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   Table of Contents - Current issue
January-March 2023
Volume 7 | Issue 1
Page Nos. 1-54

Online since Monday, March 13, 2023

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The interaction between exercise and cardiovascular disease p. 1
Steven R Bailey
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The intersection of exercise, cognition, and cardiovascular disease p. 3
Evan L OKeefe, James H O’Keefe, Carl J Lavie
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Exercise and the brain in cardiovascular disease: A narrative review Highly accessed article p. 5
Jenna L Taylor
Patients with cardiovascular diseases (CVDs) (including heart failure) are at increased risk of cognitive impairment and dementia. Vascular risk factors contribute to cognitive decline through cerebral small vessel diseases, pathological brain changes, and hypoperfusion. Habitual exercise and increased cardiorespiratory fitness are associated with higher cognitive function, greater cerebral blood flow, and attenuation of the decline in gray matter volume and white matter integrity. Furthermore, moderate-vigorous exercise training has been shown to improve cognitive function in healthy middle-aged and older adults. Cardiac rehabilitation (CR) is a class 1A recommendation for patients with CVD, which involves exercise training and intensive risk factor modification. This article reviews the current evidence for the effect of exercise-based CR on cognitive function, cerebrovascular function, and brain structure in patients with CVDs. Overall, exercise-based CR appears to improve global cognitive function and attention-psychomotor functions but not language processes. Furthermore, the effect of exercise-based CR on executive function and memory is less clear and there is limited research into the effect of exercise-based CR on cerebrovascular function and brain structure.
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Impact of cardiac rehabilitation on psychological factors, cardiorespiratory fitness, and survival: A narrative review p. 13
Nadia Isabel Abelhad, Sergey M Kachur, Alexandra Sanchez, Carl J Lavie, Richard V Milani
Cardiac rehabilitation (CR) is a form of prescribed exercise that is a multidisciplinary approach designed to improve cardiac function and quality of life following major adverse cardiovascular events. In this comprehensive overview, we will describe the individual components of exercise training and discuss the preset doses for effective CR based on recent meta-analyses. We will also review the effects of prescribed exercise medicine on outcomes such as psychosocial stress factors, cardiorespiratory fitness, and survival and their individualized impact on special populations.
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Stress, cardiovascular diseases and exercise – A narrative review p. 18
Dejana Popovic, Carl J Lavie
The assuredness that adverse life stressors can lead to major negative impacts on an individual's health has been held since antiquity. Stress is considered a state of homeostasis being challenged, with biological consequences that can cause cardiovascular diseases (CVD). Stressors may be diverse and include a variety of psychological stressors, such as family stress, job strain, effort-award imbalance, long working hours, insecurity, social isolation, and lack of purpose in life. However, stressors may also be physical, immunological, metabolic, or environmental. Type of personality, anxiety, depression, pessimism or hostility, previous experience, genomics, body composition, nutritive and training status modulate stress responses and are important co-stressors. Chronic stress is linked with altered neurohormonal activity, which increases apoptotic pathways in cardiomyocytes. These pathways contribute to impaired myocardial contractility, increased risk of myocardial ischemia, infarction, heart failure, and arrhythmias. While stress is a vital risk factor for CVD, it has not been a major focus of preventive strategies. The purpose of this article is to review the impact of stress on CVD risk with an emphasis on approaches for stress reduction. Strength and endurance exercise, although being stress itself, leads to better adaptiveness to other types of stress, and by far has played an inevitable role in CVD risk reduction. Innovative strategies to combat CVD are strongly needed and exercise may be the best population-level cost-effective approach.
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The therapeutic role of exercise training in heart failure patients: A narrative review p. 25
Ageliki Laina, Stergios Soulaidopoulos, Ioannis Doundoulakis, Petros Arsenos, Athanasios Kordalis, Panagiotis Xydis, Anastasia Xintarakou, Charalampos Kalantzis, Christina Chrysohoou, Polychronis Dilaveris, Stefanos Archontakis, Helias Sotiropoulos, Skevos Sideris, Lila Sklavi Gatzouli, Konstantinos Tsioufis, Konstantinos Athanasios Gatzoulis
Cardiac rehabilitation (CR) is a complex intervention that improves functional capacity and quality of life in patients with heart failure (HF). Besides exercise training (ET), CR includes aggressive risk factor management, education about medication adherence, stress management, and psychological support. Current guidelines strongly recommend CR as an integral part of chronic and stable HF patient care. However, CR programs are underused for multiple reasons, namely, low physician referral and patient adherence, high cost, and lack of awareness. In this review, we present existing evidence of the beneficial effects of ET and CR in HF with reduced and preserved ejection fraction, the underlying pathophysiologic mechanisms by which exercise might alleviate symptoms, and the different types of exercise that can be used in HF. Current guidelines supporting the use of CR, reasons for its underutilization, and home-based CR as an alternative or adjunct to traditional center-based programs are also described.
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A narrative review on exercise and cardiovascular disease: Physical activity thresholds for optimizing health outcomes p. 34
Barry A Franklin, Thijs M H Eijsvogels
The favorable risk factor profiles and superb cardiac performance of elite long-distance runners, as well as the anti-aging effects of exercise, have likely contributed to the escalating number of adults worldwide who have embraced the notion that “more exercise is invariably better.≵ Nevertheless, vigorous-to-high-intensity physical activity (PA), particularly when unaccustomed, appears to be a trigger for acute cardiac events in individuals with known or occult atherosclerotic cardiovascular disease or structural cardiovascular abnormalities, most notably, hypertrophic cardiomyopathy. Although regular endurance exercise and moderate-to-vigorous PA provide established cardioprotective benefits, high-volume, high-intensity exercise training regimens appear to induce maladaptive cardiac remodeling in some individuals. These potential adverse cardiac adaptations include accelerated coronary artery calcification (CAC), elevated cardiac biomarker release, myocardial fibrosis, and atrial fibrillation (AF), which may be described by a reverse J-shaped curve. However, the risk for acute cardiovascular events is lower in fit/active persons compared to their unfit/inactive counterparts with the same CAC scores. Similarly, the risk of AF is the highest in habitually sedentary older adults, decreases with light-to-moderate intensity regular PA but increases with high-volume, high-intensity exercise regimens (i.e., reverse J-shaped curve). This review examines these relations and more, with specific reference to the World Health Organization exercise intensity and duration recommendations for optimal health, as well as the thresholds for other research-based exercise metrics, including steps/day and the concept of metabolic equivalents-minutes/week. The primary beneficiaries of exercise training programs and long-term goal training intensities, based on age, sex, and “good≵ fitness, are also discussed. In summary, the benefits of regular moderate-to-vigorous PA and the associated improvements in cardiorespiratory fitness far outweigh the risks for most individuals.
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Postexercise oxygen uptake recovery delay among patients with heart failure: A systematic review p. 40
Charounipha Soydara, Corrine Yvonne Jurgens, Gregory D Lewis
Background: Peak oxygen uptake (VO2) is often the focal point of cardiopulmonary exercise testing among patients with heart failure (HF). Breath-by-breath VO2 kinetic patterns at exercise onset, during low-level and submaximal exercise, and during recovery may provide incremental insight into HF severity and etiologies of exercise limitation. Objective: The aim of this systematic review was to explore VO2 recovery delay (VO2RD) across the spectrum of left ventricular function. Methods: A systematic review was conducted using several online databases (EMBASE, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science). Steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Search terms included VO2RD OR VO2 off kinetics AND HF, peak VO2 AND recovery. All articles were uploaded to Covidence. Results: Four studies met the inclusion criteria. The definition of VO2RD varied across studies. Recovery delay was consistently observed in HF patients compared to controls indicating VO2RD discriminates between those with and without HF. Control groups showed VO2 decline almost immediately after exercise. VO2RD had a significant positive linear relationship to N-terminal prohormone of brain natriuretic and Doppler echo E/e' while demonstrating an inverse relationship with peak cardiac output and survival duration. Conclusions: VO2RD, unlike peak VO2, is relatively cardiospecific. Oxygen recovery kinetics offer insight into disease severity and discrimination of healthy participants from those with HF.
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Proposing an #EASIER cardiopulmonary rehabilitation protocol for coronavirus disease 2019 survivors p. 45
Cássia da Luz Goulart, Rebeca Nunes Silva, Murilo Rezende Oliveira, Guilherme Dionir Back, Ross Arena, Mark A Faghy, Audrey Borghi-Silva
The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that intervention in cardiopulmonary rehabilitation is of great importance, especially in the recovery stage, and should be carried out mainly with the aim of improving dyspnea, severe muscle weakness, and fatigue, to promote functional independence, and increase quality of life. Based on the limitations demonstrated in COVID-19 survivors, we developed a protocol based on the acronym #EASIER, which is divided into six phases. Such a study will be able to early identify the impact of COVID-19 in different severities as well as provide subsidies to guide physiotherapists early, through the correct prescription of rehabilitative interventional measures.
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Improving fitness through exercise will improve our heart and mind p. 49
Carl J Lavie, Icey Zhang, Doris Yang, Meiyan Liu
In the interview, Prof. Carl “Chip” J. Lavie gave suggestions on daily exercise, shared impressive cases of cardiovascular disease (CVD) patients, gave professional explanations of weight management and CVD outcomes, etc. His major viewpoints are: (a) psychological stress is a major risk factor for CVDs, (b) a low-level physical activity contributes to a high prevalence of most CVD risk factors, and regular exercise training can improve cardiac function and aerobic performance, and (c) the prognosis and survival among CVD patients with low physical activity are better in the obese than the lean.
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Cardiopulmonary exercise testing in heart failure risk assessment and prognosis p. 52
Jari A Laukkanen, Setor K Kunutsor
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