Effect of an Exergaming-Based Dance Training Paradigm on Autonomic Nervous System Modulation in Healthy Older Adults: A Randomized Controlled Trial.

The purpose of this study was to determine if an exergaming-based dance training protocol can improve heart rate variability (HRV) in healthy older adults. A total of 20 healthy older adults (≥65 years old) were randomly assigned to two groups. The intervention group received an exergaming-based dance aerobic training for 6 weeks, while the control group received a 1-hr education on conventional physical exercises. Data obtained from HRV analysis pre- (Week 0) and postintervention (Week 7) consisted of high-frequency power, low- and high-frequency ratio, and root mean square of differences and percentage of adjacent RR intervals with a difference of duration greater than 50 ms values. HRV was assessed during rest and during a 6-min walk test. In addition, the YMCA submaximal cycle ergometer test was used to acquire estimated maximal O2 consumption pre- and postintervention. After the training, the intervention group showed significant improvement in HRV high-frequency power, root mean square of differences, and percentage of adjacent RR intervals with a difference of duration greater than 50 ms values in both rest and 6-min walk test conditions compared with the control group. Similarly, the intervention group showed higher maximal O2 consumption compared with the control group after the training. Our results support the effectiveness of an exergaming-based dance aerobic training on improving cardiac autonomic control in aging.

Vascular responsiveness measured by tissue oxygen saturation reperfusion slope is sensitive to different occlusion durations and training status.

What is the central question of this study? Is the near-infrared spectroscopy-derived measure of tissue oxygen saturation (StO2) reperfusion slope sensitive to a range of ischaemic conditions, and do differences exist between trained and untrained individuals? What is the main finding and its importance? The StO2 reperfusion rate is sensitive to different occlusion durations, and changes in the reperfusion slope in response to a variety of ischaemic challenges can be used to detect differences between two groups. These data indicate that near-infrared spectroscopy-derived measures of StO2, specifically the reperfusion slope following a vascular occlusion, can be used as a sensitive measure of vascular responsiveness. The reperfusion rate of near-infrared spectroscopy-derived measures of tissue oxygen saturation (StO2) represents vascular responsiveness. This study examined whether the reperfusion slope of StO2 is sensitive to different ischaemic conditions (i.e. a dose-response relationship) and whether differences exist between two groups of different fitness levels. Nine healthy trained (T; age 25 ± 3 years; maximal oxygen uptake 63.4 ± 6.7 ml kg-1  min-1 ) and nine healthy untrained men (UT; age 21 ± 1 years; maximal oxygen uptake 46.6 ± 2.5 ml kg-1  min-1 ) performed a series of vascular occlusion tests of different durations (30 s, 1, 2, 3 and 5 min), each separated by 30 min. The StO2 was measured over the tibialis anterior using near-infrared spectroscopy, with the StO2 reperfusion slope calculated as the upslope during 10 s following cuff release. The reperfusion slope was steeper in T compared with UT at all occlusion durations (P < 0.05). For the T group, the reperfusion slopes for 30 s and 1 min occlusions were less than for all longer durations (P < 0.05). The reperfusion slope following 2 min occlusion was similar to that for 3 min (P > 0.05), but both were less steep than for 5 min of occlusion. In UT, the reperfusion slope at 30 s was smaller than for all longer occlusion durations (P < 0.05), and 1 min occlusion resulted in a reperfusion slope that was less steep than following 2 and 3 min (P < 0.05), albeit not different from 5 min (P > 0.05). The present study demonstrated that the reperfusion rate of StO2 is sensitive to different occlusion durations, and that changes in the reperfusion rate in response to a variety of ischaemic challenges can be used to detect differences in vascular responsiveness between trained and untrained groups.

Endurance training is feasible in severely disabled patients with progressive multiple sclerosis.

This study tested whether upper-body endurance training (ET) is feasible and can be performed at sufficient intensity to induce cardiovascular adaptations in severely disabled patients with progressive multiple sclerosis (MS). Eleven progressive MS patients (6.5 ≤ EDSS ≤ 8.0) scheduled for a four-week inpatient rehabilitation program were randomized to a control group (CON, n = 5) that received standard individualized MS rehabilitation or an intervention group (EXE, n = 6) that in addition received 10 sessions of predominantly upper-body ET. One patient dropped out of the EXE group (drop-out rate: 1/6~17%) and no adverse events were recorded. The EXE group completed on average 9.3±0.8 sessions (~96.0±5%). During the ET sessions an average heart rate of 93.9±9.3beats*min(-1) were sustained corresponding to 91.6±6.8% of the maximal pre-intervention heart rate. In the EXE group a trend toward a time*group interaction was seen for VO2peak (p = 0.06). ET is feasible in severely disabled patients with progressive MS and it can probably be performed at sufficient intensity to induce cardiovascular adaptations.

Effect of Cardiovascular Endurance Training on the Exercise Capacity and Endurance in Children With Cerebral Palsy.

BACKGROUND: Cerebral palsy (CP) is non-progressive brain damage that occurs before, during, or shortly after birth. CP is associated with poor physical fitness, which is linked to health problems and the development of secondary illnesses like obesity, cardiovascular disease, and diabetes. Compared to healthy peers without CP, children with CP have considerably lower VO2 peaks, which reduces their performance and aerobic capacity. OBJECTIVE: This study aimed to evaluate changes in exercise capacity and endurance among children with CP, as well as fatigue levels among their parents and caregivers, after participation in cardiovascular endurance training. METHODOLOGY: This study included 16 children aged 7-12 years with CP (Gross Motor Function Classification System levels I, II, or III). Participants completed a 12-week cardiovascular endurance program consisting of 60-minute sessions three times weekly designed to achieve 64-95% of their heart rate maximum,based on the American College of Sports Medicine guidelines. Pre- and post-intervention measurements were recorded for the following: distance covered in a six-minute walk, maximal oxygen consumption (VO2 max) level, Early Activity Scale for Endurance rating, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Fatigue Scale score and PROMIS Parent Proxy Scale and Fatigue Scale scores.  Result: Upon completing the cardiovascular endurance training, the distance covered during a six-minute walk improved by 20.95 points, resting heart rate by 5.19 points, VO2 max by 0.06 points, Early Activity Scale for Endurance by 4.06 points, PROMIS Pediatric Fatigue Scale by 7.29 points, PROMIS Parent Proxy Scale by 6.81 points, and PROMIS Fatigue Scale by 5.07 points. The maximum heart rate also showed a slight improvement of 0.33 points (p<0.01). CONCLUSION: A structured exercise protocol aimed at improving cardiovascular endurance can benefit children with CP by improving their exercise capacity and endurance, which in turn can help decrease fatigue levels among their parents and caregivers.

Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exercise.

BACKGROUND: Heat sensitivity (HS) is reported by 58% of all persons with multiple sclerosis (MS), causing symptom exacerbation possibly limiting exercise participation. OBJECTIVE: The purpose of this study was to test the hypotheses that (a) a relationship between exercise-induced changes in core-temperature (C(temp)) and changes in symptom intensity exists, and (b) that resistance exercise (RE), as a consequence of a minor increase in core temperature, will induce a lesser worsening of symptoms than endurance exercise (EE) in HS persons with MS. METHODS: On two separate days, 16 HS persons with MS randomly completed a session of RE and EE, or EE and RE, respectively. Testing was conducted pre, post and one hour after exercise and consisted of Visual Analogue Scale (VAS) scoring (fatigue, spasticity, pain, strength, walking and balance), the 5-time sit-to-stand (5STS), the Multiple Sclerosis Functional Composite (MSFC) and Body Sway. Composite scores describing average subjective symptom intensity (SI) and total number of symptoms (SN) were calculated from VAS scores. RESULTS: C(temp) (0.9±0.4°C vs 0.3±0.1°C, p<0.001), SI (1.7±1.9 cm vs 0.6±1.5 cm, p<0.05) and SN (1.6±1.9 vs 0.6±2.1, p<0.05) increased significantly more during EE than RE. Changes in C(temp) correlated to changes in SI (r=0.50, p<0.01). No differences were observed in 5STS, MSFC and Body Sway scores after EE when compared to RE. CONCLUSION: An exercise-induced increase in C(temp) is associated with increased number and severity of perceived symptoms in HS persons with MS. Based on these findings it is expected that HS persons with MS do tolerate RE better than EE.

Impact of Virtual Interviewing on Geographic Placement for Cardiology Fellowship Recruitment.

Background Virtual interviewing for cardiology fellowship was instituted in the 2021 fellowship application cycle because of the COVID-19 pandemic and restricted travel. The impact on geographic patterns of fellow-training program matching is unknown. This study sought to determine if there was a difference in geographic placement of matched fellows for cardiology fellowship match after initiation of virtual interviews compared with in-person interviewing. Methods and Results All US-based accredited cardiovascular disease fellowship programs that participated in the 2019 to 2021 fellowship match cycles and had publicly available data with fellowship and residency training locations and training year were included. Each fellow was categorized based on whether their fellowship and residency programs were in the same institution, same state, same US census region, or different census region. Categories were mutually exclusive. Of 236 eligible programs, 118 (50%) programs were identified, composed of 1787 matched fellows. Compared with the previrtual cohort (n=1178 matched fellows), there was no difference in the geographic placement during the 2021 virtual cycle (n=609 matched fellows) (P=0.19), including the proportion matched at the same program (30.6% versus 31.5%), same state but different program (13% versus 13.8%), same region but different state (24.2% versus 19.7%), or different region (35% versus 33.1%). There was also no difference when stratified by program size or geographic region. Conclusions The use of virtual interviewing in the 2021 cardiology fellowship application cycle showed no significant difference in the geographic placement of matched fellows compared with in-person interviewing. Further study is needed to evaluate the impact of virtual interviewing and optimize its use in fellowship recruitment.

[First data from a digital health app for erectile dysfunction]. / Erste Daten aus einer digitalen Gesundheits-App für Erektionsstörungen.

PURPOSE: In a systematic data analysis, we evaluated the influence of a digital health app on erection scores as well as life quality and patient activation in a group of patients with erectile dysfunction. METHODS: In all, 44 participants took part in an evidence-based program for patients with erectile dysfunction. The in app 12-week program included pelvic floor exercises and physiotherapeutic and cardiovascular training. In addition, there where sessions on mindfulness and sexual therapy as well as useful information about erectile dysfunction and its causes, nutrition, and risk factors. The median age was 46 years (19-75 years). All patients answered IIEF­5, PAM-13 and QoL-Med questionnaires at the beginning and the end of the program. A total of 27 questionnaires could be evaluated at both times. RESULTS: The average improvement in IIEF­5 score was 4.5 points (p < 0.0001). 96% of patients showed overall improvement of erection scores. Improvement in life quality was shown in 93% of participants. Moreover, there was a significant increase in patient activation scores. CONCLUSION: We were able to show that a multimodal digital app for self-management of erectile dysfunction improved not only erection scores but also life quality and patient activation. We concluded that it is possible to reproduce results of analog studies in a digital setting. Digital solutions can help to include patients in their treatment and to put guideline suggestions into practice.

The Pandemic and Beyond: Innovation in Cardiovascular Training to Improve Quality of Education and Trainees' Well-being.

During the first 2 years of the coronavirus-19 pandemic, many changes and innovations occurred to overcome the challenges associated with the pandemic and improve cardiovascular training. This review highlights the literature on the pandemic response regarding cardiovascular fellowship education and identifies areas of need to ensure future opportunities for fellows to achieve competency and career advancement. Specifically, we describe the recent changes to the four cornerstones of cardiovascular training: core content education, procedural training, career development, and the well-being of trainees.

Heart Rate Variability During Physical Exercise Is Associated With Improved Cognitive Performance in Alzheimer's Dementia Patients-A Longitudinal Feasibility Study.

Heart rate variability (HRV) rapidly gains attention as an important marker of cardiovascular autonomic modulation. Moreover, there is evidence for a link between the autonomic deficit measurable by reduced HRV and the hypoactivity of the cholinergic system, which is prominently affected in Alzheimer's disease (AD). Despite the positive influence of physical exercise on cognition and its promising association with HRV, previous studies did not explore the effect of long-term physical exercise in older adults with AD. Taking advantage of a longitudinal study we analyzed the effect of a 20-week dual task training regime (3 × 15-min per week) on the vagal mediated HRV index RMSSD (root mean square of successive RR interval differences) during physical exercise and the short-term memory performance in a AD cohort (N = 14). Each training contained physical exercise on a bicycle ergometer while memorizing 30 successively presented pictures as well as the associated post-exercise picture recognition memory test. Linear-mixed modeling revealed that HRV-RMSSD significantly increased over the intervention time. Moreover, the reaction time in the picture recognition task decreased while the accuracy remained stable. Furthermore, a significantly negative relationship between increased fitness measured by HRV-RMSSD and decreased reaction time was observed. This feasibility study points to the positive effects of a dual task regime on physical and cognitive fitness in a sample with impaired cognitive performance. Beyond this, the results show that the responsiveness of parasympathetic system as measured with HRV can be improved in patients with dementia.

Program Directors Survey on Diversity in Cardiovascular Training Programs.

BACKGROUND: Women and minorities are under-represented in cardiovascular disease (CVD) specialties. It remains unknown how characteristics of the CVD learning environment affect diversity and how program directors (PDs) approach these critical issues. OBJECTIVES: The second annual Cardiovascular PD Survey aimed to investigate characteristics of the CVD learning environment that may affect diversity and strategies PDs use to approach these issues. METHODS: The survey contained 20 questions examining U.S.-based CVD PD perceptions of diversity in CVD and related characteristics of the CVD fellowship learning environment. RESULTS: In total, 58% of PDs completed the survey. Responding programs demonstrated geographic diversity. The majority were university-based or -affiliated. A total of 86% of PDs felt diversity in CVD as a field needs to increase, and 70% agreed that training programs could play a significant role in this. In total, 89% of PDs have attempted to increase diversity in fellowship recruitment. The specific strategies used were associated with PD sex and the presence of under-represented minority trainees in the program. PDs identified lack of qualified candidates and overall culture of cardiology as the 2 most significant barriers to augmenting diversity. A majority of programs have support systems in place for minority fellows or specific gender groups, including procedures to report issues of harassment or an unsafe learning environment. PDs identified shared best practices for recruitment and implicit bias training, among others, as important resources in their efforts to support diversity in CVD training. CONCLUSIONS: Diversity is important to CVD PDs. They are striving to increase it in their programs through recruitment and strategies directed toward the fellowship learning environment. The CVD community has opportunities to standardize strategies and provide national resources to support PDs in these critical efforts.

[Current status of cardiac electrophysiology training in Germany]. / Aktueller Stand der rhythmologischen Ausbildung in Deutschland.

BACKGROUND: Cardiac electrophysiology training of young cardiologists forms the foundation of optimal heart rhythm patient care. In particular, cardiac electrophysiology is characterized by continuous innovation and has progressed rapidly over the last few years. This may have led to a gap between clinical training and the new technologies and could significantly change training requirements. OBJECTIVE: The aim of the survey was to obtain the opinion of young cardiologists about the current importance and satisfaction of cardiac electrophysiology training and to identify areas for improvement. METHODS: The survey was conducted in May 2020. Young DGK (Deutschen Gesellschaft für Kardiologie, German Society for Cardiology) members were contacted via e­mail and asked to answer an online-based questionnaire. The questionnaire containing information about the current status, satisfaction, and structures of educational and clinical proficiency of cardiac electrophysiology in Germany. RESULTS: Overall, 131 young DGK members completed the survey. Mean age was 33 ± 3.3 years and 68% of the participants were male. Among the participants, 64% were cardiology fellows, while 36% were qualified. A total of 72 participants (53%) reported overall satisfaction with their clinical training and 50% of the participants held the opinion that cardiac electrophysiology should become a larger part of their education. Training courses and fellowships were rated mostly positive (70% vs. 93%, respectively); however, the later were unknown to 41% of the participants. Areas identified for improvement included the following: establishment of general cardiac electrophysiology rotation; enabling access to procedures to gain invasive skills; increased advertising for training courses and fellowships; increase of online-based training courses. CONCLUSION: The survey underlines the interest of young cardiologists in an intensified cardiac electrophysiology training within their cardiology training.

Effect of menopause and exercise training on plasma apolipoprotein M and sphingosine-1-phosphate.

The axis of apolipoprotein M (apoM) and sphingosine-1-phosphate (S1P) is of importance to plasma lipid levels, endothelial function, and development of atherosclerosis. Menopause is accompanied by dyslipidemia and an increased risk of atherosclerosis, which can be lowered by exercise training. The aim of this study was to explore if effects of menopause and training are paralleled by changes in the apoM/S1P axis. Healthy, late premenopausal [ n = 38, age 49.2 (SD 2)] and recent postmenopausal [ n = 37, age 53.3 (SD 3)] women from the Copenhagen Women Study participated in a 3-mo, aerobic high-intensity exercise intervention. Before training, plasma apoM was higher in postmenopausal [1.08 µmol/l (SD 0.2)] compared with premenopausal [0.82 µmol/l (SD 0.2)] women ( P < 0.0001). Plasma S1P was similar in the two groups [0.44 µmol/l (SD 0.1) and 0.46 µmol/l (SD 0.1), respectively]. Thus, the pretraining S1P/apoM ratio was 26% lower in postmenopausal than premenopausal women ( P < 0.0001). After the training program, plasma apoM increased from 0.82 µmol/l (SD 0.2) to 0.90 µmol/l (SD 0.3) in premenopausal women and from 1.08 µmol/l (SD 0.2) to 1.16 µmol/l (SD 0.3) in postmenopausal women ( P < 0.05). Plasma S1P increased from 0.44 µmol/l (SD 0.1) to 0.47 µmol/l (SD 0.1) in premenopausal women and from 0.46 µmol/l (SD 0.1) to 0.48 µmol/l (SD 0.1) in postmenopausal women ( P < 0.05). The results suggest that menopause is accompanied by higher plasma apoM but not S1P concentrations and that exercise training increases plasma apoM and S1P in healthy middle-aged women irrespective of menopausal status. NEW & NOTEWORTHY The apolipoprotein M/sphingosine-1-phosphate (apoM/S1P) complex is involved in maintaining a healthy endothelial barrier function. Our study is the first, to our knowledge, to show how menopause affects the apoM/S1P axis. The results suggest that menopause is accompanied by higher plasma apoM but not S1P concentrations. Second, to our knowledge the study is also the first to show that exercise training increases both apoM/S1P in women irrespective of menopausal status.

The Importance of Global Health Experiences in the Development of New Cardiologists.

As the global burden of cardiovascular disease continues to increase worldwide, nurturing the development of early-career cardiologists interested in global health is essential to create a cadre of providers with the skill set to prevent and treat cardiovascular diseases in international settings. As such, interest in global health has increased among cardiology trainees and early-career cardiologists over the past decade. International clinical and research experiences abroad present an additional opportunity for growth and development beyond traditional cardiovascular training. We describe the American College of Cardiology International Cardiovascular Exchange Database, a new resource for cardiologists interested in pursuing short-term clinical exchange opportunities abroad, and report some of the benefits and challenges of global health cardiovascular training in both resource-limited and resource-abundant settings.

The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson's disease (PIP): a preliminary study.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease caused by loss of dopaminergic nigrostriatal neurons. Several studies have investigated various physical interventions on PD. The effects of a high intensity exercise program with focus on resistance; cardio; equilibrium; and flexibility training have not been evaluated previously. OBJECTIVE: The aim of this study was to investigate the effects of a complex, high intensity physical training program, with a long duration, on motor and non-motor symptoms in patients with PD. METHOD: 24 patients with PD Hoehn and Yahr stage 1-3 were non-randomly allocated to an intervention group (n = 12) and a control group (n = 12). The intervention group underwent 32 weeks of high intensity personalized physical training twice a week, with an optional extra training session once a week. The control group received general recommendations regarding physical activity. The primary outcomes were the change in Unified Parkinson's Disease Rating Scale Subscores (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39). RESULTS: At week 32, the training significantly improved both UPDRS motor subscores (p = 0.045), activities of daily living subscores (ADL) (p = 0.006), mentation subscores (p = 0.004) and complication subscores (p = 0.019). The effect on the PDQ39 total score was not statistically significant. The intervention group however experienced a substantial improvement of the PDQ39 items emotional well-being (-11.0) and bodily discomfort (-7.14). CONCLUSION: The results suggest that a personal high intensity exercise program may favorably influence both motor and non-motor symptoms in patients with mild to moderate PD. More studies with both higher methodology in study design and a follow-up examination are recommended.