Reliability of field- and laboratory-based assessments of health-related fitness in preschool-aged children.

OBJECTIVES: Reliable measurements of health-related fitness-cardiorespiratory endurance, muscular endurance, muscular strength, body composition, and flexibility-are imperative for understanding and tracking health-related fitness from the preschool age. This study aimed to examine the test-retest reliability of field-based (i.e., sit and reach [standard and back-saver], standing long jump, grip strength); and laboratory-based (i.e., Bruce Protocol Treadmill Test, Wingate Anaerobic Test) assessments of health-related fitness in preschool aged children (4-5 years). METHODS: Forty-two typically developing children participated in both assessment time points separated by 2-3 weeks. All fitness assessments were administered individually and repeated in the same order by the same assessor. Heteroscedasticity was examined for each parameter. Intraclass correlation coefficients were calculated to assess test-retest reliability. RESULTS: All parameters were homoscedastic. Test-retest reliability for the field-based tests and Bruce Protocol Treadmill Test parameters were moderate to good. Test-retest reliability for the Wingate Test parameters were good to excellent for maximum pedal rate, peak power, and peak power/kg; mean power and fatigue measured at 10 and 30 s demonstrated moderate to excellent test-retest reliability. CONCLUSION: The standard sit and reach, grip strength, and short-term muscle power from the Wingate test are reliable assessments of health-related fitness in preschool-aged children.

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.

Role of aortic arch vascular mechanics in cardiovagal baroreflex sensitivity.

Cardiovagal baroreflex sensitivity (cvBRS) measures the efficiency of the cardiovagal baroreflex to modulate heart rate in response to increases or decreases in systolic blood pressure (SBP). Given that baroreceptors are located in the walls of the carotid sinuses (CS) and aortic arch (AA), the arterial mechanics of these sites are important contributors to cvBRS. However, the relative contribution of CS and AA mechanics to cvBRS remains unclear. This study employed sex differences as a model to test the hypothesis that differences in cvBRS between groups would be explained by the vascular mechanics of the AA but not the CS. Thirty-six young, healthy, normotensive individuals (18 females; 24 ± 2 yr) were recruited. cvBRS was measured using transfer function analysis of the low-frequency region (0.04-0.15 Hz). Ultrasonography was performed at the CS and AA to obtain arterial diameters for the measurement of distensibility. Local pulse pressure (PP) was taken at the CS using a hand-held tonometer, whereas AA PP was estimated using a transfer function of brachial PP. Both cvBRS (25 ± 11 vs. 19 ± 7 ms/mmHg, P = 0.04) and AA distensibility (16.5 ± 6.0 vs. 10.5 ± 3.8 mmHg(-1) × 10(-3), P = 0.02) were greater in females than males. Sex differences in cvBRS were eliminated after controlling for AA distensibility (P = 0.19). There were no sex differences in CS distensibility (5.32 ± 2.3 vs. 4.63 ± 1.3 mmHg(-1) × 10(-3), P = 0.32). The present data demonstrate that AA mechanics are an important contributor to differences in cvBRS.

The Effects of Sex and Pubertal Maturation on Cardiovagal Baroreflex Sensitivity.

OBJECTIVE: To examine baroreflex sensitivity (BRS) across different stages of pubertal maturation in healthy children and adolescents. STUDY DESIGN: This study was cross-sectional and included 104 participants (53 males and 51 females) aged 8-18 years old. Participants were organized into 5 pubertal groups based on the criteria of Tanner; prepubertal (Tanner 1, n = 19), early-pubertal (Tanner 2, n = 16), peripubertal (Tanner 3, n = 24), late-pubertal (Tanner 4, n = 23), and postpubertal (Tanner 5 and 6, n = 22). Adiposity (fat-free mass, fat mass, and body fat%), body mass index, and demographic variables were collected. Beat-by-beat blood pressure and R-R interval were collected during supine rest to determine BRS. BRS was assessed by transfer function analysis in the low frequency range (0.05-0.15 Hz). RESULTS: The results demonstrated a sex-by-maturation interaction [F(4, 94) = 3.202, P = .019]. BRS decreased from early-to postpuberty in males (30 [7.1] vs 13.2 [7.8] ms/mm Hg), and remained unchanged in females. This led to significantly greater BRS in females compared with males, postpuberty (27 [7.3] vs 13.2 [7.8] ms/mm Hg). CONCLUSIONS: Controlling for both sex and maturation when examining BRS in children and adolescents with cardiovascular disease risk factors will aid in interpreting abnormally high or low BRS values.

Evidence of a hyperkinetic state in children with elevated blood pressure.

BACKGROUND: Left ventricular hypertrophy (LVH) and elevated left ventricular mass index (LVMI) are important predictors of cardiovascular morbidity and mortality in adults. Children with hypertension and pre-hypertension demonstrate LVH and greater LVMI compared to normotensive children. The impact of blood pressure (BP) on early changes in left ventricular properties provides an opportunity to understand and identify cardiovascular risk early in childhood. AIM: The aim of this study was to assess left ventricular structural and functional properties in a sample of children across a wide range of BP values. SUBJECTS AND METHODS: Children aged 11-14-years were divided into BP groups: hypertensives (HTN; ≥95th percentile; n = 21) and normotensives (NTN; <90th percentile; n = 85) based on BP measures taken at two time points. Resting supine heart rate (HR), cardiac output (CO) and total peripheral resistance (TPR) were collected along with left ventricular structural and functional properties using ultrasound sonography. RESULTS: LVMI and TPR were not different between groups. CO, HR and left ventricular end-diastolic and end-systolic volumes were elevated in the HTN group. Furthermore, HR and body mass index were found to be independent predictors of BP group status in children. CONCLUSION: These findings show that children with elevated BP are characterized by high HR and CO and normal TPR. Also, the results identify HR as a predictor of BP group status in early childhood.

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.

Long-Term Maintenance of Cardiorespiratory Fitness Gains After Cardiac Rehabilitation Reduces Mortality Risk in Patients With Multimorbidity.

PURPOSE: The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). METHODS: This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and March 2016, with follow-up through March 2017. Patients were stratified by the presence of multimorbidity, which was defined as having a diagnosis of ≥2 noncommunicable diseases (NCDs). Cox regression analyses were used to evaluate the effects of multimorbidity and CRF on mortality in patients completing CR. Symptom-limited exercise tests were completed at baseline, immediately following CR (12 wk), with a subgroup completing another test at 1-yr follow-up. Peak metabolic equivalents (METs) were determined from treadmill speed and grade. RESULTS: Of the 8320 patients (61 ± 10 yr, 82% male) included in the analyses, 5713 (69%) patients only had CVD diagnosis, 2232 (27%) had CVD+1 NCD, and 375 (4%) had CVD+≥2 NCDs. Peak METs at baseline (7.8 ± 2.0, 6.9 ± 2.0, 6.1 ± 1.9 METs), change in peak METs immediately following CR (0.98 ± 0.98, 0.83 ± 0.95, 0.76 ± 0.95 METs), and change in peak METs 1 yr after CR (0.98 ± 1.27, 0.75 ± 1.17, 0.36 ± 1.24 METs) were different ( P < .001) among the subgroups. Peak METs at 12 wk and the presence of coexisting conditions were each predictors ( P < .001) of mortality. Improvements in CRF by ≥0.5 METS from baseline to 1-yr follow-up among patients with or without multimorbidity were associated with lower mortality rates. CONCLUSION: Increasing CRF by ≥0.5 METs improves survival regardless of multimorbidity status.

An evaluation of the role of the exercise training dose for changes in exercise capacity following a standard cardiac rehabilitation program.

BACKGROUND: To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. METHODS: A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program between January 2018 and December 2019 were included in the analysis. Peak metabolic equivalents (METpeak) were determined pre- and post-CR during which total duration (ET time) and intensity [percent of heart rate peak (%HRpeak)] of supervised ET were also obtained. Training responsiveness was quantified on the basis of changes in METpeak from pre- to post-CR. A cluster analysis was performed to identity clusters demonstrating discrete levels of responsiveness (i.e., negative, low, moderate, high, and very-high). These were compared for several baseline and ET-derived variables which were also included in a multivariable linear regression model. RESULTS: At pre-CR, baseline METpeak was progressively lower with greater training responsiveness (F(4,2305) = 44.2, P < 0.01, η2p = 0.71). Likewise, average training duration (F(4,2305) = 10.7 P < 0.01, η2p = 0.02) and %HRpeak (F(4,2305) = 25.1 P < 0.01, η2p = 0.042) quantified during onsite ET sessions were progressively greater with greater training responsiveness. The multivariable linear regression model confirmed that baseline METpeak, training duration and intensity during ET, BMI, and age (P < 0.001) were significant predictors of METpeak post-CR. CONCLUSIONS: Along with baseline METpeak, delta BMI, and age, the dose of ET (i.e., training duration and intensity) predicts METpeak at the conclusion of CR. A re-evaluation of current approaches for exercise intensity prescription is recommended to extend the benefits of completing CR to all patients.

Time-of-day effect on motor coordination in youth.

The evaluation of motor coordination is important for diagnosing children and adolescents with motor impairments. However, motor coordination may be affected by time-of-day effects, and thus, the intra-day variation could subsequently influence the assessment accuracy of the standardized test used in the diagnostic process. To the best of our knowledge, no study has been conducted to examine this possibility. Therefore, the purpose of this study was to investigate the time-of-day effect on motor coordination. A convenience sample of 25 youth (17-21 years) were recruited from local high schools and a local university. The Bruininks-Oseretsky Test of Motor Proficiency - Second Edition (Short Form) was administered at three different times (morning, noon, and afternoon) over three days to explore the potential time-of-day effect on motor coordination. The starting time of the test on the first day was counterbalanced. Other factors that could potentially impact motor performance were also measured, including physical activity, chronotype, and time-since-awakening. A statistically significant main effect of time-of-day was found on overall motor coordination (p< .01) and the domain of Manual Coordination (p< .01). The time-of-day effect on the domain of Strength & Agility (p = .055) was just above the threshold of statistical significance. Further analysis showed that overall motor coordination was better at noon (p< .01) and in the afternoon (p= .052) than in the morning, whereas manual coordination was the worst in the morning (p's < .01). Strength and agility were also significantly better at noon than in the morning (p< .01). In addition, poor motor coordination in the morning was also related to longer time-since-awakening. Overall, this study identifies the time-of-day effect on motor coordination that could lead to the inconsistent classification of motor performance. Therefore, in order to avoid the potential misclassification of motor coordination, health professionals should take into account the time-of-day effect on motor coordination and the possible impact of time-since-awakening while administering the assessment in the morning.

An observational study examining utilization of prehabilitation and its association with postoperative cardiac rehabilitation participation and risk factors following coronary artery bypass grafting.

BACKGROUND: Growing evidence supports the use of prehabilitation before coronary artery bypass grafting (CABG) to improve surgical outcomes, but its feasibility and impact on risk factor management in real-world clinical settings remain unknown. This observational study examined prehabilitation utilization and its association with postoperative cardiac rehabilitation (CR) participation and cardiovascular risk profile. METHODS: As standard care in a large Canadian city, eligible patients were referred to prehabilitation upon entering the elective CABG waitlist then were re-referred to CR following surgery. Prehabilitation consisted of medically supervised exercise training and multidisciplinary support with health behavior change until the scheduled surgery. An assessment of cardiorespiratory fitness, blood pressure, body habitus, psychological distress, lipids, glycated hemoglobin, and smoking status was completed during a prehabilitation intake visit then was repeated after surgery prior to starting CR. RESULTS: Among 97 prehabilitation referrals over a 20-month period, only 49% attended an intake visit. Most patients who enrolled (n = 39) also completed (n = 37) prehabilitation. Completion of prehabilitation was significantly associated with higher CR referral (OR = 6.92, 95% CI 1.50-32.00), enrollment (OR = 14.08, 95% CI 5.09-38.94) and attendance [t(62) = 4.48, p < .001], and with improvements in cardiorespiratory fitness, body mass index, and symptoms of depression and anxiety (p < .004). CONCLUSIONS: Prehabilitation may improve CR participation and risk factors among individuals undergoing elective CABG, but more work is needed to disseminate this service to eligible patients.

Investigating the mediating role of internalizing and externalizing problems on physical fitness in children at risk for Developmental Coordination Disorder.

Children with Developmental Coordination Disorder (DCD) have poorer fitness and greater internalizing/externalizing problems compared with typically developing (TD) children. The purpose of this study was to examine the potential mediating role of internalizing/externalizing problems on the relationship between children at risk for DCD (DCDr) and physical fitness. Participants (N = 589) included 288 children with DCDr (Mage = 4.9, 67% male) and 301 TD children (Mage = 5.0, 48% male). Motor skills were assessed using the Movement Assessment Battery for Children-2nd edition (DCDr: at or below the 16th percentile, TD: >16th percentile). Parent-reported internalizing/externalizing problems were measured using the Child Behaviour Checklist. Physical fitness was measured using the Bruce protocol maximal treadmill test and a 30-second Wingate test. Tests for indirect (mediation) effects were assessed using the PROCESS v3.5 software macro. Children with DCDr had higher internalizing and externalizing problems (p < 0.001, d = 0.35-0.46) and poorer fitness levels (p < 0.001, ηp2 = 0.05-0.09). Internalizing problems mediated fitness performance on both the treadmill and Wingate test; however, externalizing problems showed no mediating effects. Thus, interventions targeting internalizing problems may contribute to improving performance on fitness-based tasks among children with DCDr. Novelty: Children at risk for DCD have poorer fitness when compared with TD children. Children at risk for DCD experience greater internalizing/externalizing problems. Internalizing problems were found to mediate the DCD-physical fitness relationship.

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.

Examining the Effects of Acute Cognitively Engaging Physical Activity on Cognition in Children.

Cognitively engaging physical activity (PA) has been suggested to have superior effects on cognition compared to PA with low cognitive demands; however, there have been few studies directly comparing these different types of activities. The aim of this study is to compare the cognitive effects of a combined physically and cognitively engaging bout of PA to a physical or cognitive activity alone in children. Children were randomized in pairs to one of three 20-min conditions: (1) a cognitive sedentary activity; (2) a non-cognitively engaging PA; and a (3) cognitively engaging PA. Executive function (EF) was assessed using a modified Eriksen flanker task immediately before and 10-15 min following the experimental condition. Children ages 6-8 years (n = 48, Mage = 7.04, SD = 1.37; 40% girls) were included in the study. A repeated measures ANOVA found no significant difference between groups with respect to scores on the flanker task. The results do not support the hypotheses that a cognitively engaging bout of PA enhances cognitive performance over non-cognitively engaging PA or sedentary activities. Possible explanations for our findings include overexertion during the acute bout of PA and depletion of positive affect prior to performing the post-intervention EF tasks.

Cancer and cardiovascular disease: The impact of cardiac rehabilitation and cardiorespiratory fitness on survival.

BACKGROUND: Cancer survivors are at increased risk for cardiovascular disease (CVD)-related morbidity and mortality. Exercise-based cardiac rehabilitation (CR) programs improve CVD risk factors, including cardiorespiratory fitness (CRF). The purpose of this study was to investigate: (1) the association between CR completion and survival, and (2) whether CRF improvements translate to increased survival among patients with comorbid cancer and CVD. METHODS: Patients with CVD and pre-existing cancer (any type) were referred to a 12-week exercise-based CR program between 01/1996 and 03/2016. Peak metabolic equivalents (METs) were assessed by graded exercise test pre-CR and at 12-weeks. Kaplan-Meier survival and multivariate cox regressions were performed to evaluate impact of CR completion and clinically-meaningful CRF improvements [ΔMETs≥1] on survival, adjusting for relevant covariates. RESULTS: Among 442 patients with CVD and cancer referred to CR (67 ± 10 years; 22% women), 361 (82%) completed CR. 102 deaths were recorded during the 12-year observation period. Compared to patients who did not complete CR, patients with comorbid cancer who completed CR demonstrated a survival advantage (63% vs 80.1%, p < .001). CRF improved among completers during the 12-week program (mean change = 0.87 ± 0.93 METs, p < .001); 41% experienced a clinically-meaningful ΔMETs≥1. A survival advantage was not observed in completers who experienced a ΔMETs≥1 improvement (p = .254). CONCLUSION: Completing a 12-week exercise-based CR program improved CRF and increased survival in patients with CVD and comorbid cancer. The results highlight the survival benefits of completing a CR program among CVD patients who experience added barriers imposed by cancer treatment and survival.

Lessons learned from community- and home-based physical activity programs: A narrative review of factors influencing women's participation in cardiac rehabilitation.

BACKGROUND: Cardiovascular disease remains a leading cause of death in women. Despite the well-known benefits of cardiac rehabilitation, it remains underutilized, especially among women. Physical activity programs in the community, however, attract a large female population, suggesting that they overcome barriers to physical activity encountered by women. The characteristics of interventions that extend beyond the traditional cardiac rehabilitation model and promote physical activity merit examination. OBJECTIVES: This narrative review aimed to: (a) summarize women's barriers to attend cardiac rehabilitation; (b) examine the characteristics of community- and home-based physical activity or lifestyle coaching interventions; and (c) discuss which barriers may be addressed by these alternative programs. METHODS: Studies were included if they: (a) were published within the past 10 years; (b) included ≥70% women with a mean age ≥45 years; (c) implemented a community- or home-based physical activity intervention or a lifestyle education/behavioral coaching program; and (d) aimed to improve physical activity levels or physical function. RESULTS: Most interventions reported high (≥70%) participation rates and significant increases in physical activity levels at follow-up; some improved physical function and/or cardiovascular disease risk factors. Community- and home-based interventions address women's cardiac rehabilitation barriers by: implementing appealing modes of physical activity (e.g. dancing, group-walking, technology-based balance exercises); adapting the program to meet participants' needs; offering flexible options regarding timing and setting (e.g. closer to home, the workplace or faith-based institutions); and promoting social interactions. CONCLUSION: Cardiac rehabilitation can be enhanced by understanding the specific needs of women; novel elements such as program offerings, convenient settings and opportunities for socialization should be considered when designing cardiac rehabilitation programs.

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).

Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program.

PURPOSE: The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes. METHODS: A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes. RESULTS: Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes. CONCLUSIONS: Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.

Motor Coordination and Moderate-to-Vigorous Physical Activity in Emerging Adults: Mediating Effect of Physical Self-Concept.

Little research has investigated the relationships among motor coordination, perceived physical self-concept (PSC), and physical activity during emerging adulthood. The purpose of this study was to investigate whether PSC mediates the relationship between motor coordination and moderate-to-vigorous physical activity (MVPA) in emerging adults. This was a cross-sectional study with 218 undergraduate students aged 17-23 years (167 females, 76.6%). Participants were asked to complete a questionnaire including self-reported measures of motor coordination, PSC and MVPA. The mediating effects of both overall and domain-specific PSC were tested on the relationship between motor coordination and MVPA. Motor coordination was found to have a significant indirect effect on MVPA through overall PSC. Exploratory analyses specifically showed a mediating effect of domain-specific PSC of activity on the relationships between motor coordination and MVPA during chores and leisure-time. Findings from the current study highlight the importance of PSC on the relationship between motor coordination and MVPA and showed that university students with poor motor coordination exhibit lower levels of PSC, specifically, the perception of activity. Future interventions targeting the enhancement of MVPA should focus on improvement in the self-perception of physical activity alongside motor skills training.

Using the 6-min Walk Test to Monitor Peak Oxygen Uptake Response to Cardiac Rehabilitation in Patients With Heart Failure.

PURPOSE: We examined the agreement between peak oxygen uptake (V˙o2peak), estimated using prediction equations from the 6-min Walk Test (6MWT), and V˙o2peak measured using a cardiopulmonary exercise test (CPX) to estimate change in V˙o2peak in patients with heart failure (HF) enrolled in cardiac rehabilitation (CR). METHODS: This was secondary analysis of 54 (including 9 women) patients with HF who completed a clinical CR program. Four previously published equations using 6MWT distance were used to estimate V˙o2peak and were compared with a CPX at baseline, follow-up, and change using the standard and modified Bland-Altman method. Analyses were repeated for quartiles of cardiorespiratory fitness (CRF) based on measured V˙o2peak from the CPX. RESULTS: Bland-Altman plots revealed proportional bias between all prediction equations and the measured V˙o2peak. The difference between methods varied by the level of CRF, with overestimation of prediction equations at greater levels of CRF and underestimation at lower levels of CRF. This poor agreement remained when comparisons were made between the estimated and measured V˙o2peak values at quartiles of CRF, indicating prediction equations have limited ability to predict V˙o2peak at any level of CRF. CONCLUSION: Estimated V˙o2peak using 6MWT distance demonstrated poor agreement with measured V˙o2peak from a CPX. While distance ambulated on the 6MWT remains an important measure of physical performance in patients with HF, prediction equations using 6MWT distance are not appropriate to monitor changes in V˙o2peak following CR in patients with HF.

Psychosocial and Cardiometabolic Health of Patients With Differing Body Mass Index Completing Cardiac Rehabilitation.

BACKGROUND: It remains unclear whether cardiac rehabilitation (CR) provides similar benefits to patients with varying levels of body mass index (BMI). We assessed the psychosocial and cardiometabolic health of patients with increased BMI who completed CR. METHODS: The records of 582 patients who completed a 3-month outpatient CR program were analyzed. On the basis of their BMI at baseline, patients were categorized as normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2), or severely obese (≥ 35.0 kg/m2). Analysis of covariance was used to compare health-related quality of life (ie, Physical Component Summary [PCS] and Mental Component Summary scores), anxiety, depression, and cardiometabolic health indicators between BMI categories after CR. RESULTS: At baseline, patients with severe obesity, when compared with those with normal BMI, had lower PCS scores (39.7 ± 8.5 vs 44.4 ± 8.4, P < 0.001), elevated levels of anxiety (7.0 ± 3.7 vs 4.8 ± 3.2, P = 0.001) and depression (5.5 ± 4.4 vs 3.4 ± 3.7, P < 0.001), higher glycated hemoglobin A1C (6.5 ± 1.1 vs 5.6 ± 0.7%, P < 0.001) and triglycerides (1.6 ± 0.5 vs 1.1 ± 0.4 mmol/L, P < 0.001), and lower high-density lipoprotein cholesterol (1.1 ± 0.3 vs 1.2 ± 0.4 mmol/L, P = 0.006). After CR, notwithstanding a greater percent weight reduction in obesity (-3.5% ± 6.9% vs +1.1% ± 7.0%, P = 0.002) and severe obesity (-6.5% ± 6.9% vs +1.1% ± 7.0%, P < 0.001), smaller improvements in PCS scores were seen in the obese (4.1 ± 7.4 vs 6.9 ± 7.6, P = 0.011) and severely obese (4.1 ± 7.6 vs 6.9 ± 7.6, P = 0.039) when compared with those with normal BMI. CONCLUSIONS: Poorer psychosocial and cardiometabolic health at baseline coupled with smaller improvements in the PCS score suggest that patients with obesity and severe obesity will benefit from enhanced care in the CR setting.