Blood Pressure Response and Vascular Function of Professional Athletes and Controls

Workload-indexed blood pressure response (wiBPR) to exercise has been shown to be superior to peak systolic blood pressure (SBP) in predicting mortality in healthy men. Thus far, however, markers of wiBPR have not been evaluated for athletes and the association with vascular function is unclear. We examined 95 male professional athletes (26±5 y) and 30 male controls (26±4 y). We assessed vascular functional parameters at rest and wiBPR with a graded bicycle ergometer test and compared values for athletes with those of controls. Athletes had a lower pulse wave velocity (6.4±0.9 vs. 7.2±1.5 m/s, p=0.001) compared to controls. SBP/Watt slope (0.34±0.13 vs. 0.44±0.12 mmHg/W), SBP/MET slope (6.2±1.8 vs. 7.85±1.8 mmHg/MET) and peak SBP/Watt ratio (0.61±0.12 vs. 0.95±0.17 mmHg/W) were lower in athletes than in controls (p<0.001). The SBP/Watt and SBP/MET slope in athletes were comparable to the reference values, whereas the peak SBP/Watt-ratio was lower. All vascular functional parameters measured were not significantly correlated to the wiBPR in either athletes or controls. In conclusion, our findings indicate the potential use of the SBP/Watt and SBP/MET slope in pre-participation screening of athletes. Further, vascular functional parameters, measured at rest, were unrelated to the wiBPR in athletes and controls.

ASSESSMENT OF AEROBIC AND ANAEROBIC EXERCISE CAPACITY AND SPORT LEVEL OF POLAND’S LEADING REPRESENTATIVE IN A SHORT TRACK IN A 4-YEAR OLYMPIC CYCLE

The purpose of the work was to characterize the 4-year preparation cycle for the Winter Olympic Games in Pyongyang (2018), the leading Polish speed skater M.W. Longitudinal tests included assessment of aerobic and anaerobic exercise capacity determined in laboratory tests, respectively in the graded bicycle ergometer test and in the Wingate test performed with the lower extremity. The longitudinal data from exercise tests obtained in the analyzed 4-year period of preparation for the Olympic Games clearly indicate a significant improvement in the skater's exercise capacity. In the examined period of 2015-2018, the athlete obtained an increase in VO2max value by 6.5% to the level of 55.8 ml/kg/min. The nature of the observed changes in selected exercise indicators corresponded to the assumptions and implementation of training plans. The examined athlete was very well prepared for qualifying starts in October-November 2017 and she won three Olympic qualifications at distances 500, 1000 and 1500 m. During the Olympic Games, the Polish representative started the competition with starts at distances 1500 (20th place) and 500 m (28th place). At the leading distance of 1000 m, the competitor started at her level, reaching 12th place thus fulfilling the pre-start assumptions.

METHOD OF CHRONIC LUNG FAILURE DIAGNOSTICS IN COPD PATIENTS BASED ON COMPUTER PULSE OXIMETRY DURING STRESS TESTING

In the article chronic lung failure method of diagnostics in chronic obstructive pulmonary disease (COPD) patients based on computer pulse oximetry during stress testing (6-walking test and bicycle ergometer test) is given. The sensitivity and the specificity of method of diagnostics with ROC-analisis is assessed. As it's identified, bicycle ergometer test use allows to increase the informativeness of lung failure degree diagnostics due to identification of COPD persons without lung failure. Different degrees of lung failure are identified in 70% COPD patients using developed method of lung failure degree diagnostics. Sever degree of lung failure is revealed in 56% COPD patients. Lung failure degree that can decrease domestic stress testing tolerance and can get worse the quality of life is revealed in 56% COPD patients. The moderate straight relationship between lung failure degrees and severity lung failure classes and COPD exacerbation risk groups is detected.

Promoting Physical Activity With Self-Tracking and Mobile-Based Coaching for Cardiac Surgery Patients During the Discharge–Rehabilitation Gap: Protocol for a Randomized Controlled Trial

Background Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. Objective In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). Methods Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. Results The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. Conclusions Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. Trial Registration Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 International Registered Report Identifier (IRRID) PRR1-10.2196/16737

Promoting Physical Activity With Self-Tracking and Mobile-Based Coaching for Cardiac Surgery Patients During the Discharge–Rehabilitation Gap: Protocol for a Randomized Controlled Trial (Preprint)

BACKGROUND Home-based cardiac rehabilitations (CRs) with digital technologies have been researched and implemented to replace, augment, and complement traditional center-based CR in recent years with considerable success. One problem that technology-enhanced home-based CR can potentially address is the gap between cardiac interventions and formal CR programs. In the Netherlands and some other countries (eg, Australia), patients after cardiac interventions stay at home for 3-4 weeks without much support from their physicians, and often engage in very little physical activity (PA). A home-based exercise program enabled by digital technologies may help patients to better prepare for the later center-based CR programs, potentially increasing the uptake rate of those programs. OBJECTIVE In a randomized controlled trial (RCT), we will evaluate the effectiveness of a home-based walking exercise program enhanced by self-tracking and mobile-based coaching (treatment condition), comparing it with a version of the same program without these technologies (control condition). The added value of the digital technologies is justified if patients in the treatment group walk more steps on average (primary outcome) and show better physical fitness in a bicycle ergometer test and higher self-efficacy toward PA (secondary outcomes). METHODS Based on a power analysis, we will recruit 100 cardiac patients and assign them evenly to the 2 parallel groups. Eligible patients are those who are scheduled in the postanesthesia care unit, know the Dutch language, have basic literacy of using smartphones, and are without medical conditions that may increase risks associated with PA. In a face-to-face meeting with a nurse practitioner, all patients are prescribed a 3-week exercise program at home (2 walking exercises per day with increasing duration), based on national and international guidelines and tailored to their physical conditions after cardiac intervention. Their physical activities (daily steps) will be measured by the Axivity AX3 accelerometer worn at hip position. Patients in the treatment group will also be supported by a Neo Health One self-tracking device and a mobile platform called Heart Angel, through which they are monitored and coached by their nurses. After the study, all patients will perform a bicycle ergometer test and return the devices within 1 week. In addition, 5 questionnaires will be sent to the patients by emails to assess their self-efficacy toward PA and other psychological states for exploratory analyses (at discharge, at the end of each monitoring week, and 1 week after the study). To minimize bias, the randomization procedure will be performed after introducing the exercise program, so the nurse practitioners are blind to the experimental conditions until that point. RESULTS The study protocol has been approved by the Medical Research Ethics Committees United on February 26, 2018 (NL 62142.100.17/R17.51). By the end of 2018, we completed a small pilot study with 8 patients and the results based on interviews and app usage data suggest that a larger clinical trial with the targeted population is feasible. We expect to complete the RCT by the end of 2021, and statistical analyses will follow. CONCLUSIONS Results of the RCT will help us to test the hypothesized benefits of self-tracking and mobile-based coaching for cardiac patients in home-based exercise programs during the discharge–rehabilitation gap. If the results are positive, cost-effectiveness analysis will be performed based on the insights of the study to inform the translation of the technology-enhanced program to clinical practice. We also note limitations of the trial in the discussion. CLINICALTRIAL Registered at Netherlands Trial Register NL8040; https://www.trialregister.nl/trial/8040 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/16737

Evaluation of Cardiovascular System Reactions when Different Muscle Groups are Activated

Research background and hypothesis. In our study, the dynamics of working muscle oxygen saturation of participants in the fi nal stages of provocative bicycle ergometer test was different. According to this, we hypothesized, that different central and peripheral reaction of cardiovascular system would dominate during local and regional exercises, too.Research aim was to evaluate central and peripheral reaction of cardiovascular system when different muscle groups are activated. Research methods. Twenty seven healthy men (age 32 ± 1.8 years, body mass index 25.3 ± 0.6 kg / m 2 ) participated in the study. All participants performed provocative bicycle ergometer test, electrocardiogram and oxygen saturation were registered. The participants performed three exercises activating different muscle groups: calf, forearm and back extension.Research results. Variation of heart rate and oxygen saturation values highlighted the difference between arm and leg training exercises. However, the load for arms and legs was individualised, both Groups A and B were different according to the dynamics of heart rate and oxygen saturation indices. Heart rate reaction to the physical load for the back muscles was unusual - heart rate decreased during the fi rst seconds of the back load. Oxygen saturation was lower in resting back muscles compared to those of resting arm and leg muscles (p < 0.05). Discussion and conclusions. The analysis of heart rate and oxygen saturation values has revealed that each functional muscle group of the human organism contains not only general but also individual activating features both integrating regulatory systems and forming a certain activation of metabolism in working muscles.Keywords: heart rate, oxygen saturation, variation of indices.

Test–retest reliability and responsiveness to change of clinical tests of physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register

Background: To maximise the benefits obtainable from exercise-based cardiac rehabilitation, an evaluation of physical fitness using reliable, clinically relevant tests is strongly recommended. Recently, objective tests of physical fitness have been implemented in the SWEDEHEART register. The reliability of these tests has, however, not been examined for patients with acute coronary syndrome. Aims: The aim of this study was to assess the test–retest reliability and responsiveness to change of the symptom-limited bicycle ergometer test, the dynamic unilateral heel-lift test and the unilateral shoulder-flexion test in patients with acute coronary syndrome. Methods: In a longitudinal study design, a total of 40 patients (mean age 63.8 ± 9.5 years, five women), with ACS, aged < 75 years, were included at a university hospital in Sweden. The intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement (SEM) and responsiveness in terms of the minimal detectable change were calculated. Results: Excellent reliability was found, showing ICC values of 0.98 (0.96–0.99), SEM 4.71 for the bicycle ergometer test, ICC 0.87 (0.75–0.93), SEM 4.62 for the shoulder-flexion test and ICC 0.84 (0.71–0.91), SEM 2.24 for the heel-lift test. The minimal detectable change was 13 W, 13 and 6 repetitions for the bicycle ergometer test, shoulder-flexion and heel-lift tests respectively. Conclusions: The test–retest reliability of clinical tests evaluating physical fitness in patients with acute coronary syndrome included in the SWEDEHEART register was excellent. This makes the future comparison and evaluation of treatment effects in large unselected clinical populations of acute coronary syndrome possible.