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.

Relationship between motor-cognitive functions and hemodynamic response of individuals with chronic stroke during and after an acute bout of aerobic exercise

Background: Individuals post-stroke commonly presents functional and cardiorespiratory deficits besides a physical inactivity lifestyle in the chronic phase of disease. Considering this, there is a hypothesis that hemodynamic responses could be affected by motor, cognitive and cardiorespiratory deficits during the aerobic exercise. In order to identify functional conditions that can influence the aerobic performance of these individuals, correlations between functional variables and hemodynamic responses during and after the aerobic exercise were studied. As a secondary purpose, the ability of return to hemodynamic resting state were also analyzed. Methods: In this experimental study, after being evaluated about their motor and cognitive function, balance and prognosis, forty participants underwent a 30-minute aerobic exercise session on a treadmill. Training heart rate, arterial blood pressure, oxygen pulse saturation, heart rate, and respiratory rate were measured before begin the exercise session, every five minutes during the exercise and five minutes after it. Results: Cardiorespiratory parameters within normality limits in all phases of the exercise and the capacity of returning to the resting state were observed. Moderate inverse correlations were found between Berg Scale and oxygen pulse saturation (r=-0.401, p=0.01), between MMSE and diastolic blood pressure (r=-0.406, p=0.009), age and diastolic blood pressure (r=-0.435, p=0.005) and between injury time and RR (r=-0.454, p=0.003). Relationship between the lesion side and the 20 minute phase of aerobic exercise was also observed (p=0.042). Conclusion: Post- stroke individuals present moderate correlation between hemodynamic and respiratory responses during aerobic exercise and balance, muscle strength, injury time, age and side of lesion. They also have the capacity to return to their cardiorespiratory and cardiovascular resting state right after the activity besides their cardiorespiratory deficits.

Effects of Acute Exposure to Thermal Stress on Cardiorespiratory Function, Skeletal Muscle Oxygenation, and Exercise Performance in Healthy Males

We investigated the effects of acute thermal stress (30 °C and 40 °C) and ordinary temperature (20 °C) on cardiorespiratory function, skeletal muscle oxygenation, and exercise performance in healthy men. Eleven healthy males (21.5 ± 2.3 years) performed a graded exercise test (GXT) using a cycle ergometer in each environmental condition (20 °C, 30 °C, and 40 °C) in a random order with an interval of 1 week between each test. Before the test, they were allowed to rest for 30 min in a given environmental condition. All dependent variables (body temperature, cardiorespiratory function parameters, skeletal muscle oxygenation profiles, and exercise performance) were measured at rest and during GXT. GXT was started at 50 W and increased by 25 W every 2 min until subjects were exhausted. Body temperature increased proportionally at rest and at the end of exercise as thermal stress increased. There were no differences in the rating of perceived exertion, oxygen uptake, respiratory exchange ratio, and carbon dioxide excretion between environmental conditions. Heart rate (HR), minute ventilation (VE), and blood lactate levels were significantly higher at 30 °C and 40 °C than at 20 °C, and oxygen pulse was significantly lower at 40 °C than at 20 °C at various exercise loads. None of the skeletal muscle oxygenation profiles showed significant changes at rest or during exercise. Maximal oxygen uptake, peak power, and exercise time significantly decreased proportionally as thermal stress increased, and this decrease was most pronounced at 40 °C. Acute thermal stress induces a decrease in exercise performance via increased body temperature, HR, VE, and blood lactate levels and decreased oxygen pulse during load-homogenized exercise. This phenomenon was more prominent at 40 °C than at 30 °C and 20 °C.

Remote exposure to secondhand tobacco smoke is associated with lower exercise capacity through effects on oxygen pulse- a proxy of cardiac stroke volume

Background: Prolonged past exposure to secondhand tobacco smoke (SHS) is associated with exercise limitation. Pulmonary factors including air trapping contribute to this limitation but the contribution of cardiovascular factors is unclear. Methods: To determine contribution of cardiovascular mechanisms to SHS-associated exercise limitation, we examined the cardiovascular responses to maximum effort exercise testing in 166 never-smokers with remote but prolonged occupational exposure to SHS and no known history of cardiovascular disease except nine with medically-controlled hypertension. We estimated the contribution of oxygen-pulse (proxy for cardiac stroke volume) and changes in systolic (SBP) and diastolic blood pressures (DBP) and heart rate (HR) over workload towards exercise capacity, and examined whether the association of SHS with exercise capacity was mediated through these variables. Results: Oxygen consumption (VO2Peak) and oxygen-pulse (O2-PulsePeak) at peak exercise were 1,516±431mL/min (100±23 %predicted) and 10.6±2.8mL/beat (117±25 %predicted), respectively, with 91 (55%) and 43 (26%) of subjects not being able to achieve their maximum predicted values. Sixty-two percent showed hypertensive response to exercise by at least one established criterion. In adjusted models, VO2Peak was associated directly with O2-Pulse and inversely with rise of SBP and DBP over workload (all P<0.05). Moreover, SHS exposure association with VO2Peak was mainly (84%) mediated through its effect on oxygen-pulse (P=0.034). Notably, although not statistically significant, a large proportion (60%) of air trapping effect on VO2Peak seemed to be mediated through oxygen-pulse (P=0.066). Discussion: In a never-smoker population with remote prolonged exposure to SHS, abnormal escalation of afterload and an SHS-associated reduction in cardiac output contributed to lower exercise capacity.

Impact of exercise based cardiac rehabilitation program in patients with transcatheter aortic valve replacement

Funding Acknowledgements Type of funding sources: None. Introduction Due to the increase in global prevalence of degenerative valve disease, aortic stenosis (AS) has played a preponderant role in the cardiovascular scenario, especially in patients undergoing transcatheter aortic valve replacement (TAVR). An alternative management for this patients are the cardiac rehabilitation programs (CRP); however, their effect has not been completely understood, both in exercise capacity and quality of life, but neither in the improvement of cardiopulmonary performance and other cardiovascular outcomes. Purpose: To evaluate the effect of the CRP on exercise tolerance and cardiopulmonary performance in patients with AS undergoing TAVR. Methods: A cohort study was conducted including 26 patients with AS undergoing TAVR and divided into an intervention group who performed a 4-week supervised training program in the Cardiac Rehabilitation Service and a control group to whom instructions and recommendations to performed unsupervised exercise at home were given. Demographic and clinical data (VO2Max, METS12, oxygen pulse, heart rate, double product, left ventricular ejection fraction, body mass index) were collected at baseline and after a 4-week follow-up. Results: 15 patients were included in the intervention group and 11 patients in the control group. There were no baseline significant differences between groups. After the intervention, significant differences were observed in the METS 12 final gain variable between the control and intervention group (4.55 vs 3.1 p = 0.01). Intergroup analysis showed significant differences (percentage changes) in the intervention group with an increase of METS12 (67.4%, p = 0.001), oxygen pulse (18.21%, p = 0.01), final METS (39.47% p = 0.001) and a decrease in VO2 recovery time (-12.5%, p = 0.05), in the ergometric performance index by heart rate (-38.17%, p = 0.001) and by double product (-38.1%, p = 0.001). Conclusions A 4-week cardiac rehabilitation program is effective to improve exercise tolerance and cardiopulmonary response in patients with AS undergoing TAVR; improvement was statistically significant in METS12, oxygen pulse, VO2 recovery time, METS-load and ergometric performance index for heart rate and double product. METS12 final gain was statistically significant in intervention group in comparison with the control group. Abstract Figure. Control vs Intervention Group (METS12)

Analysis of exercise capacity, quality of life and leisure sports in patients with a Fontan circulation

Funding Acknowledgements Type of funding sources: None. Background/Introduction: Despite the improvement in survival, patients with a Fontan circulation are exposed to numerous complications as well as a reduced exercise capacity and quality of life. Purpose To assess the influence of the type of single ventricle (right vs. left) and the amount of sporting activity on exercise capacity and health related quality of life (HRQol) in a large group of Fontan patients. Methods Retrospective analysis of standardised cardiopulmonary exercise tests (CPET) performed on a treadmill between 2014 and 2019. Questionnaires to measure HRQol and sporting activity were sent to study participants. Results 79 patients were enrolled in this study (female, n = 31). 56 of them had a systemic right ventricle (SRV), 20 had a systemic left ventricle (SLV) and 3 had diverse anatomies. Median age at CPET was 12.2 years (range 6.2-34.4 years). The results for important exercise parameters were as follows: peak oxygen uptake (VO2max) 30.7 ± 6.2 ml/kg/min, oxygen uptake at anaerobic threshold (VO2-VAT) 24.7 ± 5.8 ml/kg/min, peak oxygen pulse 8.2 ± 3.4 mlO2/beat and VE/VCO2 slope 39.8 ± 9.1. There was no significant difference in VO2max, VO2-VAT, peak oxygen pulse and VE/CO2 slope between SRV and SLV patients: VO2max 30.2 ± 5.6 vs. 32.8 ± 7.5 ml/kg/min, p = 0.14; VO2-AT 24.4 ± 5.3 vs.25.7 ± 7.3 ml/kg/min, p = 0.53; peak oxygen pulse 7.8 ± 3.2 vs. 9.5 ± 3.9 mlO2/beat, p = 0.06; VE/CO2 slope 41.1 ± 9.6 vs. 36.9 ± 6.8, p = 0.10. Analyses of the questionnaires revealed that most of the patients do leisure sports (n = 60, 76%) with nearly half of them more than two hours per week (n = 26, 33%). In a subgroup analysis of patients under 18 years (n = 51, 65%) we found that nearly all of them participate in school sports (n = 50) and have a good subjective healthiness (n = 47). VO2-VAT and VO2max correlated positively with subjective healthiness (VO2-VAT r = 0.32, p &lt; 0.05; VO2max r = 0.35, p &lt; 0.05) as well as with the amount of leisure sports activity (hours/week) (VO2-VAT r = 0.37, p &lt; 0.01; VO2max r = 0.50, p &lt; 0.01). Conclusions By analysing a large group of patients in Fontan circulation we could demonstrate that there is no difference in exercise capacity between SRV and SLV patients. Furthermore, most of the patients participate in leisure sports and have a good subjective healthiness. In a subgroup of paediatric patients, we were able to show that a better exercise capacity is associated with increased leisure sports activity and a better subjective healthiness.

Functional state dynamics in cross-country skiers in the summer and autumn preparatory phase

Background and Study Aim. To study changes in the functional state of professional Russian cross country skiers in the course of the preparatory phase and their effects on their competition ratings. Materials and methods. In this study we examined 10 cross-country skiers. The functional state was assessed through a maximal load bicycle ergometer test, coordination and special performance tests. Concentrations of lactate and cortisol were checked in the blood plasma of participants. Results. The training effects on general physical preparedness and special physical preparation in September in comparison with June were observed as an increased number of pull-ups on a pull-up bar (by 14%) and decreased time of the roller ski test (by 4%). In autumn higher systolic (by 11%) and diastolic (by 10%) arterial blood pressure levels, higher levels of plasma lactate and cortisol (by 48% and 64%, respectively) were detected (p<0.05). At anaerobic threshold the following increased: total performance capacity (by 13%), oxygen consumption (by 14%), watt pulse (by 5%), respiratory minute volume, oxygen utilization coefficient, and oxygen pulse (by 15%) (p<0.05-0.01) at rest before the ergometer test. In September upon completion of the ergometer test we observed an increase of oxygen pulse (by 7%), watt pulse (by 10%), and oxygen utilization coefficient (by 24%) (p<0.05). In autumn at the 5th minute of recovery after the ergometer test the heart rate recovered 11% faster, blood lactate – 29% faster, and the oxygen utilization rate increased by 15% (p<0.05-0.01). In June no statistically significant correlations were found between the studied indicators. In autumn statistically significant correlations appeared between indicators of the cardiorespiratory system, physical performance, and coordination test time. Conclusions. The package program for the summer-autumn training period contributes to the improvement of the functional status of the cross-country skiers and to the development of physical power, endurance, increased strength of the upper limbs, increased speed of movement on roller skis, faster and more complete recovery of physiological and biochemical parameters.