Relevance of Cardiovascular Exercise in Cancer and Cancer Therapy-Related Cardiac Dysfunction.

PURPOSE OF THE REVIEW: Cancer therapy-related cardiac dysfunction (CTRCD) has been identified as a threat to overall and cancer-related survival. Although aerobic exercise training (AET) has been shown to improve cardiorespiratory fitness (CRF), the relationship between specific exercise regimens and cancer survival, heart failure development, and reduction of CTRCD is unclear. In this review, we discuss the impact of AET on molecular pathways and the current literature of sports in the field of cardio-oncology. RECENT FINDINGS: Cardio-oncological exercise trials have focused on variations of AET intensity by using moderate continuous and high intensity interval training, which are applicable, safe, and effective approaches to improve CRF. AET increases CRF, reduces cardiovascular morbidity and heart failure hospitalization and should thus be implemented as an adjunct to standard cancer therapy, although its long-term effect on CTRCD remains unknown. Despite modulating diverse molecular pathways, it remains unknown which exercise regimen, including variations of AET duration and frequency, is most suited to facilitate peripheral and central adaptations to exercise and improve survival in cancer patients.

Reliability and validity of the modified shuttle test-paeds to measure cardiorespiratory fitness in children.

BACKGROUND: The Modified Shuttle Test-Paeds (Paeds), a recently developed 10-meter Shuttle run test for aerobic capacity in children. This study aims to investigate the construct validity (known-group and convergent validity) and test-retest reliability of the recently developed test for cardiorespiratory fitness, the Modified Shuttle Test-Paeds (Paeds). METHODS: A total of 144 participants (6-12 y) were tested on the Paeds test, and 84 children were tested on the 20-meter Shuttle Run test (20 m-SRT) to assess construct validity. To evaluate test-retest reliability, 46 children were tested twice on the Paeds. RESULTS: No sex differences were found, but there was an age effect. A strong correlation was found between Paeds and the 20 m-SRT (rs=0.78, p < 0.001). The test-retest reliability was good (ICC 0.84; 95% CI 0.74-0.91). CONCLUSION: Paeds appears to be a reliable and valid tool for estimating cardiorespiratory fitness in typically developing children aged 6-12 years and has the advantages of being shorter, needing less space, not requiring pacing and being self-motivational. More studies are needed to assess whether children reach an aerobic steady state in three minutes and how much of the results of the Paeds test can be explained by the agility component of the task (turning and grasping or aiming a bean bag). For clinical use, psychometric properties should be studied in various patient groups (e.g., ADHD, DCD, and children with intellectual disabilities).

Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis.

PURPOSE: Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS: PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS: A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION: This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.

Association between time of assessment within a school year and physical fitness of primary school children.

The dissociation of effects of age, time of assessment and cohort is a well-known challenge in developmental science. We examined effects of time of assessment in the school year on children's physical fitness using data from 75,362 German third-graders from seven cohorts. Children were tested once either in the first or second school term of third grade. Tests examined cardiorespiratory endurance (6-min run), coordination (star-run), speed (20-m sprint), lower (standing long jump) and upper (ball-push test) limbs muscle power, and flexibility (stand-and-reach test). We estimated the effect of time of assessment using a regression discontinuity design specified in a linear mixed model with random factors child and school and adjusted for age, sex, and cohort effects. Coordination, speed, and upper limbs muscle power were better in second compared to first school term, with boys exhibiting a larger increase of upper limbs muscle power than girls. There was no evidence for changes in cardiorespiratory endurance, lower limbs muscle power, and flexibility between assessments. Previously reported age and sex effects as well as secular fitness trends were replicated. There is thus evidence for improvement of some physical fitness components beyond age and cohort effects that presumably reflects the benefit of physical activity in physical education and other settings. Effects of assessment time should be taken into consideration in performance-based grading or norm-based selection of children.

Long-Term Improvement in Cardiorespiratory Fitness Ameliorates Insulin Sensitivity beyond Changes in Visceral/Ectopic Fat among Men with Visceral Obesity.

The SYNERGIE study documented the effects on cardiometabolic risk (CMR) indices of a 1-year lifestyle intervention targeting physical activity (PA) and diet followed by a 2-year maintenance period in men with visceral obesity. Improvements in CMR markers and a decrease in low-attenuation muscle (LAM) area were observed after 1 year. Despite a rebound in visceral adipose tissue (VAT) during the maintenance period, insulin resistance (IR) improved. We tested the hypothesis that variations in cardiorespiratory fitness (CRF) and LAM could explain the long-term improvement in IR. A health (n = 88; mean age 49.0 ± 8.2 years) and fitness (n = 72) evaluation was performed at 0, 1, and 3 years. Participants were classified into two groups based on their CRF response over the maintenance period (worsening: CRF- vs. maintenance/improvement: CRF+). During the maintenance period, changes in the psoas and core LAM areas correlated with changes in IR (r = 0.27; p < 0.05 and r = 0.34; p < 0.005) and changes in CRF (r = -0.31; p < 0.01 and r = -0.30; p < 0.05). IR improved in the CRF+ group (p < 0.05) but remained stable in the CRF- group. Men in the CRF+ group regained half of the changes in VAT volume and LAM at the psoas and mid-thigh compared to the CRF- group (p < 0.05). These results support the importance of targeting VAT and CRF/PA for the long-term management of CMR in men with visceral obesity.

Eight weeks of high-intensity interval vs. sprint interval training effects on overweight and obese adolescents carried out during the cool-down period of physical education classes: randomized controlled trial.

Objective: The aim of this study was to evaluate the effect of sprint interval training (SIT) and [high intensive interval training (HIIT)] carried out during the cool-down period of the physical education classes on body composition, blood pressure variables (BP) and pulse rate (PR), and cardiorespiratory fitness of adolescents who are overweight and obese, and to compare the differences in enjoyment in response to SIT vs. HIIT. Methods: For this randomized controlled trial, forty-five adolescents were recruited from a high school and were randomly placed into three groups. SIT and HIIT trained for 8 weeks, twice a week, for 12 min/session. Experimental group (EG) 3 was the control, and they maintained their regular physical education class schedule. The SIT group performed 6 sets of 60 s of work (90-95%HRmax) / 60 s of rest (50-55%HRmax), and the HIIT group performed 3 sets of 2 min of work (80-85%HRmax) / 2 min of rest (50-55%HRmax). Results: Both experimental groups showed a significant improvement in fat mass (FM) (%) and trunk FM (kg). In addition, EG2 reported a significance improvement in lean mass (kg), blood pressure BP (mmHG), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), PR (bpm), and VO2max (ml/kg/min). Conclusion: The present study found that a HIIT protocol performed during the cool-down period of the physical education classes generated adaptations such as improvement in body composition, BP variables and PR, and cardiorespiratory fitness, in overweight and obese adolescents. In contrast, the group of overweight and obese adolescents who performed SIT showed limited benefits, with changes in fat mass only.

Adolescent mental health and cardiorespiratory fitness: A comparison of two cohorts 12 years apart.

The aim of the study was to compare the mental health and cardiorespiratory fitness (CRF) of adolescents in two cross-sectional cohorts, one measured in 2003 and the other in 2015, both at age 15 and across sexes. The study also sought to estimate the association between mental health and CRF in the two cohorts and examine the relationship between the level of CRF and mental health in each cohort overall and by sex. Data from 443 participants born in 1988 (228 males, 215 females) and 303 participants born in 1999 (126 males, 177 females) were analyzed. Mental health was assessed using self-reports of body image, self-esteem, and symptoms of depression and anxiety. CRF was estimated using a maximal cycle ergometer test. From 2003 to 2015, body image scores improved (p = .043), self-esteem remained stable, and CRF declined significantly (p < .001). No self-esteem differences were observed between sexes in any cohort. Males had higher CRF and body image scores than females in both cohorts (p < .001 for all comparisons). Higher CRF correlated with fewer depressive symptoms across sexes and cohorts. Specifically, higher CRF was associated with anxiety in females and improved body image in males (2003) and both sexes (2015). Increased CRF was linked to higher self-esteem in females but not in males. Overall, higher CRF levels were associated with better mental health outcomes for both sexes. These results highlight the potential of improving adolescent mental health through increased physical fitness.

Effects of plyometric training on health-related physical fitness in untrained participants: a systematic review and meta-analysis.

Plyometric training (PT) is an effective training method for improving physical fitness among trained individuals; however, its impact on health-related physical fitness in untrained participants remains ambiguous. Therefore, this meta-analysis aimed to evaluate the effects of PT on health-related physical fitness among untrained participants. Six electronic databases (PubMed, CINAHL Plus, MEDLINE Complete, Web of Science Core Collection, SCOPUS, and SPORTDiscus) were systematically searched until March 2024. We included controlled trials that examined the effects of PT on health-related physical fitness indices in untrained participants. Twenty-one studies were eligible, including a total of 1263 participants. Our analyses revealed small to moderate effects of PT on body mass index, muscular strength, cardiorespiratory fitness, and flexibility (ES = 0.27-0.61; all p > 0.05). However, no significant effects were detected for body fat percentage and lean mass (ES = 0.21-0.41; all p > 0.05). In conclusion, the findings suggest that PT may be potentially effective in improving health-related physical fitness indices (i.e., body mass index, muscular strength, cardiorespiratory fitness, and flexibility) in untrained participants. However, the results should be interpreted cautiously due to data limitations in some fitness variables.

Mortality Benefits of Cardiac Rehabilitation in Coronary Artery Disease Are Mediated by Comprehensive Risk Factor Modification: A Retrospective Cohort Study.

BACKGROUND: Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mortality. METHODS AND RESULTS: A retrospective mediation analysis was conducted among 11 196 patients referred to a 12-week CR program following an acute coronary syndrome event between 2009 and 2019. A panel of cardiovascular risk factors was assessed at a CR intake visit and repeated on CR completion. All-cause and cardiovascular mortality were ascertained via health care administrative data sets at mean 4.2-year follow-up (SD, 2.81 years). CR completion was associated with reduced all-cause (adjusted hazard ratio [HR], 0.67 [95% CI, 0.54-0.83]) and cardiovascular (adjusted HR, 0.57 [95% CI, 0.40-0.81]) mortality, as well as improved cardiorespiratory fitness, lipid profile, body composition, psychological distress, and smoking rates (P<0.001). CR attendance had an indirect effect on all-cause mortality via improved cardiorespiratory fitness (ab=-0.006 [95% CI, -0.008 to -0.003]) and via low-density lipoprotein cholesterol (ab=-0.002 [95% CI, -0.003 to -0.0003]) and had an indirect effect on cardiovascular mortality via cardiorespiratory fitness (ab=-0.007 [95% CI, -0.012 to -0.003]). CONCLUSIONS: Cardiorespiratory fitness and lipid control partly explain the mortality benefits of CR and represent important secondary prevention targets.

Life's Essential 8 Cardiovascular Health Score and Cardiorespiratory Fitness in the Community.

BACKGROUND: The relation of cardiorespiratory fitness (CRF) to lifestyle behaviors and factors linked with cardiovascular health remains unclear. We aimed to understand how the American Heart Association's Life's Essential 8 (LE8) score (and its changes over time) relate to CRF and complementary exercise measures in community-dwelling adults. METHODS AND RESULTS: Framingham Heart Study (FHS) participants underwent maximum effort cardiopulmonary exercise testing for direct quantification of peak oxygen uptake (V̇O2). A 100-point LE8 score was constructed as the average across 8 factors: diet, physical activity, nicotine exposure, sleep, body mass index, lipids, blood glucose, and blood pressure. We related total LE8 score, score components, and change in LE8 score over 8 years with peak V̇O2 (log-transformed) and complementary CRF measures. In age- and sex-adjusted linear models (N=1838, age 54±9 years, 54% women, LE8 score 76±12), a higher LE8 score was associated favorably with peak V̇O2, ventilatory efficiency, resting heart rate, and blood pressure response to exercise (all P<0.0001). A clinically meaningful 5-point higher LE8 score was associated with a 6.0% greater peak V̇O2 (≈1.4 mL/kg per minute at sample mean). All LE8 components were significantly associated with peak V̇O2 in models adjusted for age and sex, but blood lipids, diet, and sleep health were no longer statistically significant after adjustment for all LE8 components. Over an ≈8-year interval, a 5-unit increase in LE8 score was associated with a 3.7% higher peak V̇O2 (P<0.0001). CONCLUSIONS: Higher LE8 score and improvement in LE8 over time was associated with greater CRF, highlighting the importance of the LE8 factors in maintaining CRF.

Integrated neuromuscular training intervention applied in schools induces a higher increase in salivary high molecular weight adiponectin and a more favorable body mass index, cardiorespiratory fitness and muscle strength in children as compared to the traditional physical education classes.

Background: High-molecular-weight adiponectin (HMW-adiponectin) is a cardio-metabolic health protector. Objectives: (1) to compare body mass index (BMI), cardiorespiratory fitness (CRF) and muscle strength (MS) in healthy school-children depending on their baseline salivary-HMW-adiponectin concentration; and (2) to apply a 3-month integrated neuromuscular training (INT) and evaluate its effects on salivary-HMW-adiponectin concentration, BMI, CRF and MS in the same children. Additional goal: to identify if any potential changes during the 3-month period may be related to a potential change in salivary-HMW-adiponectin concentration. Methods: Ninety children (7.4 ± 0.3 years) were recruited in primary schools and randomly allocated into control or intervention group. The intervention consisted of a 3-month INT applied during physical education (PE) classes, twice-weekly, while the control group had traditional PE classes. Body mass and height were measured, BMI was calculated and HMW-adiponectin was quantified in saliva. To assess CRF and MS, 800 m-run and hand-dynamometry were applied, respectively. All measurements were performed twice, at baseline and after 3 months. Results: Children with higher baseline salivary-HMW-adiponectin have more favorable BMI (p = 0.006) and slightly higher CRF (p = 0.017) in comparison to the children with lower baseline salivary-HMW-adiponectin. There were no big changes after the 3-month-period neither in the control, nor the INT group. However, it is worthy to note that the INT induced slightly higher increase in salivary-HMW-adiponectin (p = 0.007), and a slightly higher improvement in BMI (p = 0.028), CRF (p = 0.043) and MS (p = 0.003), as compared to the traditional PE classes. Finally, the INT-induced improvement in CRF was associated with the increased post-salivary-HMW-adiponectin concentration (p = 0.022). Conclusion: Main findings may suggest the potential utility of an INT as a cost-effective strategy that can be applied in schools to induce cardio-protective effects in school-children.

High-intensity interval training and cardiorespiratory fitness in adults: An umbrella review of systematic reviews and meta-analyses.

BACKGROUND: High-intensity interval training (HIIT) is characterized by repeated bouts of relatively intense exercise interspersed with recovery periods. Previous studies have evaluated this exercise strategy with various population subgroups, regimens, and comparator groups, limiting the generalizability of findings. We performed a novel umbrella review to generate an up-to-date synthesis of the available evidence regarding the effect of HIIT on cardiorespiratory fitness (CRF) in adults as compared to non-exercise control and traditional continuous forms of exercise such as moderate-intensity continuous training (MICT). METHODS: An umbrella review was conducted in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched until February 2024. Systematic reviews with meta-analyses comparing HIIT and active/non-active control conditions were included. Literature search, data extraction, and methodological quality assessment (AMSTAR-2) were conducted independently by two reviewers. RESULTS: Twenty-four systematic reviews with meta-analyses, representing 429 primary studies and 12 967 unique participants, met the inclusion criteria. Most of the systematic reviews received moderate-to-critically low AMSTAR-2 scores. The data showed that HIIT, including the particularly intense variant "sprint interval training" (SIT), significantly increases CRF in adults compared to non-exercise control (standardized mean difference [SMD]: 0.28 to 4.31; weighted mean difference [WMD]: 3.25 to 5.5 mL/kg/min) and MICT (SMD: 0.18 to 0.99; WMD: 0.52 to 3.76 mL/kg/min). This effect was consistently observed across specific groups of individuals (e.g., apparently healthy adults, individuals with overweight/obesity, older adults, and high-level athletes) and HIIT modalities (e.g., low-volume HIIT, whole-body HIIT, home-based HIIT, aquatic HIIT, and short SIT). CONCLUSION: Existing evidence from systematic reviews consistently supports the effect of HIIT on enhancing CRF in adults when compared to non-exercise control and MICT. Our findings offer a comprehensive basis that may potentially contribute to informing physical activity guidelines aimed at improving CRF in the general population.

ZOom Delivered Intervention Against Cognitive decline (ZODIAC) COVID-19 pandemic adaptations to the Post-Ischaemic Stroke Cardiovascular Exercise Study (PISCES): protocol for a randomised controlled trial of remotely delivered fitness training for brain health.

BACKGROUND: Stroke increases subsequent dementia risk yet there are no specific post-stroke therapies to protect cognition. Cardiorespiratory exercise is recommended for secondary prevention of stroke and may be neuroprotective. The Post Ischaemic Stroke Cardiovascular Exercise Study (PISCES) aims to reduce post-stroke secondary neurodegeneration and cognitive decline. During the pandemic, we pivoted to a ZOom Delivered Intervention Against Cognitive decline (ZODIAC) protocol, reducing pandemic-amplified barriers to exercise. METHODS: We present pandemic adaptions for a multicentre phase IIb assessor-blinded randomised controlled trial of ischaemic stroke survivors testing the efficacy and feasibility of an 8-week home-based exercise intervention delivered at 2 months post-stroke. We compare cardiorespiratory exercise (intervention arm) versus balance and stretching (active control arm). Participants are assessed with magnetic resonance imaging (MRI), fitness, blood, microbiome, and neuropsychological tests at three study visits: before and after the exercise intervention and at 12 months. Modifications to the original protocol include pre-exercise safety home visits, commercial delivery of exercise equipment to facilitate assessor blinding, and reconsideration of statistical plan to allow pooling of the studies. We have reduced in-person study visits from 27 to 3. Primary outcome remains between-group (intervention versus control) difference in brain volume change; secondary outcome is between-group difference in global cognitive ability to allow remote administration of a validated cognitive scale. DISCUSSION: Remotely delivered exercise interventions reduce participant burden and may reduce barriers to recruitment. A decrease in the number of in-person study visits can be supported by greater information capture via self-reported questionnaires and phone surveys. TRIAL REGISTRATION: Prospectively ACTRN12616000942459. Registered on July 2016.

Physiological impact of Tabata exercise on cardiometabolic and cardiorespiratory parameters in transgender people of Multan.

Objective: To investigate factors directly related to cardiometabolic and cardiorespiratory fitness in transgender people. METHODS: The cross-sectional, experimental study was conducted at the Government Girls Comprehensive Higher Secondary School, Multan, Pakistan, from January to February 2023, after approval from the ethics review committee of the Muhammad Institute of Medical and Allied Sciences, Multan, and comprised transgender people aged 17-28 years. Data was collected using the physical activity readiness questionnaire. All the participants were subjected to Tabata sessions for 4 weeks. Standard cardiometabolic and cardiorespiratory fitness values were noted at baseline and post-intervention. Data was analysed using SPSS 23. RESULTS: Of the 44 participants, 26(59%) were trans-men, 18(40.9%) were trans-women, 16(36.3%) were aged 17-19 years, and 10(22.7%) had other transgender individuals in their families. Cardiorespiratory and cardiometabolic parameters showed significant improvement post-intervention compared to baseline values (p<0.05). Conclusion: Tabata exercises were found to be useful in maintaining cardiorespiratory and cardiometabolic parameters as well in increasing the participants' motor performance.

Longitudinal associations of meeting the WHO physical activity guidelines and physical fitness, from preschool to childhood.

There is a well-established relationship between physical activity (PA) and physical fitness in children, being the latter an important marker for present and future health; however, there is still insufficient knowledge for the transition from the preschool age to early childhood. Therefore, this study in Swedish children aimed to investigate the estimated effect of meeting the aerobic component of the PA guidelines at 4 and/or 9 years of age on physical fitness measured at 9 years of age. PA was assessed using a wrist-worn ActiGraph accelerometer and identical data processing in 217 healthy children in Sweden (114 boys and 103 girls). Physical fitness test included cardiorespiratory (20 m shuttle run test), motor (4 × 10 m shuttle run), and muscular fitness (hand grip strength and long jump). A linear mixed model was run, investigating the interaction between meeting the PA guidelines and time (either 4 or 9 years of age) and each fitness component (at 4 and 9). Interactions by sex were also checked. Meeting the PA guidelines consistently (at 4 and 9 years) was significantly associated to better performance in physical fitness parameters for motor fitness (-0.76 s, p < 0.001) and lower body muscular fitness (+4.6 cm; p < 0.001) at 9 years. There was an interaction between meeting the PA guidelines and time point, for cardiorespiratory fitness (+4.58 laps; p < 0.001). This study shows that meeting the PA guidelines at 4 and 9 years of age is associated to higher physical fitness at 9 years of age.

Cardiorespiratory fitness and the association with galectin-1 in middle-aged individuals.

Galectin-1 plays a functional role in human metabolism and the levels are altered in obesity and type 2 diabetes (T2D). This study investigates the association of cardiorespiratory fitness (CRF) with galectin-1 and the interconnection with body fatness. Cross-sectional data from the Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot was analyzed, including a sample of 774 middle-aged individuals. A submaximal cycle ergometer test was used to estimate CRF as an indirect measure of the physical activity (PA) level. Serum-galectin-1 concentration was determined from venous blood collected after an overnight fast. Body mass index (BMI) was used as an indirect measure of body fatness. CRF was significantly associated with galectin-1, when controlled for age and sex (regression coefficient (regr coeff) = -0.29, p<0.001). The strength of the association was attenuated when BMI was added to the regression model (regr coeff = -0.09, p = 0.07), while the association between BMI and galectin-1 remained strong (regr coeff = 0.40, p<0.001). CRF was associated with BMI (regr coeff = -0.50, p<0.001). The indirect association between CRF and galectin-1 through BMI (-0.50 x 0.40) contributed to 69% of total association (mediation analysis). In group comparisons, individuals with low CRF-high BMI had the highest mean galectin-1 level (25 ng/ml), while individuals with high CRF-low BMI had the lowest level (21 ng/ml). Intermediate levels of galectin-1 were found in the low CRF-low BMI and high CRF-high BMI groups (both 22 ng/ml). The galectin-1 level in the low CRF-high BMI group was significantly different from the other three groups (P<0.001). In conclusion, galectin-1 is associated with CRF as an indirect measure of the PA level through interconnection with body fatness. The size of the association is of clinical relevance.

FIT calculator: a multi-risk prediction framework for medical outcomes using cardiorespiratory fitness data.

Accurately predicting patients' risk for specific medical outcomes is paramount for effective healthcare management and personalized medicine. While a substantial body of literature addresses the prediction of diverse medical conditions, existing models predominantly focus on singular outcomes, limiting their scope to one disease at a time. However, clinical reality often entails patients concurrently facing multiple health risks across various medical domains. In response to this gap, our study proposes a novel multi-risk framework adept at simultaneous risk prediction for multiple clinical outcomes, including diabetes, mortality, and hypertension. Leveraging a concise set of features extracted from patients' cardiorespiratory fitness data, our framework minimizes computational complexity while maximizing predictive accuracy. Moreover, we integrate a state-of-the-art instance-based interpretability technique into our framework, providing users with comprehensive explanations for each prediction. These explanations afford medical practitioners invaluable insights into the primary health factors influencing individual predictions, fostering greater trust and utility in the underlying prediction models. Our approach thus stands to significantly enhance healthcare decision-making processes, facilitating more targeted interventions and improving patient outcomes in clinical practice. Our prediction framework utilizes an automated machine learning framework, Auto-Weka, to optimize machine learning models and hyper-parameter configurations for the simultaneous prediction of three medical outcomes: diabetes, mortality, and hypertension. Additionally, we employ a local interpretability technique to elucidate predictions generated by our framework. These explanations manifest visually, highlighting key attributes contributing to each instance's prediction for enhanced interpretability. Using automated machine learning techniques, the models simultaneously predict hypertension, mortality, and diabetes risks, utilizing only nine patient features. They achieved an average AUC of 0.90 ± 0.001 on the hypertension dataset, 0.90 ± 0.002 on the mortality dataset, and 0.89 ± 0.001 on the diabetes dataset through tenfold cross-validation. Additionally, the models demonstrated strong performance with an average AUC of 0.89 ± 0.001 on the hypertension dataset, 0.90 ± 0.001 on the mortality dataset, and 0.89 ± 0.001 on the diabetes dataset using bootstrap evaluation with 1000 resamples.

Association of chronotropic incompetence with reduced cardiorespiratory fitness in older adults with HIV.

OBJECTIVE: Understanding the physiological drivers of reduced cardiorespiratory fitness in people with HIV (PWH) will inform strategies to optimize healthspan. Chronotropic incompetence is common in heart failure and associated with low cardiorespiratory fitness yet is understudied in PWH. The objective was to determine the prevalence of chronotropic incompetence and its relationship with cardiorespiratory fitness. DESIGN: Participants were PWH at least 50 years of age with no prior history of heart failure or coronary heart disease who were enrolled in a randomized exercise trial. Baseline cardiopulmonary exercise testing (CPET) was used to measure cardiorespiratory fitness as peak oxygen consumption (VO2peak) and calculate the chronotropic index from heart rate values. Chronotropic incompetence was defined as an index less than 80%. RESULTS: The 74 participants were on average 61 years old, 80% Black or African American, and 93% men. Chronotropic incompetence was present in 31.1%. VO2peak was significantly lower among participants with chronotropic incompetence compared with participants without chronotropic incompetence [mean (SD) ml/min/kg: 20.9 (5.1) vs. 25.0 (4.5), P = 0.001]. Linear regression showed that chronotropic incompetence and age were independent predictors of VO2peak, but smoking and comorbidity were not. The chronotropic index correlated with VO2peak (r = 0.48, P < 0.001). CONCLUSION: Among older PWH without heart failure or coronary heart disease, chronotropic incompetence was present in approximately one-third of individuals and was associated with clinically relevant impaired cardiorespiratory fitness. Investigation of chronotropic incompetence in large cohorts which includes PWH and heart failure may contribute to strategies that promote healthy aging with HIV infection and offer a preclinical window for intervention.

The International Fitness Scale (IFIS): A valid tool to assess physical fitness in French children.

BACKGROUND: The need for monitoring regularly physical fitness in youth is well established for public health issues. The aim of this study was to assess the validity and reliability of the International Fitness Scale questionnaire (IFIS) to assess physical fitness in French children in the school context. METHODS: A sample of 2 060 children (1054 boys), aged 10.6 ± 0.9 years, participated in the validation study while an independent sample of 366 children (175 boys), aged 9 to 11 years, participated in the assessment of reliability. Physical fitness was measured by a self-report of 5 questions with a 5-point Likert-scale (from very poor to very good) (IFIS), and also measured objectively by 4 field tests: cardiorespiratory fitness, muscular strength, speed/agility and flexibility. For the test-retest reliability assessment, children were instructed to complete the questionnaire twice, 1 week apart. RESULTS: For all physical fitness components studied, children reporting a good or a very good physical fitness in the IFIS had better results in objective measurements of physical fitness tests compared to children reporting a very poor to an average physical fitness (p<0.001) without or with adjustments for sex, age and weight status. The reliability coefficients were acceptable for all components of physical fitness (0.59-0.72). CONCLUSIONS: These results suggest that IFIS appears to be a useful instrument for teachers to estimate physical fitness levels of French children, possibly on a large scale.

Cardiorespiratory fitness mediates the relationship between depressive symptomatology and cognition in older but not younger adults.

Aging is commonly associated with emotional, physical, and cognitive changes, with the latter, particularly affecting executive functioning. Further, such changes may interact. For instance, depressive symptomatology is a known risk factor for developing cognitive deficits, especially at older ages. In contrast, an active lifestyle, reflected in high cardiorespiratory fitness (CRF) levels, has proven to protect against adverse effects on cognition across the adult lifespan. Hence, this study aimed to investigate the relationships between depressive symptomatology, CRF, and cognition during critical developmental stages, namely in young adults (YA), when cognitive abilities are at their peak, and in older adults (OA), when they may start to decline. Eighty-one OA with ages between 60 and 89 years (M = 70.46; SD = 7.18) and 77 YA with ages between 18 and 34 years (M = 22.54; SD = 3.72) went through (i) a sociodemographic interview, (ii) an emotional assessment, (iii) a battery of cognitive tests, and (iv) a physical evaluation assessing CRF levels, visceral fat and body-mass index. Results showed that OA exhibited lower general cognitive performance, inhibitory control, cognitive flexibility, memory, and CRF. Depressive symptoms and anxiety were not different among groups, with CRF mediating the relationship between depressive symptoms and cognition in the OA group. The present study provides valuable insights into the interplay between emotional, physical, and cognitive well-being. Additionally, it calls attention to how lifestyle factors can play a protective role against the adverse effects that depressive symptoms have on cognition, particularly at older ages.