Is breathing frequency a potential means for monitoring exercise intensity in people with atrial fibrillation and coronary heart disease when heart rate is mitigated?

PURPOSE: Moderate-intensity aerobic exercise is safe and beneficial in atrial fibrillation (AF) and coronary heart disease (CHD). Irregular or rapid heart rates (HR) in AF and other heart conditions create a challenge to using HR to monitor exercise intensity. The purpose of this study was to assess the potential of breathing frequency (BF) to monitor exercise intensity in people with AF and CHD without AF. METHODS: This observational study included 30 AF participants (19 Male, 70.7 ± 8.7 yrs) and 67 non-AF CHD participants (38 Male, 56.9 ± 11.4 yrs). All performed an incremental maximal exercise test with pulmonary gas exchange. RESULTS: Peak aerobic power in AF ( V ˙ O2peak; 17.8 ± 5.0 ml.kg-1.min-1) was lower than in CHD (26.7 ml.kg-1.min-1) (p < .001). BF responses in AF and CHD were similar (BF peak: AF 34.6 ± 5.4 and CHD 36.5 ± 5.0 breaths.min-1; p = .106); at the 1st ventilatory threshold (BF@VT-1: AF 23.2 ± 4.6; CHD 22.4 ± 4.6 breaths.min-1; p = .240). % V ˙ O2peak at VT-1 were similar in AF and CHD (AF: 59%; CHD: 57%; p = .656). CONCLUSION: With the use of wearable technologies on the rise, that now include BF, this first study provides an encouraging potential for BF to be used in AF and CHD. As the supporting data are based on incremental ramp protocol results, further research is required to assess BF validity to manage exercise intensity during longer bouts of exercise.

Sex-specific associations of fat mass and muscle mass with cardiovascular disease risk factors in adults with type 2 diabetes living with overweight and obesity: secondary analysis of the Look AHEAD trial.

BACKGROUND: Distinguishable sex differences exist in fat mass and muscle mass. High fat mass and low muscle mass are independently associated with cardiovascular disease (CVD) risk factors in people living with type 2 diabetes; however, it is unknown if the association between fat mass and CVD risk is modified by muscle mass, or vice versa. This study examined the sex-specific interplay between fat mass and muscle mass on CVD risk factors in adults with type 2 diabetes living with overweight and obesity. METHODS: Dual-energy X-ray absorptiometry (DXA) measures were used to compute fat mass index (FMI) and appendicular muscle mass index (ASMI), and participants were separated into high-fat mass vs. low-fat mass and high-muscle mass vs. low-muscle mass. A two-way analysis of covariance (ANCOVA: high-FMI vs. low-FMI by high-ASMI vs. low-ASMI) was performed on CVD risk factors (i.e., hemoglobin A1C [A1C]; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic and diastolic blood pressure; cardiorespiratory fitness, depression and health related-quality of life [HR-QoL]) at baseline and following a 1-year intensive lifestyle intervention (ILI) for females and males separately, with a primary focus on the fat mass by muscle mass interaction effects. RESULTS: Data from 1,369 participants (62.7% females) who completed baseline DXA were analyzed. In females, there was a fat mass by muscle mass interaction effect on A1C (p = 0.016) at baseline. Post-hoc analysis showed that, in the low-FMI group, A1C was significantly higher in low-ASMI when compared to high-ASMI (60.3 ± 14.1 vs. 55.5 ± 13.5 mmol/mol, p = 0.023). In the high-FMI group, there was no difference between high-ASMI and low-ASMI (56.4 ± 12.5 vs. 56.5 ± 12.8 mmol/mol, p = 0.610). In males, only high-FMI was associated with higher A1C when compared to low-FMI (57.1 ± 14.4 vs. 54.2 ± 12.0 mmol/mol, p = 0.008) at baseline. Following ILI, there were significant fat mass by muscle mass interaction effects on changes in the mental component of HR-QoL in males. CONCLUSION: Considering that A1C predicts future CVD, strategies to lower A1C may be especially important in females with low fat and low muscle mass living with type 2 diabetes. Our results highlight the complicated and sex-specific contribution of fat mass and muscle mass to CVD risk factors.

Meeting the Canadian strength training recommendations: Implications for the cardiometabolic, psychological and musculoskeletal health of nurses.

AIM: To examine the proportion of nurses meeting the strength training recommendation and its associated cardiometabolic, psychological and musculoskeletal benefits. BACKGROUND: Strength training targets poor physical and mental health often reported by nurses; however, it is unknown whether nurses are meeting the strength training guidelines. METHODS: Nurses from 14 hospitals completed a 7-day physical activity log. Nurses were considered meeting the recommendation if they reported ≥2 strength training sessions per week. Cardiometabolic, psychological and musculoskeletal health, and levels of motivation were compared between nurses meeting and not meeting the guidelines. RESULTS: Of the 307 nurses (94% female; age: 43 ± 12 years), 29 (9.4%) met the strength training recommendation. These nurses had lower body mass index (24.1 ± 2.6 vs. 27.3 ± 5.5 kg/m2 , p = .007) and waist circumference (73.8 ± 8.3 vs. 81.1 ± 11.7 cm, p = .017); and higher vigour-activity (18.0 ± 5.8 vs. 15.6 ± 6.5 points, p = .046) and self-determined motivation (relative autonomic index: 54.9 ± 20.3 vs. 45.0 ± 23.8 points, p = .042) scores than nurses not meeting the recommendation. CONCLUSION: While the proportion of nurses meeting the strength training recommendation was small (<10%), they had lower body mass and waist circumference, and higher vigour-activity. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies to increase the strength training engagement may improve the cardiometabolic health and increase vigour among nurses.

Clinical outcomes of interval training in cardiovascular disease populations: A clinical perspective.

Nearly 20 years have elapsed since the first clinical trial investigated the impact of interval training on patients with cardiovascular disease (CVD). This clinical corner discusses the health outcomes of systematic reviews and meta-analyses and appropriately powered randomized controlled trials (RCTs) which have tested these interval training programs across various CVDs (i.e., coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, and cardiac implantable electronic devices). The publications included in this clinical corner have shown that interval training leads to similar or superior improvements in V̇O2peak, functional capacity, pain free walking, QoL, anxiety, depression, and endothelial function, but the magnitude of improvements across varying protocols (e.g., length and number of work periods, intensities of work periods, duration of exercise sessions, frequency of exercise sessions, duration of program) and optimal dosage for males and females is unclear across CVD conditions. The heterogeneity in protocols, physical and mental health outcome measures, and lack of sex- and gender-based analyses calls for more high-quality research in this area.

Screening for sarcopenia with SARC-F in older patients hospitalized with cardiovascular disease.

OBJECTIVES: SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity value to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score. METHODS: This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥ 65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Areas under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g., Walking speed, leg strength, and 6-minute walking distance) of each SARC-F score. RESULTS: A total of 1066 participants (63.8% male; median age: 78 years) were included. Sarcopenia was present in 401 patients. SARC-F cut-off ≥ 2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (the AUCs = 0.658; 95% confidence interval: 0.625-0.691). Even when the patients have low scores (1-3), increasing every 1 point of SARC-F score was associated with lower physical functions, such as lower muscle strength and shorter walking distance (all p < 0.001). CONCLUSIONS: SARC-F cut-off ≥ 2 was optimal for screening sarcopenia, and even a low SARC-F score is helpful in finding earlier sarcopenia and low physical function in patients with CVD.

Effect of change in hepato-renal function and cardiac rehabilitation on mortality in patients with heart failure.

BACKGROUND: Patients with heart failure (HF) often suffer from hepato-renal dysfunction. The associations between hepato-renal function changes and mortality remain unclear. Further, the effect of cardiac rehabilitation (CR) on mortality and motor functions in patients with HF and hepato-renal dysfunction requires investigation. METHODS: We reviewed 2522 patients with HF (63.2 % male; median age: 74 years). The association between changes in hepato-renal function assessed by the Model for End-stage Liver Disease eXcluding INR (MELD-XI) score and mortality was examined. The association of CR participation with mortality and physical functions was investigated in patients with HF with decreased, unchanged, and increased MELD-XI scores. RESULTS: During the follow-up period, 519 (20.6 %) patients died. Worsened MELD-XI score was independently associated with all-cause death [adjusted hazard ratio (aHR): 1.099; 95 % confidence interval (CI): 1.061-1.138; p < 0.001]. CR participation was associated with low mortality, even in the increased MELD-XI score group (aHR: 0.498; 95 % CI: 0.333-0.745; p < 0.001). Trajectory of the MELD-XI score was not associated with physical function changes. There were no time by MELD-XI score interaction effects on handgrip strength (p = 0.084), leg strength (p = 0.082), walking speed (p = 0.583), and 6-min walking distance (p = 0.833) in patients participating in outpatient CR. CONCLUSIONS: Hepato-renal dysfunction predicts high mortality. CR participation may be helpful for a better prognosis of patients with HF and hepato-renal dysfunction.

Exercise training reduces circulating cytokines in male patients with coronary artery disease and type 2 diabetes: A pilot study.

Low-grade inflammation is central to coronary artery disease (CAD) and type 2 diabetes (T2D) and is reduced by exercise training. The objective of this study was to compare the anti-inflammatory potential of moderate-to-vigorous intensity continuous training (MICT) and high-intensity interval training (HIIT) in patients with CAD with or without T2D. The design and setting of this study is based on a secondary analysis of registered randomized clinical trial NCT02765568. Male patients with CAD were randomly assigned to either MICT or HIIT, with subgroups divided according to T2D status (non-T2D-HIIT n = 14 and non-T2D-MICT n = 13; T2D-HIIT n = 6 and T2D-MICT n = 5). The intervention was a 12-week cardiovascular rehabilitation program consisting of either MICT or HIIT (twice weekly sessions) and circulating cytokines measured pre- and post-training as inflammatory markers. The co-occurrence of CAD and T2D was associated with increased plasma IL-8 (p = 0.0331). There was an interaction between T2D and the effect of the training interventions on plasma FGF21 (p = 0.0368) and IL-6 (p = 0.0385), which were further reduced in the T2D groups. An interaction between T2D, training modalities, and the effect of time (p = 0.0415) was detected for SPARC, with HIIT increasing circulating concentrations in the control group, while lowering them in the T2D group, and the inverse occurring with MICT. The interventions also reduced plasma FGF21 (p = 0.0030), IL-6 (p = 0.0101), IL-8 (p = 0.0087), IL-10 (p < 0.0001), and IL-18 (p = 0.0009) irrespective of training modality or T2D status. HIIT and MICT resulted in similar reductions in circulating cytokines known to be increased in the context of low-grade inflammation in CAD patients, an effect more pronounced in patients with T2D for FGF21 and IL-6.

SARC-F predicts poor motor function, quality of life, and prognosis in older patients with cardiovascular disease and cognitive impairment.

OBJECTIVES: We investigated whether SARC-F scores were associated with motor function, quality of life (QOL) related to physical function, and prognosis in older patients with cardiovascular disease (CVD) and cognitive impairment. METHODS: This was a retrospective cross-sectional cohort study. The study population consisted of 408 patients with CVD (≥60 years old) who completed the SARC-F questionnaire and Mini-Cog, a cognitive function test, at discharge. Sarcopenia was defined as a total SARC-F score ≥ 4 points. Patients who were cognitively-preserved (Mini-Cog score ≥ 3 points) were excluded. Patients completed the handgrip strength, leg strength, usual gait speed, 6-minute walking distance, short physical performance battery score, and 36-item Short-Form Health Survey Physical Functioning (SF-36PF) tests before discharge. Associations of SARC-F with physical function, QOL, and prognoses (i.e., composite of all-cause death and emergency CVD rehospitalization and the number of CVD rehospitalizations) were investigated. RESULTS: Sarcopenia (SARC-F score ≥ 4 points) was associated with poorer motor function test outcomes and SF-36PF scores (all P < 0.001). The correlations remained significant after adjusting for comorbidities (e.g., anemia, prior heart failure, and renal dysfunction). Sarcopenia was also associated with a poorer prognosis (hazard ratio: 1.574; 95 % confidence interval [CI], 1.011-2.445) and an increased risk of CVD rehospitalization (incidence rate ratio: 1.911; 95 % CI, 1.312-2.782) after adjusting for comorbidities. CONCLUSIONS AND IMPLICATIONS: In older patients with CVD and cognitive impairment, the SARC-F questionnaire may be a simple and inexpensive tool for identifying patients with decreased motor function and a poor prognosis.

Prognostic impact of the coexistence of hepato-renal dysfunction and frailty in patients with heart failure.

BACKGROUND: Complex multi-organ interactions such as coexistence of hepato-renal dysfunction in heart failure (HF) adversely affects patient prognosis. However, the association between liver/kidney dysfunction and frailty and effects of their coexistence on HF prognosis remain unclear. METHODS: This retrospective cohort study included 922 patients with HF (median age, 72 years; interquartile range: 62-79 years). All patients underwent hepato-renal function testing using the model for end-stage liver disease, excluding international normalized ratio (MELD-XI) score and frailty score. Frailty was measured using a composite of four markers: handgrip strength, gait speed, serum albumin, and activities of daily living status, combined into a total frailty score (range 0-12). Patients were assigned to a frailty score <5 (without frailty) or ≥5 (frailty) group. The multivariable logistic regression model was used to analyze the association between MELD-XI score and frailty; the prognostic value of high MELD-XI score and frailty coexistence was investigated. The endpoint was all-cause mortality. RESULTS: After adjusting for covariates and dividing by the median MELD-XI score, the high MELD-XI score group [odds ratio: 1.663, 95 % confidence interval (CI): 1.200-2.304, p = 0.002] was significantly associated with frailty, compared with the low MELD-XI score group. One hundred and fifty deaths occurred during follow-up (median, 2.13 years; interquartile range, 0.93-4.09 years). Patients in the high MELD-XI score/frailty group had a significantly higher mortality risk, even after adjusting for HF severity (hazard ratio: 4.326, 95 % CI: 2.527-7.403, p < 0.001). CONCLUSIONS: Hepato-renal dysfunction is associated with frailty in patients with HF, which affects patient prognosis. BRIEF SUMMARY: This study showed that hepato-renal dysfunction in patients with HF, as assessed by the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score, is associated with frailty, even after adjusting for factors involved in the frailty or severity of HF. Additionally, high MELD-XI score combined with frailty is associated with a poorer prognosis. These results suggest that hepato-renal dysfunction and frailty can be used for risk stratification in patients with HF.

Prognostic value of liver damage assessed through direct bilirubin levels and skeletal muscle weakness in patients with heart failure.

BACKGROUND: Patients with heart failure (HF) often exhibit signs of liver dysfunction such as high bilirubin concentrations, leading to physical dysfunction and poor prognosis. Nevertheless, the relationship between direct bilirubin (DB), a fractionated form of total bilirubin, and dynapenia remains unclear, as does their effect on prognosis. OBJECTIVES: This study investigated the association between DB concentrations and dynapenia in patients with HF. METHODS: This retrospective study included patients with HF who underwent assessments for DB concentration, and handgrip and leg strengths to evaluate dynapenia and muscle weakness, respectively. Multiple logistic regression analyses examined the associations of DB with muscle strength and dynapenia. Additionally, we examined the prognostic value of comorbid high DB concentrations (≥0.5 mg/dL) and dynapenia. The endpoint was all-cause mortality. RESULTS: Of 853 inpatients, high DB was identified in 147 and dynapenia in 377 (44.2%). Multiple regression analysis revealed that high DB was independently associated with decreased muscle strength (handgrip strength, P = 0.027; leg strength, P = 0.002). After adjusting for covariates, the high DB group (odds ratio: 1.800, 95% confidence interval [CI]: 1.203-2.695, P = 0.004) had a significantly higher risk of dynapenia than the low DB group. During the follow-up period, 189 patients died (median, 1.77 years; interquartile range, 0.64-3.81 years). The risk of death was significantly higher in the high DB and dynapenia group, even after adjusting for HF severity (hazard ratio: 2.610, 95% CI: 1.680-4.051, P<0.001). CONCLUSIONS: High DB is associated with muscle weakness, and when combined with dynapenia, DB predicts a poorer prognosis in patients with HF.

Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation.

PURPOSE: The objective of this study was to investigate sex and age differences in anxiety and depression among patients with cardiovascular disease at baseline and following aerobic interval training (AIT)-based cardiac rehabilitation (CR) and secondarily to compare dropout rates between sexes and age groups. METHODS: Participants were younger (≤44 yr), middle-aged (45-64 yr), and older adults (≥65 yr). The AIT protocol consisted of: 4 × 4-min of high-intensity work periods at 85-95% peak heart rate (HR) interspersed with 3 min of lower-intensity intervals at 60-70% peak HR, twice weekly for 10 wk. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and following CR. RESULTS: At baseline, of 164 participants (32% female), 14 (35% female) were younger, 110 (33% female) were middle-aged, and 40 (30% female) were older. Older adults reported lower anxiety levels versus younger (4.4 ± 2.6 vs 7.8 ± 3.4 points, P = .008) and middle-aged adults (4.4 ± 2.6 vs 6.1 ± 3.6 points, P = .05). Baseline depression levels did not differ between age groups (P = .749). All age groups experienced a reduction in anxiety (younger =-2.67; middle-aged =-1.40; older =-0.85) and depression (younger =-1.50; middle-aged =-0.83; older =-0.70) levels following CR. Differences in dropout rates were observed between age groups (χ2[1] = 13.4, P = .001). Within each age group, 43% (female n = 2, male n = 4) of younger, 10% (female n = 8, male n = 3) of middle-aged, and 2.5% (female n = 0, male n = 1) of older participants dropped out. CONCLUSIONS: Younger and middle-aged adults experience higher levels of anxiety upon entry into CR compared with older adults. Cardiac rehabilitation was associated with significant reductions in anxiety and depression severity, yet dropout rates were highest among younger adults.

A case series of acute responses to high-intensity interval training in four males with permanent atrial fibrillation.

Background: Atrial fibrillation (AF) is a serious medical condition and a burgeoning patient population. Chronic exercise training, including high-intensity interval training (HIIT), has been shown to improve symptoms and quality of life in patients with AF. Yet, the acute responses to HIIT in this population remain understudied, leaving clinicians and patients hesitant about prescribing and engaging in high-intensity exercise, respectively. Case summary: This case series describes acute exercise responses [i.e. power output, heart rate (HR), blood pressure (BP), ratings of perceived exertion (RPE), symptoms] to 10 weeks (3 days/week) of HIIT. Participants were four white males (58-80 years old) with permanent AF, co-morbidities (diabetes, coronary artery disease, Parkinson's disease), and physical limitations. The increases in HR and BP during HIIT were modest across all participants, regardless of age and medication use. Differences in RPE were observed; the oldest participant perceived the sessions as more challenging despite a lower HR response. All patients complied with the HIIT prescription of 80-100% of peak power output by week 4. No adverse events were reported. Discussion: Patients' concerns regarding high-intensity exercise may discourage them from participating in HIIT, our results demonstrated no abnormal HR or BP (e.g. hypotension) responses during HIIT or cool-down. These findings align with the typical exercise responses noted in other cardiovascular populations. Notwithstanding the high metabolic demands of HIIT, male patients with permanent AF tolerated HIIT without problem. Further investigation of HIIT as an approach to enable those with AF to recover physical capacity and minimize symptomatology is warranted.

The Prevalence of Metabolic Dysfunction-Associated Fatty Liver Disease and Its Association with Physical Function and Prognosis in Patients with Acute Coronary Syndrome.

It is believed that patients with acute coronary syndrome (ACS) are at an increased risk of nonalcoholic fatty liver disease (NAFLD), which can lead to sarcopenia and physical dysfunction. However, the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and physical dysfunction and prognosis remains unclear. We investigated the prevalence of MAFLD in patients with ACS to assess the relationship between MAFLD and muscle strength, walking speed, and 6-min walking distance (6 MWD). We reviewed patients with ACS who were assessed for hepatic steatosis using the fatty liver index, and the results were further assessed to determine the presence of MAFLD. Among 479 enrolled hospitalized patients, MAFLD was identified in 234 (48.9%) patients. Multiple regression analysis revealed that MAFLD was independently associated with lower leg strength, gait speed, and 6 MWD (leg strength, p = 0.020; gait speed, p = 0.003 and 6 MWD, p = 0.011). Furthermore, in multivariate Poisson regression models after adjustment for clinical confounding factors, combined MAFLD and reduced physical functions were significantly associated with a higher incidence of clinical events. MAFLD is common in hospitalized patients with ACS and is associated with impaired physical function. Also, the coexistence of MAFLD and lower physical function predict the incidence of clinical events in patients with ACS.

The effects of high-intensity interval training, Nordic walking and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study).

BACKGROUND: Coronary artery disease (CAD) patients undergoing revascularization procedures often experience ongoing, diminished functional capacity, high rates of depression and markedly low quality of life (QoL). In CAD patients, studies have demonstrated that high-intensity interval training (HIIT) is superior to traditional moderate-to-vigorous intensity continuous training (MICT) for improving functional capacity, whereas no differences between Nordic walking (NW) and MICT have been observed. Mental health is equally as important as physical health, yet few studies have examined the impact of HIIT and NW on depression and QoL. The purpose of this randomized controlled trial (RCT) was to compare the effects of 12 weeks of HIIT, NW and MICT on functional capacity in CAD patients. The effects on depression severity, brain-derived neurotrophic factor (BDNF) and QoL were also examined. METHODS: CAD patients who underwent coronary revascularization procedures were randomly assigned to: (1) HIIT (4 × 4-min of high-intensity work periods at 85%-95% peak heart rate [HR]), (2) NW (resting HR [RHR] + 20-40 bpm), or (3) MICT (RHR + 20-40 bpm) twice weekly for 12 weeks. Functional capacity (six-min walk test [6MWT]), depression (Beck Depression Inventory-II [BDI-II]), BDNF (from a blood sample), and general (Short-Form 36 [SF-36]) and disease-specific (HeartQoL) QoL were measured at baseline and follow-up. Linear mixed-effects models for repeated measures were used to test the effects of time, group and time × group interactions. RESULTS: N = 135 CAD patients (aged 61 ± 7 years; male: 85%) participated. A significant time × group interaction (p = 0.042) showed greater increases in 6MWT distance (m) for NW (77.2 ± 60.9) than HIIT (51.4 ± 47.8) and MICT (48.3 ± 47.3). BDI-II significantly improved (HIIT: -1.4 ± 3.7, NW: -1.6 ± 4.0, MICT: -2.3 ± 6.0 points, main effect of time: p < 0.001) whereas BDNF concentrations did not change (HIIT: -2.5 ± 9.6, NW: -0.4 ± 7.7, MICT: -1.2 ± 6.4 ng/mL, main effect of time: p > 0.05). Significant improvements in SF-36 and HeartQoL values were observed (main effects of time: p < 0.05). HIIT, NW and MICT participants attended 17.7 ± 7.5, 18.3 ± 8.0 and 16.1 ± 7.3 of the 24 exercise sessions, respectively (p = 0.387). CONCLUSIONS: All exercise programmes (HIIT, NW, MICT) were well attended, safe and beneficial in improving physical and mental health for CAD patients. NW was, however, statistically and clinically superior in increasing functional capacity, a predictor of future cardiovascular events.

Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial.

BACKGROUND: Twelve-week high-intensity interval training (HIIT), moderate-to-vigorousintensity continuous training (MICT), and Nordic walking (NW) have been shown to improve functional capacity, quality of life (QoL), and depression symptoms in patients with coronary artery disease. However, their prolonged effects or whether the improvements can be sustained remains unknown. In this study we compared the effects of 12 weeks of HIIT, MICT, and NW on functional capacity, QoL, and depression symptoms at week 26. METHODS: Patients with coronary artery disease were randomized to a 12-week HIIT, MICT, or NW program followed by a 14-week observation phase. At baseline, and at weeks 12 and 26, functional capacity was measured with a 6-minute walk test (6MWT); QoL was assessed using the HeartQoL and Short Form-36; and depression severity using the Beck Depression Inventory-II. Prolonged (between baseline and week 26) and sustained (between weeks 12 and 26) effects were assessed using linear mixed models with repeated measures. RESULTS: Of 130 participants randomized, 86 (HIIT: n = 29; MICT: n = 27; NW: n = 30) completed week 26 assessments. There were significant improvements in 6MWT distance, QoL, and depression symptoms from baseline to week 26 (P < 0.05); NW increased 6MWT distance (+94.2 ± 65.4 m) more than HIIT (+59.9 ± 52.6 m; interaction effect P = 0.025) or MICT (+55.6 ± 48.5 m; interaction effect P = 0.010). Between weeks 12 and 26, 6MWT distance and physical QoL increased significantly (P < 0.05). CONCLUSIONS: Twelve weeks of HIIT, MICT, and NW have positive prolonged effects on functional capacity, QoL, and depression symptoms. However, NW conferred additional benefits in increasing functional capacity. The effects of the 12-week exercise programs were sustained at week 26.

Effect of High-Intensity Interval Training in Patients With Atrial Fibrillation: A Randomized Clinical Trial.

Importance: Patients with atrial fibrillation (AF) experience poor functional capacity and quality of life (QOL). High-intensity interval training (HIIT) has been shown to elicit greater improvements in functional capacity and QOL compared with moderate to vigorous intensity continuous training (MICT) in other cardiovascular populations, yet HIIT remains understudied in AF. Objective: To compare the effects of 12 weeks of HIIT and MICT-based cardiovascular rehabilitation (CR) on functional capacity and general QOL in patients with persistent and permanent AF. Disease-specific QOL, resting heart rate (HR), time in AF, and physical activity (PA) levels were also assessed. Design, Setting, and Participants: This randomized clinical trial, conducted between November 17, 2015, and February 4, 2020, at a tertiary-care cardiovascular health center in Ottawa, Canada, recruited 94 patients with persistent and permanent AF. Interventions: High-intensity interval training (23 minutes: two 8-minute interval training blocks of 30-second work periods at 80%-100% of peak power output interspersed with 30-second recovery) or CR (60 minutes: continuous aerobic conditioning within 67%-95% of peak HR and 12-16 of 20 ratings of perceived exertion) twice weekly for 12 weeks. Main Outcomes and Measures: The primary outcomes were changes in functional capacity (6-minute walk test [6MWT] distance) and general QOL (Short Form 36) from baseline to 12 weeks' follow-up. Secondary outcomes included changes in disease-specific QOL (Atrial Fibrillation Severity Scale), resting HR, time in AF, and PA levels. An intention-to-treat analysis was used to compare changes between groups. Results: Of the 94 patients who consented, 86 participated (mean [SD] age, 69 [7] years; 57 [66.3%] men). No significant differences in improvements in 6MWT distance (mean [SD], 21.3 [34.1] vs 13.2 [55.2] m; P = .42) and general QOL (Physical Component Summary, 0.5 [6.1] vs 1.1 [4.9] points; P = .87) between HIIT and CR were observed. No significant differences in improvements in disease-specific QOL (AF symptoms: -1.7 [4.3] vs -1.5 [4] points, P = .59), resting HR (-3.6 [10.6] vs -2.9 [12.4] beats per minute, P = .63), and moderate to vigorous PA levels (37.3 [93.4] vs 14.4 [125.7] min/wk; P = .35) between HIIT and CR were detected. Participants attended a mean (SD) of 18.3 (6.1) (75.1%) HIIT sessions and 20.0 (4.5) (83.4%) CR sessions (P = .36). Conclusions and Relevance: In this randomized clinical trial, twice-weekly 23-minute HIIT was as efficacious as twice-weekly 60-minute CR in improving functional capacity, general and disease-specific QOL, resting HR, and PA levels in patients with persistent and permanent AF. Trial Registration: ClinicalTrials.gov Identifier: NCT02602457.

The Physical Activity Levels and Sitting Time of Adults Living With Atrial Fibrillation: The CHAMPLAIN-AF Study.

Background: The primary goal of this study was to determine the time spent completing moderate-to-vigorous intensity physical activity (MVPA) among adults with atrial fibrillation (AF). Secondary aims examined MVPA and sitting time (ST) by AF subtypes (ie, paroxysmal, persistent, long-standing persistent, and permanent) and associations between MVPA or ST and knowledge, task self-efficacy, and outcome expectations. Methods: An observational study was conducted in the Champlain region of Ontario, Canada. AF patients completed a survey to determine MVPA and ST using the Short-Form International Physical Activity Questionnaire. Results: A total of 619 patients (66% male; median age 65 years [95% CI 64-67 years]) completed the survey. Median MVPA and ST were 100 (60-120) min/wk and 6 (5-6) h/d; 56% of patients were not meeting the Canadian 24H Movement Guidelines. Most patients (54%) did not know/were unsure of the MVPA recommendations, yet 72% thought physical activity should be part of AF management. Positive correlations were found between higher MVPA levels and the following: (i) speaking to a healthcare professional about engaging in physical activity for managing AF (ρ = 0.108, P = 0.017); (ii) greater confidence regarding ability to perform physical activity and muscle-strengthening exercise (ρ = 0.421, P < 0.01); and (iii) patient agreement that AF would be better managed if they were active (ρ = 0.205, P < 0.01). Conclusions: Many AF patients do not meet the MVPA recommendations, which may be due to lack of physical activity knowledge. Exercise professionals may help educate patients on the benefits of physical activity, improve task-self efficacy, and integrate MVPA into patient lifestyles.

Introduction: Le principal objectif de la présente étude était de déterminer le temps consacré à faire de l'activité physique modérée à vigoureuse (APMV) chez les adultes atteints de fibrillation auriculaire (FA). Les objectifs secondaires visaient à examiner l'APMV et le temps en position assise (TA) selon les sous-types de FA (c.-à-d. paroxystique, persistante, persistante de longue durée et permanente) et les associations entre l'APMV ou le TA et les connaissances, le sentiment d'auto-efficacité et les attentes de résultats. Méthodes: Nous avons réalisé une étude observationnelle dans la région de Champlain, en Ontario, au Canada. Les patients atteints de FA ont rempli une enquête pour déterminer l'APMV et le TA à l'aide du questionnaire court International Physical Activity Questionnaire (IPAQ). Résultats: Un total de 619 patients (66 % d'hommes; âge médian de 65 ans [IC à 95 % 64-67 ans]) a rempli l'enquête. L'APMV et le TPA médians étaient de 100 (60-120) min/sem et de 6 (5-6) h/j; 56 % des patients ne répondaient pas aux Directives canadiennes en matière de mouvement sur 24 heures. La plupart des patients (54 %) ne connaissaient pas les recommandations d'APMV ou n'étaient pas certains de les connaître, mais 72 % pensaient que l'activité physique devrait faire partie de la prise en charge de la FA. Nous avons observé des corrélations positives entre les degrés plus élevés d'APMV et ce qui suit : (i) le fait de parler à un professionnel de la santé de la pratique de l'activité physique pour prendre en charge la FA (ρ = 0,108, P = 0,017); (ii) la confiance accrue quant à la capacité de faire de l'activité physique et les exercices de renforcement musculaire (ρ = 0,421, P < 0,01); (iii) l'accord du patient sur le fait que la pratique de l'activité physique contribuerait à une meilleure prise en charge de la FA (ρ = 0,205, P < 0,01). Conclusions: Plusieurs patients atteints de FA ne répondaient pas aux recommandations d'APMV, possiblement en raison du manque de connaissances concernant l'activité physique. Les professionnels de l'activité physique peuvent contribuer à l'éducation des patients afin de leur faire connaître les avantages de l'activité physique, améliorer leur auto-efficacité et intégrer l'APMV à leur mode de vie.

Cardiac Rehabilitation Following Percutaneous Coronary Intervention Is Associated With Superior Psychological Health and Quality of Life in Males but Not in Females.

PURPOSE: Cardiac rehabilitation (CR) improves psychological health and health-related quality of life (HR-QoL). Yet, available evidence suggests that their degree of improvements following CR may depend on patient sex and the mode of revascularization. We examined the interplay between sex and mode of revascularization on the psychological health and HR-QoL of patients completing CR. METHODS: We analyzed the longitudinal records of patients who completed a 3-mo outpatient CR program following coronary revascularization. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale and HR-QoL was measured by the Medical Outcomes Study Short Form-36 before and after CR. A two-by-two analysis of covariance (females vs males by coronary artery bypass graft surgery [CABG] vs percutaneous coronary intervention [PCI]) was used to examine the sex-by-revascularization procedure interaction effect on changes in psychological health and HR-QoL. RESULTS: Of the 278 participants (age: 65 ± 9 yr) included in the analysis, 191 (69%) underwent PCI and 55 (20%) were females. Following CR, there was a significant sex-by-revascularization procedure interaction effect on anxiety (P = .033) and mental HR-QoL (mental component summary [MCS]; P = .040). Following CABG, females and males showed similar improvements in anxiety (-1.3 ± 3.4 vs -1.1 ± 3.6 points, P = .460) and MCS scores (5.4 ± 8.9 vs 4.5 ± 8.7 points, P = .887); following PCI, females experienced worse anxiety levels and mental component summary scores while males showed improvements (anxiety: +1.0 ± 3.8 vs -1.3 ± 3.8 points, P = .002; MCS: -1.6 ± 9.3 vs + 4.4 ± 8.9 points, P = .008, respectively). There was no interaction effect on depression. CONCLUSIONS: Continued efforts are required to improve anxiety and mental HR-QoL in females treated with PCI participating in CR.

Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation.

This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).

Moving Together While Staying Apart: Practical Recommendations for 24-Hour Home-Based Movement Behaviours for Those With Cardiovascular Disease.

The novel coronavirus disease 2019 is a global public health crisis that disproportionately affects those with preexisting conditions. Cardiovascular disease (CVD) is the leading cause of death worldwide and many key CVD risk factors are modifiable (e.g., physical inactivity, sedentary behaviour, obesity). To limit the spread of coronavirus 2019, most governments have implemented restrictions and recommended staying at home, reducing social contact to a select and exclusive few, and limiting large gatherings. Such public health constraints may have unintended, negative health consequences on 24-hour movement behaviours. The primary purpose of this review is to provide practical at-home recommendations for sedentary time, sleep, and physical activity in those living with CVD. Adults with CVD will benefit from practical recommendations to reduce sedentary time, increase purposeful exercise, and maintain optimal sleep patterns while being at home and adhering to public health restrictions. Our recommendations include the following: (i) self-monitoring sitting time; (ii) engaging in 2-3 days per week of purposeful exercise for those with low exercise capacity and > 3 days per week for those with moderate-to-high exercise capacity; (iii) self-monitoring exercise intensity through the use of scales or wearable devices; (iv) maintaining a regular sleep schedule; and (v) moving daily. Clinicians should be aware that clear communication of the importance of limiting prolonged sedentary time, engaging in regular physical activity and exercise, and ensuring optimal sleep in association with the provision of clear, comprehensible, and practical advice is fundamental to ensuring that those living with CVD respond optimally to the challenges posed by the pandemic.

La nouvelle maladie à coronavirus 2019 représente une crise de santé publique mondiale qui touche de manière disproportionnée les personnes présentant des pathologies préexistantes. Les maladies cardiovasculaires (MCV) constituent la principale cause de décès dans le monde et de nombreux facteurs de risque majeurs de MCV sont modifiables (par exemple, le manque d'activité physique, un comportement sédentaire, l'obésité). Pour limiter la propagation du coronavirus 2019, la plupart des gouvernements ont mis en place des restrictions et recommandé de rester à la maison, de réduire les contacts sociaux à un nombre de personnes restreint et exclusif, et de limiter les grands rassemblements. Ces contraintes de santé publique peuvent involontairement entraîner des conséquences sanitaires négatives sur les habitudes de déplacement sur 24 heures. L'objectif principal de cette étude est de fournir des recommandations pratiques, réalisables à domicile, en rapport avec le temps de sédentarité, le sommeil et l'activité physique chez les personnes atteintes de MCV. Les adultes atteints de MCV tireront avantage de recommandations pratiques dans le but de réduire le temps de sédentarité, augmenter l'activité physique volontaire et maintenir des habitudes de sommeil optimales, tout en restant à la maison et en respectant les restrictions sanitaires. Nos recommandations sont les suivantes: (i) autosurveillance du temps passé assis; (ii) pratique d'une activité physique volontaire 2 à 3 jours par semaine pour les personnes ayant une faible capacité d'exercice et > 3 jours par semaine pour les personnes ayant une capacité d'exercice modérée à élevée; (iii) autosurveillance de l'intensité de l'activité par l'utilisation de barème ou de dispositifs portatifs; (iv) maintien d'horaires de sommeil réguliers; et (v) action de bouger quotidiennement. Les cliniciens doivent être conscients qu'une communication claire quant à l'importance de limiter le temps de sédentarité prolongée, de pratiquer régulièrement de l'exercice ou une activité physique, et d'assurer un sommeil optimal, associée à la préconisation de conseils clairs, compréhensibles et pratiques, est fondamentale pour garantir une réponse optimale de la part des personnes vivant avec des MCV quant aux défis posés par la pandémie.