Sustainability of physical work capacity two years post outpatient cardiac rehabilitation.

OBJECTIVE: To determine if supervised training, after the completion of cardiac rehabilitation program, performed for a further two years would help maintain beneficial effects achieved during prolonged outpatient cardiac rehabilitation. DESIGN: Longitudinal parallel-grouped intervention study. SUBJECTS: Patients with coronary artery disease (n = 41, age 59.5 ± 9.3 years), who finished cardiac rehabilitation phase III in our outpatient cardiac rehabilitation facility. INTERVENTION: Two years of supervised exercise training consisting of endurance (either high intensity interval training or pyramid training) and resistance training sessions once a week. MAIN MEASUREMENT: Peak physical work capacity was assessed via an ergometry testing at the beginning and at the end of the study. RESULTS: Comparisons between end-of-cardiac rehabilitation and two years post cardiac rehabilitation revealed maintenance of peak physical work capacity after two years (begin vs end: 170 ± 59 W vs 167 ± 60 W; -0.5 ± 12.8%; p = 0.521). This was independent of exercise training protocols (percent change begin vs end: pyramid: 1.5 ± 11.8%; interval: -1.6 ± 13.4%; p = 0.459). CONCLUSION: Improvement of physical exercise capacity gained during outpatient cardiac rehabilitation can be maintained for up to two years by once-weekly supervised exercise training. Long-term, group-based exercise programs offered at the end of cardiac rehabilitation might be an effective tool to help patients maintain their physical work capacity.

Impact of exercise training and supplemental oxygen on submaximal exercise performance in patients with COPD.

Functional impairment caused by chronic obstructive pulmonary disease (COPD) impacts on activities of daily living and quality of life. Indeed, patients' submaximal exercise capacity is of crucial importance. It was the aim of this study to investigate the effects of an exercise training intervention with and without supplemental oxygen on submaximal exercise performance. This is a secondary analysis of a randomized, controlled, double-blind, crossover trial. 29 COPD patients (63.5 ± 5.9 years; FEV1 46.4 ± 8.6%) completed two consecutive 6-week periods of high-intensity interval cycling and strength training, which was performed three times/week with either supplemental oxygen or medical air (10 L/min). Submaximal exercise capacity as well as the cardiocirculatory, ventilatory, and metabolic response were evaluated at isotime (point of termination in the shortest cardiopulmonary exercise test), at physical work capacity at 110 bpm of heart rate (PWC 110), at the anaerobic threshold (AT), and at the lactate-2 mmol/L threshold. After 12 weeks of exercise training, patients improved in exercise tolerance, shown by decreased cardiocirculatory (heart rate, blood pressure) and metabolic (respiratory exchange ratio, lactate) effort at isotime; ventilatory response was not affected. Submaximal exercise capacity was improved at PWC 110, AT and the lactate-2 mmol/L threshold, respectively. Although supplemental oxygen seems to affect patients' work rate at AT and the lactate-2 mmol/L threshold, no other significant effects were found. The improved submaximal exercise capacity and tolerance might counteract patients' functional impairment. Although cardiovascular and metabolic training adaptations were shown, ventilatory efficiency remained essentially unchanged. The impact of supplemental oxygen seems less important on submaximal training effects.

Health effects of active commuting to work: The available evidence before GISMO.

Sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Global guidelines recommend for maintaining health in adults, at least 150 minutes of moderate intensity of physical activity throughout the week, but compliance is insufficient and health problems arise. One obvious way to overcome this is to integrate physical activity into the daily routine for example by active commuting to work. Scientific evidence, however, is scarce and therefore we set out to perform this systematic review of the available literature to improve understanding of the efficiency of active commuting initiatives on health. Literature searches were performed in PubMed and Cochrane database. Altogether, 37 studies were screened. Thereof, eight publications were reviewed, which included 555 participants. The mean study duration of the reviewed research was 36 ± 26 (8-72) weeks. Overall, active commuting in previously untrained subjects of both sexes significantly improved exercise capacity, maximal power, blood pressure, lipid parameters including cholesterol, high-density lipoprotein, and waist circumference. Improvement was independent of the type of active commuting. Despite relatively few studies that were previously performed, this review revealed that active commuting has health beneficial effects comparable to those of moderate exercise training.

Effects of active commuting to work for 12 months on cardiovascular risk factors and body composition.

Active commuting has the potential to decrease cardiovascular risk by increasing physical activity. We aimed to investigate the effects of active commuting to work for 12 months on body composition and cardiovascular risk factors. Therefore, 73 hospital employees (age: 46 ± 9 years, 36% males), with a predominantly passive way of commuting, were randomly assigned to an intervention group (IG) and a control group (CG) in a 2:1 fashion. The IG was further divided into a public transportation plus active commuting group (IG-PT) and a cycling group (IG-C). Both IGs were prompted to reach 150 min/wk of moderate intensity exercise. Daily self-reported commuting details were verified by GPS tracking. All subjects underwent assessment of body composition, resting blood pressure, glycemic control, and lipid profile at the beginning and end of the study. Data for final analyses were available in 62 subjects. Commuting details indicated that the subjects randomized to IG changed their commuting habits. HbA1c decreased by 0.2% [95%CI: -0.3, -0.2] in IG-PT but was not statistically different between groups (P = .06). LDL cholesterol decreased in IG-C by 0.8 mmol/L [-1.1, -0.4] and by 0.6 mmol/L [-1.2, 0.1] in IG-PT which can be considered biologically relevant but did not yield statistical significance. Body composition and blood pressure did not differ between groups. Active commuting to work for 12 months did not change body composition but yielded relevant changes in lipid profile and glycemic control. Health benefits of active commuting should be addressed by healthcare professionals when counseling individuals that seek to improve their cardiovascular risk profile.

Dose-response relationship of active commuting to work: Results of the GISMO study.

The positive health benefits of regular exercise, particularly regarding cardiovascular risk and diseases, are well recognized and scientifically evident. However, a sedentary lifestyle is one of the most important cardiovascular risk factors that are still insufficiently addressed. Leisure-time active commuting like walking and biking is an ideal way to improve exercise behavior in the general population. The purpose of this substudy of the GISMO study was to assess dose-response relations in all commuters and the three subgroups of commuters (physically active by bicycle and/or walking, physically active by using public transportation (PT), and the controls using their own vehicles). As such, a positive dose-response relationship could be confirmed in all physically active commuters compared to the control group. Whether the commuters cycled, walked, or traveled by PT -the more the physical exercise they performed (measured in metabolic equivalent [MET]-hours), the larger their gain in physical fitness (measured in gained or "Delta" Watt during a maximal exercise test), and their physical fitness at the end of the study was P = .016 and P = .003, respectively. Health-related quality of life correlated in two out of eight subdomains of the SF-36 questionnaire with MET-hours achieved during the study period (General Health and Physical Functioning). No clearly significant dose-response could be observed regarding HDL(high-density lipoprotein)-cholesterol or body composition. Our results indicate a dose-response pattern of healthy commuting in exercise capacity and health-related quality of life to increase doses of physically active commuting.

Effects of active commuting on cardiovascular risk factors: GISMO-a randomized controlled feasibility study.

A sedentary lifestyle is a major modifiable risk factor for many chronic diseases. Lifestyle modification in order to increase exercise capacity is key in the prevention and rehabilitation of chronic diseases. This could be achieved by active commute. The aim of this study was to assess the effects of daily active commuting on physical activity (PA) and exercise capacity. Seventy-three healthy hospital employees (age: 46 ± 9 years, 38% male), with a predominantly passive way of commuting, were randomly assigned to two parallel groups, a control group (CG, N = 22) or an intervention group (IG, N = 51), which was further split into public transportation/active commuting (IG-PT, N = 25) and cycling (IG-C, N = 26). Both intervention groups were asked to reach 150 min/wk of moderate- to vigorous-intensity exercise during their commute for 1 year. CG maintained a passive commuting mode. All participants underwent assessment of anthropometry, risk factor stratification, and exercise capacity by a medical doctor at the Institute of Sports Medicine, Prevention and Rehabilitation. Weekly physical activity, using the International Physical Activity Questionnaire and commuting behavior, using an online diary, were used to assess physical activity. At the end of the study, the change in exercise capacity did significantly differ between IG and CG (P = .003, ES = 0.82). Actively covered distances through commuting significantly differed between groups (walking P = .026; cycling P < .001). Therefore, active commuting improves exercise capacity and can be recommended to the working population to increase exercise capacity.

Effects of active commuting on health-related quality of life and sickness-related absence.

Increased physical activity is associated with numerous health benefits. This study investigated the effect of active commuting (walking and cycling to work) on health-related quality of life (HRQoL) and absence days from work due to sickness in healthy working adults. In total, 73 participants (age: 46 ± 9 years), all working at a tertiary university hospital in Salzburg, Austria, were randomized into an intervention group (IG, n = 51) and a control group (CG, n = 22). The IG was asked to commute actively for twelve months, whereas the CG did not have to change their usual commuting behavior. IG was divided into two subgroups: IG-C (cycling, n = 26) was asked to commute by bicycle and IG-PT (public transport, n = 25) partially using public transportation and walked the remaining distance to work. Significant positive changes in IG were observed in four subcomponents of the SF-36 (physical functioning (95 [10] to 100 [8.8], P = .023), mental health (82 [15] to 86 [15], P = .036), vitality (65 [20] to 70 [14], P = .005), and general health (70 [19] to 80 [24], P = .004)) as well as the physical component summary score (56.5 [9] to 59.2 [6.3], P = .002). IG-C showed greater and more statistically significant changes regarding HRQoL compared to IG-PT. Associations between active commuting and sick-leave days were only observed in IG-PT (7.5 [14.8] to 4.0 [11.3] days, P = .038). In conclusion, active commuting improves various components of HRQoL and might therefore be a possible strategy to increase quality of life in the workforce.

Merging self-reported with technically sensed data for tracking mobility behavior in a naturalistic intervention study. Insights from the GISMO study.

Sound exposure data are central for any intervention study. In the case of utilitarian mobility, where studies cannot be conducted in controlled environments, exposure data are commonly self-reported. For short-term intervention studies, wearable devices with location sensors are increasingly employed. We aimed to combine self-reported and technically sensed mobility data, in order to provide more accurate and reliable exposure data for GISMO, a long-term intervention study. Through spatio-temporal data matching procedures, we are able to determine the amount of mobility for all modes at the best possible accuracy level. Self-reported data deviate ±10% from the corrected reference. Derived modal split statistics prove high compliance to the respective recommendations for the control group (CG) and the two intervention groups (IG-PT, IG-C). About 73.7% of total mileage was travelled by car in CG. This share was 10.3% (IG-PT) and 9.7% (IG-C), respectively, in the intervention groups. Commuting distances were comparable in CG and IG, but annual mean travel times differ between x ¯  = 8,458 min (σ = 6,427 min) for IG-PT, x ¯  = 8,444 min (σ = 5,961 min) for IG-C, and x ¯  = 5,223 min (σ = 5,463 min) for CG. Seasonal variabilities of modal split statistics were observable. However, in IG-PT and IG-C no shift toward the car occurred during winter months. Although no perfect single-method solution for acquiring exposure data in mobility-related, naturalistic intervention studies exists, we achieved substantially improved results by combining two data sources, based on spatio-temporal matching procedures.

Impairment of left atrial mechanics does not contribute to the reduction in stroke volume after active ascent to 4559 m.

Hypoxia challenges left ventricular (LV) function due to reduced energy supply. Conflicting results exist whether high-altitude exposure impairs LV diastolic function and thus contributes to the high altitude-induced increase in systolic pulmonary artery pressure (sPAP) and reduction in stroke volume (SV). This study aimed to assess LV diastolic function, LV end-diastolic pressure (LVEDP), and LA mechanics using comprehensive echocardiographic imaging in healthy volunteers at 4559 m. Fifty subjects performed rapid (<20 hours) and active ascent from 1130 m to 4559 m (high). All participants underwent echocardiography during baseline examination at 424 m (low) as well as 7, 20 and 44 hours after arrival at high altitude. Heart rate (HR), sPAP, and comprehensive volumetric- and Doppler- as well as speckle tracking-derived LA strain parameters were obtained to assess LV diastolic function, LA mechanics, and LVEDP in a multiparametric approach. Data for final analyses were available in 46 subjects. HR (low: 64 ± 11 vs high: 79 ± 14 beats/min, P < 0.001) and sPAP (low: 24.4 ± 3.8 vs high: 38.5 ± 8.2 mm Hg, P < 0.001) increased following ascent and remained elevated at high altitude. Stroke volume (low: 64.5 ± 15.0 vs high: 58.1 ± 16.4 mL, P < 0.001) and EDV decreased following ascent and remained decreased at high altitude due to decreased LV passive filling volume, whereas LA mechanics were preserved. There was no case of LV diastolic dysfunction or increased LVEDP estimates. In summary, this study shows that rapid and active ascent of healthy individuals to 4559 m impairs passive filling and SV of the LV. These alterations were not related to changes in LV and LA mechanics.

Molecular effects of exercise training in patients with cardiovascular disease: focus on skeletal muscle, endothelium, and myocardium.

For decades, we have known that exercise training exerts beneficial effects on the human body, and clear evidence is available that a higher fitness level is associated with a lower incidence of suffering premature cardiovascular death. Despite this knowledge, it took some time to also incorporate physical exercise training into the treatment plan for patients with cardiovascular disease (CVD). In recent years, in addition to continuous exercise training, further training modalities such as high-intensity interval training and pyramid training have been introduced for coronary artery disease patients. The beneficial effect for patients with CVD is clearly documented, and during the last years, we have also started to understand the molecular mechanisms occurring in the skeletal muscle (limb muscle and diaphragm) and endothelium, two systems contributing to exercise intolerance in these patients. In the present review, we describe the effects of the different training modalities in CVD and summarize the molecular effects mainly in the skeletal muscle and cardiovascular system.

Investigating shared decision-making during the use of a digital health tool for physical activity planning in cardiac rehabilitation.

Background: Shared decision making (SDM) between healthcare professionals and persons with CVD can have a positive impact on motivation, adherence, or sustainability regarding long-term goals and integration of cardiovascular disease (CVD) rehabilitation in the everyday lives of persons with CVD. SDM can foster the transition between regular heart-healthy activity at rehabilitation facilities and more independent activity at home, but it is often challenging to implement SDM given limited time and resources, e.g., in the daily practice of rehabilitation. Digital tools can help but must be appropriately tailored for situated use and user needs. Objective: We aimed to (1) describe in how far SDM is manifested in the situated context when using a digital tool developed by our group, and, based on that, (2) reflect on how digital health tools can be designed to facilitate and improve the SDM process. Methods: In the context of a field study, we investigated how SDM is already naturally applied and manifested when using a digital tool for joint physical activity planning in cardiac rehabilitation in clinical practice. In a two-week qualitative study, we collected data on expectations, experiences and interactions during the use of a digital health tool by seven persons with CVD and five healthcare professionals. Data was collected by means of observations, interviews, questionnaires and a self-reported diary, and analysed with a particular focus on episodes related to SDM. Results: We found that SDM was manifested in the situated context to limited extent. For example, we identified high improvement potential for more structured goal-setting and more explicit consideration of preferences and routines. Based on mapping our findings to temporal phases where SDM can be adopted, we highlight implications for design to further support SDM in clinical practice. We consider this as "SDM supportive design in digital health apps," suggesting for example step-by-step guidance to be used during the actual consultation. Conclusion: This study contributes to further understanding and integration of SDM in digital health tools with a focus on rehabilitation, to empower and support both persons with CVD and healthcare professionals.

The effect of exercise training on endothelial function in postmenopausal women with breast cancer under aromatase inhibitor therapy.

BACKGROUND: Breast cancer is the leading non-cardiovascular cause of death in women. In endocrine receptor positive women, aromatase inhibitors (AI) are the therapy of choice despite the fact that a decrease in systemic estrogen levels may result in endothelial dysfunction and eventually in cardiovascular disease. In this study, we assessed whether exercise training (ET), which has repeatedly shown to lead to an improvement of endothelial dysfunction, will also exert this effect in postmenopausal women with AI treated breast cancer. METHODS: Thirty two postmenopausal women with AI treated breast cancer were randomized to an intervention group (ET; 6 months, supervised training plus 6 months without intervention) or control group of usual care (UC; 12 months without intervention plus initial exercise counseling). Endothelial function was assessed via Reactive Hyperemia Index (RHI) measured non-invasively with the EndoPAT-System at baseline, 6 and 12 months. RESULTS: After 6 months of supervised ET, changes in maximal exercise capacity were significantly greater in ET than in UC (∆W: 24.1 ± 11.5 vs. 1.1 ± 8.2 watts; p < 0.001). Even though 43.8% of all participants had endothelial dysfunction at baseline, there were no significant group differences in the changes of RHI between ET (∆RHI: -0.1 ± 1.04) and UC (0.02 ± 0.75; p = 0.323) after 6 months. CONCLUSION: Even though ET led to significantly greater improvement in exercise capacity in postmenopausal women with AI treated breast cancer than exercise counseling only, it did not exert any measurable effects on endothelial dysfunction.

Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study.

OBJECTIVE: To assess the impact of the closure of group-based cardiac rehabilitation (CR) training during the first COVID-19 lockdown in spring 2020 on patients' physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown. DESIGN: Mixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown. SETTING: Outpatient CR centre in Salzburg, Austria. PARTICIPANTS: Twenty-seven patients [six female, mean (SD) age 69 (7.4) years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020. OUTCOME MEASURES: Quantitative: exercise capacity (maximal ergometer test, submaximal ergometer training), cardiovascular risk (Framingham risk score, blood pressure, body mass index, lipids). Qualitative: individual semi-structured interviews. RESULTS: Exercise capacity had significantly reduced from pre- to post-lockdown: mean (SD) power (W) in maximal ergometry 165 (70) vs. 151 (70), p < 0.001; submaximal ergometer training 99 (40) vs. 97 (40), p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 (63%) said they had been unable to maintain their exercise levels, and 15 (56%) felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity. CONCLUSION: This study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward.

Valorization of Natural Cardio Trekking Trails Through Open Innovation for the Promotion of Sustainable Cross-generational Health-Oriented Tourism in the Connect2Move Project: Protocol for a Cross-sectional Study.

BACKGROUND: Hiking is one of the most popular forms of exercise in the alpine region. However, besides its health benefits, hiking is the alpine activity with the highest incidence of cardiac events. Most incidents occur due to overexertion or underestimation of the physiological strain of hiking. OBJECTIVE: This project will establish a standardized cardio trekking test trail to evaluate the exercise capacity of tourists within hiking areas and deliver a tool for the prevention of hiking-associated cardiac incidents. Further, individual exercise intensity for a hiking tour will be predicted and visualized in digital maps. METHODS: This cooperation study between Austria and Germany will first validate a 1-km outdoor cardio trekking test trail at 2 different study sites. Then, exercise intensity measures on 8-km hiking trails will be evaluated during hiking to estimate overall hiking intensity. A total of 144 healthy adults (aged >45 years) will perform a treadmill test in the laboratory and a 1-km hiking test outdoors. They will wear a portable spirometry device that measures gas exchange, as well as heart rate, walking speed, ventilation, GPS location, and altitude throughout the tests. Estimation models for exercise capacity based on measured parameters will be calculated. RESULTS: The project "Connect2Move" was funded in December 2019 by the European Regional Development Fund (INTERREG V-A Programme Austria-Bavaria - 2014-2020; Project Number AB296). "Connect2Move" started in January 2020 and runs until the end of June 2022. By the end of April 2022, 162 participants were tested in the laboratory, and of these, 144 were tested outdoors. The data analysis will be completed by the end of June 2022, and results are expected to be published by the end of 2022. CONCLUSIONS: Individual prediction of exercise capacity in healthy individuals with interest in hiking aims at the prevention of hiking-associated cardiovascular events caused by overexertion. Integration of a mathematical equation into existing hiking apps will allow individual hiking route recommendations derived from individual performance on a standardized cardio trekking test trail. TRIAL REGISTRATION: ClinicalTrails.gov NCT05226806; https://clinicaltrials.gov/ct2/show/NCT05226806. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39038.

Preserved right ventricular function but increased right atrial contractile demand in altitude-induced pulmonary hypertension.

PURPOSE: Ascent to high altitude increases right ventricular (RV) afterload and decreases myocardial energy supply. This study evaluates physiologic variables and comprehensive echocardiographic indices of RV and right atrial (RA) function following rapid ascent to high altitude. METHODS: Fifty healthy volunteers actively ascended from 1130 to 4559 m in < 22 h. All participants underwent 2D echocardiography during baseline examination at low altitude (424 m) and at three study time-points (7, 20 and 44 h) after arrival at high altitude. In addition to systolic pulmonary artery pressure (sPAP), comprehensive 2D planimetric-, tissue Doppler- and speckle-tracking-derived strain indices of RA and RV function were obtained. RESULTS: sPAP increased from baseline (24 ± 4 mmHg) to the first altitude examination (39 ± 8 mmHg, p < 0.001) and remained elevated during the following 44 h. Global RV function did not change. RA reservoir strain showed a trend towards increase from baseline (50.2 ± 12.1%) to the first altitude examination (53.8 ± 11.0%, p = 0.07) secondary to a significant increase of RA contraction strain (19.2 ± 6.4 vs. 25.4 ± 9.6%, p < 0.001). Volumetric RA data largely paralleled RA strain results and RA active emptying volume was increased throughout the 44 h stay at high altitude. CONCLUSION: Active and rapid ascent of healthy individuals to 4559 m is associated with an increased contractile performance of the RA that compensates for the increased workload of the RV.

Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: A nationwide registry.

AIM: Cardiac rehabilitation (CR) is a key component of the treatment of cardiac diseases. The Austrian outpatient CR model is unique, as it provides patients with an extended professionally supervised, multidisciplinary program of 4-6 weeks of phase II (OUT-II) and 6-12 months of phase III (OUT-III) CR. The aim of this analysis was to assess the efficacy of the Austrian outpatient CR model using a nationwide registry. METHODS: Data of all consecutive patients (N = 7560) who completed OUT-II and/or OUT-III between 1 January 2005 and 31 December 2015 were entered prospectively into a registry. OUT-III patients were analyzed separately according to whether the preceding phase II was performed as outpatient (OUT-II/OUT-III, N = 2403) or in-patient (IN-II/OUT-III, N = 2789). All patients underwent assessment of anthropometry, resting blood pressure, lipid profile, fasting blood glucose, exercise capacity, quality of life, anxiety and depression. RESULTS: During OUT-II, patients significantly improved their metabolic risk factor profile and increased exercise capacity by 14.3%. OUT-II/OUT-III patients achieved an additional increase in exercise capacity by 10%, further improvement in high-density lipoprotein (HDL) and stabilization of the remaining risk factors. IN-II/OUT-III patients increased their maximal exercise capacity by 18.4% and there was improvement in blood pressure, HDL, low-density lipoprotein and glucose levels. CONCLUSION: Extended, professionally supervised, multidisciplinary outpatient CR in a large nationwide registry of consecutive patients consistently improved maximal exercise capacity and relevant modifiable cardiovascular risk factors beyond effects seen after IN- or OUT-II alone.

Endurance Athletes Are at Increased Risk for Early Acute Mountain Sickness at 3450 m.

INTRODUCTION: Acute mountain sickness (AMS) may develop in nonacclimatized individuals after exposure to altitudes ≥2500 m. Anecdotal reports suggest that endurance-trained (ET) athletes with a high maximal oxygen uptake (V˙O2max) may be at increased risk for AMS. Possible underlying mechanisms include a training-induced increase in resting parasympathetic activity, higher resting metabolic rate (RMR), and lower hypoxic ventilatory response (HVR). METHODS: In 38 healthy, nonacclimatized men (19 ET and 19 untrained controls [UT], V˙O2max 66 ± 6 mL·min·kg vs 45 ± 7 mL·min·kg; P < 0.001) peripheral oxygen saturation (SpO2), heart rate variability, RMR, and poikilocapnic HVR were assessed at 424 m and during 48 h at 3450 m after passive ascent by train (~2 h). Acute mountain sickness was evaluated by AMS cerebral (AMS-C) score. RESULTS: On day 1 at altitude, ET presented with a higher AMS incidence (42% vs 11%; P < 0.05) and severity (AMS-C score: ET, 0.48 ± 0.5 vs UT, 0.21 ± 0.2; P = 0.03), but no group difference was found on days 2 and 3. SpO2 decreased upon arrival at altitude (ET: 82% ± 6% vs UT: 83% ± 4%; ptime <0.001) with a significantly different time course between ET and UT (ptime × group = 0.045). Parasympathetic activity decreased at altitude (P < 0.001) but was always higher in ET (P < 0.05). At altitude RMR increased (P < 0.001) and was higher in ET (P < 0.001). Hypoxic ventilatory response increased only in ET (P < 0.05) and was greater than in UT after 24 and 48 h (P < 0.05). CONCLUSIONS: Endurance-trained athletes are at higher risk for developing AMS on the first day after passive and rapid ascent to 3450 m, possibly due to an increased parasympathetic activity and an increased RMR, while HVR appeared to be of minor importance. Differences in AMS time course and physiological responses should be taken into consideration when ET are planning high-altitude sojourns.

Supervised versus autonomous exercise training in breast cancer patients: A multicenter randomized clinical trial.

BACKGROUND: There is a well-known correlation between obesity, sedentary lifestyle, and breast cancer incidence and outcome. The Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT) exercise study was a multicenter, randomized clinical trial and assessed the feasibility and efficacy of physical training in 50 breast cancer patients undergoing aromatase inhibitor treatment. METHODS: Postmenopausal, estrogen receptor-positive breast cancer patients under aromatase inhibitor treatment were randomized 1:1 to counseling and unsupervised training for 48 weeks (unsupervised arm) or counseling and a sequential training (supervised arm) with a supervised phase (24 weeks) followed by unsupervised physical training (further 24 weeks). Primary endpoint was the individual maximum power output on a cycle ergometer after 24 weeks of exercise. A key secondary endpoint was the feasibility of achieving 12 METh/week (metabolic equivalent of task hours per week). RESULTS: Twenty-three patients (92%) in the unsupervised arm and 19 patients (76%) in the supervised arm with early-stage breast cancer completed the study. After 24 weeks, the supervised arm achieved a significantly higher maximum output in watt (mean 132 ±  standard deviation [SD] 34; 95% confidence interval [CI] 117-147) compared to baseline (107 ± 25; 95%CI 97-117; P = 0.012) with a numerically higher output than the unsupervised arm (week 24 115 ± 25; 95%CI 105-125; P = 0.059). Significantly higher METh/week was reported in the supervised arm compared to the unsupervised arm during the whole study period (week 1-24 unsupervised: 18.3 (7.6-58.3); supervised: 28.5 (6.7-40.1); P = 0.043; week 25-48; P = 0.041)). CONCLUSION: This trial indicates that patients in an exercise program achieve higher fitness levels during supervised than unsupervised training.

Reliability of echocardiographic speckle-tracking derived bi-atrial strain assessment under different hemodynamic conditions.

The aim of this study was to assess intra- and inter-observer variability of left (LA) and right atrial (RA) strain indices obtained by two-dimensional speckle-tracking echocardiography (2D-STE) in a healthy group of individuals at low-altitude and after rapid ascent to high-altitude in order to provoke altered systemic and pulmonary hemodynamics otherwise seen in various cardiac diseases. Twenty healthy subjects underwent transthoracic echocardiography during a baseline examination at low-altitude (424 m) as well as 7, 20 and 44 h after arrival at high-altitude (4559 m). Atrial strain indices (i.e. reservoir, conduit and contractile strain) were determined off-line by two independent observers. Intra- and inter-observer reproducibility of variables was assessed by intra-class correlation coefficients (ICCs), coefficients of variation and Bland Altman plots. Heart rate, systemic blood pressure and pulmonary artery pressure increased significantly from low-altitude to the first examination at high-altitude. Intra-observer ICCs were ≥0.90 except for RA conduit strain with an ICC of 0.86. The mean intra-observer differences were small and limits of agreement of relative differences were narrow for all atrial strain parameters (<3 and <16%, respectively). Inter-observer ICCs (0.80-0.90), mean biases and limits of agreement (<4 and <20%, respectively) were greater than intra-observer results for all parameters. Intra- and inter-obserer ICCs for all atrial strain variables did not differ between low- and high-altitude. 2D-STE-derived bi-atrial strain indices have excellent intra- and moderate inter-observer reproducibility with no effect of high-altitude-induced hemodynamic changes on reliability results.