Cardiac remodeling in amateur triathletes after 24 weeks of exercise training for a half-Ironman event: a brief report.

BACKGROUND: Triathletes' physiological adaptations to exercise training can have a different impact on cardiac remodeling based on the extreme exercise preparation. Moreover, cardiac remodeling might be different depending on whether triathletes have trained for many years or if they just decided to be more active. Nevertheless, data are limited in amateur endurance athletes and studies about them are key for their safety. Therefore, we investigated the effects of exercise training for a half-ironman on cardiac remodeling. METHODS: A total of 24 amateur athletes underwent a 24-week exercise program and were followed by three-dimensional echocardiography to assess its global impact on cardiac remodeling. Subanalyses were performed based on participants past-training experience (low versus high). RESULTS: We found significant group effects on the right and left ventricle, significant time effect on the right ventricle. No significant interaction effects were observed. We observed significant correlations between the right ventricle, clinical and performance characteristics where the peak power output explained 38% of the variance, while the body surface area, weight and power at the second ventilatory threshold explained 34%, 31% and 30%, respectively. CONCLUSIONS: Changes in cardiac remodeling in response to an exercise program for a half-ironman are not homogeneous across the ventricles and are influenced by participants' past-training experience. This study strengthens our knowledge of extreme exercise training for a half-ironman to further develop better training programs and medical follow-up in amateur triathletes.

Clinical Implementation of Different Strategies for Exercise-Based Rehabilitation in Kidney and Liver Transplant Recipients: A Pilot Study. / Implementação Clínica de Diferentes Estratégias para Reabilitação Baseada em Exercícios em Receptores de Transplante de Rim e Fígado: Um Estudo Piloto.

BACKGROUND: Cardiovascular disease is among the leading causes of death in solid organ transplant recipients with a functional graft. Although these patients could theoretically benefit from exercise-based rehabilitation (EBR) programs, their implementation is a challenge. OBJECTIVE: We present our initial experience on different delivery modes of a pilot EBR program in kidney and liver transplant recipients. METHODS: Thirty-two kidney or liver transplant recipients were invited for a 6-month EBR program delivered at the hospital gym, community gym or at home, according to the patient's preference. The significance level adopted was 5%. RESULTS: Ten patients (31%) did not complete their program. Among the 22 who did, 7 trained at the hospital gym, 7 at the community gym, and 8 at home. The overall effect was an 11.4% increase in maximum METs (Hedges' effect size g = 0.39). The hospital gym group had an increase in METs of 25.5% (g= 0.58, medium effect size) versus 10% (g= 0.25), and 6.5% (g= 0.20) for the community gym and home groups, respectively. There was a beneficial effect on systolic and diastolic blood pressures, greater for the hospital gym (g= 0.51 and 0.40) and community gym (g= 0.60 and 1.15) groups than for the patients training at home (g= 0.07 and 0.10). No significant adverse event was reported during the follow-up. CONCLUSION: EBR programs in kidney and liver transplant recipients should be encouraged, even if they are delivered outside a hospital gym, since they are safe with positive effects on exercise capacity and cardiovascular risk factors.

FUNDAMENTO: A doença cardiovascular está entre as principais causas de morte entre pacientes transplantados. Embora esses pacientes possam teoricamente se beneficiar de programas de reabilitação baseada em exercícios (RBE), sua implementação ainda é um desafio. OBJETIVO: Apresentamos nossa experiência inicial em diferentes modos de realização de um programa piloto de RBE em receptores de transplante de rim e fígado. MÉTODOS: Trinta e dois pacientes transplantados renais ou hepáticos foram convidados para um programa de RBE de 6 meses realizado na academia do hospital, na academia comunitária ou em casa, de acordo com a preferência do paciente. O nível de significância adotado foi de 5%. RESULTADOS: Dez pacientes (31%) não completaram o programa. Entre os 22 que completaram, 7 treinaram na academia do hospital, 7 na academia comunitária e 8 em casa. O efeito geral foi um aumento de 11,4% nos METs máximos (tamanho do efeito de Hedges g = 0,39). O grupo de academia hospitalar teve um aumento nos METs de 25,5% (g = 0,58, tamanho de efeito médio) versus 10% (g = 0,25) e 6,5% (g = 0,20) para os grupos de academia comunitária e em casa, respectivamente. Houve efeito benéfico nas pressões arteriais sistólica e diastólica, maior para os grupos academia hospitalar (g= 0,51 e 0,40) e academia comunitária (g= 0,60 e 1,15) do que para os pacientes treinando em casa (g= 0,07 e 0,10). Nenhum evento adverso significativo foi relatado durante o seguimento. CONCLUSÃO: Programas de RBE em receptores de transplante de rim e fígado devem ser incentivados, mesmo que sejam realizados fora da academia do hospital, pois são seguros com efeitos positivos na capacidade de exercício e nos fatores de risco cardiovascular.

Implementação Clínica de Diferentes Estratégias para Reabilitação Baseada em Exercícios em Receptores de Transplante de Rim e Fígado: Um Estudo Piloto / Clinical Implementation of Different Strategies for Exercise-Based Rehabilitation in Kidney and Liver Transplant Recipients: A Pilot Study

Resumo Fundamento: A doença cardiovascular está entre as principais causas de morte entre pacientes transplantados. Embora esses pacientes possam teoricamente se beneficiar de programas de reabilitação baseada em exercícios (RBE), sua implementação ainda é um desafio. Objetivo: Apresentamos nossa experiência inicial em diferentes modos de realização de um programa piloto de RBE em receptores de transplante de rim e fígado. Métodos: Trinta e dois pacientes transplantados renais ou hepáticos foram convidados para um programa de RBE de 6 meses realizado na academia do hospital, na academia comunitária ou em casa, de acordo com a preferência do paciente. O nível de significância adotado foi de 5%. Resultados: Dez pacientes (31%) não completaram o programa. Entre os 22 que completaram, 7 treinaram na academia do hospital, 7 na academia comunitária e 8 em casa. O efeito geral foi um aumento de 11,4% nos METs máximos (tamanho do efeito de Hedges g = 0,39). O grupo de academia hospitalar teve um aumento nos METs de 25,5% (g = 0,58, tamanho de efeito médio) versus 10% (g = 0,25) e 6,5% (g = 0,20) para os grupos de academia comunitária e em casa, respectivamente. Houve efeito benéfico nas pressões arteriais sistólica e diastólica, maior para os grupos academia hospitalar (g= 0,51 e 0,40) e academia comunitária (g= 0,60 e 1,15) do que para os pacientes treinando em casa (g= 0,07 e 0,10). Nenhum evento adverso significativo foi relatado durante o seguimento. Conclusão: Programas de RBE em receptores de transplante de rim e fígado devem ser incentivados, mesmo que sejam realizados fora da academia do hospital, pois são seguros com efeitos positivos na capacidade de exercício e nos fatores de risco cardiovascular.

Abstract Background: Cardiovascular disease is among the leading causes of death in solid organ transplant recipients with a functional graft. Although these patients could theoretically benefit from exercise-based rehabilitation (EBR) programs, their implementation is a challenge. Objective: We present our initial experience on different delivery modes of a pilot EBR program in kidney and liver transplant recipients. Methods: Thirty-two kidney or liver transplant recipients were invited for a 6-month EBR program delivered at the hospital gym, community gym or at home, according to the patient's preference. The significance level adopted was 5%. Results: Ten patients (31%) did not complete their program. Among the 22 who did, 7 trained at the hospital gym, 7 at the community gym, and 8 at home. The overall effect was an 11.4% increase in maximum METs (Hedges' effect size g = 0.39). The hospital gym group had an increase in METs of 25.5% (g= 0.58, medium effect size) versus 10% (g= 0.25), and 6.5% (g= 0.20) for the community gym and home groups, respectively. There was a beneficial effect on systolic and diastolic blood pressures, greater for the hospital gym (g= 0.51 and 0.40) and community gym (g= 0.60 and 1.15) groups than for the patients training at home (g= 0.07 and 0.10). No significant adverse event was reported during the follow-up. Conclusion: EBR programs in kidney and liver transplant recipients should be encouraged, even if they are delivered outside a hospital gym, since they are safe with positive effects on exercise capacity and cardiovascular risk factors.

Psychological Status During and After the Preparation of a Long-distance Triathlon Event in Amateur Athletes.

Preparation for an endurance event among amateur athletes requires a major commitment on their part. Knowing amateur athletes' psychological characteristics during a training period should be a priority for coaches and athletes. The aim of our longitudinal study was to characterize the psychological profile of amateur athletes over a training period of six months prior to and after a long-distance triathlon. Thirty-two amateur athletes (13 females; 19 males; 1.5±1.3 years of experience) were recruited for this observational study. All participants (39±9.9 years old; weighs 73±12.9 kg; measure 172±10.2 cm) underwent a physical fitness assessment pre- and post 6-months of training, a monthly psychological questionnaire battery assessing mood, positive and negative affect, passion and motivation and, for some participants (n=5), an interview post event. Positive emotions increased until the sixth month, from 38.1±22.0 to 54.3±7.2 (Z=3.49, p<0.001, r=0.80). Participants were more harmonious (29.0±3.0) than obsessive (13.0±1.0) with their triathlon's passion (Z=4.91, p<0.001, r=0.85). Participants felt a high level of intrinsic motivation (15.9±1.76) and a low level of external motivation (4.9±1.08) about their triathlon training (p<0.05). The vigor score is the only sub scale that significantly changed from the 1st to the 6th month of training, and ranged between 21.4±10.6 and 28.1±4.1 (Z=2.0, p=0.046, r=0.46). This longitudinal observational study is the first to have explored athletes' psychological and emotional parameters over a training period of six months prior to a long-distance triathlon event and one month after. Thus, specific interventions and mental training can be structured around these important milestones.

Remote Ischemic Preconditioning Does Not Improve the Six Minutes Walk Test Performance in Chronic Heart Failure Patients: a Randomised Pilot Trial.

Cycles of ischemia and reperfusion induced with a pressure cuff on a skeletal muscle, also know as remote ischemic preconditioning (RIPC), appears to improve performance in different time-trial events in healthy individuals. Our primary goal was to assess the effect of RIPC in heart failure (HF) patients' functional capacity using the six-minute walk test (6MWT). A randomized crossover design comparing RIPC (4 × five-minutes of upper arm ischemia) to the SHAM procedure was done in 15 patients prior to a 6MWT. The primary outcome measure was the total distance walked in a standardized 6MWT (20m corridor). Metabolic and hemodynamic responses were measured using gas exchange analysis with a portable metabolic analyzer and peripheral skeletal muscle oxygen saturation (smO2) with near-infrared spectroscopy. The total distance travelled during 6MWT was not significantly different between the RIPC (347 ± 63 m) and the SHAM procedure (352 ± 65 m; p = 0.514). Relative oxygen uptake did not change when comparing interventions: 10.26 ± 2.01 ml/kg/min vs 10.69 ± 2.51 ml/kg/min (RIPC vs SHAM, respectively, p = 0.278). As well, no significant differences were observed for heart rate, respiratory exchange ratio, smO2, and ventilation. Even though HF patients tolerated well the RIPC intervention, it did not provide any significant improvement in functional capacity and other physiological parameters in our sample of patients.

Preparation for an Half-Ironmantm Triathlon amongst Amateur Athletes: Finishing Rate and Physiological Adaptation.

Long distance triathlon has gained in popularity amongst the general population. Coaches establish training programs based upon their knowledge, personal experience and on current training principles. The goal was to observe the effect of a triathlon training program for a half Ironman event in neophyte amateur athletes. A specific triathlon training program was followed from February to June 2016 by a group preparing for their first half ironman. Out of the 32 participants (19 Males and 13 Females; mean age of 39 ± 9.9 years old; body weight of 72.7 ± 13.4 kg and a height of 171.5 ± 10.2 cm), only one did not complete the event. A mean training volume of 410 ± 201 min per week led to a mean finishing time of 6 hours 28 minutes. The training program significantly increased the maximal oxygen consumption (45.9 ± 8.2 to 48.6 ± 7.5 ml/kg/min, p =0.002) and the maximal power output (293.1 ± 63.7 to 307.8 ± 58.7 W, p < 0.001). The absolute oxygen consumption and power output at both ventilatory thresholds also significantly increased (VT1: 2.2 ± 0.4 to 2.5 ± 0.5 L, p = 0.001; 157.8 ± 41.8 to 176.7 ± 41.1 W p = 0.009 and VT2: 2.9 ± 0.4 to 3.0 ± 0.4 L, p = 0.017; 229.3 ± 62.0 to 244.8± 55.2 W, p = 0.022 ). A significant diminution of waist circumference was observed (83.2 ± 10.0 to 81.8 ± 9.5 cm, p = 0.032) with no significant changes in body weight. Thus, a 24-week specific training program appears to be safe and efficient for amateur athletes aiming to finish their first half- Ironman event.