Improved Walk Test Performance and Blood Pressure Responses in Men and Women Completing Cardiac Rehabilitation: Implications Regarding Exercise Trainability.

Purpose. To evaluate changes in walk test performance and blood pressure (BP) responses following a 12-week exercise-based outpatient cardiac rehabilitation (CR) program. Methods. Six-Minute Walk Test (6MWT) and resting systolic BP (SBP), diastolic BP (DBP), post-6MWT heart rate (HR), and post-6MWT BPs were measured before and after CR in 311 (237 men,74 women) patients. Using age as a covariate, 2 by 2 (Gender × Measurement) ANCOVAs were used to determine differences in 6MWT performance and hemodynamic variables. Results. After adjusting for age, men covered a greater 6MWT distance than women; pre-CR versus post-CR program values are as follows: men, 429.3 ± 94.6 versus 557.6 ± 90.7 m, P ≤ .001; women, 374.9 ± 100.7 versus 483.2 ± 82.9 m, P ≤ .001. Both genders reduced resting DBP following the CR program (men: 67.2 ± 9.8 vs 65.6 ± 8.5 mm Hg, P = .034; women: 69.2 ± 10.7 vs 65.0 ± 8.0 mm Hg, P = .001) and increased HR following the 6MWT after the CR program (men: 97.7 ± 16.8 vs 112.7 ± 21.3 bpm, P ≤ .001; women: 100.7 ± 20.8 vs 110.2 ± 22.0 bpm, P ≤ .001). Similarly, SBP increased immediately following the 6MWT (122.8 ± 18.5 vs 133.6 ± 20.7 mm Hg; P ≤ .001) in men but not in women. Conclusion. The present findings indicate similar relative improvements in 6MWT performance and BP responses in adherent men and women following an exercise-based CR program.

Evidencia científica de la rehabilitación cardiaca en Costa Rica / Scientific Evidence of Rehabilitation Cardiac in Costa Rica

Resumen A pesar de la amplia evidencia científica de los beneficios de la Rehabilitación Cardiaca (RC) a nivel mundial, la investigación en Costa Rica en esta área continúa siendo escasa. Objetivo: Presentar la evidencia científica de las investigaciones realizadas por programas de RC en Costa Rica. Metodología: se realizó una búsqueda de artículos en las bases de datos "PUBMED""ScienceDirect""SportDiscus" y "Google Académico", utilizando las palabras claves: "Rehabilitación cardiaca en Costa Rica", "Cardiac Rehabilitation AND Costa Rica". Los estudios incluidos fueron publicaciones en revistas indexadas entre los años 2000 a octubre de 2021. Resultados: Se encontraron 14 publicaciones en revistas indexadas, ocho publicaciones en revistas costarricenses y seis internacionales. Los principales resultados de las investigaciones fueron que el VO2máx aumentó entre 19 % a 30 %. La capacidad funcional mejoró entre 31 % a 34 %, la presión arterial sistólica disminuyó entre 4 mmHg y 7,8 mmHg y la presión arterial diastólica se redujo entre 1,2 y 2 mmHg. También, se reportó mejorías en IMC, colesterol total, HDL-C y disminuciones en triglicéridos. Los niveles de estrés percibido disminuyeron el 50 % y los estados de ánimo tuvieron reducciones en la fatiga 58 %, la tensión en 60 % y el vigor aumentó 31 % después de una o varias semanas de RC. Asimismo, la calidad de vida de los pacientes mejoró. Conclusión: Los programas de RC en Costa Rica lograron aumentar el VO2máx, la capacidad funcional, disminuir la presión arterial y mejorar los factores de riesgo coronario de los pacientes con ECV. Además, la RC contribuye psicológicamente, puesto que disminuye el estrés, mejora los estados de ánimo y la calidad de vida de los pacientes cardiacos.

Abstract Despite the extensive scientific evidence regarding the health benefits of Cardiac Rehabilitation (CR) worldwide, research in Costa Rica in this area is still lacking. Objective: To present the scientific evidence of CR research made in Costa Rica. Methods: This systematic review searched articles in electronic databases: "PUBMED" "ScienceDirect" "SportDiscus" y "Google Scholar", using keywords: "Rehabilitación cardiaca en Costa Rica", "Cardiac Rehabilitation AND Costa Rica", The studies included were from years 2000 to October 2021 and publications on indexed journals. Results: A total of 14 publications were found in indexed journals, 8 in Costa Rican journals and 6 on international journals. The main results from these publications were that VO2max increased between 19% to 30%. functional capacity improved 31% to 34%, systolic blood pressure decreased 4 mmHg to 7.8 mmHg and diastolic blood pressure reduced 1.2 to 2 mmHg. Improvements in BMI, total cholesterol, HDL-C and reductions in triglycerides were also found. Perceived stress decreased by 50% and mood states of fatigue reduced 58%, tension 60% and vigor increased 31% after one or several weeks. Conclusión: CR programs in Costa Rica reported improvements in VO2max, functional capacity, reductions in blood pressure, and improvements in coronary risk factors from patients with cardiovascular disease. Furthermore, CR contributes to improving psychological outcomes by reducing stress, improvement of mood states and quality of life in cardiac patients.

Cardiac rehabilitation availability and characteristics in Latin America and the Caribbean: A Global Comparison.

BACKGROUND: This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. METHODS: In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online survey was administered to identified programs, assessing capacity and characteristics. CR need was computed relative to ischemic heart disease (IHD) incidence from the Global Burden of Disease study. RESULTS: ≥1 CR program was identified in 24 LAC countries (68.5% availability; median = 3 programs/country). Data were collected in 20/24 countries (83.3%); 139/255 programs responded (54.5%), and compared to responses from 1082 programs in 111 countries. LAC density was 1 CR spot per 24 IHD patients/year (vs 18 globally). Greatest need was observed in Brazil, Dominican Republic and Mexico (all with >150,000 spots needed/year). In 62.8% (vs 37.2% globally P < .001) of CR programs, patients pay out-of-pocket for some or all of CR. CR teams were comprised of a mean of 5.0 ± 2.3 staff (vs 6.0 ± 2.8 globally; P < .001); Social workers, dietitians, kinesiologists, and nurses were significantly less common on CR teams than globally. Median number of core components offered was 8 (vs 9 globally; P < .001). Median dose of CR was 36 sessions (vs 24 globally; P < .001). Only 27 (20.9%) programs offered alternative CR models (vs 31.1% globally; P < .01). CONCLUSION: In LAC countries, there is very limited CR capacity in relation to need. CR dose is high, but comprehensiveness low, which could be rectified with a more multidisciplinary team.

Rehabilitación cardíaca domiciliaria como alternativa en tiempos de pandemia: una revisión sistemática / Home cardiac rehabilitation as an alternative in times of pandemic: a systematic review

Resumen La pandemia mundial producto del coronavirus que causa la enfermedad (COVID-19) ha ocasionado un gran impacto a nivel mundial y en los programas de rehabilitación cardíaca tradicional (RCT). En la actualidad, se debe promover que los pacientes con enfermedades cardiovasculares (ECV) se mantengan haciendo ejercicio físico a pesar de la pandemia. Objetivo: Analizar la evidencia científica sobre rehabilitación cardíaca domiciliar (RCD) y RCT en la seguridad del paciente y su eficacia en la mejora del volumen de oxígeno máximo (VO2máx) y capacidad funcional en pacientes con ECV. Metodología: Se desarrolló mediante los lineamientos PRISMA. Se realizó la búsqueda de artículos en las bases de datos: "PubMed", "ScienceDirect", "Academic Search Ultimate" y "SportDiscus". Se utilizó el término de búsqueda: ("heart disease" OR "cardiac disease" OR "coronary artery disease" OR "heart failure") AND ("cardiac rehabilitation" OR "center based" OR "exercise" OR "training") AND ("home based" OR "home training" OR "home exercise") NOT ("animal"). Resultados: Se analizaron un total de 1516 estudios de los cuales se incluyeron 21 artículos. La muestra fue de 1316 pacientes con ECV. Existe una prevalencia de eventos adversos de 3.8% en la RCD y de 4.3% en RCT. El VO2máx aumentó entre 4.1% a 39.6% utilizando la RCD y entre 4% y 54.1% con RCT. La capacidad funcional incrementó entre 3.0% y 11.7% con RCD y entre 4.9% y 11.8% con RCT. Conclusiones: Los programas de RCD son tan seguros y eficaces como los programas de RCT manifestando incrementos similares en el VO2máx y la capacidad funcional.

Abstract Home cardiac rehabilitation as an alternative in times of pandemic: a systematic review The worldwide pandemic caused by the coronavirus disease (COVID-19) has produced global health, economic and social impact, as well in traditional cardiac rehabilitation (CR) programs. Patients with cardiovascular disease (CVD) should be encouraged to keep doing exercise, despite the pandemic. Objective: To analyze the scientific evidence on home-based CR (HBCR) and traditional CR (TRC) in patient safety and its efficacy in improving the maximum oxygen volume (VO2max) and functional capacity in patients with CVD. Methods: This systematic review was developed through PRISMA agreements. The scientific articles were searched using the electronic databases: "PubMed", "ScienceDirect", "Academic Search Ultimate" and "SportDiscus". Two search terms or Boolean phrase were used: ("heart disease" OR "cardiac diseases" OR "coronary artery disease" OR "heart failure") AND ("cardiac rehabilitation" OR "center-based" OR "exercise" OR "training") AND ("home-based" OR "home training" OR "home exercise") NOT ("animal"). Results: A total of 1516 studies were reviewed where 21 articles were included and 1316 patients with CVD that met inclusion criteria. The prevalence of adverse events was 3.8% in HCR and 4.3% in TCR. VO2max increased from 4.1% to 39.6% with HCR and between 4.0% to 54.1% with TCR. Functional capacity increased between 3.0% to 11.7% with HCR and between 4.9% and 11.8% withTCR. Conclusions: This scientific evidence shows that HBCR programs are as safe and effective as TCR programs providing similar improving effects on increasing VO2max and functional capacity and offering a great exercise alternative during the COVID-19 pandemic.

Alterations of Serum Ser312-Phosphorylated Fetuin-A from Exercise-Induced Moderate Body Weight Loss in Individuals with Obesity.

OBJECTIVE: Phosphorylated fetuin-A (pFet-A) inhibits insulin action and has been shown to be associated with obesity and insulin resistance. The objective of this cohort study was to assess the effect of incremental body weight loss on alterations in serum pFet-A and indexes of insulin sensitivity. METHODS: A total of 16 men with obesity attained a targeted weight loss of 8% to 10% of their initial body weight by achieving an energy expenditure/deficit of 2,000 to 2,500 kcal/wk. Anthropometric assessments and blood samples were obtained every 4 weeks. Weight loss was calculated and partitioned as 2% to 4%, 4% to 6%, 6% to 8%, and 8% to 10% compared with initial body weight. RESULTS: Targeted body weight loss of 8% to 10% decreased serum pFet-A, pFet-A:Fet-A ratio, fasting insulin, log(homeostasis model assessment of insulin resistance), quantitative insulin sensitivity check index, adipose insulin resistance, and insulin resistance index significantly. Percent changes in serum pFet-A were associated with percent changes in indexes of insulin sensitivity. Unlike insulin sensitivity indexes, which were altered starting with 6% to 8% weight loss, serum pFet-A levels were significantly decreased by 19.6% starting with 2% to 4% weight loss and decreased by 25.6%, 36.8%, and 42.3% with 4% to 6%, 6% to 8%, and 8% to 10% weight loss, respectively. CONCLUSIONS: This study reports for the first time that the insulin-sensitizing effects of moderate weight loss are associated with a reduction in serum pFet-A levels.

Adaptaciones cardiovasculares del entrenamiento interválico de alta intensidad en pacientes con insuficiencia cardíaca / Cardiovascular adaptations of high intensity interval training in patients with heart failure: A systematic review

Resumen El entrenamiento interválico de alta intensidad (HIIT) es una modalidad de ejercicio físico que ha demostrado superiores adaptaciones cardiovasculares que el entrenamiento continuo de intensidad moderada (MICT) en pacientes con insuficiencia cardiaca (IC). Sin embargo, si las adaptaciones cardiovasculares se dan en pacientes con IC con fracción de eyección (FE) disminuida esta menos definido. Propósito: Revisar la evidencia científica sobre la efectividad del HIIT en comparación con el MICT en las adaptaciones cardiovasculares de pacientes con IC que presenten FE reducida. Metodología: Se desarrolló una revisión sistemática de literatura utilizando las bases de datos: "PubMed", "Academic Search Complete", "SportDiscus" y "ScienceDirect" hasta julio del 2018. Se utilizaron varios términos de búsqueda (frase boolena) o palabras claves para encontrar los artículos de la revisión: (''Heart Failure'') AND (''high intensity interval training'' OR ''continuous training'') AND ("ejection fraction" OR "VO2peak" OR "functional capacity" OR "ventricular remodeling") NOT ("animals"). El año de publicación de los estudios incluidos estuvo entre el 2007 y 2018. Resultados: Se revisaron un total de 243 estudios, donde al final se incluyeron 22 estudios cuantitativos con un total de 658 pacientes para realizar esta revisión sistemática de literatura. El HIIT es efectivo en el incremento del VO2máx en pacientes con IC, representando aumentos entre el 5.7% y el 46.2%. Además, se encontraron mayores efectos del HIIT sobre el MICT, siempre y cuando los intervalos de baja intensidad fueron activos y a una intensidad entre el 40% y el 60% de la FCreserva. También, cuando las sesiones de entrenamiento del HIIT y del MICT presentan un mismo gasto energético los efectos se igualan. Se encontraron mejorías en la FEVI entre un 2.6% y 35.7%, en algunos casos sin ser estadísticamente significativa. El HIIT genera una disminución en la remodelación del VI, reportándose una reducción de la dimensión ventricular izquierda diastólica (LVEDD) entre un 7.4% y un 11.5% y de la dimensión ventricular izquierda sistólica (LVESD) en un 14.5%. Conclusión: El protocolo HIIT es más efectivo que el MICT para mejorar el VO2máx de los pacientes con IC con FE disminuida. Con respecto a la remodelación ventricular y a la FEVI, el entrenamiento HIIT no es concluyente según esta revisión sistemática, ya que hay mucha variabilidad en los resultados.

Abstract Cardiovascular adaptations of high intensity interval training in patients with heart failure: A systematic review High intensity interval training (HIIT) is an exercise training modality that has been demonstrated superior cardiovascular adaptations than moderate intensity continuous training (MICT) in patients with heart failure (HF). However, if these cardiovascular adaptations are similar in HF patients with reduced ejection fraction (EF) is less defined. Purpose: To review the scientific evidence of the effectiveness of HIIT versus MICT on cardiovascular adaptations in HF patients with reduced EF. Methods: A systematic review of literature using electronic data resources: PubMed, Academic Search Complete, SportDiscus and ScienceDirect until july 2008. The key terms used were: (''Heart Failure'') AND (''high intensity Interval training'' OR ''continuous training'') AND ("ejection fraction" OR "VO2peak" OR "functional capacity" OR "ventricular remodeling") NOT ("animals"). The year of publication of the included studies was between 2007 and 2018. Results: Two-hundred and forty-three studies were searched and 22 articles were included with a total of 658 to perform this systematic literature review. HIIT was better than MICT on improvements in VO2max when the period of Interval training at low intensity was continuous at 40% to 60% of heart rate reserve (HRR). Also, when the training sessions of HIIT and MICT have the same energy expenditure, the effects are equalized. Improvements in the EF of the left ventricle was found between 2.6% y 35.7% in some cases, but not statistically significant. HIIT generates a decrease in LV remodeling, reporting a reduction of the left ventricular diastolic dimension (LVEDD) between 7.4% and 11.5% and of the left ventricular systolic dimension (LVESD) by 14.5%. Conclusión: HIIT is more effective than the MICT in improving the VO2max of patients with HF with decreased EF. With regard to ventricular remodeling and LVEF, HIIT training is not conclusive according to this systematic review, since there is much variability in the results.

Phosphorylation status of fetuin-A is critical for inhibition of insulin action and is correlated with obesity and insulin resistance.

Fetuin-A (Fet-A), a hepatokine associated with insulin resistance, obesity, and incident type 2 diabetes, is shown to exist in both phosphorylated and dephosphorylated forms in circulation. However, studies on fetuin-A phosphorylation status in insulin-resistant conditions and its functional significance are limited. We demonstrate that serum phosphofetuin-A (Ser312) levels were significantly elevated in high-fat diet-induced obese mice, insulin-resistant Zucker diabetic fatty rats, and in individuals with obesity who are insulin resistant. Unlike serum total fetuin-A, serum phosphofetuin-A was associated with body weight, insulin, and markers of insulin resistance. To characterize potential mechanisms, fetuin-A was purified from Hep3B human hepatoma cells. Hep3B Fet-A was phosphorylated (Ser312) and inhibited insulin-stimulated glucose uptake and glycogen synthesis in L6GLUT4 myoblasts. Furthermore, single (Ser312Ala) and double (Ser312Ala + Ser120Ala) phosphorylation-defective Fet-A mutants were without effect on glucose uptake and glycogen synthesis in L6GLUT4 myoblasts. Together, our studies demonstrate that phosphorylation status of Fet-A (Ser312) is associated with obesity and insulin resistance and raise the possibility that Fet-A phosphorylation may play a role in regulation of insulin action.

Efecto de un programa de ejercicios en la capacidad funcional y respuesta hemodinámica de pacientes con enfermedad cardiovascular / The Effect of Exercise Training on Functional Capacity and Hemodynamic Responses in Cardiac Patients

Resumen:Introducción:la sobrevivencia después de un evento cardiaco ha aumentado en Costa Rica en la última década. Por consiguiente, este aspecto podría ser atribuido a los programas de rehabilitación cardiaca (RC). La RC mejora la capacidad funcional, reduce la presión arterial en reposo y durante el ejercicio; sin embargo, estos factores no han sido bien estable cidos en pacientes cardiacos costarricenses.Propósito:examinar el efecto de un programa de ejercicios en la capacidad funcional y la respuesta hemodinámica de pacientes con enfermedad cardiovascular.Metodología:doscientos veinte y seis pacientes cardiacos con una edad = 58 ± 13 años, estatura = 1,67 ± 0,9 metros; peso = 75,0 ± 12,0 kg; IMC = 26,7 ± 3,7 kg/m2; VO2max = 13,4 ± 4,9 ml/kg/min, frecuencia cardiaca en reposo (FCrep) = 71 ± 13 lpm; presión arterial sistólica (PAS) = 112 ± 18 mmHg y presión arterial (PAD) diastólica = 69 ± 10 mmHg, participantes de nuestro programa de RC de la Universidad Nacional. Los pacientes completaron una prueba de caminata de 6 minutos (PC6M) antes y después de cumplir un programa de ejercicios de 12 semanas. La capacidad funcional de ejercicio y el VO2máx fueron estimados con la utilización de la distancia recorrida en la PC6M. Se empleó la prueba T para medidas repetidas para determinar las diferencias entre las mediciones antes y después del programa. También se calcularon los tamaños de efecto (TE) y la probabilidad se estableció a prioride P ≤ 0,05.Resultados:Los pacientes mejoraron su capacidad funcional de ejercicio un 31% en la de 410 ± 100 a 539 ± 93 m, IC 95 % -138,4 a -118,8, P<0,001, y el VO2max un 25 % de 13,4 ± 5,0 a 16,8 ± 5,2 ml/kg/min, IC 95 % -3,7 a -3,1, P< 0,001. La PAS disminuyó un 3,6 %, de 112 ± 18 a 108 ± 17 mmHg, IC 95 %1,48 a 5,98, P= 0,001 y la PAD se redujo un 2,9 %, de 69 ± 10 a 67 ± 9,0 mmHg, IC 95 % 0,82 a 3,6, P= 0,002. La presión arterial media (PAM) de igual forma disminuyó un 3,6 %, de 83 ± 11 a 80 ± 10 mmHg, IC 95 % 1,2 a 4,2, P< 0,001. Los tamaños de efecto para la PC6M, VO2max, PAS, PAD y PAM son 1,29, 0,68, 0,22, 0,22 y 0,27 respectivamente. Los pacientes mostraron una mejor frecuencia cardiaca de recuperación a los 5 minutos después de la PC6M (35 latidos por minuto, IC 95 % 20,9 a 24,8, P<0.001) versus 23 latidos por minuto, IC 95 % 33,3 a 37,7, P<0,001). También se registró una mayor recuperación en la PAS (29 mmHg, IC 95 % 15,06 a 19,25, P<0,001) en contraste con 17 mmHg, IC 95 % 25,01 a 32,6, P<0,001). Los tamaños de efecto para la frecuencia cardiaca y la PAS de recuperación después de la PC6M fueron 0,85 y 0,73 respectivamente.Conclusión:Nuestro programa de rehabilitación cardiaca aumentó la capacidad funcional y mejoró la respuesta hemo dinámica después del ejercicio. Estos hallazgos proveen una evidencia razonable que la RC puede contribuir a la sobrevi vencia y la calidad de vida de los pacientes cardiacos costarricenses.

Abstract:Survival after a cardiac event has increased in Costa Rica over the last decade. Increased survival and quality of life are attributed to improved cardiac rehabilitation (CR) programming. CR is thought to enhance functional exercise capacityand reduce resting and exercise blood pressures; yet, these factors are not well characterized in Costa Rican patients.Purpose:To examine the effect of exercise training on functional capacity and hemodynamic responses in cardiac patients.Methods:Two hundred and twenty six cardiac patients (age = 58.0 ± 13 years, height = 1.67 ± 0.9 m, weight = 75.0 ± 12.0 kg, BMI = 26.7 ± 3.7 kg/m2, VO2máx = 13.4 ± 4.9 ml/kg/min), resting heart rate = 71 ± 13 bpm, systolic blood pressure (SBP) = 112 ± 18, diastolic blood pressure (DBP) = 69 ± 10) from our University-based CR program performed a 6-minute walking Test (6MWT) before and after completing a twelve-week exercise program. Functional capacity and VO2máx were estimated based on the 6MWT. Paired t-test was used to determine pre-and post rehabilitation outcomes differences. Effect sizes were also calculated P≤ 0.05 a priori.Results:Patients improved their functional exercise capacity using the 6MWT by 31%, from (410 ± 100 to 539 ± 93 m, CI 95% -138.4 to -118.8, P<0.001), and VO2max by 25% from (13.4 ± 5.0 to 16.8 ± 5.2 ml/kg/min, CI 95%-3.7 to -3.1, P< 0.001). Resting SBP was reduced by 3.6 %, from (112 ± 18 to 108 ± 17 mmHg, CI 95% 1.48 to 5.98, P= 0.001) and resting DBP was reduced by 2.9 %, from (69 ± 10 to 67 ± 9.0 mmHg, CI 95% 0.82 to 3.6, P= 0.002). Mean arterial pressure (MAP) was also reduced by 3.6 %, from (83 ± 11 to 80 ± 10 mmHg, CI 95% 1.2 to 4.2, P< 0.001). Effect sizes for 6MWT, VO2max, SBP, DBP and MAP were (1.29, 0.68, 0.22, 0.22 and 0.27 respectively). Patients exhibited a greater five minute heart rate recovery after post 6MWT 35 beats per minute, (CI 95% 20.9 a 24.8, P<0.001) versus 23 beats per minute, (IC 95% 33.3 a 37.7, P<0.001) at the beginning of the CR. We also had a greater SBP recovery 29 mmHg (CI 95% 15.06 a 19.25, P<0.001) than 17 mmHg at, (IC 95% 25.01 a 32.6, P<0.001) at the initial of the CR program. The effect sizes for heart rate and SBP recovery after the 6MWT were 0.85 and 0.73 respectively.Conclusion:Our twelve-week cardiac rehabilitation program improved functional capacity and enhanced hemodynamic responses after exercise. These findings provide plausible evidence that CR may contribute to improved survival and quality of life in Costa Rican CR patients.

Efecto de dos protocolos de ejercicio físico en parámetros antropométricos y fisiológicos en pacientes con enfermedad coronaria / Effect of two protocols on physical exercise in anthropometric and physiologic parameters in patients with coronary artery disease

Introducción. El ejercicio físico es esencial para la prevención, tratamiento y rehabilitación de la enfermedad cardiaca, yaque proporciona una serie de beneficios fisiológicos que mejoran la salud y la calidad de vida del paciente.Objetivo. Realizar una comparación entre dos protocolos de rehabilitación cardiaca de fase II, uno bajo las normas de laAsociación Americana de Rehabilitación Cardio-pulmonar (AACRP) y el otro tradicionalista, basado en movimiento básico,sin principios regulados de entrenamiento físico.Metodología. Es un estudio experimental con un diseño de medidas repetidas, en pacientes cardiópatas remitidos a unprograma de rehabilitación cardiaca. Se dividieron en dos grupos: el grupo 1 que trabajó con el protocolo recomendadopor la AARCP y el grupo 2, que trabajó con un protocolo tradicional. Se evaluaron parámetros antropométricos (peso, porcentajede grasa corporal e índice de masa corporal), fisiológicos (frecuencia cardiaca y presión arterial de reposo, consumomáximo de oxígeno y flexibilidad) y bioquímicos (glucemia y perfil lipídico) antes y después del programa de ejercicioscuya duración fue 12 semanas.Resultados. Se reclutaron 35 pacientes, 17 en el grupo 1 y 18 en el grupo 2. El grupo 1 mostró resultados significativamentesuperiores (p<0,05) en las variables peso corporal, porcentaje de grasa corporal, flexibilidad y frecuencia cardiaca dereposo; con ambos protocolos se registraron cambios significativos (p<0,05) en la presión arterial de reposo y el consumomáximo de oxígeno. No se encontraron cambios significativos en el perfil bioquímico con ningún protocolo.Conclusión: El protocolo de ejercicio recomendado por la AARCP mostró resultados superiores al protocolo de ejercicio noestructurado en variables físicas y fisiológicas, pero no en el perfil bioquímico.

Introduction. Exercise is an essential component in cardiac rehabilitation and for secondary prevention in patientswith coronary heart disease. There are several physiological exercise-related benefits from participating in a cardiacrehabilitation program that help to improve health and quality of life.Objective. The main purpose of the study was to compare two phase-II cardiac rehabilitation protocols. One protocolfollowed the guidelines of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and thesecond protocol followed a traditionally nonmonitored exercise training (TNET) program.Methodology. This was an experimental study with a repetitive measurement design, in patients referred for cardiacrehabilitation. The patients were divided into 2 groups: one followed the AARCP protocol and the second group followedthe TNET program. Anthropometric variables such as height, body weight and body fat, were measured and body massindex was calculated. Physiological variables such as resting heart rate, resting blood pressure, flexibility and peak oxygenconsumption were also assessed. Blood glucose, total cholesterol, low and high density lipoprotein cholesterol andtriglycerides were measured as biochemical variables before and after the 12 weeks of exercise training.Results: Thirty five patients were divided into two groups. The AACVPR group (n=18) and the TNET group (n=17). TheAACVPR group showed significantly better results (p<0.05) in decreasing body weight, body fat and resting heart rate, andin improving flexibility than did the TNET group. Both protocols showed similar results for blood pressure and peak oxygenconsumption. There was no significant change in any of the biochemical variables in either group after exercise training.Conclusion: The AACVPR cardiac rehabilitation protocol showed superior results in anthropometric and physiologicalvariables as compared to the TNET cardiac rehabilitation protocol.

Who is likely to benefit from phase II cardiac rehabilitation?

PURPOSE: To ascertain which patients are most likely to benefit from a phase II cardiac rehabilitation (CR) program. METHODS: A retrospective chart review was conducted on 425 patients who completed a 6-minute walk test (6MWT), body weight (BW), and the Medical Outcomes Short Form Health Survey physical (PCS) and mental (MCS) component scores before and after CR. These variables were compared between patients who attended 24 or less and 25 or more sessions and between tertiles on the basis of initial 6MWT and the relative change in 6MWT. RESULTS: The entire cohort of patients improved their 6MWT 20.1 +/- 16.3% with CR (P < .001). On average, patients experienced a modest reduction in BW (P = .03) and had higher PCS and MCS scores (P < .001 for both) after CR. The improvement in 6MWT was inversely related to initial walk distance (r = -0.465, P < .001). Patients in the lowest initial 6MWT tertile exhibited greater improvement in the 6MWT than those in the highest tertile (28 +/- 20 vs 13 +/- 10%, P < .001). Patients who attended 25 or more sessions demonstrated greater 6MWT (20 +/- 18 vs 18 +/- 14%, P = .012) and reductions in BW (-1.3 +/- 2.8 vs -0.5 +/- 2.5 kg, P = .003) than those attending 24 or fewer sessions. Patients exhibiting greater than 23% improvement in 6MWT lost more BW (-1.4 +/- 2.9 vs -0.6 +/- 2.5 kg, P = .006) and exhibited greater PCS (10.2 +/- 9.8 vs 6.3 +/- 9.4, P = .004) than those exhibiting <12% improvement. CONCLUSIONS: Most patients benefit physically and mentally from CR. Patients with lower initial functional ability and who attend 25 or more sessions enjoy the greatest improvements in walking ability and perception of physical health and function.

Duathlon performance unaltered by short-term changes in dietary fat and carbohydrates.

PURPOSE: This study investigated the effects of short-term dietary changes on metabolism and duathlon performance. METHODS: Eleven men underwent a high-fat (HF; >65% fat from energy) or a high-carbohydrate (CHO; HC) diet (>60% CHO from energy). Energy intake was individualized, and commercially available foods were prepared and packaged for each participant 48 hr before they completed a laboratory-based duathlon (5-km run, 30 km cycling, and 10-km run). Blood samples were obtained before, immediately after, and 1 and 2 hr after the duathlon for determination of glucose, insulin, and glucagon. Oxygen consumption, ratings of perceived exertion (RPE), and respiratory-exchange ratio were assessed, and fat and CHO oxidation were estimated before, during, and after the duathlon. RESULTS: Dietary records indicated a significant difference in fat content ingested before the duathlons (p < .05). Time to complete the duathlon did not differ between the HC- and the HF-diet trials. CHO-oxidation rate was higher during the HC-diet trial than during the HF-diet trial (p = .006). Fat-oxidation rates were higher in the HF-diet trial than in the HC-diet trial (p = .001). No differences in RPE were found between dietary trials. Blood glucose concentration was higher immediately after the duathlon in the HC-diet trial than in the HF-diet trial and remained higher 1 and 2 hr after the duathlon (p < .05). CONCLUSION: Duathlon performance was not altered by short-term changes in dietary fat or CHO composition despite higher blood glucose concentrations under the HC condition.

Initial metabolic state and exercise-induced endotoxaemia are unrelated to gastrointestinal symptoms during exercise.

The aim of the study was to investigate the association between the initial metabolic state and exercise-induced endotoxaemia on the appearance of gastrointestinal symptoms (GIS) during exercise. Eleven males (36.6 ± 4.9 yrs, 1.7 ± 0.1 m, 74.5 ± 7.7 kg, DEXA body fat % 17.2 ± 6.6, VO2max 57.4 ± 7.4 ml·kg(-1)·min(-1)) underwent two isoenergetic diets designed to change their initial metabolic status by either depleting or maintaining their hepatic and muscular glycogen content. These diets and accompanying exercise sessions were performed by each participant in the days before completing a laboratory-based duathlon (5-km run, 30-km cycling, 10-km run). Blood samples were obtained before, immediately and 1- and 2-h following the duathlon for determination of insulin (IN), glucagon (GL), endotoxin, aspartic aminotransferase (AST), and alanine aminotransferase (ALT) markers. GIS were assessed by survey before and after exercise. Diet content produced a different energy status as determined by macronutrient content and the IN/GL ratio (p < 0.05), and mild exercise-induced endotoxaemia was observed in both experimental duathlons. Regardless of the diet, the AST/ALT ratio following exercise and in the recovery phase indicated hepatocyte and liver parenchyma structural damage. In spite of GIS, no significant correlations between endotoxin levels and GIS were found. In conclusion, increased markers of endotoxaemia observed with the high-intensity exercise were unrelated to hepatic function and/or GIS before and after exercise. Key pointsGastrointestinal symptoms before, during, and after a competition are reported by approximately 20%-50% of the athletes participating in endurance events such as marathon, cycling and triathlon.Energy status, exercise-induced endotoxaemia and liver structural damage might be related to gastrointestinal symptoms.In this study, gastrointestinal symptoms observed before and after endurance exercise were unrelated to endotoxin levels or hepatic structural damage.