Blood pressure response during exercise testing in individuals with and without hypertension: The value of the recovery phase.

BACKGROUND: Hypertension and exercise testing are essential for cardiovascular risk assessment. However, an exact description of blood pressure (BP) in patients with a hypertensive response during exercise (HRE), especially in the recovery phase is lacking. Herein, we aimed to analyse BP and heart rate during exercise testing and recovery in patients with an HRE. METHODS: 800 patients aged 17-90 with an HRE during a standardized bicycle ergometry test were recruited. The BP behaviour during exercise testing was correlated with clinical data. Furthermore, data were analysed according to the presence of pre-existent hypertension. RESULTS: Of the 800 patients included in this study 497 (62%) were previously diagnosed with hypertension. Analysis of covariance showed a significantly faster systolic (ß [95% CI] 8.0 [4.9-11.1]) and diastolic (2.4 [0.4-4.4]) BP recovery 3 min after maximal exercise in patients without hypertension in univariable models. These results remained robust in fully adjusted models taking into account age, sex, body mass index, cardiovascular disease, and antihypertensive treatment for systolic (5.3 [1.2-9.4]) and diastolic BP (4.5 [1.9-7.0]). Furthermore, patients with hypertension displayed higher systolic BP during maximal exercise in univariable (3.8 [0.1-7.5]) and fully adjusted (5.5 [1.1-10.0]) models. There was no difference in maximum diastolic BP between groups. CONCLUSION: In this large cohort study, patients without hypertension showed a faster systolic and diastolic BP recovery and lower maximal systolic BP compared to patients with hypertension. Overall, this study provides new insights into cardiovascular health during recovery phase.

Long-term outcomes after echocardiography versus fluoroscopy-guided left atrial appendage closure: Is there still a role for a simplified approach?

BACKGROUND: Left atrial appendage closure (LAAC) represents an alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation (AF). While transoesophageal echocardiography is the current standard for guiding LAAC procedures, several centers have employed fluoroscopic guidance alone. However, data on long-term outcomes are lacking. METHODS: A total of 536 patients with AF undergoing LAAC and with available data on long-term follow-up were included in the retrospective, single-center analysis. Outcomes of patients undergoing fluoroscopy-guided LAAC were compared with those undergoing echocardiography guided LAAC. Time-dependent analysis was performed with the Kaplan-Meier method. RESULTS: A total of 234 (44%) and 302 (56%) patients were treated with echocardiography and fluoroscopy guidance, respectively. Baseline characteristics did not differ between the two groups. Procedural success rates were high in both groups (97% of fluoroscopy vs. 98% of echocardiography guided procedures; p = 0.92) and rates of relevant peri-device leaks (p = 0.50) and device-related thrombus formation (p = 0.22) did not differ between groups. Median clinical follow-up time was 48 (IQR 19-73) months. Rates of all-cause mortality (p = 0.15, HR 0.83, CI 0.64-1.07) and stroke (p = 0.076, HR 2.23, CI 0.90-5.54) were comparable among groups. CONCLUSION: LAAC with fluoroscopy guidance alone is equally safe and leads to similar clinical outcome compared to LAAC with additional echocardiography guidance.

Daylight saving time was not associated with a change in suicide rates in Austria, Switzerland and Sweden.

BACKGROUND: Some studies have reported an increase in suicides after the start of daylight saving time (DST), but the evidence is mixed and more research about proposed mechanisms (disrupted sleep, changing light exposure) is needed. METHODS: In our preregistered study, we analyzed change in suicide rates in the 2 weeks before/after DST, based on data between 1980 and 2022 from Austria, Switzerland and Sweden, using Poisson regression models and changepoint analyses. To explore the impact of disrupted sleep, we repeated the analysis for retired people who are likely less bound to DST, and for younger people. To explore the effect of changed daylight exposure, we repeated the analysis for northern and southern regions because twilight and daylight exposure varies by latitude. RESULTS: Suicide rates did not significantly increase after the start of DST (adjusted incidence rate ratio IRR = 0.98, 95% CI 0.91-1.06, P = 0.66, n = 13 362 suicides) or after DST ended (adjusted IRR = 0.99, 95% CI 0.91-1.07, P = 0.76, n = 12 319 suicides). There were no statistically significant findings among younger or older subgroups and also not in Sweden and Austria/Switzerland. No changepoints were detected. CONCLUSIONS: There were no significant changes in suicide rates associated with DST and no clear evidence to support proposed mechanisms (light exposure, disruption of sleep). Our study is one of the largest and was adequately powered. Nonetheless, even larger studies to detect smaller effects could be important to inform the debate about harms and benefits of DST.

Dipeptidyl peptidase 3 plasma levels predict cardiogenic shock and mortality in acute coronary syndromes.

BACKGROUND AND AIMS: Dipeptidyl peptidase 3 (DPP3) is a protease involved in the degradation of angiotensin II which disturbs peripheral blood pressure regulation and compromises left ventricular function. This study examined the relationship of circulating DPP3 (cDPP3) with cardiogenic shock (CS) and mortality in patients presenting with acute coronary syndromes (ACS). METHODS: Plasma cDPP3 levels were assessed at baseline and 12-24 h after presentation in patients with ACS prospectively enrolled into the multi-centre SPUM-ACS study (n = 4787). RESULTS: Circulating DPP3 levels were associated with in-hospital CS when accounting for established risk factors including the ORBI risk score [per log-2 increase, hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.05-1.82, P = .021]. High cDPP3 was an independent predictor of mortality at 30 days (HR 1.87, 95% CI 1.36-2.58, P < .001) and at one year (HR 1.61, 95% CI 1.28-2.02, P < .001) after adjustment for established risk factors and the GRACE 2.0 score. Compared to values within the normal range, persistently elevated cDPP3 levels at 12-24 h were associated with 13.4-fold increased 30-day mortality risk (HR 13.42, 95% CI 4.86-37.09, P < .001) and 5.8-fold increased 1-year mortality risk (HR 5.79, 95% CI 2.70-12.42, P < .001). Results were consistent across various patient subgroups. CONCLUSIONS: This study identifies cDPP3 as a novel marker of CS and increased mortality in patients with ACS. Circulating DPP3 offers prognostic information beyond established risk factors and improves early risk assessment.

Alive and kicking: suicide rates and major soccer events in Austria, Germany and Switzerland.

BACKGROUND: Major sporting events are postulated to reduce suicide rates by increased social connectedness, by identifying with winning teams, or, conversely, to increase suicide rates by the 'broken promise effect'. METHODS: In our observational epidemiological study, we investigated changes in suicide rates between 1970 and 2017 in Austria, Germany and Switzerland during the European and World Soccer Championships in general, and on days that the home team played, won or lost. RESULTS: Combining all three studied nations no statistically significant change in the incidence of daily suicides during soccer championships compared to a control period was noted (38.29 ± 9.02 vs. 37.33 ± 10.58; incidence risk ratio = 1.03; 95% confidence interval: 1.01-1.05, P = 0.05). Essentially, no differences in the expected directions were found, and none remained statistically significant after correcting for multiple comparisons in subgroups for country, age and gender in all three studied countries. Compared to a control period, neither a significant difference in the respective national suicide rate was found after Germany's four championship victories nor after Austria's emotional only win over Germany. CONCLUSION: Our results do not support the assumption of increased social connectedness and, thus, lowered suicide risk during major sporting events or changes in suicide risk depending on the outcome of important games as predicted by the broken promise effect or changes in self-efficacy by identification with winning teams.

Helicobacter pylori and cardiovascular risk: Only a dead Helicobacter is a good Helicobacter?

OBJECTIVES: Helicobacter pylori (H. pylori) and cardiovascular (CV) disease share common symptoms and underlie many general medical complaints. Preliminary studies suggest an association between H. pylori positivity and CV risk, and gastroenterological guidelines recommend eradication of H. pylori in patients with manifest atherosclerosis. Therefore, the aim of this study was to examine the reciprocal association of H. pylori positivity and CV risk for their independence of shared risk factors. METHODS: We included 3284 asymptomatic participants of a colorectal cancer screening cohort who were offered and underwent upper gastrointestinal endoscopy. We calculated the 10-year risk for a CV event using the novel SCORE2 for each patient. We evaluated the association between H. pylori positivity and CV risk assessed by SCORE2 using both multilevel logistic and linear regression. We adjusted for age, sex and the concomitant diagnosis of metabolic syndrome. Lastly, we assessed the association between H. pylori status and mortality using proportional hazard Cox regression. RESULTS: In total, 2659 patients were H. pylori negative and 625 H. pylori positive. Helicobacter pylori positivity was associated with SCORE2 and remained so (r = .33; 95% CI 0.09-0.57; p = .006) after adjustment for age, sex, and the diagnosis of metabolic syndrome. Also, SCORE2 was associated with higher odds for H. pylori positivity (aOR 1.03 95% CI 1.01-1.05; p = .02) even after multivariable adjustment. Helicobacter pylori positivity was associated with neither CV (HR 0.60 95% CI 0.14-2.63; p = .50) nor all-cause (HR 1.20 95% CI 0.77-1.87; p = .43) mortality during a median follow-up of 9 years. CONCLUSIONS: In our study, H. pylori positivity and CV risk were independently associated. This did not translate into a dissimilar CV mortality between H. pylori positive and H. pylori negative patients. However, the overwhelming majority of our patients underwent H. pylori eradication. We, therefore, think that H. pylori eradication is at least safe from a cardiovascular perspective and warranted from gastrointestinal standpoint.

A Conditional GAN for Generating Time Series Data for Stress Detection in Wearable Physiological Sensor Data.

Human-centered applications using wearable sensors in combination with machine learning have received a great deal of attention in the last couple of years. At the same time, wearable sensors have also evolved and are now able to accurately measure physiological signals and are, therefore, suitable for detecting body reactions to stress. The field of machine learning, or more precisely, deep learning, has been able to produce outstanding results. However, in order to produce these good results, large amounts of labeled data are needed, which, in the context of physiological data related to stress detection, are a great challenge to collect, as they usually require costly experiments or expert knowledge. This usually results in an imbalanced and small dataset, which makes it difficult to train a deep learning algorithm. In recent studies, this problem is tackled with data augmentation via a Generative Adversarial Network (GAN). Conditional GANs (cGAN) are particularly suitable for this as they provide the opportunity to feed auxiliary information such as a class label into the training process to generate labeled data. However, it has been found that during the training process of GANs, different problems usually occur, such as mode collapse or vanishing gradients. To tackle the problems mentioned above, we propose a Long Short-Term Memory (LSTM) network, combined with a Fully Convolutional Network (FCN) cGAN architecture, with an additional diversity term to generate synthetic physiological data, which are used to augment the training dataset to improve the performance of a binary classifier for stress detection. We evaluated the methodology on our collected physiological measurement dataset, and we were able to show that using the method, the performance of an LSTM and an FCN classifier could be improved. Further, we showed that the generated data could not be distinguished from the real data any longer.

Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD.

Functional impairment caused by chronic obstructive pulmonary disease (COPD) impacts on activities of daily living and quality of life. Indeed, patients' submaximal exercise capacity is of crucial importance. It was the aim of this study to investigate the effects of an exercise training intervention with and without supplemental oxygen on submaximal exercise performance. This is a secondary analysis of a randomized, controlled, double-blind, crossover trial. 29 COPD patients (63.5 ± 5.9 years; FEV1 46.4 ± 8.6%) completed two consecutive 6-week periods of high-intensity interval cycling and strength training, which was performed three times/week with either supplemental oxygen or medical air (10 L/min). Submaximal exercise capacity as well as the cardiocirculatory, ventilatory, and metabolic response were evaluated at isotime (point of termination in the shortest cardiopulmonary exercise test), at physical work capacity at 110 bpm of heart rate (PWC 110), at the anaerobic threshold (AT), and at the lactate-2 mmol/L threshold. After 12 weeks of exercise training, patients improved in exercise tolerance, shown by decreased cardiocirculatory (heart rate, blood pressure) and metabolic (respiratory exchange ratio, lactate) effort at isotime; ventilatory response was not affected. Submaximal exercise capacity was improved at PWC 110, AT and the lactate-2 mmol/L threshold, respectively. Although supplemental oxygen seems to affect patients' work rate at AT and the lactate-2 mmol/L threshold, no other significant effects were found. The improved submaximal exercise capacity and tolerance might counteract patients' functional impairment. Although cardiovascular and metabolic training adaptations were shown, ventilatory efficiency remained essentially unchanged. The impact of supplemental oxygen seems less important on submaximal training effects.

Athletes and Hypertension.

PURPOSE OF REVIEW: We reviewed most current medical literature in order to describe the epidemiology, clinical manifestation, outcome, and management of hypertension in athletes. RECENT FINDINGS: An estimated quarter of the world's population is suffering from hypertension and this prevalence is also reflected in athletes and in individuals involved in leisure time sport activities. Several studies found an inverse relationship between physical activity and blood pressure. Therefore, physical exercise is recommended to prevent, manage, and treat hypertension. On the other hand, the prevalence of hypertension may vary by sport and in some cases may even be higher in athletes competing in certain disciplines than in the general population. Hypertension is the most common medical condition in athletes and may raise concerns about its management and the individual's eligibility for competitive sports. A thorough clinical evaluation should be performed to correctly diagnose or rule out hypertension in athletes, describe the individual's risk profile, rule out secondary causes, and detect possible hypertension-mediated organ damage caused by hypertension at an early stage. Based on most recent clinical research and international consensus documents, we propose a diagnostic algorithm as well the non-pharmacological and pharmacological management of hypertension in athletes. Although elevated blood pressure levels are less common in the active population, athletes are not protected from hypertension. A thorough diagnostic approach may help to identify individual at risk for adverse cardiovascular events and to address the optimal treatment as well as sport recommendations.

The Use of Pulse Oximetry in the Assessment of Acclimatization to High Altitude.

Background: Finger pulse oximeters are widely used to monitor physiological responses to high-altitude exposure, the progress of acclimatization, and/or the potential development of high-altitude related diseases. Although there is increasing evidence for its invaluable support at high altitude, some controversy remains, largely due to differences in individual preconditions, evaluation purposes, measurement methods, the use of different devices, and the lacking ability to interpret data correctly. Therefore, this review is aimed at providing information on the functioning of pulse oximeters, appropriate measurement methods and published time courses of pulse oximetry data (peripheral oxygen saturation, (SpO2) and heart rate (HR), recorded at rest and submaximal exercise during exposure to various altitudes. Results: The presented findings from the literature review confirm rather large variations of pulse oximetry measures (SpO2 and HR) during acute exposure and acclimatization to high altitude, related to the varying conditions between studies mentioned above. It turned out that particularly SpO2 levels decrease with acute altitude/hypoxia exposure and partly recover during acclimatization, with an opposite trend of HR. Moreover, the development of acute mountain sickness (AMS) was consistently associated with lower SpO2 values compared to individuals free from AMS. Conclusions: The use of finger pulse oximetry at high altitude is considered as a valuable tool in the evaluation of individual acclimatization to high altitude but also to monitor AMS progression and treatment efficacy.

Wearable Cardioverter-Defibrillator-Measured Step Count for the Surveillance of Physical Fitness during Cardiac Rehabilitation.

BACKGROUND: The wearable cardioverter-defibrillator (WCD) has a built-in accelerometer, which allows tracking of patients' physical activity by remote monitoring. It is unclear whether WCD-measured physical activity, step count, and heart rate correlate with established tools for the assessment of cardiopulmonary fitness such as the 6-min walk test (6MWT). OBJECTIVE: To correlate measurements of patient physical activity through the WCD with a supervised 6MWT during in-patient cardiac rehabilitation (CR) and to allow their use as surrogate parameters of cardiopulmonary fitness in an out-patient setting. METHODS: Consecutive patients with a history of WCD use treated at our center and an in-patient CR following an index hospitalization were included. Baseline characteristics, measurements of WCD accelerometer (median daily step count, median daily activity level), median daily heart rate, and clinically supervised 6MWT at admission and discharge of CR were obtained. RESULTS: Forty-one patients with a mean age of 55.5 (±11.5) years were included. Thirty-five patients (85.4%) were male and 28 patients (68%) had a primary prophylactic WCD-indication. The most common underlying heart diseases were ischemic heart disease (24 patients 58.6%) and dilated cardiomyopathy (13 patients, 31.7%). Median CR duration was 20 (IQR 19.75-26.25) days. 6MWT distance increased from a mean of 329 m (±107) to 470 m (±116) during CR (p < 0.0001). The median daily step count and activity level increased significantly, from 5542 steps (IQR 3718-7055) to 8778 (IQR 6229-12,920, p < 0.0001) and median 117 × 106 (IQR 96 × 106-142 × 106) threshold value exceedance (TVE) to 146 × 106 TVE (IQR 110 × 106-169 × 106, p < 0.0001), respectively. The median heart rate was 74.9 bpm (IQR 65.8-84.5) and 70.2 (IQR 64.1-77.3, p = 0.09) at admission and discharge, respectively. Of all three parameters, median daily step count showed the best correlation to the results of the 6MWT at admission and discharge (r = 0.32, p = 0.04 and 0.37, p = 0.02, respectively). CONCLUSIONS: Remote monitoring of median daily step count as assessed by the WCD's accelerometer showed positive correlation with the 6MWT and could serve as a surrogate for cardiopulmonary exercise capacity. Assessment of daily step count and activity level measured remotely by the WCD could help to tailor optimal exercise instruction for patients not attending CR.

Mesenchymal iron deposition is associated with adverse long-term outcome in non-alcoholic fatty liver disease.

BACKGROUND & AIMS: Approximately one-third of patients with non-alcoholic fatty liver disease (NAFLD) show signs of mild-to-moderate iron overload. The impact of histological iron deposition on the clinical course of patients with NAFLD has not been established. METHODS & RESULTS: For this retrospective study, 299 consecutive patients with biopsy-proven NAFLD and a mean follow-up of 8.4 (±4.1; range: 0.3-18.0) years were allocated to one of four groups according to presence of hepatic iron in the reticuloendothelial system (RES) and/or hepatocytes (HC): 156 subjects (52%) showed no stainable iron (NONE), 58 (19%) exclusively reticuloendothelial (xRES), 19 (6%) exclusively hepatocellular (xHC) and 66 (22%) showed a mixed (HC/RES) pattern of iron deposition. A long-term analysis for overall survival, hepatic, cardiovascular or extrahepatic-malignant events was conducted. Based on multivariate Cox proportional hazards models any reticuloendothelial iron was associated with fatal and non-fatal hepatic events. Specifically, xRES showed a cause-specific hazard ratio (csHR) of 2.4 (95%-CI, 1.0-5.8; P = .048) for hepatic as well as cardiovascular fatal and non-fatal events combined (csHR 3.2; 95%-CI, 1.2-8.2; P = .015). Furthermore, the mixed HC/RES iron pattern showed a higher rate of combined hepatic fatal and non-fatal events (csHR 3.6; 95%-CI, 1.4-9.5; P = .010), while xHC iron deposition was not associated with any defined events. CONCLUSIONS: The presence of reticuloendothelial-accentuated hepatic iron distribution patterns is associated with detrimental long-term outcomes reflected in a higher rate of both liver-related and cardiovascular fatal and non-fatal events.

Health effects of active commuting to work: The available evidence before GISMO.

Sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Global guidelines recommend for maintaining health in adults, at least 150 minutes of moderate intensity of physical activity throughout the week, but compliance is insufficient and health problems arise. One obvious way to overcome this is to integrate physical activity into the daily routine for example by active commuting to work. Scientific evidence, however, is scarce and therefore we set out to perform this systematic review of the available literature to improve understanding of the efficiency of active commuting initiatives on health. Literature searches were performed in PubMed and Cochrane database. Altogether, 37 studies were screened. Thereof, eight publications were reviewed, which included 555 participants. The mean study duration of the reviewed research was 36 ± 26 (8-72) weeks. Overall, active commuting in previously untrained subjects of both sexes significantly improved exercise capacity, maximal power, blood pressure, lipid parameters including cholesterol, high-density lipoprotein, and waist circumference. Improvement was independent of the type of active commuting. Despite relatively few studies that were previously performed, this review revealed that active commuting has health beneficial effects comparable to those of moderate exercise training.

Effects of active commuting to work for 12 months on cardiovascular risk factors and body composition.

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG-PT) and a cycling group (IG-C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self-reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: -0.3, -0.2] in IG-PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG-C by 0.8 mmol/L [-1.1, -0.4] and by 0.6 mmol/L [-1.2, 0.1] in IG-PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

Dose-response relationship of active commuting to work: Results of the GISMO study.

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT -the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or "Delta" Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.

Effects of active commuting on cardiovascular risk factors: GISMO-a randomized controlled feasibility study.

A sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Lifestyle modification in order to increase exercise capacity is key in the prevention and rehabilitation of chronic diseases. This could be achieved by active commute. The aim of this study was to assess the effects of daily active commuting on physical activity (PA) and exercise capacity. Seventy-three healthy hospital employees (age: 46 ± 9 years, 38% male), with a predominantly passive way of commuting, were randomly assigned to two parallel groups, a control group (CG, N = 22) or an intervention group (IG, N = 51), which was further split into public transportation/active commuting (IG-PT, N = 25) and cycling (IG-C, N = 26). Both intervention groups were asked to reach 150 min/wk of moderate- to vigorous-intensity exercise during their commute for 1 year. CG maintained a passive commuting mode. All participants underwent assessment of anthropometry, risk factor stratification, and exercise capacity by a medical doctor at the Institute of Sports Medicine, Prevention and Rehabilitation. Weekly physical activity, using the International Physical Activity Questionnaire and commuting behavior, using an online diary, were used to assess physical activity. At the end of the study, the change in exercise capacity did significantly differ between IG and CG (P = .003, ES = 0.82). Actively covered distances through commuting significantly differed between groups (walking P = .026; cycling P < .001). Therefore, active commuting improves exercise capacity and can be recommended to the working population to increase exercise capacity.

Effects of active commuting on health-related quality of life and sickness-related absence.

Increased physical activity is associated with numerous health benefits. This study investigated the effect of active commuting (walking and cycling to work) on health-related quality of life (HRQoL) and absence days from work due to sickness in healthy working adults. In total, 73 participants (age: 46 ± 9 years), all working at a tertiary university hospital in Salzburg, Austria, were randomized into an intervention group (IG, n = 51) and a control group (CG, n = 22). The IG was asked to commute actively for twelve months, whereas the CG did not have to change their usual commuting behavior. IG was divided into two subgroups: IG-C (cycling, n = 26) was asked to commute by bicycle and IG-PT (public transport, n = 25) partially using public transportation and walked the remaining distance to work. Significant positive changes in IG were observed in four subcomponents of the SF-36 (physical functioning (95 [10] to 100 [8.8], P = .023), mental health (82 [15] to 86 [15], P = .036), vitality (65 [20] to 70 [14], P = .005), and general health (70 [19] to 80 [24], P = .004)) as well as the physical component summary score (56.5 [9] to 59.2 [6.3], P = .002). IG-C showed greater and more statistically significant changes regarding HRQoL compared to IG-PT. Associations between active commuting and sick-leave days were only observed in IG-PT (7.5 [14.8] to 4.0 [11.3] days, P = .038). In conclusion, active commuting improves various components of HRQoL and might therefore be a possible strategy to increase quality of life in the workforce.

Merging self-reported with technically sensed data for tracking mobility behavior in a naturalistic intervention study. Insights from the GISMO study.

Sound exposure data are central for any intervention study. In the case of utilitarian mobility, where studies cannot be conducted in controlled environments, exposure data are commonly self-reported. For short-term intervention studies, wearable devices with location sensors are increasingly employed. We aimed to combine self-reported and technically sensed mobility data, in order to provide more accurate and reliable exposure data for GISMO, a long-term intervention study. Through spatio-temporal data matching procedures, we are able to determine the amount of mobility for all modes at the best possible accuracy level. Self-reported data deviate ±10% from the corrected reference. Derived modal split statistics prove high compliance to the respective recommendations for the control group (CG) and the two intervention groups (IG-PT, IG-C). About 73.7% of total mileage was travelled by car in CG. This share was 10.3% (IG-PT) and 9.7% (IG-C), respectively, in the intervention groups. Commuting distances were comparable in CG and IG, but annual mean travel times differ between x ¯  = 8,458 min (σ = 6,427 min) for IG-PT, x ¯  = 8,444 min (σ = 5,961 min) for IG-C, and x ¯  = 5,223 min (σ = 5,463 min) for CG. Seasonal variabilities of modal split statistics were observable. However, in IG-PT and IG-C no shift toward the car occurred during winter months. Although no perfect single-method solution for acquiring exposure data in mobility-related, naturalistic intervention studies exists, we achieved substantially improved results by combining two data sources, based on spatio-temporal matching procedures.

The Cardiovascular Response to Interval Exercise Is Modified by the Contraction Type and Training in Proportion to Metabolic Stress of Recruited Muscle Groups.

BACKGROUND: Conventional forms of endurance training based on shortening contractions improve aerobic capacity but elicit a detriment of muscle strength. We hypothesized that eccentric interval training, loading muscle during the lengthening phase of contraction, overcome this interference and potentially adverse cardiovascular reactions, enhancing both muscle metabolism and strength, in association with the stress experienced during exercise. METHODS: Twelve healthy participants completed an eight-week program of work-matched progressive interval-type pedaling exercise on a soft robot under predominately concentric or eccentric load. RESULTS: Eccentric interval training specifically enhanced the peak power of positive anaerobic contractions (+28%), mitigated the strain on muscle's aerobic metabolism, and lowered hemodynamic stress during interval exercise, concomitant with a lowered contribution of positive work to the target output. Concentric training alone lowered blood glucose concentration during interval exercise and mitigated heart rate and blood lactate concentration during ramp exercise. Training-induced adjustments for lactate and positive peak power were independently correlated (p < 0.05, |r| > 0.7) with indices of metabolic and mechanical muscle stress during exercise. DISCUSSION: Task-specific improvements in strength and muscle's metabolic capacity were induced with eccentric interval exercise lowering cardiovascular risk factors, except for blood glucose concentration, possibly through altered neuromuscular coordination.