1
|
Baga K, Salvatore GM, Bercovitz I, Folk AL, Singh R, König LM, Butryn ML, Mogle JA, Arigo D. Physical Activity Measurement Reactivity Among Midlife Adults With Elevated Risk for Cardiovascular Disease: Protocol for Coordinated Analyses Across Six Studies. JMIR Res Protoc 2025; 14:e67438. [PMID: 40267469 PMCID: PMC12059496 DOI: 10.2196/67438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 02/17/2025] [Accepted: 03/20/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the United States, and adults aged 40-60 years with specific health conditions are at particularly elevated risk for developing CVD. Physical activity (PA) is a key cardioprotective behavior and many interventions exist to promote PA in this group. Effective promotion requires accurate assessment of PA behavior; as PA is often estimated by averaging across multiple days, a threat to accurate assessment is measurement reactivity, or an atypical increase in PA behavior at the start of measurement periods that may bias conclusions. Evidence for PA measurement reactivity is equivocal, though concern has resulted in recommendations to add or drop PA measurement days from inclusion, which may introduce undue burden on participants. At present, the extent of PA measurement reactivity and the behaviors most likely to be affected (eg, steps vs minutes of exercise) among those at risk for CVD are unclear, as are participant characteristics such as gender and study expectations (eg, intervention vs observation only) that may contribute to differences in these patterns. OBJECTIVE The goal of this study is to improve on the current understanding of the extent of PA measurement reactivity and potential moderators among US adults aged 40-60 years with CVD risk factors. METHODS To achieve this goal, we will conduct coordinated multilevel analyses across 6 studies. Data are from nationally representative, publicly available datasets (observation only: 2 studies) and baseline weeks of observation from behavioral weight loss clinical trials (4 studies), all collected in the United States. The publicly available datasets National Health and Nutrition Examination Survey (NHANES; 2013-2014) and the Midlife in the United States (MIDUS) Study (2004-2009; total n=1385) were used, which are available from the Inter-university Consortium for Political and Social Research website. Behavioral weight loss trials were conducted by the Drexel University Weight Eating and Lifestyle (WELL) Center (2011-2023; total n=444), in person or remotely via Zoom. Relevant data from each study were extracted for adults aged 40-60 years who have ≥1 risk factor for CVD (total n=1832; 11,707 total days of PA measurement with 6-7 days per person). Changes in PA behavior across the measurement period will be examined at the day level, using 2-level multilevel models (days nested within persons) and cross-level interactions (for moderation effects). RESULTS This project was funded in August 2022 and received supplementary funding in September 2023. Dataset acquisition and data cleaning were completed in October 2024. Analyses are expected to be completed in April 2025, and findings are anticipated to be shared in July 2025. CONCLUSIONS Results from this coordinated analysis project will provide the first large-scale estimation of the extent of PA measurement reactivity in an at-risk group. Findings will inform best practices for mitigating potential measurement reactivity in multiday assessments of PA behavior. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/67438.
Collapse
Affiliation(s)
- Kiri Baga
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | - Iris Bercovitz
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Amanda L Folk
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Ria Singh
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Laura M König
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Meghan L Butryn
- Weight, Eating, and Lifestyle Science (WELL) Center, Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | | | - Danielle Arigo
- Department of Psychology, Rowan University, Glassboro, NJ, United States
- Department of Family Medicine, Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, United States
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, United States
| |
Collapse
|
2
|
Tian Q, Guo J, Ding J, Zhu Y. The relationship between unhealthy lifestyle behaviors and depression: Evidence from NHANES. J Affect Disord 2025; 384:214-221. [PMID: 40258422 DOI: 10.1016/j.jad.2025.04.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 04/14/2025] [Accepted: 04/18/2025] [Indexed: 04/23/2025]
Abstract
BACKGROUND With increasing recognition of the complex interplay between lifestyle behaviors and mental health, this study aims to explore the relationship between Unhealthy Lifestyle Behaviors (ULB) and depression in a representative sample of the US population. The study proposes ULB as a holistic measure for assessing depression risk. METHODS We analyzed data from 21,854 participants from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. ULB's impact on depression was examined via multivariate logistic and linear regression, with nonlinear relationships assessed using weighted restricted cubic splines. Stratified analyses evaluated consistency across different demographics and health conditions. RESULTS The cohort's average age was 45.63 ± 0.26 years, with 51.89 % males. A higher depression prevalence was observed in females (p < 0.001). After adjusting for covariates, a significant association emerged between higher ULB scores and increased depression risk [OR: 1.232, 95 % CI: 1.106,1.372]. No significant interactions were found in subgroup analyses by gender, age, ethnicity, hypertension, and hyperlipidemia (all P for interaction >0.05), indicating a consistent ULB-depression link across groups. CONCLUSIONS This study highlights ULB's potential as a predictive indicator for depression, emphasizing its importance in mental health evaluations. The findings suggest that incorporating comprehensive lifestyle assessments into mental health screenings could enhance the identification and prevention of depression. Additional research is needed to confirm these initial results and to investigate the causal pathways involved.
Collapse
Affiliation(s)
- Qian Tian
- Department of Psychology, School of Social Development and Public Policy, Fudan University, ShangHai, China
| | - Jiahui Guo
- Department of Psychology, School of Social Development and Public Policy, Fudan University, ShangHai, China
| | - Jingyun Ding
- Mental Wellbeing and Counseling Services, Fudan University, ShangHai, China.
| | - Yan Zhu
- Psychological Counseling Center, Shanghai University, Shanghai, China.
| |
Collapse
|
3
|
Kasman M, Sedlak AB, Reader L, Heerman WJ, Pate RR, Ramirez AG, Sommer EC, Barkin SL, Hammond RA. Leveraging agent-based modeling and a randomized intervention to advance childhood physical activity: A study protocol. PLoS One 2025; 20:e0321301. [PMID: 40233067 PMCID: PMC11999168 DOI: 10.1371/journal.pone.0321301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 04/17/2025] Open
Abstract
This study (1R01HD107002-01A1) protocol describes the planned creation and use of an agent-based model (ABM) of early childhood physical activity (PA). Successful early childhood PA interventions can potentially play an important role in both increasing overall population health as well as closing health disparities across subpopulations. At present, effective strategies for doing so are currently unknown. In large part, this is because PA determinants operate across levels dynamically, interact with one another, and can differ substantially across children. A complex systems approach-specifically, ABM-can be used to provide important insights about effect pathways driving child PA. Design of the proposed ABM will be based on high-quality extant research on childhood physical activity while allowing for the testing of hypotheses that extend beyond this body of literature. Its primary source of input data will be participants in GROW (NCT01316653), a completed cohort-based randomized controlled trial (RCT) that includes extensive longitudinal PA data collected from accelerometer observations of children from ages 3-9. We will iteratively test and improve upon an etiologic ABM of childhood PA, ensuring that it can satisfactorily reproduce micro- and macro-level influences and trends comparable to those seen in GROW. The tested ABM will then be used to extrapolate beyond the context of the GROW RCT, experimentally identifying potentially efficacious intervention strategies to improve childhood physical activity through program implementation or changes in policies and practices. We will use expert input to identify promising intervention approaches. We will use the model to systematically experiment with a wide array of different hypothetical combinations of intervention specifications and combinations. At the end of the model experimentation step, we expect to generate insights of broad applicability to the field of PA science regarding what might work, and for whom, in promoting PA and reducing disparities in these behaviors.
Collapse
Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, United States of America
| | - Adam B. Sedlak
- Department of Mechanical and Aerospace Engineering, University of California San Diego Jacobs School of Engineering, San Diego, California, United States of America
| | - Lydia Reader
- Division of Computational and Data Sciences, Washington University in St. Louis, St Louis, Missouri, United States of America
| | - William J. Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Russell R. Pate
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Amelie G. Ramirez
- Institute for Health Promotion Research and Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Evan C. Sommer
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Shari L. Barkin
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, United States of America
- Brown School at Washington University, St. Louis, Missouri, United States of America
- The Santa Fe Institute, Santa Fe, New Mexico, United States of America
| |
Collapse
|
4
|
Conradson HE, Chirico D, King-Shier K, Rouleau C, Campbell TS, Aggarwal S, Arena R, Hauer T, Wilton SB, Williamson TM. Women's Improvements in Cardiorespiratory Fitness Following Cardiac Rehabilitation Differ by Body Mass Index Category. CJC Open 2025; 7:525-534. [PMID: 40433134 PMCID: PMC12105753 DOI: 10.1016/j.cjco.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 12/10/2024] [Indexed: 05/29/2025] Open
Abstract
Background Improving women's cardiovascular outcomes requires optimizing cardiorespiratory fitness (CRF), as higher CRF predicts improved mortality in people with cardiovascular disease (CVD). As such, increasing CRF is a key goal of cardiac rehabilitation (CR). This study assesses the potential influence of body habitus, assessed by body mass index (BMI), on improvements in CRF in women with CVD. Methods Women (18+ years) diagnosed with CVD who completed a 12-week exercise-based CR program between 1996 and 2016 were included in this retrospective analysis. Women completed a symptom-limited graded exercise test before CR and at CR completion to determine CRF via peak metabolic equivalents (METs). Women were categorized by baseline BMI: normal = 18.5 to 24.9 kg/m2, overweight = 25.0 to 29.9 kg/m2, and obese ≥ 30 kg/m2. Mixed analysis of covariance (ANCOVA) was performed to evaluate the impact of BMI classification on ΔMETs at 12 weeks. Results Data from 1313 women (mean age = 62 ± 11 years) were analyzed. Results from mixed ANCOVA indicated a significant time (pre-CR, 12 weeks) by BMI category interaction (F [2,1307] = 3.20, P = 0.041, ƞp2 = 0.005). Follow-up analyses of variance (ANOVAs) showed significant improvements in ΔMETs in women with normal and overweight BMI categories (standard mean difference =1.03, n = 454 and 0.92, n = 461, respectively, P < 0.001). However, ΔMETs among women classified as obese was nonsignificant using a Bonferroni-adjusted alpha of 0.017 (standardized mean difference [SMD] = 0.79, P = 0.028; n = 398). Conclusions A 12-week exercise-based CR program increased CRF in women classified as normal or overweight by BMI, whereas those with obesity did not realize similar improvements. Women with obesity may need tailored strategies to increase their improvements in CRF in CR. Clinical Trial Registration REB18-0083.
Collapse
Affiliation(s)
| | - Daniele Chirico
- Faculty of Kinesiology, University of Calgary and TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Codie Rouleau
- Department of Psychology, University of Calgary and TotalCardiology, Research Network, Calgary, Alberta, Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary and TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Sandeep Aggarwal
- Departments of Cardiac Sciences and Community Health Sciences, University of Calgary and TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Ross Arena
- Department of Physical Therapy, University of Illinois Chicago, Chicago, Illinois, USA and TotalCardiology Research Network, Calgary, Alberta, Canada
| | - Trina Hauer
- Clinical Operations, TotalCardiology Research Network, Calgary Alberta, Canada
| | - Stephen B. Wilton
- Departments of Cardiac Sciences and Community Health Sciences, University of Calgary and TotalCardiology Research Network, Calgary, Alberta, Canada
| | | |
Collapse
|
5
|
Cao Y, Zhuang C, Zhang Y, Liu C, Li Y. Association of weekend warriors and other physical activity patterns with hypertension in NHANES 2007-2018. Sci Rep 2025; 15:10042. [PMID: 40122925 PMCID: PMC11930929 DOI: 10.1038/s41598-025-95402-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 03/20/2025] [Indexed: 03/25/2025] Open
Abstract
To accommodate the fast-paced nature of modern life, the "Weekend Warriors (WW)" has emerged as a novel physical activity (PA) indicator. This study aims to investigate the relationship between WW and other PA patterns with hypertension, thereby addressing a significant research gap. Data from 30,697 participants in the National Health and Nutrition Examination Survey conducted between 2007 and 2018 were analyzed. We employed multiple regression analyses to examine the relationships among WW, other PA patterns, PA duration, PA intensity, and hypertension, with data stratified by various characteristics. Results showed that compared to the inactive group, the insufficiently PA pattern (OR = 0.9, 95% CI 0.8, 1.0), the WW group (OR = 0.9, 95% CI 0.7, 1.1), and the regularly active group (OR = 0.8, 95% CI 0.8, 0.9) were all negatively associated with hypertension, with the WW group showing a trend towards a reduced prevalence of hypertension (P for trend < 0.01). This association was particularly evident among middle-aged and older adults aged 41-80 years. Additionally, total moderate-to-vigorous physical activity (MVPA) time, as well as moderate and vigorous PA intensity, showed "L"-shaped and "U"-shaped relationships with hypertension, with inflection points at 2640 MET minutes, 45%, and 62%, respectively. Our study provides insights for selecting suitable PA patterns but indicates the need for further research.
Collapse
Affiliation(s)
- Yuhan Cao
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Chenyu Zhuang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Yaojia Zhang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Caiyu Liu
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Yan Li
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, China.
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Medical College, Yangzhou University, Yangzhou, 225009, China.
- Medical College, Yangzhou University, Yangzhou, 225002, China.
| |
Collapse
|
6
|
Ueno K, Kaneko H, Kamiya K, Suzuki Y, Okada A, Takeda N, Fujiu K, Morita H, Ako J, Node K, Yasunaga H, Komuro I. Age-Dependent Relationship of Physical Inactivity With Incident Cardiovascular Disease: Analysis of a Large Japanese Cohort. Can J Cardiol 2025; 41:470-477. [PMID: 38906248 DOI: 10.1016/j.cjca.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND There have been limited studies examining age-dependent associations between physical inactivity and cardiovascular disease (CVD). We aimed to clarify the age-dependent relationship of physical inactivity with incident CVD. METHODS We analyzed 1,097,424 participants, aged 18 to 105 years, without histories of CVD, enrolled in the DeSC database (median age, 63 years; 46.4% men). We categorized participants into the following 4 groups based on age: ≤ 44 years (n = 203,835); 45 to 64 years (n = 403,619); 65 to 79 years (n = 437,236); and ≥ 80 years (n = 52,734). We used 3 physical inactivity components gained from the self-reported questionnaire during a health checkup. The outcomes were composite CVD events including myocardial infarction, stroke, heart failure, and each CVD event. RESULTS During a mean follow-up of 3.2 ± 1.9 years, 81,649 CVD events were observed. The hazard ratios of 3 physical inactivity components for CVD events increased with age category (P for interaction < 0.001). For example, the hazard ratio (95% confidence interval) of physical inactivity defined as not doing light sweaty exercise for 30 minutes at least twice a week for incident CVD in the groups aged ≤ 44 years, 45 to 64 years, 65 to 79 years, and ≥ 80 years were 0.97 (0.88-1.05), 1.08 (1.05-1.12), 1.12 (1.10-1.15), and 1.17 (1.12-1.21), respectively (P for interaction < 0.001). This association was consistent across subtypes of CVD including heart failure, myocardial infarction, and stroke. CONCLUSIONS The association of physical inactivity with a higher risk of developing CVD increased with age. Preventive efforts for physical activity optimization may be more valuable in older people.
Collapse
Affiliation(s)
- Kensuke Ueno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine and The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Frontier Cardiovascular Science, The University of Tokyo, Tokyo, Japan; International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
7
|
Svane J, Wiktorski T, Eftestøl T, Ørn S. Alterations in the autonomic and haemodynamic response to prolonged high-intensity endurance exercise in individuals with coronary artery calcification. Exp Physiol 2025; 110:454-463. [PMID: 39739445 PMCID: PMC11868015 DOI: 10.1113/ep092201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 10/28/2024] [Indexed: 01/02/2025]
Abstract
Endurance exercise is associated with increased life duration and improved life quality. Paradoxically, high exercise intensity is also associated with increased coronary artery calcification (CAC) and a small but significant increased risk of adverse cardiac events during exercise. The mechanisms underlying the development of CAC during prolonged high-intensity endurance exercise are unknown. This study aims to determine if there are differences in cardiovascular haemodynamic measures and heart rate variability (HRV) in individuals with (CAC+) and without CAC (CAC-). Hemodynamic measures from 56 healthy, middle-aged (median [interquartile range] 51 [43-58] years) individuals (41 men/15 women) participating in a 91 km [251.2 [217.2-271.6] min] leisure sport mountain bike race were included in this study. Twenty-five participants (20 men/5 women) were classified as CAC+ based on coronary computed tomographic assessment. Haemodynamic measures and HRV were quantified at the top of the hardest hill (THH) during the last quarter of the race. At the top of THH, CAC+ individuals had significantly higher systolic blood pressure (SBP) (235 [225-245] mmHg vs. 220 [193-238] mmHg, P = 0.008), higher diastolic blood pressure (DBP) (105 [95-110] mmHg vs. 95 [85-110] mmHg, P = 0.006), higher pulse pressure (130 [125-140] mmHg vs. 123 [110-130] mmHg, P = 0.039), higher mean rate pressure product (33,882 [30,872-35,053] bpm × mmHg vs. 31,028 [27,392-33,047] bpm × mmHg, P = 0.028), and larger increase in DBP from baseline (20 [20-30] mmHg vs. 10 [0-20] mmHg, P = 0.001), compared with CAC- individuals. Further, CAC+ participants showed a significant reduction in the low-frequency component of HRV (HRVLF) (6.3 [2.4-11.5] ms2 vs. 12.4 [6.8-20.2] ms2, P = 0.044). In multivariable analysis, HRVLF was an independent predictor of the presence of CAC even after adjusting for established risk factors of atherosclerosis: age, sex, body mass index, maximum heart rate,V ̇ O 2 max ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{max}}}}$ , smoking, resting SBP and resting DBP. CAC+ individuals had significant alterations in haemodynamic measures and HRVLF following prolonged high-intensity endurance exercise compared with individuals without CAC. HRVLF was an independent predictor of CAC, suggesting an adverse autonomic response to high-intensity endurance exercise in individuals with CAC.
Collapse
Affiliation(s)
- Jakob Svane
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
| | - Tomasz Wiktorski
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
| | - Trygve Eftestøl
- Department of Electrical Engineering and Computer ScienceUniversity of StavangerStavangerNorway
| | - Stein Ørn
- Division of CardiologyStavanger University HospitalStavangerNorway
| |
Collapse
|
8
|
Tardo DT, Papadakis M. Are the Cardiovascular Benefits and Potential Risks of Physical Activity and Exercise Dependent on Race, Ethnicity, or Sex? Can J Cardiol 2025; 41:456-469. [PMID: 39547410 DOI: 10.1016/j.cjca.2024.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 11/02/2024] [Accepted: 11/08/2024] [Indexed: 11/17/2024] Open
Abstract
Physical activity (PA) is established as a cornerstone of cardiovascular health, however, disparities in participation exist across sociocultural groups, which in turn affect cardiovascular outcomes. Evidence suggests that although the positive cardiovascular effects of exercise are consistent across populations, notable differences in the magnitude of these benefits exist for racial and ethnic minorities and the female sex. Women derive greater protection from PA compared with men, with reduced rates of sudden cardiac death. In this review we examine the complex interplay of race and/or ethnicity and sex on the cardiovascular benefits associated with PA and exercise, cardiovascular adaptations to exercise, risks of sudden cardiac death, and "excessive" volume of exercise. Understanding these factors is crucial for developing targeted interventions to promote cardiovascular health and offset disparities.
Collapse
Affiliation(s)
- Daniel T Tardo
- Cardiovascular and Genomics Research Institute, City St George's University of London, London, United Kingdom; St George's University Hospitals NHS Foundation Trust, London, United Kingdom; School of Medicine, The University of Notre Dame, Sydney, Australia. https://twitter.com/DrDanTardo
| | - Michael Papadakis
- Cardiovascular and Genomics Research Institute, City St George's University of London, London, United Kingdom; St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Cleveland Clinic London, London, United Kingdom.
| |
Collapse
|
9
|
Chen ML, Li J, Iyer KR, Tcheandjieu C, Jimenez S, Salfati ELI, Del Gobbo LC, Stefanick ML, Desai M, Xue X, Assimes TL. Premorbid predictors of death at initial presentation of coronary heart disease in the Women's Health Initiative study. Am J Prev Cardiol 2025; 21:100931. [PMID: 39911229 PMCID: PMC11795550 DOI: 10.1016/j.ajpc.2025.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 12/20/2024] [Accepted: 01/12/2025] [Indexed: 02/07/2025] Open
Abstract
Background Premorbid health traits that increase the risk of dying at the time of initial presentation of coronary heart disease (CHD) remain poorly characterized. Methods We followed 148,230 post-menopausal participants in the Women's Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event. Results A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product, an electrocardiographic measure highly correlated with left ventricular mass index on echocardiography, each independently increased the relative risk (RR) of dying from one's initial presentation of CHD by 46 % (95 % confidence interval [CI], 35 to 58 %), 30 % (8 to 51 %,), and 17 % (7 to 28 %), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one's relative risk by 32 % (12 to 49 %). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years. Conclusions Modifiable factors affect a post-menopausal woman's risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality risk of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.
Collapse
Affiliation(s)
- Ming-Li Chen
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Jin Li
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Thermo Fisher Scientific, South San Francisco, CA, USA
| | - Kruthika R. Iyer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto VA Healthcare System, Palo Alto, CA, USA
- Gladstone Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, CA, USA
| | - Catherine Tcheandjieu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto VA Healthcare System, Palo Alto, CA, USA
- Gladstone Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, CA, USA
| | - Shirin Jimenez
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Internal Medicine (Division of Cardiovascular Medicine), University of California Davis Health, Davis, CA, USA
| | - Elias Levy Itshak Salfati
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Scripps Research Translational Institute at Scripps Research, La Jolla, CA, USA
| | - Liana C. Del Gobbo
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Manisha Desai
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiaonan Xue
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Palo Alto VA Healthcare System, Palo Alto, CA, USA
| |
Collapse
|
10
|
Wilson OWA, Wojcik KM, Cohen CM, Kamil D, Butera G, Matthews CE, Dieli-Conwright CM, Jayasekera J. Exercise and cardiovascular health among breast cancer survivors: a scoping review of current observational evidence. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2025; 11:24. [PMID: 40012001 DOI: 10.1186/s40959-025-00310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 01/23/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND Breast cancer survivors are at increased risk of cardiovascular events due to the cardiotoxic effects of cancer treatment. Exercise participation can lower the risk of various adverse cardiovascular health outcomes. However, most breast cancer survivors do not meet exercise guidelines. OBJECTIVES To map and critically evaluate the observational literature describing the direction and strength of the relationship between post-diagnosis leisure-time exercise (aerobic and muscle-strengthening) and cardiovascular health (cardiovascular disease, cardiac function, and related physiological risk factors) among diverse breast cancer survivors; and identify variations in this relationship based on race, ethnicity, and/or socioeconomic status. METHODS Our scoping review was conducted in accordance with established guidelines and frameworks. Seven databases were searched. Participant characteristics, findings regarding the relationship between exercise and cardiovascular health, and any variations in this relationship were extracted. Article quality was appraised using the Mixed Methods Appraisal Tool. RESULTS Fourteen sources were identified, and study quality varied. Two adjusted analyses found aerobic exercise may lower the risk of cardiovascular disease. There was limited data found on the direction and strength of an adjusted relationship between exercise (aerobic or muscle-strengthening) and other cardiovascular outcomes or possible variations in the relationship across racial, ethnic, or socioeconomic groups. CONCLUSION Findings highlight a considerable gap in knowledge regarding the relationship between exercise and cardiovascular health among diverse breast cancer survivors. Further longitudinal observational research is needed to better establish the direction and strength of this relationship, and how it differs based on race, ethnicity, or socioeconomic status.
Collapse
Affiliation(s)
- Oliver W A Wilson
- National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M Wojcik
- National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Camryn M Cohen
- Clinical Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dalya Kamil
- National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MA, USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jinani Jayasekera
- National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
11
|
Yu T, Parry M, Yu T, Xu L, Wu Y, Zeng T, Leng X, Tong Q, Li F. Effectiveness of Mobile Health-Based Gamification Interventions for Improving Physical Activity in Individuals With Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Serious Games 2025; 13:e64410. [PMID: 39854099 PMCID: PMC11806271 DOI: 10.2196/64410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 11/28/2024] [Accepted: 12/06/2024] [Indexed: 01/26/2025] Open
Abstract
BACKGROUND Gamification refers to using game design elements in nongame contexts. Promoting physical activity (PA) through gamification is a novel and promising avenue for improving lifestyles and mitigating the advancement of cardiovascular diseases (CVDs). However, evidence of its effectiveness remains mixed. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the efficacy of gamification interventions in promoting PA during short-term and follow-up periods in individuals with CVDs and to explore the most effective game design elements. METHODS A comprehensive search of 7 electronic databases was conducted for randomized controlled trials published in English from January 1, 2010, to February 3, 2024. Eligible studies used mobile health-based gamification interventions to promote PA or reduce sedentary behavior in individuals with CVDs. In total, 2 independent reviewers screened the retrieved records, extracted data, and evaluated the risk of bias using the RoB 2 tool. Discrepancies were resolved by a third reviewer. Meta-analyses were performed using a random-effects model with the Sidik-Jonkman method adjusted by the Knapp-Hartung method. Sensitivity analysis and influence analysis examined the robustness of results, while prediction intervals indicated heterogeneity. A meta-regression using a multimodel inference approach explored the most important game design elements. Statistical analyses were conducted using R (version 4.3.2; R Foundation for Statistical Computing). RESULTS In total, 6 randomized controlled trials were included. Meta-analysis of 5 studies revealed a small effect of gamification interventions on short-term PA (after sensitivity analysis: Hedges g=0.32, 95% CI 0.19-0.45, 95% prediction interval [PI] 0.02-0.62). Meta-analysis of 3 studies found the maintenance effect (measured with follow-up averaging 2.5 months after the end of the intervention) was small (Hedges g=0.20, 95% CI 0.12-0.29, 95% PI -0.01 to 0.41). A meta-analysis of 3 studies found participants taking 696.96 more steps per day than the control group (95% CI 327.80 to 1066.12, 95% PI -121.39 to 1515.31). "Feedback" was the most important game design element, followed by "Avatar." CONCLUSIONS This meta-analysis demonstrates that gamification interventions effectively promote PA in individuals with CVD, with effects persisting beyond the intervention period, indicating they are not merely novel effects caused by the game nature of gamification. The 95% PI suggests that implementing gamification interventions in similar populations in the future will lead to actual effects in promoting PA in the vast majority of cases. However, the limited number of included studies underscores the urgent need for more high-quality research in this emerging field. TRIAL REGISTRATION PROSPERO CRD42024518795; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=518795.
Collapse
Affiliation(s)
- Tianzhuo Yu
- School of Nursing, Jilin University, Changchun, China
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Monica Parry
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, China
| | - Linqi Xu
- Faculty of Medicine and Life Sciences, University of Hasselt, Diepenbeek, Belgium
| | - Yuejin Wu
- School of Nursing, Jilin University, Changchun, China
| | - Ting Zeng
- School of Nursing, Jilin University, Changchun, China
| | - Xin Leng
- School of Nursing, Jilin University, Changchun, China
| | - Qian Tong
- Department of Cardiovascular Medicine, Bethune First Hospital of Jilin University, Changchun, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, China
| |
Collapse
|
12
|
Smail EJ, Kaufmann CN, King AC, Espeland MA, Anton S, Manini TM. Effects of a Physical Activity Intervention on Perceived Stress, Fatigue, and Depressive Symptoms in Older Adults: A Secondary Analysis of the LIFE Study. J Gerontol A Biol Sci Med Sci 2025; 80:glae290. [PMID: 39704362 PMCID: PMC11756278 DOI: 10.1093/gerona/glae290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Indexed: 12/21/2024] Open
Abstract
BACKGROUND Engaging in physical activity is critical for maintaining well-being in older adults, particularly those at heightened risk for mobility disability. We assessed the effects of a physical activity (PA) intervention on perceived stress, fatigue, and depressive symptoms compared to a health education (HE) program in older adults with mobility challenges and evaluated differential effects of the interventions among those with the poorest self-rated mental health at baseline. METHODS Secondary data analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, a single-blinded, parallel randomized controlled trial conducted between February 2010 and December 2013. The PA intervention included walking, strength exercises, balance training, and flexibility activities. The HE intervention consisted of workshops on health topics for older adults. The main outcomes for our analysis included standardized scales with participants self-reporting their stress, fatigue, and depressive symptoms at baseline, 12 months, and 24 months postrandomization. RESULTS Results from the 1 495 participants (Mage = 78 years; 66% female in both groups) showed no significant between-group differences in perceived stress, fatigue, or depressive symptom scores over time. However, in both intervention groups, participants with worse baseline scores showed a steady improvement in symptom scores over time compared to the remaining participants, who showed some decline (p value for interaction < .05). CONCLUSIONS Among mobility-impaired individuals, a long-duration, group-based PA intervention had no more impact on stress, fatigue, or depressive symptoms compared to a group-based HE intervention. However, participants with higher symptoms at baseline showed improvement over time in both intervention groups.
Collapse
Affiliation(s)
- Emily J Smail
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Christopher N Kaufmann
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark A Espeland
- Division of Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Stephen Anton
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Todd M Manini
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
13
|
Zhao Q, Feng Q, Seow WJ. Impact of air pollution on depressive symptoms and the modifying role of physical activity: Evidence from the CHARLS study. JOURNAL OF HAZARDOUS MATERIALS 2025; 482:136507. [PMID: 39579693 DOI: 10.1016/j.jhazmat.2024.136507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 11/12/2024] [Accepted: 11/12/2024] [Indexed: 11/25/2024]
Abstract
The association between air pollution and depressive symptoms has not been thoroughly investigated, and the role of physical activity (PA) is particularly unclear. Although PA has been shown to alleviate depression, it may also increase exposure to air pollution, potentially exacerbating its adverse effects. A total of 17,332 participants aged 45 years and older from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study to assess the causal effect of air pollution on depressive symptoms in China and to clarify the role of PA in this relationship. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Data on particulate matter (PM1, PM2.5, and PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were obtained from the ChinaHighAirPollutants (CHAP) dataset. PA levels were measured using a standardized questionnaire and categorized as low or high. An instrumental variable (IV) approach was used to estimate the causal effect of air pollution on depressive symptoms. Potential effect modification by PA was assessed. The IV estimates showed that all air pollutants were significantly and adversely associated with depressive symptoms, with a per interquartile range (IQR) increase in PM1, PM2.5, PM10, NO2, SO2, O3, and CO associated with 1.57 (95% confidence interval (CI): 1.15, 1.99), 1.49 (95% CI: 1.10, 1.89), 1.71 (95% CI: 1.26, 2.17), 2.22 (95% CI: 1.62, 2.81), 1.30 (95% CI: 0.96, 1.65), 4.67 (95% CI: 3.37, 5.98), and 0.97 (95% CI: 0.71, 1.22) units increase in CES-D scores, respectively. PA significantly modified this association, with higher PA levels mitigating the adverse effects of air pollution on depressive symptoms.
Collapse
Affiliation(s)
- Qi Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Qiushi Feng
- Department of Sociology and Anthropology, National University of Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore.
| |
Collapse
|
14
|
Geng J, Zhang X, Guo Y, Wen H, Guo D, Liang Q, Pu S, Wang Y, Liu M, Li Z, Hu W, Yang X, Chang P, Hu L, Li Y. Moderate-intensity interval exercise exacerbates cardiac lipotoxicity in high-fat, high-calories diet-fed mice. Nat Commun 2025; 16:613. [PMID: 39800728 PMCID: PMC11725574 DOI: 10.1038/s41467-025-55917-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/02/2025] [Indexed: 01/16/2025] Open
Abstract
Physical exercise is a cornerstone for preventing diet-induced obesity, while it is unclear whether physical exercise could offset high-fat, high-calories diet (HFCD)-induced cardiac dysfunction. Here, mice were fed with HFCD and simultaneously subjected to physical exercise. As expected, physical exercise prevented HFCD-induced whole-body fat deposition. However, physical exercise exacerbated HFCD-induced cardiac damage. Further metabolomic analysis results showed that physical exercise induced circulating lipid redistribution, leading to excessive cardiac lipid uptake and lipotoxicity. Our study provides valuable insights into the cardiac effects of exercise in mice fed with HFCD, suggesting that counteracting the negative effect of HFCD by simultaneous physical exercise might be detrimental. Moreover, inappropriate physical exercise may damage certain organs even though it leads to weight loss and overall metabolic benefits. Of note, the current findings are based on animal experiments, the generalizability of these findings beyond this specific diet and mouse strain remains to be further explored.
Collapse
Affiliation(s)
- Jing Geng
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Xiaoliang Zhang
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
- Department of Cardiology, No.901 Hospital of PLA, Hefei, China
| | - Yanjie Guo
- Xi'an International Medical Center Hospital, Xi'an, China
| | - He Wen
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Dong Guo
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Qi Liang
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Siying Pu
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Ying Wang
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Mingchuan Liu
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Zhelong Li
- Department of Ultrasound Diagnostics, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Wei Hu
- Department of Ultrasound Diagnostics, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Xue Yang
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China
| | - Pan Chang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Medical College, Xi'an, China
| | - Lang Hu
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China.
| | - Yan Li
- Department of Cardiology, Tangdu Hospital, Airforce Medical University, Xi'an, China.
| |
Collapse
|
15
|
Yates T, Razieh C, Henson J, Rowlands AV, Goldney J, Gulsin GS, Davies MJ, Khunti K, Zaccardi F, McCann GP. Device-measured physical activity and cardiac structure by magnetic resonance. Eur Heart J 2025; 46:176-186. [PMID: 39140328 PMCID: PMC11704417 DOI: 10.1093/eurheartj/ehae506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/18/2024] [Accepted: 07/25/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND AND AIMS Although extreme cardiac adaptions mirroring phenotypes of cardiomyopathy have been observed in endurance athletes, adaptions to high levels of physical activity within the wider population are under-explored. Therefore, in this study, associations between device-measured physical activity and clinically relevant cardiac magnetic resonance volumetric indices were investigated. METHODS Individuals without known cardiovascular disease or hypertension were included from the UK Biobank. Cardiac magnetic resonance data were collected between 2015 and 2019, and measures of end-diastolic chamber volume, left ventricular (LV) wall thickness, and LV ejection fraction were extracted. Moderate-to-vigorous-intensity physical activity (MVPA), vigorous-intensity physical activity (VPA), and total physical activity were assessed via wrist-worn accelerometers. RESULTS A total of 5977 women (median age and MVPA: 62 years and 46.8 min/day, respectively) and 4134 men (64 years and 49.8 min/day, respectively) were included. Each additional 10 min/day of MVPA was associated with a 0.70 [95% confidence interval (CI): 0.62, 0.79] mL/m2 higher indexed LV end-diastolic volume (LVEDVi) in women and a 1.08 (95% CI: 0.95, 1.20) mL/m2 higher LVEDVi in men. However, even within the top decile of MVPA, LVEDVi values remained within the normal ranges [79.1 (95% CI: 78.3, 80.0) mL/m2 in women and 91.4 (95% CI: 90.1, 92.7) mL/m2 in men]. Associations with MVPA were also observed for the right ventricle and the left/right atria, with an inverse association observed for LV ejection fraction. Associations of MVPA with maximum or average LV wall thickness were not clinically meaningful. Results for total physical activity and VPA mirrored those for MVPA. CONCLUSIONS High levels of device-measured physical activity were associated with cardiac remodelling within normal ranges.
Collapse
Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Joe Henson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Jonathan Goldney
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- Leicester Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
16
|
Bai B, Liu Q, Liu Y, Liu F, Wang Y, Chen Y, Liang Y, Wang H, Wu C, Guo L, Ma H, Geng Q. Long-term trends in lifestyle factors among respondents with dyslipidemia in the United States. Am J Med Sci 2024; 368:600-609. [PMID: 38972378 DOI: 10.1016/j.amjms.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 05/15/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES To explore the long-term trends in unhealthy lifestyle factors and the risk sociodemographic subgroups among people with dyslipidemia. METHODS Data extracted from the 1999 to 2018 National Health and Nutrition Examination Survey (NHANES). Lifestyle factors were smoking status, alcohol drinking, obesity, dietary quality, depression, physical activity, and sedentary behavior. A Joinpoint regression model was used to estimate trends in the log-transformed age-standardized prevalence. Multinomial logistic regression models adjusted for age, sex, and race/ethnicity were used to analyze subgroups by sociodemographic factors. RESULTS Data for 33,680 respondents were extracted between 1999 and 2018. The prevalence of smoking and poor-quality diet decreased from 1999 to 2018 (P<0.001), while obesity significantly increased (P<0.001). The prevalence of depression marginally increased from 2005 to 2018 (P=0.074). We observed that non-Hispanic Black individuals, Hispanics, males, as well as those with lower family income-to-poverty ratios and education levels, unemployed individuals, or those lacking a spouse/live-in partner, were at elevated risk of unhealthy lifestyle factors when compared to the reference groups. CONCLUSIONS Among NHANES respondents from 1999 to 2018 with dyslipidemia, significant reductions in the prevalence of current smoking and poor diet were observed, while the prevalence of obesity was markedly increased. There were sociodemographic differences in the management of lifestyle factors. Further initiatives to encourage people with dyslipidemia are required to reduce potential adverse outcomes.
Collapse
Affiliation(s)
- Bingqing Bai
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou 511442, PR China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Quanjun Liu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yuting Liu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Fengyao Liu
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Yu Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yilin Chen
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanting Liang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Haochen Wang
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Chao Wu
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Lan Guo
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Huan Ma
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China.
| | - Qingshan Geng
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, PR China.
| |
Collapse
|
17
|
Romeo B, Bergami M, Cenko E, Manfrini O, Bugiardini R. Sex Disparities in Ischemic Heart Disease Mortality in Europe. JACC. ADVANCES 2024; 3:101252. [PMID: 39817073 PMCID: PMC11733970 DOI: 10.1016/j.jacadv.2024.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 01/03/2025]
Abstract
Background Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and countries can help in tailoring effective public health policies. Objectives The purpose of the study was to examine trends in sex differences in IHD prevalence and prognosis within the EU. Methods We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex-specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019. Results Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women (from 1.752 to 1.662) and men (from 3.372 to 3.135), sex disparities in ASMR-to-ASPR index (EU average: 4.96% vs 4.34%) persisted (with a women-to-men ratio ranging from 1.05 to 1.44). No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania, which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12, and Germany: 4.79% vs 3.80%; ratio: 1.26). Conclusions Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality.
Collapse
Affiliation(s)
- Benedetta Romeo
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Bergami
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Edina Cenko
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Olivia Manfrini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola Hospital, Bologna, Italy
| | - Raffaele Bugiardini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
18
|
Counts CJ, John-Henderson NA. Childhood trauma and college student health: a review of the literature. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:2783-2797. [PMID: 36595473 DOI: 10.1080/07448481.2022.2130336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 06/17/2023]
Abstract
The experience of childhood trauma is known to predict health-relevant outcomes across the lifespan. Previous reviews summarize existing knowledge of the implications of childhood trauma for health in young adults and adults more generally. The current theoretical review aims to integrate the existing literature on the relationship between childhood trauma and health-relevant outcomes specifically in college students, consolidating findings across specific health domains. Further, the following theoretical review highlights the need for more research in this area and discusses how college campuses may use the knowledge in this area of work to develop targeted interventions aimed at improving the health of college students who experienced trauma in childhood.
Collapse
Affiliation(s)
- Cory J Counts
- Department of Psychology, Montana State University, Bozeman, Montana, USA
| | | |
Collapse
|
19
|
Flack JM, Bitner S, Buhnerkempe M. Evolving the Role of Black Race in Hypertension Therapeutics. Am J Hypertens 2024; 37:739-744. [PMID: 39022802 DOI: 10.1093/ajh/hpae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/30/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
Black race has been used to guide antihypertensive drug selection for Black patients based on predominant between race (same drug) and intra-race (different drugs) blood pressure (BP) response patterns. Accordingly, thiazide diuretics and calcium antagonists have been recommended over renin-angiotensin system (RAS) inhibitors (angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors) and beta blockers for Black patients. Current antihypertensive drug prescribing reflects historical guidance as calcium antagonists and thiazide diuretics are prescribed more and RAS blockers less in Black than White patients. Hypertension control rates in Blacks, lag those for Whites despite their greater use of combination drug therapy and lesser use of monotherapy. This is also true across drug regimens containing any of the 4 recommended classes for initial therapy as well as for evidence-based combination drug therapy (calcium antagonist or thiazide diuretic + RAS blocker) regimens for which there is no known racial disparity in BP response. Current recommendations acknowledge the need for combination drug therapy in most, especially in Black patients. One exemplary comprehensive hypertension control program achieved >80% control rates in Black and White patients with minimal racial disparity while utilizing a race-agnostic therapeutic algorithm. Black patients manifest robust, if not outsized, BP responses to diet/lifestyle modifications. Importantly, race neither appears to be a necessary nor sufficient consideration for the selection of effective drug therapy. Accordingly, we urge the initiation of adequately intense race-agnostic drug therapy coupled with greater emphasis on diet/lifestyle modifications for Black patients as the cornerstone of a race-informed approach to hypertension therapeutics.
Collapse
Affiliation(s)
- John M Flack
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Stephanie Bitner
- Hypertension Section, Division of General Internal Medicine, Department of Medicine, Southern Illinois University School of Medicine, Springfield IL, USA
| | - Michael Buhnerkempe
- Department of Medicine, Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
20
|
Saz-Lara A, Cavero-Redondo I, Del Saz-Lara A, Rodríguez-Gutiérrez E, Bizzozero-Peroni B, Pascual-Morena C. The acute effect of exercise on the endothelial glycocalyx in healthy adults: A systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14240. [PMID: 38747101 DOI: 10.1111/eci.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND In recent years, it has been demonstrated that when the endothelial glycocalyx, composed of proteoglycans, glycosaminoglycans and glycoproteins, is altered or modified, this property is lost, playing a fundamental role in cardiovascular pathologies. Cardiovascular risk factors can destroy the endothelial glycocalyx layer. Exercise has a positive effect on cardiovascular risk factors, but little is known about its direct effect on the integrity of the endothelial layer. METHODS The Cochrane Library, PubMed, Web of Science and Scopus databases were searched from their inception to June 30, 2022. The DerSimonian and Laird method was used to compute pooled effect size estimates and their respective 95% confidence intervals for the acute effect of exercise (within 24 h) on the endothelial glycocalyx and its components in healthy adults. RESULTS Ten studies were included in the meta-analysis, with a total of 252 healthy subjects. The types of exercise included were resistance training, interval training, resistance training and maximal incremental exercise, with a duration range of 30-60 min. Glycocalyx assessment times included ranged from 0 to 90 min post-exercise. Our findings showed that endothelial glycocalyx increases after acute effect of exercise in healthy population (.56, 95% CI: .38, .74). The acute effect of exercise on endothelial glycocalyx components were .47 (95% CIs: .27, .67) for glycosaminoglycans, .67 (95% CIs: .08, 1.26) for proteoglycans and .61 (95% CIs: .35, .86) for glycoproteins. CONCLUSIONS In a healthy population, various types of exercise showed an acute improvement of the endothelial glycocalyx and its individual components.
Collapse
Affiliation(s)
- Alicia Saz-Lara
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Andrea Del Saz-Lara
- Laboratory of Epigenetics of Lipid Metabolism, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, Madrid, Spain
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM + CSIC, Madrid, Spain
| | | | - Bruno Bizzozero-Peroni
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Departamento de Educación Físicay Salud, Instituto Superior de Educación Física, Universidad de la República, Rivera, Uruguay
| | | |
Collapse
|
21
|
Schrauben SJ, Park D, Amaral S, Purcell A, Zhang S, Kearney M, Bilger A, Feldman HI, Dember LM. Supporting Self-Management of Healthy Behaviors in Chronic Kidney Disease and Hypertension: The Supporting Self-Management of Healthy Behaviors Pilot Randomized Trial. Clin J Am Soc Nephrol 2024; 19:1109-1118. [PMID: 38954482 PMCID: PMC11390029 DOI: 10.2215/cjn.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
Key Points Support programs for self-management are underutilized among people with CKD. Implementing a smartphone support tool for self-monitoring physical activity and BP was feasible among people with CKD and hypertension. Despite low digital health literacy, Supporting Self-Management of Healthy Behaviors was observed to be readily usable because of high levels of adherence and usability scores. Background Support programs for self-management are underutilized among people with CKD. We examined the feasibility of a smartphone-based intervention to support physical activity and BP monitoring, Supporting Self-Management of Healthy Behaviors (SMART-HABITS), for individuals with CKD and hypertension. Methods SMART-HABITS was piloted in a 12-week randomized cross-over trial among people with CKD and hypertension. Participants were asked to monitor BP ≥3-times/wk and step counts ≥5-times/wk. Participants were randomized to BP communication approach–self-report through text message for 6 weeks versus automatic reporting with a smartphone application (app) paired to a Bluetooth enabled BP machine for the alternate 6 weeks. The approach to monitoring and reporting steps was the same during both phases. Primary outcomes were adoption (retention and use of SMART-HABITS dashboard), adherence (% of transmitted BP and step counts), and acceptability as assessed with surveys and interviews. Secondary outcomes were reach, maintenance, CKD knowledge, digital health literacy, self-management, self-efficacy, quality of life, step counts, and BP values. Interviews were conducted at study end. Results Of the 47 randomized participants, 44 (94%) completed the text phase and 43 (92%) completed the app phase. The median age was 63 years, 49% were female, and 45% were Black. Retention was 91%. BP adherence was 87% in the text phase and 74% in the app phase, and step count adherence was 97%. Acceptability scores were high, and interviews largely conveyed acceptance. CKD knowledge increased but remaining survey scores did not change. Mean step counts increased from the prestudy period similarly in both phases. BP did not change over time. Conclusions Implementing a smartphone support tool for self-management was feasible among people with CKD and hypertension. The approach can supplement clinic-based care and potentially lead to less cardiovascular disease and CKD progression. Clinical Trial registry name and registration number: NCT04858295 .
Collapse
Affiliation(s)
- Sarah J. Schrauben
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane Park
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sandra Amaral
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Siqi Zhang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Kearney
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea Bilger
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I. Feldman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura M. Dember
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
22
|
Litwin L, Sundholm JKM, Olander RFW, Meinilä J, Kulmala J, Tammelin TH, Rönö K, Koivusalo SB, Eriksson JG, Sarkola T. Associations Between Sedentary Time, Physical Activity, and Cardiovascular Health in 6-Year-Old Children Born to Mothers With Increased Cardiometabolic Risk. Pediatr Exerc Sci 2024; 36:146-154. [PMID: 38154001 DOI: 10.1123/pes.2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 12/30/2023]
Abstract
PURPOSE To assess associations between sedentary time (ST), physical activity (PA), and cardiovascular health in early childhood. METHOD Cross-sectional study including 160 children (age 6.1 y [SD 0.5], 86 boys, 93 maternal body mass index ≥ 30 kg/m2, and 73 gestational diabetes) assessed for pulse wave velocity, echocardiography, ultra-high frequency 48-70 MHz vascular ultrasound, and accelerometery. RESULTS Boys had 385 (SD 53) minutes per day ST, 305 (SD 44) minutes per day light PA, and 81 (SD 22) minutes per day moderate to vigorous PA (MVPA). Girls had 415 (SD 50) minutes per day ST, 283 (SD 40) minutes per day light PA, and 66 (SD 19) minutes per day MVPA. In adjusted analyses, MVPA was inversely associated with resting heart rate (β = -6.6; 95% confidence interval, -12.5 to -0.7) and positively associated with left ventricular mass (β = 6.8; 1.4-12.3), radial intima-media thickness (β = 11.4; 5.4-17.5), brachial intima-media thickness (β = 8.0; 2.0-14.0), and femoral intima-media thickness (β = 1.3; 0.2-2.3). MVPA was inversely associated with body fat percentage (β = -3.4; -6.6 to -0.2), diastolic blood pressure (β = -0.05; -0.8 to -0.1), and femoral (β = -18.1; -32.4 to -0.8) and radial (β = -13.4; -24.0 to -2.9) circumferential wall stress in boys only. ST and pulse wave velocity showed no significant associations. CONCLUSIONS In young at-risk children, MVPA is associated with cardiovascular remodeling, partly in a sex-dependant way, likely representing physiological adaptation, but ST shows no association with cardiovascular health in early childhood.
Collapse
Affiliation(s)
- Linda Litwin
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
- Department of Congenital Heart Defects and Pediatric Cardiology, FMS in Zabrze, Medical University of Silesia, Katowice,Poland
| | - Johnny K M Sundholm
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
- Minerva Foundation Institute for Medical Research, Helsinki,Finland
| | - Rasmus F W Olander
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
| | - Jelena Meinilä
- Department of Food and Nutrition, University of Helsinki, Helsinki,Finland
| | - Janne Kulmala
- Likes, School of Health and Social Studies, Jamk University of Applied Sciences, Jyväskylä,Finland
| | - Tuija H Tammelin
- Likes, School of Health and Social Studies, Jamk University of Applied Sciences, Jyväskylä,Finland
| | - Kristiina Rönö
- Women's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
| | - Saila B Koivusalo
- Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku,Finland
- University of Helsinki and Helsinki University Hospital, Helsinki,Finland
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki,Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
- Human Potential Translational Research Programme and Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University Singapore, Singapore,Singapore
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore,Singapore
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,Finland
- Minerva Foundation Institute for Medical Research, Helsinki,Finland
| |
Collapse
|
23
|
Noh S, Choo J. Gender-Specific Clustering of Lifestyle Behaviors and Its Impacts on Cardiovascular Health. J Cardiovasc Nurs 2024; 39:E115-E125. [PMID: 37249529 DOI: 10.1097/jcn.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Unhealthy lifestyle behaviors associated with cardiovascular risk manifest a clustering pattern. OBJECTIVE Our aim was to identify behavioral clusters by using 5 unhealthy lifestyle behaviors among the Korean population and examine the impacts of identified behavioral clusters on cardiovascular health (CVH). METHODS A cross-sectional study was conducted using data from the sixth Korea National Health and Nutrition Examination Survey. The participants were 7898, aged 19 to 64 years. The cluster analysis was performed using the behaviors of current smoking, binge drinking, physical inactivity, insufficient fruit intake, and sugar-sweetened beverage drinking. Cardiovascular health was defined as a composite modified z score calculated using biophysical factors. RESULTS Men manifested 4 clusters (ie, risky binge drinkers, dominant smokers, dominant sugar-sweetened beverage drinkers, and nonsubstance/low-fruit eaters) characterized predominantly by substance use; women had 4 clusters (ie, substance users, physically inactive/low-fruit eaters, physically inactive/fruit eaters, and active adherers) characterized predominantly by physical inactivity. Among men, the clusters of dominant smokers and risky binge drinkers had significantly lower CVH scores than those with poor eating behaviors. Among women, the clusters of substance users and physically inactive/low-fruit eaters had significantly lower CVH scores than the active adherers. All the clusters in men had lower CVH scores than the worst cluster in women. CONCLUSIONS There was a gender difference in the clustering pattern. The clusters with smoking and binge drinking in men and women were associated with negative impacts on CVH. Healthcare professionals should pay attention to the clustering pattern to design an efficient lifestyle intervention for cardiovascular disease prevention.
Collapse
|
24
|
Burger AL, Wegberger C, Tscharre M, Kaufmann CC, Muthspiel M, Pogran E, Freynhofer MK, Szalay A, Huber K, Jäger B. Impact of an Ultra-Endurance Marathon on Cardiac Function in Association with Cardiovascular Biomarkers. SPORTS MEDICINE - OPEN 2024; 10:67. [PMID: 38851665 PMCID: PMC11162405 DOI: 10.1186/s40798-024-00737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Participation in ultra-endurance races may lead to a transient decline in cardiac function and increased cardiovascular biomarkers. This study aims to assess alterations in biventricular function immediately and five days after the competition in relation to elevation of high-sensitivity cardiac Troponin I (hs-cTnI) and N-terminal-pro-brain-natriuretic-peptide (NT-proBNP). METHODS AND RESULTS Fifteen participants of an ultramarathon (UM) with a running distance of 130 km were included. Transthoracic echocardiography and quantification of biomarkers was performed before, immediately after and five days after the race. A significant reduction in right ventricular fractional area change (FAC) was observed after the race (48.0 ± 4.6% vs. 46.7 ± 3.8%, p = 0.011) that persisted five days later (48.0 ± 4.6% vs. 46.3 ± 3.9%, p = 0.027). No difference in left ventricular ejection fraction (LVEF) was found (p = 0.510). Upon stratification according to biomarkers, participants with NT-proBNP above the median had a significantly reduced LVEF directly (60.8 ± 3.6% vs. 56.9 ± 4.8%, p = 0.030) and five days after the race (60.8 ± 3.6% vs. 55.3 ± 4.5%, p = 0.007) compared to baseline values. FAC was significantly reduced five days after the race (48.4 ± 5.1 vs. 44.3 ± 3.9, p = 0.044). Athletes with hs-cTnI above the median had a significantly reduced FAC directly after the race (48.1 ± 4.6 vs. 46.5 ± 4.4, p = 0.038), while no difference in LVEF was observed. No alteration in cardiac function was observed if hs-cTnI or NT-proBNP was below the median. CONCLUSION A slight decline in cardiac function after prolonged strenuous exercise was observed in athletes with an elevation of hs-cTnI and NT-proBNP above the median but not below.
Collapse
Affiliation(s)
- Achim Leo Burger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria.
- Medical School, Sigmund Freud University, Vienna, Austria.
| | - Claudia Wegberger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Maximilian Tscharre
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Christoph C Kaufmann
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Marie Muthspiel
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Edita Pogran
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Matthias K Freynhofer
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Alexander Szalay
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
| | - Kurt Huber
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | - Bernhard Jäger
- 3rd Medical Department with Cardiology and Intensive Care Medicine, Clinic Ottakring, Montleartstrasse 37, 1160, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| |
Collapse
|
25
|
Tamiya H, Kawashiri H, Miyamoto T, Tsubaki A. Acute Effects of Skeletal Muscle Electrical Stimulation on Central and Lower Extremity Hemodynamics. Cureus 2024; 16:e62988. [PMID: 38915840 PMCID: PMC11194163 DOI: 10.7759/cureus.62988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Belt electrode-skeletal muscle electrical stimulation (B-SES) is a treatment prescribed for individuals with difficulty performing exercise therapy that improves muscle strength, exercise tolerance, and glucose metabolism. However, the effects of B-SES on the hemodynamics of the central and lower extremity conduit arteries have not been studied. Therefore, this study compared the acute effects of B-SES on the central and lower extremity conduit arteries in healthy young males. METHODS This randomized crossover study included nine healthy young males (mean age: 21.0±1.1 years). Participants were assigned to the following experimental conditions, with a washout period of one week: condition 1 included 20 min of electrical stimulation of the lower extremity at the participant's sensation threshold intensity (Sham, n=9) and condition 2 included 20 min of electrical stimulation of the lower extremity at the maximum intensity the participant can tolerate (B-SES, n=9). The heart rate (HR), stroke volume (SV), cardiac output (CO), mean arterial pressure (MAP), and total peripheral vascular resistance (TPR) were measured as central hemodynamics. The hemodynamics of the lower extremity conduit arteries were measured and calculated for the shallow femoral artery (SFA), including vessel diameter, mean blood flow velocity (MBFV), shear rate (SR), and mean blood flow (MBF) rate. These indices were measured before stimulation (Pre), 10 min after the start of stimulation (Stimulating), and immediately after the end of stimulation (Post). These indices were compared using a repeated two-way analysis of variance. RESULTS In B-SES, HR (Pre: 63.2±8.6; Stimulating: 73.7±6.9; Post: 70.0±4.2 bpm, p<0.01), CO (Pre: 5.1±1.0; Stimulating: 6.5±1.5, p<0.01; Post: 6.3±1.2 L/min, p=0.02), and MAP (Pre: 104.0±11.5; Stimulating: 116.4±10.8, p<0.01; Post: 109.6±9.7 mmHg, p=0.02) increased significantly. In addition, B-SES significantly increased MBFV (Pre: 19.2±4.0; Stimulating: 50.5±14.9; Post: 30.1±4.0 cm/s, p<0.01), SR (Pre: 118.9±28.8; Stimulating: 302.7±91. 2, p<0.01; Post: 182.1±70.1/s, p=0.02), and MBF (Pre: 382.0±61.5; Stimulating: 1009.6±321.4; Post: 626.8±176.6 mL/min, p<0.01). However, there were no significant changes in SV and TPR. CONCLUSIONS The findings of this study indicate that B-SES in healthy young males increases CO without increasing SV or TPR and improves the MBFV and SR in the SFA.
Collapse
Affiliation(s)
- Hajime Tamiya
- Department of Exercise Physiology, Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, JPN
| | - Hina Kawashiri
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, JPN
| | - Toshiaki Miyamoto
- Department of Physical Therapy, Faculty of Rehabilitation, Kansai Medical University, Osaka, JPN
| | - Atsuhiro Tsubaki
- Department of Exercise Physiology, Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, JPN
| |
Collapse
|
26
|
Ung GA, Nguyen KH, Hui A, Wong ND, Dineen EH. Impact of cardiorespiratory fitness and diabetes status on cardiovascular disease and all-cause mortality: An NHANES retrospective cohort study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 42:100395. [PMID: 38689681 PMCID: PMC11059329 DOI: 10.1016/j.ahjo.2024.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
High cardiorespiratory fitness (CRF) is associated with decreased mortality in people with pre-diabetes (pre-DM) and diabetes mellitus (DM); however, the degree to which CRF attenuates the risk of cardiovascular disease (CVD)-related and all-cause mortality is unclear. Study objective We examined the impact of CRF status on CVD-related morbidity and all-cause mortality in non-DM, Pre-DM, and DM populations. Design and setting 13,968 adults from the Third US National Health and Nutrition Examination Survey (NHANES III) were stratified into non-DM, pre-DM, or DM groups based on HbA1c levels. VO2Max was calculated using the Fitness Registry and Importance of Exercise: A National Database (FRIEND) equation. Participants Participants were categorized into tertiles of VO2Max; first VO2Max tertile was the lowest VO2Max and third VO2Max tertile was the highest. Main outcome measures Cox regression was used to analyze the relationship between glycemic levels, VO2Max, and CVD-related and all-cause mortality. Results Those with DM in the highest fitness tertile had CVD (HR 0.13; 95 % CI 0.06, 0.27; p < 0.0001) and all cause (HR 0.28; 95 % CI 0.21, 0.38; p < 0.0001) mortality rates as low or lower than those with pre-DM (CVD HR 1.02; 95 % CI 0.78, 1.33 p < 0.892; all cause HR 0.96; 95 % CI 0.83, 1.12; p < 0.5496) or non-DM (CVD HR 0.65; 95 % CI 0.52, 0.80; p < 0.0001; all cause HR 0.61; 95 % CI 0.55, 0.68; p < 0.0001) at lower fitness levels. Regardless of DM status, there was lower all-cause mortality with higher CRF levels. Conclusions Higher fitness levels in DM individuals are associated with total and CVD mortality rates as low or lower than those without DM with lower fitness.
Collapse
Affiliation(s)
- Gwendolyn A. Ung
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Kevin H. Nguyen
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Alvin Hui
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Nathan D. Wong
- Division of Cardiology, University of California, Irvine School of Medicine, Irvine, CA, United States of America
| | - Elizabeth H. Dineen
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United States of America
| |
Collapse
|
27
|
Sharma A, Ananthan VA, Yousaf H. Evaluating the Factors Associated With Increased Risk of Self-Reported Ischemic Heart Disease in Patients With Arthritis. Am J Lifestyle Med 2024:15598276241254329. [PMID: 39554925 PMCID: PMC11562468 DOI: 10.1177/15598276241254329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Abstract
Introduction. Arthritis has increased systematic repercussions either by extra-articular manifestations or due to limited activities. Methods. In this study, we used the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS), a large, nationally representative, cross-sectional telephone survey. The data was divided into the participants having arthritis and no arthritis. Results represented as an odds ratio (OR) with a 95% confidence interval (CI). We used a multivariate-adjusted logistic regression model to analyze the results. Fisher's t-test was used to compare between 2 groups. P-value < 0.05 was considered significant. Results. BRFSS survey results led to 835,452 participants included in the final analysis. Of the included participant, 267020 has arthritis, and 568432 do not. In the arthritis group, 38.7% were males, and 61.3% were females. We found that patients with arthritis have a higher prevalence of diabetes and stroke. Adjusted logistic regression analysis showed that patients with arthritis have higher odds of reporting ischemic heart disease (IHD) (OR = 1.05, 95% CI 1.05-1.05, p-value < 0.001). Also, poor health status (mental, general, and physical) patients are more likely to report IHD. Conclusion. Patients with arthritis are more likely to report IHD, which further increases in patients with poor health status.
Collapse
Affiliation(s)
- Akash Sharma
- Department of Medicine, University at Buffalo (Catholic Health System – Sisters of Charity Hospital), Buffalo, NY, USA
- Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha Univerisity, Chennai, India
| | | | - Hamza Yousaf
- Department of Medicine, University at Buffalo (Catholic Health System – Sisters of Charity Hospital), Buffalo, NY, USA
| |
Collapse
|
28
|
Shilton T, Bauman A, Beger B, Chalkley A, Champagne B, Elings-Pers M, Giles-Corti B, Goenka S, Miller M, Milton K, Oyeyemi A, Ross R, Sallis JF, Armstrong-Walenczak K, Salmon J, Whitsel LP. More People, More Active, More Often for Heart Health - Taking Action on Physical Activity. Glob Heart 2024; 19:42. [PMID: 38708404 PMCID: PMC11067976 DOI: 10.5334/gh.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/12/2024] [Indexed: 05/07/2024] Open
Abstract
Physical inactivity is a leading contributor to increased cardiovascular morbidity and mortality. Almost 500 million new cases of preventable noncommunicable diseases (NCDs) will occur globally between 2020 and 2030 due to physical inactivity, costing just over US$300 billion, or around US$ 27 billion annually (WHO 2022). Active adults can achieve a reduction of up to 35% in risk of death from cardiovascular disease. Physical activity also helps in moderating cardiovascular disease risk factors such as high blood pressure, unhealthy weight and type 2 diabetes. For people with cardiovascular disease, hypertension, type 2 diabetes and many cancers, physical activity is an established and evidence-based part of treatment and management. For children and young people, physical activity affords important health benefits. Physical activity can also achieve important cross-sector goals. Increased walking and cycling can reduce journeys by vehicles, air pollution, and traffic congestion and contribute to increased safety and liveability in cities.
Collapse
Affiliation(s)
| | | | - Birgit Beger
- World Heart Federation, BE
- European Heart Network, BE
| | - Anna Chalkley
- Faculty of Life Sciences and Health Studies, University of Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, UK
| | | | | | - Billie Giles-Corti
- Centre for Urban Research, RMIT University, AU
- Telethon Kids Institute, AU
| | - Shifalika Goenka
- Public Health Foundation of India, IN
- Centre for Chronic Disease Control, IN
| | - Mark Miller
- World Heart Federation, UK
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Karen Milton
- Norwich Medical School, University of East Anglia, UK
| | | | - Robert Ross
- Queen’s University School of Kinesiology and Health Studies, CA
| | - James F. Sallis
- Herbert Wertheim School of Public Health, University of California, US
- Mary MacKillop Institute for Health Research, Australian Catholic University, AU
| | | | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, AU
| | | |
Collapse
|
29
|
Conte E, Pizzamiglio F, Dessanai MA, Guarnieri G, Ardizzone V, Schillaci M, Dello Russo A, Casella M, Mushtaq S, Melotti E, Marchetti D, Volpato V, Drago G, Gigante C, Sforza C, Bartorelli AL, Pepi M, Pontone G, Tondo C, Andreini D. Prevalence and prognosis of structural heart disease among athletes with negative T waves and normal transthoracic echocardiography. Clin Res Cardiol 2024; 113:706-715. [PMID: 37582977 DOI: 10.1007/s00392-023-02282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate the prevalence and prognosis of structural heart disease (SHD) among competitive athletes with negative T waves without pathological findings at transthoracic echocardiogram. METHODS From a prospective register of 450 athletes consecutively evaluated during a second-level cardiological examination, we retrospectively identified all subjects with the following inclusion criteria: (1) not previously known cardiovascular disease; (2) negative T waves in leads other than V1-V2; (3) normal transthoracic echocardiogram. Patients underwent cardiac MRI and CT. The primary endpoint was the diagnosis of definite SHD after multimodality imaging evaluation. A follow-up was collected for a combined end-point of sudden death, resuscitated sudden cardiac death and hospitalization for any cardiovascular causes. RESULTS A total of 55 competitive athletes were finally enrolled (50 males, 90%) with a mean age of 27.5 ± 14.1 years. Among the population enrolled 16 (29.1%) athletes had a final diagnosis of SHD. At multivariate analysis, only deep negative T waves remained statistically significant [OR (95% CI) 7.81 (1.24-49.08), p = 0.0285]. Contemporary identification of deep negative T waves and complex arrhythmias in the same patients appeared to have an incremental diagnostic value. No events were collected at 49.3 ± 12.3 months of follow-up. CONCLUSIONS In a cohort of athletes with negative T waves at ECG, cardiac MRI (and selected use of cardiac CT) enabled the identification of 16 (29.1%) subjects with SHD despite normal transthoracic echocardiography. Deep negative T waves and complex ventricular arrhythmias were the only clinical characteristic associated with SHD diagnosis.
Collapse
Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy.
- Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | | | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti" Ancona, Ancona, Italy
| | | | | | | | | | | | | | - Chiarella Sforza
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| |
Collapse
|
30
|
Li Y, He W, Jiang J, Zhang J, Ding M, Li G, Luo X, Ma Z, Li J, Ma Y, Shen Y, Han X. Non-Pharmacological Interventions in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2024; 105:963-974. [PMID: 37499852 DOI: 10.1016/j.apmr.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF). DATA SOURCES We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023. STUDY SELECTION Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included. DATA EXTRACTION Data were extracted by 2 independent reviewers based on a pre-tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method. DATA SYNTHESIS A total of 82 eligible studies (4574 participants) were included. We performed a random-effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high-intensity aerobic interval training (HIAIT) was best on improving 6-minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high-intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO2; 3.48 mL/kg•min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N-terminal pro-B-type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate-intensity aerobic continuous training (MIACT) plus moderate-intensity resistance training (MIRT) had additional benefits in Peak VO2, 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events. CONCLUSIONS Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL.
Collapse
Affiliation(s)
- Yilun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Wenbo He
- Institute of Hospital Management, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jingwen Jiang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jiawen Zhang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Mingfeng Ding
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Gaiyun Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaolei Luo
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Ziyuan Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jingyi Li
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yichen Ma
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yanfei Shen
- Office of Legal Affairs, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xuemei Han
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
| |
Collapse
|
31
|
Ahn HJ, Choi EK, Rhee TM, Choi J, Lee KY, Kwon S, Lee SR, Oh S, Lip GYH. Accelerometer-derived physical activity and the risk of death, heart failure, and stroke in patients with atrial fibrillation: a prospective study from UK Biobank. Br J Sports Med 2024; 58:427-434. [PMID: 38418213 DOI: 10.1136/bjsports-2023-106862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Data on cardiovascular outcomes according to objectively measured physical activity (PA) in patients with atrial fibrillation (AF) are scarce. This study explored the associations between PA derived from wrist-worn accelerometers and the risk of death, incident heart failure (HF), and incident stroke in patients with AF. METHODS From 37 990 patients with AF in UK Biobank, 2324 patients with accelerometer data were included. Weekly moderate-to-vigorous PA (MVPA) duration was computed from accelerometer data. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, incident HF, and incident stroke. Restricted cubic splines estimated the dose-response associations between MVPA duration and the outcomes. The adjusted HRs (aHRs) of the outcomes according to adherence to PA standard guidelines (performing MVPA≥150 min/week) were also evaluated. RESULTS The mean age was 66.9±6.2 years and 64.9% were male. During a median follow-up of 6.7 years, there were 181 all-cause deaths, 62 cardiovascular deaths, 225 cases of incident HF, and 91 cases of incident stroke; the overall incidence rate per 1000 patient-years was 11.76, 4.03, 15.16 and 5.99, respectively. There was a linear inverse dose-response relationship between MVPA (≥108 min/week) and all-cause mortality. Performing MVPA for 105-590 min/week was associated with a lower risk of HF than those with no measurable MVPA. The risk of stroke and cardiovascular mortality was not associated with MVPA. Performing guideline-adherent MVPA was related to a 30% lower risk of all-cause mortality (aHR: 0.70 (0.50-0.98), p=0.04) and 33% lower risk of HF (aHR 0.67 (0.49-0.93), p=0.02). CONCLUSION In patients with AF, accelerometer-derived PA data supports lower risks of all-cause mortality and HF according to a greater level of MVPA and adherence to PA guidelines. Regular MVPA should be encouraged in patients with AF as a part of integrated management.
Collapse
Affiliation(s)
- Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - JungMin Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Yeon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
32
|
Lin Z, Wang M, Ma J, Liu Y, Lawrence WR, Chen S, Zhang W, Hu J, He G, Liu T, Zhang M, Ma W. The joint effects of mixture exposure to multiple meteorological factors on step count: A panel study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 346:123469. [PMID: 38395131 DOI: 10.1016/j.envpol.2024.123469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/21/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
The public health burden of increasing extreme weather events has been well documented. However, the influence of meteorological factors on physical activity remains limited. Existing mixture effect methods cannot handle cumulative lag effects. Therefore, we developed quantile g-computation Distributed lag non-linear model (QG-DLNM) by embedding a DLNM into quantile g-computation to allow for the concurrent consideration of both cumulated lag effects and mixture effects. We gathered repeated measurement data from Henan Province in China to investigate both the individual impact of meteorological factor on step counts using a DLNM, and the joint effect using the QG-DLNM. We projected future step counts linked to changes in temperature and relative humidity driven by climate change under three scenarios from the sixth phase of the Coupled Model Intercomparison Project. Our findings indicate there are inversed U-shaped associations for temperature, wind speed, and mixture exposure with step counts, peaking at 11.6 °C in temperature, 2.7 m/s in wind speed, and 30th percentile in mixture exposure. However, there are negative associations between relative humidity and rainfall with step counts. Additionally, relative humidity possesses the highest weights in the joint effect (49% contribution). Compared to 2022s, future step counts are projected to decrease due to temperature changes, while increase due to relative humidity changes. However, when considering both future temperature and humidity changes driven by climate change, the projections indicate a decrease in step counts. Our findings may suggest Chinese physical activity will be negatively influenced by global warming.
Collapse
Affiliation(s)
- Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Mengmeng Wang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, 1066 Xueyuan Boulevard, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Junrong Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Yingyin Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Wayne R Lawrence
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, 1 University Place, Rensselaer, NY, 12144, USA
| | - Shirui Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jianxiong Hu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, 1066 Xueyuan Boulevard, Nanshan District, Shenzhen, Guangdong, 518055, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, 511443, China.
| |
Collapse
|
33
|
Sanjo K, Hebiguchi K, Tang C, Rashed EA, Kodera S, Togo H, Hirata A. Sensitivity of Electrocardiogram on Electrode-Pair Locations for Wearable Devices: Computational Analysis of Amplitude and Waveform Distortion. BIOSENSORS 2024; 14:153. [PMID: 38534260 DOI: 10.3390/bios14030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
An electrocardiogram (ECG) is used to observe the electrical activity of the heart via electrodes on the body surface. Recently, an ECG with fewer electrodes, such as a bipolar ECG in which two electrodes are attached to the chest, has been employed as wearable devices. However, the effect of different geometrical factors and electrode-pair locations on the amplitude and waveform of ECG signals remains unclear. In this study, we computationally evaluated the effects of body morphology, heart size and orientation, and electrode misalignment on ECG signals for 48 scenarios using 35 bipolar electrode pairs (1680 waveforms) with a dynamic time warping (DTW) algorithm. It was observed that the physique of the human body model predominantly affected the amplitude and waveform of the ECG signals. A multivariate analysis indicated that the heart-electrode distance and the solid angle of the heart from the electrode characterized the amplitude and waveform of the ECG signals, respectively. Furthermore, the electrode locations for less individual variability and less waveform distortion were close to the location of electrodes V2 and V3 in the standard 12-lead. These findings will facilitate the placement of ECG electrodes and interpretation of the measured ECG signals for wearable devices.
Collapse
Affiliation(s)
- Kiyoto Sanjo
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Kazuki Hebiguchi
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Cheng Tang
- Faculty of Information Science and Electrical Engineering, Kyushu University, Fukuoka 819-0395, Japan
| | - Essam A Rashed
- Graduate School of Information Science, University of Hyogo, Kobe 650-0047, Japan
| | - Sachiko Kodera
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| | - Hiroyoshi Togo
- NTT Device Innovation Center, NTT Corporation, Atsugi 243-0198, Japan
| | - Akimasa Hirata
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya 466-8555, Japan
| |
Collapse
|
34
|
Andresen K, Klæboe LG, Lie ØH, Broch K, Kvaslerud AB, Bosse G, Hopp E, de Lange C, Haugaa KH, Edvardsen T. No adverse association between exercise exposure and diffuse myocardial fibrosis in male endurance athletes. Sci Rep 2024; 14:6581. [PMID: 38503845 PMCID: PMC10951320 DOI: 10.1038/s41598-024-57233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 03/21/2024] Open
Abstract
The potential association between endurance exercise and myocardial fibrosis is controversial. Data on exercise exposure and diffuse myocardial fibrosis in endurance athletes are scarce and conflicting. We aimed to investigate the association between exercise exposure and markers of diffuse myocardial fibrosis by cardiovascular magnetic resonance imaging (CMR) in endurance athletes. We examined 27 healthy adult male competitive endurance athletes aged 41 ± 9 years and 16 healthy controls in a cross sectional study using 3 Tesla CMR including late gadolinium enhancement and T1 mapping. Athletes reported detailed exercise history from 12 years of age. Left ventricular total mass, cellular mass and extracellular mass were higher in athletes than controls (86 vs. 58 g/m2, 67 vs. 44 g/m2 and 19 vs. 13 g/m2, all p < 0.01). Extracellular volume (ECV) was lower (21.5% vs. 23.8%, p = 0.03) and native T1 time was shorter (1214 ms vs. 1268 ms, p < 0.01) in the athletes. Increasing exercise dose was independently associated with shorter native T1 time (regression coefficient - 24.1, p < 0.05), but expressed no association with ECV. Our results indicate that diffuse myocardial fibrosis has a low prevalence in healthy male endurance athletes and do not indicate an adverse dose-response relationship between exercise and diffuse myocardial fibrosis in healthy athletes.
Collapse
Affiliation(s)
- Kristoffer Andresen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Haugen Lie
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
| | - Kaspar Broch
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anette Borger Kvaslerud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gerhard Bosse
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Charlotte de Lange
- Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatric Radiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Hermann Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Heart and Lung Diseases Unit, Department of Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Nydalen, P. O. Box 4950, N-0424, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| |
Collapse
|
35
|
Leijon M, Algotson A, Bernhardsson S, Ekholm D, Ersberg L, Höök MJS, Klüft C, Müssener U, Garås ES, Nilsen P. Generation Pep - study protocol for an intersectoral community-wide physical activity and healthy eating habits initiative for children and young people in Sweden. Front Public Health 2024; 12:1299099. [PMID: 38435288 PMCID: PMC10904517 DOI: 10.3389/fpubh.2024.1299099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background There is overwhelming evidence for the preventive effects of regular physical activity and healthy eating habits on the risk for developing a non-communicable disease (NCD). Increasing attention has been paid to community-wide approaches in the battle against NCDs. Communities can create supportive policies, modify physical environments, and foster local stakeholder engagement through intersectoral collaboration to encourage communities to support healthy lifestyles. The Pep initiative is based on intersectoral community-wide collaboration among Sweden's municipalities. Primary targets are municipality professionals who work with children and young people as well as parents of children <18 years. The goal is to spread knowledge and create commitment to children's and young people's health with a special focus on physical activity and healthy eating habits to facilitate and support a healthy lifestyle. The overarching aim of the research project described in this study protocol is to investigate factors that influence the implementation of the Pep initiative in Sweden, to inform tailored implementation strategies addressing the needs and local prerequisites of the different municipalities. Methods The project includes a qualitative and a quantitative study and is framed by a theoretical model involving four complementary forms of knowledge, explicitly recognized in the Pep initiative: knowledge about the issue; knowledge about interventions; knowledge about the context; and knowledge about implementation. Study 1 is a focus group study exploring barriers and facilitators for implementing the Pep initiative. The study will be carried out in six municipalities, selected purposively to provide wide variation in municipality characteristics, including population size and geographical location. Data will be analyzed using thematic analysis. Study 2 is a cross-sectional web-based survey investigating the implementability of the Pep initiative in Sweden's 290 municipalities. Conditions for implementing different areas of the Pep initiative will be examined in terms of the acceptability, appropriateness, and feasibility, three predictors of implementation success. Data will be analyzed using non-parametric statistics. Discussion The findings of the two studies will increase understanding of the prerequisites for implementing the Pep initiative in Swedish municipalities, which will provide valuable input into how implementation of the Pep initiative can best be facilitated in the different municipality settings.
Collapse
Affiliation(s)
- Matti Leijon
- Generation Pep, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Albin Algotson
- Department of Management and Engineering, Faculty of Science and Engineering, Linköping University, Linköping, Sweden
| | - Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development, and Innovation Primary Health Care, Gothenburg, Sweden
- Department of Health and Rehabilitation, Unit of Physiotherapy, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - David Ekholm
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | | | | | - Carolina Klüft
- Generation Pep, Stockholm, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| |
Collapse
|
36
|
Li X, Zeng J, Chen B, Fan M, Wang J, Wei L, Ren Y, Xu S. Effects of the Timing of Intense Physical Activity on Hypertension Risk in a General Population: A UK-Biobank Study. Curr Hypertens Rep 2024; 26:81-90. [PMID: 37948020 DOI: 10.1007/s11906-023-01278-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE OF REVIEW It has recently been suggested that the timing of exercise is important in the subsequent development of hypertension. We used the UK Biobank database which prospectively collates data in over 500,000 people aged between 40 and 69 years to determine the relationship between the chronoactivity pattern of exercise and the risk of incident hypertension. RECENT FINDINGS We analyzed data from 70,617 participants with 7-day Axivity AX3 triaxial accelerometry information available. Comparisons were made by a K-means clustering analysis separating groups according to the daily timing of physical activity and intensity. Subgroup, sensitivity analyses, and Cox proportional hazard model were performed. The mean age of the cohort was 61.17 (± 7.89) years with 40.05% men, and there was a mean follow-up of 7.54 (± 1.65) years. Participants were separated into 4 clusters with 6341 developing hypertension. Cluster 1 (early morning physical activity) and Cluster 2 (early morning and later physical activity) had a significantly reduced risk of incident hypertension (adjusted HR 0.870 [95%CI 0.812-0.932) vs. 0.895 [95%CI 0.825-0.972], respectively) when compared with Cluster 3 (physical activity intensity spread evenly throughout the day). Cluster 1 and Cluster 2 cases with High Intensity physical activity had a lower risk of hypertension; however, Low Intensity physical activity in Cluster 1 still reduced the risk of incident hypertension. There was a lower risk of hypertension in Cluster 1 and Cluster 2 in both morning and evening sleep chronotypes. The development of incident hypertension is significantly reduced in those who engage in some level of physical activity earlier in the day. Hypertension (high blood pressure) is a global problem with a high economic health burden that has been shown to be a major risk factor for diabetes, cardiovascular, and kidney disease. Our study has used a large maintained UK biological database to determine the impact of physical exercise on reducing the subsequent development of hypertension during follow-up from data provided by more than 70,000 participants. When we segregated patients into clusters of exercise timing, we found that the risk of developing hypertension over time was reduced for patients who performed exercise earlier in the morning than at other times of the day. This benefit was still evident even when the intensity of regular physical activity was low.
Collapse
Affiliation(s)
- Xiaying Li
- College of Medicine, Wuhan University of Science & Technology, Wuhan, 430081, China
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Jingjing Zeng
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Bo Chen
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Menglin Fan
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Jie Wang
- Department of Endocrinology, Daxing Hospital, Xi'an, 710000, China
| | - Lingqi Wei
- College of Medicine, Wuhan University of Science & Technology, Wuhan, 430081, China
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China
| | - Yong Ren
- Department of Cardiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
| | - Shaoyong Xu
- Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
- Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, China.
| |
Collapse
|
37
|
Ingwersen M, Kunstmann I, Oswald C, Best N, Weisser B, Teichgräber U. Exercise Training for Patients With Peripheral Arterial Occlusive Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:879-885. [PMID: 38019155 PMCID: PMC10859744 DOI: 10.3238/arztebl.m2023.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND One-third of all persons with peripheral arterial occlusive disease (PAOD) suffer from intermittent claudication. Exercise training under appropriate supervision is recommended in the pertinent guidelines, but physicians order it too rarely, and so-called vascular exercise groups are not available everywhere. This situation needs improvement in view of the impor - tance of walking ability and cardiorespiratory fitness for patients' quality of life and long-term disease outcome. METHODS We review the scientific evidence on exercise training and on ways to lower barriers to the ordering of exercise training and to patient participation, on the basis of pertinent articles retrieved by a search of PubMed and in specialized sports science journals. RESULTS 10 meta-analyses, 12 randomized controlled trials (RCTs), and 7 cohort studies were considered for this review. Largescale cohort studies have shown that exercise is associated with a lower risk of death (relative risk 0.65-0.78 after 12 months of exercise training, compared to an inactive lifestyle). Exercise training also improves the maximal walking distance by a mean of 136 m (training at home) or 180-310 m (supervised training). An additional improvement by a mean of 282 m can be expected from a combination of exercise training and endovascular revascularization. Further behavior-modifying interventions, such as goal-setting, planning, and feedback, increase both the maximum walking distance and the weekly duration of exercise. CONCLUSION Exercise improves walking ability and lowers mortality. To attract patients with intermittent claudication to exercise training, a broad assortment of analog, digital and telemetric tools and a dense network of vascular exercise groups should be made available, along with regular contact between physicians and patients.
Collapse
Affiliation(s)
- Maja Ingwersen
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Ina Kunstmann
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Carolin Oswald
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Norman Best
- Institute of Physical and Rehabilitation Medicine, Sophien and Hufeland Hospital Weimar, Academic Teaching Hospital, University of Jena, Jena, Germany
| | - Burkhard Weisser
- Institute of Sports Science, Department of Sports Medicine, Kiel University, Kiel, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| |
Collapse
|
38
|
Peterson NE, Bate DA, Macintosh JL, Trujillo Tanner C. Wearable Activity Trackers That Motivate Women to Increase Physical Activity: Mixed Methods Study. JMIR Form Res 2023; 7:e48704. [PMID: 38096000 PMCID: PMC10755652 DOI: 10.2196/48704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/21/2023] [Accepted: 11/09/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Physical inactivity is a significant public health concern, particularly among women in the United States. Wearable activity trackers (WATs) have been proposed as a potential solution to increase awareness of and engagement in physical activity (PA). However, to be effective, WATs must include features and designs that encourage daily use. OBJECTIVE This study aims to explore the features and designs of WATs that appeal to women and determine whether devices with these attributes are effective motivators for women to be physically active. METHODS A mixed methods study guided by the self-determination theory was conducted among 15 women. Participants trialed 3 WATs with influence in their respective accessory domains: Apple Watch for the wrist; Oura Ring for the finger; and Bellabeat Leaf Urban for multiple sites (it can be worn as a bracelet, necklace, or clip). Participants documented their daily PA levels and rated their satisfaction with each device's comfort, features, and motivational effect. Focus groups were also conducted to gather additional feedback and experiences within the a priori areas of comfort, features, and motivation. RESULTS Behavioral Regulation in Exercise Questionnaire-2 scores indicated that most participants (14/15, 93%) were motivated at baseline (amotivation score: mean 0.13, SD 0.45), but on average, participants did not meet the national minimum PA guidelines according to the self-reported Physical Activity Vital Sign questionnaire (moderate to vigorous PA score: mean 144, SD 97.5 min/wk). Mean WAT wear time was 16.9 (SD 4.4) hours, 19.4 (SD 5.3) hours, and 20.4 (SD 4.7) hours for Apple Watch, Bellabeat Leaf Urban, and Oura Ring, respectively. During focus groups, participants reinforced their quantitative ratings and rankings of the WATs based on personal experiences. Participants shared a variety of both activity-related and non-activity-related features that they look for in a motivating device. When considering what the ideal WAT would be for a woman, participants suggested features of (1) comfort, (2) extended battery life, (3) durability, (4) immediate PA feedback, (5) intuitive PA sensing, and (6) programmability. CONCLUSIONS This study is the first to specifically address women's experiences with and preferences for different types of WATs. Those who work with women should realize how they view WATs and the role they play in motivation to be active.
Collapse
Affiliation(s)
- Neil E Peterson
- College of Nursing, Brigham Young University, Provo, UT, United States
| | | | | | | |
Collapse
|
39
|
Upadhya B, Hegde S, Tannu M, Stacey RB, Kalogeropoulos A, Schocken DD. Preventing new-onset heart failure: Intervening at stage A. Am J Prev Cardiol 2023; 16:100609. [PMID: 37876857 PMCID: PMC10590769 DOI: 10.1016/j.ajpc.2023.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023] Open
Abstract
Heart failure (HF) prevention is an urgent public health need with national and global implications. Stage A HF patients do not show HF symptoms or structural heart disease but are at risk of HF development. There are no unique recommendations on detecting Stage A patients. Patients in Stage A are heterogeneous; many patients have different combinations of risk factors and, therefore, have markedly different absolute risks for HF. Comprehensive strategies to prevent HF at Stage A include intensive blood pressure lowering, adequate glycemic and lipid management, and heart-healthy behaviors (adopting Life's Essential 8). First and foremost, it is imperative to improve public awareness of HF risk factors and implement healthy lifestyle choices very early. In addition, recognize the HF risk-enhancing factors, which are nontraditional cardiovascular (CV) risk factors that identify individuals at high risk for HF (genetic susceptibility for HF, atrial fibrillation, chronic kidney disease, chronic liver disease, chronic inflammatory disease, sleep-disordered breathing, adverse pregnancy outcomes, radiation therapy, a history of cardiotoxic chemotherapy exposure, and COVID-19). Early use of biomarkers, imaging markers, and echocardiography (noninvasive measures of subclinical systolic and diastolic dysfunction) may enhance risk prediction among individuals without established CV disease and prevent chemotherapy-induced cardiomyopathy. Efforts are needed to address social determinants of HF risk for primordial HF prevention.Central illustrationPolicies developed by organizations such as the American Heart Association, American College of Cardiology, and the American Diabetes Association to reduce CV disease events must go beyond secondary prevention and encompass primordial and primary prevention.
Collapse
Affiliation(s)
- Bharathi Upadhya
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Manasi Tannu
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - R. Brandon Stacey
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andreas Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Long Island, NY, USA
| | - Douglas D. Schocken
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
40
|
Fruytier LA, Janssen DM, Campero Jurado I, van de Sande DA, Lorato I, Stuart S, Panditha P, de Kok M, Kemps HM. The Utility of a Novel Electrocardiogram Patch Using Dry Electrodes Technology for Arrhythmia Detection During Exercise and Prolonged Monitoring: Proof-of-Concept Study. JMIR Form Res 2023; 7:e49346. [PMID: 38032699 PMCID: PMC10722364 DOI: 10.2196/49346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Accurate detection of myocardial ischemia and arrhythmias during free-living exercise could play a pivotal role in screening and monitoring for the prevention of exercise-related cardiovascular events in high-risk populations. Although remote electrocardiogram (ECG) solutions are emerging rapidly, existing technology is neither designed nor validated for continuous use during vigorous exercise. OBJECTIVE In this proof-of-concept study, we evaluated the usability, signal quality, and accuracy for arrhythmia detection of a single-lead ECG patch platform featuring self-adhesive dry electrode technology in individuals with chronic coronary syndrome. This sensor was evaluated during exercise and for prolonged, continuous monitoring. METHODS We recruited a total of 6 consecutive patients with chronic coronary syndrome scheduled for an exercise stress test (EST) as part of routine cardiac follow-up. Traditional 12-lead ECG recording was combined with monitoring with the ECG patch. Following the EST, the participants continuously wore the sensor for 5 days. Intraclass correlation coefficients (ICC) and Wilcoxon signed rank tests were used to assess the utility of detecting arrhythmias with the patch by comparing the evaluations of 2 blinded assessors. Signal quality during EST and prolonged monitoring was evaluated by using a signal quality indicator. Additionally, connection time was calculated for prolonged ECG monitoring. The comfort and usability of the patch were evaluated by a web-based self-assessment questionnaire. RESULTS A total of 6 male patients with chronic coronary syndrome (mean age 69.8, SD 6.2 years) completed the study protocol. The patch was worn for a mean of 118.3 (SD 5.6) hours. The level of agreement between the patch and 12-lead ECG was excellent for the detection of premature atrial contractions and premature ventricular contractions during the whole test (ICC=0.998, ICC=1.000). No significant differences in the total number of premature atrial contractions and premature ventricular contractions were detected neither during the entire exercise test (P=.79 and P=.18, respectively) nor during the exercise and recovery stages separately (P=.41, P=.66, P=.18, and P=.66). A total of 1 episode of atrial fibrillation was detected by both methods. Total connection time during recording was between 88% and 100% for all participants. There were no reports of skin irritation, erythema, or pain while wearing the patch. CONCLUSIONS This proof-of-concept study showed that this innovative ECG patch based on self-adhesive dry electrode technology can potentially be used for arrhythmia detection during vigorous exercise. The results suggest that the wearable patch is also usable for prolonged continuous ECG monitoring in free-living conditions and can therefore be of potential use in cardiac rehabilitation and tele-monitoring for the prevention of exercise-related cardiovascular events. Future efforts will focus on optimizing signal quality over time and conducting a larger-scale validation study focusing on both arrhythmia and ischemia detection.
Collapse
Affiliation(s)
- Lonneke A Fruytier
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
| | - Daan M Janssen
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
| | - Israel Campero Jurado
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Danny Ajp van de Sande
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ilde Lorato
- Stichting imec Nederland, Eindhoven, Netherlands
| | | | | | | | - Hareld Mc Kemps
- Department of Cardiology, Máxima MC Eindhoven/Veldhoven, Veldhoven, Netherlands
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| |
Collapse
|
41
|
Magnon V, Dutheil F, Chausse P, Vallet GT. Mind your heart to bear the weight: Cardiac interoception predicts action-related visual perception when wearing a heavy backpack. Q J Exp Psychol (Hove) 2023; 76:2232-2240. [PMID: 36468180 DOI: 10.1177/17470218221145932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Visual perception can be modulated by the physiological potential for action. For instance, it was famously shown that a geographical slant appears steeper when wearing a heavy backpack than not wearing any. However, those results are not always replicated. In the present exploratory study, we test the hypothesis that the backpack weight's effect on perception relies on the ability of the cognitive system to integrate the physiological constraint's change rather than the change itself. Young adults (n = 54) wore an electrocardiogram monitor and completed a computerised task in which photographs of real geographical slants were displayed on a screen while wearing a heavy versus light backpack. The activity of the vagus nerve, as an index of physiological adaptability, was recorded as a proxy of the physiological state during the task. The participants also completed an interoception task assessing one's ability to detect his or her own heartbeat as the index of integration ability of the cognitive system. While Bayesian analyses revealed no difference in angle estimation between carrying a heavy versus light backpack, the results indicated that interoception predicted less accurate angle estimation only when wearing a heavy backpack. In contrast, there was anecdotal evidence that vagal activity changes predicted visual perception. Interoception might thus play a crucial role in the interplay between the physiological potential for action and action-related visual perception.
Collapse
Affiliation(s)
- Valentin Magnon
- Department of Psychology, University Clermont Auvergne, LAPSCO-UMR CNRS 6024, Clermont-Ferrand, France
| | - Frederic Dutheil
- University Clermont Auvergne, LAPSCO-UMR CNRS 6024, CHU Clermont-Ferrand, WittyFit, Clermont-Ferrand, France
| | - Pierre Chausse
- Department of Psychology, University Clermont Auvergne, LAPSCO-UMR CNRS 6024, Clermont-Ferrand, France
| | - Guillaume T Vallet
- Department of Psychology, University Clermont Auvergne, LAPSCO-UMR CNRS 6024, Clermont-Ferrand, France
| |
Collapse
|
42
|
de Lucena Alves CP, Crochemore-Silva I, Lima NP, Coenen P, Horta BL. Prospective Association of Occupational and Leisure-Time Physical Activity With Cardiovascular Risk Factors in Early Adulthood: Findings From Pelotas (Brazil) 1982 Birth Cohort. J Phys Act Health 2023; 20:832-839. [PMID: 37491012 DOI: 10.1123/jpah.2022-0610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/05/2023] [Accepted: 05/17/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND The benefits of physical activity in health outcomes are well established. However, recent evidence suggests that benefits may differ by domain and population. Thus, we aimed to investigate the prospective association of occupational (OPA) and leisure-time physical activity (LTPA) with cardiovascular risk factors. METHODS In 1982, the maternity hospitals of Pelotas were visited daily; those live births whose families lived in urban areas were evaluated, and their mothers were later interviewed (n = 5914). In the 2004/5 follow-up (23 y old), both OPA and LTPA were measured in 4295 participants using their respective sections of the International Physical Activity Questionnaire. In the 2012 follow-up (30 y old), the following cardiovascular risk factors were collected: high-density lipoprotein (in milligrams per deciliter), low-density lipoprotein (in milligrams per deciliter), triglycerides (in milligrams per deciliter), glucose (in milligrams per deciliter), and blood pressure (in millimeters of mercury). Multivariable linear regressions were performed to evaluate associations between OPA and LTPA with these specific cardiovascular risk factors. RESULTS In total, 3241 participants were analyzed. Our main findings suggest that there was no association between OPA and LTPA with high- and low-density lipoprotein. There were inverse associations between OPA and lower levels of triglycerides among males (β = -0.002; 95% confidence interval, -0.003 to -0.000) and positive associations between LTPA and higher levels of diastolic blood pressure among females (β = 0.111; 95% confidence interval, 0.005-0.216). CONCLUSION In conclusion, our findings suggest that there was no association, or association with limited clinical relevance, of OPA and LTPA with cardiovascular risk factors in early adulthood.
Collapse
Affiliation(s)
| | - Inácio Crochemore-Silva
- Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS,Brazil
- Postgraduate Program in Physical Education, Federal University of Pelotas (UFPel), Pelotas, RS,Brazil
| | - Natália P Lima
- Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS,Brazil
| | - Pieter Coenen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam,The Netherlands
| | - Bernardo Lessa Horta
- Graduate Program in Epidemiology, Federal University of Pelotas (UFPel), Pelotas, RS,Brazil
| |
Collapse
|
43
|
Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
Collapse
Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| |
Collapse
|
44
|
Peter‐Marske KM, Evenson KR, Moore CC, Cuthbertson CC, Howard AG, Shiroma EJ, Buring JE, Lee I. Association of Accelerometer-Measured Physical Activity and Sedentary Behavior With Incident Cardiovascular Disease, Myocardial Infarction, and Ischemic Stroke: The Women's Health Study. J Am Heart Assoc 2023; 12:e028180. [PMID: 36974744 PMCID: PMC10122899 DOI: 10.1161/jaha.122.028180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 03/29/2023]
Abstract
Background Few studies have investigated associations of acclerometer-based assessments of physical activity (PA) and sedentary behavior (SB) with incidence of cardiovascular disease (CVD) and its components. This prospective cohort study assessed the associations of accelerometer-measured PA and SB with total CVD, myocardial infarction, and ischemic stroke (IS). Methods and Results The authors included 16 031 women aged 62 years and older, free of CVD, with adherent accelerometer wear (≥10 hours/day for ≥4 days) from the Women's Health Study (mean age, 71.4 years [SD, 5.6 years]). Hip-worn ActiGraph GT3X+ accelerometers measured total volume of PA (total average daily vector magnitude), minutes per day of high-light PA and moderate to vigorous PA (MVPA), and SB. Women reported diagnoses of CVD, which were adjudicated using medical records and death certificates. Hazard ratios (HRs) were estimated for each exposure, and 95% CIs using Cox proportional hazards models were adjusted for accelerometer wear time, age, self-reported general health, postmenopausal hormone therapy, smoking status, and alcohol use. The hypothetical effect of replacing 10 minutes/day of SB or high-light PA with MVPA on CVD incidence was assessed using adjusted isotemporal substitution Cox models. Over a mean of 7.1 years (SD, 1.6 years) of follow-up, 482 total CVD cases, 107 myocardial infarction cases, and 181 IS cases were diagnosed. Compared with the lowest quartiles of total average daily vector magnitude and MVPA (≤60 minutes), women who were in the highest quartiles (>120 minutes of MVPA) had a 43% (95% CI, 24%-58%) and 38% (95% CI, 18%-54%) lower hazard of total CVD, respectively. Estimates were similar for total average daily vector magnitude and MVPA with IS, but PA was not associated with myocardial infarction overall. High-light PA was not associated with any CVD outcomes. Women who spent <7.4 hours sedentary per day had a 33% (95% CI, 11%-49%) lower hazard of total CVD compared with those who spent ≥9.5 hours sedentary. Replacing 10 minutes of SB with MVPA was associated with a 4% lower incidence of total CVD (HR, 0.96 [95% CI, 0.93-0.99]). Conclusions Accelerometer-assessed total PA and MVPA were inversely associated with total CVD and IS incidence, and SB was directly associated with total CVD; high-light PA was not related to CVD.
Collapse
Affiliation(s)
- Kennedy M. Peter‐Marske
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Christopher C. Moore
- Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | | | - Annie Green Howard
- Department of Biostatistics, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Eric J. Shiroma
- Laboratory of Epidemiology and Population SciencesNational Institute on AgingBaltimoreMDUSA
| | - Julie E. Buring
- Division of Preventive MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMAUSA
| | - I‐Min Lee
- Division of Preventive MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonMAUSA
- Department of EpidemiologyHarvard T. H. Chan School of Public HealthBostonMAUSA
| |
Collapse
|
45
|
Zhao J, Yu Y, Zhu X, Xie Y, Ai S, Lehmann HI, Deng X, Hu F, Li G, Zhou Y, Xiao J. Predicting risk on cardiovascular or cerebrovascular disease based on a physical activity cohort: Results from APAC study. MedComm (Beijing) 2023; 4:e220. [PMID: 36911159 PMCID: PMC9999708 DOI: 10.1002/mco2.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 03/12/2023] Open
Abstract
Commonly used prediction models have been primarily constructed without taking physical activity into account. Using the Kailuan physical activity cohorts from Asymptomatic Polyvascular Abnormalities in Community (APAC) study, we developed a 9-year cardiovascular or cerebrovascular disease (CVD) risk prediction equation. Participants in this study were included from APAC cohort, which included 5440 participants from the Kailuan cohort in China. Cox proportional hazard regression model was applied to construct sex-specific risk prediction equations for the physical activity cohort (PA equation). Proposed equations were compared with the 10-year risk prediction model, which is developed for atherosclerotic cardiovascular disease risk in Chinese cohorts (China-PAR equation). C statistics of PA equations were 0.755 (95% confidence interval, 0.750-0.758) for men and 0.801 (95% confidence interval, 0.790-0.813) for women. The estimated area under the receiver operating characteristic curves in the validation set shows that the PA equations perform as good as the China-PAR. From calibration among four categories of predicted risks, the predicted risk rates by PA equations were almost identical to the Kaplan-Meier observed rates. Therefore, our developed sex-specific PA equations have effective performance for predicting CVD for physically active cohorts in the physical activity cohort in Kailuan.
Collapse
Affiliation(s)
- Juan Zhao
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of MedicineShanghai UniversityNantongChina
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life ScienceShanghai UniversityShanghaiChina
- School of PharmacyShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Ye Yu
- Clinical Research Institute, Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xiaolan Zhu
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of MedicineShanghai UniversityNantongChina
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life ScienceShanghai UniversityShanghaiChina
| | - Yuling Xie
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of MedicineShanghai UniversityNantongChina
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life ScienceShanghai UniversityShanghaiChina
| | - Songwei Ai
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of MedicineShanghai UniversityNantongChina
| | - H. Immo Lehmann
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Xuan Deng
- Clinical Research Institute, Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Feifei Hu
- Clinical Research Institute, Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Guoping Li
- Cardiovascular Division of the Massachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Yong Zhou
- Clinical Research Institute, Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Junjie Xiao
- Institute of Geriatrics (Shanghai University), Affiliated Nantong Hospital of Shanghai University (The Sixth People's Hospital of Nantong), School of MedicineShanghai UniversityNantongChina
- Cardiac Regeneration and Ageing Lab, Institute of Cardiovascular Sciences, Shanghai Engineering Research Center of Organ Repair, School of Life ScienceShanghai UniversityShanghaiChina
| |
Collapse
|
46
|
Yu H, Song Y, Wang Y, Wang X, Li H, Feng X, Yu M. The Impact of Temperature on 24-Hour Movement Behaviors among Chinese Freshmen Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4970. [PMID: 36981878 PMCID: PMC10049201 DOI: 10.3390/ijerph20064970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Human populations worldwide have experienced substantial climate change issues. Gaps in scientific literature remain regarding the relationship between temperature and 24-hour movement behavior among people. The purpose of this study is to examine the impact of temperature on 24-hour movement behavior including physical activity (PA), sedentary behavior (SB) and sleep duration among university students living in Beijing, China. METHODS We conducted follow-up health surveys on 44,693 freshmen students enrolled at Tsinghua University from 2012 to 2018. PA and SB were measured by using the short version of the International Physical Activity Questionnaire (IPAQ-s); sleep duration was estimated by using The Pittsburgh Sleep Quality Index (CPSQI). Corresponding temperature data measured by the Beijing Meteorological Service were collected to include average daily temperature from the nearest weather station to Tsinghua university. The data were analyzed using linear individual fixed-effect regressions. RESULTS An increase in temperature (temperature range 2.29-28.73 °C) by 1 °C was associated with an increase in 0.66 weekly minutes of vigorous physical activity (VPA) (95% confidence interval [CI] = 0.49, 0.82), an increase in 0.56 weekly minutes of moderate physical activity (MPA)(95% CI = 0.32, 0.79), an increase in 1.21 weekly minutes of moderate to vigorous physical activity (MVPA) (95% CI = 0.90, 1.53), an increase in 0.55 weekly minutes of walking (95% CI = 0.31, 0.78), an increase in 1.76 weekly minutes of total PA (95% CI = 1.35, 2.17), and a reduction in 1.60 weekly minutes of sleeping (95% CI = -2.09, -1.11). There was no significant correlation between temperature and sedentary behavior among participants. CONCLUSIONS Temperature was significantly positively correlated with physical activity levels in the Chinese freshmen students, and significantly negatively correlated with sleep duration. Replication of this study is warranted among various populations within China. The evidence of this novel study focused on understanding the relationship between climate change and 24-hour movement behaviors among people for developing effective adaptation strategies to climate change to improve people's health behavior. This study has important implications for future study, as knowledge of the impact of temperature on movement behavior may help in the interpretation of their results and translate into improving people's health behavior.
Collapse
Affiliation(s)
- Hongjun Yu
- Department of Physical Education, Tsinghua University, Beijing 100084, China
| | - Yiling Song
- Department of Physical Education, Tsinghua University, Beijing 100084, China
| | - Yangyang Wang
- Department of Physical Education, Tsinghua University, Beijing 100084, China
| | - Xiaoxin Wang
- Department of Physical Education, Tsinghua University, Beijing 100084, China
| | - Haoxuan Li
- Department of Physical Education, Tsinghua University, Beijing 100084, China
| | - Xiaolu Feng
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou 310058, China
| | - Miao Yu
- Renmin University of China Libraries, Beijing 100872, China
| |
Collapse
|
47
|
Association between knee osteoarthritis and the risk of cardiovascular disease and the synergistic adverse effects of lack of exercise. Sci Rep 2023; 13:2777. [PMID: 36797339 PMCID: PMC9935498 DOI: 10.1038/s41598-023-29581-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
We aimed to determine whether knee OA is associated with CVD risk and all-cause death and to evaluate whether the association differs by exercise behavior. We used Korea National Health Insurance Service (KNHIS) database and included 201,466 participants (7572 subjects diagnosed with knee OA) who underwent health screening between 2009 and 2015. Those who had been diagnosed with knee OA or CVD before the index year were excluded. Cox proportional hazard models were used after adjusting for sociodemographic and CVD risk factors to evaluate the association between knee OA and CVD risk and all-cause death. Stratification analysis was further performed to determine the effect of exercise behavior on this relationship. During a median follow-up of 7.06 ± 2.24 years, 8743 CVD (2510 MI and 6553 stroke) cases developed. Individuals with knee OA had increased risks of CVD [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.15-1.38], myocardial infarction (MI) (HR 1.20, 95% CI 1.00-1.44), and stroke (HR 1.29, 95% CI 1.16-1.43) compared with those without knee OA. Those with knee OA who did not exercise had an increased risk of CVD (HR 1.25, 95% CI 1.11-1.40), whereas no significant increased CVD risk was observed in those with knee OA who exercised at least once a week (HR 1.11, 95% CI 0.96-1.28). There was no association between knee osteoarthritis and all-cause death. Knee OA was independently associated with an increased risk of CVD. Lack of exercise might have a synergistic adverse effect on the association between knee OA and CVD.
Collapse
|
48
|
Albalak G, Stijntjes M, van Bodegom D, Jukema JW, Atsma DE, van Heemst D, Noordam R. Setting your clock: associations between timing of objective physical activity and cardiovascular disease risk in the general population. Eur J Prev Cardiol 2023; 30:232-240. [PMID: 36372091 DOI: 10.1093/eurjpc/zwac239] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
AIMS Little is known about the impact of daily physical activity timing (here referred to as 'chronoactivity') on cardiovascular disease (CVD) risk. We aimed to examined the associations between chronoactivity and multiple CVD outcomes in the UK Biobank. METHODS AND RESULTS physical activity data were collected in the UK-Biobank through triaxial accelerometer over a 7-day measurement period. We used K-means clustering to create clusters of participants with similar chronoactivity irrespective of the mean daily intensity of the physical activity. Multivariable-adjusted Cox-proportional hazard models were used to estimate hazard ratios (HRs) comparing the different clusters adjusted for age and sex (model 1), and baseline cardiovascular risk factors (model 2). Additional stratified analyses were done by sex, mean activity level, and self-reported sleep chronotype. We included 86 657 individuals (58% female, mean age: 61.6 [SD: 7.8] years, mean BMI: 26.6 [4.5] kg/m2). Over a follow-up period of 6 years, 3707 incident CVD events were reported. Overall, participants with a tendency of late morning physical activity had a lower risk of incident coronary artery disease (HR: 0.84, 95%CI: 0.77, 0.92) and stroke (HR: 0.83, 95%CI: 0.70, 0.98) compared to participants with a midday pattern of physical activity. These effects were more pronounced in women (P-value for interaction = 0.001). We did not find evidence favouring effect modification by total activity level and sleep chronotype. CONCLUSION Irrespective of total physical activity, morning physical activity was associated with lower risks of incident cardiovascular diseases, highlighting the potential importance of chronoactivity in CVD prevention.
Collapse
Affiliation(s)
- Gali Albalak
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Marjon Stijntjes
- Department of Rehabilitation Medicine, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (building 34), 2628 CD Delft, The Netherlands
| | - David van Bodegom
- Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands
| |
Collapse
|
49
|
Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis 2023; 10:jcdd10020068. [PMID: 36826564 PMCID: PMC9965876 DOI: 10.3390/jcdd10020068] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions.
Collapse
|
50
|
Morales-Palomo F, Moreno-Cabañas A, Alvarez-Jimenez L, Ortega JF, Mora-Rodriguez R. Effect of Yearly Exercise on Medication Expense and Benefit-Cost Ratio in Individuals with Metabolic Syndrome: A Randomized Clinical Trial. Med Sci Sports Exerc 2023; 55:158-166. [PMID: 36171184 DOI: 10.1249/mss.0000000000003053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Lifestyle modification through incorporation of exercise training could improve metabolic syndrome (MetS) clinical components (hypertension, dyslipidemia, hyperglycemia, and visceral abdominal obesity). We aimed to assess if long-term exercise training could restrain the increased pharmacological cost of the clinical management of the MetS. METHODS Medicine cost during a 5-yr-long randomized controlled exercise intervention trial was analyzed. After a per-protocol analysis, a group of 64 individuals 53 ± 2 yr old, with overweight (body mass index, 33.4 ± 0.9 kg·m -2 ) and MetS (3.6 ± 0.2 factors) were randomized to a training (4 months·yr -1 for 5 yr; EXERCISE, n = 25) or to a control group (CONTROL, n = 26). Subjects were studied on three occasions during the 5-yr follow-up. Participants continued their routine medication managed by their general practitioner. The main outcome is the 5-yr evolution of medication cost to treat MetS (hyperglycemia, hypertension, and hyperlipidemia). A secondary outcome is the benefit-cost ratio of the exercise intervention. RESULTS In CONTROL, medicine cost increased 160% from baseline ( P < 0.001), whereas in EXERCISE, it remained unchanged (33%; P = 0.25). After the 5-yr follow-up, medicine use was 60% and medicine cost 74% higher in CONTROL than EXERCISE ( P < 0.05 in both cases). However, MetS z score was similarly reduced over time in both groups ( P = 0.244 for group-time interaction). The number of prescribed medications increased after 5 yr in CONTROL (89%; P < 0.001), whereas it remained stable with yearly training (17%; P = 0.72 in EXERCISE). Ten-year atherosclerotic cardiovascular disease risk estimation increased only in CONTROL (15%; P = 0.05 for group-time interaction). The benefit in medicine savings (€153 per year and patient) triplicated the estimated cost (€50.8 per year and patient) of the exercise intervention. CONCLUSIONS A 5-yr-long supervised exercise training program in middle-age individuals with MetS prevents the need for increasing medicine use. The savings in pharmacological therapy outweighs the estimated costs of implementing the exercise program.
Collapse
Affiliation(s)
- Felix Morales-Palomo
- Exercise Physiology Lab at Toledo, University of Castilla-La Mancha, Toledo, SPAIN
| | | | | | | | | |
Collapse
|