Comparison of physical activity and quality of life between obese individuals with obstructive sleep apnea syndrome and individuals with obesity hypoventilation syndrome.

PURPOSE: Obstructive Sleep Apnea Syndrome (OSAS) and Obesity Hypoventilation Syndrome (OHS) share common causal factors and comorbidities but may have a variable effect on physical activity and associated quality of life, due to differences in pathophysiology. The aim of this study was to compare the levels of physical activity, mental health and quality of life between matched obese patients with either OSAS or OHS, aiming to identify which of the two syndromes may impose the most severe impact on these variables, for the first time in literature. METHODS: A total of 76 obese patients (OSAS: Ν1 = 48, OHS: N2 = 26) of similar age (58.2 ± 12.2 vs. 63.6 ± 9.8; p > 0.05), BMI (37.2 ± 6.2 vs. 40.3 ± 7.3; p > 0.05), and Apnea-Hypopnea Index (AHI) under non-invasive ventilation, completed International Physical Activity Questionnaire (IPAQ), Short-Form Health Questionnaire (SF-36), Personal Well-Being (PWB) Scale and Hospital Anxiety and Depression Scale (HADS-A and HADS-D), in this cross-sectional study. RESULTS: Both groups had similar scores in SF-36, HADS-A and HADS-D, while prevalence of clinical cases of anxiety (HADS-A > 8) and depression (HADS-D > 8) were also similar. OSAS patients scored significantly higher in physical activity [absolute IPAQ values 1100.75(7753.5) for OSAS vs. 518(3806) for OHS; p = 0.029]. Group comparisons yielded significant differences in physical functioning (p < 0.05) and general health perceptions (p < 0.05), in favor of the OSAS group. CONCLUSION: Both syndromes significantly affect patients' quality of life and physical activity, with the burden being heavier for OHS patients. Daily physical activity seems to be more impaired among obese OHS patients perhaps due to daytime hypercapnia.

DE-PASS best evidence statement (BESt): determinants of adolescents' device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis.

BACKGROUND: Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings. METHODS: A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked. PROSPERO ID: CRD42021282874. RESULTS: Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found. CONCLUSIONS: Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables.

Towards Automating Personal Exercise Assessment and Guidance with Affordable Mobile Technology.

Physical activity (PA) offers many benefits for human health. However, beginners often feel discouraged when introduced to basic exercise routines. Due to lack of experience and personal guidance, they might abandon efforts or experience musculoskeletal injuries. Additionally, due to phenomena such as pandemics and limited access to supervised exercise spaces, especially for the elderly, the need to develop personalized systems has become apparent. In this work, we develop a monitored physical exercise system that offers real-time guidance and recommendations during exercise, designed to assist users in their home environment. For this purpose, we used posture estimation interfaces that recognize body movement using a computer or smartphone camera. The chosen pose estimation model was BlazePose. Machine learning and signal processing techniques were used to identify the exercise currently being performed. The performances of three machine learning classifiers were evaluated for the exercise recognition task, achieving test-set accuracy between 94.76% and 100%. The research methodology included kinematic analysis (KA) of five selected exercises and statistical studies on performance and range of motion (ROM), which enabled the identification of deviations from the expected exercise execution to support guidance. To this end, data was collected from 57 volunteers, contributing to a comprehensive understanding of exercise performance. By leveraging the capabilities of the BlazePose model, an interactive tool for patients is proposed that could support rehabilitation programs remotely.

Assessing Static Balance, Balance Confidence, and Fall Rate in Patients with Heart Failure and Preserved Ejection Fraction: A Comprehensive Analysis.

Chronic heart failure (CHF) is a complex clinical syndrome, associated with frailty, higher fall rates, and frequent hospitalizations. Heart Failure (HF) and preserved ejection fraction (HFpEF) is defined as a condition where a patient with HF have a diagnosis of left ventricular ejection fraction (LVEF) of ≥ 50%. The risk of HFpEF increases with age and is related to higher non-cardiovascular mortality. The aim of this study was to evaluate static balance and examine the effect of task difficulty on the discriminating power of balance control between patients with HFpEF (Patients with HFpEF) and their healthy controls. Moreover, the associations between static balance parameters, balance confidence, falls, lean muscle mass, and strength were assessed. Seventy two patients with HFpEF (mean age: 66.0 ± 11.6 years) and seventy two age- and gender-matched healthy individuals (mean age: 65.3 ± 9.5 years) participated in this study. Participants underwent a 30 s bilateral stance (BS) test and a 20 s Tandem-Romberg stance (TRS) on a force platform, evaluating the Range and Standard Deviation of Center of Pressure (COP) displacement parameters in both axes. Balance confidence was evaluated by the Activities-Specific Balance Confidence (ABC) Scale, and the number of falls during the last year was recorded. Lower limb strength was measured using an isokinetic dynamometer, isometric leg strength, and a Sit-to-Stand test. Bioelectrical impedance analysis was conducted to assess lean fat mass, lean fat mass index, and lean%. Patients with HFpEF presented with lower static balance in BS and TRS compared to healthy controls (p < 0.05), lower balance confidence by 21.5% (p < 0.05), and a higher incidence of falls by 72.9% (p < 0.05). BS was a better descriptor of the between-group difference. Furthermore, static balance, assessed in controlled lab conditions, was found to have little if no relationship to falls, strength, lean muscle mass, and balance confidence. Although no correlation was noted between the static balance parameters and falls, the fall rate was related to balance confidence, age, muscle strength, and lean fat.

Validity of the CALERA Research Sensor to Assess Body Core Temperature during Maximum Exercise in Patients with Heart Failure.

(1) Background: It is important to monitor the body core temperature (Tc) of individuals with chronic heart failure (CHF) during rest or exercise, as they are susceptible to complications. Gastrointestinal capsules are a robust indicator of the Tc at rest and during exercise. A practical and non-invasive sensor called CALERA Research was recently introduced, promising accuracy, sensitivity, continuous real-time analysis, repeatability, and reproducibility. This study aimed to assess the validity of the CALERA Research sensor when monitoring patients with CHF during periods of rest, throughout brief cardiopulmonary exercise testing, and during their subsequent recovery. (2) Methods: Twelve male CHF patients volunteered to participate in a 70-min protocol in a laboratory at 28 °C and 39% relative humidity. After remaining calm for 20 min, they underwent a symptom-limited stress test combined with ergospirometry on a treadmill, followed by 40 min of seated recovery. The Tc was continuously monitored by both Tc devices. (3) Results: The Tc values from the CALERA Research sensor and the gastrointestinal sensor showed no associations at rest (r = 0.056, p = 0.154) and during exercise (r = -0.015, p = 0.829) and a weak association during recovery (r = 0.292, p < 0.001). The Cohen's effect size of the differences between the two Tc assessment methods for rest, exercise, and recovery was 1.04 (large), 0.18 (none), and 0.45 (small), respectively. The 95% limit of agreement for the CALERA Research sensor was -0.057 ± 1.03 °C. (4) Conclusions: The CALERA sensor is a practical and, potentially, promising device, but it does not provide an accurate Tc estimation in CHF patients at rest, during brief exercise testing, and during recovery.

Needs, barriers and facilitators for a healthier lifestyle in haemodialysis patients: The GoodRENal project.

BACKGROUND: Malnutrition, sedentary lifestyle, cognitive dysfunction and poor psychological well-being are often reported in patients on haemodialysis (HD). AIMS: We aimed to explore needs, barriers and facilitators-as perceived by patients, their carers, and healthcare professionals (HCPs) for increasing the adherence to the diet, to physical activity and cognition and psychological well-being. METHODS: This is an observational cross-sectional study following the STROBE statement. This study is part of an ERASMUS+ project, GoodRENal-aiming to develop digital tools as an educational approach to patients on HD. For that, the GoodRENal comprises HD centers located in four Belgium, Greece, Spain and Sweden. Exploratory questionnaires were developed regarding the perceived needs, barriers and facilitators regarding the diet, physical activity, cognition and psychological well-being from the perspective of patients, their carers and HCPs. RESULTS: In total, 38 patients, 34 carers and 38 HCPs were included. Nutrition: For patients and carers, the main needs to adhere to the diet included learning more about nutrients and minerals. For patients, the main barrier was not being able to eat what they like. Physical activity: As needs it was reported information about type of appropriate physical activity, while fatigue was listed as the main barrier. For Cognitive and emotional state, it was perceived as positive for patients and carers perception but not for HCPs. The HCPs identified as needs working as a team, having access to specialised HCP and being able to talk to patients in private. CONCLUSIONS: Patients and their carers listed as needs guidance regarding nutrition and physical activity but were positive with their cognitive and emotional state. The HCPs corroborated these needs and emphasised the importance of teamwork and expert support.

European Society of Organ Transplantation (ESOT) Consensus Statement on Prehabilitation for Solid Organ Transplantation Candidates.

There is increasingly growing evidence and awareness that prehabilitation in waitlisted solid organ transplant candidates may benefit clinical transplant outcomes and improve the patient's overall health and quality of life. Lifestyle changes, consisting of physical training, dietary management, and psychosocial interventions, aim to optimize the patient's physical and mental health before undergoing surgery, so as to enhance their ability to overcome procedure-associated stress, reduce complications, and accelerate post-operative recovery. Clinical data are promising but few, and evidence-based recommendations are scarce. To address the need for clinical guidelines, The European Society of Organ Transplantation (ESOT) convened a dedicated Working Group "Prehabilitation in Solid Organ Transplant Candidates," comprising experts in physical exercise, nutrition and psychosocial interventions, to review the literature on prehabilitation in this population, and develop recommendations. These were discussed and voted upon during the Consensus Conference in Prague, 13-15 November 2022. A high degree of consensus existed amongst all stakeholders including transplant recipients and their representatives. Ten recommendations were formulated that are a balanced representation of current published evidence and real-world practice. The findings and recommendations of the Working Group on Prehabilitation for solid organ transplant candidates are presented in this article.

The Effects of a Visual Stimuli Training Program on Reaction Time, Cognitive Function, and Fitness in Young Soccer Players.

The purpose of the present study was to examine whether a visual stimuli program during soccer training can affect reaction time (RT), cognitive function, and physical fitness in adolescent soccer players. Thirty-eight male soccer players aged 10−15 were randomly assigned to either the intervention (Group A) or the control group (Group B). At baseline and at the end of the 6-month study FITLIGHT Trainer, the Cognitive Function Scanner Mobile Test Suite, a Virtual Reality (VR) game, and the ALPHA­Fitness and the Eurofit test batteries were used to measure participants' abilities. After the baseline assessment, Group A followed their regular soccer training combined with a visual stimuli program, while Group B continued their regular soccer training program alone for 6 months. At the end of the 6-month study, Group A showed statistically significant improvements in simple RT by 11.8% (p = 0.002), repeated sprints by 13.4% (p ≤ 0.001), and Pen-to-Point Cognitive Function by 71.62% (p < 0.001) and 72.51% for dominant and non-dominant hands, respectively. However, a between-groups analysis showed that there was no statistically significant difference between the two groups in most of the measurements studied. In conclusion, a visual stimuli training program does not seem to add any value to the traditional soccer training program for adolescents. Nevertheless, this study helps to underline the potential of newly emerging technology as a tool for the assessment of RT.

Effects of a Long-Term Wearable Activity Tracker-Based Exercise Intervention on Cardiac Morphology and Function of Patients with Cystic Fibrosis.

Several studies have shown that patients with cystic fibrosis (CF), even at a young age, have pulmonary and cardiac abnormalities. The main complications are cardiac right ventricular (RV) systolic and/or diastolic dysfunction and pulmonary hypertension, which affects their prognosis. Exercise training (ET) is recommended in patients with CF as a therapeutic modality to improve physical fitness and health-related quality of life. However, questions remain regarding its optimal effective and safe dose and its effects on the patients' cardiac function. The study aimed to provide a wearable activity tracker (WAT)-based ET to promote physical activity in CF patients and assess its effects on cardiac morphology and function. Forty-two stable CF individuals (aged 16.8 ± 3.6 years) were randomly assigned to either the intervention (Group A) or the control group (Group B). Group A participated in a 1-year WAT-based ET program three times per week. All patients underwent a 6-min walking test (6-MWT) and an echocardiographic assessment focused mainly on RV anatomy and function at the baseline and the end of the study. RV systolic function was evaluated by measuring the tricuspid annular plane systolic excursion (TAPSE), the systolic tricuspid annular velocity (TVS'), the RV free-wall longitudinal strain (RVFWSL), and the right ventricular four-chamber longitudinal strain (RV4CSL). RV diastolic function was assessed using early (TVE) and late (TVA) diastolic transtricuspid flow velocity and their ratio TVE/A. Pulmonary artery systolic pressure (PASP) was also estimated. In Group A after ET, the 6MWT distance improved by 20.6% (p < 0.05), TVA decreased by 17% (p < 0.05), and TVE/A increased by 13.2% (p < 0.05). Moreover, TAPSE, TVS', RVFWSL, and RV4CSL increased by 8.3% (p < 0.05), 9.0% (p < 0.05), 13.7% (p < 0.05), and 26.7% (p < 0.05), respectively, while PASP decreased by 7.6% (p < 0.05). At the end of the study, there was a significant linear correlation between the number of steps and the PASP (r = −0.727, p < 0.01) as well as the indices of RV systolic function in Group A. In conclusion, WAT is a valuable tool for implementing an effective ET program in CF. Furthermore, ET has a positive effect on RV systolic and diastolic function.

Arterial Function after a 246 km Ultra-marathon Running Race.

There is little research about the effects of ultra-endurance exercise on arterial morphological and functional properties. The aim was to assess the acute changes of the carotid-femoral pulse wave velocity and carotid doppler-derived parameters following an ultra-marathon race as well as the intima-media thickness of the carotid artery in ultra-marathon runners. Twenty athletes were examined at baseline and within 10 mins after a 246 km running race. Measurements included carotid-femoral pulse wave velocity, peak-systolic and end-diastolic velocities of carotid artery blood flow, pulsatility and resistivity indices and blood biochemical parameters. The intima-media thickness of the right and left carotid artery was measured before the race. Arterial stiffness and carotid artery intima media thickness at rest remained within known normal limits. The ultra-marathon race significantly increased carotid-femoral pulse wave velocity by 22.6% and pulsatility index by 10.2%. There was a decrease in body weight by 3.35% and an increase of all biochemical markers of muscle damage after the race. Additionally, C-reactive protein was correlated with both pulsatility and resistivity indices post-race. This study shows that immediately after a 246 km ultra-marathon running race, acute increase of arterial stiffness and vascular resistance were evident. The carotid artery thickness of ultra-marathon runners was within normal range.

"OPTImAL": an ontology for patient adherence modeling in physical activity domain.

BACKGROUND: Maintaining physical fitness is a crucial component of the therapeutic process for patients with cardiovascular disease (CVD). Despite the known importance of being physically active, patient adherence to exercise, both in daily life and during cardiac rehabilitation (CR), is low. Patient adherence is frequently composed of numerous determinants associated with different patient aspects (e.g., psychological, clinical, etc.). Understanding the influence of such determinants is a central component of developing personalized interventions to improve or maintain patient adherence. Medical research produced evidence regarding factors affecting patients' adherence to physical activity regimen. However, the heterogeneity of the available data is a significant challenge for knowledge reusability. Ontologies constitute one of the methods applied for efficient knowledge sharing and reuse. In this paper, we are proposing an ontology called OPTImAL, focusing on CVD patient adherence to physical activity and exercise training. METHODS: OPTImAL was developed following the Ontology Development 101 methodology and refined based on the NeOn framework. First, we defined the ontology specification (i.e., purpose, scope, target users, etc.). Then, we elicited domain knowledge based on the published studies. Further, the model was conceptualized, formalized and implemented, while the developed ontology was validated for its consistency. An independent cardiologist and three CR trainers evaluated the ontology for its appropriateness and usefulness. RESULTS: We developed a formal model that includes 142 classes, ten object properties, and 371 individuals, that describes the relations of different factors of CVD patient profile to adherence and adherence quality, as well as the associated types and dimensions of physical activity and exercise. 2637 logical axioms were constructed to comprise the overall concepts that the ontology defines. The ontology was successfully validated for its consistency and preliminary evaluated for its appropriateness and usefulness in medical practice. CONCLUSIONS: OPTImAL describes relations of 320 factors originated from 60 multidimensional aspects (e.g., social, clinical, psychological, etc.) affecting CVD patient adherence to physical activity and exercise. The formal model is evidence-based and can serve as a knowledge tool in the practice of cardiac rehabilitation experts, supporting the process of activity regimen recommendation for better patient adherence.

Relationships between abdominal aortic calcification, glomerular filtration rate, and cardiovascular risk factors in patients with non-dialysis dependent chronic kidney disease
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BACKGROUND: Abdominal aortic calcification (AAC) is an established risk factor for cardiovascular events in patients with chronic kidney disease (CKD). We hypothesized that AAC is associated with a decline in glomerular filtration rate (GFR) as well as with some other cardiovascular risk factors. MATERIALS AND METHODS: This is a cross-sectional analysis of baseline data from a randomized controlled clinical trial (RENEXC). A total of 151 patients (aged 66 ± 14 years) with an average measured GFR (mGFR) of 22.5 ± 8.2 mL/min/1.73m2, not on renal replacement therapy, irrespective of number of comorbidities, were included. GFR was measured with iohexol clearance and estimated using cystatin C- and creatinine-based equations (eGFR). AAC was evaluated with lateral lumbar X-ray using the scoring system described by Kauppila. All patients underwent laboratory analyses, 24-hour ambulatory blood pressure monitoring, and standard echocardiography. Multiple linear regression analyses controlling for sex, age, cardiovascular comorbidities, and hypertension were performed. RESULTS: The prevalence of AAC in this group of patients was 73%, and 47% had severe calcification (AAC score ≥ 7). More men (76%) had AAC than women (69%). AAC score was associated with mGFR (p = 0.03), eGFR (p = 0.006), plasma albumin (p = 0.006), plasma phosphate (p = 0.01), pulse pressure (p = 0.004), left ventricular mass (LVM) (p = 0.02), left atrial volume (LAV; p < 0.001), and left atrial volume index (LAVI; p = 0.001). CONCLUSION: AAC was highly prevalent in CKD. The degree of calcification in the abdominal aorta was strongly associated with a decline in GFR, a decrease in plasma albumin, an increase in plasma phosphate, an increase in pulse pressure, and cardiac structural changes, such as an increase in LVM, LAV, and LAVI.
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Relationship between declining glomerular filtration rate and measures of cardiac and vascular autonomic neuropathy.

AIM: Cardiac and vascular autonomic neuropathy contributes to increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to analyze the effects of a decline in glomerular filtration rate (GFR) on heart rate variability (HRV) and nocturnal blood pressure dipping. METHODS: This cross-sectional study comprises 124 patients (46 women, 78 men; age 66 ± 14 years) with chronic kidney disease (CKD) 3-5, not on renal replacement therapy. GFR was measured with iohexol clearance, HRV with 24 h Holter electrocardiogram (ECG) and nocturnal dipping with 24 hour ambulatory blood pressure. RESULTS: The GFR was 22.5 ± 8.5 mL/min per 1.73 m2 . The main finding was a significant curvilinear association between the 24 h standard deviation of NN interval (24SDNN) in the HRV analysis and GFR (P = 0.01), logGFR (P = 0.006), diabetes mellitus (P = 0.05) and beta blocker treatment (0.03), respectively. The effect of diabetes mellitus on 24SDNN corresponded to a decline in GFR from 30 to 12 mL/min per 1.73 m2 . There were significant curvilinear associations between systolic nocturnal dipping (P = 0.02) and diastolic nocturnal dipping (P = 0.05), respectively, and diabetes mellitus but not with GFR or logGFR. CONCLUSION: In conclusion, cardiac sympathetic overdrive and decreased vagal control appear during CKD 4 and 5. The association with GFR is curvilinear. Diabetes mellitus was significantly associated with both cardiac and vascular autonomic neuropathy, as measured by heart rate variability and nocturnal blood pressure dipping, respectively. Knowing that arrhythmias, often due to sympathetic hyperactivity, are an important cause of sudden death in the dialysis population, this study contributes important knowledge on possible intervention thresholds.

Effect of Moderate Aerobic Exercise Training on Endothelial Function and Arterial Stiffness in CKD Stages 3-4: A Randomized Controlled Trial.

BACKGROUND: Evidence of a beneficial effect of exercise training on mediators of vascular disease is accumulating in chronic kidney disease (CKD), but its effect on vascular function in vivo still has to be established. The present study was designed to investigate whether a formal aerobic exercise training program improves peripheral endothelial function in patients with CKD stages 3 to 4. STUDY DESIGN: Randomized controlled trial with a parallel-group design. SETTING & PARTICIPANTS: 48 patients with CKD stages 3 to 4 without established cardiovascular disease were randomly assigned to either an exercise training program or usual care. 40 patients completed the study (exercise training, 19; usual care, 21). INTERVENTION: The 3-month home-based aerobic training program consisted of 4 daily cycling sessions of 10 minutes each at a target heart rate, calculated as 90% of the heart rate achieved at the anaerobic threshold. Patients in the usual-care group were given standard therapy. OUTCOMES: The primary outcome was peripheral endothelial function. Secondary outcomes were aerobic capacity, arterial stiffness, numbers of endothelial (EPCs) and osteogenic progenitor cells (OPCs), migratory function of circulatory angiogenic cells, and health-related quality of life. MEASUREMENTS: Endothelial function was assessed with flow-mediated dilation of the brachial artery, aerobic capacity by peak oxygen uptake (VO(2peak)), arterial stiffness by carotid-femoral pulse wave velocity, numbers of EPCs and OPCs by flow cytometry, circulatory angiogenic cell function by an in vitro migratory assay, and quality of life by the Kidney Disease Quality of Life-Short Form questionnaire. RESULTS: Exercise training significantly improved VO(2peak) and quality of life, but not in vivo vascular function (flow-mediated dilation and carotid-femoral pulse wave velocity) or cellular markers for vascular function (EPC and OPC count and circulatory angiogenic cell migratory function). LIMITATIONS: Short duration and intermittent nature of the exercise intervention. CONCLUSIONS: In patients with CKD stages 3 to 4 without overt cardiovascular disease, 3 months of aerobic exercise training improved VO(2peak) and quality of life, without altering endothelial function or arterial stiffness.

Functional and psychosocial effects of either a traditional dancing or a formal exercising training program in patients with chronic heart failure: a comparative randomized controlled study.

OBJECTIVE: To compare the effects of traditional dancing with formal exercise training in terms of functional and cardiovascular benefits and motivation in patients with chronic heart failure. DESIGN: Randomized controlled trial. SETTING: Sports Medicine Laboratory. SUBJECTS: Fifty-one Greek male patients aged 67.1±5.5 years with chronic heart failure of New York Heart Association (NYHA) class II-III, participated in an eight-month study. INTERVENTIONS: They were randomly assigned to either training with Greek traditional dances (group A, n=18), formal exercise training (group B, n=16) or a sedentary control group (group C, n=17). MAIN MEASURES: At entry and the end of the study all patients underwent cardiopulmonary exercise testing, functional ability assessment and quality of life evaluations. The Intrinsic Motivation Inventory was also used to assess participants' subjective experience. RESULTS: After training group A showed increased peak oxygen consumption by 33.8% (19.5 vs. 26.1 ml/kg/min, p<0.05) and B by 32.3% (19.5 vs. 25.8 ml/kg/min, p<0.05), maximal treadmill tolerance by 48.5% (p<0.05) and by 46.4% (p<0.05), and a decreased Slope of expired minute ventilation for carbon dioxide output (VE/VCO2) slope by 18% (p<0.05) and 19.5% (p<0.05), respectively. Trained patients revealed significant improvement in the quality of life indices. Intrinsic Motivation Inventory was increased only in group A by 26.2% (3.08 vs. 3.87, p<0.05). CONCLUSIONS: Exercise training in chronic heart failure patients with Greek traditional dances led to functional and cardiovascular benefits similar to formal exercise training and to a higher level of motivation.

Electrocardiographic characteristics of pediatric and adolescent football players.

Electrocardiographic characteristics of children and adolescents present differences compared to adults. The aim of our work was to study electrocardiograms (ECGs) of football male players from childhood to late adolescence and examine if the ECG parameters are influenced by systematic exercise. One thousand fifty-four football players participated and formed four groups. Group A included 89 players aged 5-7 years, group B 353 players aged 8-11 years, group C consisted of 355 football players 12-15 yearsold and group D of 257 players with 16-18 years of age. All participants underwent preparticipation screening, including 12-lead surface ECG. Heart rate (HR), PR, RR, QRS, QT, QTc intervals, QT dispersion (QTdisp) and QRS axis were calculated. All ECGs were evaluated according to the current preparticipation cardiac screening guidelines, that refer to athletes aged 12-35 years and do not include pediatric players. Eleven percent of the participants presented an ECG finding. Group D obtained the lowest values of HR, QTc and the highest of PR, RR, QRS, QT intervals and QTdisp, whereas no differences in QRS axis were reported. Incomplete Right Bandle Branch Block (RBBB) was the most frequent ECG peculiarity, detected in 7.3% of the participants. Years of training were statistically significantly correlated to HR, PR, RR, QRS and QT intervals. In conclusion, guidelines for ECG interpretation of athletes in childhood, early and late adolescence are needed.

Unraveling of Molecular Mechanisms of Cognitive Frailty in Chronic Kidney Disease: How Exercise Makes a Difference.

As our population ages, the medical challenges it faces become increasingly acute, with chronic kidney disease (CKD) becoming more prevalent among older adults. Frailty is alarmingly more common in CKD patients than in the general populace, putting the elderly at high risk of both physical and cognitive decline. CKD not only accelerates physical deterioration, but also heightens vascular dysfunction, calcification, arterial rigidity, systemic inflammation, oxidative stress, and cognitive impairment. Cognitive frailty, a distinct syndrome marked by cognitive deficits caused by physiological causes (excluding Alzheimer's and other dementias), is a critical concern. Although cognitive impairment has been well-studied, the molecular mechanisms driving cognitive frailty remain largely uncharted. Comprehensive interventions, including cutting-edge pharmaceuticals and lifestyle changes, are pivotal and effective, especially in the early stages of CKD. Recent research suggests that systematic exercise could counteract cognitive decline by improving brain blood flow, boosting neuroplasticity through the brain-derived neurotrophic factor (BDNF), and by triggering the release of neurotrophic factors such as insulin-like growth factor (IGF-1). This review delves into the molecular pathways of cognitive frailty in CKD, identifies key risk factors, and highlights therapeutic approaches, particularly the potent role of exercise in enhancing cognitive health.

Exploring the feasibility, acceptability, and safety of a real-time cardiac telerehabilitation and tele coaching programme using wearable devices in people with a recent myocardial infarction.

BACKGROUND: Cardiac rehabilitation (CR) constitutes the recommended nonpharmacological approach for cardiac patients with cardiovascular disease such as people following a recent (i.e., < 4 week) myocardial infarction (MI). Recent evidence suggests that cardiac telerehabilitation may be as effective as traditional (i.e., in person) CR in people following a recent MI. Nevertheless, the feasibility, acceptability, and safety of such an exercise programme has yet to be examined. METHODS: Forty-four (11 women, 33 men) people following a recent MI were randomly allocated into two groups (online home-based and gym-based groups). The groups underwent a 24-week CR programme thrice per week. All patients performed the baseline, and 24 weeks follow up measurements where feasibility, acceptability, and safety were assessed. RESULTS: Eligibility and recruitment rates were found to be 61.5% and 42%, respectively. Compliance to the thrice weekly, 24-week exercise programme for the online- and gym-based groups were 91.6% and 90.9%, respectively. There were no dropouts during the exercise programmes, however four participants, two from each group, were lost to follow up at 6 months. The average percentage of peak HR (% HRpeak) for the online group was 66.6% ± 4.5 and for the gym-based group was 67.2% ± 5. The average RPE and affect during exercise was for both groups 12 ± 1 ("somewhat hard") and 3 ± 1 ("good"), respectively. During the 6-month exercise intervention period for both groups, the exercise-induced symptoms were minimal to none. The user suitability evaluation questionnaire revealed that the online real time telerehabilitation and tele coaching programme was enjoyable (4.85 ± 0.37) and did not induce general discomfort (1.20 ± 0.41). CONCLUSION: Our cardiac telerehabilitation programme seems to be feasible, acceptable, safe, and enjoyable for people with a recent MI. Our participants had an overall positive experience and acceptability of the cardiac telerehabilitation and tele coaching using wearable devices. TRIAL REGISTRATION: ClinicalTrial.gov, ID NCT06071273, 10/02/2023, retrospectively registered.

The Attitudes of Patients with Cardiovascular Diseases towards Online Exercise with the Mobile Monitoring of Their Health-Related Vital Signs.

The health care cost of cardiovascular diseases (CVD) in the EU is estimated to be today over 282 billion euros. It is well documented today that exercise training is one of the main strategies for secondary disease prevention and the follow-up integration of these patients. This study aimed to examine patients' attitudes towards online exercise with mobile monitoring of their vital signs. More specifically, the research objectives were as follows: (a) to examine patients' attitudes and expectations of online exercise, (b) cluster patients in high- and low-attitude groups and examine their intention to participate in online exercise, and (c) to examine age and gender differences in terms of their intention to exercise online. The final goal of this project was to develop a real application that could be of use to patients and professionals. Data were collected from fifty patients in the city of Thessaloniki, Greece. The results revealed that most patients were positive about exercising online if the programs were perceived as fun and, especially, safe. The use of an online monitoring application with the distant supervision of health professionals could both motivate them and strengthen their feeling of safety.

Head and neck cooling enhance exercise tolerance in individuals with multiple sclerosis.

BACKGROUND: Individuals with Multiple Sclerosis (MS) experience impairments in heat dissipation, compromising core temperature regulation during exercise. OBJECTIVE: To examine the efficacy of combined head-and-neck cooling as administered via a commercially available cooling cap and neck wrap in mitigating increases in core temperature during exercise. METHODS: On separate days, ten (7 females) adults (46.1 ± 11.6 years) with relapsing-remitting MS performed semi-recumbent cycling consisting of an incremental exercise bout to volitional fatigue in a temperate environment (23 °C, 50 % relative humidity) while undergoing head-and-neck cooling using a cooling cap and neck wrap maintained at 10 °C (COLD) or 24-26 °C (NEUTRAL). Prior to and following a 30-minute post-exercise recovery, functional capacity was assessed by a battery of tests consisting of a 2-minute walk test, Timed 25-Foot Walk test, sit-to-stand test, and Berg Balance Scale. Core (ingestible pill) and skin temperatures were recorded continuously. The level of fatigue was measured with questionnaires. RESULTS: The duration of the incremental exercise test increased with the application of COLD (28.4 ± 5.1 min) versus NEUTRAL water (vs 20.8 ± 5.1 min) (p = 0.001) and was paralleled by a significant reduction in body temperatures (∼1 °C, p < 0.05). The distance covered during the 2-min walk test performed after the incremental exercise test increased with the COLD (176.5 ± 0.6 m), relative to the NEUTRAL condition (147.7 ± 43.5 m) (p = 0.01). Fatigue levels did not change between conditions. CONCLUSION: We show that head-and-neck cooling with cold water effectively enhances exercise tolerance and mitigates increases in core temperature during exercise in individuals with MS.