Effect of Weight Self-Stigma and Self-Esteem on Aerobic Exercise Capacity in Adult Women with Different Body Compositions

Background: Overweight individuals face weight-related stigmatization, driving self-exclusion from exercise and physical activity. The extent to which weight self-stigma and self-esteem are associated with aerobic capacity remains unclear. Therefore, this study aimed to characterize the cardiopulmonary fitness, weight self-stigma, and self-esteem of overweight women and examine whether weight self-stigma and self-esteem predict cardiopulmonary aerobic capacity. Methods: A cross-sectional study was conducted with 66 women stratified into two groups: a normal weight (NW) group and an overweight (OW) group. The mean body mass indexes and ages of the NW and OW groups were 20.4 ± 0.36 kg/m2 and 29.5 ± 0.8 kg/m2, and 24 ± 7 years and 21 ± 3 years, respectively. Submaximal exercise testing using the modified Bruce treadmill protocol was conducted to measure the predicted oxygen uptake (VO2 peak) and energy expenditure. The Weight Self-Stigma Questionnaire and the Rosenberg Self-Esteem Scale were used. Results: Significantly lower mean of predicted VO2 peak and higher mean of energy expenditure were reported in the OW group compared with the NW group (25.8 ± 5.3 mL/kg/min vs. 28.7 ± 4.8 mL/kg/min, p = 0.001 and 9.7 ± 1.9 kcal/min vs. 7.5 ± 1.8 kcal, p = 0.03, respectively). There was a significant difference in weight self-stigma and self-esteem between the groups. Regression model analysis indicated that weight self-stigma and self-esteem explained 45% of the variance in the predicted VO2 peak. Conclusion: Strategies enhancing self-esteem and avoiding stigmatization should be embraced to promote fitness and engagement in physical activity among OW women.

The Effect of Voxelotor on Exercise Capacity of Youths with Sickle Cell Anemia

Background/Hypothesis: Children and adults with sickle cell anemia (SCA) exhibit decreased cardiopulmonary fitness. Anemia is directly related to oxygen carrying capacity and is one factor that affects cardiopulmonary fitness. The new sickle cell drug voxelotor raises hemoglobin in patients with SCA treated or untreated with hydroxyurea. We hypothesized that voxelotor improves exercise capacity in youths with SCA. Methods: A single-center, open-label, single-arm longitudinal interventional pilot study was conducted for patients with SCA age > 12. Participants performed baseline Cardiopulmonary Exercise Testing (CPET#1), took 1500mg voxelotor for 2 months, then CPET was repeated (CPET#2). A modified Bruce Protocol using 2-minute stages was performed on a motorized treadmill, for a goal of 8-12 minutes of exercise. Breath by breath gas exchange data were collected and analyzed using a VMax Encore 29C metabolic cart. The metabolic test included standard monitoring of heart rate, EKG ST changes, arrhythmias, and O2 saturation. A respiratory quotient >1.1 was used as evidence of participant effort. Peak oxygen consumption (peak VO2), anaerobic threshold (AT), O2 pulse, VE/VCO2 slope, and time exercised in CPET#1 and CPET#2 were compared for each participant. The primary endpoint was peak VO2. Hemoglobin (Hgb), reticulocyte count, and bilirubin were measured before CPET#1 and CPET#2. Pill count was used to monitor medication adherence and left shift of the P50 oxygen dissociation curve was used to document biochemical effect of voxelotor. Patient Global Impression of Change (PGIC) and Clinician Global Impression of Change (CGIC) surveys were collected at the end of the study. Statistical analysis was performed using Student's paired T-test. Results: Nine SCA patients ages 12-20, including 4 males and 5 females, completed the study. All had Hgb SS and were stably maintained on hydroxyurea, which was continued without dose change during the study. After 2 months of voxelotor, all participants demonstrated expected hematologic changes, including mean rise in Hgb +1.3 g/dL (95% C.I.= 0.8, 1.7), mean decrease in reticulocyte count -2.4% (95% C.I.= -4.1, -0.8), and mean decrease in bilirubin -0.4 mg/dL (95% C.I.= -0.8, -0.1). All participants demonstrated voxelotor adherence and leftward shift of p50 (Table 1). Oxygen consumption, measured as percent predicted peak VO2 (ml/kg/min), ranged from 52% to 80% in CPET#1 and from 55% to 71% in CPET#2. The changes in peak VO2 for individual participants ranged from -10% to +10% of predicted peak VO2, with a mean difference of -2.2% (95% CI = -7.1, 2.7), which is insignificant (p=0.3). Using +/- 6% as variability in peak VO2 measurement, 5 participants exhibited no change, 3 participants had decrease in peak VO2 of -7%, -9%, and -10%, while peak VO2 increased by +10% for a single participant, who started to exercise on his own after starting voxelotor. Changes in individuals' anaerobic threshold, O2 pulse, VE/VCO2 slope, and time exercised were not significant and did not correlate with changes in peak VO2. All participants achieved respiratory quotient >1.1, assuring participant effort during CPET (Table 2). On the 7-point PGIC questionnaire evaluating activity limitations, symptoms, emotions, and overall quality of life, 7 out of 9 participants reported positive change, including "a great deal better," "definite," and "moderate" improvements. Two participants reported minimal to no change, and no participants reported worsening. In comparison, clinicians reported "minimal" to "much" improvement on CGIC for all participants. Overall, patient impression of improvement was higher than clinician impression of improvement. Conclusion: This pilot study demonstrated the feasibility of using CPET to evaluate exercise capacity longitudinally in youths with SCA. After addition of voxelotor to hydroxyurea for 2 months, all patients perceived global improvement. Peak VO2 did not change in 8 out of 9 participants and improved for 1 participant who exercised between the 2 CPETs. To increase peak VO2, higher Hgb increase, concurrent regular exercise, and longer exposure to voxelotor may be necessary. This study was funded by Global Blood Therapeutics Figure 1 Figure 1. Disclosures Larkin: Forma Therapeutics, Inc.: Research Funding. Dulman: Pfizer: Other: own stock. Kuypers: Forma Therapeutics, Inc.: Research Funding.

Wearable Cardioverter–Defibrillator-Measured Step Count for the Surveillance of Physical Fitness during Cardiac Rehabilitation

Background: The wearable cardioverter–defibrillator (WCD) has a built-in accelerometer, which allows tracking of patients’ physical activity by remote monitoring. It is unclear whether WCD-measured physical activity, step count, and heart rate correlate with established tools for the assessment of cardiopulmonary fitness such as the 6-min walk test (6MWT). Objective: To correlate measurements of patient physical activity through the WCD with a supervised 6MWT during in-patient cardiac rehabilitation (CR) and to allow their use as surrogate parameters of cardiopulmonary fitness in an out-patient setting. Methods: Consecutive patients with a history of WCD use treated at our center and an in-patient CR following an index hospitalization were included. Baseline characteristics, measurements of WCD accelerometer (median daily step count, median daily activity level), median daily heart rate, and clinically supervised 6MWT at admission and discharge of CR were obtained. Results: Forty-one patients with a mean age of 55.5 (±11.5) years were included. Thirty-five patients (85.4%) were male and 28 patients (68%) had a primary prophylactic WCD-indication. The most common underlying heart diseases were ischemic heart disease (24 patients 58.6%) and dilated cardiomyopathy (13 patients, 31.7%). Median CR duration was 20 (IQR 19.75–26.25) days. 6MWT distance increased from a mean of 329 m (±107) to 470 m (±116) during CR (p < 0.0001). The median daily step count and activity level increased significantly, from 5542 steps (IQR 3718–7055) to 8778 (IQR 6229–12,920, p < 0.0001) and median 117 × 106 (IQR 96 × 106–142 × 106) threshold value exceedance (TVE) to 146 × 106 TVE (IQR 110 × 106–169 × 106, p < 0.0001), respectively. The median heart rate was 74.9 bpm (IQR 65.8–84.5) and 70.2 (IQR 64.1–77.3, p = 0.09) at admission and discharge, respectively. Of all three parameters, median daily step count showed the best correlation to the results of the 6MWT at admission and discharge (r = 0.32, p = 0.04 and 0.37, p = 0.02, respectively). Conclusions: Remote monitoring of median daily step count as assessed by the WCD’s accelerometer showed positive correlation with the 6MWT and could serve as a surrogate for cardiopulmonary exercise capacity. Assessment of daily step count and activity level measured remotely by the WCD could help to tailor optimal exercise instruction for patients not attending CR.

Manifestation of cardiopulmonary exercise testing in an HIV-infected patient with highly active anti-retroviral therapy: A Case Report

Background: Human immunodeficiency virus (HIV) is a retrovirus that causes severe immunodeficiency syndrome in most patients if left untreated. It has been a reportable disease in Taiwan since 1984, and was diagnosed in 41,679 patients until June 2020. However, there is no previous study evaluating aerobic capacity in HIV-infected patient in Taiwan. Case report: A 50-year-old male with HIV infection visited our rehabilitation center for cardiopulmonary exercise testing (CPET) due to dyspnea on exertion sometimes. He received a highly active antiretroviral therapy (HAART) regimen since 2015. He could achieve VO2max during CPET. The maximal aerobic ability was about 91.95% of the predicted, and functional aerobic impairment (FAI) was within normal limit. His VO2 peak was 8.3 MET, equal to 29.05 mL/kg/min. Additionally, VO2 AT was 4.5 MET, equal to 15.75 mL/kg/min. We make recommendations of physical exercise training program according to CPET results. Conclusion: The difference of disease duration, HAART regimen and time of HAART will affect the cardiopulmonary fitness results. However, our HIV-infected patient showed normal aerobic fitness following the CPET, and aerobic capacity did not impair in HIV-infected patient receiving HAART due to personalized life-style modification.

Normative values of muscular and cardiorespiratory fitness and their relationship with anthropometric variables in Colombian adolescents. Multicentre study (Valores normativos de aptitud muscular y cardiorrespiratoria y su relación con variables antropomé

Objectives: The purposes of this research were: 1. To establish reference values for cardiorespiratory fitness and muscular fitness. 2. To establish the relationship between anthropometric characteristics and physical fitness parameters. Materials and Methods: Cross-sectional, multicentre, analytical study; students aged between 12 and 18 years from 10 Colombian cities were evaluated. The sample was 3455 students with a reliability of 95%, a statistical power of 84%, and an expected correlation of 0.30. Anthropometric variables, General Strength Index (GSI), and Cardiopulmonary Capacity were taken into account. A two-way analysis of variance (two-way ANOVA) was performed with Bonferroni post hoc adjustments. A Box-Cox Cole and Green (BCCG) lest squares method (LMS) distribution was performed. Results: A higher performance was found on males in all tests performed, and a higher average body mass index (BMI), waist-height index, and fat percentage on the females. Weak to moderate negative correlations were identified between muscular and cardiopulmonary fitness and anthropometric variables. Additionally, significant differences were identified between GSI with waist circumference and fat percentage. Conclusion: Cardiorespiratory fitness assessment and GSI are tools to be considered as a complement to the evaluation of academic programs with school health prevention objectives. Resumen: Objetivos: Los objetivos de esta investigación fueron: 1. Establecer valores de referencia para la aptitud cardiorrespiratoria y la aptitud muscular. 2. Establecer la relación entre características antropométricas y parámetros de aptitud física. Materiales y Métodos: Estudio analítico, transversal, multicéntrico; Se evaluó a estudiantes de entre 12 y 18 años de 10 ciudades colombianas. La muestra fue de 3455 estudiantes con una confiabilidad del 95%, un poder estadístico del 84% y una correlación esperada de 0.30. Se tomaron en cuenta variables antropométricas, Índice de Fuerza General (GSI) y Capacidad Cardiopulmonar. Se realizó un análisis de varianza bidireccional (ANOVA bidireccional) con ajustes post hoc de Bonferroni. Se realizó el cálculo de los percentiles normalizados a partir del método de mínimos cuadrados (LMS) de Box-Cox Cole y Green (BCCG). Resultados: Se encontró un mayor rendimiento en los hombres en todas las pruebas realizadas, sin embargo, se evidencio un índice de masa corporal (IMC) promedio, índice de cintura y porcentaje de grasa más altos en las mujeres. Se identificaron correlaciones negativas débiles a moderadas entre la aptitud muscular y cardiopulmonar y las variables antropométricas. Además, se identificaron diferencias significativas entre GSI con la circunferencia de cintura y el porcentaje de grasa. Conclusión: La evaluación de la aptitud cardiorrespiratoria y el GSI son herramientas a considerar como un complemento a la evaluación de los programas académicos con objetivos de prevención en salud escolar.

A Canine's Behavior and Cognitive State as It Relates to Immobility and the Success of Physical Rehabilitation in the Non-ambulatory Spinal Cord Patient

Physical rehabilitation (PR) is recommended following spinal cord injury to help improve and maintain muscle elasticity, joint mobility, and nerve health. It can also be used to relieve pain and improve cardiopulmonary fitness in an immobile patient. There is evidence, in human medicine, that PR plays a critical role in mental health and the psychological state of the patient. As part of the assessment phase, human physical therapists often identify psychosocial symptoms and barriers at the start of PR that ultimately may affect improvement in human patients suffering from injury and the loss of mobility. Patient psychological state plays an integral role in healing and outcome during treatment and rehabilitation. Specific interventions set to address these symptoms can better outcome. Arguably, one of the most emotionally traumatizing injuries suffered by a canine patient can be immobility secondary to spinal cord injury. Poorly understood is the role the canine cognitive state plays in the success of rehabilitation following spinal cord injury. Should breed, age, sex, physical fitness, personality, previous experiences and history or home lifestyle, affect the PR assessment of these patients? Do these factors affect eventual outcome following PR? The purpose of this manuscript is to explore psychosocial barriers encountered during injury rehabilitation in humans and determine if the similar barriers need to be considered when assessing a canine patient for spinal cord injury rehabilitation.