[Quality Performance Measures in Cardiac Rehabilitation - Results of a Delphi Survey of Members of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases (DGPR)]. / Indikatoren der Ergebnisqualität kardiologischer Rehabilitation.

OBJECTIVE: The present investigation aimed an explorative acquisition of potential performance measures for quantifying the quality of cardiac rehabilitation (CR) for patients under 65 years of age. METHODS: A 4-level web based Delphi survey of physicians, psychologists, and sports or physiotherapists in CR was conducted from April to July in 2016. The experts assessed several parameters of physical performance, social medicine, subjective health and cardiovascular risk factors regarding their suitability as performance measures of CR. RESULTS: Of the 44 predetermined as well as by the participants proposed parameters, 21 parameters (48%) were selected as potential performance measures. Half of these were psychosocial factors. Merely, smoking habits, blood pressure, LDL-cholesterol and maximum capacity on exercise-ECG achieved a consensus (agreement>75% of the respondents). CONCLUSIONS: The experts' choice of performance measures was little consistent. Therefore, a clinical investigation and scientific evaluation of the predefined parameters is essential.

[User Interest in Digital Health Technologies to Enhance Physical Activity in Students and Staff of a University]. / Nutzerinteresse an mobilen digitalen Assistenzsystemen zur Förderung körperlicher Aktivität bei Studierenden und Mitarbeitern einer Universität.

INTRODUCTION: Though health-enhancing effects of physical activity are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) technologies might be able to increase the physical activity level. However, the interest of potential users is a mandatory basis for this. METHOD: We conducted an online-survey from 06-07/2015 by asking students and employees from the University of Potsdam for their activity level, interest in mHealth training support and other relevant parameters. RESULTS: 1 217 students and 485 employees (67.3% and 67.5% female, 26.0±4.9 and 42.7±11.7 years, respectively) participated in the survey. 70.1% of employees and 52.7% of students did not follow the recommendation for physical activity (3 times per week). 53.2% (students) and 44.2% (employees), independent of age, sex, BMI and level of education or professional qualification, indicated their interest in mHealth technology offering training support. CONCLUSION: Even in a younger population with higher education, most respondents reported an insufficient level of physical activity. About half of them indicated their interest in training support. Therefore, the use of personalized mHealth technology may be of increasing significance for a positive change of lifestyle.

Lysophosphatidic Acid Inhibits Insulin Signaling in Primary Rat Hepatocytes via the LPA3 Receptor Subtype and is Increased in Obesity.

BACKGROUND/AIMS: Obesity is a main risk factor for the development of hepatic insulin resistance and it is accompanied by adipocyte hypertrophy and an elevated expression of different adipokines such as autotaxin (ATX). ATX converts lysophosphatidylcholine to lysophosphatidic acid (LPA) and acts as the main producer of extracellular LPA. This bioactive lipid regulates a broad range of physiological and pathological responses by activation of LPA receptors (LPA1-6). METHODS: The activation of phosphatidylinositide 3-kinases (PI3K) signaling (Akt and GSK-3ß) was analyzed via western blotting in primary rat hepatocytes. Incorporation of glucose into glycogen was measured by using radio labeled glucose. Real-time PCR analysis and pharmacological modulation of LPA receptors were performed. Human plasma LPA levels of obese (BMI > 30, n = 18) and normal weight individuals (BMI 18.5-25, n = 14) were analyzed by liquid chromatography tandem-mass spectrometry (LC-MS/MS). RESULTS: Pretreatment of primary hepatocytes with LPA resulted in an inhibition of insulin-mediated Gck expression, PI3K activation and glycogen synthesis. Pharmacological approaches revealed that the LPA3-receptor subtype is responsible for the inhibitory effect of LPA on insulin signaling. Moreover, human plasma LPA concentrations (16: 0 LPA) of obese participants (BMI > 30) are significantly elevated in comparison to normal weight individuals (BMI 18.5-25). CONCLUSION: LPA is able to interrupt insulin signaling in primary rat hepatocytes via the LPA3 receptor subtype. Moreover, the bioactive lipid LPA (16: 0) is increased in obesity.

Protocol of the Berlin Long-term Observation of Vascular Events (BeLOVE): a prospective cohort study with deep phenotyping and long-term follow up of cardiovascular high-risk patients.

INTRODUCTION: The Berlin Long-term Observation of Vascular Events is a prospective cohort study that aims to improve prediction and disease-overarching mechanistic understanding of cardiovascular (CV) disease progression by comprehensively investigating a high-risk patient population with different organ manifestations. METHODS AND ANALYSIS: A total of 8000 adult patients will be recruited who have either suffered an acute CV event (CVE) requiring hospitalisation or who have not experienced a recent acute CVE but are at high CV risk. An initial study examination is performed during the acute treatment phase of the index CVE or after inclusion into the chronic high risk arm. Deep phenotyping is then performed after ~90 days and includes assessments of the patient's medical history, health status and behaviour, cardiovascular, nutritional, metabolic, and anthropometric parameters, and patient-related outcome measures. Biospecimens are collected for analyses including 'OMICs' technologies (e.g., genomics, metabolomics, proteomics). Subcohorts undergo MRI of the brain, heart, lung and kidney, as well as more comprehensive metabolic, neurological and CV examinations. All participants are followed up for up to 10 years to assess clinical outcomes, primarily major adverse CVEs and patient-reported (value-based) outcomes. State-of-the-art clinical research methods, as well as emerging techniques from systems medicine and artificial intelligence, will be used to identify associations between patient characteristics, longitudinal changes and outcomes. ETHICS AND DISSEMINATION: The study was approved by the Charité-Universitätsmedizin Berlin ethics committee (EA1/066/17). The results of the study will be disseminated through international peer-reviewed publications and congress presentations. STUDY REGISTRATION: First study phase: Approved WHO primary register: German Clinical Trials Register: https://drks.de/search/de/trial/DRKS00016852; WHO International Clinical Registry Platform: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00016852. Recruitment started on July 18, 2017.Second study phase: Approved WHO primary register: German Clinical Trials Register DRKS00023323, date of registration: November 4, 2020, URL: http://www.drks.de/ DRKS00023323. Recruitment started on January 1, 2021.

Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation.

INTRODUCTION: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. METHODS: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. RESULTS: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42-3.36; P < 0.01). CONCLUSION: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.

User Interest in Digital Health Technologies to Encourage Physical Activity: Results of a Survey in Students and Staff of a German University.

BACKGROUND: Although the benefits for health of physical activity (PA) are well documented, the majority of the population is unable to implement present recommendations into daily routine. Mobile health (mHealth) apps could help increase the level of PA. However, this is contingent on the interest of potential users. OBJECTIVE: The aim of this study was the explorative, nuanced determination of the interest in mHealth apps with respect to PA among students and staff of a university. METHODS: We conducted a Web-based survey from June to July 2015 in which students and employees from the University of Potsdam were asked about their activity level, interest in mHealth fitness apps, chronic diseases, and sociodemographic parameters. RESULTS: A total of 1217 students (67.30%, 819/1217; female; 26.0 years [SD 4.9]) and 485 employees (67.5%, 327/485; female; 42.7 years [SD 11.7]) participated in the survey. The recommendation for PA (3 times per week) was not met by 70.1% (340/485) of employees and 52.67% (641/1217) of students. Within these groups, 53.2% (341/641 students) and 44.2% (150/340 employees)-independent of age, sex, body mass index (BMI), and level of education or professional qualification-indicated an interest in mHealth fitness apps. CONCLUSIONS: Even in a younger, highly educated population, the majority of respondents reported an insufficient level of PA. About half of them indicated their interest in training support. This suggests that the use of personalized mobile fitness apps may become increasingly significant for a positive change of lifestyle.