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Background : Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of HF and is associated with high morbidity and mortality. The primary chronic symptom in HFpEF is exercise intolerance, associated with reduced quality of life (QoL). Emerging evidence implicates left atrial (LA) dysfunction as an important pathophysiologic mechanism. Here we extend prior observations by relating LA dysfunction to peak oxygen uptake (peak VO2), physical function (distance walked in six minutes, 6MWD) and QoL (Kansas City Cardiomyopathy Questionnaire, KCCQ). Methods : We compared 75 older, obese, HFpEF patients to 53 healthy age-matched controls. LA strain was assessed by magnetic resonance cine imaging using feature tracking. LA function was defined according to its three distinct phases, with the LA serving as a reservoir during systole, as a conduit during early diastole, and as a booster pump at the end of diastole. LA stiffness index was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e’, by Doppler ultrasound) and LA reservoir strain. Results : HFpEF had decreased reservoir strain (16.4±4.4% vs. 18.2±3.5%, p=0.018), lower conduit strain (7.7±3.3% vs. 9.1±3.4%, p=0.028), and increased stiffness index (0.86±0.39 vs. 0.53±0.18, p Conclusion : LA stiffness is independently associated with impaired exercise tolerance and QoL and may be an important therapeutic target in obese HFpEF. Registration : NCT00959660

INTRODUCTION: The relationship between physical activity (PA), exercise capacity, and quality of life (QOL) in obese heart failure with preserved ejection fraction (HFpEF) is poorly understood. METHODS: This was an ancillary study to a clinical trial. Accelerometers were used to measure light PA (LPA), moderate to vigorous PA (MVPA), total PA, PA energy expenditure (PAEE), and steps. Peak VO(2), exercise time, and six-minute walk distance, as well as QOL measures were obtained. Pearson correlations were performed to examine relationships between PA, exercise capacity, and QOL. RESULTS: Patients (n=58) were 68.0±5.7 years old, 78% female, 59% white, and obese (BMI 39.1±6.1 kg/m(2)). Patients had low levels of objectively measured PA as well as reduced exercise capacity and poor QOL. LPA (r=0.32, p=0.014) and steps/day (r =0.30, p=0.022) were modestly correlated with peak VO(2). All PA variables were modestly correlated with exercise time (r=0.33–0.49, all p

OBJECTIVE Moderate- to vigorous-intensity physical activity (MVPA) improves cardiovascular health. Few studies have examined MVPA timing. We examined the associations of timing of bout-related MVPA with cardiorespiratory fitness and cardiovascular risk in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Baseline 7-day hip-worn accelerometry data from Look AHEAD participants (n = 2,153, 57% women) were analyzed to identify bout-related MVPA (≥3 METs/min for ≥10 min). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups on the basis of the time of day with the majority of bout-related MVPA (METs × min): ≥50% of bout-related MVPA during the same time window (morning, midday, afternoon, or evening), RESULTS Cardiorespiratory fitness was highly associated with timing of bout-related MVPA (P = 0.0005), independent of weekly bout-related MVPA volume and intensity. Importantly, this association varied by sex (P = 0.02). In men, the midday group had the lowest fitness (β = −0.46 [95% CI −0.87, −0.06]), while the mixed group in women was the least fit. Framingham risk score (FRS) was associated with timing of bout-related MVPA (P = 0.02), which also differed by sex (P = 0.0007). The male morning group had the highest 4-year FRS (2.18% [0.70, 3.65]), but no association was observed in women. CONCLUSIONS Timing of bout-related MVPA is associated with cardiorespiratory fitness and cardiovascular risk in men with type 2 diabetes, independent of bout-related MVPA volume and intensity. Prospective studies are needed to determine the impacts of MVPA timing on cardiovascular health.

Background: To examine the relationship between early physical activity (PA) adoption (2, 3, and 4 mo) and longer-term PA adherence (1 y) among individuals who were inactive at baseline and received a lifestyle intervention. Methods: Participants (n = 637) received weekly behavioral weight loss sessions, calorie reduction, and PA goals (50–175 min/wk progression). PA was assessed via self-reported measures at baseline, months 2 to 4, and 1 year. Results: PA at months 2 to 4 was significantly correlated with PA at 1 year (rs = .29–.35, P P P Conclusions: Failure to achieve PA goals at 2, 3, or 4 months results in less overall PA at 1 year. Thus, PA observed as early as month 2 may be a useful indicator for identifying at-risk individuals who may benefit from more intensive PA intervention strategies.

Aggressive risk factor modification, including smoking cessation, blood pressure management, and more intensive efforts to control hyperlipidemia, as well as stress management training, are associated with improved cardiovascular outcomes and impressive mortality reductions. This commentary addresses these topics, with specific reference to lifestyle modification and complementary cardioprotective medications.

PURPOSE: Although exercise training (ET) has been shown to improve both physical function and health-related quality of life (HRQOL) in older patients with heart failure and preserved ejection fraction (HFpEF), the relationship between changes in these important patient-centered outcome measures has not been adequately investigated. METHODS: Patients (n=116) with HFpEF (from two previous randomized controlled trials) were assigned to either 16-wk of endurance exercise training (ET) or attention-control (CON). The ET in both trials consisted of up to 60 minof moderate-intensity endurance ET 3 time/wk. Peak exercise oxygen uptake (VO(2peak)), and other exercise capacity measures were obtained from a cardiopulmonary exercise test on an electronically-braked cycle ergometer and 6 min walk test (6MWT). HRQOL was assessed using the Minnesota Living with Heart Failure (MLHF) Questionnaire and the Short Form Health Survey (SF-36). RESULTS: Compared to CON, the ET group demonstrated significant improvement in measures of physical function (VO(2peak) and 6MWT) at 16 wk of follow-up. There were no significant differences observed between the groups for MLHF scores, but the ET group showed significant improvements on the SF-36. There were no significant correlations between change in any of the physical function and HRQOL measures in the ET group. CONCLUSIONS: While endurance ET improved both physical function and some domains of HRQOL, the lack of significant correlations between changes in these measures suggests the effects of ET on physical function and HRQOL are largely independent of one another. Since these measures assess important and unique patient-centered outcomes in HFpEF patients, both physical function and HRQOL should be assessed in exercise-based programs and clinical trials.

Risk to individuals for cardiovascular events are invariably tied to their exposure to major coronary risk factors. This risk can be substantially mitigated by lifestyle behaviors. This first part of this Commentary focuses on the important role both adopting healthful dietary patterns and regularly obtaining adequate physical activity have as preventative therapies for cardiovascular diseases.

Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of all heart failure (HF) cases and is the fastest growing form of HF in the United States. The cornerstone symptom of clinically stable HFpEF is severe exercise intolerance (defined as reduced peak exercise oxygen uptake, VO2peak) secondary to central and peripheral abnormalities that result in reduced oxygen delivery to and/or use by exercising skeletal muscle. To date, pharmacotherapy has not been shown to improve VO2peak, quality of life, and survival in patients with HFpEF. In contrast, exercise training is currently the only efficacious treatment strategy to improve VO2peak, aerobic endurance, and quality of life in patients with HFpEF. In this updated review, we discuss the specific central and peripheral mechanisms that are responsible for the impaired exercise responses as well as the role of exercise training to improve VO2peak in clinically stable patients with HFpEF. We also discuss the central and peripheral adaptations that contribute to the exercise training-mediated improvement in VO2peak in HFpEF. Finally, we provide clinical exercise physiologists with evidence-based exercise prescription guidelines to assist with the safe implementation of exercise-based cardiac rehabilitation programs in clinically stable patients with HFpEF.

Although survival rates for stage I to III breast cancer have greatly increased, in part due to improved treatment options, this progress is threatened by increased cardiovascular (CV) events for survivors. More than 35% of women experience CV injury, left ventricular (LV) dysfunction, exercise

Objectives The aim of this study was to evaluate the association between age and invasive cardiovascular hemodynamics during upright exercise among healthy adults. Background The marked age-related decline in maximal exercise oxygen uptake (peak VO2) may contribute to the high burden of heart failure among older individuals and their greater severity of exertional symptoms. However, the mechanisms underlying this decline are not well understood. Methods A total of 104 healthy community-dwelling volunteers age 20 to 76 years well screened for cardiovascular disease underwent exhaustive upright exercise with brachial and pulmonary artery catheters; radionuclide ventriculography; and expired gas analysis for the measurement of peak VO2, cardiac output, left ventricular stroke volume, end-diastolic volume, end-systolic volume, ejection fraction, pulmonary capillary wedge pressure, and arteriovenous oxygen difference. Results Over a 5.5-decade age range, there was a 40% decline in peak VO2 due primarily to reduced peak exercise cardiac output; peak arteriovenous oxygen difference was unaffected by age. The lower age-related exercise cardiac output was related to lower peak exercise heart rate and stroke volume. Aging was also associated with lower peak exercise ejection fraction, indicating reduced inotropic reserve. Peak exercise end-diastolic volume was lower with aging despite similar left ventricular filling pressure, suggesting age-related reduced diastolic compliance limiting the use of the Frank-Starling mechanism to compensate for reduced chronotropic and inotropic reserves. These age relationships were unaffected by sex. Conclusions The age-related decline in exercise capacity among healthy persons is due predominantly to cardiac mechanisms, including reduced chronotropic and inotropic reserve and possibly reduced Frank-Starling reserve. Peak exercise left ventricular filling pressure and arteriovenous oxygen difference are unchanged with healthy aging.

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most rapidly increasing form of HF, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. In the highest age decile (≥90 years old), nearly all patients with HFpEF. As our understanding of the disease has grown in the last few years, we now know that HFpEF is a systemic disorder influenced by aging processes. The involvement of this broad collection of abnormalities in HFpEF, the recognition of the high frequency and impact of noncardiac comorbidities, and systemic, multiorgan involvement, and its nearly exclusive existence in older persons, has led to the recognition of HFpEF as a true geriatric syndrome. Most of the conventional therapeutics used in other cardiac diseases have failed to improve HFpEF patient outcomes significantly. Several recent studies have evaluated exercise training (ET) as a therapeutic management strategy in patients with HFpEF. Although these studies were not designed to address clinical endpoints, such as HF hospitalizations and mortality, they have shown that ET is a safe and effective intervention to improve peak oxygen consumption, physical function, and quality of life in clinically stable HF patients. Recently, a progressive, multidomain physical rehabilitation study among older adults showed that it is feasible in older patients with acute decompensated HF who have high frailty and comorbidities and showed improvement in physical function. However, the lack of Centers for Medicare and Medicaid Services coverage can be a major barrier to formal cardiac rehabilitation in older HFpEF patients. Unfortunately, insistence upon demonstration of mortality improvement before approving reimbursement overlooks the valuable and demonstrated benefits of physical function and life quality.

Spencer W Sullivan,1,2 Niles A Fleet,3 Vanessa A Brooks,3 Jennifer Bido,2 Benedict U Nwachukwu,2 Peter H Brubaker1 1Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, 27106, USA; 2Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, 10021, USA; 3Department of Sports Medicine, Wake Forest University, Winston-Salem, NC, 27106, USACorrespondence: Spencer W Sullivan 1109 Crowne Oaks Circle, Winston Salem, NC, 27106, USATel +1 317 775 2626Fax +1 646 885 8252Email spencer.sullivan44@gmail.comBackground: Bilateral leg power is being increasingly investigated as a proxy for the recovery of muscle performance after injury. Functional tests like the single leg hop for distance (SLHD) and single leg vertical jump (SLVJ) are often used to determine symmetry and return to play (RTP) readiness. As an injury predictor, leg power is accurately measured with the Keiser Air420 seated leg press.Purpose: To measure and analyze lower leg asymmetry in healthy collegiate athletes across each test battery.Methods: Eighty-eight healthy student-athletes (44 males, 44 females) across 14 varsity teams at Wake Forest University performed the SLHD, SLVJ, and the Keiser. Horizontal and vertical displacement were measured via the SLHD and SLVJ, respectively. Peak power was recorded via the Keiser Air420 leg press. Pearson correlations and repeated measures ANOVA were used to calculate associations and compare bilateral asymmetry indices (BAI) and raw scores.Results: There was a significant effect on each test’s raw BAI (P < 0.01). The mean absolute BAI were 5.42 ± 4.9%, 6.64 ± 4.9% and 5.36 ± 4.7% for the SLHD, SLVJ and Keiser, respectively. The SLVJ and Keiser (dominant leg r = 0.832, nondominant leg r = 0.826) were more highly correlated than the SLHD and Keiser (dominant leg r = 0.645, nondominant leg r = 0.687), all of which were statistically significant (P < 0.01).Conclusion: At the 90th percentile, healthy collegiate athletes attained < 15% BAI. We recommend the implementation of a battery of tests to determine normative lower limb asymmetry. A battery of functional tests may present different asymmetry indices as opposed the 10% reference asymmetry.Keywords: lower leg, power testing, functional testing, limb symmetry, athlete, return to play

BACKGROUND Older patients with acute decompensated heart failure (ADHF) have severely impaired physical function (PF) and quality of life (QOL). However, relationships between impairments in PF and QOL are unknown but are relevant to clinical practice and trial design. METHODS We assessed 202 consecutive patients hospitalized with ADHF in the multicenter Rehabilitation Therapy in Older Acute HF Patients (REHAB-HF) Trial. PF measures included Short Physical Performance Battery (SPPB) and 6-min walk distance (6MWD). Disease-specific QOL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). General QOL was assessed by the Short Form-12 (SF-12) and EuroQol-5D-5L. PF was evaluated as a predictor of QOL using stepwise regression adjusted for age, sex, race, and New York Heart Association class. RESULTS Participants were 72 ± 8 years, 54% women, 55% minority race, 52% with reduced ejection fraction, and body mass index 33 ± 9 kg/m2 . Participants had severe impairments in PF (6MWD 185 ± 99 m, SPPB 6.0 ± 2.5 units) and disease-specific QOL (KCCQ Overall Score 41 ± 21 and Physical Score 47 ± 24) and general QOL (SF-12 Physical Score 28 ± 9 and EuroQol Visual Analog Scale 57 ± 23). There were modest, statistically significant correlations between 6MWD and KCCQ Overall, KCCQ Physical Limitation, and SF-12 Physical Scores (r = 0.23, p

Purpose Lack of physical activity (PA) is an important risk for heart failure (HF). The objective of this study was to examine PA trends in HF and non-HF participants from a nationally representative sample of US adults from 2007 to 2016. Methods Work-related/recreational activities (min/wk) were calculated on the basis of the reported frequency, intensity, and duration, respectively. Multivariable analyses were performed using National Health and Nutrition Examination Survey data. Results Among 28 824 participants, younger (aged 18-64 yr) HF participants reported less PA time than non-HF groups, especially vigorous PA. Differences were found to be smaller in older (≥ 65 yr) participants. Overall, the percentage of younger participants who met PA guidelines was significantly lower in the HF individuals in work-related PA and total PA from 2007 to 2016 than in the non-HF participants (OR = 0.55: 95% CI, 0.39-0.59 for total PA, 0.45, 0.28-0.75 for vigorous work-related PA, and 0.68, 0.47-0.97 for moderate work-related PA, respectively). In older participants, only when considering total PA, the prevalence of meeting PA guidelines was significantly different between HF and non-HF groups (0.78, 0.62-0.98). Conclusions Self-reported PA, especially vigorous activities, is much lower in older HF participants. However, the disparity in meeting PA guidelines between those with HF and without HF is remarkable in younger individuals. Future research should focus on better understanding the psychological and physical barriers to engaging in PA among HF patients.

The anaerobic threshold (AT), obtained during cardiopulmonary exercise testing (CPET), is an important prognostic measure and can be used to develop an exercise prescription in patients after a myocardial infarction (post-MI). The purpose of this study was to examine the central and peripheral determinants of AT in post-MI patients end-tidal oxygen partial pressure (PETO2) measures. We performed cardiopulmonary exercise testing (CPET) on 148 consecutively enrolled post-MI patients to determine PETO2 measured at the AT (AT PETO2) and ΔPETO2 (difference between resting PETO2 and AT PETO2). We subsequently investigated the relationship between these measures of PETO2 and the individual AT for each patient. Multivariate linear regression analysis indicated that AT PETO2 and ΔPETO2 were independently and significantly associated with the AT (β = −0.344, p

This study tested the hypothesis that early left ventricular (LV) relaxation is impaired in older obese patients with heart failure with preserved ejection fraction (HFpEF), and related to decreased peak exercise oxygen uptake (peak V̇o(2)). LV strain and strain rate were measured by feature tracking of magnetic resonance cine images in 79 older obese patients with HFpEF (mean age: 66 yr; mean body mass index: 38 kg/m(2)) and 54 healthy control participants. LV diastolic strain rates were indexed to cardiac preload as estimated by echocardiography derived diastolic filling pressures (E/e′), and correlated to peak V̇o(2). LV circumferential early diastolic strain rate was impaired in HFpEF compared with controls (0.93 ± 0.05/s vs. 1.20 ± 0.07/s, P = 0.014); however, we observed no group differences in early LV radial or longitudinal diastolic strain rates. Isolating myocardial relaxation by indexing all three early LV diastolic strain rates (i.e. circumferential, radial, and longitudinal) to E/e′ amplified the group difference in early LV diastolic circumferential strain rate (0.08 ± 0.03 vs. 0.13 ± 0.05, P < 0.0001), and unmasked differences in early radial and longitudinal diastolic strain rate. Moreover, when indexing to E/e′, early LV diastolic strain rates from all three principal strains, were modestly related with peak V̇o(2) (R = 0.36, −0.27, and 0.35, respectively, all P < 0.01); this response, however, was almost entirely driven by E/e′ itself, (R = −0.52, P < 0.001). Taken together, we found that although LV relaxation is impaired in older obese patients with HFpEF, and modestly correlates with their severely reduced peak exercise V̇o(2), LV filling pressures appear to play a much more important role in determining exercise intolerance. NEW & NOTEWORTHY Using a multimodal imaging approach to uncouple tissue deformation from atrial pressure, we found that left ventricular (LV) relaxation is impaired in older obese patients with HFpEF, but only modestly correlates with their severely reduced peak V̇o(2). In contrast, the data show a much stronger relationship between elevated LV filling pressures and exercise intolerance, refocusing future therapeutic priorities.

Introduction: Physical activity is associated with decreased rates of atherosclerotic cardiovascular disease (ASCVD) and mortality. However, high levels of physical activity (PA) have paradoxically been linked with elevated levels of coronary artery calcium (CAC). It remains unclear whether high levels of physical activity in the presence of high CAC are associated with adverse outcomes in a diverse, multi-ethnic population. Hypothesis: We hypothesized that high compared to low levels of PA are associated with a reduction in incident ASCVD and all-cause mortality, even in the presence of high CAC. Methods: Baseline total PA (MET-min/week) in the Multi-Ethnic Study of Atherosclerosis (MESA), obtained via questionnaire, was divided into quartiles. CAC was dichotomized into low (CAC Results: Among the 6,814 participants included in this study, the average age was 62 years, 53% were female, and 38% were non-Hispanic white. In participants with CAC Conclusions: Our study suggests that high levels of PA are associated with a reduced risk of ASCVD and all-cause mortality among individuals with low CAC, and a reduced risk of all-cause mortality among individuals with high CAC. There was no evidence to suggest an increased risk of ASCVD from high levels of PA in individuals with high CAC.

Background: Moderate-to-vigorous physical activity (MVPA) is an important treatment in type 2 diabetes (T2D). Few studies examine the timing of MVPA, as there are no established methods to characterize the MVPA bout timing throughout the day. We determined the timing of MVPA bouts in adults with T2D, and examined whether cardiorespiratory fitness and odds of cardiovascular disease (CVD) history relate to timing of MVPA bouts in men and women. Methods: Baseline data from Look AHEAD participants (n=2153, 57% women) were analyzed. Cardiorespiratory fitness assessed by VO2max test was expressed as METs. MVPA bouts (≥3METs in ≥10mins bouts) were determined using the hip-worn RT3 accelerometer for 7 days. Participants were categorized into six groups based on the time of day with the major amount of MVPA bouts (MET-min): ≥50% of MVPA bouts during the same time window (Early morning, Late morning, Afternoon, or Evening, N=214-280/group), Results: Cardiorespiratory fitness differed by timing of MVPA bout category (P Conclusion: Higher cardiorespiratory fitness associated with evening MVPA bouts in women, and with early morning MVPA bouts in men independent of total amount of bout-MVPA. Prospective studies are needed to investigate the relationship between timing of MVPA and cardiovascular outcomes to optimize MVPA benefits in adults with T2D. Disclosure J. Qian: None. M.P. Walkup: None. S. Chen: None. P.H. Brubaker: None. D. Bond: None. P.A. Richey: None. J.M. Jakicic: Advisory Panel; Self; Weight Watchers International, Inc. K. Hu: None. F.A. Scheer: None. R. Middelbeek: None.

Introduction: Heart failure (HF) is a growing public health problem which is the leading cause of hospitalization. About half of people who develop HF die within 5 years of diagnosis. Recent evidence suggests that physical inactivity may be an important risk for HF. However, the importance of physical activity in the prevention and treatment have not been adequately recognized. Self-reported physical activity can provide insights into the impact of lifestyle behaviors on mortality. The objective of this study was to determine the relationship between physical activity and HF in a nationally representative sample of United States (US) adults. Methods: The 2007-2016 National Health and Nutrition Examination Survey data collection cycles were used for this analysis. Participants aged 65 and older with HF were defined as those who answered “yes” to the question: “Has a doctor or other health professional ever told you that you had congestive HF?” Frequency and duration of self-reported moderate-intensity (“Days moderate recreational activities” and “Minutes moderate recreational activities”) and vigorous-intensity Days vigorous recreational activities” and “Minutes vigorous recreational activities”) physical activity were collected through questionnaires as well in all data cycles. We used 2018 Physical Activity Guidelines for Americans Older Adults, which recommended that most older adults (age≥65 years) participate in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week as our cut-off points for calculating moderate-to-vigorous physical activity. Results: Between 2007-2008 and 2015-2016, the percentage of US adults ≥65 years with HF increased from 2.76% to 3.69% (p=0.04). Although a similar percentage of participants who met the criteria of at least 150 minutes of moderate-intensity activity per week was noted in both groups from 2007 to 2016 (on average, HF: 56.9% vs. HF-free: 56.7%, respectively, p>0.05), more HF-free participants reported at least 75 minutes of vigorous-intensity recreational activities per week compared to HF participants in each calendar year (82.8% vs. 66.7%, 85.0% vs. 70.0%, 83.5% vs. 55.0%, 87.0% vs.75%, 85.2% vs. 63.6%, respectively, p Conclusions: Our findings illustrate lower self-reported physical recreational activities, especially vigorous activities, in older participants who report a diagnosis of HF and more participants without HF report vigorous-intensity recreational activities. Future study should focus on understanding the physical limitations of HF patients, which is paramount in developing cardiac rehabilitation strategies to improve their function capacity.

In older patients (70 ± 7 years) with chronic well-compensated heart failure with preserved ejection and controlled blood pressure, 6 months treatment with aliskiren (direct renin inhibitor) showed non-significant trends for modest improvements in peak exercise oxygen consumption (14.9 ± 0.2 mL kg-1 min-1 versus 14.4 ± 0.2 mL kg-1 min-1; P = .10, trend) and ventilatory anaerobic threshold (888 ± 19 mL/min versus 841 ± 18 mL/min; P = .08).

Background and aims Physical activity (PA) levels are related to mortality and morbidity in patients with chronic heart failure (CHF). Health utility (HU), a very important cost-effectiveness analysis for health care and health status, is measured by several preference-based utility measures. This study aimed to evaluate the relation between PA and HU and the effect of disease severity on PA and HU in patients with CHF. Methods We enrolled 226 consecutive outpatients with CHF (mean age, 57.5years; males, 79.6%) in this retrospective cross-sectional study. Patients were divided into three groups by NYHA class for classification of disease severity. Patient characteristics, average step count in steps/day, PA energy expenditure (PAEE) in kcal/day for 7days as assessed by accelerometer, and HU assessed by Short Form-6D were compared between the groups. Results Average step count (r=0.37, P

Objectives To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF). Design Randomized, placebo-controlled, double-blind trial. Setting Academic medical center, Winston-Salem, North Carolina. Participants Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP). Measurements Participants were randomized into a 9-month treatment of spironolactone 25 mg/d vs placebo. Assessments were peak exercise oxygen consumption (VO2), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), cardiac magnetic resonance imaging, Doppler echocardiography, and vascular ultrasound. Results Seventy-one participants completed the trial: 37 in the spironolactone group and 34 in the placebo group. Adherence according to pill count was excellent (spironolactone 95%, placebo 97%). Mean spironolactone dose was 24.3 ± 2.9 mg/d and was well tolerated. Spironolactone significantly reduced systolic and diastolic BP at rest and peak exercise. At 9-month follow-up, baseline-adjusted peak VO2, the primary outcome, was 13.5 ± 0.3 mL/kg per minute in the spironolactone group versus 13.9 ± 0.3 mL/kg per minute in the placebo group (adjusted mean difference −0.4 mL/kg per minute; 95% confidence interval = −1.1–0.4 mL/kg per minute; P = .38). The 95% confidence intervals of spironolactone's effect on peak VO2 (−8.2% to 3.2%) excluded a clinically significant beneficial effect. There were also no significant differences in 6-minute walk distance, arterial stiffness, left ventricular (LV) mass, LV mass/end-diastolic volume, or MLHFQ score. Conclusion In older adults with stable compensated HFpEF, 9 months of spironolactone 25 mg/d was well tolerated and reduced BP but did not improve exercise capacity, quality of life, LV mass, or arterial stiffness.

Objective The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults. Methods A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions. Results A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = 92.2 ± 11.2, P ≤ .01); and higher in NDYN-O compared with DYN-O ( P = .008). Additionally, NDYN-O demonstrated higher diastolic blood pressure compared with DYN-O (70.9 ± 10.1 vs 67.7 ± 9.7, P ≤ .001). No significant differences were found across dynapenia and obesity status for all other metabolic components ( P > .05). The odds of having MetS or its individual components were similar in obese and nonobese, combined or not with dynapenia (nonsignificant odds ratio [95% confidence interval]). Conclusion Nonobese dynapenic older adults had fewer metabolic disease risk factors than nonobese and nondynapenic older adults. Moreover, among obese older adults, dynapenia was associated with lower risk of meeting MetS criteria for waist circumference and diastolic blood pressure. Additionally, the presence of dynapenia did not increase cardiometabolic disease risk in either obese or nonobese older adults.

The aims of the study were to evaluate the relationship between Modified Shuttle Walk Test (MSWT) with peak oxygen uptake ( V ˙ O 2peak ) in overweight/obese people with primary hypertension (HTN) and to develop an equation for the MSWT to predict V ˙ O 2peak . Participants (N = 256, 53.9 ± 8.1 years old) with HTN and overweight/obesity performed a cardiorespiratory exercise test to peak exertion on an upright bicycle ergometer using an incremental ramp protocol and the 15-level MSWT. The formula of Singh et al was used as a template to predict V ˙ O 2peak , and a new equation was generated from the measured V ˙ O 2peak -MSWT relationship in this investigation. The correlation between measured and predicted V ˙ O 2peak for Singh et al equation was moderate ( r = 0.60, P −1 minute −1 , SEE% = 21%. The correlation between MSWT and measured V ˙ O 2peak as well as for the new equation was strong ( r = 0.72, P −1 minute −1 , SEE% = 19%. These results indicate that MSWT does not accurately predict functional capacity in overweight/obese people with HTN and questions the validity of using this test to evaluate exercise intolerance. A more accurate determination from a new equation in the current study incorporating more variables from MSWT to estimate V ˙ O 2peak has been performed but still results in substantial error.

Objectives To systematically examine the relative magnitude and predictors of responses to exercise training in older adult with heart failure (HF) with reduced ejection fraction (HFrEF), and preserved EF (HFpEF). Design Secondary analysis of a randomized controlled trial. Setting Outpatient cardiac rehabilitation program. Participants Individuals with HF (24 HFrEF, 24 HFpEF) who underwent supervised exercise training. Measurements The study included individual-level data from the exercise training arms of a randomized controlled trial that evaluated the effect of 16 weeks of supervised moderate-intensity endurance exercise training in older adults with chronic, stable HFpEF and HFrEF. Changes in peak oxygen uptake (VO2peak) in response to supervised training in individuals with HFpEF were compared with that of individuals with HFrEF. The significant clinical predictors of changes in VO2peak with exercise training were assessed using univariate and multivariate regression models. Results Training-related improvement in VO2peak was higher in participants with HFpEF than in those with HFrEF (change: 18.7 ± 17.6% vs −0.3 ± 15.4%, P

Renal function (RF) and activities of daily living (ADL) are risk factors for heart failure (HF) patients. We evaluated differences in motor and cognitive ADL in relation to RF in elderly hospitalized HF patients. Participants were selected from 414 consecutive hospitalized HF patients based on certain criteria. We investigated patient characteristics including Functional Independence Measure (FIM) and estimated glomerular filtration rate (eGFR). Subjects were divided into three groups by RF level and analyzed with one-way ANOVA and Chi-square tests and two-way ANCOVA and multiple comparison tests. Of the 414 patients, 165 met the inclusion criteria (high RF: 41, moderate RF: 84, low RF: 40). There were significant differences between the three groups in age, eGFR, hemoglobin level, mobility, cognitive function, and length of hospital stay (p

Objective To evaluate the change in the 6-minute walk test (6-MWT) distance relative to changes in key functional capacity measures after 16 weeks of exercise training in older patients (≥65y) who have heart failure with preserved ejection fraction (HFpEF). Design Prospective, randomized, single-blinded (by researchers to patient group) comparison of 2 groups of HFpEF patients. Setting Hospital and clinic records; ambulatory outpatients. Participants Participants (N=47) randomly assigned to an attention control (AC) (n=24) or exercise training (ET) (n=23) group. Intervention The ET group performed cycling and walking at 50% to 70% of peak oxygen uptake ( V ˙ o 2 peak) intensity (3d/wk, 60min each session). Main Outcome Measures V ˙ o 2 peak, ventilatory threshold (VT), and 6-MWT distance were measured at baseline and after the 16-week study period. Results At follow-up, the 6-MWT distance was higher than at the baseline in both the ET (11%, P =.005) and AC (9%, P =.004) groups. In contrast, V ˙ o 2 peak and VT values increased in the ET group (19% and 11%, respectively; P =.001), but decreased in the AC group at follow-up (2% and 0%, respectively). The change in V ˙ o 2 peak versus 6-MWT distance after training was also not significantly correlated in the AC group ( r =.01, P =.95) or in the ET group ( r =.13, P =.57). The change in 6-MWT distance and VT (an objective submaximal exercise measure) was also not significantly correlated in the AC group ( r =.08, P =.74) or in the ET group ( r =.16, P =.50). Conclusions The results of this study challenge the validity of using the 6-MWT as a serial measure of exercise tolerance in elderly HFpEF patients and suggest that submaximal and peak exercise should be determined objectively by VT and V ˙ o 2 peak in this patient population.

PURPOSE The study aimed to investigate the differences in oxygen uptake ((Equation is included in full-text article.)O2) and heart rate (HR) (at rest, submaximal exercise, peak exercise, and recovery) in patients with heart failure with preserved ejection fraction (HFpEF) with β-blockers (BB) or without BB treatment (NBB) and to analyze the relationship between HR reserve (HRresv) and peak (Equation is included in full-text article.)O2 ((Equation is included in full-text article.)O2peak) in BB and NBB. METHODS A total of 174 HFpEF patients (>65 yr; BB, n = 59; NBB, n = 115) were assessed with a cardiopulmonary exercise test to peak exertion using an incremental protocol. After 5 min of supine rest, HR and (Equation is included in full-text article.)O2 (HRrest, (Equation is included in full-text article.)O2rest) at submaximal exercise (HRsubmax, (Equation is included in full-text article.)O2submax), at peak exercise (HRpeak, (Equation is included in full-text article.)O2peak), at 1 min of passive recovery (HRrec1), HRresv (HRpeak- HRrest), and HR recovery (HRrecov = HRpeak- HRrec1) were evaluated. RESULTS Analysis showed that HRrest (66.0 ± 12.2 vs 69.7 ± 10.6 bpm), HRsubmax (91.7 ± 16.2 vs 98.6 ± 15.2 bpm), and HRrec1 (102.9 ± 18.9 vs 109.4 ± 16.9 bpm) were significantly lower (P ≤ .05) in BB than in NBB, respectively. However, there were no significant differences (P > .05) between the BB and the NBB for HRpeak, HRresv, HRrecov, (Equation is included in full-text article.)O2rest, (Equation is included in full-text article.)O2submax, and (Equation is included in full-text article.)O2peak. A significant relationship was found between HRresv and (Equation is included in full-text article.)O2peak values in both groups (BB, r = 0.52; NBB, r = 0.49, P < .001). CONCLUSIONS The nonsignificant differences in HRpeak, HRresv, HRrecov, or (Equation is included in full-text article.)O2 values between BB and NBB HFpEF patients, along with significant correlation between HRresv and (Equation is included in full-text article.)O2peak, suggest that these measures may have equal utility in prognostic and functional assessment as well as clinical applications, including the prescription of exercise, in elderly HFpEF patients.

We measured peak exercise capacity (VO2 peak) and resting and 20-s immediately post-exercise (IPE) measures of left ventricular (LV) volumes and cardiac output in 14 (5 men and 9 women) anthracycline-treated cancer survivors (ATS) ≥12 months removed from their treatment, and 14 age-, gender

Background Cancer survivors experience on average a 20% reduction in peak exercise capacity (VO2 peak) post-cancer treatment. Intermuscular fat (IMF) is a strong predictor of reduced exercise capacity in heart failure (HF) patients; however it is unknown whether increased IMF is related to reduced VO2 peak in cancer survivors. Methods and results Twenty eight individuals: 14 cancer survivors > 12-months post-cancer treatment and 14 individuals without cancer were matched on age, gender, and body mass index (BMI). Participants underwent magnetic resonance imaging (MRI) assessments of IMF within the paraspinal muscles, VO2 peak and exercise-associated measures of left ventricular ejection fraction (LVEF). Blinded analyses were performed. Associations between the ratio of IMF to skeletal muscle (SM) were estimated using Pearson’s partial correlation coefficients. Individuals with cancer and non-cancer comparators were of similar age (54 ± 17 versus 54 ± 15 years; p = 1.0), gender (5 men and 9 women, both groups), and BMI (27 ± 4 versus 26 ± 4; p = 0.57). Peak VO2 was 22% lower in cancer survivors versus non-cancer comparators (26.9 vs 34.3 ml/kg/min; p = 0.005), and was correlated with IMF:SM in both cancer survivors and non-cancer individuals after accounting for exercise-associated LVEF, resting LVEF, BMI, other body fat depots, and cardiovascular disease (CVD) co-morbidities (p

Introduction: Heart failure with preserved ejection fraction (HFpEF) is the most rapidly increasing type of heart failure. Markedly reduced exercise capacity (peak VO 2 ) is the primary manifestation of chronic HFpEF and impacts quality of life (QOL); however, its relationship to objectively measured physical activity (PA) levels is unknown. Accordingly, we prospectively measured PA, exercise performance, and QOL in older patients with chronic obese HFpEF. Hypothesis: PA levels would be low in obese HFpEF patients and would be strongly correlated with reduced exercise performance and QOL. Methods: Obese HFpEF patients ≥60 years old (N=58) wore Kenz Lifecorder EX accelerometers to obtain light PA (LPA), moderate-vigorous PA (MVPA), PA energy expenditure (PAEE), and steps. Peak VO 2 and ventilatory anaerobic threshold (VAT) were assessed by cardiopulmonary exercise testing, and six-minute walk distance (6MWD) was assessed using the Guyatt method. QOL was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ), Minnesota Living with Heart Failure Questionnaire (MLHF), and Short Form 36 (SF-36). Pearson correlations were performed to examine relationships between PA, exercise performance, and QOL. Results: Patients were 68.0±5.7 years old, 78% (45 of 58) female, 59% (34 of 58) white, obese (BMI 39.1±6.1 kg/m 2 ), and had predominantly NYHA class II symptoms (62%, 36 of 58). Patients had low PA levels with 33.4±12.6 min/day of LPA, 10.4±6.7 min/day of MVPA, 3785±1436 steps/day, and a PAEE of 147±57 kcal/day. Patients also had low exercise performance with peak VO 2 of 14.4±2.7 ml/kg/min, VAT of 9.7±1.9 ml/kg/min, and 6MWD of 410±75 meters. LPA (r=0.32, p=0.014) and steps/day (r =0.30, p=0.022) were modestly correlated with peak VO 2 , but MVPA and PAEE were not. All PA measures were moderately correlated with 6MWD (r=0.41-0.49, all p Conclusion: Obese HFpEF patients had low levels of objectively measured daily PA and low exercise performance. Contrary to our hypothesis, PA levels were only modestly correlated with exercise performance including peak VO 2 and 6MWD. PA was not correlated with any assessment of QOL. This indicates that measures of PA, exercise capacity, and QOL assess different aspects of the patient experience in obese HFpEF and are largely independent of each other. While each remains a valid potential target for intervention, they should not be considered interchangeable.

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.

The major structural component of a blood clot is a meshwork of fibrin fibers. It has long been thought that the internal structure of fibrin fibers is homogeneous; that is, the protein density and the bond density between protofibrils are uniform and do not depend on fiber diameter. We performed experiments to investigate the internal structure of fibrin fibers. We formed fibrin fibers with fluorescently labeled fibrinogen and determined the light intensity of a fiber,I, as a function of fiber diameter,D. The intensity and, thus, the total number of fibrin molecules in a cross-section scaled asD1.4. This means that the protein density (fibrin per cross-sectional area),ρp, is not homogeneous but instead strongly decreases with fiber diameter asD-0.6. Thinner fibers are denser than thicker fibers. We also determined Young’s modulus,Y, as a function of fiber diameter.Ydecreased strongly with increasingD;Yscaled asD-1.5. This implies that the bond density,ρb, also scales asD-1.5. Thinner fibers are stiffer than thicker fibers. Our data suggest that fibrin fibers have a dense, well-connected core and a sparse, loosely connected periphery. In contrast, electrospun fibrinogen fibers, used as a control, have a homogeneous cross-section.

Physical inactivity is a well-established major risk factor for cardiovascular disease. As such, physical activity counseling is 1 of the 10 core components of cardiac rehabilitation/secondary prevention programs recommended by the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). In addition, the ability to perform a physical activity assessment and report outcomes is 1 of the 10 core competencies of cardiac rehabilitation/secondary prevention professionals published by the AACVPR. Unfortunately, standardized procedures for physical activity assessment of cardiac rehabilitation patients have not been developed and published. Thus, the objective of this AACVPR statement is to provide an overview of physical activity assessment concepts and procedures and to provide a recommended approach for performing a standardized assessment of physical activity in all comprehensive cardiac rehabilitation programs following the core components recommendations.

Heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure (HF) in the general adult population, is inextricably related to aging. It is rare in persons younger than 55 years of age and increases linearly with age thereafter. Among women >65 years of age, 85% of

TPS602 Background: Modern treatment for breast cancer (BC) has led to improved survival; however, this improvement can be offset by an increase in cancer therapy-related morbidity and mortality. Over one-third of early stage BC patients treated with cancer therapy experience CV injury, left ventricular (LV) dysfunction, exercise intolerance, or fatigue. CV disease is a leading cause of mortality in BC survivors. There is limited information on the time course and long-term CV health of BC survivors. UPBEAT, a multicenter study, will prospectively evaluate CV risk factors and outcomes in early stage BC patients, treated with modern anticancer therapies. This will facilitate evaluation of primary CV prevention strategies in this patient population. Methods: This is a prospective cohort study of 840 patients with early stage (I-III) BC treated with chemotherapy +/- radiation and 160 controls. Baseline and serial longitudinal measures will examine the influence of cancer treatment on CV function, exercise capacity and fatigue, and the future development of CV events. The comprehensive assessment includes: ascertainment of cardiac biomarkers, CV risk factors, comorbidities, functional status (e.g., disability measures, expanded short physical performance battery), neurocognitive tests, behavioral risk factors, socio-demographics, and quality of life at baseline, 3-, 12-, and 24-mos. Outcomes measured at the same time points include a deep phenotyping of CV dysfunction (via cardiac MRI assessing LV end diastolic volume, LV end systolic volume, LV ejection fraction, myocardial strain, strain rate, left atrial volumes and mass, and aortic stiffness), exercise intolerance (submaximal as 6-minute walk test and maximal as VO2 peak via cardiopulmonary exercise test), and fatigue (via FACT-F). Eligibility criteria: age > 18 years; ECOG 0-2, able to walk without symptoms; receiving chemotherapy +/- HER2 targeted agent(s). To date, 244 participants are enrolled through 12 NCORP or ECOG-ACRIN sites. An additional 7 sites are onboarding and will be enrolling later in the year. Participants will be followed for 9 years with active surveillance of CV events (i.e., heart failure, myocardial infarction, stroke, all-cause and CV death). EA NCORP Grant: 2 UG1 CA189828 06; Research Base Grant: 2UG1 CA189824; R01: 1R01CA199167. Clinical trial information: NCT02791581 .

Background: Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment. Methods and Results: We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non–Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ 2 tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF ( P P =0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups ( P =0.11–0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines ( r =−0.27; P r =0.11; P =0.45). Moreover, this finding was independent of LVEF changes and body weight. Conclusions: Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.

The study aimed to assess whether the Modified Shuttle Walk Test (MSWT) can detect changes in cardiorespiratory fitness (CRF) in overweight/obese people with hypertension (HTN) after an exercise intervention evaluating the equation presented in the previous research by Jurio-Iriarte et al. Participants (N= 248) performed a peak cardiorespiratory exercise test (CPET) and MSWT before and after 16-weeks of different types of aerobic exercise intervention. The formula of Jurio-Iriarte et al. was used to predict peak oxygen uptake (V̇O

BACKGROUND: Recent studies indicate that excess total body adipose contributes to exercise intolerance in heart failure with preserved ejection fraction (HFpEF). However, the impact of the pattern of regional (abdominal, cardiac, intermuscular) adipose deposition on exercise intolerance in HFpEF is unknown. METHODS: We measured total body (dual-energy x-ray absorptiometry) and regional adipose (magnetic resonance imaging), peak oxygen uptake (peak VO(2)), 6-minute walk distance (6MWD), short physical performance battery (SPPB), and leg press power in 100 older obese HFpEF patients and 61 healthy controls (HC), and adjusted for age, gender, race, and body surface area. RESULTS: Peak VO(2) (15.7±0.4 vs. 23.0±0.6 ml/kg/min; p

We appreciate the thoughtful comments by Drs. Goldsmith and Simegn. We agree that a clearer understanding of various heart failure with preserved ejection (HFpEF) phenotypes, such as the 5 phenotypes proposed by Shah et al. [(1)][1] can facilitate advances in understanding and treating this

Health care professionals engaged in the management of coronary artery disease (CAD) patients, both in primary and secondary prevention settings, should possess the knowledge to develop and modify both aerobic exercise as well as musculoskeletal resistance exercise training programs. The traditional exercise prescription (ExRx) for aerobic-type exercise describes the intensity, frequency, duration, and mode of exercise, as well as the rate of progression. The more contemporary ExRx focuses on the energy expenditure associated with all physical activity not just structured exercise bouts. The total “volume or dose” of physical activity is associated with important health outcomes, including the potential to prevent and potentially reverse CAD lesions. Also, emerging evidence supporting the use of high-intensity interval training in CAD patients will also be provided. Furthermore, this review will also address the issue of generating an appropriate ExRx in the absence of maximal exercise “stress” test data, a common occurrence in the primary care setting and in this era of health care cost containment. Prescribing resistance exercise for CAD patients requires careful consideration and will be discussed in this review. Finally, this review will conclude with a section that describes the special considerations and/or modifications for some common comorbidities seen in CAD patients

BACKGROUND: Accelerometry has become the gold standard for evaluating physical activity in the health sciences. An important feature of using this technology is the cutpoint for determining moderate to vigorous physical activity (MVPA) because this is a key component of exercise prescription. This article focused on evaluating what cutpoint is appropriate for use with older adults 70-89 years who are physically compromised. METHODS: The analyses are based on data collected from the Lifestyle Interventions and Independence for Elders (LIFE) study. Accelerometry data were collected during a 40-minute, overground, walking exercise session in a subset of participants at four sites; we also used 1-week baseline and 6-month accelerometry data collected in the main trial. RESULTS: There was extreme variability in median counts per minute (CPM) achieved during a controlled bout of exercise (n = 140; median = 1,220 CPM (25th, 75th percentile = 715, 1,930 CPM). An equation combining age, age(2), and 400 m gait speed explained 61% of the variance in CPM achieved during this session. When applied to the LIFE accelerometry data (n = 1,448), the use of an individually tailored cutpoint based on this equation resulted in markedly different patterns of MVPA as compared with using standard fixed cutpoints. CONCLUSIONS: The findings of this study have important implications for the use and interpretations of accelerometry data and in the design/delivery of physical activity interventions with older adults. Language: en

Background Data are sparse regarding the value of physical activity ( PA ) surveillance among older adults—particularly among those with mobility limitations. The objective of this study was to examine longitudinal associations between objectively measured daily PA and the incidence of cardiovascular events among older adults in the LIFE (Lifestyle Interventions and Independence for Elders) study. Methods and Results Cardiovascular events were adjudicated based on medical records review, and cardiovascular risk factors were controlled for in the analysis. Home‐based activity data were collected by hip‐worn accelerometers at baseline and at 6, 12, and 24 months postrandomization to either a physical activity or health education intervention. LIFE study participants (n=1590; age 78.9±5.2 [ SD ] years; 67.2% women) at baseline had an 11% lower incidence of experiencing a subsequent cardiovascular event per 500 steps taken per day based on activity data (hazard ratio, 0.89; 95% confidence interval, 0.84–0.96; P =0.001). At baseline, every 30 minutes spent performing activities ≥500 counts per minute (hazard ratio, 0.75; confidence interval, 0.65–0.89 [ P =0.001]) were also associated with a lower incidence of cardiovascular events. Throughout follow‐up (6, 12, and 24 months), both the number of steps per day (per 500 steps; hazard ratio, 0.90, confidence interval, 0.85–0.96 [ P =0.001]) and duration of activity ≥500 counts per minute (per 30 minutes; hazard ratio, 0.76; confidence interval, 0.63–0.90 [ P =0.002]) were significantly associated with lower cardiovascular event rates. Conclusions Objective measurements of physical activity via accelerometry were associated with cardiovascular events among older adults with limited mobility (summary score >10 on the Short Physical Performance Battery) both using baseline and longitudinal data. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01072500.

Background Gastrointestinal cancer patients are susceptible to significant postoperative morbidity. The aim of this systematic review was to examine the effects of preoperative exercise therapy (PET) on patients undergoing surgery for GI malignancies. Methods In accordance with PRISMA statement, all prospective clinical trials of PET for patients diagnosed with GI cancer were identified by searching MEDLINE, Embase, Cochrane Library, ProQuest, PROSPERO, and DARE (March 8, 2017). The characteristics and outcomes of each study were extracted and reviewed. Risk of bias was evaluated using the Cochrane risk of bias tool by two independent reviewers. Results Nine studies (534 total patients) were included in the systematic review. All interventions involved aerobic training but varied in terms of frequency, duration, and intensity. PET was effective in reducing heart rate, as well as increasing oxygen consumption and peak power output. The postoperative course was also improved, as PET was associated with more rapid recovery to baseline functional capacity after surgery. Conclusions PET for surgical patients with gastrointestinal malignancies may improve physical fitness and aid in postoperative recovery.