Cardiopulmonary rehabilitation's influence on cognitive functions, psychological state, and sleep quality in long COVID-19 patients: A randomized controlled trial.

CLINICALTRIALS.GOV: NCT05035628.Trial registration: ClinicalTrials.gov identifier: NCT05035628..

Cardiorespiratory Fitness Moderates the Age-Related Association Between Executive Functioning and Mobility: Evidence From Remote Assessments.

Background and Objectives: In older adults, executive functions are important for daily-life function and mobility. Evidence suggests that the relationship between cognition and mobility is dynamic and could vary according to individual factors, but whether cardiorespiratory fitness reduces the age-related increase of interdependence between mobility and cognition remains unexplored. Research Design and Methods: One hundred eighty-nine participants (aged 50-87) were divided into 3 groups according to their age: middle-aged (MA; <65), young older adults (YOA; 65-74), and old older adults (OOA; ≥75). Participants performed Timed Up and Go and executive functioning assessments (Oral Trail Making Test and Phonologic verbal fluency) remotely by videoconference. Participants completed the Matthews questionnaire to estimate their cardiorespiratory fitness (VO2 max in ml/min/kg). A 3-way moderation was used to address whether cardiorespiratory fitness interacts with age to moderate the relationship between cognition and mobility. Results: Results showed that the cardiorespiratory fitness × age interaction moderated the association between executive functioning and mobility (ß = -0.05; p = .048; R 2 = 17.6; p < .001). At lower levels of physical fitness (<19.16 ml/min/kg), executive functioning significantly influenced YOA's mobility (ß = -0.48, p = .004) and to a greater extent OOA's mobility (ß = -0.96, p = .002). Discussion and Implications: Our results support the idea of a dynamic relationship between mobility and executive functioning during aging and suggest that physical fitness could play a significant role in reducing their interdependency.

Mastering the Relationship between the Body and the Brain? The Case of a Female Master Athlete.

BACKGROUND: Physical inactivity significantly increases risk of cardiovascular diseases, which are highly prevalent in aging. Conversely, higher levels of physical activity in aging have been associated with benefits for physical and cognitive health and is hypothesized to prevent and reduce development of cardiovascular risk factors. However, those older adults with the highest activity levels (i.e., Master Athletes [MA]) are relatively understudied, and even fewer studies involve female MA. OBJECTIVE: The aim of this study was to compare the physiological, physical, and cognitive profiles of an 83-year-old track-and-field MA runner to a sample of inactive age-matched females. RESULTS: Results revealed the MA had a high peak oxygen uptake and had superior performance on visuospatial memory tasks compared to her inactive counterparts. Cerebral blood flow was slightly elevated in the MA, but lower cerebrovascular reactivity was revealed compared to the other female included in the magnetic resonance imaging portion. CONCLUSION: Our results suggest that high levels of physical activity have benefits on multiple aspects of an aging female's life and that more studies should include MA, as well as a spectrum of cardiorespiratory fitness to further understand the role of physical activity in female aging.

Cardiopulmonary Rehabilitation in Long-COVID-19 Patients with Persistent Breathlessness and Fatigue: The COVID-Rehab Study.

(1) Background: Cardiopulmonary and brain functions are frequently impaired after COVID-19 infection. Exercise rehabilitation could have a major impact on the healing process of patients affected by long COVID-19. (2) Methods: The COVID-Rehab study will investigate the effectiveness of an eight-week cardiopulmonary rehabilitation program on cardiorespiratory fitness (V˙O2max) in long-COVID-19 individuals. Secondary objectives will include functional capacity, quality of life, perceived stress, sleep quality (questionnaires), respiratory capacity (spirometry test), coagulation, inflammatory and oxidative-stress profile (blood draw), cognition (neuropsychological tests), neurovascular coupling and pulsatility (fNIRS). The COVID-Rehab project was a randomised clinical trial with two intervention arms (1:1 ratio) that will be blindly evaluated. It will recruit a total of 40 individuals: (1) rehabilitation: centre-based exercise-training program (eight weeks, three times per week); (2) control: individuals will have to maintain their daily habits. (3) Conclusions: Currently, there are no specific rehabilitation guidelines for long-COVID-19 patients, but preliminary studies show encouraging results. Clinicaltrials.gov (NCT05035628).

Videoconference version of the Montreal Cognitive Assessment: normative data for Quebec-French people aged 50 years and older.

BACKGROUND: The COVID-19 pandemic forced health professionals to rapidly develop and implement telepractice and remote assessments. Recent reviews appear to confirm the validity of a wide range of neuropsychological tests for teleneuropsychology and among these, the Montreal Cognitive Assessment (MoCA), a cognitive screening test widely used in clinical settings. The normative data specific to the context of videoconference administration is essential, particularly that consider sociodemographic characteristics. AIMS: This study had for objective to develop French-Quebec normative data for videoconference-administration of the MoCA that consider sociodemographic characteristics. METHODS: A total of 230 community-dwelling adults aged 50 years and older taking part in clinical trials completed the MoCA by videoconference. Regression analyses were run with sex, education, and age as predictors of the total MoCA scores, based on previously published norms. As an exploratory analysis, a second regression analysis was also run with cardiovascular disease as a predictor. RESULTS: Regression analyses revealed that older age and lower education were associated with poorer total MoCA scores, for medium effect size (p < 0.001, R2 = 0.17). Neither sex nor cardiovascular disease, were significant predictors in our analyses. For clinicians, a regression equation was proposed to calculate Z scores. DISCUSSION: This study provides normative data for the MoCA administered via videoconference in Quebec-French individuals aged 50 years and over. CONCLUSIONS: The present normative data will not only allow clinicians to continue to perform assessments remotely in this pandemic period but will also allow them to perform cognitive assessments to patients located in remote areas.

How and Why Patients Adhere to a Prescribed Cardiac Rehabilitation Program: A Longitudinal Phenomenological Study of Patients with Acute Coronary Syndrome.

Background. Adherence to cardiac rehabilitation remains a challenge despite established evidence that engaging in regular exercise is a strong preventive measure to experiencing a second cardiac event. A recent study found a six-month cardiac rehabilitation program to be effective for facilitating regular exercise behavior among patients diagnosed with acute coronary syndrome. The purpose of this study was to conduct a phenomenological investigation using Colaizzi's descriptive technique to understand mechanisms responsible for behavior change. Methods. Data were collected and analyzed among patients with acute coronary syndrome at a cardiac rehabilitation using semi-structured interviews that were conducted over the phone across three months. Conclusion. Thematic analysis of 15 semi-structured interviews resulted in 124 statements that were analyzed. The data yielded seven themes that included "motivation to follow prescribed exercise program", "volitional decision", "capability of performing exercise", "connectedness to peers", "planning", "habit formation", and "adopting healthy behaviors beyond exercise". The emerged themes align with construct definitions of the self-determination theory, which include the three psychological needs (autonomy, competence, and relatedness), in addition to autonomous motivation, which represents internally driven reasons to participate in exercise. Planning and habit formation themes support contemporary research that identifies these constructs responsible for behavioral maintenance. While these themes help explain exercise participation, the final theme, adopting healthy behaviors beyond exercise, reflects the impact of the program on having a change towards a healthier lifestyle. The findings highlight the complexity of exercise behavior, and that long-term participation is likely explained by amalgamating the self-determination theory.

Investigation of the Effects of Home-Based Exercise and Cognitive Training on Cognitive and Physical Functions in Cardiac Patients: The COVEPICARDIO Study Protocol of a Randomized Clinical Trial.

Introduction: During the COVID-19 pandemic, confinement measures are likely to produce collateral damage to health (stress, confusion, anxiety), especially in frail individuals and those living with cardiovascular disease (CVD). In cardiac patients in particular, these measures dramatically increase the level of physical inactivity and sedentary lifestyle, which can decrease cardiorespiratory capacity and increase the risk of acute events, rehospitalization, and depressive syndromes. Maintaining a minimum level of physical activity and cognitive stimulation during the COVID-19 crisis is essential for cardiac patients. This study is designed to document the effects of 6 months of home-based physical exercise alone or combined with cognitive training on cognitive and physical functions in patients with CVD over 50 years old. Methods and Analysis: 122 patients (>50 years old) with stable CVD and no contraindication to perform physical exercise training will be recruited and randomly assigned to one of the 2 following arms: (1) Home-based physical exercise alone, (2) Home-based physical exercise combined with cognitive training. The intervention lasts 6 months, with remote assessments performed prior to, mid and post-training. A follow-up 6 months after the end of the intervention (12 month) is also proposed. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as performances on measures of executive functions, processing speed, and episodic memory. The secondary outcome is physical performance, including balance, gait and mobility, leg muscle strength and estimated cardiorespiratory fitness. Tertiary outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported online questionnaires. Discussion: With the COVID-19 crisis, there is a critical need for remote exercise and cognitive training, and to further investigate this topic, in particular for cardiac patients. The present context can be viewed as an opportunity to perform a major shift from center-based programs to home-based physical exercise. This is especially important to reach out to older adults living in remote areas, where access to such interventions is limited. ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT04661189], NCT04661189.

Facilitating Exercise Habit Formation among Cardiac Rehabilitation Patients: A Randomized Controlled Pilot Trial.

BACKGROUND: The importance of promoting exercise adherence among individuals with acute coronary syndrome (ACS) is imperative. However, challenges in maintaining behavior among ACS patients are also well-documented. Emerging findings in the general population have supported the use of habit-formation techniques, which include incorporating routine consistency and cues, to be effective for facilitating exercise behavior. The effectiveness of habit formation approaches, however, has not been tested on participants with ACS. The purpose of this study was to test the effectiveness of facilitating physical activity habits among patients with ACS in a two-arm, parallel design, randomized controlled pilot trial. METHODS: Participants (n = 13) were older adult patients (M age = 64.20, SD = 5.35) with ACS who were referred to a cardiac rehabilitation center. The experimental group attended monthly group meetings from months 1-3 and received phone call follow-ups from months 4-6. CONCLUSIONS: The experimental group showed an increase in weekly moderate-to-vigorous level physical activity, M = 228.20 mins (SD = 112.45), compared with the control group, M = 151.17 (SD = 112.22), d = 0.61. The experimental condition also showed greater use of routine consistency (experimental: M = 4.60 (SD = 0.548); control: M = 3.76 (SD = 1.62)) and cue usage (experimental: M = 3.60 (SD = 0.471); control: M= 2.60 (SD = 0.398)) over the control condition at the six-month mark. The study supports the effectiveness of habit-building techniques among patients with ACS, with effect sizes ranging from a medium to large magnitude. Findings from this pilot study support a full clinical trial with larger sample size.

Investigating the role of self-control beliefs in predicting exercise behaviour: A longitudinal study.

BACKGROUND: Engaging in exercise behaviour regularly requires a repeated investment of resources to reap the health benefits. An individual's self-control resources, when performing a behaviour can be perceived as being recharged or depleted. The investigation on how self-control beliefs resources predict exercise behaviour is very limited in the literature. The purpose of this study was to understand how self-control beliefs predict exercise behaviour across time in a physical activity model. METHODS: Participants (N = 161) were a sample of adults recruited across twelve gyms and recreation centres in a large city. Participants completed surveys across five months. Data were analysed using a multilevel structural equation model with participants (level 2) nested within time (level 1). RESULTS: Behaviour was found to be a function of intention, habit, and planning. Specifically, planning moderated the intention-behaviour relationship, where those who scored higher on planning engaged in more exercise. Self-control beliefs functioned as a proximal predictor of autonomous motivation and predicted habit, and intention when accounting for total effects. CONCLUSIONS: Self-control beliefs played a pivotal role in supporting recognized exercise determinants. Exercise-focussed interventions that help participants strengthen their beliefs as recharging and reduce depletion beliefs could be beneficial for promoting regular exercise.

Cardiorespiratory Fitness Mediates Cognitive Performance in Chronic Heart Failure Patients and Heart Transplant Recipients.

We compared cognitive profiles in chronic heart failure patients (HF), heart transplant recipients (HT) and healthy controls (HC) and examined the relationship between cardiorespiratory fitness (V˙O2peak), peak cardiac output (COpeak) and cognitive performance. Stable HT patients (n = 11), HF patients (n = 11) and HC (n = 13) (61.5 ± 8.5 years) were recruited. Four cognitive composite scores targeting different cognitive functions were computed from neuropsychological tests: working memory, processing speed, executive functions and verbal memory. Processing speed and executive function scores were higher, which indicates lower performances in HF and HT compared to HC (p < 0.05). V˙O2peak and first ventilatory threshold (VT1) were lower in HF and HT vs. HC (p < 0.01). COpeak was lower in HF vs. HT and HC (p < 0.01). Processing speed, executive function and verbal memory performances were correlated with V˙O2peak, VT1 and peak cardiac hemodynamics (p < 0.05). Mediation analyses showed that V˙O2peak and VT1 mediated the relationship between group and processing speed and executive function performances in HF and HT. COpeak fully mediated executive function and processing speed performances in HF only. V˙O2peak and COpeak were related to cognitive performance in the entire sample. In addition, V˙O2peak and VT1 fully mediated the relationship between group and executive function and processing speed performances.