Rethinking Rehabilitation: A REVIEW OF PATIENT POPULATIONS WHO CAN BENEFIT FROM CARDIAC REHABILITATION.

Although cardiac rehabilitation (CR) is safe and highly effective for individuals with various cardiovascular health conditions, to date there are only seven diagnoses or procedures identified by the Centers for Medicare & Medicaid Services that qualify for referral. When considering the growing number of individuals with cardiovascular disease (CVD), or other health conditions that increase the risk for CVD, it is important to determine the extent for which CR could benefit these populations. Furthermore, there are some patients who may currently be eligible for CR (spontaneous coronary artery dissection, left ventricular assistant device) but make up a relatively small proportion of the populations that are regularly attending and participating. Thus, these patient populations and special considerations for exercise might be less familiar to professionals who are supervising their programs. The purpose of this review is to summarize the current literature surrounding exercise testing and programming among four specific patient populations that either do not currently qualify for (chronic and end-stage renal disease, breast cancer survivor) or who are eligible but less commonly seen in CR (sudden coronary artery dissection, left ventricular assist device). While current evidence suggests that individuals with these health conditions can safely participate in and may benefit from supervised exercise programming, there is an immediate need for high-quality, multisite clinical trials to develop more specific exercise recommendations and support the inclusion of these populations in future CR programs.

Cardiovascular and skeletal muscle health with lifelong exercise.

The purpose of this study was to examine the effects of aerobic lifelong exercise (LLE) on maximum oxygen consumption (V̇o2max) and skeletal muscle metabolic fitness in trained women ( n = 7, 72 ± 2 yr) and men ( n = 21, 74 ± 1 yr) and compare them to old, healthy nonexercisers (OH; women: n = 10, 75 ± 1 yr; men: n = 10, 75 ± 1 yr) and young exercisers (YE; women: n = 10, 25 ± 1 yr; men: n = 10, 25 ± 1 yr). LLE men were further subdivided based on intensity of lifelong exercise and competitive status into performance (LLE-P, n = 14) and fitness (LLE-F, n = 7). On average, LLE exercised 5 day/wk for 7 h/wk over the past 52 ± 1 yr. Each subject performed a maximal cycle test to assess V̇o2max and had a vastus lateralis muscle biopsy to examine capillarization and metabolic enzymes [citrate synthase, ß-hydroxyacyl-CoA dehydrogenase (ß-HAD), and glycogen phosphorylase]. V̇o2max had a hierarchical pattern (YE > LLE > OH, P < 0.05) for women (44 ± 2 > 26 ± 2 > 18 ± 1 ml·kg-1·min-1) and men (53 ± 3 > 34 ± 1 > 22 ± 1 ml·kg-1·min-1) and was greater ( P < 0.05) in LLE-P (38 ± 1 ml·kg-1·min-1) than LLE-F (27 ± 2 ml·kg-1·min-1). LLE men regardless of intensity and women had similar capillarization and aerobic enzyme activity (citrate synthase and ß-HAD) as YE, which were 20%-90% greater ( P < 0.05) than OH. In summary, these data show a substantial V̇o2max benefit with LLE that tracked similarly between the sexes, with further enhancement in performance-trained men. For skeletal muscle, 50+ years of aerobic exercise fully preserved capillarization and aerobic enzymes, regardless of intensity. These data suggest that skeletal muscle metabolic fitness may be easier to maintain with lifelong aerobic exercise than more central aspects of the cardiovascular system. NEW & NOTEWORTHY Lifelong exercise (LLE) is a relatively new and evolving area of study with information especially limited in women and individuals with varying exercise intensity habits. These data show a substantial maximal oxygen consumption benefit with LLE that tracked similarly between the sexes. Our findings contribute to the very limited skeletal muscle biopsy data from LLE women (>70 yr), and similar to men, revealed a preserved metabolic phenotype comparable to young exercisers.

Variability in Intensity Related to Increased Overall Bout Intensity.

OBJECTIVE: We examined the relationship between variability in self-regulated exercise intensity and overall intensity during acute exercise. METHODS: Overall, 32 participants (age; 20±4y, body mass index (BMI) 24.1±3.6 kg/m2) completed a 30-minute self-regulated treadmill exercise bout. Participants were blinded to treadmill settings and adjusted speed and incline every 5-minutes as desired. RESULTS: Variability in exercise intensity (metabolic equivalent standard deviation (METSD)) was positively correlated with (r = .567, p = .001) and explained a significant portion of the overall exercise intensity (ß = .574, t = 3.713, p = .001). When accounting for physiological variables, METSD (ß = .381, t = 2.242, p = .034) and VO2peak (ß = .575, t = 2.864, p = .008) predicted overall intensity. When controlling for physiological and psychological variables, in addition to METSD (ß = .388), tolerance for exercise intensity (ß = 3.124) became a significant predictor of overall bout intensity (p < .05). CONCLUSIONS: In-task variability in exercise intensity was posi- tively related to the average intensity of the bout. Future studies should explore the utility of explicitly encouraging individuals to incorporate intra-bout variety for increasing the exercise dose while maintaining a degree of autonomy.

Energy Cost of Active and Sedentary Music Video Games: Drum and Handheld Gaming vs. Walking and Sitting.

To compare energy expenditure during and after active and handheld video game drumming compared to walking and sitting. Ten experienced, college-aged men performed four protocols (one per week): no-exercise seated control (CTRL), virtual drumming on a handheld gaming device (HANDHELD), active drumming on drum pads (DRUM), and walking on a treadmill at ~30% of VO2max (WALK). Protocols were performed after an overnight fast, and expired air was collected continuously during (30min) and after (30min) exercise. DRUM and HANDHELD song lists, day of the week, and time of day were identical for each participant. Significant differences (p < 0.05) among the average rates of energy expenditure (kcal·min-1) during activity included WALK > DRUM > HANDHELD. No significant differences in the rates of energy expenditure among groups during recovery were observed. Total energy expenditure was significantly greater (p < 0.05) during WALK (149.5 ± 30.6 kcal) compared to DRUM (118.7 ± 18.8 kcal) and HANDHELD (44.9±11.6 kcal), and greater during DRUM compared to HANDHELD. Total energy expenditure was not significantly different between HANDHELD (44.9 ± 11.6 kcal) and CTRL (38.2 ± 6.0 kcal). Active video game drumming at expert-level significantly increased energy expenditure compared to handheld, but it hardly met moderate-intensity activity standards, and energy expenditure was greatest during walking. Energy expenditure with handheld video game drumming was not different from no-exercise control. Thus, traditional aerobic exercise remains at the forefront for achieving the minimum amount and intensity of physical activity for health, individuals desiring to use video games for achieving weekly physical activity recommendations should choose games that require significant involvement of lower-body musculature, and time spent playing sedentary games should be a limited part of an active lifestyle.

Portable open-circuit spirometry systems.

BACKGROUND: The purpose of this review is to describe the evolution of portable open-circuit spirometry systems, and discuss their validity, reliability, and principles of operation. METHODS: Eleven devices were selected for review: the Oxylog, Aerosport KB1-C, Cosmed K2, Cosmed K4RQ, Cosmed K4b2, MetaMax I, MetaMax II, Metamax3B/VmaxST, Medgraphics VO2000, Oxycon Mobile I and Oxycon Mobile II. The validity (compared to the Douglas bag method [DBM]) and reliability of each device for measuring VO2 was summarized. RESULTS: Mean differences in resting measurements of VO2 were within ±0.05 L/min for all devices except one (difference of 0.17 L/min). When compared to the DBM, VO2 differences for all devices ranged from 0.01 L/min to 0.29 L/min during submaximal intensity exercise and from 0.01 L/min to 0.36 L/min during vigorous/maximal intensity. During submaximal and maximal intensities, ICC ranged from 0.66-0.99 and CV ranged from 2.0-14.2%. Of these devices, four used breath-by-breath technology and six used micro-proportional sampling technology. Validity and reliability of devices did not seem to differ between methods of gas collection. CONCLUSIONS: Of the three commercially available devices in 2015, all were found to be reliable. Two of the three systems (Cosmed K4b2 and Oxycon Mobile II) provided valid estimates of VO2 (mean values within ±0.10 L/min of DBM) during rest, and submaximal and maximal intensities, while the MetaMax3B slightly overestimated VO2, particularly at maximal exercise.

StepWatch accuracy during walking, running, and intermittent activities.

INTRODUCTION: The purpose of this study was two-fold: 1) to investigate effects of cadence and sensitivity settings for the StepWatch (SW3) on step count accuracy over a wide range of ambulatory speeds, and 2) to compare the preprogrammed "quick start" settings to modified settings during intermittent lifestyle activities. METHODS: Part 1: Fifteen participants (18-57 years of age) performed two trials of treadmill walking and running at ten speeds ranging from 26.8 to 268mmin-1 while wearing four SW3 devices. During the first trial, the cadence setting was maintained while sensitivity was varied; in the second trial sensitivity was maintained while the cadence setting was varied. Part 2: Fifteen participants performed four intermittent activities and drove an automobile while wearing two SW3 devices, one with preprogrammed settings and the other with the modified settings determined in Part 1. RESULTS: Part 1: The modified settings (cadence setting of 70% of default and sensitivity of 16) provided the greatest step counting accuracy across a wide range of speeds reporting 96.0-104% of actual steps between 53.6 and 268mmin-1. Part 2: The preprogrammed settings tended to have higher accuracy for light household tasks (recording 88% to 94% of actual steps) than the modified settings (recording 82% to 86% of actual steps) which showed a trend towards higher accuracy for tennis (recording 93% vs. 89% of actual steps) (p<0.05). CONCLUSION: The preprogrammed "quick start" StepWatch settings should be used with individuals who do not engage in running and vigorous sports. However, for individuals who engage in running and tennis, use of modified settings may result in improved step counting accuracy.

Psycho-Physiological Effects of Television Viewing During Exercise.

We propose that enjoyment is an important factor in the adoption and long-term maintenance of exercise. Television (TV) viewing is believed to be a highly enjoyed leisure-time activity, combining it with exercise may make for a more enjoyable exercise experience. The objective of this study was to examine the effects of television (TV) viewing on psychological and physiological variables during a moderate-intensity exercise bout. Twenty-eight insufficiently active (<150 minutes per week of moderate intensity PA and/or 75 minutes of vigorous PA) adults (Age: M = 47.4 ± 7.6 years) participated in this study. Each participant performed three separate 30-minute walking bouts on a motorized treadmill. During each bout, participants watched a program they selected (30-minute scripted show) (self-selected TV condition), a British Broadcasting Corporation (BBC) nature program (standardized TV condition), or no TV program (no TV condition). Participants were unable to select the nature program as their self-selected program, as it was not a 30-minute scripted program. A Polar Heart Rate (HR) monitor and validated surveys on affect and enjoyment were used. Participants reported greater enjoyment of exercise for both self-selected and standardized TV conditions (97.1 ± 15.2 and 92.7 ± 15.2), compared to the No TV condition (77.5 ± 13.4, p < 0.001). The two TV conditions resulted in similar levels of focus on TV viewing (self-selected TV: 81.2 ± 19.7; standardized TV: 79.1 ± 14.2, p > 0.05) and dissociation from walking (self-selected TV: 38.1 ± 6.7 and standardized TV: 33.2 ± 3.9); they also resulted in more dissociation than the no TV condition (TV: 72.6 ± 5.6, p = 0.002). The findings indicate that TV viewing, regardless of whether the programming is self-selected or standardized, associates with greater enjoyment of exercise.