Schlagheck ML; Bansi J; Wenzel C; Kuzdas-Sallaberger M; Kiesl D; Gonzenbach R; Zimmer P;

European journal of neurology [Eur J Neurol] 2023 May 20.
Date of Electronic Publication: 2023 May 20.

Background: Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS that attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET), and (ii) to provide insight into participant characteristics that limit maximal exercise performance.
Methods: This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n=380 inpatient pwMS (mean age: 48±11 years; 66% female). Chi-square or Fisher’s exact tests were conducted to compare differences in the distribution of criteria achieved. Participants’ characteristics were examined as potential predictors using binary logistic regression.
Results: Only 60% of the overall sample attained a respiratory exchange ratio ≥1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six per cent met at least two out of three criteria. The disability status, gender, disease course and body mass index were associated with the attainment of maximal effort.
Conclusions: Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimise CPET protocols in restrictive groups of pwMS.

Masood IR; Rezvan PH; Lee K; Vervaet H; Kuo C; Loss K; Menteer J; Souza A; Freyer D; Su JA;

Pediatric cardiology [Pediatr Cardiol] 2023 May 22.
Date of Electronic Publication: 2023 May 22.

Cancer survivors exposed to anthracycline chemotherapy are at risk for developing cardiomyopathy, which may have delayed clinical manifestation. In a retrospective cross-sectional study, we evaluated the utility of cardiopulmonary exercise testing (CPET) for detecting early cardiac disease in 35 pediatric cancer survivors by examining the associations between peak exercise capacity (measured via percent predicted peak VO ₂ ) and resting left ventricular (LV) function on echocardiography and cardiac magnetic resonance imaging (cMRI). We additionally assessed the relationships between LV size on resting echocardiography or cMRI and percent predicted peak VO ₂ since LV growth arrest can occur in anthracycline-exposed patients prior to changes in LV systolic function. We found reduced exercise capacity in this cohort, with low percent predicted peak VO ₂ (62%, IQR: 53-75%). While most patients in our pediatric cohort had normal LV systolic function, we observed associations between percent predicted peak VO ₂ and echocardiographic and cMRI measures of LV size. These findings indicate that CPET may be more sensitive in manifesting early anthracycline-induced cardiomyopathy than echocardiography in pediatric cancer survivors. Our study also highlights the importance of assessing LV size in addition to function in pediatric cancer survivors exposed to anthracyclines.

Holzemer NF; Silveira LJ; Kay J; Khanna AD; Jacobsen RM;

Pediatric cardiology [Pediatr Cardiol] 2023 May 23.
Date of Electronic Publication: 2023 May 23.

Hypertension (HTN) is common in patients with a history of coarctation of the aorta (CoA) and remains underrecognized and undertreated. Studies in the non-coarctation otherwise healthy adult population have correlated an exaggerated blood pressure response during mild to moderate exercise with subsequent diagnosis of HTN. The goal of this study was to determine if blood pressure response to submaximal exercise in normotensive CoA patients correlated with development of HTN.Retrospective chart review was performed in individuals ≥ 13 years old with CoA and no diagnosis of HTN at time of cardiopulmonary exercise testing (CPET). Systolic blood pressure (SBP) during CPET at rest, submax 1 (stage 1 Bruce or minute 2 bicycle ramp), submax 2 (stage 2 Bruce or minute 4 bicycle ramp), and peak were recorded. The primary composite outcome was HTN diagnosis or initiation of anti-hypertensive medications at follow up.There were 177 patients (53% female, median age 18.5 years), of whom 38 patients (21%) met composite outcome during a median follow up of 46 months. Men were more likely to develop hypertension. Age at repair and age at CPET were not significant covariates. At each stage of CPET, SBP was significantly higher in those who met the composite outcome. Submax 2 SBP ≥ 145 mmHg was 75% sensitive, 71% specific in males and 67% sensitive, 76% specific in females for development of composite outcome.Our study shows an exaggerated SBP response to submaximal exercise may portend an increased risk of developing hypertension during short- to mid-term follow up.

Gumm A; Ginde S; Hoffman G; Liegl M; Mack C; Simpson P; Telega G; Vitola B; Chugh A;

Pediatric cardiology [Pediatr Cardiol] 2023 May 23.
Date of Electronic Publication: 2023 May 23.

The Fontan procedure results in chronic hepatic congestion and Fontan-associated liver disease (FALD) characterized by progressive liver fibrosis and cirrhosis. Exercise is recommended in this population, but may accelerate the progression of FALD from abrupt elevations in central venous pressure. The aim of this study was to assess if acute liver injury occurs after high-intensity exercise in patients with Fontan physiology. Ten patients were enrolled. Nine had normal systolic ventricular function and one had an ejection fraction < 40%. During cardiopulmonary exercise testing, patients had near-infrared spectroscopy (NIRS) to measure oxygen saturation of multiple organs, including the liver, and underwent pre- and post-exercise testing with liver elastography, laboratory markers, and cytokines to assess liver injury. The hepatic and renal NIRS showed a statistically significant decrease in oxygenation during exercise, and the hepatic NIRS had the slowest recovery compared to renal, cerebral, and peripheral muscle NIRS. A clinically significant increase in shear wave velocity occurred after exercise testing only in the one patient with systolic dysfunction. There was a statistically significant, albeit trivial, increase in ALT and GGT after exercise. Fibrogenic cytokines traditionally associated with FALD did not increase significantly in our cohort; however, pro-inflammatory cytokines that predispose to fibrogenesis did significantly rise during exercise. Although patients with Fontan circulation demonstrated a significant reduction in hepatic tissue oxygenation based on NIRS saturations during exercise, there was no clinical evidence of acute increase in liver congestion or acute liver injury following high-intensity exercise.

Bailey DM; Davies RG; Glamorgan, UK.; Rose GA; Lewis MH; Aldayem AA; Twine CP; Awad W; Glamorgan, UK.; Jubouri M; Mohammed I; Mestres CA; Chen EP; Coselli JS; Williams IM; Glamorgan, UK.; Bashir M;

Experimental physiology [Exp Physiol] 2023 May 26.
Date of Electronic Publication: 2023 May 26.

The extent to which patients with an abdominal aortic aneurysm (AAA) should exercise remains unclear, given theoretical concerns over the perceived risk of blood pressure-induced rupture, which is often catastrophic. This is especially pertinent during cardiopulmonary exercise testing, when patients are required to perform incremental exercise to symptom-limited exhaustion for the determination of cardiorespiratory fitness. This multimodal metric is being used increasingly as a complementary diagnostic tool to inform risk stratification and subsequent management of patients undergoing AAA surgery. In this review, we bring together a multidisciplinary group of physiologists, exercise scientists, anaesthetists, radiologists and surgeons to challenge the enduring ‘myth’ that AAA patients should be fearful of and avoid rigorous exercise. On the contrary, by appraising fundamental vascular mechanobiological forces associated with exercise, in conjunction with ‘methodological’ recommendations for risk mitigation specific to this patient population, we highlight that the benefits conferred by cardiopulmonary exercise testing and exercise training across the continuum of intensity far outweigh the short-term risks posed by potential AAA rupture.

Da Silva BR; Kirkham AA; Ford KL; Haykowsky MJ; Canada.Paterson DI; Joy AA; Pituskin E; Thompson R; Prado CM;

Clinical nutrition ESPEN [Clin Nutr ESPEN] 2023 Jun; Vol. 55, pp. 208-211.
Date of Electronic Publication: 2023 Mar 27.

Background & Aim: Phase angle (PhA) obtained from bioelectrical impedance analysis (BIA) is an indicator of cellular integrity and relates to several chronic conditions. The purpose of this secondary analysis was to evaluate the association of PhA with health-related physical fitness, namely, cardiorespiratory fitness, skeletal muscle volume, and myosteatosis (i.e. muscle health) in older breast cancer survivors.
Methods: Twenty-two women ≥60 years with a body mass index (BMI) ≥25 kg/m ² and who completed chemotherapy for early-stage breast cancer were included. BIA, cardiopulmonary exercise tests and magnetic resonance imaging scans were completed before and after eight weeks of time-restricted eating.
Results: At baseline, PhA was associated with cardiorespiratory fitness (R ²  = 0.54, p < 0.01) and skeletal muscle volume (R ²  = 0.83, p < 0.01) and myosteatosis (R ²  = 0.25, p = 0.02). Results were similar at follow-up.
Conclusion: Findings from this pilot study suggest that higher values of PhA are associated with better health-related physical fitness among older breast cancer survivors.

Saeki H; Kuramoto M; Iida Y; Yasumura K; Arita Y; Ogasawara N;

Circulation reports [Circ Rep] 2023 Mar 31; Vol. 5 (5), pp. 167-176.
Date of Electronic Publication: 2023 Mar 31 (Print Publication: 2023).

Background: In outpatient center-based cardiac rehabilitation (O-CBCR), moderate-intensity continuous training (MICT) based on the anaerobic threshold (AT) determined by cardiopulmonary exercise stress testing is recommended. However, it is unclear whether differences in exercise intensity within the MICT domain affect peak oxygen uptake (%peakV̇O ₂ ).
Methods and Results: We retrospectively evaluated patients who underwent O-CBCR at Japan Community Healthcare Organization Osaka Hospital. Those treated with the constant-load method were designated as Group A (n=38), whereas those treated with the variable-load method were designated as Group B (n=48). Although the change in exercise intensity was significantly greater in Group B by approximately 4.5 W, the change in %peakV̇O₂ was not significantly different between groups. Group A had a significantly longer exercise time than Group B (by approximately 4-5 min). No deaths or hospitalizations occurred in either group. The percentage of episodes with exercise cessation was similar between the 2 groups, but the percentage of episodes with load reduction was significantly higher in Group B, mostly because of the increased heart rate.
Conclusions: In supervised MICT based on AT, the variable-load method increased exercise intensity more than the constant-load method without severe complications, but did not improve %peakV̇O₂ .

Brito GM; do Prado DML; Rezende DA; de Matos LDNJ; Loturco I; Vieira MLC; Alô ROB; Bianchini FR; Pinto AJ; Roschel H; Lemes ÍR; Gualano B;

Frontiers in medicine [Front Med (Lausanne)] 2023 Apr 26; Vol. 10, pp. 1128414.
Date of Electronic Publication: 2023 Apr 26 (Print Publication: 2023).

Introduction: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms.
Methods: Participants’ assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis.
Results: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO ₂ slope; p <0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p =0.007), PETCO2 max ( p =0.009), and dysfunctional breathing ( p =0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing ( p =0.008).
Discussion: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

Chaumont M; Forton K; Gillet A; Lamotte M;

Healthcare (Basel, Switzerland) [Healthcare (Basel)] 2023 Apr 30; Vol. 11 (9).
Date of Electronic Publication: 2023 Apr 30.

Cardiopulmonary exercise testing (CPET) was limited to peak oxygen consumption analysis (VO ₂ peak), and now the ventilation/carbon dioxide production (VE/VCO₂ ) slope is recognized as having independent prognostic value. Unlike VO₂ peak, the VE/VCO₂ slope does not require maximal effort, making it more feasible. There is no consensus on how to measure the VE/VCO₂ slope; therefore, we assessed whether different methods affect its value. This is a retrospective study assessing sociodemographic data, left ventricular ejection fraction, CPET parameters, and indications of patients referred for CPET. The VE/VCO₂ slope was measured to the first ventilatory threshold (VT1-slope), secondary threshold (VT2-slope), and included all test data (full-slope). Of the 697 CPETs analyzed, 308 reached VT2. All VE/VCO₂ slopes increased with age, regardless of test indications. In patients not reaching VT2, the VT1-slope was 32 vs. 36 ( p < 0.001) for the full-slope; in those surpassing VT2, the VT1-slope was 29 vs. 33 ( p < 0.001) for the VT2-slope and 37 (all p < 0.001) for the full-slope. The mean difference between the submaximal and full-slopes was ±4 units, sufficient to reclassify patients from low to high risk for heart failure or pulmonary hypertension.
We conclude that the method used for determining the VE/VCO₂ slope greatly influences the result, the significant variations limiting its prognostic value. The calculation method must be standardized to improve its prognostic value.

Blokland IJ; Groot FP; Bennekom PDCAM; de Koning DJJ; van Dieen PDJH; Houdijk PDH;

Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2023 May 10.
Date of Electronic Publication: 2023 May 10.

Objective: To provide reference values of cardiorespiratory fitness for individuals post-stroke in clinical rehabilitation and to gain insight in characteristics related to cardiorespiratory fitness post stroke.
Design: A retrospective cohort study. Reference equations of cardiopulmonary fitness corrected for age and sex for the 5 ^th ,25 ^th , 50 ^th , 75 ^th and 95 ^th percentile were constructed with quantile regression analysis. The relation between patient characteristics and cardiorespiratory fitness was determined by linear regression analyses adjusted for sex and age. Multivariate regression models of cardiorespiratory fitness were constructed.
Setting: Clinical rehabilitation centre PARTICIPANTS: 405 individuals post-stroke who performed a cardiopulmonary exercise test as part of clinical rehabilitation between July 2015 and May 2021.
Main Outcome Measures: Cardiorespiratory fitness in terms of peak oxygen uptake (V˙O ₂ peak) and oxygen uptake at ventilatory threshold (V˙O ₂ -VT).
Results: References equations for cardiorespiratory fitness stratified by sex and age were provided based on 405 individuals post-stroke. Median V˙O ₂ peak was 17.8[range 8.4-39.6] ml/kg/min and median V˙O ₂ -VT was 9.7[range 5.9-26.6] ml/kg/min. Cardiorespiratory fitness was lower in individuals who were older, female, using beta-blocker medication and in individuals with higher BMI and lower motor ability.
Conclusions: Population specific reference values of cardiorespiratory fitness for individuals post-stroke corrected for age and sex were presented. These can give individuals post-stroke and health-care providers insight in their cardiorespiratory fitness compared to their peers. Furthermore, they can be used to determine the potential necessity for cardiorespiratory fitness training as part of the rehabilitation program for an individual post-stroke to enhance their fitness, functioning and health. Especially, individuals post-stroke with more mobility limitations and beta-blocker use are at a higher risk of low cardiorespiratory fitness.