The Impact of Cardiac Rehabilitation on Activities of Daily Life in Elderly Patients With Heart Failure

Background: In elderly chronic heart failure (HF) patients, activities of daily living (ADLs) require the use of a high proportion of patients’ peak aerobic capacity, heart rate, and ventilation.Objectives: To assess the effects of short-term comprehensive cardiac rehabilitation (CR) on the metabolic requirement of ADLs in elderly patients with chronic HF.Methods: The study population comprised 99 elderly chronic HF patients (mean age 72 ± 5 years, 80% male, 61% ejection fraction <40%, mean NT-proBNP 2,559 ± 4,511 pg/ml) participating in a short-term (mean days 19 ± 7) residential CR program. Before and after CR, participants, while wearing a portable ergospirometer, performed a standardized ADL battery: ADL1 (getting dressed), ADL2 (folding 8 towels), ADL3 (putting away 6 bottles), ADL4 (making a bed), ADL5 (sweeping the floor for 4 min), ADL6 (climbing 1 flight of stairs carrying a 1.5 Kg load), and ADL7 (a standard 6-min walking test).Results: After CR, task-related oxygen uptake did not change in any of the domestic ADLs. Notably, there was a significant decrease in the cumulative time required to perform ADLs (ADL 1–4 and ADL6; from 412 ± 147 to 388 ± 141 s, p = 0.001) and a reduction in maximal heart rate in ADL1 and 3 (p = 0.005 and p = 0.027, respectively). Changes occurred in the 6MWT with an increase in oxygen uptake (p = 0.005) and in the distance covered (p < 0.001) and a significant decrease in the Borg scale of dyspnea (p = 0.004).Conclusion: Elderly patients with chronic heart failure who are engaged in a short-term residential CR program improve the performance of routine ADLs.

Performance and Recovery of Well-Trained Younger and Older Athletes during Different HIIT Protocols

Due to physiological and morphological differences, younger and older athletes may recover differently from training loads. High-intensity interval training (HIIT) protocols are useful for studying the progression of recovery. It was the objective of this study to determine age differences in performance and recovery following different HIIT protocols. Methods: 12 younger (24.5 ± 3.7 years) and 12 older (47.3 ± 8.6 years) well-trained cyclists and triathletes took part in this study. Between the age groups there were no significant differences in relative peak power to fat-free mass, maximal heart rate (HR), training volume, and VO2max-percentiles (%). Participants performed different HIIT protocols consisting of 4 × 30 s Wingate tests with different active rest intervals (1, 3, or 10 min). Peak and average power, lactate, HR, respiratory exchange ratio (RER), subjective rating of perceived exertion (RPE), and recovery (Total Quality Recovery scale, TQR) were assessed. Results: During the different HIIT protocols, metabolic, cardiovascular, and subjective recovery were similar between the two groups. No significant differences were found in average lactate concentration, peak and average power, fatigue (%), %HRmax, RER, RPE, and TQR values between the groups (p > 0.05). Conclusion: The findings of this study indicate that recovery following HIIT does not differ between the two age groups. Furthermore, older and younger participants displayed similar lactate kinetics after the intermittent exercise protocols.

Physical and physiological demands according to gender, playing positions, and match outcomes in youth basketball players.

This study aimed to compare physical and physiological demands in youth basketball players according to gender, playing positions, and match outcomes. 64 players (32 female and 32 male) from eight youth sub-elite basketball teams were monitored using an Ultra-Wide Band system and inertial measurement unit in three consecutive matches. The results showed some significant differences, although with magnitudes qualified as small. When the teams won, the guards covered a greater distance at 0-6 km/h than when they lost. When teams lost, the centers covered more distance at 12-18 km/h and 18-21 km/h. The winning female teams presented a lower maximal heart rate (HRmax) compared to the losing teams. The forwards of the winning teams performed greater efforts at 70-80% HRmax, while the forwards of losing teams performed more efforts at 90-95% HRmax. The greatest number of accelerations and decelerations were performed by the female guards and the male forwards. The number of jumps was higher in the male guards and forwards than in the female ones. HRmax was higher in the forwards of the female teams. Efforts at 80%-90% HRmax were higher in male centers. When the female teams won, they had a lower HRmax than when they lost. When efforts exceed 90% of HRmax the teams lost. In conclusion, despite the differences found, the effect of these contextual variables on physical and physiological demands is unclear. Nevertheless, knowing the game's requirements can help the design of training that enhances the performance of youth basketball players

Integrated Physiological, Biomechanical, and Subjective Responses for the Selection of Assistive Level in Pedelec Cycling

In recent decade, pedelec has become one of the most popular transportation modes due to its effectiveness in reducing physical effort. The effects of using pedelec as an alternative mode of exercise were explored in previous studies. However, the effects of pedelec parameters were not quantified for the self-selected gear ratio, random riding speed, and varied road slopes, which restricted its application. Hence, this study aimed to evaluate the effects of gear ratio and assistive torque and to determine the optimum riding condition regarding physiological, biomechanical, and subjective responses of the rider. The riding tests consisted of simulated slope (1.0 vs. 2.5% grade), gear ratio (light vs. heavy), and assistive levels (0.5, 1, 1.5, and 2), and the tests were conducted in a randomized order. A total of 19 non-athletes completed the riding tests to evaluate physiological [metabolic equivalent of task (MET), heart rate, and gross efficiency (GE)], biomechanical [muscle activity (expressed as reference voluntary contraction, RVC) and power output], and subjective responses [rating of perceived exertion (RPE) and sense of comfort (SC)]. The test conditions induced moderate to vigorous intensities (3.7–7.4 METs, 58.5–80.3% of maximal heart rate, 11.1–29.5% of RVC rectus femoris activity, and 9.4–14.2 RPEs). The effects of gear ratio and assistive level on the physiological responses were significant. Riding with the heavy gear ratio showed advantages in METs and GE. For the optimum assistive level selection, low GE and limited improvement in subjective responses suggested the impact of low-power output conditions. Overall, for the health pedelec commuters, riding with 0.75 W/kg power output with 50 rpm cadence is recommended to obtain the moderate intensity (4.7 METs) and the advantages in GE and subjective feelings. Moreover, the findings can be applied to exercise intensity control and save battery energy effectively in varying riding conditions.

Systematic Review and Meta-Analysis of the Relationship between Actual Exercise Intensity and Rating of Perceived Exertion in the Overweight and Obese Population

The number of overweight (OW) and obese (OB) children, adolescents, and adults has increased globally. Exercise intensity, both actual and perceived, is a significant factor in a variety of health-related investigations and rehabilitation trainings. Despite this, literature on the connection between actual exercise intensity and the rating of perceived exertion (RPE) in overweight and obese populations is lacking. A systematic review, meta-analysis, combined analysis of variance (Brown–Forsythe ANOVA), and Spearman correlation were performed to fill this gap. After preliminary assessments, ten studies were classified as having a low risk of bias and a degree of heterogeneity (I2 = 34%; p = 0.05). The RPE scores (F = 0.032; p = 0.859), physiological index (percentage of maximal heart rate (%HRmax) (F = 0.028; p = 0.869), and percentage of maximal oxygen uptake (%VO2max) (F = 2.434; p = 0.136) demonstrated consistency without being significantly different between the normal weight (NW) and OW/OB groups. The RPE scores varied by age (NW (coefficient values) = 0.677 ***, OW = 0.585 **), as well as by indoor temperature (OW only, coefficient values = 0.422 *), body mass index (NW (coefficient values) = 0.516 **, OW = 0.580 **), and test time (NW only, coefficient values = 0.451 *). We conclude that RPE is appropriate for the following OW and OB people: (1) those who are older than 21.5 (the lowest age in the group of ≥18) years old and younger than 58.6 (the highest age in the group of ≥18) years old, without any other diseases, and (2) those who engage in low-intensity exercise while maintaining a standard indoor temperature. Future studies may address alternative techniques for increasing the reliability of longitudinal comparisons and gender comparisons, as well as investigate other possible confounding factors.

Effect of Small Sided Game Duration with Floater Player on Internal and External Load of Female Handball Players

Introduction. The present study deals with the effect of the duration of small-sided games (SSGs) with a floater player on the external (covered distance) and internal (heart rate) load of the elite female players. Material and methods. The research group consisted of nine professional elite female team handball field players (age 22.8 ± 4.5 years) playing in the first international league for female players in the Czech Republic. Their height was 170.4 ± 6.4 cm, weight 67.7 ± 9.2 kg, and maximal heart rate 200.2 ± 3.3 beats∙min-1. The duration of the SSGs was 4 (SSG4) minutes, 5 (SSG5) minutes, and 6 (SSG6) minutes. Results. The highest heart rate value of 177.2 ± 9.9 beats / minute resp. 88.5 ± 4.4% HRmax was measured in SSG5. The lowest mean heart rate values were measured at SSG6 of 172.01 ± 15.7 beats / min resp. 85.9 ± 6.8% HRmax. Most time 38 resp. 34% of the drill time, players were in the 85-90% HRmax load intensity zone of SSG4 and SSG5. There was a statistically significant difference in load intensity zones of 80-85% HRmax and ≥ 95% HRmax between SSG5 and SSG6 and p = .008 (η2 p = 0.22) and .013 (η2 p = 0.26), respectively. In the rating of perceived exertion (RPE) evaluation, there was a statistically significant difference in SSG6 and SSG4 p = .003 (η2 p = 0.27) and between SSG6 and SSG5 p = .004 (η2 p = 0.25). The total longest distance in SSG6 was 786.8 ± 41.9 m, but in the one-minute drill the longest average distance in SSG4 was 136.2 ± 21.1 metres per minute. Conclusions . SSGs with a floater are a suitable means for training technical and tactical activities in handball with an overlap into fitness training in women’s handball. According to our results, the intensity of the load will not decrease if we increase the game time to six minutes and also the covered distance will not decrease during the game.

122 Exercise stress echocardiography in paediatric and adolescent patients: what is the role?

Aims To describe the current application of exercise stress echocardiography (ESE) in our Paediatric Cardiology Departments. Methods and results Baseline and under stress symptoms, vital parameters, ECG, and echocardiograms from patients who underwent ESE in our centres, were retrospectively analysed and compared, as well as clinical management plans formulated based on ESEs results. Forty-five patients from Centre 1 (median age 16 years), including 87% of patients with congenital heart diseases (CHDs), and 20 patients from Centre 2 (median age 11 years), mainly tested to rule out myocardial ischemia, were included. Among patients from Centre 1, 28 had previously been treated surgically, 6 percutaneously, and 11 were under follow-up. Indications for ESE/patients’ native diagnosis are illustrated in the picture. Centre 1: Exercise was maximal in 17 patients, with 2 of them having symptoms at the peak of exercise. It was stopped beforehand in 28 patients because of dyspnoea (3) and muscle fatigue (25). No arrhythmia was detected. ESE was considered as positive in 14 patients; after that, 3 patients underwent percutaneous interventions, 2 underwent cardiac surgery, 3 received indication for cardiac catheterization, 4 for advanced cardiac imaging, and 2 for exercise restriction and medical therapy. Centre 2: 15 patients (75%) completed the exercise, and none of them developed symptoms. In the remaining 25%, exercise was stopped because of muscle exhaustion. No arrhythmia was detected, and all the ESEs were negative. Comparing the cohorts, no differences in terms of ejection fraction were noticed at rest and under stress. Patients in cohort 1 were older (P = 0.002), they achieved lower average maximal heart rate (P = 0.0001), performed less lasting exercise (P = 0.05), and ESE was maximal less frequently (P = 0.005). Lastly, they had significant changes in clinical decisions (P = 0.004). Conclusions In paediatric cardiology, particularly in children with CHDs, ESE is a promising technique and could influence significantly clinical management plans.

769 Differential pharmacological modulation of arrhythmic phenotype in catecholaminergic polymorphic ventricular tachycardia: not all betablockers are the same

Aims Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic disorder that predisposes patients to develop catecholamine-mediated ventricular arrhythmias (VA), manifesting as exercise- or emotion-induced syncope or cardiac arrest. Due to the catecholaminergic nature of CPVT, exercise stress test (EST) represents the most important diagnostic test. Although widely used in clinical practice to monitor response to therapy, how BBs modulate the occurrence of ventricular arrhythmias during EST in CPVT patients is unclear. To compare the relative efficacy of different classes of betablockers (BBs, β1-selective BBs vs. nadolol) on the arrhythmic manifestations during ESTs performed off-therapy and on-therapy in patients with CPVT. Methods and results We selected 72 patients (45 females) with pathogenic or likely pathogenic variants on RYR2 or CASQ2 from our cohort of 246 genotype-positive CPVT patients, who had at least one EST off-therapy and at least one EST during BB therapy. Overall, 507 ESTs (77 ESTs off-therapy, 29 ESTs during β1-selective BBs, and 401 during nadolol) were prospectively collected over 11.1 ± 6.8 years of follow-up and analysed, with a median of 5 ESTs per patient [interquartile range (IQR): 3–10 ESTs, range: 2–27 ESTs]. In the absence of therapy, VT was documented in 46/77 (60%) cases. BB therapy with nadolol significantly reduced VT at EST to 10% (41/398; P < 0.001). Conversely, β1-selective BBs did not significantly decrease VT incidence at EST (13/29, 45%, P = 0.289) as compared to baseline. Importantly, nadolol was superior in preventing VT both when compared to off-therapy [odds ratio (OR): 33.9, 95% confidence interval (CI): 15.6–73.5, P < 0.001] but also when compared to β1-selective BBs [OR: 18.0, 95% CI: 6.0–53.5, P < 0.001]. Although β1-selective BBs significantly increased the total exercise time free of arrhythmias (median 248 s, IQR: 212–315 s) as compared to baseline (median 83 s, IQR: 12–207 s; P < 0.001), arrhythmia-free exercise time during nadolol (median 381 s, IQR: 251–543 s) was significantly longer as compared to both off-therapy (P < 0.001) and β1-selective BBs (P = 0.020). Multivariate mixed effects logistic regression confirmed that at parity of time of occurrence of first arrhythmia and percentage of maximal heart rate reached, both of which were significantly associated to VT occurrence (P = 0.001 for both), the use of nadolol (OR: 0.23; 95% CI: 0.09–0.60; P = 0.011) was independently associated with decreased incidence of VT. Focusing on the 14 patients (overall 133 ESTs) who had at least one ESTs after the occurrence of VT in nadolol, we dissected the effect of dose increase on the probability of VT reoccurrence. Following the documentation of breakthrough VT, increasing the dose of nadolol by 0.5 mg/kg reduced by 2.5 times the probability of having a recurrence of VT (OR: −2.49, 95% CI: −3.96 to − 1.0; P < 0.001). Conclusions Once CPVT is diagnosed, nadolol at 1 mg/kg/day should be used as preferred therapy as it has been shown to suppress VT in most patients. In rare instances in which VA persist despite an adequate nadolol dose, dose increase to 1.5 mg/kg/day may represent an efficacious antiarrhythmic strategy.

Interval Training with Different Intensities in Overweight/Obese Adolescent Females

To compare the effects of 12 weeks of high-intensity interval training (HIIT) versus moderate-intensity interval training (MIIT) on hematological and inflammatory markers in youth females, 38 overweight/obese females (16.4±1.0 yrs.) were randomly assigned to HIIT (2×6–8 repetitions of 30 s at 100–110% maximal aerobic speed (MAS), with 30 s active recovery between repetitions at 50% MAS; n=13), MIIT (2×6–8 repetitions of 30 s at 70–80% MAS, with 30 s active recovery between repetitions at 50% MAS; n=13), and a control group (CG, no intervention; n=12). Body composition, blood pressure, maximal heart rate, hematological and inflammatory markers (C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]) markers were assessed in all groups before and following the training program. Results revealed a significant (P<0.05) interaction effect for body composition, systolic blood pressure (SBP), MAS, maximal heart rate, and CRP. Within-group analyses for the HIIT and MIIT groups showed significant improvements in body mass (P=0.009 and P=0.025, respectively), BMI Z-score (P=0.011 and P=0.028, respectively), and MAS (P<0.001 and P=0.011, respectively). The HIIT program showed a significant decrease in body fat (P=0.002), waist circumference (P=0.002), maximal heart rate (P=0.003), SBP (P=0.001), and plasma CRP (P=0.004). In both groups, no significant changes were observed in ESR and hematological markers after intervention. No variable changed in CG. HIIT was the effective method to manage cardiometabolic health and inflammatory disorders in obese youth.

Effects of a 12-Week Recreational Skiing Program on Cardio-Pulmonary Fitness in the Elderly: Results from the Salzburg Skiing in the Elderly Study (SASES)

Objectives: To investigate whether recreational alpine skiing in the elderly can improve cardio-pulmonary fitness. Design: Randomized controlled study with pre–post repeated measurements. Methods: A total of 48 elderly participants (60–76 years) were randomly assigned to either participate in a 12-week guided recreational skiing program (intervention group, IG, average of 28.5 ± 2.6 skiing days) or to continue a sedentary ski-free lifestyle (control group, CG). Cardio-pulmonary exercise testing (CPET) and pulmonary function testing were performed in both groups before (PRE) and after (POST) the intervention/control period to compare parameters PRE vs. POST CPET. Results: At baseline, IG and CG did not differ significantly with respect to CPET and pulmonary function parameters. At POST, several measures of maximal exercise capacity and breathing economy were significantly improved in IG as compared to CG: maximal oxygen capacity (IG: 33.8 ± 7.9; CG: 28.7 ± 5.9 mL/min/kg; p = 0.030), maximal carbon dioxide production (IG: 36.2 ± 7.7; CG: 31.8 ± 6.5 mL/min/kg; p = 0.05), maximal oxygen pulse (IG: 16.8 ± 4.2; CG: 13.2 ± 4 mL/heart beat; p = 0.010), maximal minute ventilation (IG: 96.8 ± 17.8; CG: 81.3 ± 21.9 l/min; p = 0.025), and maximal metabolic equivalent of task (METs, IG: 9.65 ± 2.26; CG: 8.19 ± 1.68 METs; p = 0.029). Except for oxygen pulse, these significant changes could also be observed at the anaerobic threshold. Maximal heart rate and pulmonary function parameters remained essentially unchanged. Conclusion: Regular recreational skiing improves cardio-pulmonary fitness along with breathing economy and thus can contribute to a heart-healthy lifestyle for the elderly.