplant mortality was predicted by AT with a mean
difference of 2.0 (95% confidence interval, CI: 0.42–3.59; Z= 2.48, P=
0.01) between survivors and nonsurvivors. The peak VO2was not
significant (0.77 95% CI: −1.36 to 2.90; Z= 0.71, P= 0.48). Patient’s
listed for liver transplant have significant functional limitations,
with a weighted mean VO2 below the threshold level required for
independent living. Although heterogeneity in study designs with
respect to timing, CPET variables, and cut‐off values precluded the
determination of CPET mortality thresholds, the studies support CPET as
an objective and independent predictor of pre‐ and post‐transplant
mortality.

Potential Effects on Cardiorespiratory and Metabolic Status After a Concurrent Strength and Endurance Training Program in Diabetes Patients — a Randomized Controlled TrialPotential Effects on Cardiorespiratory and Metabolic Status After a Concurrent Strength and Endurance Training Program in Diabetes Patients — a Randomized Controlled Trial

Bassi, Daniela; Mendes, Renata; Arakelian, Vivian; Caruso, Flávia; Cabiddu, Ramona; Júnior, José;
Arena, Ross; Borghi-Silva, Audrey.

Sports Medicine – Open, December 2016, Vol. 2 Issue: Number 1 p1-13, 13p;

Abstract: Concurrent aerobic and resistance training (CART) programs have been widely recommended as
an important strategy to improve physiologic and functional performance
in patients with chronic diseases. However, the impact of a
personalized CART program in patients with type 2 diabetes (T2D)
requires investigation. Therefore, the primary aim of the current study
is to investigate the impact of CART programs on metabolic profile,
glycemic control, and exercise capacity in patients with diabetes.
We evaluated 41 subjects with T2D (15 females and 19
males, 50.8 ± 7 years); subjects were randomized into two groups;
sedentary (SG) and CART (CART-G). CART was performed over 1.10-h
sessions (30-min aerobic and 30-min resistance exercises) three
times/week for 12 weeks. Body composition, biochemical analyses,
peripheral muscular strength, and cardiopulmonary exercise testing were
primary measurements.                   The glycated hemoglobin HbA1c
(65.4 ± 17.9 to 55.9 ± 12.7 mmol/mol), cholesterol (198.38.1 ± 50.3 to
186.8 ± 35.1 mg/dl), and homeostasis model assessment insulin
resistance (HOMA-IR) (6.4 ± 6.8 to 5.0 ± 1.4) decreased in the CART-G
compared to the SG. Although body weight did not significantly change
after training, skinfold measurement indicated decreased body fat in
the CART-G only. CART significantly enhanced muscle strength compared
to the SG (p< 0.05). CART was also associated with significant increase
in peak oxygen uptake and maximal workload compared to the SG
(p< 0.05).                   These data support CART as an important
strategy in the treatment of patients with T2D, producing both
physiologic and functional improvements.

FACTORS AFFECTING THE COMPONENTS OF THE ALVEOLAR C02 OUTPUT-02 UPTAKE RELATIONSHIP DURING INCREMENTAL EXERCISE IN MAN [1991!!]

CHRISTOPHER B. COOPER, WILLIAM L. BEAVER, DAN M. COOPER
AND KARLMAN WASSERMAN
Experimental Physiology (1992), 77, 51-64

The V VO (alveolar CO2 output-alveolar 02 uptake) relationship ( V-slope) during increasing
work rate (r-amp) cycle ergometer exercise has two approximately linear components: a lower
component slope (S,) with a value of about 0-95 and a steeper, upper component (S2). We
examined the effect of muscle glycogen depletion (protocol 1) and the rate of increase in work
rate (ramp rate) without muscle glycogen depletion (protocol 2) on S1 and S2. In protocol 1,
ten healthy men with a mean age of 31 4 years (S.D. 6-2) were studied on each of 3 days (days
I and 3 were control days). They performed a ramp exercise test to maximum tolerance and
steady-state tests at rest, during unloaded pedalling and at two constant work rates below their
anaerobic threshold (AT). To deplete muscle glycogen before the test on day 2, the subjects
performed 2 h of very heavy cycle exercise on the preceding day and fasted overnight. Si was
reduced on day 2 (0 79 compared with 0 95, P < 0 001), as was the VC0 -VO slope derived
from steady-state measurements (0 81 compared with 0 99, P < 0 001), but AT and the slope
difference (S2 -S5) were unchanged. In protocol 2, seven healthy men with a mean age of 20 6
years (S.D. 2-4) performed ramp tests at three different rates of increasing work rate (1 5, 30 and
60 W min’), each ramp rate being performed twice in random sequence. The ramp rate did not
affect Si but S2 was steeper with the faster rates of work rate increase (127, 143 and 163,
respectively, P < 0 01). Our findings support the concept that the lower component of the Vslope
plot (below AT) represents muscle substrate respiratory quotient (RQ) while the
difference between Si and S2 reflects ‘excess CO2’ derived from bicarbonate buffering of lactic
acid.

FACTORS AFFECTING THE COMPONENTS OF THE ALVEOLAR C02 OUTPUT-02 UPTAKE RELATIONSHIP DURING INCREMENTAL EXERCISE IN MAN [1991!!]

CHRISTOPHER B. COOPER, WILLIAM L. BEAVER, DAN M. COOPER
AND KARLMAN WASSERMAN

The V VO (alveolar CO2 output-alveolar 02 uptake) relationship ( V-slope) during increasing
work rate (r-amp) cycle ergometer exercise has two approximately linear components: a lower
component slope (S,) with a value of about 0-95 and a steeper, upper component (S2). We
examined the effect of muscle glycogen depletion (protocol 1) and the rate of increase in work
rate (ramp rate) without muscle glycogen depletion (protocol 2) on S1 and S2. In protocol 1,
ten healthy men with a mean age of 31 4 years (S.D. 6-2) were studied on each of 3 days (days
I and 3 were control days). They performed a ramp exercise test to maximum tolerance and
steady-state tests at rest, during unloaded pedalling and at two constant work rates below their
anaerobic threshold (AT). To deplete muscle glycogen before the test on day 2, the subjects
performed 2 h of very heavy cycle exercise on the preceding day and fasted overnight. Si was
reduced on day 2 (0 79 compared with 0 95, P < 0 001), as was the VC0 -VO slope derived
from steady-state measurements (0 81 compared with 0 99, P < 0 001), but AT and the slope
difference (S2 -S5) were unchanged. In protocol 2, seven healthy men with a mean age of 20 6
years (S.D. 2-4) performed ramp tests at three different rates of increasing work rate (1 5, 30 and
60 W min’), each ramp rate being performed twice in random sequence. The ramp rate did not
affect Si but S2 was steeper with the faster rates of work rate increase (127, 143 and 163,
respectively, P < 0 01). Our findings support the concept that the lower component of the Vslope
plot (below AT) represents muscle substrate respiratory quotient (RQ) while the
difference between Si and S2 reflects ‘excess CO2’ derived from bicarbonate buffering of lactic acid.

Influence of increased metabolic rate on [ 13C] bicarbonate washout kinetics

BARSTOW, THOMAS J., DAN M. COOPER, ERIC M. SOBEL,
ELLIOT M. LANDAW, AND SAM EPSTEIN.

Am. J. Phvsiol. 259 (Regulatory Integrative Comp. Physiol. 28): Rl63-
Rl?l, 1990.-

The effect of changes in metabolic rate on the
dynamics of CO, exchange among its various compartments in
the human body is not well understood. We examined COz
dynamics in six healthy male subjects using an intravenous
bolus of [ “‘Clbicarbonate. Subjects were studied while resting,
during light exercise [50% of the lactate threshold (LT), 3-4
times resting 0, uptake (VOW)], and during moderate exercise
(95% of the LT, 6 times resting VO,). The sum of three
exponential terms well described the washout of 1’3C02 in exhaled
breath both at rest and during each exercise level despite
substantial increases in metabolic rate accompanying the exercise
studies. Average recovery of “‘C label rose from 67%
during rest to 80% during light and moderate exercise (P <
0.01). The estimate of CO, elimination (ho2) calculated from
the washout parameters and corrected for recovery was in very
good agreement with the VCO~ directly measured simultaneously
breath by breath (r = 0.993, SE for VCO~ = 0.079 l/min).
By use of a three-compartment mammillary model, the quantity
of CO, in the central pool (Q1) doubled from rest to light
exercise (233 & 60 to 479 t 76 mmol, P < 0.01) but did not
change further with moderate exercise (458 & 74 mmol). Rate
constants for exchange between pools and for irreversible loss
from the system tended to increase with metabolic rate, but
there was large variation in the responses. We conclude that
the compartmental dynamics of CO, transport and storage are
very sensitive to changes in metabolic rate induced by exercise.