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Quantificazione degli adattamenti muscolari metabolici attraverso spettroscopia a raggi infrarossi e risposta emodinamica a seguito di un programma riabilitativo di cammino alla massima velocità libera dal dolore nell’arteriopatia periferica
No full textBackground: exercise training reduces walking disability in peripheral arterial disease (PAD).
Metabolic adaptations induced by rehabilitation programs have been documented by invasive
methods. Near infrared spectroscopy (NIRS), potentially useful for the study of non-invasive static
and dynamic muscle metabolism, has not yet been used to assess the effects of exercise in PAD.
The aim of the present study is to document hemodynamic and metabolic adaptations, by NIRS
technique, associated with variations in performance recorded at the end of a program of exercise
therapy in PAD prescribed at hospital and carried out at home (Ti.To).
Method: 55 PAD patients with claudicatio intermittens (group E) and 15 healthy subject (group C)
were enrolled. Evaluation were carried out upon entry (T0) and at 7±2 month (T9). Ankle-brachial
index (ABI) and muscle VO2 consumption (mVO2 ) in the gastrocnemius by NIRS, were determined
at rest. Participants than performed an incremental treadmill test for determination of pain threshold
speed (PTS). Cardiovascular response (dFc), and rate of muscle oxygenation, were determined in a
predetermined speed range (1,7-3 km/h) by NIRS, through quantification of variation in oxygenated
(O2Hb), deoxygenated (HHb), total (tHb) and differential (dHb) haemoglobin.
Group E performed a rehabilitation program (Ti-To) based on 2 daily 10-min home walking session
at maximal asymptomatic speed and the patients attending monthly check-ups at hospital. Group C
continued to carry out normal daily activities. Results: 42 patients and 15 healthy subjects were studied. All subject in group E completed the Ti-
To program. Group C showed no significant changes in hemodynamic and metabolic parameters at
the end of the study.
At the end of the rehabilitation program group E, while continuing to show different values of
outcome parameters than the group C, showed a trend to normalization with a) significantly
changes in PTS (p<0.0001) compared with significantly higher values of ABI (p<0.0001) and
mVO2 (p=0.0011), b) lower muscle perfusion deficit in dynamic phase for increase of O2HbAUC
(p=0.0010) and c) concomitant reduction of cardiovascular response (p=0.0293).
At the end of rehabilitation program, compared to the group with significant ABI increase, patient
without favorable hemodynamic changes in worse limb showed a dramatic increase in mVO2 and
similar functional changes.
Conclusion: Ti-To program in PAD leads to functional improvements by means of peripheral
adaptations, hemodynamic or muscles, otherwise combined together, with reduction of
compensatory cardiovascular response.
NIRS measurement, allows to non-invasive study of muscle metabolic useful to evaluate the effects
of different rehabilitative training program in PAD
Association between VO2peak and hospitalization: a 3-year follow-up study in 1308 cardiac outpatients
No full textBackground/Aim Cardiovascular diseases (CVD) are the leading cause of mortality in the world and 'produce immense global health and economic burdens', mostly attributable to hospital costs.1 The determination of peak oxygen consumption (VO2peak) is used for assessing disease severity, predicting prognosis, and examining the effectiveness of training programs for individuals with CVD.2
Aim of the study was to determine the association between VO2peak estimated by a moderate 1-km treadmill walk (1km-TWT)3 and all-cause hospitalization in cardiac outpatients.
Methods We studied 1308 men aged 25-85 years at baseline, referred to our Center for an exercise-based secondary prevention programme. Participants were instructed to select a walking pace at a perceived intensity of 11-13 on the 6-20 Borg Scale to be maintained during the 1-km-TWT. The equation for VO2peak estimation was applied considering age, BMI, heart rate, and time to complete the 1-km3. All-cause hospitalization was checked 3 years after enrollment.
Results Patients were subdivided into tertiles of VO2peak. Estimated VO2peak resulted 19.62.4, 23.81.1, and 29.03.0 mL/kg/min for the first (n=436, LOW FIT), second (n=436, MODERATE FIT), and third (n=436, HIGH FIT) tertile, respectively. During the following 3 years, hospitalizations were 203 for LOW FIT group (47% of the sample), 151 for MODERATE FIT group (35% of the sample), and 109 for HIGH FIT group (25% of the sample) (Figure). Compared to the LOW FIT group, the fully-adjusted hazard ratios for hospitalization were 0.79 (95%CI 0.59 to 1.05, P=0.10) for the MODERATE FIT group, and 0.53 (95%CI 0.35 to 0.79, P=0.002) for the HIGH FIT group (P for trend ≥0.0001). Hospital stay was 3654, 1963, and 1090 days for LOW, MODERATE, and HIGH FIT groups, respectively. The mean healthcare costs for hospitalization during the 3-years tracking period were 36% and 64% lower in the HIGH FIT and MODERATE FIT groups versus LOW FIT group (1.74, 1.11, and 0.63 million euros respectively).
Conclusions An inverse association was found between exercise capacity and all-cause hospitalization in stable outpatients with cardiovascular disease. The lower VO2peak was associated with higher rates of hospitalization, independently of traditional cardiovascular risk factors and disease severity. The higher the baseline VO2peak, the lower the hospitalization rate, the shorter the length of hospital stay, and the lower the corresponding healthcare costs. The 1km-TWT represents a simple tool for assessing cardiorespiratory fitness and for predicting prognosis in patients with CVD
Sport therapy for hypertension. Why, How, How much?
No full textMany pathologic conditions are associated with inactivity and sedentary lifestyle. Exercise may increase physical fitness and cardiovascular efficiency, and improve body composition, lipid profiles and insulin resistance, thus preventing or reducing the effects of metabolic and cardiovascular diseases, including hypertension. Both acute and chronic exercise, alone or combined with lifestyle modifications, are effective in blood pressure reduction, as well as in avoiding or reducing the need for pharmacologic therapy in hypertensive patients.
The hypotensive effect of aerobic exercise is observed in a large percentage of subjects, with some differences due to age, gender, race, health conditions, parental history and genetic factors.
Physical training regulates autonomic nervous system activity and, by increased blood flow and shear stress, increases nitric oxide production in endothelial cells and its bioavailability for vascular smooth muscle, up-regulating the level of antioxidant enzymes.
Different types of exercise have been proposed. Endurance training is primarily considered effective, and resistance training can be combined with it. Low or moderate intensity training in sedentary patients with hypertension is necessary, and tailored programs can also make exercise safe and effective in special populations.
Exercise programs, either under supervision or home-based, allow an effective non-pharmacological reduction of hypertension, together with a reduction of risk factors, with possible beneficial effects on cardiovascular morbidity and mortality
Time-loss injuries in MotoGP championships [Lesiónes con pérdida de tiempo de participación en campeonatos de MotoGP]
No full textSummary Introduction: MotoGP (Moto Grand Prix) is the premier class of motorcycle road racing events held on road circuits over a distance between 100 and 130 kilometers. Despite its worldwide popularity, there are only few studies published in the scientific literature, thus the aim of this paper is to contribute to the discussion about epidemiological data regarding the injuries of MotoGP riders. Material and method: Riders involved in the Moto Grand Prix (MotoGP) World Championships 2019, 2020, and 2021 were studied for time-loss injuries (TLI) by searching the official websites of riders themselves, races, sports newspapers. Results: Twenty-nine riders (age 28.0±4.7 yrs; BMI 21.8±1.2 kg/m2) with 11.8±8.2 yrs of experience in MotoGP and in motor racing championships, participated in the MotoGP World Championships 2019, 2020 and 2021. They reported 26 TLI during races, without difference between race and pre-race practice. TLI prevalence tends to increase linearly as riders participate in more than one subsequent Championship (R2= 0.998; p<0.001), with a risk of 100% through the entire career. Incidence of TLI was 21.2/1000 hours of race (CI 95%: 9.7-32.8). TLI were classified as contusions (35%), bone fractures (32%), sprains (10%), concussions (10%), compartment syndromes (6%) and reopening of surgical wound (3%). Fractures accounted for 1.5% of the falls in the 2019-2021 championships and for 59% of TLI in career, affecting the upper limb in 62% of cases of fractures. Injuries were due to lowside (46%), collisions (38%), highside (8%), speed wobble (4%) and gust of wind (4%). The median absence from trainings and competitions due to TLI was 18 days (range 1-271). Conclusions: Training sessions and testing are equally occasions for TLI and should be considered for prevention and safety promotion of MotoGP riders.Introducción: MotoGP (Moto Grand Prix) es la clase principal de eventos de carreras de motos en carretera que se llevan
a cabo en circuitos de carretera en una distancia de entre 100 y 130 kilómetros. A pesar de su popularidad mundial, existen
pocos estudios publicados en la literatura científica, por lo que el objetivo de este artículo es contribuir a la discusión sobre
la epidemiológia de los pilotos de MotoGP.
Material y método: Se estudiaron los pilotos que participaron en los Campeonatos del Mundo de MotoGP 2019, 2020 y
2021 para detectar lesiones por pérdida de tiempo (TLI) mediante una búsqueda en los sitios web oficiales de los propios
pilotos, carreras y periódicos deportivos.
Resultados: Veintinueve pilotos (edad 28,0±4,7 años; IMC 21,8±1,2 kg/m2
) con 11,8±8,2 años de experiencia en MotoGP y
en campeonatos de motociclismo, reportaron 26 TLI durante las carreras, sin diferencia entre carreras y práctica previa a las
carreras. La prevalencia de TLI tiende a aumentar linealmente a medida que los pilotos participan en más de un Campeonato
(R2
= 0,998; P <0,001), con un riesgo del 100% a lo largo de toda la carrera deportiva. La incidencia de TLI fue de 21,2/1000
horas de carrera (IC 95%: 9,7-32,8). Los TLI se clasificaron en contusiones (35%), fracturas (32%), esguinces (10%), conmociones
cerebrales (10%), síndromes compartimentales (6%) y reapertura de herida quirúrgica (3%). Las fracturas representaron el
1,5% de las caídas en los campeonatos 2019-2021 y el 59% de TLI en carrera, afectando al miembro superior en el 62% de los
casos de fracturas. Las lesiones se debieron a lowside (46%), colisiones (3 %), highside (8%), oscilaciones de velocidad (4%)
y ráfagas de viento (4%). La ausencia media de entrenamientos y competiciones debido a TLI fue de 18 días (rango 1-271).
Conclusiones: Las sesiones de entrenamiento y las pruebas son igualmente ocasiones para TLI y deben ser consideradas
para la prevención y promoción de la seguridad de los pilotos de MotoGP
Attenuation of the increase of heart rate and oxygen consumption during progressive exercise in professional rugby players
No full textBackground: The response of oxygen uptake (VO2) and heart rate (HR) to continuous progressive large muscle mass exercise is not always linear. This study aimed to compare the patterns of the Speed/VO2 (S/VO2) and speed/HR (S/HR) relationships during an incremental treadmill-running test in professional rugby players. Methods: Fourteen professional rugby athletes performed a maximal incremental treadmill-running test, following the Conconi test protocol. Speed, heart rate, and gas exchange parameters were recorded. The slope of the S/VO2 and S/HR relationships were mathematically determined. Results: The S/VO2 and S/HR relationships were linear up to a submaximal speed and curvilinear thereafter. The speed of locomotion at which the slope of the S/VO2 and S/HR relationships start to attenuate (VO2att and HRatt) were coincident (12.3±1.0 and 12.4±0.9 km/h), strongly correlated and in good agreement. VO2 values at VO2att (44.9±8.7 mL/kg/min) were significantly correlated with VO2 values at the ventilatory threshold (43.3±6.0 mL/kg/min) (R2=0.83, P=0.001) and in good agreement. The running speed/VO2 ratio (ΔS/ΔVO2) up to VO2att was significantly lower than that beyond VO2att (2.98±1.1 vs 5.16±2.31); P<0,001). Conclusions: The speed/oxygen uptake and S/HR relationships during progressive exercise start to attenuate at a coincident exercise intensity, and at oxygen uptake values strongly correlated with the ventilatory threshold. These findings further support the usefulness of the attenuation of the S/HR relationship as a practical tool for exercise testing and training purposes in professional rugby players
Cardiovascular strain in peripheral arterial disease. A study with Near Infrared Spectroscopy
No full textPatients with peripheral arterial disease (PAD) are at high cardiovascular risk and are limited by claudication.
The relationship between insufficient oxygen delivery to working muscles and cardiovascular response during exercise has not been adequately investigated in PAD patients. Near Infrared Spectroscopy (NIRS) is a tool potentially useful for the study of circulatory disorders, allowing a dynamic evaluation of muscle metabolism . Objectives We studied whether the peripheral metabolic demand during walking affects the cardiovascular response in PAD patients compared to healthy subjects using NIRS.
Subjects Fourty-three consecutive untrained patients with claudication (males=39, age 69.5±8.2), and eighteen healthy subjects (males=12, age 33.6±15.8) were studied. Methods At rest ankle-brachial index (ABI) and VO2 at gastrocnemius with arterial occlusion method by NIRS (Oxymon-MKIII, Artinis-The Netherlands) were
determined. Subjects performed a level walking incremental treadmill test, with NIRS probes positioned at each calf, up to a speed of 3 Km/h. Variations of total (tHb), oxygenated (O2Hb) and deoxygenated haemoglobin (HHb) and of the differential value (Hbdiff) were recorded and quantified by the calculation of area-under-curve (A) for the range 1.6- 3.0 Km/h. Resting (standing) and final heart-rate were recorded (Heart Rate Monitor, Polar) and the difference (ΔHR) calculated. Results All subjects completed the test. Thirty patients referred claudication. A different muscle metabolism was observed in the legs of PAD patients compared to those of healthy subjects during the test. Patients with PAD showed higher ΔHR(P=0.0001), associated only to ABI of the most diseased leg in a stepwise multiple regression analysis among different independent factors considered (ABI, age, BMI, A-O2Hb, A-HHb). No difference of ΔHR was observed in PAD patients with and without beta-blocker (b-b) therapy. Conclusions
During an incremental submaximal test PAD patients showed different muscle metabolism and an exaggerated increase in heart rate compared to healthy subjects. The rise was inversely correlated to the severity of the disease of the worse leg and was not reduced in patients with b-b therapy. The cardiovascular strain induced by PAD, even during the low intensity daily activities, might represent an additional risk factor in patients at unfavourable cardio-vascular outcome
Improvements in walking speed reduce mortality in patients with cardiovascular disease during exercise-based secondary prevention: findings from the ITER registry
No full textAim: To investigate associations between walking speed (WS) and mortality among patients with stable cardiovascular disease (CVD). Additionally, it sought to analyse the impact of a long-term exercise intervention on physical function by analysing the relationship between changes in WS and mortality over a decade of observation. Methods: Of the 3,328 patients included in the ITER registry (NCT05817305) between 1997 and 2023, 2,858 (aged 65±11 years) were analysed. Walking speed was measured using the 1-km treadmill walking test (1k-TWT). Patients were initially categorized into tertiles based on baseline WS and subsequently divided into six categories by associating baseline WS with changes over time. Cox proportional hazard models were used to examine associations between WS, all-cause and disease-specific mortality, adjusting for demographic and clinical confounders. Results: A total of 1,031 patients died over a median follow-up of 11 years. Higher baseline WS was inversely associated with mortality with magnitudes ranging from 23% (95% CI: 0.56,1.06) lower risk for cancer to 58% (95% CI: 0.32,0.54) lower risk for CVD. A similar trend resulted in WS improvements over time, particularly among the LowWS-improved group, with a 38% (95% CI: 0.52, 0.74) lower risk for all-cause mortality, which was comparable to the HighWS-decreased patients. Conclusions: The 1k-TWT is an effective predictor of mortality among CVD patients and a valuable educational tool for exercise-based interventions in secondary prevention. These findings highlight the efficacy of exercise-based programs to improve physical function and reduce mortality, underscoring the importance of promoting exercise as part of long-term CVD management.Aims To investigate associations between walking speed (WS) and mortality among patients with stable cardiovascular disease (CVD). Additionally, it sought to analyse the impact of a long-term exercise intervention on physical function by analysing the relationship between changes in WS and mortality over a decade of observation.Methods and results Of the 3328 patients included in the ITER registry (NCT05817305) between 1997 and 2023, 2858 (aged 65 +/- 11 years) were analysed. Walking speed was measured using the 1-km treadmill walking test (1k-TWT). Patients were initially categorized into tertiles based on baseline WS and subsequently divided into six categories by associating baseline WS with changes over time. Cox proportional hazard models were used to examine associations between WS, all-cause and disease-specific mortality, adjusting for demographic and clinical confounders. A total of 1031 patients died over a median follow-up of 11 years. Higher baseline WS was inversely associ..
Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants
No full textSelected near-infrared spectroscopy (NIRS) parameters were assessed in healthy untrained participants and in peripheral arterial disease (PAD) trained patients to evaluate their usefulness in rehabilitative outcome. Forty-five PAD and 15 healthy participants were studied at entry and at 34 ± 2 weeks. Healthy participants performed their usual activities. Patients with PAD performed 2 home-based programs: structured at prescribed pace (S-pre, n = 31) and unstructured at free pace (U-free, n = 14). We measured ankle-brachial index (ABI), NIRS calf oxygen consumption at rest, NIRS dynamic muscle perfusion during an incremental test, and walking capacity. In all patients with PAD the NIRS parameters significantly increased approaching the stable values of untrained healthy participants. Among PAD, only S-pre group showed significant improvements in hemodynamic, functional, and NIRS parameters with selective adaptations in the worse legs. The assessment of NIRS parameters, that were found stable without training in healthy and modified in PAD only following structured training, might outline the local exercise-induced adaptations. © 2012 The Author(s)
Circadian variation of cardiovascular events and morning blood pressure surge
No full textMost cardiovascular functions exhibit circadian changes. On one hand, predictable-in-time differences in the
physiological status of the cardiovascular system give rise to rhythmic variations in the susceptibility to morbid and mortal
events. On the other, the pathological mechanisms of cardiovascular disease exhibit temporal changes in both their
manifestation and severity, leading to predictable-in-time differences in the ability to precipitate the overt expression of
disease. It is known that the occurrence of cardiovascular events shows temporal patterns that vary with time. The incidence
of potentially life-threatening cardiovascular events, e.g. acute myocardial ischemia and infarction, sudden cardiac
death, ischemic and hemorrhagic stroke, and rupture or dissection of aortic aneurysms, displays a diurnal pattern, tending
to be higher in the morning. On arousal and the start of daily activities, blood pressure (BP) shows a surge that may last 4-
6 h. Morning BP surge, together with circadian variations in biochemical and physiological parameters, may be potential
triggers for acute cardiovascular events. This may open up potential for applications in medical therapy. It is possible that
antihypertensive medication given once daily in the morning may not protect against this surge if its duration of action is
too short. Thus, the timing of drug administration or specific drug delivery systems that lead to a greater effect at night
and/or mitigate the early morning BP surge may provide protection against cardiovascular events
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