Comparing the Efficacy of Digital and In-Person Weight Loss Interventions for Patients with Obesity and Glycemic Disorders: Evidence from a Randomized Non-Inferiority Trial.

Digital weight loss interventions present a viable and cost-effective alternative to traditional therapy. However, further evidence is needed to establish the equal effectiveness of both approaches. This randomized controlled non-inferiority trial aimed to compare the effects of an intensive in-person weight loss intervention program with Vitadio digital therapy. One hundred patients with obesity and diagnosed with type 2 diabetes, prediabetes, or insulin resistance were enrolled and randomly assigned to one of the two treatment groups. Over a 6-month period, the control group received five in-person consultations with a physician who specialized in obesity treatment, a dietitian and/or a nutrition nurse, while the intervention group followed the digital program based on a multimodal therapeutic approach. The extent of weight loss was assessed and compared between the groups. Additionally, changes in body composition and metabolic parameters for the digital intervention group were analyzed. The study results demonstrated comparable effectiveness of both treatments for weight reduction. The positive effects of Vitadio were further evidenced by favorable changes in body composition and lipid metabolism and improved glycemic control in the intervention group. These findings suggest that Vitadio is an effective tool for assisting patients with managing obesity and preventing diabetes progression.

Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort.

Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.

COVID-19 reduces cardiorespiratory fitness even months after a mild to moderate acute phase: a retrospective cohort study.

BACKGROUND: COVID-19 survivors may experience long-term health problems, including deterioration of cardiorespiratory fitness (CRF), as demonstrated by several cross-sectional studies that compared the results of cardiopulmonary exercise tests (CPET) performed only after COVID-19 with predicted values. This study aimed to analyze a change in CRF between repeated CPETs in response to suffered COVID-19. METHODS: A total of 127 healthcare workers (HCWs; mean age 55.7 years) underwent two CPETs with a mean interval of 762 days. Forty HCWs suffered from COVID-19 (mild to moderate severity) in the interim (321 days before the second CPET), and 87 HCWs formed a control group. Mixed-effects regression with multiple adjustment and interaction terms was used for two response variables - maximum oxygen uptake (VO2 max) and power output. RESULTS: Between both CPETs, mean VO2 max decreased statistically significantly in the COVID-19 subgroup (by 3.12 mL/kg/min, p = .034) and insignificantly in controls (by 0.56 mL/kg/min, p = .412). The proportion of HCWs achieving predicted VO2 max decreased from 75.9% to 59.5% (p = .161) in COVID-19 survivors, while it increased from 73.8% to 81% (p = .274) in controls. COVID-19 (ß = -0.66, p = .014) and body mass index (ß = -0.49, p < .001) were independent negative predictors of VO2 max change. COVID-19 was not associated with a change in power output. CONCLUSIONS: On the basis of repeated CPETs, COVID-19 significantly, albeit rather modestly, reduces CRF almost one year after infection. The reduction persists even after the acute phase with mild or moderate severity.

Preparticipation Screening of Athletes: The Prevalence of Positive Family History.

Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and predictors of positive FH of SCD and CVD in athletes using four widely used preparticipation screening (PPS) systems. The secondary objective was to compare the functionality of the screening systems. In a cohort of 13,876 athletes, 1.28% had a positive FH in at least one PPS system. Multivariate logistic regression analysis identified the maximum heart rate as significantly associated with positive FH (OR = 1.042, 95% CI = 1.027-1.056, p < 0.001). The highest prevalence of positive FH was found using the PPE-4 system (1.20%), followed by FIFA, AHA, and IOC systems (1.11%, 0.89%, and 0.71%, respectively). In conclusion, the prevalence of positive FH for SCD and CVD in Czech athletes was found to be 1.28%. Furthermore, positive FH was associated with a higher maximum heart rate at the peak of the exercise test. The findings of this study revealed significant differences in detection rates between PPS protocols, so further research is needed to determine the optimal method of FH collection.

Post-COVID Syndrome and Cardiorespiratory Fitness-26-Month Experience of Single Center.

INTRODUCTION: Persistent post-COVID syndrome, also referred to as long COVID, is a pathologic entity that involves persistent physical, medical, and cognitive sequelae following COVID-19. Decreased fitness has repeatedly been reported in numerous studies dealing with post-COVID syndrome, however, it is still not fully clear which groups of patients may be more susceptible for persisting symptoms. AIM: The aim of our study was to evaluate the number of post-COVID patients with cardiac symptoms, where these patients were evaluated by CPET and the results compared with a control group of patients. METHODS: Follow-up of patients in post-COVID outpatient clinic from 1 March 2020 to 31 May 2022. Inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. The initial examination was performed 4-12 weeks after the disease onset. All patients with possible cardiac symptoms had completed cardiopulmonary exercise testing. The control group was randomly selected from a database of clients in 2019, with the preventive reason for evaluation. RESULTS: From 1 March 2020 to 31 May 2022, 2732 patients (45.7% males) were evaluated with a mean age of 54.6 ± 14.7. CPET was indicated only in 97 patients (3.5%). Seventy-four patients (26 male) achieved the exercise maximum and a comparison were made with a control group (same age (p = 0.801), BMI (p = 0.721), and sex ratio). No significant dependence between the parameter VO2 max mL/kg/min and post-COVID disability was demonstrated (p = 0.412). Spearman's correlation analysis did not show a significant relationship between the parameter VO2 max mL/kg/min and the severity of COVID-19 (p = 0.285). CONCLUSIONS: Cardiac symptoms occurred in only a small percentage of patients in our study. There is a need for further studies that would objectively evaluate the effect of COVID-19 disease on the patient's health.

COVID-19 and post-COVID - Jekyll and Hyde of modern medicine.

COVID-19 pandemic has massive impact on the whole world, lead to the death of milions of people and required excessive restrictions with large economical, psychological and other impacts. Post-COVID syndrome is defined according to the Czech pneumological and phtizeological society as a complex of symptoms persisting for more than 12 weeks from the acute stage of COVID-19 and which is not possible to explain by other causes. Exact pathopysiological mechanisms and its frequency are still not known, and the data from the literature are not consisent. We present case reports of 2 patients with very different disease and convalescence course. COVID-19 and post-COVID syndrome represent large space for the further research. The prediction of the persisting limitations and other consequencies of the diseases is still not possible. Even though there is usualy higher incidence of post-COVID symptoms in patients surviving severe COVID-19 course, the presented case reports show paradoxically exactly the oposite situation.

Comparing Digital Therapeutic Intervention with an Intensive Obesity Management Program: Randomized Controlled Trial.

In this study, we evaluated whether the digital program Vitadio achieves comparable results to those of an intensive in-person lifestyle intervention in obesity management. This is a 12-month prospective, randomized controlled trial. Obese patients with insulin resistance, prediabetes or type 2 diabetes were included. The intervention group (IG) used Vitadio. The control group (CG) received a series of in-person consultations. Body weight and various metabolic parameters were observed and analyzed with ANOVA. The trial is ongoing and the presented findings are preliminary. Among 100 participants (29% men; mean age, 43 years; mean BMI, 40.1 kg/m2), 78 completed 3-month follow-up, and 51 have completed the 6-month follow-up so far. Participants significantly (p < 0.01) reduced body weight at 3 months (IG: −5.9 ± 5.0%; CG: −4.2 ± 5.0%) and 6 months (IG: −6.6±6.1%; CG: −7.1 ± 7.1%), and the difference between groups was not significant. The IG achieved favorable change in body composition; significant improvement in TAG (−0.6 ± 0.9 mmol/l, p < 0.01), HDL (0.1 ± 0.1%, p < 0.05), HbA1c (−0.2 ± 0.5%, p < 0.05) and FG (−0.5 ± 1.5 mmol/l, p < 0.05); and a superior (p = 0.02) HOMA-IR reduction (−2.5 ± 5.2, p < 0.01). The digital intervention achieved comparable results to those of the intensive obesity management program. The results suggest that Vitadio is an effective tool for supporting patients in obesity management and diabetes prevention.

Are our nurses healthy? Cardiorespiratory fitness in a very exhausting profession.

OBJECTIVES: Low cardiorespiratory fitness (CRF) is related to higher risk of cardiovascular diseases, increase in all-cause mortality and higher risk of different tumors. The reverse is also true; improvement in CRF is related to decrease in mortality. Cardiopulmonary exercise testing (CPET) is a standard and also the most precise test for determination of CRF - the best possibility is the maximal test measuring different parameters including maximal oxygen consumption. Healthcare professionals throughout the developed world have markedly high rates of sickness absence, burnout, and distress compared to other sectors and this leads to higher risk factors. The study aimed to assess CRF in a group of nurses in a big hospital and compare it with population norms and available published results. METHODS: Nurses over 50 years of age working in one faculty hospital were gradually included in the study from the beginning of 2018. These nurses work in physically demanding positions. A CPET was carried out following the Bruce protocol. RESULTS: 90 nurses (84 females and 6 males), mean age 55.7 years, were evaluated by CPET. The resting blood pressure was within the norm in 58 persons (64.44%), maximal oxygen consumption in 61 persons (67.8%), W/kg in 25 persons (46.2%). We detected a hypertension reaction in 28 persons (31.1%), some types of arrhythmia in 17 persons (18.9%) and signs of ischaemia in 8 persons (8.9%). The result of CPET led to further examination in 42 persons (46.6%). Detailed examination resulted in change of medication in 21 nurses (23.3%). New diseases were diagnosed in 15 nurses (hypertension, atrial fibrillation, mitral valve prolapse indicated for cardiac surgery, coronary artery stenosis, and lipid disorders). CONCLUSIONS: It was concluded that the usage of CPET during the regular medical check-ups significantly increases detection of hidden diseases and thus improves the care for nurses.

Clinical aspects of epicardial fat deposition.

Obesity is a chronic metabolic disease which is characterized by an increased body fat. Obesity increases cardiovascular morbidity and mortality and presents an important socioeconomic burden for the health system. So-called “central-android-abdominal-visceral” obesity plays an important role in the development of cardiovascular diseases. Adipose tissue is nowadays considered to be metabolically active tissue which is involved in many metabolic processes, managing food intake, lipid metabolism regulation, and also inflammatory diseases. Many cytokines, such as those regulating body temperature, are produced by the adipose tissue. In the last few years, many studies of ectopic adipose tissue including epicardial fat were published. This is a complex organ which consists of adipocytes, stromal cells, macrophages, and network of neural cells and blood capillaries. This thesis summarizes updated information regarding physiological and pathophysiological role of epicardial fat, epicardial fat measurement and a possible connection with common diseases, such as ischemic heart disease, cardiac arrhythmias, diabetes mellitus, chronic obstructive pulmonary disease and disease of thyroid gland.

Is population's cardiorespiratory fitness really declining?

OBJECTIVE: Cardiorespiratory fitness (CRF) is defined as the capacity of the cardiovascular and pulmonary systems to meet the oxygen demands of the body during physical work. Poor CRF is connected with a higher risk for the development of various noninfectious diseases such as cardiovascular disease or malignancies. The standard test for the assessment of CRF is exercise testing with the measurement of maximal oxygen consumption (VO2 max). Standard VO2 max values for adult men and women in the Czech Republic have been available since the 1970s without being updated. According to experts, these standard values are now unusable for contemporary CRF measurements of the population in the Czech Republic. The Fitness Registry and the Importance of Exercise: a National Database (FRIEND) - 4,494 patients (1,717 men) defined new standard values for bicycle ergometry CRF for the population in the United States of America. The aim of the study was the statistical comparison of VO2 max values (reference standards) in the 1970s population in the Czech Republic with the new reference standards of the FRIEND registry. METHODS: All analyses were performed using IBM SPSS statistics and all tests with a p-value of less than 0.05 were considered statistically significant. RESULTS: VO2 max norms for women in the Czech population were higher in all age categories with statistically significant differences in the categories 30-39, 40-49 and 50-59 (p < 0.001). In the male population aged 20-29 years, VO2 max was significantly higher in the FRIEND registry (p < 0.001) in contrast to the other age categories, 30-39, 40-49 and 50-59, which were significantly higher in the Czech population (p < 0.001). CONCLUSIONS: Czech VO2 max population norms from the 1970s are (with the exception of age category 20-29 years) higher than values from the recent FRIEND registry.

High incidence of masked hypertension in patientswith obstructive sleep apnoea despite normal automatedoffice blood pressure measurement results.

INTRODUCTION: Obstructive sleep apnoea (OSA) is a well-known risk factor for masked hypertension (MH) and masked uncontrolled hypertension (MUCH). Automated ambulatory office blood pressure measurement (AOBP) might better correlate with the results of ambulatory blood pressure measurements (ABPM) compared to routine office blood pressure measurement (OBPM). The aim of this study was to compare the diagnostic rate of MH/MUCH when using OBPM and AOBP in combination with ABPM. MATERIAL AND METHODS: 65 OSA patients, of which 58 were males, (AHI > 5, mean 44.4; range 5-103) of average age 48.8 ± 10.7 years were involved in this study. Following MH/MUCH criteria were used; Criteria I: OBPM < 140/90 mm Hg and daytime ABPM > 135/85 mm Hg; Criteria II: AOBP < 140/90 mm Hg and daytime ABPM > 135/85 mm Hg; Criteria III: AOBP < 135/85 mm Hg and daytime ABPM > 135/85 mm Hg. RESULTS: MH/MUCH criteria I was met in 16 patients (24.6%) with criteria II being met in 37 patients (56.9%), and criteria III in 33 (51.0%), p < 0.0001. Both systolic and diastolic OBPM were significantly higher than AOBP; Systolic (mm Hg): 135.3 ± 12.3 vs 122.1 ± 10.1 (p < 0.0001); Diastolic (mm Hg): 87.4 ± 8.9 vs 77.1 ± 9.3 (p < 0.0001). AOBP was significantly lower than daytime ABPM; Systolic (mm Hg): 122.1 ± 10.1 vs 138.9 ± 10.5 (p < 0.0001); Diastolic (mm Hg): 77.1 ± 9.3 vs 81.6 ± 8.1 (p < 0.0001). Non-dipping phenomenon was present in 38 patients (58.4%). Nocturnal hypertension was present in 55 patients (84.6%). CONCLUSIONS: In patients with OSA there is a much higher prevalence of MH/MUCH despite normal AOBP, therefore it is necessary to perform a 24-hour ABPM even if OBPM and AOBP are normal.

[Epicardial fat and osteoprotegerin - does a mutual relation exist? Pilot study]. / Epikardiální tuk a osteoprotegerin - existují vzájemné souvislosti? Pilotní studie.

INTRODUCTION: Epicardial fat (EPI) plays important role in development of metabolic and cardiovascular diseases. According to population studies EPI represents independent risk factor of cardiovascular diseases (CVD) and also for neoplasms. Osteoprotegerin (OPG) is a glycoprotein which have role in regulation of immune and cardiovascular systems. High serum levels of OPG are connected with high cardiovascular risk. The aim of our study was to evaluate possible correlation between EPI and OPG level in asymptomatic relatives of patients with CVD. MATERIAL AND METHODS: 53 asymptomatic relatives (37 male) (median age 53 years) of patients with CVD (ischemic heart disease, cerebrovascular disease) were included. Physical examination and biochemistry analysis were performed. GE Vivid 7 (GE Medical) was used for echocardiography. EPI was measured according to guidelines using parasternal long axis in diastole as a space in front of right ventricle. RESULTS: EPI was present in 46 subjects (86.8 %) with mean value of 2.91 mm. In 10 subjects was the amount of EPI > 5 mm. Spearmann correlation analysis found statistically significant correlation between EPI and OPG (r = 0.271; p = 0.05) and age (r = 0.500; p < 0.0001). We have not found correlation between EPI, glycaemia and level of insulin, glycated Hb, total, LDL, HDL cholesterol and triglycerides. CONCLUSION: We have found positive correlation between EPI and OPG. More studies are needed to confirm applicability of this correlation in risk stratification.Key words: cardiovascular risk - epicardial fat - osteoprotegerin.

Possitive correlation between adipocyte fatty acid-binding protein and epicardial fat in patients with a family history of cardiovascular disesase.

BACKGROUND: Adipocyte fatty acid-binding protein (A-FABP) is a promising link between metabolic syndrome and atherosclerosis. Epicardial fat (EPI) is an independent risk factor for cardiovascular disease (CVD). OBJECTIVE: The aim of this pilot study was to evaluate the correlation between EPI and A-FABP in asymptomatic patients with a family history of CVD. METHODS: 59 subjects (39 males) (median = 54 years old) were enrolled in the study and their EPI thickness and A-FABP levels were assessed. RESULTS: EPI was found in 46 patients (77.9%). There were positive correlations between EPI and A-FABP (r=0.336; P=0.010), age (r=0.526; P<0.001), fibrinogen (r=0.304; P=0.023) and systolic blood pressure (r=0.279; P=0.034). A positive correlation was found between EPI and A-FABP in a subgroup of overweight and obese patients (0.389; P=0.041, 0.407; P=0.004) and in the subgroup of patients with excluded CVD (r=0.368; P=0.006). CONCLUSIONS: We found a positive correlation between EPI and A-FABP in a group of patients with a family history of CVD and in subgroups of overweight and obese patients.

Effectiveness of ß-blockers in physically active patients with hypertension: protocol of a systematic review.

INTRODUCTION: Based on more than 5 decades of epidemiological studies, it is now widely accepted that higher physical activity patterns and levels of cardiorespiratory fitness are associated with better health outcomes. Therefore, it is necessary to consider how treatment methods affect these two components. Clinically, one very important question concerns the influence of aerobic performance on patients being treated for hypertension. The administration of ß-blockers can significantly reduce maximal-and especially submaximal-aerobic exercise capacity. The objective of this review is to determine, by comparison of existing mono and combination therapy, which ß-blockers are less physically limiting for patients with hypertension who are physically active. METHODS: A three-step strategy will be adopted in the review, following the methods used by the Joanna Briggs Institute (JBI). The initial search will be conducted using the MEDLINE and EMBASE databases. The second search will involve the listed databases for the published literature (MEDLINE, Biomedica Czechoslovaca, Tripdatabase, Pedro, EMBASE, the Cochrane Central Register of Controlled Trials, Cinahl, WoS) and the unpublished literature (Open Grey, Current Controlled Trials, MedNar, ClinicalTrials.gov, Cos Conference Papers Index, the International Clinical Trials Registry Platform of the WHO). Following the JBI methodology, analysis of title/abstracts and full texts, critical appraisal and data extraction will be carried out on selected studies using the JBI tool, MAStARI. This will be performed by two independent reviewers. If possible, statistical meta-analysis will be pooled. Statistical heterogeneity will be assessed. Subgroup analysis will be used for different age and gender characteristics. Funnel plots, Begg's rank correlation and Egger's regression test will be used to detect or correct publication bias. ETHICS AND DISSEMINATION: The results will be disseminated by publishing in a peer-reviewed journal. Ethical assessment is not needed-we will search/evaluate the existing sources of literature. TRIAL REGISTRATION NUMBER: CRD42015026914.

Positive effect of yoga on cardiorespiratory fitness: A pilot study.

INTRODUCTION: Cardiovascular disease (CVD) is the leading cause of death in developed countries. An integral part of primary prevention is physical activity. One form of physical activity to be potentially used is yoga, but this activity is associated with lower energy expenditure than that recommended for prevention. The study aimed at assessing the effect of regular yoga sessions on the aerobic capacity of the practitioners and comparing it with the normal population performing physical activity recommended by guidelines. MATERIALS AND METHODS: Fifty-eight persons (16 males) with a mean age of 50.0 ± 11.06 years comprising the yoga group practiced yoga for at least 1 h a day for over 2 years. They underwent spiroergometry under maximal exercise testing to assess basic performance parameters. Their results were compared with those in 54 age-matched controls (16 males mean age of 48 ± 11.86 years performing a regular aerobic physical activity for at least 7 h a week. RESULTS: The yoga group had statistically significantly higher maximum performance per kilogram (P = 0.007) and maximum oxygen consumption per kilogram per minute (P = 0.028). CONCLUSIONS: Despite low energy expenditure, yoga practices are better in some cardiorespiratory fitness parameters than other aerobic activities recommended by current guidelines for CVD prevention.

Which health professionals are most at risk for cardiovascular disease? Or do not be a manager.

OBJECTIVES: Health care workers constitute a high-risk occupational category owing to the character of their work that includes high-risk environment, shift work and mental as well as physical stress. In occupational medicine, caring for their health condition should be a priority and include measures aimed at preventing cardiovascular diseases. The study aimed at determining the prevalence of cardiovascular disease (CVD) risk factors in employees of a large hospital and assessing their effect on the incidence of cardiovascular events. MATERIALS AND METHODS: The group comprised 3124 employees with a mean age of 36.1 years (SD = 11.4), out of whom 562 were males (mean age of 37.1 years, range: 18-72; SD = 12.26) and 2562 were females (mean age of 35.9 years, range: 18-68; SD = 11.24). At their initial examination, the employees filled in a questionnaire on basic CVD risk factors (according to valid recommendations). This was supplemented with objective data to determine the risk of CVD using valid charts. From this group, a subset of persons at a high or intermediate risk was selected, comprising 247 individuals with a mean age of 54.1 years (SD = 5.73). After 5-9 years (mean 7.24±1.38 years), they either underwent another examination or their health status was ascertained by phone or in a computer database. The end point was the incidence of cardiovascular events (sudden death, acute myocardial infarction, unstable angina pectoris, percutaneous coronary intervention, cardiac failure, stroke or transient ischemic attack). RESULTS: The end point was noted in a total of 15 males (6.07%) and 6 females (2.42%), being statistically significantly present in managers (males p < 0.00007, females p < 0.00001), male physicians/surgeons (p < 0.025), tertiary-educated males (p < 0.0095), female smokers (p < 0.015), male ex-smokers (p < 0.007), overweight or obese males (p < 0.02) and those with the waist-to-hip ratio above 1.0 (p < 0.005). CONCLUSIONS: Cardiovascular events are most likely to occur in obese male physicians/surgeons holding managerial positions and in female managers.