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1.
Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review.
Holland, AE, Malaguti, C, Hoffman, M, Lahham, A, Burge, AT, Dowman, L, May, AK, Bondarenko, J, Graco, M, Tikellis, G, et al
Chronic respiratory disease. 2020;:1479973120952418
Abstract
OBJECTIVES To identify exercise tests that are suitable for home-based or remote administration in people with chronic lung disease. METHODS Rapid review of studies that reported home-based or remote administration of an exercise test in people with chronic lung disease, and studies reporting their clinimetric (measurement) properties. RESULTS 84 studies were included. Tests used at home were the 6-minute walk test (6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go (TUG, 4 studies) and step tests (two studies). Exercise tests administered remotely were the 6MWT (two studies) and step test (one study). Compared to centre-based testing the 6MWT distance was similar when performed outdoors but shorter when performed at home (two studies). The STS, TUG and step tests were feasible, reliable (intra-class correlation coefficients >0.80), valid (concurrent and known groups validity) and moderately responsive to pulmonary rehabilitation (medium effect sizes). These tests elicited less desaturation than the 6MWT, and validated methods to prescribe exercise were not reported. DISCUSSION The STS, step and TUG tests can be performed at home, but do not accurately document desaturation with walking or allow exercise prescription. Patients at risk of desaturation should be prioritised for centre-based exercise testing when this is available.
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2.
Implications of Cardio-Respiratory Fitness on the Performance of Exercise Tests.
Jelinek, M, Hossack, K
Heart, lung & circulation. 2019;(4):e64-e66
Abstract
In 2016, the American Heart Association (AHA) produced a position paper on cardiorespiratory fitness (CRF) which defined CRF as the most important cardiac risk factor in the assessment of prognosis in a wide variety of clinical states [1]. The aim of the paper was to improve patient management and to encourage life-style based strategies designed to improve cardiovascular risk. The authors showed that: In this Brief Communication, we expand on how CRF can be assessed and reported in exercise testing.
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3.
A practical clinical approach to utilize cardiopulmonary exercise testing in the evaluation and management of coronary artery disease: a primer for cardiologists.
Chaudhry, S, Arena, R, Bhatt, DL, Verma, S, Kumar, N
Current opinion in cardiology. 2018;(2):168-177
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Abstract
PURPOSE OF REVIEW There is growing clinical interest for the use of cardiopulmonary exercise testing (CPET) to evaluate patients with or suspected coronary artery disease (CAD). With mounting evidence, this concise review with relevant teaching cases helps to illustrate how to integrate CPET data into real world patient care. RECENT FINDINGS CPET provides a novel and purely physiological basis to identify cardiac dysfunction in symptomatic patients with both obstructive-CAD and nonobstructive-CAD (NO-CAD). In many cases, abnormal cardiac response on CPET may be the only objective evidence of potentially undertreated ischemic heart disease. When symptomatic patients have NO-CAD on coronary angiogram, they are still at increased risk for cardiovascular events. This problem appears to be more common in women than men and may warrant more aggressive risk factor modification. As the main intervention is lifestyle (diet, smoking cessation, exercise) and medical therapy (statins, angiotensin-converting enzyme inhibitors, beta-blockers), serial CPET testing enables close surveillance of cardiovascular function and is responsive to clinical status. SUMMARY CPET can enhance outpatient evaluation and management of CAD. Diagnostically, it can help to identify physiologically significant obstructive-CAD and NO-CAD in patients with normal routine cardiac testing. CPET may be of particular value in symptomatic women with NO-CAD. Prognostically, precise quantification of improvements in exercise capacity may help to improve long-term lifestyle and medication adherence for this chronic condition.
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[Diagnosis and Treatment of Physical Frailty].
Braun, T, Thiel, C, Schulz, RJ, Grüneberg, C
Deutsche medizinische Wochenschrift (1946). 2017;(2):117-122
Abstract
Physical frailty is a physiological syndrome of older people. It is characterized by a reduced reserve, a reduced stressor resistance, and vulnerability to negative health outcomes. The assessment of physical frailty is increasingly applied to identify high risk patients prior to medical or surgical interventions. The present article describes Fried's frailty phenotype, which is the most frequently applied diagnostic instrument of physical frailty, together with evidence based treatment options.
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Systematic Review of the Association Between Physical Fitness and Musculoskeletal Injury Risk: Part 2-Muscular Endurance and Muscular Strength.
de la Motte, SJ, Gribbin, TC, Lisman, P, Murphy, K, Deuster, PA
Journal of strength and conditioning research. 2017;(11):3218-3234
Abstract
de la Motte, SJ, Gribbin, TC, Lisman, P, Murphy, K, and Deuster, PA. A systematic review of the association between physical fitness and musculoskeletal injury risk: part 2-muscular endurance and muscular strength. J Strength Cond Res 31(11): 3218-3234, 2017-This is a systematic review and evaluation of the current evidence on the association between both muscular endurance (ME) and muscular strength (MS) and musculoskeletal injury (MSK-I) risk in military and civilian populations. MEDLINE, EBSCO, EMBASE, and the Defense Technical Information Center were searched for original studies published from 1970 through 2015 which examined associations between physical fitness (ME and MS) and MSK-I in military or civilian populations. Methodological quality and strength of the evidence were determined following criteria adapted from previously published systematic reviews. Forty-five of 4,229 citations met our inclusion criteria. Although results for some tests did vary by sex, taken together, our primary findings indicate there is (a) a strong evidence that poor performance in a push-up test is associated with MSK-I risk; (b) moderate evidence that poor performance in sit-up test is associated with MSK-I risk; (c) moderate evidence that isokinetic ankle and knee flexion strength, and isometric strength assessments at the back, elbow, or knee are associated with MSK-I risk; and (d) limited evidence that poor performance in a pull-up test and isotonic assessments of muscular strength are associated with MSK-I. Several measures of ME/MS are moderately or strongly associated with risk of MSK-I, but additional research is needed to identify and recommend specific assessments of ME/MS that predict MSK-I in both men and women. Future studies should also consider measures of ME and MS as a function of upper body, lower body, and core strength, and their potential association with specific, rather than general, MSK-I.
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Physiological responses during exercise with video games in patients with cystic fibrosis: A systematic review.
Carbonera, RP, Vendrusculo, FM, Donadio, MV
Respiratory medicine. 2016;:63-69
Abstract
BACKGROUND Interactive video games are recently being used as an exercise tool in cystic fibrosis (CF). This study aimed to assess the literature describing whether video games generate a physiological response similar to the exercise intensity needed for training in CF. METHODS An online search in PubMed, Embase, Cochrane, SciELO, LILACS and PEDro databases was conducted and original studies describing physiological responses of the use of video games as exercise in CF were included. RESULTS In four, out of five studies, the heart rate achieved during video games was within the standards recommended for training (60-80%). Two studies assessed VO2 and showed higher levels compared to the six-minute walk test. No desaturation was reported. Most games were classified as moderate intensity. Only one study used a maximum exercise test as comparator. CONCLUSION Interactive video games generate a heart rate response similar to the intensity required for training in CF patients.
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Validity of Submaximal Step Tests to Estimate Maximal Oxygen Uptake in Healthy Adults.
Bennett, H, Parfitt, G, Davison, K, Eston, R
Sports medicine (Auckland, N.Z.). 2016;(5):737-50
Abstract
BACKGROUND Aerobic capacity (VO2max) is a strong predictor of health and fitness and is considered a key physiological measure in the healthy adult population. Submaximal step tests provide a safe, simple and ecologically valid means of assessing VO2max in both the general population and a rehabilitation setting. However, no studies have attempted to synthesize the existing knowledge regarding the validity of the multiple step-test protocols available to estimate VO2max in the healthy adult population. OBJECTIVES The objective of this study was to systematically review literature on the validity and reliability of submaximal step-test protocols to estimate VO2max in healthy adults (age 18-65 years). DATA SOURCES AND STUDY SELECTION A systematic literature search of the MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library databases was performed. The search returned 690 studies that underwent the initial screening process. To be included, the study had to (1) have participants deemed to be healthy and aged between 18 and 65 years; (2) assess VO2max by means of a submaximal step test against a graded exercise test (GXT) to volitional exhaustion; and (3) be available in English. Reference lists from included articles were screened for additional articles. DATA ANALYSIS AND STUDY APPRAISAL METHODS The primary outcome measures used were the validity statistics between the actual measured VO2max and predicted VO2max values, and the reported direction of the statistically significant difference between the measured VO2max and the predicted VO2max. The Quality Assessment Tool for Quantitative Studies was used to assess the risk of bias in each included study, and was adapted to the type of quantitative study design used. RESULTS The combined database search produced 690 studies, from which 644 were excluded during the screening process. Following full-text assessment, a further 39 studies were excluded based on the eligibility criteria detailed previously. Four additional studies were located via the reference lists of the included studies, leaving 11 studies that fulfilled the inclusion criteria and which compared eight different step-test protocols against a direct measure of VO2max incurred during a maximal GXT. Validity measures varied, with a broad range of correlation coefficients reported across the 11 studies (r = 0.469-0.95). Of the 11 studies, two reported reliability measures, demonstrating good test-retest reliability [mean -0.8 ± 3.7 mL kg(-1) min(-1) (±7.7 % of the mean measured VO2max)]. CONCLUSIONS Considering the relationship between VO2max and various markers of health, the use of step tests as a measure of health in both the general adult population and rehabilitation settings is advocated. Step tests provide a simple, effective and ecologically valid method of submaximally assessing VO2max that can be implemented in a variety of situations within the general adult population. Future research is needed to assess the reliability of the majority of the step-test procedures reviewed. Based on the validity measures, submaximal step-test protocols are an acceptable means of estimating VO2max in the generally healthy adult population. For tracking changes in cardiorespiratory fitness, the Chester Step test appears to be an appropriate tool due to its high test-retest reliability.
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Acute and training effects of resistance exercise on heart rate variability.
Kingsley, JD, Figueroa, A
Clinical physiology and functional imaging. 2016;(3):179-87
Abstract
Heart rate variability (HRV) has been used as a non-invasive method to evaluate heart rate (HR) regulation by the parasympathetic and sympathetic divisions of the autonomic nervous system. In this review, we discuss the effect of resistance exercise both acutely and after training on HRV in healthy individuals and in those with diseases characterized by autonomic dysfunction, such as hypertension and fibromyalgia. HR recovery after exercise is influenced by parasympathetic reactivation and sympathetic recovery to resting levels. Therefore, examination of HRV in response to acute exercise yields valuable insight into autonomic cardiovascular modulation and possible underlying risk for disease. Acute resistance exercise has shown to decrease cardiac parasympathetic modulation more than aerobic exercise in young healthy adults suggesting an increased risk for cardiovascular dysfunction after resistance exercise. Resistance exercise training appears to have no effect on resting HRV in healthy young adults, while it may improve parasympathetic modulation in middle-aged adults with autonomic dysfunction. Acute resistance exercise appears to decrease parasympathetic activity regardless of age. This review examines the acute and chronic effects of resistance exercise on HRV in young and older adults.
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Behavioral and cognitive effects of tyrosine intake in healthy human adults.
Hase, A, Jung, SE, aan het Rot, M
Pharmacology, biochemistry, and behavior. 2015;:1-6
Abstract
The amino acid tyrosine is the precursor to the catecholamine neurotransmitters dopamine and norepinephrine. Increasing tyrosine uptake may positively influence catecholamine-related psychological functioning. We conducted a systematic review to examine the effects of tyrosine on behavior and cognition. Fifteen studies were reviewed. All studies except one involved tyrosine loading during a single test session. In most behavioral studies, there were no significant effects of tyrosine on exercise performance. In contrast, cognitive studies employing neuropsychological measures found that tyrosine loading acutely counteracts decrements in working memory and information processing that are induced by demanding situational conditions such as extreme weather or cognitive load. The buffering effects of tyrosine on cognition may be explained by tyrosine's ability to neutralize depleted brain catecholamine levels. There is evidence that tyrosine may benefit healthy individuals exposed to demanding situational conditions. For future research we recommend moving from studying the acute effects of a single tyrosine load in small samples to studying the behavioral and cognitive effects of tyrosine in larger groups over multiple weeks.
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Exercise-induced ischemic preconditioning detected by sequential exercise stress tests: a meta-analysis.
Lalonde, F, Poirier, P, Sylvestre, MP, Arvisais, D, Curnier, D
European journal of preventive cardiology. 2015;(1):100-12
Abstract
Exercise-induced ischemic preconditioning (IPC) can be assessed with the second exercise stress test during sequential testing. Exercise-induced IPC is defined as the time to 1 mm ST segment depression (STD), the rate-pressure product (RPP) at 1 mm STD, the maximal ST depression and the rate-pressure product at peak exercise. The purpose of this meta-analysis is to validate the parameters used to assess exercise-induced IPC in the scientific community. A literature search was performed using electronic database. The main key words were limited to human studies, which were (a) ischemic preconditioning, (b) warm-up phenomenon, and (c) exercise. Meta-analyses were performed on the study-specific mean difference between the clinical measures obtained in the two consecutive stress tests (second minus first test score). Random effect models were fitted with inverse variance weighting to provide greater weight to studies with larger sample size and more precise estimates. The search resulted in 309 articles of which 34 were included after revision (1053 patients). Results are: (a) time to 1 mm ST segment depression increased by 91 s (95% confidence interval (CI): 75-108), p < 0.001; (b) peak ST depression decreased by -0.38 mm (95% CI: -0.66 to -0.10), p < 0.01; and (c) rate-pressure product at 1 mm STD increased by 1.80 × 10(3)mmHg (95% CI: 1.0-2.0), p < 0.001. This is the first meta-analysis to set clinical parameters to assess the benefit of exercise-induced ischemic preconditioning in sequential stress testing. The results of this first meta-analysis on the sequential stress test confirm what is presented in the literature by independent studies on exercise-induced ischemic preconditioning. From now on, the results could be used in further research to set standardized parameters to assess the phenomenon.