Peterman JE; Arena R; Myers J; Marzolini S; Ades PA; Savage PD; Lavie CJ; Kaminsky LA;

Journal of the American Heart Association [J Am Heart Assoc] 2021 Nov 16; Vol. 10 (22), pp. e022336.
Date of Electronic Publication: 2021 Nov 08.

Background The importance of cardiorespiratory fitness for stratifying risk and guiding clinical decisions in patients with cardiovascular disease is well-established. To optimize the clinical value of cardiorespiratory fitness, normative reference standards are essential. The purpose of this report is to extend previous cardiorespiratory fitness normative standards by providing updated cardiorespiratory fitness reference standards according to cardiovascular disease category and testing modality.
Methods and Results The analysis included 15 045 tests (8079 treadmill, 6966 cycle) from FRIEND (Fitness Registry and the Importance of Exercise National Database). Using data from tests conducted January 1, 1974, through March 1, 2021, percentiles of directly measured peak oxygen consumption (VO _2peak ) were determined for each decade from 30 through 89 years of age for men and women with a diagnosis of coronary artery bypass surgery, myocardial infarction, percutaneous coronary intervention, or heart failure. There were significant differences between sex and age groups for VO _2peak ( P <0.001). The mean VO _2peak was 23% higher for men compared with women and VO _2peak decreased by a mean of 7% per decade for both sexes. Among each decade, the mean VO _2peak from treadmill tests was 21% higher than the VO _2peak from cycle tests. Differences in VO _2peak were observed among the age groups in both sexes according to cardiovascular disease category.
Conclusions This report provides normative reference standards by cardiovascular disease category for both men and women performing cardiopulmonary exercise testing on a treadmill or cycle ergometer. These updated and enhanced reference standards can assist with patient risk stratification and guide clinical care.

Van Aerde N, Meersseman P, Debaveye Y, Wilmer A, Casaer MP, Gunst J, Wauters J, Wouters PJ, Goetschalckx K, Gosselink R, Van den Berghe G, Hermans G.

Intensive Care Med. 2021 Nov 8:1-10. doi: 10.1007/s00134-021-06541-9. Online ahead of print.

PURPOSE: To evaluate aerobic exercise capacity in 5-year intensive care unit (ICU) survivors and to assess the association between severity of organ failure in ICU and exercise capacity up to 5-year follow-up.
METHODS: Secondary analysis of the EPaNIC follow-up cohort (NCT00512122) including 433 patients screened with cardiopulmonary exercise testing (CPET) between 1 and 5 years following ICU admission. Exercise capacity in 5-year ICU survivors (N = 361) was referenced to a historic sedentary population and further compared to demographically matched controls (N = 49). In 5-year ICU survivors performing a maximal CPET (respiratory exchange ratio > 1.05, N = 313), abnormal exercise capacity was defined as peak oxygen consumption (VO2peak) < 85% of predicted peak oxygen consumption (%predVO2peak), based on the historic sedentary population. Exercise liming factors were identified. To study the association between severity of organ failure, quantified as the maximal Sequential Organ Failure Assessment score during ICU-stay (SOFA-max), and exercise capacity as assessed with VO2peak, a linear mixed model was built, adjusting for predefined confounders and including all follow-up CPET studies. RESULTS: Exercise capacity was abnormal in 118/313 (37.7%) 5-year survivors versus 1/48 (2.1%) controls with a maximal CPET, p < 0.001. Aerobic exercise capacity was lower in 5-year survivors than in controls (VO2peak: 24.0 ± 9.7 ml/min/kg versus 31.7 ± 8.4 ml/min/kg, p < 0.001; %predVO2peak: 94% ± 31% versus 123% ± 25%, p < 0.001). Muscular limitation frequently contributed to impaired exercise capacity at 5-year [71/118 (60.2%)]. SOFA-max independently associated with VO2peak throughout follow-up.
CONCLUSIONS: Critical illness survivors often display abnormal aerobic exercise capacity, frequently involving muscular limitation. Severity of organ failure throughout the ICU stay independently associates with these impairments.

Malcolm A West FRCS, PhD, William CA Baker BMBS, Saqib Rahman MRCS, Alicia Munro BMBS, Sandy Jack PhD, Michael PW Grocott MD, FRCA, Timothy J Underwood FRCS, PhD, Denny ZH Levett FRCA, PhD, For the Fit-4-Surgery Consortium

Journal of Surgical Oncology; 31 August 2021
https://doi.org/10.1002/jso.26652

Okólska M; Łach J; Matusik PT; Pająk J;Mroczek T; Podolec P; Tomkiewicz-Pająk L;

Journal of clinical medicine [J Clin Med] 2021 Sep 29; Vol. 10 (19).
Date of Electronic Publication: 2021 Sep 29.

Reduction of heart rate variability (HRV) parameters may be a risk factor and precede the occurrence of arrhythmias or the development of heart failure and complications in people with postinfarct left ventricular dysfunction and after coronary artery bypass grafting. Data on this issue in adults after a Fontan operation (FO) are scarce. This study assessed the association between HRV, exercise capacity, and multiorgan complications in adults after FO. Data were obtained from 30 FO patients (mean age 24 ± 5.4 years) and 30 healthy controls matched for age and sex. HRV was investigated in all patients by clinical examination, laboratory tests, echocardiography, a cardiopulmonary exercise test, and 24-h electrocardiogram. The HRV parameters were reduced in the FO group. Reduced HRV parameters were associated with patients’ age at the time of FO, time since surgery, impaired exercise capacity, chronotropic incompetence parameters, and multiorgan complications. Univariate analysis showed that saturated O ₂ at rest, percentage difference between adjacent NN intervals of >50 ms duration, and peak heart rate were associated with chronotropic index. Multivariable analysis revealed that all three variables were independent predictors of the chronotropic index. The results of this study suggest novel pathophysiological mechanisms that link HRV, physical performance, and organ damage in patients after FO.

Acar RD; Sarıbaş E; Güney PA; Kafkas Ç; Aydınlı D; Taşçı E; Kırali MK;

Journal of breath research [J Breath Res] 2021 Oct 04; Vol. 15 (4).
Date of Electronic Publication: 2021 Oct 04.

This study aimed to evaluate the cardiopulmonary function and impairment of exercise endurance in patients with COVID-19 after 3 months of the second wave of the pandemic in Turkey. A total of 51 consecutive COVID-19 survivors, mostly healthcare providers, still working in the emergency room and intensive care units of the hospital after the second wave of Covid 19 pandemia were included in this study. Cardiopulmonary exercise stress test was performed. The median of the exercise time of the COVID-19 survivors, was 10 (4.5-13) minutes and the mean 6.8 ± 1.3 Mets was achieved. The VO ₂ max of the COVID-19 survivors was 24 ± 4.6 ml kg ^-1 min ^-1 which corresponds the 85 ± 10% of the predicted VO ₂ max value. The VO ₂ WRs value which was reported about 8.5-11 ml min ^-1 per watt in healthy individuals as normal was found lower in Covid 19 survivors (5.6 ± 1.4). The percentage of the maximum peak VO ₂ calculated according to the predictable peak VO ₂ of the COVID-19 survivors, was found significantly lower in male patients (92 ± 9.5% vs 80 ± 8.5%, p : 0.000). Also, there was a positive correlation between the percentage of the maximum predicted VO ₂ measurements and age ( r : 0.320, p : 0000). The peak VO ₂ values of COVID-19 survivors decreased, and simultaneously, their exercise performance decreased due to peripheral muscle involvement. We believe that COVID-19 significantly affects men and young patients.

Wan X; Liu C; Olson TP;Chen X; Lu W; Jiang W;

Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2021 Oct 11; Vol. 8, pp. 734687.
Date of Electronic Publication: 2021 Oct 11 (Print Publication: 2021).

Background: As demand for cardiopulmonary exercise test using a supine position has increased, so have the testing options. However, it remains uncertain whether the existing evaluation criteria for the upright position are suitable for the supine position. The purpose of this meta-analysis is to compare the differences in peak oxygen uptake (VO _2peak ) between upright and supine lower extremity bicycle exercise.
Methods: We searched PubMed, Web Of Science and Embase from inception to March 27, 2021. Self-control studies comparing VO _2peak between upright and supine were included. The quality of the included studies was assessed using a checklist adapted from published papers in this field. The effect of posture on VO _2peak was pooled using random/fixed effects model.
Results: This meta-analysis included 32 self-control studies, involving 546 participants (63% were male). 21 studies included only healthy people, 9 studies included patients with cardiopulmonary disease, and 2 studies included both the healthy and cardiopulmonary patients. In terms of study quality, most of the studies ( n = 21, 66%) describe the exercise protocol, and we judged theVO _2peak to be valid in 26 (81%) studies. Meta-analysis showed that the upright VO _2peak exceeded the supine VO _2peak [relative VO _2peak : mean difference (MD) 2.63 ml/kg/min, 95% confidence interval (CI) 1.66-3.59, I² = 56%, p < 0.05; absolute VO _2peak : MD 0.18 L/min, 95% CI 0.10-0.26, I² = 63%, p < 0.05). Moreover, subgroup analysis showed there was more pooled difference in healthy people (4.04 ml/kg/min or 0.22 L/min) than in cardiopulmonary patients (1.03 ml/kg/min or 0.12 L/min).
Conclusion: VO _2peak in the upright position is higher than that in supine position. However, whether this difference has clinical significance needs further verification.

Allen SK; Brown V;White D; King D; Hunt J; Wainwright J; Emery A; Hodge E; Kehinde A; Prabhu P; Rockall TA; Preston SR; Sultan J;

Annals of surgical oncology [Ann Surg Oncol] 2021 Nov 01.
Date of Electronic Publication: 2021 Nov 01.

Background: Neoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO ₂ ), skeletal muscle mass, QOL, and neoadjuvant therapy completion.
Methods: This parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.
Results: Fifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO ₂ decline {-0.4 [95% confidence interval (CI) -0.8 to 0.1] vs. -2.5 [95% CI -2.8 to -2.2] mL/kg/min; p = 0.022}, less muscle loss [-11.6 (95% CI -14.2 to -9.0) vs. -15.6 (95% CI -18.7 to -15.4) cm ² /m ² ; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.
Conclusions: This study has demonstrated some retention of cardiopulmonary fitness (peak VO ₂ ), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes. Trial Registration ClinicalTrials.gov NCT02950324.

Pang CL; Gooneratne M; Partridge JS;

BJA Education, 21(8) 314-320 (2021)

No abstract available

Delsart P; Delahaye C; Devos P; Domanski O; Azzaoui R; Sobocinski J; Juthier F; Vincentelli A; Rousse N; Mugnier A; Soquet J; Loobuyck V; Koussa M; Modine T; Jegou B; Bical A; Hysi I; Fabre O; Pontana F; Matran R; Mounier-Vehier C; Montaigne D;

Clinical Cardiology. 44(2):252-260, 2021 Feb.

BACKGROUND: Although recommendations encourage daily moderate activities
in post aortic dissection, very little data exists regarding
cardiopulmonary exercise testing (CPET) to personalize those patient’s
physical rehabilitation and assess their cardiovascular prognosis.

DESIGN: We aimed at testing the prognostic insight of CPET regarding
aortic and cardiovascular events by exploring a prospective cohort of
patients followed-up after acute aortic dissection.

METHODS: Patients referred to our department after an acute (type A or B)
aortic dissection were prospectively included in a cohort between
September 2012 and October 2017. CPET was performed once optimal blood
pressure control was obtained. Clinical follow-up was done after CPET for
new aortic event and major cardio-vascular events (MCE) not directly
related to the aorta.

RESULTS: Among the 165 patients who underwent CPET, no adverse event was
observed during exercise testing. Peak oxygen pulse was 1.46(1.22-1.84)
mlO2/beat, that is, 97 (83-113) % of its predicted value, suggesting
cardiac exercise limitation in a population under beta blockers (92% of
the population). During a follow-up of 39(20-51) months from CPET, 42
aortic event recurrences and 22 MCE not related to aorta occurred. Low
peak oxygen pulse (<85% of predicted value) was independently predictive
of aortic event recurrence, while low peak oxygen uptake (<70% of
predicted value) was an independent predictor of MCE occurrence.

CONCLUSION: CPET is safe in postaortic dissection patients should be used
to not only to personalize exercise rehabilitation, but also to identify
those patients with the highest risk for new aortic events and MCE not
directly related to aorta.

Lewthwaite H; Elsewify O; Niro F; Bourbeau J; Guenette JA; Maltais F;
Marciniuk DD; O’Donnell DE; Smith BM; Stickland MK; Tan WC; Jensen D;

Chest. 159(5):1922-1933, 2021 05.

RESEARCH QUESTION: This study aimed to develop an updated normative
reference set for physiologic and symptom responses at Tvent during cycle
CPET (primary aim) and to evaluate previously recommended reference
equations from a 1985 study for predicting Tvent responses (secondary
aim).

STUDY DESIGN AND METHODS: Participants were adults 40 to 80 years of age
who were free of clinically relevant disease from the Canadian Cohort
Obstructive Lung Disease. Rate of oxygen consumption (VO2) at Tvent was
identified by two independent raters; physiologic and symptom responses
corresponding to VO2 at Tvent were identified by linear interpolation.
Reference ranges (5th-95th percentiles) for responses at Tvent were
calculated according to participant sex and age for 29 and eight
variables, respectively. Prediction models were developed for nine
variables (oxygen pulse, VO2, rate of CO2 production, minute ventilation,
tidal volume, inspiratory capacity, end-inspiratory lung volume [in liters
and as percentage of total lung capacity], and end-expiratory lung volume)
using quantile regression, estimating the 5th (lower limit of normal),
50th (normal), and 95th (upper limit of normal) percentiles based on
readily available participant characteristics. The two one-sided test of
equivalence for paired samples evaluated the measured and 1985-predicted
VO2 at Tvent for equivalence.

RESULTS: Reference ranges and equations were developed based on 96
participants (49% men) with a mean +/- SD age of 63 +/- 9 years. Mean VO2
at Tvent was 50% of measured VO2 peak; the normal range was 33% to 66%.
The 1985 reference equations overpredicted VO2 at Tvent: mean difference
in men, -0.17 L/min (95% CI, -0.25 to -0.09 L/min); mean difference in
women, -0.19 L/min (95% CI, -0.27 to -0.12 L/min).

INTERPRETATION: A contemporary reference set of CPET responses at Tvent
from Canadian adults 40 to 80 years of age is presented that differs from
the previously recommended and often used reference set from 1985.