Safety and outcomes of a structured exercise programme in young patients with hypertrophic cardiomyopathy: the SAFE-HCM trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Basu ◽  
P Poveda Velazquez ◽  
G Parry-Williams ◽  
C Miles ◽  
F Tilby-Jones ◽  
...  

Abstract Background Contemporary studies in hypertrophic cardiomyopathy (HCM) suggest that moderate intensity exercise can improve cardiorespiratory fitness without raising significant safety concerns. Although low/moderate intensity exercise may be appropriate for older HCM patients, it is unlikely to attract younger, often asymptomatic patients, who wish to engage in higher intensity regimes. Purpose To assess the feasibility, safety and outcomes of an individually tailored, high intensity exercise programme in young patients with HCM. Methods In this RCT, 80 patients with HCM, aged 16–60 (mean 45.7, [SD8.6]) underwent baseline testing with ECG, echocardiography, blood testing, exercise testing, 48-hour ECG and psychological assessment. Individuals were randomised to a 12-week supervised exercise programme (HRR increased from 70–85%) (n=40) or usual activity (n=40). Baseline investigations were repeated at 12 weeks. Feasibility was assessed by a) recruitment, adherence and retention rates; b) staffing ratios and logistics; c) acceptability of the intervention/educational materials. Safety was assessed as a composite of 1) cardiovascular death, 2) cardiac arrest, 3) device therapy, 4) exercise induced syncope, 5) sustained/non-sustained (NS) ventricular tachycardia (VT) or 6) sustained atrial arrhythmias. Secondary outcomes included health and psychological benefits. Results 67 individuals (82.5%) completed the study. Reasons for refusal included travel, work and family commitments. The majority (64.7%) of exercising individuals progressed to 85%HRR. Resource requirements were similar to other programmes. All individuals felt supported, more confident to exercise, and found educational materials clear and informative. There was no significant difference between groups for the composite safety outcome. One individual experienced exercise induced syncope due to ventricular standstill (exercise) and another sustained VT (control). Both required device implantation. There was no significant difference between groups in episodes of NSVT (p=0.573) or ectopic burden (p=0.729). At 12 weeks, exercise group participants demonstrated greater activity levels (+1.1 hours [CI 0.2–2.1], p=0.024). The change in peak aerobic capacity (+255.2ml/min [CI 93.2–417.1], p=0.003), time to anaerobic threshold (AT) (+115s [CI 54.2–176.0], p<0.001), total exercise time (+108.1s [CI 33.1–183.0], p=0.005) and oxygen uptake at AT (+2.44ml/kg/min [CI 0.6–4.2], p=0.009) were all significantly greater in the exercise group. HADS anxiety (p<0.001) and depression (p=0.017) scores demonstrated the greatest reduction in the exercise group. Conclusions A high intensity exercise programme is feasible in young patients with HCM, with considerable gains in cardiorespiratory fitness and psychological outcomes. Importantly, arrhythmia burden was not increased in the exercise group. Further research is still required to assess the long-term safety of high intensity exercise in the HCM population. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Cardiac Risk in the Young

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
J Basu ◽  
S Jayakumar ◽  
C Miles ◽  
G Parry-Williams ◽  
H Maclachlan ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young Background Moderate intensity exercise training in older patients with hypertrophic cardiomyopathy (HCM) can improve functional capacity, without significant harm. However, younger patients are attracted to high intensity training (HIT) regimes. The SAFE-HCM study demonstrated that an individually tailored, HIT programme in young patients with HCM was feasible, and provided both health and psychological benefits, without an increase in the burden of arrhythmia. Purpose To assess whether observed benefits of a HIT programme in young patients with HCM are sustained at 6 months. Methods Eighty patients with HCM (45.7y+/-8.6) underwent baseline clinical and psychological assessment. Individuals were randomised to a 12-week HIT programme (n = 40) or usual care (n = 40). Baseline evaluation was repeated at 12 weeks (T12). Feasibility, safety, health and psychological benefits were assessed. At 12-weeks individuals were encouraged to continue with the frequency and intensity of physical activity (PA) achieved at the end of the cardiac rehabilitation programme. Participants in the exercise arm were invited to follow-up at 6 months (T6m). Results The majority (83%) of participants completed the 12-week study. At T12 there was no significant difference between groups in the composite arrhythmia safety outcome (p = 0.99). The indices of exercise capacity were significantly improved in the exercise compared to the control group; peak VO2 (+3.7ml/kg/min [CI 1.1,6.3], p = 0.006), VO2/kg at anaerobic threshold (VO2/kgAT) (+2.44ml/kg/min [CI 0.6,4.2], p = 0.009), time to AT (+115s [CI 54.3,175.9], p < 0.001) and exercise time (max ET) (+108s [CI 33.7,182.2], p = 0.005). The exercise group also demonstrated greater reduction in systolic BP (-7.3mmHg [CI -11.7,-2.8], p = 0.002), BMI (-0.8kg/m2 [CI-1.1,-0.4], p < 0.001), anxiety (-2.6 [CI-3.6,-1.6], p= <0.001) and depression (-1.1 [CI -2.0,-0.2], p = 0.015) scores. At T6m patient reported exercise adherence was comparable to baseline PA in 33/34 of the exercise group attending for follow up. Most exercise gains dissipated with the exception of time to AT (p = 0.002), max ET (p = 0.003), VO2/kgAT (p = 0.04) and anxiety score (p < 0.001) (Figure 1). There were no sustained episodes of atrial or ventricular arrhythmias. The incidence of NSVT did not differ between time points (p = 0.09). Conclusion A 12-week HIT programme in young patients with HCM offers considerable gains in fitness and psychological outcomes, with no increase in arrhythmic burden. At T6m exercise levels as well as most physiological adaptations and health benefits returned to baseline, as seen in other studies when formal participation in an exercise programme comes to an end. This highlights the importance of the implementation of strategies to encourage ongoing engagement in PA. Potential solutions include identification of barriers to exercise, as well as adoption of novel tele-rehabilation approaches. Abstract Figure 1 Sustained benefits at T6m


Author(s):  
Ki Jun Park ◽  
Junechul Kim

Abstract Objectives This study aimed to investigate the effects of probiotics on inflammatory cytokines, neurotransmitters, and motor functions during different levels of exercise. Methods Female adolescent mice (n=140) were divided into two groups, of which one group was fed probiotics and the other group was not. For both groups, three levels of exercise were conducted: non-exercise, moderate-intensity exercise, and high-intensity exercise. Probiotics acquisition and aerobic treadmill exercise were the main variables during the growth period. We evaluated motor function with a rotarod test and analyzed cytokines and neurotransmitters in the cerebellum. Results In acceleration mode, the moderate and high-intensity exercise groups showed longer running times than the non-exercise groups (P<0.001). Also, the probiotic-ingestion group had longer latency before falling than those who did not take probiotics in both the high-intensity and the non-exercise groups (P=0.002, P=0.002, respectively). In steady-state mode, the non-exercise group showed lower records compared with the moderate and high-intensity exercise groups (P=0.017, P=0.004, respectively). The inflammatory cytokine levels were high in the groups that performed moderate and high-intensity exercises, but the high levels were relieved in those taking probiotics. The GABA concentration was high for the exercise group and the probiotic-ingestion group. Conclusion Taken together, probiotics help improve motor skills during moderate and high-intensity exercise and help relieve inflammatory responses in the brain. Thus, we suggest that probiotics can be a useful supplement for brain and body development during exercise in adolescence.


2019 ◽  
Vol 1 (2) ◽  
pp. 38
Author(s):  
Averina Octaxena Aslani ◽  
Hanna Goenawan ◽  
Nova Sylviana

Exercise is one of the factors that affect cardiovascular health. Exercise has been proven to reduce the number of cardiovascular diseases. However, it is also known that doing intense exercise has an adverse effect on heart health which can increase the risk of cardiovascular disease. While doing exercise, there is compensation from the heart itself by producing substances to maintain the heart to remain functional, known as cardiac biomarkers, including ANP and SERCA2a. Thus far, the recommended intensity is moderate-intensity exercise, which is optimal for heart health, but this recommendation has not been supported by biomolecular study. Therefore, this research was conducted. This study was done using semi-quantitative analytic method and experimental study design. Total of 24 male wistar rats were divided randomly into 4 groups: 1 control group (0m/min) and 3 exercise groups (low-: 10m/min, moderate-: 20m/min, high- intensity exercise: 30m/min). All groups received 30 min/day running, 5x/week for 12 weeks. The rats were terminated under anaesthesia, cardiac muscle extraction was done from left ventricle, and gene expression of ANP and SERCA2a is studied. Statistical analysis was done using SPSS software with one-way ANOVA followed by post hoc comparisons if the p-values < 0.05. The expression of ANP increased but insignificant in low-, moderate-, and high-intensity exercise group of rat (0.8720.034 vs 0.9010.018 vs 0.9160.015 vs 0.9380.025; p=0.304). The expression of SERCA2a also increased insignificantly in low-, moderate-, and high-intensity exercise group of rat (1.0440.019 vs 1.0510.015 vs 1.0630.011 vs 1.0820.027; p=0.493). Different exercise intensity didnt have significant effect on ANP and SERCA2a expression in rat cardiac muscle.


Author(s):  
David Redding ◽  
Angela Maron ◽  
Emily Venvertloh ◽  
Tania Ghazarian ◽  
Erika Polanco

The purpose of this observational study is to determine whether moderate-intensity exercises improve the quality of sleep for subjects with insomnia. The duration of this observational study was four weeks. For the first two weeks of the observational study, subjects served as their own control and completed a sleep log. At the beginning of the third week, subjects were randomly split into (1) Group One with moderate-intensity exercise or (2) Group Two with high-intensity exercise. Two-tailed t-tests displayed significant improvements in quality of sleep with the implementation of both moderate and high-intensity exercise. However, Group One participants were found to feel significantly more well-rested than Group Two. The moderate-intensity exercise group showed improvement in quality of sleep, the number of awakenings, and restfulness. In comparison, the high-intensity exercise group demonstrated improvement in the number of awakenings and daytime sleepiness; although, without reported improvement in sleep quality. There were variables in participants’ sleeping environments, including changes in sleep location, travel, sleep-inducing medication, alcohol use, anxiety, unanticipated noise disturbances, and use of electronic devices before bed that was not controlled for in this observational study.


2021 ◽  
Vol 2 (2) ◽  
pp. 59
Author(s):  
Averina Octaxena Aslani ◽  
Hanna Goenawan ◽  
Nova Sylviana

Exercise is one of the factors that affect cardiovascular health. Exercise has been proven to reduce the number of cardiovascular diseases. However, it is also known that doing intense exercise has an adverse effect on heart health which can increase the risk of cardiovascular disease. While doing exercise, there is compensation from the heart itself by producing substances to maintain the heart to remain functional, known as cardiac biomarkers, including ANP and SERCA2a. Thus far, the recommended intensity is moderate-intensity exercise, which is optimal for heart health, but this recommendation has not been supported by biomolecular study. Therefore, this research was conducted. This study was done using semi-quantitative analytic method and experimental study design. Total of 24 male wistar rats were divided randomly into 4 groups: 1 control group (0m/min) and 3 exercise groups (low-: 10m/min, moderate-: 20m/min, high- intensity exercise: 30m/min). All groups received 30 min/day running, 5x/week for 12 weeks. The rats were terminated under anaesthesia, cardiac muscle extraction was done from left ventricle, and gene expression of ANP and SERCA2a is studied. Statistical analysis was done using SPSS software with one-way ANOVA followed by post hoc comparisons if the p-values < 0.05. The expression of ANP increased but insignificant in low-, moderate-, and high-intensity exercise group of rat (0.872±0.034 vs 0.901±0.018 vs 0.916±0.015 vs 0.938±0.025; p=0.304). The expression of SERCA2a also increased insignificantly in low-, moderate-, and high-intensity exercise group of rat (1.044±0.019 vs 1.051±0.015 vs 1.063±0.011 vs 1.082±0.027; p=0.493). Different exercise intensity didn’t have significant effect on ANP and SERCA2a expression in rat cardiac muscle.


Author(s):  
Huohuo Wang ◽  
Juanjuan Wang ◽  
Yihua Zhu ◽  
Huiping Yan ◽  
Yifan Lu

The objective of the study was to investigate the effects of different intensity exercise and 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) exposure on glucose metabolism in Sprague Dawley (SD) rats, as well as the action of insulin receptor substrate (IRS)/phosphatidylinositol-3-kinases (PI3K)/protein kinase (AKT) signaling pathway in it. Besides that, we explored whether exercise can alleviate the toxicity induced by TCDD. Sixty male SD rats (8 weeks old) were randomly divided into non-exercise group, none-exercise toxic group, moderate-intensity exercise group, moderate-intensity exercise toxic group, high-intensity exercise group, high-intensity exercise toxic group. The toxic groups were intraperitoneally injected with TCDD, which the dose was 6.4 µg/kg· BW for the first week, then 21% of the above week dose for continuous 8 weeks. The 8-week treadmill running of moderate intensity (15 m/min, 60 min/day) and high intensity (26 m/min, 35 min/day) were implemented separately in exercise groups five times a week. After detecting the concentration of fasting serum glucose, insulin and C-peptide, the index of the homeostasis model assessment of insulin resistance (HOMA-IR) and islet β-cell secretion (HOMA-β) were calculated. We measured the hepatic mRNA expression levels of IRS2, phosphatidylinositol-3-kinases catalytic subunit alpha (PIK3CA), AKT by real-time PCR. The protein expression of total IRS2 (tIRS2), phosphorylated IRS2 at Ser731 (pSer731), total PIK3CA (tPIK3CA), total Akt (tAkt), phosphorylated Akt at Thr308 (pThr308) in liver were analyzed by western blot. We observed that compared to the non-exercise group, insulin and HOMA-IR index were significantly higher in the none-exercise toxic group (p < 0.05), while glucose, insulin, C-peptide and HOMA-IR index were significantly lower in the moderate-intensity exercise group (p < 0.05). In the high-intensity exercise group, the HOMA-IR index was significantly lower and the gene expression of IRS2 was significantly higher than in the non-exercise group (p < 0.05). Besides that, the HOMA-β index in the moderate-intensity exercise toxic group was significantly higher compared to the none-exercise toxic group and moderate-intensity exercise group (p < 0.05). The level of IRS2mRNA was significantly lower in the high-intensity exercise toxic group than in the high-intensity exercise group (p < 0.05). Our results demonstrated that 8-week TCDD exposure could induce insulin resistance in rats, while exercise could improve insulin sensitivity in which moderate intensity was more obvious than high intensity exercise. Meanwhile, both intensity exercise could not effectively alleviate the insulin resistance induced by TCDD, but high intensity exercise could promote compensatory insulin secretion to maintain glucose homeostasis. Although the gene expression of IRS2 was changed in high-intensity exercise groups, the mediation role of the hepatic IRS2/PI3K/AKT pathway in the effects of exercise and TCDD exposure on glucose metabolism remains very limited.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Katrin A Dias ◽  
James P Macnamara ◽  
Christopher M Hearon ◽  
Mitchel Samels ◽  
Aslan Turer ◽  
...  

Introduction: Patients with hypertrophic cardiomyopathy (HCM) are excluded from high intensity activities due to perceived fear of sudden cardiac death. Observational data from athletes with HCM suggest that engaging in high intensity exercise (HIE) may be safe and is associated with higher cardiorespiratory fitness. Whether HIE can safely elicit a superior increase in fitness compared to moderate intensity exercise in patients with HCM is unclear. Methods: Nine HCM patients (49 ± 7 years, 3 female) were assessed for maximal oxygen uptake (VO 2 max, Douglas Bag method), cardiac output (Q c , acetylene rebreathing), and peripheral oxygen extraction (av-O 2 diff, Fick equation) before randomization and after 5 months of MIE or HIE training. Patients completed 3-4 sessions of MIE each week, while the HIE group also incorporated 1-2 supervised high intensity interval training sessions/week from month 3 onwards. Arrhythmias were monitored via pre-existing implantable cardiac defibrillators or implantable loop recorders placed prior to training. Results: Five months of MIE increased absolute VO 2 max by 3% and relative VO 2 max by 4%, while HIE consistently increased absolute VO 2 max by 6% and relative VO 2 max by 5% (Figure). Maximal Q c did not change after MIE but increased in all HIE patients (+1.2L/min, 95% CI -1.4 to 3.9), while maximal av-O 2 diff remained stable in both groups. Training compliance was 84 ± 15% in HIE and 93 ± 11% in MIE. There were no serious exercise-related adverse events in either group though two HIE subjects had arrhythmias at rest: 1) 14-beat run of wide complex tachycardia of uncertain mechanism given underlying conduction disease prior to a training session, and 2) 11 beats of non-sustained ventricular tachycardia prior to post exercise testing. Conclusions: Preliminary findings show that five months of HIE safely and consistently increased cardiorespiratory fitness in patients with HCM, though overall the improvements were comparable to MIE.


2018 ◽  
Vol 1 (3) ◽  
Author(s):  
Yiyi Liu ◽  
Hao Su ◽  
Zhongye Jiang ◽  
Tianhao Wen ◽  
Jia Shao

Objective The HIIT and moderate-intensity exercise are two different exercise models among the public fitness. In recent years, HIIT become more and more popular, unfortunately, there is a tremendous lack of research being done effects of mitochondrial reverse transcriptase (TERT) on age-related degeneration of skeletal muscle by HIIT. The purpose of this study was to compare the HIIT group and moderate-intensity group, and research difference of telomerase expression and cardiopulmonary endurance between the exercise group and the quiet control group was discussed. Methods  fifty-nine male Wistar rats were divided into three groups at random: control group (Q=19), moderate-intensity intervention group (M=20), and HIIT intervention group (H=20). The rats in Q group did not any exercise, and the rats in M group developed the exercise with 60% VO2max intensity for 8 weeks. H group did a training program for an 8-week exercise with alternating 40%, 60%, and 80% VO2max intensities. The rats in the experimental group were exercised for 50 minutes every day and trained for 5 days per week. After the baseline value group was sampled, each group of rats was selected after the training reached the specified number of weeks (4 and 8 weeks), and the maximum oxygen uptake test was performed before the material was taken. Single factor analysis of variance were used to assess differences in VO2max, and expression of protein between conditions. Results It was found that H group VO2max was significantly higher than M group and Q group (P<0.05). At same time, the mTERT expression of the M group at the 4th week was significantly higher than that of the Q group (P<0.05). The mTERT expression in group H was significantly higher than that in group Q at week 8 (P<0.05).There was no significant difference between the H group and the Q group at 8th week (P<0.05). Conclusions 1. HIIT exercise lasting for 8 weeks can effectively inhibit the decrease of maximal oxygen uptake in aging rats compared with moderate exercise. 2. HIIT training for 8 weeks promotes the expression of mTERT; 3. The maintenance of VO2max in aging rats may be related to the enhancement of mitochondrial antioxidant function by HIIT-promoted TERT to mitochondrial translocation.


2021 ◽  
Author(s):  
Xuchang Zhou ◽  
Hong Cao ◽  
Miao Wang ◽  
Jun Zou ◽  
wei wu

Abstract Background The purpose of this study was to explore whether moderate-intensity exercise can alleviate motion-induced post-traumatic osteoarthritis (PTOA) and the expression change of lncRNA H19 during this progression.Methods Twenty-week-old male C57BL/6 mice were randomly divided into five groups: model control group (CM group, n = 6), treadmill model group (M group, n = 6), rehabilitation control group (CK group, n = 6), treadmill model + rehabilitation training group (K group, n = 6) and treadmill model + rest group (J group, n = 6). Paraffin sections were used to observe the pathological changes in the mouse knee joint in each group. A micro-CT was used to scan the knee joint to obtain the morphological indexes of tibial plateau bone. Real-time PCR was used to detect the mRNA levels of inflammatory factors, synthetic and catabolic factors in cartilage. Results After high-intensity exercise for four weeks, the inflammation and catabolism of the mouse knee cartilage were enhanced, and the anabolism was weakened. Further study showed that these results were partially reversed after four-week moderate-intensity training. The results of hematoxylin-eosin staining confirmed this finding. Meanwhile, high-intensity exercise reduced the expression of lncRNA H19 in cartilage, while the expression of lncRNA H19 increased after four weeks of moderate-intensity exercise.Conclusion High-intensity treadmill running can cause injury to the knee cartilage in C57BL/6 mice which leads to PTOA and an decrease of lncRNA H19 expression in cartilage. Moderate-intensity exercise can relieve PTOA and partially reverse lncRNA H19 expression.


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