Sabbahi A; Arena R; Kaminsky LA; Myers J; Fernhall B; Sundeep C;
Phillips SA

Journal of Human Hypertension. 35(8):685-695, 2021 08. VI 1

It has been established that blacks have higher overall incidence and
prevalence of hypertension compared to their white counterparts. However,
the maximum blood pressure (BP) response of blacks to exercise has not
been characterized. A total of 5996 apparently healthy men from the
Fitness Registry and Importance of Exercise: A National Database (FRIEND)
who underwent maximum cardiopulmonary exercise tests on a cycle ergometer
were included in this analysis. Of these participants, 1245 (21%)
self-identified as black while the remaining 4751 (79%) identified as
white. All subjects had a respiratory exchange ratio (RER) of >=1.0 and
had no reports of cardiovascular or pulmonary disease. Systolic BP (BP)
response to exercise was indexed according to increase in workload
(SBP/MET-slope). Both racial groups were subdivided into age groups by
decade. Black men had higher peak SBP and higher SBP/MET-slopes compared
to white men across all age groups (p < 0.001). Resting SBP was not
different between blacks and whites except within the 18-29-year age
group. The differences in peak SBP and SBP/MET-slope between age and race
groups indicate that black men have an exaggerated BP response to exercise
irrespective of resting BP values. Further investigation is warranted to
determine the underlying mechanisms responsible and clinical implications
for this exaggerated BP response to exercise.

Valborgland T; Isaksen K; Munk PS; Larsen AI;

Rehabilitation research and practice [Rehabil Res Pract] 2021 Sep 30; Vol. 2021, pp. 6619747.
Date of Electronic Publication: 2021 Sep 30 (Print Publication: 2021).

Purpose: Exercise training is an essential treatment option for patients with chronic heart failure (CHF). However, it remains controversial, which surrogate measures of functional work capacity are most reliable. The purpose of this paper was to compare functional capacity work measured as capillary lactate concentrations area under the curve (AUC) with standard cardiopulmonary exercise testing (CPET) with VO _2peak and the 6-minute walk test (6 MWT).
Methods: Twenty-three patients in New York Heart Association (NYHA) class II/III with left ventricular ejection fraction (LVEF) <35% were randomised to home-based recommendation of regular exercise (RRE) (controls), moderate continuous training (MCT) or aerobic interval training (AIT). The MCT and AIT groups underwent 12 weeks of supervised exercise training. Exercise testing was performed as standard CPET treadmill test with analysis of VO _2peak , the 6 MWT and a novel 30-minute submaximal treadmill test with capillary lactate AUC.
Results: All patients had statistically significant improvements in VO _2peak , 6 MWT and lactate AUC after 12 weeks of exercise training: 6 MWT (p =0.035), VO _2peak (p =0.049) and lactate AUC (p =0.002). Lactate AUC (p =0.046) and 6MWT (p =0.035), but not VO _2peak revealed difference between the exercise modalities regarding functional work capacity.
Conclusion: 6-MWT and lactate AUC, but not VO _2peak , were able to reveal a statistically significant improvement in functional capacity between different exercise modalities.

Argillander TE; Heil TC; Melis RJF; Klaase JM;

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2021 Oct 01. Date of Electronic Publication: 2021 Oct 01.

Background: Abdominal cancer surgery is associated with considerable morbidity in older patients. Assessment of preoperative physical status is therefore essential. The aim of this review was to describe and compare the objective physical tests that are currently used in abdominal cancer surgery in the older patient population with regard to postoperative outcomes.
Methods: Medline, Embase, CINAHL and Web of Science were searched until 31 December 2020. Non-interventional cohort studies were eligible if they included patients ≥65 years undergoing abdominal cancer surgery, reported results on objective preoperative physical assessment such as Cardiopulmonary Exercise Testing (CPET), field walk tests or muscle strength, and on postoperative outcomes.
Results: 23 publications were included (10 CPET, 13 non-CPET including Timed Up & Go, grip strength, 6-minute walking test (6MWT) and incremental shuttle walk test (ISWT)). Meta-analysis was precluded due to heterogeneity between study cohorts, different cut-off points, and inconsistent reporting of outcomes. In CPET studies, ventilatory anaerobic threshold and minute ventilation/carbon dioxide production gradient were associated with adverse outcomes. ISWT and 6MWT predicted outcomes in two studies. Tests addressing muscle strength and function were of limited value. No study compared different physical tests.
Discussion: CPET has the ability to predict adverse postoperative outcomes, but it is time-consuming and requires expert assessment. ISWT or 6MWT might be a feasible alternative to estimate aerobic capacity. Muscle strength and function tests currently have limited value in risk prediction. Future research should compare the predictive value of different physical instruments with regard to postoperative outcomes in older surgical patients.

Andonian BJ; Hardy N; Bendelac A; Polys N; Kraus WE;

Current sports medicine reports [Curr Sports Med Rep] 2021 Oct 01; Vol. 20 (10), pp. 545-552.

Abstract: Cardiopulmonary exercise testing (CPET) is a dynamic clinical tool for determining the cause for a person’s exercise limitation. CPET provides clinicians with fundamental knowledge of the coupling of external to internal respiration (oxygen and carbon dioxide) during exercise. Subtle perturbations in CPET parameters can differentiate exercise responses among individual patients and disease states. However, perhaps because of the challenges in interpretation given the amount and complexity of data obtained, CPET is underused. In this article, we review fundamental concepts in CPET data interpretation and visualization. We also discuss future directions for how to best use CPET results to guide clinical care. Finally, we share a novel three-dimensional graphical platform for CPET data that simplifies conceptualization of organ system-specific (cardiac, pulmonary, and skeletal muscle) exercise limitations. Our goal is to make CPET testing more accessible to the general medical provider and make the test of greater use in the medical toolbox.

Arena R; Faghy MA;

Expert review of cardiovascular therapy [Expert Rev Cardiovasc Ther] 2021 Oct 08.
Date of Electronic Publication: 2021 Oct 08.

No abstract available

Pella E; Boutou AK; Alexandrou ME; Bakaloudi DR; Sarridou D; Boulmpou A; Papadopoulos C; Papagianni A; Sarafidis P;

Annals of physical and rehabilitation medicine [Ann Phys Rehabil Med] 2021 Oct 08, pp. 101588.
Date of Electronic Publication: 2021 Oct 08.

Background: Patients with chronic kidney disease (CKD) often present reduced physical activity and exercise tolerance due to factors relevant to co-existing disturbances of the cardiac, nervous and muscular systems. Cardiopulmonary exercise testing (CPET) is used for clinical evaluation of exercise limitation and related symptoms (i.e., dyspnea, fatigue) in several medical fields.
Objectives: This is a systematic review and meta-analysis of studies using CPET technology to examine cardiopulmonary reserve in individuals with versus without CKD.
Methods: Literature search involved PubMed, Web of Science and Scopus databases; manual search of article references and of grey literature was also performed. Observational studies and randomized trials that used CPET for patients with CKD stage 1-5 versus controls were eligible. The primary outcome was peak oxygen uptake (VO ₂ peak). The Newcastle-Ottawa Scale was used to evaluate the quality of retrieved studies.
Results: From an initial 4944 literature records, we identified 29 studies fulfilling the inclusion criteria; of these, 25 studies (2,213 participants) with complete data were included in the final meta-analysis. VO ₂ peak was significantly lower in CKD patients than controls without CKD [standardized mean difference (SMD) -1.40, 95% confidence interval (CI) -1.68; -1.13)]. Values were lower for CKD than non-CKD for oxygen consumption at anaerobic threshold (SMD -1.06, 95% CI -1.34; -0.79) and maximum workload [weighted mean difference (WMD) -58.26, 95% CI 74.14; -42.38]. In 3 studies, CKD patients had higher VO ₂ peak than controls with heart failure without CKD (WMD 6.60, 95% CI 3.02; 10.18). Sensitivity analyses confirmed the robustness of these findings.
Conclusions: VO ₂ peak and other commonly analyzed CPET variables were lower in patients with CKD than controls, which indicates reduced functional cardiopulmonary reserve in CKD. In contrast, patients with CKD performed better than controls with heart failure without CKD. Overall, rehabilitation programs should be more widely applied to individuals with CKD.

Cardiology in the young [Cardiol Young] 2021 Oct 04, pp. 1-4. Date of Electronic Publication: 2021 Oct 04.

Martin Talavera M;
Manso B;
Garcia de Vinuesa PG;
Cejudo Ramos P;
Rodriguez Puras MJ;
Wals Rodriguez AJ;
Garcia de Vinuesa PG,

Introduction: Cardiopulmonary exercise test (CPET) allows quantification of functional capacity of patients with Fontan. The objective of this study was to determine the role of CPET parameters in predicting a higher maximum oxygen consumption (VO2 max) and to analyse the role of CPET parameters in predicting an unfavourable outcome.
Methods: A retrospective, cross-sectional, descriptive study was carried out on 57 patients with Fontan, who had undergone incremental CPET with cycloergometer between 2010 and 2020. Determinants of VO2 max and determinants of clinical deterioration were analysed.
Results: In the univariate analysis, the variables significantly related to VO2 max were: age, sex, body mass index (BMI), years of Fontan evolution, intracardiac Fontan, oxygen consumption at anaerobic threshold (VO2AT), CO2 equivalents at anaerobic threshold (VE/VCO2) and chronotropic insufficiency. The multiple linear regression model that best fitted the relationship between VO2 max and independent variables (correlation coefficient 0.73) included sex (correlation index 3.35; p = 0.02), BMI (-0.27; p = 0.02), chronotropic failure (-2.79; p = 0.01) and VO2AT (0.92; p < 0.0001). In the univariate analysis of the prognostic CPET variables related to an unfavourable clinical situation, significance was only obtained with chronotropic insufficiency (p = 0.003). In multivariate analysis, chronotropic insufficiency maintains its association [p= 0.017, OR = 4.65 (1.3-16.5)].
Conclusions: In conclusion, together with the anthropometric parameters universally related to VO2 max, chronotropic insufficiency and VO2AT are the main determinants of functional capacity in patients with Fontan. Moreover, chronotropic insufficiency is closely related to unfavourable clinical evolution. Our data would support the intensive treatment of chronotropic insufficiency in order to improve the quality of life and the clinical situation of patients with Fontan.

Martin Talavera M;Manso B; Seville, Spain.Cejudo Ramos P; Rodriguez Puras MJ; Wals Rodriguez AJ;
Garcia de Vinuesa PG;

Cardiology in the young [Cardiol Young] 2021 Oct 04, pp. 1-4. Date of Electronic Publication: 2021 Oct 04.

Introduction: Cardiopulmonary exercise test (CPET) allows quantification of functional capacity of patients with Fontan. The objective of this study was to determine the role of CPET parameters in predicting a higher maximum oxygen consumption (VO2 max) and to analyse the role of CPET parameters in predicting an unfavourable outcome.
Methods: A retrospective, cross-sectional, descriptive study was carried out on 57 patients with Fontan, who had undergone incremental CPET with cycloergometer between 2010 and 2020. Determinants of VO2 max and determinants of clinical deterioration were analysed.
Results: In the univariate analysis, the variables significantly related to VO2 max were: age, sex, body mass index (BMI), years of Fontan evolution, intracardiac Fontan, oxygen consumption at anaerobic threshold (VO2AT), CO2 equivalents at anaerobic threshold (VE/VCO2) and chronotropic insufficiency. The multiple linear regression model that best fitted the relationship between VO2 max and independent variables (correlation coefficient 0.73) included sex (correlation index 3.35; p = 0.02), BMI (-0.27; p = 0.02), chronotropic failure (-2.79; p = 0.01) and VO2AT (0.92; p < 0.0001). In the univariate analysis of the prognostic CPET variables related to an unfavourable clinical situation, significance was only obtained with chronotropic insufficiency (p = 0.003). In multivariate analysis, chronotropic insufficiency maintains its association [p= 0.017, OR = 4.65 (1.3-16.5)].
Conclusions: In conclusion, together with the anthropometric parameters universally related to VO2 max, chronotropic insufficiency and VO2AT are the main determinants of functional capacity in patients with Fontan. Moreover, chronotropic insufficiency is closely related to unfavourable clinical evolution. Our data would support the intensive treatment of chronotropic insufficiency in order to improve the quality of life and the clinical situation of patients with Fontan.

Berkel AEM; van Dijk DPJ; Prins SN; van Meeteren NLU; Olde Damink SWM; Klaase JM; Bongers BC;

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
[Colorectal Dis] 2021 Oct 06. Date of Electronic Publication: 2021 Oct 06.

Aim: Though cardiopulmonary exercise testing (CPET) is considered the gold standard, the preoperative abdominal computed tomography (CT) scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT-scan derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery.
Method: In this retrospective cohort study, CT-images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass, and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT-scan derived body composition variables, CPET-derived aerobic fitness, and other preoperative patient-related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤11.1 mL/kg/min as cut-off for having a high risk for postoperative complications.
Results: Data from 78 patients (45 males, mean (SD) age 74.5 (6.4) years) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R ² of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass, and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P=0.033) and higher VAT mass (odds ratio 1.02; P=0.036) were associated with an increased risk of an AT ≤11.1 mL/kg/min.
Conclusion: Body composition variables from the preoperative CT-scan were moderately associated with preoperative CPET-derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤11.1 mL/kg/min.

Smarz K;Jaxa-Chamiec T; Zaborska B; Tysarowski M; Budaj A;

Journal of clinical medicine [J Clin Med] 2021 Sep 09; Vol. 10 (18). Date of Electronic Publication: 2021 Sep 09.

Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO ₂ ) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO ₂ Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO ₂ improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO ₂ . In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO ₂ Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise.