Kato, Yuko;
Suzuki, Shinya; Uejima, Tokuhisa; Semba, Hiroaki; Nagayama, Osamu;
Hayama, Etsuko; Yamashita, Takeshi.

European Journal of Preventive
Cardiology, September 2016, Vol. 23 Issue: Number 13 p1429-1436, 8p;

Abstract: Background  Resting heart rate is a surrogate marker
associated with achieved exercise capacity, which has been observed in
patients with sinus rhythm. The aim of this study was to examine and
compare the relationships between resting heart rate and peak oxygen
consumption in atrial fibrillation and sinus rhythm.Methods and results
A total of 2160 consecutive patients undergoing cardiopulmonary
exercise testing in our single-hospital cohort were divided into two
groups according to rhythm status: an atrial fibrillation group
(N= 320) and a sinus rhythm group (N= 1840). In the total cohort and
sinus rhythm group, resting heart rate was negatively correlated with
percentage of predicted peak oxygen consumption (Ptrend< 0.0001); in
atrial fibrillation patients, this correlation was apparently positive
(Ptrend= 0.032). Multivariate analysis of the total cohort showed a
significant interaction between resting heart rate and rhythm status
for peak oxygen consumption after adjustments for age, sex, ejection
fraction, structural heart diseases and heart rate-lowering drugs. In
the sinus rhythm group, resting heart rate was an independent, negative
contributing factor for peak oxygen consumption, even after the
adjustments for patient background. However, in the atrial fibrillation
group, resting heart rate was a weak positive or non-independent
contributing factor for peak oxygen consumption after the same
adjustments.Conclusions  The impact of resting heart rate on exercise
capacity differed completely between atrial fibrillation and sinus
rhythm, suggesting that heart rate control may need to be managed
differently for atrial fibrillation and sinus rhythm, in light of
exercise capacity that is related to quality of life and prognosis.

Müller, Jan; Meyer, Joanna; Elmenhorst, Julia;
Oberhoffer, Renate.

The Journal of Clinical Hypertension, August 2016,
Vol. 18 Issue: Number 8 p762-765, 4p;

Abstract: Cardiopulmonary fitness
benefits cardiovascular health. Various studies have shown a strong
negative correlation between exercise capacity and arterial stiffness
in adults. However, evidence for this connection in children and
adolescents is scarce. About 320 healthy children and adolescents (252
male, 14.0±2.1 years) were evaluated with regard to their demographic,
anthropometric and hemodynamic parameters, and their peak oxygen
uptake. Peripheral and central systolic blood pressures were measured
with patients in a supine position using an oscillometric device. Peak
oxygen uptake was assessed by cardiopulmonary exercise testing. In
multivariate regression, only peripheral systolic blood pressure
(β=0.653, P<.001) and body weight (β=0.284, P<.001) emerged as
independent determinants for central systolic blood pressure. Body
weight therefore determines central systolic blood pressure in children
and adolescents rather than measures of cardiorespiratory fitness. The
prevention of overweight in childhood is necessary to reduce stiffening
of the arteries and delay the onset of cardiovascular disease.

Stenehjem, Jo S; Smeland, Knut B; Murbraech, Klaus; Holte, Harald;
Kvaløy, Stein; Thorsen, Lene; Arbo, Ingerid; Jones, Lee W; Aakhus,
Svend; Lund, May Brit; Kiserud, Cecilie E.

British Journal of Cancer,
July 2016, Vol. 115 Issue: Number 2 p178-187, 10p;

Abstract:
Background:Cardiorespiratory fitness as measured by peak oxygen
consumption (VO2peak) is a strong predictor of longevity and may be
compromised by anticancer therapy, inactivity, and smoking. We compared
VO2peakamong lymphoma survivors (LSs) with reference data from healthy
sedentary subjects, after a 10.2-year (mean) follow-up post high-dose
chemotherapy with autologous stem cell transplantation (HDT-ASCT). We
further examined the association between VO2peakand treatment, physical
activity, smoking, pulmonary, and cardiac function.

Methods:
Lymphoma
survivors treated with HDT-ASCT in Norway 1987–2008 were eligible.
VO2peakwas assessed by cardiopulmonary exercise testing. Pulmonary
function testing and echocardiography were also conducted. Data on
treatment, physical activity, and smoking were collected from hospital
records and questionnaires. VO2peakwas compared with age–sex predicted
reference data. Linear regression was used to associate clinical
factors with VO2peakcross-sectionally.Results:A total of 194 LSs
without heart failure were studied. Mean VO2peakwas 4.5% and 7.7% below
norms in females and males, respectively. Twenty-two percent had
impaired (<80% predicted) VO2peak. Decreasing VO2peakwas associated
with impaired diffusion capacity and current smoking, while physical
activity level and VO2peakwere positively associated.Conclusion:We
suggest increased attention towards physical activity counseling and
smoking cessation advice to preserve cardiorespiratory fitness in LSs
after HDT-ASCT. Patients with impaired diffusion capacity may benefit
from subsequent monitoring to detect pulmonary vascular diseases.

Y.H. Liu, B.P. Dhakal, C. Keesakul, R.M. Kacmarek, G.D. Lewis, and Y. Jiang

BJA, 117 (1): 129-131 (2016)

CORRESPONDENCE

Macías-Rodríguez, Ricardo U; Ilarraza-Lomelí, Hermes;
Ruiz-Margáin, Astrid; Ponce-de-León-Rosales, Sergio; Vargas-Vorácková,
Florencia; García-Flores, Octavio; Torre, Aldo; Duarte-Rojo, Andrés.
Clinical and Translational Gastroenterology, July 2016, Vol. 7 Issue:
Number 7 pe180-e180, 1p;

Abstract: OBJECTIVES:Exercise has been
scarcely studied in patients with cirrhosis, and prior evidence showed
hepatic venous pressure gradient (HVPG) to be increased in response to
exercise. The aim of this study was to investigate the effects of a
supervised physical exercise program (PEP) in patients with
cirrhosis.

METHODS:In an open-label, pilot clinical trial, patients with
cirrhosis were randomized to PEP (cycloergometry/kinesiotherapy plus
nutritional therapy, n=14) or control (nutritional therapy, n=15); for
14 weeks. Primary outcomes were: the effect of PEP in HVPG, and quality
of life (chronic liver disease questionnaire, CLDQ). As secondary
outcomes we investigated changes in physical fitness (cardiopulmonary
exercise testing), nutritional status (phase angle—bioelectrical
impedance), ammonia levels, and safety.

RESULTS:Twenty-two patients
completed the study (11 each). HVPG decreased in subjects allocated to
PEP (−2.5 mm Hg (interquartile range: −5.25 to 2); P=0.05), and
increased in controls (4 mm Hg (0–5); P=0.039), with a significant
between-groups difference (P=0.009). No major changes were noted in
CLDQ in both groups. There was significant improvement in ventilatory
efficiency (VE/VCO2) in PEP group (−1.9 (−3.12 to −0.1); P=0.033), but
not in controls (−0.4 (−5.7 to 1.4); P=0.467). Phase angle improvement
and a less-pronounced exercise-induced hyperammonemia were noted only
in PEP group. No episodes of variceal bleeding or hepatic
encephalopathy were observed.

CONCLUSIONS:A supervised PEP in patients
with cirrhosis decreases the HVPG and improves nutritional status with
no changes in quality of life. Further studies evaluating physical
training in cirrhosis are eagerly awaited in order to better define the
benefits of sustained exercise.

Abumehdi, Mohammad R.; Wardle,
Andrew J.; Nazzal, Rewa; Charalampopoulos, Athanasios; Schulze-Neick,
Ingram; Derrick, Graham; Moledina, Shahin; Giardini, Alessandro.
Cardiology in the Young, August 2016, Vol. 26 Issue: Number 6
p1144-1150, 7p;

Abstract:

AbstractBackground   Cardiopulmonary exercise
testing helps prognosticate and guide treatment in adults with
pulmonary hypertension. Concerns regarding its feasibility and safety
limit its use in children with pulmonary hypertension. We aimed to
assess the feasibility and safety of cardiopulmonary exercise testing
in a large paediatric pulmonary hypertension cohort.

Methods  We reviewed
all consecutive cardiopulmonary exercise tests performed between March,
2004 and November, 2013. The exclusion criteria were as follows: height
<120 cm, World Health Organization class IV, history of
exercise-induced syncope, or significant ischaemia/arrhythmias.
Significant events recorded were as follows: patient-reported symptoms,
arrhythmias, electrocardiogram abnormalities, and abnormal responses of
arterial O2saturation.

Results  A total of 98 children underwent 167
cardiopulmonary exercise tests. The median age was 14 years
(inter-quartile range 10–15 years). Peak oxygen uptake was 20.4±7.3
ml/kg/minute, corresponding to 51.8±18.3% of the predicted value. Peak
respiratory quotient was 1.08±0.16. All the tests except two were
maximal, being terminated prematurely for clinical reasons. Baseline
Oxygen saturation was 93.3±8.8% and was 81.2±19.5% at peak exercise. A
drop in arterial O2saturation >20% was observed in 23.5% of the
patients. Moreover, five patients (3.0%) experienced dizziness, one
requiring termination of cardiopulmonary exercise testing; five
children (3.0%) experienced chest pain, with early cardiopulmonary
exercise test termination in one patient. No significant arrhythmias or
electrocardiogram changes were observed.

Conclusion  Exercise testing in
non-severely symptomatic children with pulmonary hypertension is safe
and practical, and can be performed in a large number of children with
pulmonary hypertension in a controlled environment with an experienced
team. Side-effects were not serious and were resolved promptly with
test termination.

Di Thommazo-Luporini,
Luciana; Carvalho, Lívia Pinheiro; Luporini, Rafael Luís; Trimer,
Renata; Pantoni, Camila Bianca Falasco; Martinez, Adalberto Felipe;
Catai, Aparecida Maria; Arena, Ross; Borghi-Silva, Audrey.

Disability & Rehabilitation, August 2016, Vol. 38 Issue: Number 18 p1820-1829, 10p;

Abstract: AbstractPurpose:To investigate if cardiovascular and
metabolic responses to the six-minute walk test (6MWT) and incremental
shuttle walking test (ISWT) are in agreement with cardiopulmonary
exercise testing (CPX) and determine if both submaximal tests are
interchangeable in obese and eutrophic individuals.Method:Observational
and cross-sectional study included 51 obese women (ObG) and 21 controls
(CG) (20–45 years old). Subjects underwent clinical evaluation, CPX,
the 6MWT and ISWT. We applied Bland–Altman plots to assess agreement
between walking tests and CPX. Correlation analysis assessed
relationships between key variables.

Results:There was an agreement
between CPX and both the 6MWT [oxygen uptake (VO2mL kg−1 min−1) = 6.9
(CI: 5.7–8.1), and heart rate (bpm) = 37.0 (CI: 33.3–40.7)] and ISWT
[VO2(mL kg−1 min−1) = 6.1 (CI: 4.9–7.3), and heart rate (bpm) = 36.2
(CI: 32.1–40.3)]. We found similar cardiovascular and metabolic
responses to both tests in the ObG but not in the CG. Strong
correlations were demonstrated between 6MWT and ISWT variables: VO2(
r = 0.70); dyspnoea (r = 0.80); and leg fatigue
(r = 0.70).

Conclusions:6MWT and ISWT may both hold interchangeable
clinical value when contrasted with CPX in obese women and may be a
viable alternative in the clinical setting when resources and staffing
are limited.Implications for RehabilitationObesity is a worldwide
epidemic, with high prevalence in women, and it is associated to
impaired cardiorespiratory fitness and functional capacity as well as
high mortality risk. Assessing oxygen uptake by means of cardiopulmonary
exercise testing is the gold standard method for evaluating and
stratifying cardiorespiratory fitness, however it is not ever applied
due to costs and staffing.Walking field tests may be a cost-effective
approach that provides valuable information regarding the functional
capacity in agreement to metabolic and cardiovascular responses of
cardiopulmonary exercise testing.

Story, Christina; Bryant, Ashley Leak; Phillips, Brett;
Bailey, Charlotte; Shields, Edgar W.; Battaglini, Claudio.

Biological Research for Nursing, July 2016, Vol. 18 Issue: Number 4 p432-438, 7p;

Abstract: Introduction:  Cardiopulmonary exercise testing (CPET), the
gold standard of cardiopulmonary evaluation, is used to determine
VO2 levels at different aerobic exercise training intensities; however,
it may not be feasible to conduct CPET in all clinical settings.

Aims:
To compare the heart rate reserve (HRR) and percent of 220-age methods
for prescribing cycle ergometry exercise intensity using heart rate
(HR) against the HRs obtained during a CPET in adults undergoing
treatment for acute leukemia (AL).Methods:  In this exploratory study,
part of a larger randomized controlled trial, 14 adults with AL
completed CPET on a cycle ergometer with indirect calorimetry within 96
hr of admission to a cancer hospital to determine VO2peakand HR
corresponding to low (40% VO2peak), moderate (60% VO2peak), and high
(75% VO2peak) exercise intensities. Analyses of variance were used to
compare estimated HR for each intensity level using the HRR and percent
of 220-age methods with HR determined via VO2peak.Results:  HR
corresponding to low-intensity exercise differed significantly across
all three methods (p≤ .05). No significant differences were observed
between HR estimated via the percent of 220-age method and determined
via VO2peakat moderate (100 ± 8 and 113 ± 24 bpm, p= .122) or high
intensities (125 ± 10 and 123 ± 25 bpm, p= .994).

Conclusion:  In adults
with AL, HR-based methods for defining aerobic exercise intensities
should be used with caution. At low intensity, neither should be used,
while at moderate and high intensities, the percent of 220-age equation
might serve as an adequate substitute for CPET.

Chan, K. E.; Pathak, S.; Smart, N. J.; Batchelor, N.; Daniels, I. R..

Colorectal Disease, June 2016, Vol. 18 Issue: Number 6 p578-585, 8p;

Abstract:
Advanced age and occult cardiorespiratory disease are associated with
increased morbidity and mortality following surgery. Cardiopulmonary
exercise testing (CPET) may allow the identification of high‐risk
patients and facilitate planned postoperative critical care support.
The aim of this study was to determine whether preoperative CPETin
patients aged over 80 undergoing elective colorectal cancer resection
was associated with improved outcome. All patients aged 80 years and
above undergoing elective colorectal cancer resection between 1 March
2011 and 1 September 2013 were retrospectively analysed. Referral for
CPET testing was at the discretion of the operating surgeon.
Postoperative critical care unit (CCU) admission was based upon the
CPETresults. Ninety‐four patients were identified, of whom 48 underwent
CPETtesting. The CPET group were significantly older than the
non‐CPETgroup (85 vs83 years, P= 0.04) and were more likely to have a
planned admission to CCU postoperatively (P< 0.0001). Despite the
increased use of CCU resources, the overall CCU length of stay (LOS) in
the CPET group did not differ from the non‐CPETgroup, but the
non‐CPET group had a higher proportion of Level‐3 care. There were no
differences in the incidence of unplanned CCU admission between the
CPET and the non‐CPETgroup (P= 0.23). There were no differences in
overall LOS between the two groups (P= 0.42). There was no difference in
mortality (P= 0.11), overall complications (P= 0.53) or severe
complications (P= 0.3). Preoperative CPET testing in patients aged over
80 undergoing elective colorectal cancer resection allows
identification of higher‐risk patients and mitigation of risk by
preemptive admission to a CCU. This stratification allows equivalent
results to be achieved in high‐ and low‐risk elderly patients
undergoing colorectal surgery.

Boereboom, C.; Phillips, B.;
Williams, J.; Lund, J..

Techniques in Coloproctology, June 2016, Vol.
20 Issue: Number 6 p375-382, 8p;

Abstract: Over 41,000 people were
diagnosed with colorectal cancer (CRC) in the UK in 2011. The incidence
of CRC increases with age. Many elderly patients undergo surgery for
CRC, the only curative treatment. Such patients are exposed to risks,
which increase with age and reduced physical fitness. Endurance-based
exercise training programmes can improve physical fitness, but such
programmes do not comply with the UK, National Cancer Action Team
31-day time-to-treatment target. High-intensity interval training (HIT)
can improve physical performance within 2–4 weeks, but few studies have
shown HIT to be effective in elderly individuals, and those who do
employ programmes longer than 31 days. Therefore, we investigated
whether HIT could improve cardiorespiratory fitness in elderly
volunteers, age-matched to a CRC population, within 31 days.
This observational cohort study recruited 21 healthy elderly
participants (8 male and 13 female; age 67 years (range 62–73 years))
who undertook cardiopulmonary exercise testing before and after
completing 12 sessions of HIT within a 31-day period.
Peak oxygen consumption (VO2peak) (23.9 ± 4.7 vs. 26.2 ± 5.4 ml/kg/min,
p= 0.0014) and oxygen consumption at anaerobic threshold (17.86 ± 4.45
vs. 20.21 ± 4.11 ml/kg/min, p= 0.008) increased after HIT.
It is possible to improve cardiorespiratory fitness in 31 days in
individuals of comparable age to those presenting for CRC surgery.