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Background: Studies have found that individuals with a genetic risk of hypertension may show an abnormal blood pressure (BP) reaction to various stressors and varied exercise protocols. Thus, these individuals may show an abnormal BP reaction in their daily activities. A submaximal exercise test usually mimics dynamic daily activities. This study was done to understand the BP reaction to the treadmill test in these individuals during incremental submaximal exercise testing. Aims and Objectives: The aims and objectives of the study are to compare BP reaction to treadmill test in healthy normotensive males with and without genetic risk of hypertension. Materials and Methods: A total of 100 healthy normotensive males between the age group of 35 and 45 years old took part in the study -- fifty men with genetic risk of hypertension and 50 men without genetic risk of hypertension. The reaction of BP to exercise was done by treadmill test using submaximal Bruce protocol. The BP and pulse rate during rest, at the termination of each stage of the treadmill test, and during recovery were measured in each group. Data analysis was done using unpaired t-tests between the groups. Results: The systolic and diastolic BP were significantly increased during each stage of the treadmill test and during recovery in normotensive men with genetic risk of hypertension (P < 0.001). Conclusion: Genetic risk of hypertension leads to increased BP reaction to exercise and during recovery in healthy normotensive males. Incremental exercise testing may have predictive value in recognizing individuals with a greater risk of developing systemic hypertension in the future. [ABSTRACT FROM AUTHOR]

Introduction: Knee Osteoarthritis (OA) is a significant cause of disability globally and is rapidly becoming a major health issue. The part of the knee most affected by OA is the patellofemoral joint. This type of arthritis poses challenges for both patients and healthcare providers in managing symptoms and improving the quality of life for those affected. However, there’s a lack of data on specific therapies for the patellofemoral joint. Aim: To investigate if a varied frequency treadmill exercises protocol involving retro-walking has a greater impact on musculoskeletal responses, leading to better improvements in individuals with symptomatic Patellofemoral Joint Osteoarthritis (PFOA). Materials and Methods: The present study was an experimental research design i.e., between -subjects experimental design in which 60 participants with patellofemoral arthritis were enrolled based on the inclusion criteria. The study was conducted in the Department of Orthopaedics, SGT Medical College Hospital and Research Institute in Gurugram, Haryana, India for a duration of one year (May 2022- May 2023). Participants were randomly randomised to three distinct exercise program groups with varying intensity levels for retro-walking on a treadmill for six weeks, and all three groups received conventional treatment six days/week for six weeks. All participants were evaluated at three-time intervals of baseline, at the end of the third week, and after intervention (end of the sixth week) for the evaluation of several musculoskeletal parameters affecting patellofemoral arthritis. Statistical analysis was carried out using the IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Comparison for within group differences between various outcome measures at various intervals of time was done using repeated measures of Analysis of Variance (ANOVA) and post-hoc analysis for mean values with Least Significant Difference (LSD) whereas for between group analysis One-way ANOVA and post-hoc Analysis for mean values was done with p-value set at

Introduction: Knee Osteoarthritis (OA) is a significant cause of disability globally and is rapidly becoming a major health issue. The part of the knee most affected by OA is the patellofemoral joint. This type of arthritis poses challenges for both patients and healthcare providers in managing symptoms and improving the quality of life for those affected. However, there's a lack of data on specific therapies for the patellofemoral joint. Aim: To investigate if a varied frequency treadmill exercises protocol involving retro-walking has a greater impact on musculoskeletal responses, leading to better improvements in individuals with symptomatic Patellofemoral Joint Osteoarthritis (PFOA). Materials and Methods: The present study was an experimental research design i.e., between -subjects experimental design in which 60 participants with patellofemoral arthritis were enrolled based on the inclusion criteria. The study was conducted in the Department of Orthopaedics, SGT Medical College Hospital and Research Institute in Gurugram, Haryana, India for a duration of one year (May 2022- May 2023). Participants were randomly randomised to three distinct exercise program groups with varying intensity levels for retro-walking on a treadmill for six weeks, and all three groups received conventional treatment six days/week for six weeks. All participants were evaluated at three-time intervals of baseline, at the end of the third week, and after intervention (end of the sixth week) for the evaluation of several musculoskeletal parameters affecting patellofemoral arthritis. Statistical analysis was carried out using the IBM Statistical Package for the Social Sciences (SPSS) version 26.0. Comparison for within group differences between various outcome measures at various intervals of time was done using repeated measures of Analysis of Variance (ANOVA) and post-hoc analysis for mean values with Least Significant Difference (LSD) whereas for between group analysis One-way ANOVA and post-hoc Analysis for mean values was done with p-value set at <0.05. Result: Significant statistical and clinical differences were observed in musculoskeletal responses, Q-angle (p-value=0.001) and popliteal angle (p-value=0.001) in the high frequency group (group C) performing the protocol five times a week for six weeks leading to a better quality of life followed by group B and group A, respectively. Conclusion: The main finding of the present study suggested that the dosage for retro-walking on treadmill among patients with patellofemoral arthritis requires at least walking for five times/week for six weeks to get more clinical improvement in Musculoskeletal Disorders (MSD). [ABSTRACT FROM AUTHOR]

Background: The use of elastomeric technology in sports garments is increasing in popularity; however, its specific impact on physiological and psychological variables is not fully understood. Thus, we aimed to analyze the physiological (muscle activation of the pectoralis major, triceps brachii, anterior deltoid, and rectus abdominis, capillary blood lactate, systolic and diastolic blood pressure, and heart rate) and psychological (global and respiratory rating of perceived exertion [RPE]) responses during an incremental treadmill test wearing a new sports garment for the upper body that incorporates elastomeric technology or a placebo garment. Methods: Eighteen physically active young adults participated in two randomized sessions, one wearing the elastomeric garment and the other wearing a placebo. Participants performed in both sessions the same treadmill incremental test (i.e., starting at 8 km/h, an increase of 2 km/h each stage, stage duration of 3 min, and inclination of 1%; the test ended after completing the 18 km/h Stage or participant volitional exhaustion). The dependent variables were assessed before, during, and/or after the test. Nonparametric tests evaluated differences. Results: The elastomeric garment led to a greater muscle activation (p < 0.05) in the pectoralis major at 16 km/h (+33.35%, p = 0.01, d = 0.47) and 18 km/h (+32.09%, p = 0.02, d = 0.55) and in the triceps brachii at 10 km/h (+20.28%, p = 0.01, d = 0.41) and 12 km/h (+34.95%, p = 0.04, d = 0.28). Additionally, lower lactate was observed at the end of the test (-7.81%, p = 0.01, d = 0.68) and after 5 min of recovery (-13.71%, p < 0.001, d = 1.00) with the elastomeric garment. Nonsignificant differences between the garments were encountered in the time to exhaustion, cardiovascular responses, or ratings of perceived exertion. Conclusion: These findings suggest that elastomeric garments enhance physiological responses (muscle activation and blood lactate) during an incremental treadmill test without impairing physical performance or effort perception. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVD) such as ischemic heart disease (IHD) and cerebrovascular accidents such as stroke lead to 17.7 million deaths and are the leading cause of death worldwide. Global Burden of Disease study found that age-standardized CVD death rate in India (272/100,000 population) is much higher than the global average (235/100,000 population). Aims and Objectives: This study aimed to compare among different coronary risk factors like dyslipidemia, diabetes mellitus hypertension (HTN), and obesity which may lead to coronary artery disease (CAD) and early detection of ischemic heart disease by the stress treadmill test (TMT) among the patients having coronary risk factors. Materials and Methods: This is a prospective and observational study among 170 patients of age group 18–60 years having one or more coronary risk factors such as dyslipidemia, HTN, diabetes mellitus, and obesity. Patients with diagnosed IHD and other chronic debilitating diseases were excluded from the study. Results: Out of 170 patients, 153 patients were males and 17 patients were females. Among all these patients, 42 patients were suffering from dyslipidemia, 44 patients were suffering from Type 2 diabetes, 45 patients were suffering from HTN, and 39 patients were having more than one risk factor. All 170 patients with coronary risk factors performed TMT. Out of those patients, 53 were found to be TMT-positive. Binary regression analysis showed among all the selected risk factors, dyslipidemia (P

The top cause of death around the world, cardiovascular disease is also the primary cause of death in India. In 2016, India anticipates a total of 62.5 million premature deaths due to cardiovascular disease. Aim: This research was conducted with the goals of (1) determining whether resting global longitudinal strain (GLS) correlates with angiographic severity in patients with coronary artery disease by using the GENSINI and SYNTAX scores; (2) evaluating the validity of using GLS to diagnose severe coronary artery disease; and (3) determining whether or not GLS can be used to diagnose severe coronary artery disease. It was anticipated that the study's findings would provide solutions to both problems." Materials & methods: To participate in the experiment, participants were required to either have coronary artery disease or a clinically comparable diagnosis. The study was conducted at the SCB Medical College and Hospital in Cuttack, which served as the location. Patients who had unstable angina, chronic stable angina, or myocardial infarction that did not involve ST-elevation were recruited to take part in the trial if they satisfied the inclusion criteria. The observational research method, known as cross-sectional research, was used for this study. One hundred and ten patients were evaluated for coronary artery disease as a potential diagnosis. Patients eligible to take part in the trial, defined as those who satisfied the inclusion criteria and made an appointment with a cardiologist at SCB Medical College and Hospital between August 2020 and December 2021, were allowed to do so. Conclusion: When evaluated during rest using 2D speckle tracking echocardiography, GLS reliably predicts the prevalence, severity, and degree of CAD. This test has a very high sensitivity and specificity. GLS has an early detection rate of 88.89% specificity and 84.62% sensitivity for severe CAD. The well-known SYNTAX and GENSINI scores show a linear but negative relationship between CAD complexity and GLS. 2-D-STE can improve echocardiography for the diagnosis of CAD by identifying high-risk individuals and providing the treating physician with more information. When the pretest chance of coronary artery disease is low, strain imaging can reveal significant illness in the heart's arteries. This is especially true during the entirety of the examination. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVD) such as ischemic heart disease (IHD) and cerebrovascular accidents such as stroke lead to 17.7 million deaths and are the leading cause of death worldwide. Global Burden of Disease study found that age-standardized CVD death rate in India (272/100,000 population) is much higher than the global average (235/100,000 population). Aims and Objectives: This study aimed to compare among different coronary risk factors like dyslipidemia, diabetes mellitus hypertension (HTN), and obesity which may lead to coronary artery disease (CAD) and early detection of ischemic heart disease by the stress treadmill test (TMT) among the patients having coronary risk factors. Materials and Methods: This is a prospective and observational study among 170 patients of age group 18-60 years having one or more coronary risk factors such as dyslipidemia, HTN, diabetes mellitus, and obesity. Patients with diagnosed IHD and other chronic debilitating diseases were excluded from the study. Results: Out of 170 patients, 153 patients were males and 17 patients were females. Among all these patients, 42 patients were suffering from dyslipidemia, 44 patients were suffering from Type 2 diabetes, 45 patients were suffering from HTN, and 39 patients were having more than one risk factor. All 170 patients with coronary risk factors performed TMT. Out of those patients, 53 were found to be TMTpositive. Binary regression analysis showed among all the selected risk factors, dyslipidemia (P<0.05; odds ratio [OR]-2.104) and HTN (P<0.05; OR-2.159) were found to be significantly associated with the positive outcome of TMT. All 53 TMT-positive patients were selected for CAG. Out of those patients, 37 were found to be suffering from CAD. Binary regression analysis showed among all the selected risk factors, dyslipidemia (P<0.05; OR-1.964) and HTN (P<0.05; OR-2.125) were found to be significantly associated with the positive outcome of CAG. Conclusion: Dyslipidemia and HTN were found to be significantly associated with the TMT-positivity as well as CAD. Diabetes mellitus and obesity were not statistically significant, though OR was more than 1 for both these risk factors. [ABSTRACT FROM AUTHOR]

Background: The use of elastomeric technology in sports garments is increasing in popularity; however, its specific impact on physiological and psychological variables is not fully understood. Thus, we aimed to analyze the physiological (muscle activation of the pectoralis major, triceps brachii, anterior deltoid, and rectus abdominis, capillary blood lactate, systolic and diastolic blood pressure, and heart rate) and psychological (global and respiratory rating of perceived exertion [RPE]) responses during an incremental treadmill test wearing a new sports garment for the upper body that incorporates elastomeric technology or a placebo garment.Methods: Eighteen physically active young adults participated in two randomized sessions, one wearing the elastomeric garment and the other wearing a placebo. Participants performed in both sessions the same treadmill incremental test (i.e., starting at 8 km/h, an increase of 2 km/h each stage, stage duration of 3 min, and inclination of 1%; the test ended after completing the 18 km/h Stage or participant volitional exhaustion). The dependent variables were assessed before, during, and/or after the test. Nonparametric tests evaluated differences.Results: The elastomeric garment led to a greater muscle activation (p < 0.05) in the pectoralis major at 16 km/h (+33.35%, p = 0.01, d = 0.47) and 18 km/h (+32.09%, p = 0.02, d = 0.55) and in the triceps brachii at 10 km/h (+20.28%, p = 0.01, d = 0.41) and 12 km/h (+34.95%, p = 0.04, d = 0.28). Additionally, lower lactate was observed at the end of the test (−7.81%, p = 0.01, d = 0.68) and after 5 min of recovery (−13.71%, p < 0.001, d = 1.00) with the elastomeric garment. Nonsignificant differences between the garments were encountered in the time to exhaustion, cardiovascular responses, or ratings of perceived exertion.Conclusion: These findings suggest that elastomeric garments enhance physiological responses (muscle activation and blood lactate) during an incremental treadmill test without impairing physical performance or effort perception.

PURPOSE Cardiorespiratory fitness is closely related to cardiovascular and chronic diseases and is an important predictor of mortality. Despite the significance of cardiorespiratory fitness, currently, a lack of research exists that validates the effectiveness of the 6-minute walk test, specifically in the Korean population. Therefore, the purpose of this study was to verify the validity of the 6-minute walk test for Korean older individuals and to develop a maximum oxygen consumption (VO2max) prediction equation. METHODS A total of 167 participants were included in the final analysis, after excluding 33 of the 200 participants. Moreover, VO2max was measured by performing a submaximal exercise test on a treadmill, and the total distance and heart rate were measured using a 6-minute walk test. Pearson's correlation coefficient was calculated to verify the criterion validity between VO2max and total distance in the 6-minute walk test. To develop a VO2max prediction equation, multiple regression analysis was conducted and cross-validation of the developed prediction equation was confirmed. RESULTS The correlation coefficient between VO2max and the 6-minute walk test was 0.575 (p

Abstract Background Poor performance is a multifactorial syndrome of racehorses, commonly associated with subclinical disorders, which can be diagnosed by exercise testing. Objectives Describe the prevalence of medical causes of poor performance in Standardbreds unassociated with lameness, and evaluate their relationships with fitness variables measured by exercise treadmill test. Animals Hospital population of 259 nonlame Standardbred trotters referred for poor performance. Methods The horses' medical records were retrospectively reviewed. Horses underwent a diagnostic protocol including resting examination, plasma lactate concentration, treadmill test with continuous ECG and assessment of fitness variables, creatine kinase activity, treadmill endoscopy, postexercise tracheobronchoscopy, bronchoalveolar lavage (BAL), and gastroscopy. The prevalence of different disorders was evaluated, including cardiac arrhythmias, exertional myopathies, dynamic upper airway obstructions (DUAOs), exercise‐induced pulmonary hemorrhage (EIPH), moderate equine asthma (MEA), and gastric ulcers (EGUS). The associations of these disorders with fitness variables were investigated individually and using multivariable models. Results Moderate equine asthma and EGUS were the most common disorders, followed by EIPH, DUAOs, cardiac arrhythmias, and exertional myopathies. Hemosiderin score was positively correlated with BAL neutrophils, eosinophils, and mast cells; increased creatine kinase activity was associated with BAL neutrophilia, DUAOs, premature complexes, and squamous gastric disease. Treadmill velocity at a plasma lactate concentration of 4 mmol/L and at heart rate of 200 beats per minute was negatively affected by BAL neutrophilia, multiple DUAOs, exertional myopathies, and squamous gastric disease. Conclusions The multifactorial nature of poor performance was confirmed, with MEA, DUAOs, myopathies and EGUS representing the main diseases involved in fitness impairment.

Objective: The objective of this study was to assess the Framingham Risk Score as well as the prevalence of coronary artery disease (CAD) in people living with HIV/AIDS (PLHA) male patients, in an Indian setting. Design: This descriptive pilot study was conducted in a multispecialty hospital which is a reference center for HIV/AIDS. Materials and Methods: The study included 50 HIV-positive male patients who underwent basic biochemical analysis, namely lipid profile, blood sugar (fasting), electrocardiogram, CD4 count along with basic personal history (including smoking habits and lifestyle), course of disease progression, and drug history. All were subjected to a two-dimensional echocardiogram and treadmill test (TMT). Subjects with a positive TMT underwent a confirmatory stress thallium/coronary angiography. Framingham Risk Scores were calculated, using standard scoring charts. Standard protocol forms were made for each patient. Results: The median diagnosed duration of HIV disease was 2.8 years (range: 0.5–7 years). The median 10-year risk of CAD (as calculated from the Framingham scores) was 1%. Major contributing risk factors were dyslipidemia, diabetes, and hypertension and were found to be greater as compared to published literature. Four patients had positive TMT, but all four had a negative, coronary angiogram. Conclusions: Biological plausibility suggests that CAD may be more common in PLHA due to the chronic inflammatory nature of the disease and the effects of the dyslipidemia effect of ART; however, our pilot study with the limitations could not substantiate this.

Background: Poor performance is a multifactorial syndrome of racehorses, commonly associated with subclinical disorders, which can be diagnosed by exercise testing. Objectives: Describe the prevalence of medical causes of poor performance in Standardbreds unassociated with lameness, and evaluate their relationships with fitness variables measured by exercise treadmill test. Animals: Hospital population of 259 nonlame Standardbred trotters referred for poor performance. Methods: The horses' medical records were retrospectively reviewed. Horses underwent a diagnostic protocol including resting examination, plasma lactate concentration, treadmill test with continuous ECG and assessment of fitness variables, creatine kinase activity, treadmill endoscopy, postexercise tracheobronchoscopy, bronchoalveolar lavage (BAL), and gastroscopy. The prevalence of different disorders was evaluated, including cardiac arrhythmias, exertional myopathies, dynamic upper airway obstructions (DUAOs), exercise‐induced pulmonary hemorrhage (EIPH), moderate equine asthma (MEA), and gastric ulcers (EGUS). The associations of these disorders with fitness variables were investigated individually and using multivariable models. Results: Moderate equine asthma and EGUS were the most common disorders, followed by EIPH, DUAOs, cardiac arrhythmias, and exertional myopathies. Hemosiderin score was positively correlated with BAL neutrophils, eosinophils, and mast cells; increased creatine kinase activity was associated with BAL neutrophilia, DUAOs, premature complexes, and squamous gastric disease. Treadmill velocity at a plasma lactate concentration of 4 mmol/L and at heart rate of 200 beats per minute was negatively affected by BAL neutrophilia, multiple DUAOs, exertional myopathies, and squamous gastric disease. Conclusions: The multifactorial nature of poor performance was confirmed, with MEA, DUAOs, myopathies and EGUS representing the main diseases involved in fitness impairment. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes mellitus (T2DM) is the risk factor for coronary artery disease (CAD). Material and Methods: In this study, we assessed the prevalence of CAD in asymptomatic T2DM patients and its correlation with invasive testing in treadmill testing (TMT)-positive cases. A total of 90 patients with asymptomatic T2DM were recruited and subjected to TMT TMT-positive patients were subjected to coronary angiography (CAG). Results: At baseline, the mean duration of T2DM (years) was 4.87 ± 4.04 with mean levels of HbA1c (%) of 7.96 ± 1.02. TMT was positive in 28 patients (31.1%) for reversible myocardial ischaemia (RMI), and among them, 16 patients consented to CAG, of which 14 required coronary angioplasty and the remaining two (7.1%) had to undergo coronary artery bypass grafting (CABG). The remaining 12 TMT positives (42.9%) were managed medically. Conclusion: To conclude, there is a high prevalence of silent CAD in T2DM. They need regular screening to detect the same and prevent the morbidity and mortality associated with overt CAD. Hence, it is important to screen people with type 2 diabetes, to prevent the morbidity and mortality associated with overt CAD.

ObjectiveThe objective was to assess the accuracy and optimal threshold of the Walking Impairment Questionnaire (WIQ) and the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in identifying patients with a maximal walking distance (MWD) below or equal to 250 m.MethodsThis retrospective study screened 388 consecutive patients with suspected symptomatic lower extremity arterial disease (LEAD). Collected data included the patient's history, resting ankle-brachial index, WIQ, and WELCH. MWD was assessed with a treadmill test at 2 mph (3.2 km/h) with a 10% grade. An optimized threshold for detection of MWD ≤ 250 m was determined for each questionnaire via receiver operating characteristic (ROC) curves. Subsequently, multivariate analysis was performed to build a new simple score to detect MWD ≤ 250 m.ResultsThe study included 297 patients (63 ± 10 years old). With a threshold of ≤ 64%, the WIQ predicted MWD ≤ 250 m with an accuracy of 71.4% (66.2, 76.5%). With a threshold of ≤ 22, the WELCH predicted a treadmill walking distance of ≤ 250 m with an accuracy of 68.7% (63.4, 74.0%). A new score with only four “yes or no” questions had an accuracy of 71.4% (66.3, 76.6%). Items on this new score consisted of the level of difficulty of walking 1 block, declared maximum walking distance, usual walking speed, and maximum duration of slow walking.ConclusionA WIQ score ≤ 64% and a WELCH score ≤ 22 help to predict a walking distance of ≤ 250 m in a treadmill test at 2 mph (3.2 km/h) with a 10% grade. A 4-item score could be used for rapid evaluation of walking distance among patients with LEAD, but the validity of this 4-item score requires further confirmation studies.

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Resumo: Apesar dos avanços da medicina, há já várias décadas que os exames comparticipados pelo Serviço Nacional de Saúde (SNS) para o estudo e estratificação de risco da doença coronária se mantêm inalterados em cuidados de saúde primários. Apesar do desajuste à prática clínica contemporânea ser há muito evidente, a recente publicação das Recomendações Europeias para o diagnóstico e tratamento da síndrome coronária crónica veio realçar ainda mais este desfasamento e evidenciar a necessidade imperiosa de mudança na forma como são estudados estes pacientes em Portugal. No seguimento desta publicação, o Grupo de Estudo de Cardiologia Nuclear, Ressonância Magnética (RM) e Tomografia Computorizada (TC) Cardíaca, o Grupo de Estudo de Ecocardiografia e o Grupo de Estudos de Patofisiologia do Esforço e Reabilitação Cardíaca da Sociedade Portuguesa de Cardiologia iniciaram um processo de reflexão conjunta sobre as limitações atuais e a forma como poderiam ser aplicadas as recomendações internacionais no nosso país. Para tal, os autores sugerem que os novos métodos de imagem (ecocardiograma de esforço ou de sobrecarga, TC e RM cardíaca) se associem à prova de esforço e cintigrafia de perfusão do miocárdio no portfólio de exames oferecidos pelo SNS. Esta alteração permitiria uma plena adoção das recomendações europeias e uma melhor utilização dos meios, de acordo com o contexto clínico, a disponibilidade e as particularidades locais. A adoção de “normas de orientação clínica” baseadas nestes pressupostos traduzir‐se‐ia numa melhoria qualitativa na abordagem e otimização terapêutica destes pacientes, ao mesmo tempo em que potenciaria uma gestão eficaz dos recursos disponíveis, com potenciais ganhos de saúde e financeiros. Abstract: Despite constant medical evolution, the reimbursement policy of Portuguese National Health Service (NHS) for the study and risk stratification of coronary heart disease has remained unchanged for several decades. Lack of adjustment to contemporary clinical practice has long been evident. However, the recent publication of the European Guidelines for diagnosis and treatment of chronic coronary syndromes further highlighted this gap and the urgent need for a change. Prompted by these Guidelines, the Working Group on Nuclear Cardiology, Cardiac Magnetic Resonance and Cardiac CT, the Working Group on Echocardiography and the Working Group on Stress Pathophysiology and Cardiac Rehabilitation of the Portuguese Society of Cardiology, began a process of joint reflection on the current limitations and how these recommendations could be applied in Portugal. To this end, the authors suggest that the new imaging methods (stress echocardiogram, cardiac computed tomography and cardiac magnetic resonance), should be added to exercise treadmill stress test and myocardial perfusion scintigraphy in the available exam portfolio within the Portuguese NHS. This change would allow full adoption of European guidelines and a better use of tests, according to clinical context, availability and local specificities. The adoption of clinical guidance standards, based on these assumptions, would translate into a qualitative improvement in the management of these patients and would promote an effective use of the available resources, with potential health and financial gains.

Abstract This study aimed to explore the possible target and mechanism of the wheel treadmill (WTM) test for motor function recovery of spinal cord injury (SCI). Rats were divided into sham, control and WTM groups to establish an SCI mode. Rats in the WTM group were trained on the WTM test, and Basso–Beattie–Bresnahan (BBB) scores were determined. The samples were collected, and mRNA sequencing was conducted to determine the changes in gene expression. The coexpressed genes were screened to construct a protein–protein interaction (PPI), followed by the Kyoto Encyclopedia of Genes and Genomes pathway and Gene Ontology function enrichment analysis, and the differentially expressed genes (DEGs) volcano map and hub gene expression heat map were constructed using R language. The BBB scores in the control and WTM groups increased with time, with the WTM group scoring higher than the control group. The results of rat spinal cord tissue sequencing showed that a total of 1679 DEGs were screened in the sham and control groups; 928 DEGs and 731 overlapping genes were screened in the WTM and control groups. The key genes were identified by PPI analysis. One hundred and thirty‐three genes were found to be overlapping by combined analysis of spinal cord sequencing data and BBB scores of rats at Week 7. The top 10 DEGs from high to low were Tyrobp, Rac2, Cd68, C1qb, Aif1, Cd74, Spi1, Fcer1g, RT1‐DA, and Ccl4. The terms with the highest enrichment scores were microglia‐mediated positive regulation of cytotoxicity and major histocompatibility complex class II protein complexes. Treatment with the WTM test promotes recovery of motor function after SCI in rats by modulating intercellular communication and immune function.

Simple Summary: Among racehorses, mild–moderate equine asthma (MEA) represents the second most frequent cause of poor performance. Multiple authors have tried to identify the direct effects of tracheal mucus accumulation and the cytological profile of the bronchoalveolar lavage (BAL) on athletic capacity, obtaining contrasting results. The present retrospective study aims to investigate the associations between different signs of airway inflammation and a series of fitness parameters obtained through a standardized incremental treadmill test in a population of 116 poorly performing Standardbred racehorses. The possible relationships between treadmill parameters and endoscopic scores, BAL leukocyte populations, and bacterial cultures of tracheal wash were statistically evaluated. The percentage of neutrophils in the BAL was correlated with several fitness parameters, negatively affecting aerobic capacity; analogously, horses with neutrophilic or mixed MEA showed worse athletic capacity compared with those with eosinophilic–mastocytic MEA. These results suggest that lower airway neutrophilia negatively affects sports performance. Mild–moderate equine asthma (MEA) is a common respiratory disorder among racehorses, characterized by lower airway inflammation. Although it is generally agreed that MEA causes poor performance, contrasting results have been reported about the effects of tracheal mucus and the leukocyte populations of the bronchoalveolar lavage (BAL) on performance. This study aims to investigate the associations between airway inflammation and fitness parameters measured during an incremental treadmill test on Standardbred racehorses. For this purpose, the clinical records of 116 Standardbreds subjected to a diagnostic protocol for poor performance were retrospectively reviewed. Parametric and nonparametric statistics were used to evaluate the relationships between endoscopic scores, BAL cytological results, and fitness parameters. Moreover, horses were divided into MEA and non-MEA groups and into neutrophilic, eosinophilic–mastocytic, and mixed MEA groups; fitness parameters were compared between groups. Neutrophils percentages were inversely correlated with the speed at a heart rate of 200 bpm, the speed and heart rate at a plasma lactate concentration of 4 mmol/L (VLa4 and HRLa4), and the maximal speed, while they were positively correlated with higher lactate concentrations. Moreover, significant differences were detected between different MEA subtypes concerning VLa4, HRLa4, and lactate concentrations. These results suggest that airway neutrophilic inflammation impairs athletic capacity in Standardbreds. [ABSTRACT FROM AUTHOR]

Background and objectives: Vortioxetine (VRT) is a relatively new selective serotonin reuptake inhibitor (SSRI) antidepressant and serotonin receptor modulator, approved for the treatment of major depression and generalized anxiety disorder. Depression has been linked with psychomotor disengagement, oxidative stress burden and decreased blood levels of brain-derived neurotrophic factor (BDNF). In our study we performed the experimental investigation of VRT, magnesium and of their association on the rats' endurance capacity, motor behavior and blood biological disturbances in rats subjected to forced exercise in treadmill test. Materials and Methods: The substances were administered orally for 14 consecutive days, as follows: group 1 (control): distilled water 0.3 mL/100 g body; group 2 (Mg): magnesium chloride 200 mg/kg body; group 3 (VRT): VRT 20 mg/kg body; group 4 (VRT+Mg): VRT 20 mg/kg body + magnesium chloride 200 mg/kg body. Magnesium was used as positive control substance with known effects in treadmill test. The consequences of VRT treatment on glucose, cortisol, BDNF and oxidative stress biomarkers (superoxide-dismutase, malondialdehyde, glutathione-peroxidase, lactate dehydrogenase) were also assessed. Results and conclusions: The use of VRT resulted in an improvement in motor capacity and an increase of the rats' endurance to physical effort. The administration of VRT increased the serum BDNF levels and reduced the oxidative stress in rats subjected to physical effort. The association of magnesium potentiated the effects of VRT on physical performances, the antioxidant activity and the decreasing in serum stress markers in treadmill test in rats. [ABSTRACT FROM AUTHOR]

IntroductionEquine Gastric Ulcer Syndrome (EGUS) is a highly prevalent disorder in horses, which can be classified, based on the localization of the lesions, as Equine Squamous Gastric Disease (ESGD) or Equine Glandular Gastric Disease (EGGD). Although EGUS is recognized as a common cause of poor performance in racehorses, objective investigations about its relation with athletic capacity are lacking. Therefore, the present retrospective study aims to evaluate the associations between EGUS severity and some fitness parameters measured during an incremental treadmill test in Standardbred racehorses in training.MethodsWith this aim, data from 87 Standard bred racehorses which underwent a complete diagnostic evaluation for poor performance was reviewed. During gastroscopic examination, a 0-4 score was assigned to ESGD, while EGGD was evaluated for absence/presence; a total EGUS score was obtained by adding 1 point to ESGD score in horses showing concomitant EGGD. Fitness parameters obtained during incremental treadmill test included speed at a heart rate of 200 bpm (V200), speed and heart rate at a blood lactate of 4 mmol/L (VLa4, HRLa4), peak lactate, lactate and heart rate at 30 minutes post-exercise, maximum speed, minimum pH and maximum hematocrit. The associations between fitness parameters and EGUS and ESGD scores were evaluated by Spearman correlation, while Mann-Whitney test was used to compare them between horses with or without EGGD. Statistical significance was set at p

Objective: To compare the six-minute walk test and the Modified Bruce treadmill test in paediatric patients with severe burns. Subjects: A total of 67 children, aged 7–17 years, with severe burns. Methods: Participants were assigned to perform the six-minute walk test and the Modified Bruce treadmill test in randomized order on discharge from acute burn care. Primary outcome measure was heart rate. Secondary outcome measures were distance walked, Borg’s CR-10 rate of perceived exertion, and maximal oxygen uptake (VO2). Results: A total of 67 participants were enrolled. Thirty-eight patients completed both tests. The mean six-minute walk test maximum heart rate was 135 ± 19 bpm (range 97–180 bpm) and the mean Modified Bruce treadmill test maximum heart rate was 148 ± 24 bpm (range 100–197 bpm; p ≤ 0.05), with a weak positive correlation of R² = 0.14. The mean six-minute walk test maximum distance was 294 ± 124 m (range 55 to 522 m) while the mean Modified Bruce treadmill test maximum distance was 439 ± 181 m (range 53 to 976 m; p ≤ 0.05), with no correlation of R² = 0.006. The mean RPE CR-10 score for the six-minute walk test was 3 ± 2.5 (range 0–10) vs a mean RPE CR-10 score of 10 ± 0 for the Modified Bruce treadmill test. Conclusion: The Modified Bruce treadmill test challenges the cardiorespiratory system significantly more than the six-minute walk test, as reflected by maximum heart rate measurements, and the perception of effort (i.e. rate of perceived exertion) by the patient. When possible, the Modified Bruce treadmill test should be used to assess cardiovascular functional capacity. However, the six-minute walk test may be more clinically feasible for use with paediatric patients with burns, and provides information about submaximal functional exercise capacity. LAY ABSTRACT Children with severe burns benefit from an implemented outpatient exercise rehabilitation programme. Before prescribing an aerobic exercise programme, patients should be tested in objective manner. Two common tests for these purposes are the six-minute walk test and the Modified Bruce Treadmill test. These tests have been used for measurement of the cardiopulmonary function in this population. The aim of this study was to compare these tests and the level of agreement of their responses. A total of 67 children with major burns participated in the study. Of these, 38 children completed both tests after they were treated in the acute care unit. This study showed that the treadmill test is not in agreement with the six-minute walk test in terms of heart rate. The results suggest the treadmill test should be used to assess cardiovascular functional capacity. However, the six-minute walk test may be more clinically feasible and provides information about submaximal functional exercise capacity.

When Positive Ischemic Response on Treadmill Test Implies Otherwise: One Overlooked Pitfall on TMT Background: Particular ischemic process that portrayed in Electrocardiogram (ECG) changes bear similar depiction to different conditions, one of them is hypokalemia. On the other hand, Treadmill Test (TMT) has been used for decades for risk stratifying and diagnosing coronary artery disease as a non-invasive, safe and affordable screening test. However, using ECG changes as interpretation, TMT could have incidence of false positive results reported in various conditions, one of which is hypokalemia. The aim is to report a case of positive ischemic response resemblance in TMT of patient with severe hypokalemia. Case Illustration: A-43-years-old female with history of unstable angina pectoris with risk factors of diabetes mellitus and hypertension underwent several examinations. Computed Tomography Coronary Angiography (CTCA) showed a 60% stenosis lesion in Left Anterior Descending (LAD) coronary artery. Within 3 minutes of TMT the ECG showed ST-segment depression in lead II, III, aVF, V1-V6 and prominent elevation in lead aVR. Fear of left main coronary artery occlusion, the test was terminated and the patient was immediately planned for urgent Percutaneous Coronary Intervention (PCI). The result indicated non-significant coronary lesion. Potassium concentration of 1.87 mmol per liter and troponin levels were normal. Unbeknownst before, the patient had multiple episodes of vomiting for a whole day and felt dehydrated prior to the TMT. Patient then treated for potassium implementation and discharged uneventfully. Conclusion: Hypokalemia could induce widespread ST-Segment depression or ST-Segment elevation in right limb lead. Peculiarly in context of stress testing or accompanied with chest pain, it is difficult to differentiate ECG changes in hypokalemia with true myocardial ischemia. Hypokalemia should be considered when TMT result is not concordance with true myocardial ischemia.

Abstract Background Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP). Method Fifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups. Results One-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps

The average oxygen uptake measured during the treadmill test was consistent with values measured during previously published studies on the aerobic demand of simulated fire-rescue work. The treadmill test required similar rates of air consumption compared to initial attack fire-fighting. The test demonstrated acceptable test-retest reliability. Objective: This 2-part study evaluated validity and reliability of a treadmill test for structural firefighters. Methods: Wearing fire protective ensemble, 260 participants walked at 1.56 m·s–1, completing a 5-min warm-up, an 8-min stage at a 5.71° incline, then graded stages to exhaustion. In Part 2, 21 participants completed the test on 3 separate days under standardized conditions. Results: Average (±SD) oxygen uptake ( V ˙ O 2 ) during minutes 1–13 was similar to reported values for simulated fire-rescue work. During the 13th min, V ˙ O 2 was consistent with V ˙ O 2 peak recommendations for firefighters. in Part 2, exercise duration increased between trials 1 and 2 before stabilizing but V ˙ O 2 peak was consistent. Conclusions: Congruence with reported V ˙ O 2 during simulated firefighting and recommendations for V ˙ O 2 peak confirmed validity. Acceptable test-retest reliability was demonstrated. We conclude that the test is valid and reliable for evaluating cardiorespiratory endurance for firefighting. [ABSTRACT FROM AUTHOR]

Background and Objectives: The treadmill test (TMT) is a predictive tool for myocardial ischemia. Recently, exercise-provoked ventricular premature contracture (VPC) during TMT was shown to have a relation with coronary artery disease and cardiovascular mortality. Therefore, we evaluate clinical correlates of exercise-provoked VPC and compare the predictive power for myocardial ischemia and cardiovascular events. Method: Data of 408 patients (≥18 years of age) who underwent TMT for work up of angina, palpitation, dyspnea, syncope, or arrhythmia between February 2015, and January 2016, were collected with consent at Samsung Medical Center, Seoul, Republic of Korea. Among total of 408 patients, 208 were excluded according to the previous history of PCI or CABG, previous MI, decreased left ventricular ejection fraction lower than 50%, arrhythmia that could affect ST-segment change on ECG. Results: Among 200 patients, 32 (16.0%) developed exercise-provoked VPC (21 patients in the exercise phase, 20 patients in the recovery phase). Of them, 20 patients (10.0%) showed positive TMT, and 4 patients (2.0%) underwent revascularization after TMT. Among 21 patients showing exercise phase VPC, 5 (23.8%) showed positive TMT results. In patients younger than 65 years, exercise phase VPC was associated with positive TMT (odds ratio 6.879, 1.458–32.453) considering demographics and previous medical history in multivariable analysis. Among the 20 patients showing recovery phase VPC, 2 (10.0%) underwent revascularization after TMT. In multivariable analysis, recovery phase VPC was associated with revascularization (odds ratio 9.381, 1.144–76.948) considering age, sex, BMI, and TMT result. Conclusion: VPC during the treadmill test was a useful predictor of myocardial ischemia in this study. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine blood pressure (BP) and heart rate (HR) responses triggered during an isokinetic testing protocol in professional soccer players and compare cardiovascular parameters at completion of this isokinetic protocol with those during a treadmill test. Using purposive sampling, 63 professional soccer players were recruited. Cardiovascular responses were measured noninvasively during a bilateral testing protocol of knee flexion and extension. Treadmill ergospirometry following an incremental speed protocol was performed to analyze the same cardiovascular parameters at rest and at completion of this test. There were significant differences in diastolic blood pressure (DBP) and HR according to field position. The parameters presented high homogeneity at both competitive levels. Systolic blood pressure, mean arterial pressure, HR, and rate pressure product at completion of the treadmill test were significantly higher than those at completion of the isokinetic protocol. Intermittent isokinetic testing protocol of the knee triggers normal and safe BP and HR responses in healthy professional soccer players. The HR of the defenders was higher than those of the forwards and midfielders but was independent of the competitive level. The values of cardiovascular parameters at isokinetic protocol completion were lower than those during the treadmill test. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a major cause of morbidity and mortality in diabetics. However diabetic patients do not present with typical anginal symptoms or may be even asymptomatic and silent coronary artery disease (CAD) is prevalent in diabetics. Moreover silent CAD is not different from symptomatic CAD with respect to prognosis and adverse effects. Aim: The study was done to demonstrate the prevalence of silent myocardial ischemic changes in asymptomatic type 2 diabetes mellitus patients with normal resting ECG by doing a stress exercise test. Methodology: This descriptive study was done in 100 patients with type 2 diabetes more than 2 years who did not have any history of cardiovascular disease or symptoms. Detailed history was taken and investigations such as HbA1c, fasting and postprandial blood sugar, serum creatinine, urine examination were done. Resting ECG, Echocardiogram was found to be normal and they were subjected to a treadmill test. Results: Among the 100 participants 18 persons (18%) had positive ECG findings in treadmill test. A positive association was found between the duration of diabetes and prevalence of positive treadmill test. Conclusion: There is significant prevalence of silent CAD in diabetic patients and they tend to present with advanced disease at presentation and have poorer prognosis compared to non diabetic population. Hence it is necessary to screen early for silent CAD in diabetics to improve disease outcomes.

BackgroundPrecision and accuracy assurance in cardiopulmonary exercise testing (CPET) facilitates multicenter clinical trials by maximizing statistical power and minimizing participant risk. Current guidelines recommend quality control that is largely based on precision at individual testing centers (minimizing test-retest variability). The aim of this study was to establish a multicenter biological quality control (BioQC) method that considers both precision and accuracy in CPET.MethodsBioQC testing was 6-min treadmill walking at 20 W and 70 W (below the lactate threshold) with healthy non-smoking laboratory staff (15 centers; ~16 months). Measurements were made twice within the initial 4 weeks and quarterly thereafter. Quality control was based on: 1) within-center precision (coefficient of variation [CV] for oxygen uptake [V̇O2], carbon dioxide output [V̇CO2], and minute ventilation [V̇E] within ±10%); and 2) a criterion that V̇O2 at 20 W and 70 W, and ∆V̇O2/∆WR were each within ±10 % predicted. "Failed" BioQC tests (i.e., those outside the predetermined criterion) prompted troubleshooting and repeated measurements. An additional retrospective analysis, using a composite z-score combining both BioQC precision and accuracy of V̇O2 at 70 W and ∆V̇O2/∆WR, was compared with the other methods.ResultsOf 129 tests (5 to 8 per center), 98 (76%) were accepted by within-center precision alone. Within-center CV was

The purpose of this study was to compare the validity of three submaximal exercise tests (SMETs) and develop practical predictive models for the VO2max in Korean adults. A total of 541 (287 males and 254 females) adults participated in this study. Their ages ranged from 19 to 64. The VO2max was measured using the maximal-graded exercise treadmill test. The SMETs were performed by a treadmill test, the YMCA step test, and the PACER test. Regression analysis was conducted to compare the validity of the VO2max predictive equations using SMETs. The validity of the predictive models was evaluated using explanatory power, standard error of estimate (SEE), and Bland-Altman analysis. The explanatory power between the measured VO2max and the predicted VO2max was 58.0% (<0.001), 59.2% (<0.001), and 71.7% (<0.001), respectively. The SEEs were 4.545, 4.478, and 3.732 (mL/kg/min). The models were significant predictors of VO2max and had acceptable validity in a large sample of Korean adults. Especially, among the predictive models, PACER had the highest acceptable effectiveness. Therefore, the equations developed in this study are recommended to better evaluate the cardiovascular endurance of Korean adults. [ABSTRACT FROM AUTHOR]

Background  Myocardial bridge (MB) is a portion of an epicardial coronary artery that takes an intramuscular course. The systolic compression of MB often gets carried over to early and mid-diastole, compromising coronary blood flow. In clinical practice, we encounter patients with angina, non-invasive evidence of ischemia, and a MB as the only relevant finding on angiography. In view of studies in support of decreased coronary flow reserve in MB, we assessed the physiological significance of MB by fractional flow reserve (FFR). Methods and Results  We enrolled eight patients with chronic stable angina and positive noninvasive stress test, who had no significant CAD, and with evidence of MB in the left anterior descending artery. Mean age of population was 57.14 ± 6.25 years. Two (25%) were females and six (75%) were males. Four (50%) were smokers, five (62.5%) were diabetics, and two (25%) were hypertensives. Mean length of MB is 19.4 ± 5.04 mm. All underwent physiological assessment by FFR and the baseline, post nitroglycerin (NTG), and post adenosine readings were noted. Mean pre-NTG value, post-NTG, and post-adenosine were 0.974 ± 0.022, 0.96 ± 0.03, and 0.88 ± 0.042 (≤0.80 hemodynamically significant) respectively. Paired t -test showed significant reduction in FFR after NTG (p  = 0.0452) and post-adenosine (p  = 0.011) but all eight patients did not get significant FFR. Conclusion  MB was found to be physiologically insignificant in our group of patients. But a statistical significant reduction of FFR in MB, post NTG and post adenosine, does impress on the fact that, an extensive study over a longer period of course, could throw light on this unsettled area of physiological significance and optimal therapeutic approach. [ABSTRACT FROM AUTHOR]

Cable yarding operations on steep terrain have always been a challenge with respect to safety as they are mostly undertaken by manual laborers, particularly in South Korea. Steep slopes are associated with a high workload for choker setters. Therefore, the main goals of this study were to determine the heart rate and oxygen consumption of choker setters and evaluate their workload during clear-cut operations on a Larix kaempferi stand using a Polar M400, H7 heart rate sensor. Three choker setters were continuously evaluated during one working day. Overall, the mean working heart rate (HRw) during choking operations ranged from 87 to 104 bpm at a maximum oxygen consumption rate of 0.9 to 1.4 L/min. The choker setters recorded most of the effective work time on the "wait" (68.5%) and "walk-in" (7.8%) work elements. In addition, the physiological workload differed among the various elements of the cable yarding operation, with a higher HRw associated with a higher workload. Our findings may provide useful information for managing the health and safety of forestry crews during cable extraction activities. [ABSTRACT FROM AUTHOR]

Despite a gradually decreased mortality from cardiovascular diseases, including coronary artery disease (CAD), they remain the main cause of death in the world. In the coming decades, an increased prevalence of CAD is expected. While methods that are more sensitive are used to diagnose CAD and mortality of the acute forms decreases due to high-tech treatment methods, the prevalence of CAD chronic forms is gradually increasing. According to the modern clinical guidelines, examination and treatment of a particular patient with stable CAD depends on its prognosis, since only in high-risk patients myocardial revascularization can improve life prognosis, however, most patients receive unified therapy. Despite the fact that there are many prognostically significant factors, models and indices developed to assess the risk of death and cardiovascular complications in CAD, a unified approach to risk stratification does not currently exist. The article provides a literary review of how historically the main prognostically significant signs were identified (including clinical anamnestic and psychosocial characteristics, comorbidity, data of non-invasive instrumental studies such as electrocardiography, echocardiography, tests with dosed physical activity, invasive coronary angiography and some of the existing prognostic models and indices that can help a practitioner in stratifying the risk of cardiovascular complications in a patient with stable CAD.

Introduction: Under short stretch bandages (SSB), the pressures drop over time. These pressures are documented in non standardized-way and vary from one study to another. Objective: A standardized stress test on a treadmill should help to better understand this evolution and thus to document with more precision the behavior of 3 bandages in use. Materials and Methods: Three bandage kits (Urgo K2, Kit Biflex and a kit consisting of padding + 2 cotton SSB2 were tested in 30 subjects (60 legs) before and after a treadmill test (3 km/h, 6% slope for 30 min or 1.5 km). Results: Before the test, the bandages were applied with nonsignificantly different resting interface pressures (respectively 40.58 ± 2.7 mmHg, 41.05 ± 2.17 mmHg, 38.16 ± 2.98 mmHg). When standing, the pressures were significantly different between Urgo K2, Kit Biflex and SSB2(55.58 ± 6.15 mmHg, 57.3 ± 6.53 mmHg versus 62.3 ± 5.07 mmHg for SSB2). Similarly, the static stiffness indexes (SSI) showed significant differences (15 ± 5.05mmHg and 16.25 ± 6.28 mmHg versus 24.13 ± 4.65 mmHg for SSB2). After the test, resting pressures drop but more significantly under the SSB2 compared to the other 2 multilayer bandages (resting pressures: 31.95 ± 2.66 mmHg and 34.61 ± 2.28 mmHg vs. 25.95 ± 3.15 mmHg for SSB2). However, the SSI is not significantly different from the SSI calculated before the treadmill test (15.41 ± 4.44 mmHg and 15.66 ± 4.85 mmHg vs. 25.06 ± 4.98 mmHg). Conclusions: The treadmill test makes it possible to quantify and to compare the drop in pressure under different bandages in the same conditions. This test could be useful in clinical research before the clinical phases of development, especially in the case of venous leg ulcer. On the other hand, in case of mixed ulcers, the drop in pressure in lying position in multilayer bandages ensure a continuation of the arterial influx in case of mixed ulcers.

Background: Coronary artery disease (CAD) is a common medical problem that remains a great cause of morbidity and mortality. Based on clinical manifestation, CAD span from chronic stable angina to acute coronary syndrome (ACS), which encompasses (1) unstable angina (UA), (2) non-ST-elevation myocardial infarction (NSTEMI), and (3) ST-elevation myocardial infarction (STEMI). Objective: This study was conducted to describe the risk stratification and prognosis of CAD in Yemeni patients undergoing an exercise stress test. Method: A retrospective descriptive study involved the records of 302 patients who undergoing exercise stress testing by the Bruce protocol of Treadmill (TMT). Results: Out of 302 patients, the mean age was 43.29 years, (range, 22–70 years), and 79.80% were males. The majority of patients (86.75%) were normal. Most of the affected patients (82.50%) were males. All of the affected peoples were more than 30 years old with predominance in more than 50 years old. Results showed that 45% of the positive (+ve) patients were in high-risk group, and 55% were in intermediate and low-risk groups. Conclusions: CAD affects males more than females. It affects patients older than 30 years and predominates in elderly patients. Most of the affected patients were in the high, intermediate, and low-risk groups and rarely were in the very high-risk group.

Objectives: In this study, we aimed to assess the maximal oxygen uptake (VO 2max ) of young, healthy, non-athletic Saudi men using maximum graded exercise with instant breath-by-breath analysis and to compare this value to the predicted VO 2max by international formulae. Methods: In this cross-sectional study, 88 young non-athletic normal-weight Saudi subjects were recruited from Eastern Province of Saudi Arabia with mean age (21.3 ± 1.5 years), weight: (64.7 ± 7.5 kg), height: (172.3 ± 6.1 cm) and body mass index: (21.8 ± 2.1). All subjects were interviewed and examined for eligibility, after which they performed maximum graded exercise testing on a treadmill to obtain VO 2max . The predicted VO 2max was also generated using the following formulae (Edvardsen, Fairbarns, FRIENDS, Hansen, and Jones). Results: The mean measured VO 2max was 41.9 ± 7.2 ml/kg/min. While the predicted VO 2max using the formulae were: Edvardsen = 66.8 ± 7.9, Fairbarns = 64.1 ± 4.7, FRIENDS = 53.5 ± 2.2, Hansen = 42.8 ± 0.54, and Jones = 50.9 ± 5.1 ml/kg/min. There was a significant difference between all the predicted VO 2max and the measured one using the paired t-test (P < 0.001), except for the Hansen's predicted value (P = 0.212). The effect size index (Cohen's d) for the comparison of Hansen's VO 2max and measured VO 2max was trivial and equal to 0.13. The Bland-Altman test showed good agreement between the measured and Hansen's predicted VO 2max . Conclusion: This study demonstrated the mean VO 2max value of young, healthy, and non-athletic Saudi men. This value was lower than Western values, which might be due to low physical activity or racial differences. Most international formulae overestimate the VO 2max in this population, except for the Hansen equation. Therefore, Hansen's predicted VO 2max might be the best available reference value for the diagnosis and prognosis of young Saudi individuals undergoing maximum exercise testing., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

• Peripheral arterial disease is a phenotype of atherosclerotic disease often associated with coronary or cerebral artery disease • Supervised exercise therapy is highly recommended in peripheral arterial disease • The type of exercise (treadmill, track walking, ergometer), frequency (3 to 5 days per week), intensity (speed and incline), and duration (30 minutes) are determined based on the results of the exercise stress test for each patient • A multidisciplinary team approach is effective in comprehensive cardiac rehabilitation for peripheral arterial disease Peripheral arterial disease (PAD) is a phenotype of atherosclerotic disease often associated with cerebrovascular or coronary artery disease. The incidence of cardiovascular events in patients with PAD is 5.4% per year, which is higher than that of cerebrovascular or coronary artery disease. The most useful screening method for PAD is the ankle brachial pressure index (ABI). The ABI should be measured in (1) all patients with lower limb symptoms such as claudication, (2) all patients aged 65 years and over, and (3) those aged 50 to 65 years who have risk factors such as smoking and diabetes mellitus. PAD is diagnosed if the ABI is <0.9. A comprehensive cardiac rehabilitation program includes complete smoking cessation, blood pressure control with antihypertensive medications and salt reduction for hypertension, glycemic control for diabetes mellitus, and appropriate medications such as antiplatelet agents and statins. A multidisciplinary team approach is effective in comprehensive cardiac rehabilitation for patients with PAD, even those with critical limb ischemia (CLI). Exercise therapy is a crucial and essential treatment for PAD, except in CLI. Exercise therapy is contraindicated in patients with acute arterial occlusion and CLI with infection. PAD is often associated with other atherosclerotic diseases; the patient should be monitored for ischemic heart disease during the initial exercise stress test using the Gardner treadmill protocol. Supervised exercise therapy is highly recommended (Class I, Level of Evidence A). Alternatively, a home-based exercise program is feasible (Class IIa, Level of Evidence A). The exercise type (treadmill, track walking, ergometer), frequency (3 to 5 days per week), intensity (speed and incline), and duration (30 minutes) are determined based on the exercise stress test results for each patient. Exercise should be continued at least 3 times a week for at least 12 weeks. Cilostazol is highly recommended (Class I, Level of Evidence A). [Display omitted] [ABSTRACT FROM AUTHOR]

Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO2)]. Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise. Results: Maximum walking distance (MWD) was 290 m (120–652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p -value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD. Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers. [ABSTRACT FROM AUTHOR]

The 2-minute step test (2MST) requires minimal resources and is valid in adults older than 60 years. Here we investigate if the 2MST can be used to estimate peak oxygen consumption (VO2peak) in healthy middle-aged adults (40–59 years old). Thirty-six participants completed the 2MST and a maximal graded treadmill test with breath-by-breath gas analysis. Outcome measures included the number of steps completed in the 2MST, VO2peak (ml/kg/min), waist circumference (cm), resting blood pressure (mmHg) and body mass index (kg/m2). Data were analyzed using Pearson correlation coefficients and multivariate linear regression analyses. There was a moderate relationship between 2MST peak steps completed and VO2peak (r =.54, p =.001). The 2MST model, including 2MST peak steps, height and waist circumference, predicted VO2peak with r =.80 (p <.001). The 2MST may be a good predictor of VO2peak in healthy middle-aged adults, and may be suitable for primary health-care settings and large-scale epidemiological studies. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12617000091303, , date registered: 17 January 2017. [ABSTRACT FROM AUTHOR]

Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO2)].Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise.Results: Maximum walking distance (MWD) was 290 m (120–652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p-value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD.Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers.

Over the last decade, a huge number of herbal supplements have been introduced into the practice of sports medicine in order to increase physical performance. Medicinal plants are a valuable source of a large number of secondary metabolites, such as polyphenols, triterpenes and adaptogens. This determines the ability of herbal medicines to compensate for the deficiency of nutrients in the human body. The use of secondary products of processing provides an opportunity to obtain additional products of high biological value, and to purposefully spend natural resources’ reserves. Based on the literature data on the properties of leuzea and ursolic acid, the researchers of the Laboratory of Pharmacological Research NIOCH SB RAS developed a composition of two plant components: extracts of leuzea and cranberry meal, containing 0.31% ecdysten and 40% ursolic acid, respectively. The aim of this work is to study the effect of the composition of leuzea and cranberry meal extracts and its individual components on performance in a treadmill test in male CD-1 mice. To confirm the increase in physical performance, the concentration of lactate and blood glucose was determined. After a seven-day acclimation, test compounds were administered daily for two weeks, with all mice receiving exercise (at least 24 h between each run). At the end of the experiment, the concentration of lactate and glucose in the blood was measured. The composition of leuzea and cranberry meal extracts significantly reduced the concentration of lactate and glucose in the blood, indicating its ability to increase physical performance.

Mild–moderate equine asthma (MEA) is a common respiratory disorder among racehorses, characterized by lower airway inflammation. Although it is generally agreed that MEA causes poor performance, contrasting results have been reported about the effects of tracheal mucus and the leukocyte populations of the bronchoalveolar lavage (BAL) on performance. This study aims to investigate the associations between airway inflammation and fitness parameters measured during an incremental treadmill test on Standardbred racehorses. For this purpose, the clinical records of 116 Standardbreds subjected to a diagnostic protocol for poor performance were retrospectively reviewed. Parametric and nonparametric statistics were used to evaluate the relationships between endoscopic scores, BAL cytological results, and fitness parameters. Moreover, horses were divided into MEA and non-MEA groups and into neutrophilic, eosinophilic–mastocytic, and mixed MEA groups; fitness parameters were compared between groups. Neutrophils percentages were inversely correlated with the speed at a heart rate of 200 bpm, the speed and heart rate at a plasma lactate concentration of 4 mmol/L (VLa4 and HRLa4), and the maximal speed, while they were positively correlated with higher lactate concentrations. Moreover, significant differences were detected between different MEA subtypes concerning VLa4, HRLa4, and lactate concentrations. These results suggest that airway neutrophilic inflammation impairs athletic capacity in Standardbreds.

Background and objectives: Vortioxetine (VRT) is a relatively new selective serotonin reuptake inhibitor (SSRI) antidepressant and serotonin receptor modulator, approved for the treatment of major depression and generalized anxiety disorder. Depression has been linked with psychomotor disengagement, oxidative stress burden and decreased blood levels of brain-derived neurotrophic factor (BDNF). In our study we performed the experimental investigation of VRT, magnesium and of their association on the rats’ endurance capacity, motor behavior and blood biological disturbances in rats subjected to forced exercise in treadmill test. Materials and Methods: The substances were administered orally for 14 consecutive days, as follows: group 1 (control): distilled water 0.3 mL/100 g body; group 2 (Mg): magnesium chloride 200 mg/kg body; group 3 (VRT): VRT 20 mg/kg body; group 4 (VRT+Mg): VRT 20 mg/kg body + magnesium chloride 200 mg/kg body. Magnesium was used as positive control substance with known effects in treadmill test. The consequences of VRT treatment on glucose, cortisol, BDNF and oxidative stress biomarkers (superoxide-dismutase, malondialdehyde, glutathione-peroxidase, lactate dehydrogenase) were also assessed. Results and conclusions: The use of VRT resulted in an improvement in motor capacity and an increase of the rats’ endurance to physical effort. The administration of VRT increased the serum BDNF levels and reduced the oxidative stress in rats subjected to physical effort. The association of magnesium potentiated the effects of VRT on physical performances, the antioxidant activity and the decreasing in serum stress markers in treadmill test in rats.

Background: Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP). Method: Fifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups. Results: One-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps < 0.001). The nLBP group also had less kinesiophobia than the LSS one (p < 0.001), but was similar to the PAD group. The global health rating was not statistically different between groups (p = 0.118). Conclusion: The test was able to distinguish neurogenic from vascular or nLBP related claudication. However, further studies are needed to validate this new treadmill walking test. Trial registration: clinicaltrials.gov (NCT04058171), Registered August 15, 2019 –Registered during recruitment [ABSTRACT FROM AUTHOR]

In the context of the COVID-19 pandemic, the use of surgical masks has become the new normal. The use of these devices in exercise and medical situations has been advocated with the purpose of reducing contagions, but some concerns exist regarding its impact of physical fitness and safety of use. If the use of mask while exercising can cause decreased functional capacity or dangerous hypoxemia is still something we know little of. Therefore, we performed maximal treadmill stress tests in 12 healthy young subjects, with and without surgical mask use, and measured exercise capacity, oxygen saturation (rest, peak exercise and post-exercise) and electrocardiographic changes on a standard treadmill test. Exercise capacity and oxygen saturation levels decreased in peak exercise vs rest in a statistically significant manner when mask was used. ECG changes, although not significant, were present in 3 subjects when mask was used and disappeared when the test was made unmasked. We concluded that masked exercise has the potential to cause decreased exercise load and oxygen saturation and potentially cause diagnostic errors in medical exams. [ABSTRACT FROM AUTHOR]

To determine (a) whether patients with peripheral artery disease (PAD) who walked at least 7000 and 10,000 steps/day had better ambulatory function and health-related quality of life (HRQoL) than patients who walked less than 7000 steps/day, and (b) whether differences in ambulatory function and HRQoL in patients grouped according to these daily step count criteria persisted after adjusting for covariates. Two hundred forty-eight patients were assessed on their daily ambulatory activity for 1 week with a step activity monitor, and were grouped according to daily step count targets. Patients who took fewer than 7000 steps/day were included in group 1 (n = 153), those who took 7000 to 9999 steps/day were included in group 2 (n = 57), and patients who took at least 10,000 steps/day were included in group 3 (n = 38). Primary outcomes were the 6-minute walk distance (6MWD) and Walking Impairment Questionnaire (WIQ) distance score, which is a disease-specific measurement of HRQoL. Patients were further characterized on demographic variables, comorbid conditions, and cardiovascular risk factors. The groups were significantly different on ankle-brachial index (P =.02), and on the prevalence of hypertension (P =.04), diabetes (P <.01), abdominal obesity (P <.01), arthritis (P =.04), and chronic obstructive pulmonary disease (P <.01). Thus, these variables served as covariates in adjusted analyses, along with age, weight, and sex. The 6MWD (mean ± standard deviation) was significantly different among the groups in unadjusted (P <.01) and adjusted (P <.01) analyses (group 1, 313 ± 90 m; group 2, 378 ± 84 m; and group 3, 414 ± 77 m), with groups 2 and 3 having a higher 6MWD than group 1 (P <.01). The WIQ distance score was significantly different among the groups in unadjusted (P <.01) and adjusted (P <.01) analyses (group 1, 30 ± 30%; group 2, 45 ± 35%; and group 3, 47 ± 34%), with groups 2 and 3 having higher WIQ distance scores than group 1 (P <.01). Patients with PAD who walked more than 7000 and 10,000 steps/day had greater ambulatory function and HRQoL than patients who walked fewer than 7000 steps/day. Second, the greater ambulatory function and HRQoL associated with walking 7000 and 10,000 steps/day persisted after adjusting for covariates. This study provides preliminary evidence that patients with PAD who walk more than 7000 steps/day have better ambulatory function and HRQoL than patients below this threshold. [ABSTRACT FROM AUTHOR]

We describe an elderly woman who underwent a treadmill test preoperatively and was found to have Exercise-induced Left Bundle Branch Block without chest pain. Coronary angiogram was done which revealed a 70% stenosis in the fi rst diagonal branch of Left Anterior Descending Artery and a 40% lesion in proximal Right Coronary Artery. Available literature attributes rate-dependent transient conduction defects to obstructive lesions of coronary arteries, slow arterial blood fl ow, vasospasms as well as pathology in the Bundle of His.

In the context of the COVID-19 pandemic, the use of surgical masks has become the new normal. The use of these devices in exercise and medical situations has been advocated with the purpose of reducing contagions, but some concerns exist regarding its impact of physical fitness and safety of use. If the use of mask while exercising can cause decreased functional capacity or dangerous hypoxemia is still something we know little of. Therefore, we performed maximal treadmill stress tests in 12 healthy young subjects, with and without surgical mask use, and measured exercise capacity, oxygen saturation (rest, peak exercise and post-exercise) and electrocardiographic changes on a standard treadmill test. Exercise capacity and oxygen saturation levels decreased in peak exercise vs rest in a statistically significant manner when mask was used. ECG changes, although not significant, were present in 3 subjects when mask was used and disappeared when the test was made unmasked. We concluded that masked exercise has the potential to cause decreased exercise load and oxygen saturation and potentially cause diagnostic errors in medical exams.

Background and Objectives: The treadmill test (TMT) is a predictive tool for myocardial ischemia. Recently, exercise-provoked ventricular premature contracture (VPC) during TMT was shown to have a relation with coronary artery disease and cardiovascular mortality. Therefore, we evaluate clinical correlates of exercise-provoked VPC and compare the predictive power for myocardial ischemia and cardiovascular events. Method: Data of 408 patients (≥18 years of age) who underwent TMT for work up of angina, palpitation, dyspnea, syncope, or arrhythmia between February 2015, and January 2016, were collected with consent at Samsung Medical Center, Seoul, Republic of Korea. Among total of 408 patients, 208 were excluded according to the previous history of PCI or CABG, previous MI, decreased left ventricular ejection fraction lower than 50%, arrhythmia that could affect ST-segment change on ECG. Results: Among 200 patients, 32 (16.0%) developed exercise-provoked VPC (21 patients in the exercise phase, 20 patients in the recovery phase). Of them, 20 patients (10.0%) showed positive TMT, and 4 patients (2.0%) underwent revascularization after TMT. Among 21 patients showing exercise phase VPC, 5 (23.8%) showed positive TMT results. In patients younger than 65 years, exercise phase VPC was associated with positive TMT (odds ratio 6.879, 1.458–32.453) considering demographics and previous medical history in multivariable analysis. Among the 20 patients showing recovery phase VPC, 2 (10.0%) underwent revascularization after TMT. In multivariable analysis, recovery phase VPC was associated with revascularization (odds ratio 9.381, 1.144–76.948) considering age, sex, BMI, and TMT result. Conclusion: VPC during the treadmill test was a useful predictor of myocardial ischemia in this study.