Prevalence of atrial fibrillation in adults participating in a large-scale voluntary screening programme in Belgium.

OBJECTIVE: Atrial fibrillation (AF) is a common arrhythmia in clinical practice. AF fulfils many of the criteria for a screening programme. No data about the prevalence of AF in non-hospitalized patients are available in Belgium. The aim of the study was to assess feasibility and effectiveness of a nationwide-organized voluntary screening programme in the general population in Belgium. METHODS: A total of 13.564 participants were screened, of whom 10,758 were older than 40 years (GSP group). Participants filled in stroke risk stratification questionnaires (CHADS2 and CHA2DS2-VASc). A one-lead electrocardiogram was performed. RESULTS: 228 participants had AF at the time of screening (AF group), with 125 women and 103 men (i.e., 1.9% and 2.6% of total women and men), representing a prevalence of 2.2% (95% CI 1.3% and 3.0%) of the screened population. Age of the AF group was 67 +/- 12 y (range 40-87 y). Using the CHADS2-score, 58% of participants with a positive AF screening had a high risk score, and 21% had an intermediate risk score. Using the CHA2DS2-VASc-score, 72% of the participants had a high risk score, and 21% had an intermediate risk score. CONCLUSION: AF was present in 2.2% of the respondents. At least 60% of AF group had an increased risk for thrombo-embolism. Although substantial methodological issues limit the exact interpretation of these results, the present study shows that a volunatry screening programme with a simple screening protocol is able to detect an important number of patients with previously undetected AF.

Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes. DESIGN: A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training. SETTING: University Hospital Ghent (Belgium). SUBJECTS: Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8). INTERVENTIONS: Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities. MAIN MEASURES: Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak Vo(2), peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed. RESULTS: At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve. CONCLUSION: Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being.

The effect of combined exercise training in adolescents who are overweight or obese with intellectual disability: the role of training frequency.

Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

Intratest reliability and test-retest reproducibility of the oxygen uptake efficiency slope in healthy participants.

BACKGROUND: The oxygen uptake efficiency slope (OUES) is a newer ventilatory exercise parameter, used in the evaluation of healthy participants and patients with cardiovascular disease. However, few data about the reliability and reproducibility of OUES are available. Our study assessed intratest reliability and test-retest reproducibility of OUES in healthy participants. DESIGN AND METHODS: Eighteen participants (age 28+/-6 years, BMI 22.1+/-1.9 kg/m, 10 men) performed two identical maximal exercise tests on a bicycle ergometer. To assess test-retest reproducibility, we performed Bland-Altman analysis and calculated the coefficient of repeatability of the main ventilatory variables. RESULTS: OUES remained stable during the second part of the exercise test. Mean values varied 2.4+/-4.0% between OUES calculated at 70% (OUES70) and at 100% of exercise duration. Mean variation decreased to 1.4+/-2.3% when OUES was calculated at 90% of exercise duration (OUES90). The Bland-Altman 95% limits of agreement for OUES90 were +3 and -6%, those for OUES70 were +11 and -8%. The coefficient of repeatability for OUES was 597 ml/min or 18.7% of the average value of repeated OUES measurements. These results were similar to those of peak oxygen uptake and minute ventilation/carbon dioxide output. However, the test-retest reproducibility for submaximal-derived values of OUES was lower, as we noted higher coefficients of repeatability for OUES90 and OUES70, increasing up to 27% of the average of repeated values. CONCLUSION: OUES shows excellent intratest reliability and has a test-retest reproducibility that is similar to that of peak oxygen uptake and minute ventilation/carbon dioxide output slope. However, its reproducibility becomes higher when it is calculated from increasing levels of achieved exercise intensity.

The influence of combined exercise training on indices of obesity, physical fitness and lipid profile in overweight and obese adolescents with mental retardation.

INTRODUCTION: This study investigated the effect of combined exercise training on indices of body composition, physical fitness and lipid profile in adolescents with mental retardation. MATERIALS AND METHODS: Thirty adolescents with mental retardation (total IQ, 45-70) received exercise training (n = 15) or no training (n = 15). Groups were matched for age, sex and mental retardation. Before and after the intervention period, indices of body composition, physical fitness and lipid profile were measured. RESULTS: In comparison with the control group, weight, body mass index, waist and fat mass decreased significantly, while relative fat-free mass increased. The level of triglycerides, total cholesterol and low-density lipoprotein decreased significantly, while high-density lipoprotein increased. Muscle strength, muscle fatigue resistance and sit-to-stand were ameliorated. PeakVO2/peak power decreased significantly. The distance covered in the 6-min walk test (6MWT) increased with 50 m. CONCLUSION: In conclusion, combined exercise training has a positive effect on indices of obesity, physical fitness and lipid profile in adolescents with mental retardation.

Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure.

BACKGROUND: The oxygen uptake efficiency slope (OUES) is a new exercise parameter that provides prognostic power in patients with CHF. Little is known about the effects of exercise training (ET) on OUES. AIM: To describe the response of OUES to 6 months of ET in CHF patients and compare its evolution to that of other exercise variables. METHODS: 35 patients with CHF (NYHA II-III, age 54+/-9y, LVEF 31+/-10%) performed 3 maximal exercise tests, i.e. at the start, middle and end of a 6 month ET program. OUES, PeakVO(2), ventilatory anaerobic threshold (VAT) and slope VE/VCO(2) were determined. RESULTS: OUES, peakVO(2), VAT, slope VE/VCO(2), peak Watt, 6MWT and NYHA-class improved during the first part of the ET period (p<0.05). Only VAT, peak Watt and 6MWT continued to improve during the second part of the ET period (p<0.05) Improvements in OUES correlated better with improvements in peakVO(2) (r=0.77, p<0.001), than changes in other prognostic variables. DISCUSSION: OUES improves significantly after 6 months of ET. Changes in peakVO(2) correlate best with changes in OUES. OUES is sensitive to ET and can be used to evaluate the progression of exercise capacity in CHF patients.

Prospective evaluation of the oxygen uptake efficiency slope as a submaximal predictor of peak oxygen uptake in aged patients with ischemic heart disease.

BACKGROUND: The purpose of this study was to evaluate the oxygen uptake efficiency slope (OUES) as a predictor of peak oxygen consumption (VO2) in aged patients with coronary artery disease (CAD) and to compare its predictive value to that of ventilatory anaerobic threshold (VAT). METHODS: A total of 160 aged (>60 years) patients with stable CAD performed a maximal cardiopulmonary exercise test. The equations were computed by using data of 85 randomly selected patients and were validated in the remaining 75 patients. Bland-Altman (BA) analysis was used to assess the agreement between measured and predicted peak VO2. RESULTS: In the first 85 patients, peak VO2 correlated best with VAT and OUES per kilogram (P < .001). The linear regression to predict peak VO2 for OUES per kilogram was peak VO2 = 4.591 + 0.64 x OUES/kg (SEE = 2.61 mL kg(-1) min(-1)). The BA 95% limits of agreement were -29% and +30% of the predicted value. For VAT, the linear regression to predict peak VO2 was peak VO2 = 2.995 + 1.251 x VAT (SEE = 2.26 mL kg(-1) min(-1)). The BA 95% limits of agreement were -23% and +33% of the predicted value. Cross-tabulation analysis in 3 subgroups with different exercise capacities showed significant relationship between predicted and measured peak VO2 (all P < .001). OUES per kilogram showed the best measure of agreement with measured peak VO2, resulting in high sensitivity and specificity scores. CONCLUSION: OUES is not able to acceptably predict peak VO2 in aged patients with CAD but is at least as performant as VAT in categorizing patients into subgroups with different exercise capacities. Therefore, the objectively measurable OUES is the preferred submaximal predictor of functional capacity in the assessment of aged patients with CAD.

Oxygen uptake efficiency slope, a new submaximal parameter in evaluating exercise capacity in chronic heart failure patients.

BACKGROUND: The oxygen uptake efficiency slope (OUES) is a new submaximal parameter which objectively predicts the maximal exercise capacity in children and healthy subjects. However, the usefulness of OUES in adult patients with and without advanced heart failure remains undetermined. The present study investigates the stability and the usefulness of OUES in adult cardiac patients with and without heart failure. METHODS: Forty-five patients with advanced heart failure (group A) and 35 patients with ischemic heart disease but normal left ventricular ejection fraction (group B) performed a maximal exercise test. PeakVO2 and percentage of predicted peakVO2 were markers of maximal exercise capacity, whereas OUES, ventilatory anaerobic threshold (VAT), and slope VE/VCO2 were calculated as parameters of submaximal exercise. RESULTS: Group A patients had lower peakVO2 (P < .001), lower percentage of predicted peakVO2 (P = .001), lower VAT (P < .05), steeper slope VE/VCO2 (P < .001), and lower OUES (P < .02). Within group A, significant differences were found for VAT, slope VE/VCO2, and OUES (all P < .01) between patients with peakVO2 above and below 14 mL O2/kg/min. Of all the submaximal parameters, VAT correlated best with peakVO2 (r =.814, P < .01) followed by OUES/kg (r = .781, P < .01), and slope VE/VCO2 (r = -.492, P < .001). However, VAT could not be determined in 18 (23%) patients. CONCLUSIONS: OUES remains stable over the entire exercise duration and is significantly correlated with peakVO2 in adult cardiac patients with and without impaired LVEF. Therefore, OUES could be helpful to assess exercise performance in advanced heart failure patients unable to perform a maximal exercise test. Further studies are needed to confirm our hypothesis.

Physical fitness in morbidly obese patients: effect of gastric bypass surgery and exercise training.

BACKGROUND: There is a growing consensus that bariatric surgery is currently the most efficacious and long-term treatment for clinically severe obesity. However, it remains to be determined whether poor physical fitness, an important characteristic of these patients, improves as well. The purpose of this pilot study is to investigate the effect of gastric bypass surgery on physical fitness and to determine if an exercise program in the first 4 months is beneficial. METHODS: Fifteen morbidly obese patients (BMI 43.0 kg/m(2)) were tested before and 4 months after gastric bypass surgery. Eight of them followed a combined endurance and strength training program. Before and after 4 months the operation, anthropometrical characteristics were measured, and an extensive assessment of physical fitness (strength, aerobic, and functional capacity) was performed. RESULTS: Large-scale weight loss through gastric bypass surgery results in a decrease in dynamic and static muscle strength and no improvement of aerobic capacity. In contrast, an intensive exercise program could prevent the decrease and even induced an increase in strength of most muscle groups. Together with an improvement in aerobic capacity, functional capacity increased significantly. Both groups evolved equally with regard to body composition (decrease in fat mass and fat-free mass). CONCLUSIONS: An exercise training program in the first 4 months after bariatric surgery is effective and should be promoted, considering the fact that physical fitness does not improve by weight loss only.

Chronic kidney disease is associated with decreased exercise capacity and impaired ventilatory efficiency in heart transplantation patients.

PURPOSE: Chronic kidney disease (CKD) is common after heart transplantation (HTx). This study assessed the influence of CKD on exercise capacity and ventilatory efficiency after HTx. METHODS: This cross-sectional study included 79 HTx patients (age 64 +/- 10 years, 66 men) at 8.1 +/- 4.3 years post-HTx who underwent maximal exercise testing, cardiac function assessment, and blood analysis. According to estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)), patients were categorized as having severe (Group 1, GFR < or = 30; n = 15), moderate (Group 2, GFR 30-60; n = 40), and mild (Group 3, GFR > 60; n = 24) renal impairment. RESULTS: Patients in Group 1 were older, had lower peakVO(2) and impaired ventilatory efficiency compared with Groups 2 and 3 (all p < 0.05) Peak Watts, peak ventilation, and peak heart rate were lower in Group 1 compared with Group 3 (all p < 0.05). Exercise-derived variables did not differ significantly between Groups 2 and 3. GFR correlated with peakVO(2)/kg (r = 0.47; p < 0.01) and peak Watts (r = 0.34, p < 0.01). GFR (adjusted r(2) = 0.34), mean arterial pulmonary pressure, and age were the strongest independent predictors of peakVO(2). The proposed model explained 48% of variability in peakVO(2). By receiver operator characteristic analysis, eGFR was superior in distinguishing patients with impaired from those with preserved exercise capacity (peakVO(2) < 18 vs > 18 ml/kg/min). CONCLUSION: Chronic KD after HTx is associated with impaired maximal exercise capacity and decreased ventilatory efficiency. GFR is a strong independent non-exercise-derived predictor of peak VO(2) in these patients.

Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients.

OBJECTIVE: To investigate the influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. DESIGN: A double-blind randomized controlled trial with patients receiving either combination (COM), endurance (END) or no training (C). SETTING: Sint-Jozef hospital (Belgium), general practice (Holland). SUBJECTS: Forty-six type 2 diabetes patients (17 female, 29 male). INTERVENTIONS: COM versus END and C. Patients exercised for three months, three times a week for 1 hour. MAIN MEASURES: Six-minute walk test (6MW T), peak Vo(2), strength in upper and lower limbs, sit-to-stand, height, weight, body mass index, fat mass, glycosylated haemoglobin (HbA1c), glycaemia, triglycerides, high-density lipoprotein (HDL), total cholesterol and quality of life (General Health Survey Short Form (SF-36)). RESULTS: COM had significant better results on sit-to-stand (P<0.05), 6MW T (P<0.01), strength in upper (P<0.001) and lower limbs (P<0.001) compared with C. A different evolution among COM and C was found for HbA1c (P<0.05) and cholesterol (P<0.01), both decreased in COM and increased in C. HDL increased in COM and decreased in C (P<0.01). END had significant higher results on the 6MW T (P<0.01) compared with C. Compared with END, COM had significantly higher results on strength in upper (P<0.01) and lower limbs (P<0.01). The evolution of SF-36 items was not significantly different between the three groups. CONCLUSION: In diabetes type 2 patients, COM had significant better effects on indices of physical condition, diabetes and cardiovascular risk compared with C. Compared with END, COM gave a tendency towards better results, however more research with a larger number of participants is needed.

Response of the oxygen uptake efficiency slope to orthotopic heart transplantation: lack of correlation with changes in central hemodynamic parameters and resting lung function.

BACKGROUND: Recently, a new linear measure of ventilatory response to exercise, the oxygen uptake efficiency slope (OUES), was proposed in the evaluation of heart failure patients. No data are available on the response of the OUES after orthotopic heart transplantation (HTx). METHODS: Thirty patients who underwent HTx between 1999 and 2003 were included in the study. Data from maximal cardiopulmonary exercise test, resting pulmonary function and hemodynamic assessment were collected before the transplant at time of screening and 1 year after HTx. RESULTS: During the first year after HTx, OUES and normalized OUES for body weight (OUES/kg) increased significantly from 15.6 +/- 4.9 to 19.7 +/- 4.8 (p < 0.05). Changes in OUES/kg were significantly correlated with changes in peak VO2, VAT and peak VE, and inversely to changes in peak VD/VT, but not to changes in VE/VCO2 slope (all p < 0.05). Changes in OUES or OUES/kg did not correlate with any changes in measures of resting lung volumes or capacities and measures of central hemodynamic function after HTx. CONCLUSIONS: OUES improved significantly after HTx, but, similar to other exercise parameters, remained considerably impaired. The changes in OUES were highly correlated with the improvements in other exercise variables, but did not correlate with marked improvements in central hemodynamics or resting lung function.

Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance.

AIMS: Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. METHODS AND RESULTS: Twenty-eight patients with CHF (LV ejection fraction 25 +/- 7%), broad QRS complex (171 +/- 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 +/- 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 +/- 21 to 19 +/- 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 +/- 0.12 to 0.20 +/- 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 +/- 0.12 to 0.31 +/- 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 +/- 1.2 to 2.0 +/- 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 +/- 0.3 to 1.8 +/- 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 +/- 0.06 cm(2), P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 +/- 7 to 35 +/- 9%, P < 0.001), peak oxygen uptake (from 11.7 +/- 2.4 to 13.7 +/- 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 +/- 1681 to 1963 +/- 1361 pg/mL, P = 0.067). CONCLUSION: CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.

VE/VCO2 slope and oxygen uptake efficiency slope in patients with coronary artery disease and intermediate peakVO2.

BACKGROUND: Peak exercise oxygen uptake (peakVO2) is a widely used prognosticator. Novel spirometric parameters, less affected by submaximal performance, such as the rate of increase of minute ventilation per unit decrease of carbon dioxide production (VE/VCO2 slope) and the oxygen uptake efficiency slope (OUES) have recently been introduced. AIM: To evaluate the discriminative value of OUES, as compared to VE/VCO2 slope in patients with coronary artery disease (CAD) and intermediate peakVO2 values. METHODS AND RESULTS: Bicycle spiroergometry was applied in 214 patients with CAD (age 67+/-8 years, 85% men). OUES was strongly related to peakVO2 (r=0.79). New York Heart Association (NYHA) class, 6-min walking distance, N-terminal pro-brain natriuretic peptide (NT-proBNP), inflammatory markers, left ventricular (LV) volumes and ejection fraction were evaluated. NT-proBNP levels predicted independently VE/VCO2-slope and OUES. Patients with intermediate peakVO2 (12-18 ml/kg per min) and increased VE/VCO2-slope (> or = 35) had higher NYHA class, lower walking distance, higher NT-proBNP levels and higher LV volumes as compared to patients with a similar peakVO2 but lower VE/VCO2-slope. Similar findings were found for patients with intermediate peakVO2 and high OUES/kg (median value>15.3). CONCLUSION: In CAD patients, OUES was strongly correlated with peakVO2. Both VE/VCO2 slope and OUES were independently associated with NT-proBNP levels. Both VE/VCO2 slope and OUES/kg were able to identify a subgroup of patients with an intermediate peakVO2 that was characterized by advanced remodelling and a higher degree of neurohumoral activation.