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Cardiorespiratory optimal point during exercise testing is related to cardiovascular and all-cause mortality.
Laukkanen, JA, Kunutsor, SK, Araújo, CG, Savonen, K
Scandinavian journal of medicine & science in sports. 2021;(10):1949-1961
Abstract
Cardiorespiratory optimal point (COP) during exercise may be a potentially clinically useful cardiopulmonary exercise testing (CPET) variable, but its prognostic relevance for adverse cardiovascular disease (CVD) outcomes is unknown. We aimed to assess the association of COP during exercise with fatal mortality outcomes and the extent to which COP could improve the prediction of CVD mortality. Cardiorespiratory optimal point, the minimum value of the ventilatory equivalent for oxygen (VE/VO2) in a given minute of a CPET, was defined in 2,205 men who underwent CPET. Hazard ratios (HRs) (95% confidence intervals [CIs]) for outcomes and measures of risk discrimination for CVD mortality were calculated. During a median follow-up of 28.8 years, 402 fatal CHDs, 607 fatal CVDs, and 1,348 all-cause mortality events occurred. COP was continually associated with each outcome in a dose-response manner. On adjustment for established and emerging risk factors, the HRs (95% CIs) for fatal CHD, fatal CVD, and all-cause mortality were 3.05 (1.94-4.81), 2.82 (1.91-4.18) and 2.46 (1.85-3.27), respectively, per standard deviation increase in COP. After further adjustment for high sensitivity C-reactive protein, the HRs were 2.82 (1.78-4.46), 2.57 (1.73-3.81), and 2.27 (1.70-3.02), respectively. Addition of COP to a CVD mortality risk prediction model containing established risk factors was associated with a C-index change of 0.0139 (0.0040 to 0.0238; p = 0.006) at 25 years. COP during exercise is directly associated with fatal cardiovascular and all-cause mortality events in dose-response fashions. COP during exercise may improve the prediction of the long-term risk for CVD mortality.
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Improved cardiorespiratory fitness following moderate exercise may encourage inactive people for doable and sustainable behavioral change.
Pavlik, G, Bakács, E, Csajági, E, Bakács, T, Noe, J, Kirschner, R
The Journal of sports medicine and physical fitness. 2019;(3):502-509
Abstract
BACKGROUND Global physical inactivity pandemic is responsible for more than 5 million deaths annually through its effects on non-communicable diseases. This requires urgent intervention. The aim of this study was to investigate the associations of physical activity with cardiovascular fitness in a cross-sectional retrospective observational fashion. Data were collected for 21 years from 2530 healthy volunteers and athletes representing the entire spectrum of physical activity from the totally inactive sedentary persons to the highly trained national athletes. METHODS Cardiac fitness was investigated echocardiographically, which is characterized by reduced resting heart rate (RHR), increased relative left ventricular muscular mass (rLVMM), improved left ventricular diastolic function (characterized by the ratio of early to late ventricular peak velocities, E/A) and peak exercise oxygen consumption. RESULTS We found that even moderate exercise is associated with improved cardiac characteristics. With increasing exercise level, the RHR decreased from 69 to 63.3, 61.4, 58.6, 56.1, and 55.8/min in non-athletes, leisure athletes, lower class athletes, 2nd class athletes, 1st class athletes, and national athletes, respectively. While the rLVMM was increased from 64.6 to 70.7, 76.3, 78.5, 86.7, and 88.9 in the same groups. The E/A ratio also increased from 1.71 to 1.72, 1.85, 2.04 in the non-athletes, leisure athletes, lower class athletes, and 2nd class athletes, respectively, but then decreased to 1.92 and 1.98 in the 1st class athletes and national athletes. The largest exercise-induced improvement of cardiac fitness was observed between the inactive and the least active group, which did not increase further in the highly trained national athletes enduring up to 20 training hours per week. CONCLUSIONS Our findings indicate that cardiac fitness can be improved by moderate exercise in sedentary persons. This information would help physicians to encourage inactive patients, who find physical exercise intimidating, for doable and sustainable behavioral change.
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Examining the impact of a summer learning program on children's weight status and cardiorespiratory fitness: A natural experiment.
Hunt, ET, Whitfield, ML, Brazendale, K, Beets, MW, Weaver, RG
Evaluation and program planning. 2019;:84-90
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Abstract
UNLABELLED This study examined the impact of an existing 7-week summer learning program on children's weight status and cardiorespiratory fitness (CRF). METHODS Using an observational repeated measures within-subjects design, children's (N = 20 mean age = 6.35; 45% female; 80% African American) height, weight, and CRF (i.e., Fitnessgram PACER), were measured during the first and final week of the seven week program. Descriptive statistics were calculated for all variables. Median regression analysis examined estimated the differences in BMI zscore, overweight and obesity prevalence, and CRF during the first week (baseline) compared to the final week (outcome). RESULTS Of those enrolled initially in the program, 77% attended for more than 4 weeks. When controlling for attendance and sex, no statistically significant changes were observed for, median zBMI (pre: 0.12, post: 0.11) or CRF (pre: 10, post: 13.5 PACER laps). All children except for one maintained the same weight status (e.g. normal weight, overweight) from baseline to outcome. A total of 12 participants increased or maintained the number of PACER laps completed, while 8 participants' PACER laps decreased. CONCLUSION The results of this natural experiment provides preliminary evidence that participation in a structured summer program can potentially mitigate unhealthy weight gains and fitness loss over the summer for some children. Future studies with larger more representative samples are needed to establish the impact of structured summer programming on children's CRF and weight status.
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Sedentary Behavior, Physical Activity, and Fitness-The Maastricht Study.
VAN DER Velde, JHPM, Koster, A, VAN DER Berg, JD, Sep, SJS, VAN DER Kallen, CJH, Dagnelie, PC, Schram, MT, Henry, RMA, Eussen, SJPM, VAN Dongen, MCJM, et al
Medicine and science in sports and exercise. 2017;(8):1583-1591
Abstract
PURPOSE This cross-sectional study examined the mutual independent associations of sedentary behavior, lower intensity physical activity (LPA) and higher intensity physical activity (HPA) (an approximation of moderate to vigorous physical activity with cardiorespiratory fitness (CRF). METHODS Two thousand twenty-four participants were included from The Maastricht Study (mean ± SD age, 59.7 ± 8.1 yr; 49.6% men). With the activPAL3 activity monitor, we assessed sedentary time (ST), sedentary pattern variables (number of sedentary breaks, average sedentary bout duration, and number of prolonged sedentary bouts [≥30 min]), LPA, and HPA. CRF was calculated as maximum power output per kilogram body mass (Wmax·kg) estimated from a submaximal cycle ergometer test. Linear regression analyses and isotemporal substitution analyses were used to examine associations of ST, sedentary pattern variables, and HPA with CRF. Analyses were stratified by sex. RESULTS One hour of ST per day was associated with a lower Wmax·kg: Bmen = -0.03 (95% confidence interval [CI], -0.05 to -0.01) and Bwomen = -0.02 (95% CI, -0.04 to 0.00), independent of HPA. No statistically significant associations between sedentary patterns variables and CRF were observed. LPA was associated with a higher Wmax·kg: Bmen = 0.12 (95% CI, 0.07-0.17) and Bwomen = 0.12 (95% CI, 0.07-0.18). HPA was associated with a higher Wmax·kg: Bmen = 0.48 (95% CI, 0.38-0.58) and Bwomen = 0.27 (95% CI, 0.18-0.36). Replacing ST with LPA (Bmen, 0.08; 95% CI, 0.03-0.14; Bwomen, 0.10; 95% CI, 0.05-0.16) or with HPA (Bmen, 0.49; 95% CI, 0.39-0.59; Bwomen = 0.28; 95% CI, 0.19-0.36), but not with standing was associated with higher CRF. CONCLUSIONS Modest associations between sedentary behavior and CRF were observed. Replacing ST with LPA was associated with higher CRF, which could be of particular importance for individuals who cannot engage in HPA. Nonetheless, replacing ST with HPA was associated with greatest estimated change in CRF.
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The association between midlife cardiorespiratory fitness and later life chronic kidney disease: The Cooper Center Longitudinal Study.
DeFina, LF, Barlow, CE, Radford, NB, Leonard, D, Willis, BL
Preventive medicine. 2016;:178-183
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major public health problem, particularly in older age and in those with diabetes mellitus (DM), with high comorbidity and treatment costs. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 17,979 participants, 22% women with a mean age of 50.0 (SD 8.8), in the Cooper Center Longitudinal Study (CCLS) seen initially between 1971 to 2009 who also received Medicare coverage from 1999 to 2009. PREDICTORS Age, body mass index, blood pressure, cholesterol, glucose levels, current tobacco use, and cardiorespiratory fitness. OUTCOMES Incident CKD and DM were determined from Medicare administrative claims data. RESULTS During 116,973person-years of observation, 2022 cases of incident CKD occurred. Multivariable-adjusted proportional hazards models revealed a 24% lower risk of CKD among moderate fit (hazards ratio[HR] 0.76, 95% CI 0.67-0.85 compared to low fit) and a 34% lower risk of CKD among high fit (HR 0.66, 95% CI 0.58-0.76 compared to low fit). Even following the development of DM, fitness was associated with lower risk of CKD (HR 0.94, 95% CI 0.89-0.99) per 1-MET increment. LIMITATIONS Relatively homogeneous population of well-educated Caucasians. CONCLUSION Results of the present study suggest that higher fitness is associated with lower risk of CKD decades later even in at-risk populations such as diabetics. The findings support a role for enhancing fitness through regular physical activity in preventive strategies for CKD including those who may develop DM in later life.
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Cardiorespiratory Fitness Is Associated with Better Executive Function in Young Women.
Scott, SP, DE Souza, MJ, Koehler, K, Petkus, DL, Murray-Kolb, LE
Medicine and science in sports and exercise. 2016;(10):1994-2002
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PURPOSE A positive association between cardiorespiratory fitness (CRF) and cognitive function has been demonstrated mainly in children and older adults. Women attending college live in a cognitively demanding setting where optimal cognition matters but often experience declines in CRF. Our aim was to test whether CRF is associated with executive function in young adult women. METHODS Participants in this cross-sectional study included 120 healthy women age 18-35 yr in a university setting. Each woman completed a maximal treadmill-based exercise test to determine peak oxygen uptake (V˙O2peak), computerized tests of executive function, and questionnaires to assess motivation and other factors with potential to influence physical and cognitive performance. RESULTS Overall CRF was excellent, with a sample mean V˙O2peak of 44.6 mL·min·kg. After adjusting for covariates, higher V˙O2peak was associated with better performance on attention (P < 0.01), learning/shifting (P < 0.01), working memory (P < 0.01), and problem-solving (P < 0.05) tasks. Likewise, when women were grouped according to the American College of Sports Medicine fitness classification, performance on executive function tasks was poorest in women with very poor or poor CRF. Women with superior CRF performed best on executive function tasks, and performance was intermediate in women with fair, good, or excellent CRF. CONCLUSION The findings from this cross-sectional study suggest that optimal cognition is related to CRF in young adult women. Future studies are needed to test whether strategies to improve CRF are effective in improving cognitive function.
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Cardiorespiratory Fitness Suppresses Age-Related Arterial Stiffening in Healthy Adults: A 2-Year Longitudinal Observational Study.
Gando, Y, Murakami, H, Kawakami, R, Yamamoto, K, Kawano, H, Tanaka, N, Sawada, SS, Miyatake, N, Miyachi, M
Journal of clinical hypertension (Greenwich, Conn.). 2016;(4):292-8
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Cardiorespiratory fitness is negatively associated with arterial stiffness, although it is unclear whether it is associated with prospective arterial stiffness changes. The authors examined cardiorespiratory fitness and arterial stiffness progression in a 2-year follow-up study of 470 healthy men and women aged 26 to 69 years. Peak oxygen uptake (V˙O2peak) was measured at baseline using a graded cycle exercise test. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV) at baseline and after 2 years. Two-year changes in baPWV were significantly higher in patients in the lowest V˙O2peak tertile (28.8±7.6 cm/s) compared with those in the highest V˙O2peak tertile (-1.4±7.5 cm/s) (P=.024) and were inversely correlated with V˙O2peak (r=-.112, P=.015). Stepwise multiple regression analysis revealed that age, glucose, baPWV, V˙O2peak, and sex were independent correlates of 2-year changes in baPWV, suggesting that higher cardiorespiratory fitness is associated with age-related arterial stiffening suppression.