The ambulatory hypotensive effect of aerobic training: a reappraisal through a meta-analysis of selected moderators.

The effectiveness of regular exercise in decreasing both systolic and diastolic blood pressure (BP) is well-established. Our purpose was to assess the impact of both subject and physical activity program characteristics on ambulatory BP through a meta-analysis of the existing literature. Three databases (PubMed, Embase, Web of Science) were searched using relevant terms and strategies. From 637 identified records, 37 studies met inclusion criteria: details about training intervention and participant characteristics, pre- and post-training ambulatory BP measurements, at home (HBPM) or during 24-h (ABPM). The weighted mean difference was for 24-h systolic/diastolic ABPM (n = 847 participants): -4.06/-2.77 mmHg (95%CI: -5.19 to -2.93/-3.58 to -1.97; P < 0.001), for daytime (ABPM or HBPM, n = 983): -3.78/-2.73 mmHg (95%CI: -5.09 to -2.47/-3.57 to -1.89; P < 0.001) and nighttime ABPM periods (n = 796): -2.35/-1.70 mmHg (95%CI: -3.26 to -1.44/-2.45 to -0.95; P < 0.001). Characteristics significantly influencing BP improvement were: an initial office BP ≥130/85 mmHg and diet-induced weight-loss. We found no differences according to sex, age, or training characteristics (intensity, number of sessions, training duration). Antihypertensive effects of aerobic training assessed by ambulatory BP measurements appear significant and clinically relevant for both daytime and nighttime periods, in particular for participants with an office BP ≥130/85 mmHg.

Is practice rate rather than exercise intensity more important in health benefits of moderately obese postmenopausal women?

OBJECTIVE: The aim of this study was to evaluate the impact of brisk walking on physical fitness, body composition and fasting lipid-lipoprotein profile of women 50-65 years-old, once adherence or exercise intensity is considered. METHODS: A sample of 159 healthy, sedentary, obese postmenopausal women (body mass index [BMI]=29-35 kg/m2) was subjected to 3 sessions/week of 45 min-walking, at 60% of heart rate reserve (HRR), during 16 weeks. Body composition, physical fitness and fasting lipid-lipoprotein profile were assessed before and after the intervention. RESULTS: Among the three tertiles of adherence to exercise sessions (<71%, 71-87%,>87%) women displaying the greatest one were characterized by the highest reduction in body weight (-1.9±2.7 kg) (mean±SD), fat mass (-2.0±2.3 kg) and waist girth (-4.4±3.4 cm) and the best improvement in physical fitness (7.3±3.5 mL O2/kg/min), (P<0.0001). A comparable analysis based on tertiles of walking intensity (<56%, 56-63%,>63% HRR) did not show between-group differences in body composition or physical fitness. Also, the fasting lipid-lipoprotein profile was improved by a reduction of cholesterol, LDL cholesterol, and triglyceride levels and by an increase in HDL cholesterol, irrespective of the participants' adherence (0.05

Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients.

BACKGROUND: QT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients. OBJECTIVES: To describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS. METHODS: Sixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15-30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion=QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention. RESULTS: No adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = -0.69, P < 0.0001) and in heart rate recovery (r = -0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups. CONCLUSION: In MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.

Accelerometer as a tool to assess sedentarity and adherence to physical activity recommendations after cardiac rehabilitation program.

PURPOSE: To objectively assess, in stable cardiac patients, the adherence to physical activity (PA) recommendations using an accelerometer at 2 or 12 months after the discharge of cardiac rehabilitation program (CRP). METHODS: Eighty cardiac patients wore an accelerometer at 2 months (group 1, short-term adherence, n = 41) or one-year (group 2, long-term adherence, n = 39) after a CRP including therapeutic education about regular PA. PA was classified as "light" (1.8-2.9 Metabolic Equivalent of Task [METs]), "moderate" (3-5.9 METs), or "intense" (>6 METs). Energy expenditure (EE, in Kcal) and time (min) spent in these three different levels were measured during a one-week period with the MyWellness Key actimeter (MWK). Motivational readiness for change was also assessed at the end of CRP. Patients were considered as physically active when a minimum of 150 min of moderate PA during the one-week period was achieved. RESULTS: Both groups were comparable, except for exercise capacity at the end of the CRP which was slightly higher in group 1 (167.5 ± 42.3 versus 140.7 ± 46.1 W, P < 0.01). The total weekly active EE averaged 676.7 ± 353.2 kcal and 609.5 ± 433.5 kcal in group 1 and 2, respectively. The time spent within the light-intensity range PA was 319.4 ± 170.9 and 310.9 ± 160.6 min, and the time spent within the moderate-intensity range averaged 157.4 ± 115.4 and 165 ± 77.2 min per week for group 1 and 2, respectively. Fifty-three percent and 41% of patients remained active in both groups respectively. CONCLUSION: About half of the patients are non-adherent to PA after CRP and do not reach target levels recommended by physicians. The first 2 months following the discharge of CRP seem to be of outmost importance for lifestyle modifications maintenance, and further study monitoring more closely PA decrease could help to clarify the optimal follow-up options.

Non-pharmacological strategies in cardiovascular prevention: 2011 highlights.

The clinical efficacy of cardiac rehabilitation programs is clearly recognized. Yet, as regards the three main currently employed strategies (exercise, education, and psychobehavioral support), new ideas regularly appear, stemming from studies aimed at providing proof of their efficacy and innocuousness, along with optimal modes of prescription and, at times, their cost-benefit ratio. This ongoing work, which was initially developed in view of enriching the "What's new in?" section of the Sofmer website, represents a selection of articles that may be non-exhaustive, yet is maximally diversified and as representative as possible of the main 2011 highlights in the field of cardiovascular prevention. Each of the articles selected puts forward an original idea, confirms the existence of an effect that was suspected or has had some impact on clinical practice in the field of non-pharmacological management of cardiovascular disease. In line with the multidisciplinary approach of Physical Medicine and Rehabilitation (PMR), the Sofmer cardiovascular rehabilitation group has associated itself with a wide range of specialists (PMR, cardiologists, exercise physiologists, experts in the science and technology of physical activities), all of whom are involved in clinical research and the management of more and more patients. Our objective was consequently to compile a selection of commented articles most likely to interest the different operatives (doctors, nurses, physiotherapists, dietitians, adapted physical activity instructors, psychologists) working with these patients in rehabilitation units or in phase III associative structures. Their goals may vary: (1) learners may wish to further their knowledge of cardiac rehabilitation techniques; (2) practitioners may be interested in continued education but not have the time for regular bibliographic updates; (3) researchers may be intent on informing themselves on the latest breakthroughs and/or arousing their imagination...Enjoy your reading!

Short-term impact of a 4-week intensive cardiac rehabilitation program on quality of life and anxiety-depression.

INTRODUCTION: Cardiac rehabilitation programs are well recognized as being essential to the comprehensive care of patients with cardiovascular disease and chronic heart failure. These programs aim at reducing cardiovascular risks, promoting healthy lifestyle behaviours and compliance as well as limiting disability and increasing quality of life (QoL) of cardiac patients. PURPOSE: To evaluate the impact of a 4-week cardiac rehabilitation program on physical parameters and several aspects of the QoL of cardiac patients. METHODS: A cohort of 101 cardiac patients (men: 70%) mean age 65±12 years (mean±SD) participated in a cardiac rehabilitation program. Before and after the 4-week cardiac rehabilitation program, the study recorded and assessed the patients' physical parameters such as weight, body mass index (BMI), waist circumference and effort tolerance as well as QoL using different questionnaires: SF-36 Health Survey (SF-36), Hospital Anxiety and Depression Scale (HAD) and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The patients' physical parameters (BMI and waist circumference) decreased by 3%, while effort tolerance increased by 25% (P<0.0001). Furthermore, for all patients, the PSQI, HAD and physical and mental SF-36 scores improved significantly (P<0.0001). The different SF-36 subscales' scores did also increase after the program (P<0.0001). CONCLUSION: Despite a modest weight loss and reduction in waist circumference, a 4-week cardiac rehabilitation program (short-term) seems to be sufficient for improving patients' physical state and mental well-being.

Vo2 requirement at different displayed power outputs on five cycle ergometer models: a preliminary study.

BACKGROUND AND AIMS: The validity of five brands of cycle ergometers was evaluated by the comparison of the Vo(2) requirements at different displayed power. METHODS AND RESULTS: Five physically active men performed a continuous incremental exercise test on five ergometers (Ergomeca, Lifecycle, Monark, Polar S710 and CompuTrainer). The latter was also compared with a standard dynamometer in order to associate Vo(2) values with the real power. Every test started with a 5-min warm-up on the same cycle ergometer (Ergomeca) at 100 W to make sure that the Vo(2) differences do not come from Vo(2) measurement error. Only last minute steady-state Vo(2) values of each 2-min stage were used for the Vo(2)-watt curve. Large differences (5- 10 ml kg(-1) min(-1)) at the same displayed power indicate inaccuracy of displayed power output (PO). Using corrected power values from the dynamometer revealed that for the same Vo(2) the CompuTrainer underestimates PO by approximately 30 W between 100 and 300 W, whereas the Lifecycle overestimate it by 3-53 W from 100 to 300 W. The Monark and Polar S710 underestimate PO by 15 W and the Ergomeca by approximately 5 W. CONCLUSION: Inaccuracies between -10% and 18% in displayed PO of various cycle ergometers question their interchangeability.