West, M.; Loughney, L.;  Ambler, G.; Dimitrov, B.; Kelly, J.; Mythen, M.; Sturgess, R.;
Calverley, P.; Kendrick, A.; Grocott, M.; Jack, S..

BMC Cancer, December 2016, Vol. 16 Issue: Number 1 p1-8, 8p;

Abstract: In 2014 approximately 21,200 patients were diagnosed with oesophageal and
gastric cancer in England and Wales, of whom 37 % underwent planned
curative treatments. Potentially curative surgical resection is
associated with significant morbidity and mortality. For operable
locally advanced disease, neoadjuvant chemotherapy (NAC) improves
survival over surgery alone. However, NAC carries the risk of toxicity
and is associated with a decrease in physical fitness, which may in
turn influence subsequent clinical outcome. Lower levels of physical
fitness are associated with worse outcome following major surgery in
general and Upper Gastrointestinal Surgery (UGI) surgery in particular.
Cardiopulmonary exercise testing (CPET) provides an objective
assessment of physical fitness. The aim of this study is to test the
hypothesis that NAC prior to upper gastrointestinal cancer surgery is
associated with a decrease in physical fitness and that the magnitude
of the change in physical fitness will predict mortality 1 year
following surgery.                   This study is a multi-centre,
prospective, blinded, observational cohort study of participants with
oesophageal and gastric cancer scheduled for neoadjuvant cancer
treatment (chemo- and chemoradiotherapy) and surgery. The primary
endpoints are physical fitness (oxygen uptake at lactate threshold
measured using CPET) and 1-year mortality following surgery; secondary
endpoints include post-operative morbidity (Post-Operative Morbidity
Survey (POMS)) 5 days after surgery and patient related quality of life
(EQ-5D-5 L).                   The principal benefits of this study, if
the underlying hypothesis is correct, will be to facilitate better
selection of treatments (e.g. NAC, Surgery) in patients with
oesophageal or gastric cancer. It may also be possible to develop new
treatments to reduce the effects of neoadjuvant cancer treatment on
physical fitness. These results will contribute to the design of a
large, multi-centre trial to determine whether an in-hospital
exercise-training programme that increases physical fitness leads to
improved overall survival.

Lamb, Benjamin Wilfrid; Tan, Wei Shen; Eneje, Philip; Bruce, David;
Jones, Amy; Ahmad, Imran; Sridhar, Ashwin; Baker, Hilary; Briggs, Tim
P.; Hines, John E.; Nathan, Senthil; Martin, Daniel; Stephens, Robert
C.; Kelly, John D..

Urologic Oncology, September 2016, Vol. 34 Issue:
Number 9 p417.e17-417.e23, 7p;

Abstract: Patients undergoing radical
cystectomy have associated comorbidities resulting in reduced
cardiorespiratory fitness. Preoperative cardiopulmonary exercise
testing (CPET) measures including anaerobic threshold (AT) can predict
major adverse events (MAE) and hospital length of stay (LOS) for
patients undergoing open and robotic cystectomy with extracorporeal
diversion. Our objective was to determine the relationship between CPET
measures and outcome in patients undergoing robotic radical cystectomy
and intracorporeal diversion (intracorporeal robotic assisted radical
cystectomy [iRARC]).

Broch, Kaspar; Urheim, Stig; Massey, Richard; Stueflotten, Wenche; Fosså, Kristian; Hopp,
Einar; Aakhus, Svend; Gullestad, Lars.

International Journal of Cardiology, November 2016, Vol. 223 Issue: Number 1 p688-692, 5p;
Abstract: In patients with chronic, hemodynamically significant aortic
regurgitation (AR), a long period of left ventricular remodeling
usually occurs prior to the development of symptoms or left ventricular
dysfunction. The value of cardiopulmonary exercise testing in patients
with asymptomatic AR is not established.

Cornelis, Nils; Buys, Roselien.

International Journal of Cardiology, November
2016, Vol. 222 Issue: Number 1 p538-547, 10p;

Abstract: Cardiopulmonary
exercise testing (CPET) has become part of screening and evaluation in
cardiology. The exercise modalities most often used in CPET are the
treadmill (TM) and upright bicycle (UB). Nowadays, also the supine
bicycle (SB) is becoming more often used, especially when combined with
cardiac imaging

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.