Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients.

BACKGROUND: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. METHODS AND RESULTS: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0-2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0-2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96-4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. CONCLUSIONS: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

Energy balance dynamics during short-term high-intensity functional training.

CrossFit (CF; CrossFit Inc., Washington, DC, USA) is a form of high-intensity functional training that focuses on training across the entire spectrum of physical fitness. CF has been shown to improve a number of indicators of health but little information assessing energy balance exists. The purpose of the present study was to investigate energy balance during 1 week of CF training. Men and women (n = 21; mean ± SD; age, 43.5 ± 8.4 years; body mass index, 27.8 ± 4.9 kg·m-2), with ≥3 months CF experience, had body composition assessed via air displacement plethysmography before and after 1 week of CF training. Participants wore ActiHeart monitors to assess total energy expenditure (TEE), activity energy expenditure, and CF energy expenditure (CF EE). Energy intake was assessed from TEE and Δ body composition. CF EE averaged 605 ± 219 kcal per 72 ± 10 min session. Weekly CF EE was 2723 ± 986 kcal. Participants were in an energy deficit (TEE: 3674 ± 855 kcal·day-1; energy intake: 3167 ± 1401 kcal·day-1). Results of the present study indicate that CF training can account for a significant portion of daily activity energy expenditure. The weekly expenditure is within levels shown to induce clinically meaningful weight loss in overweight/obese populations.

Energy compensation after sprint- and high-intensity interval training.

BACKGROUND: Many individuals lose less weight than expected in response to exercise interventions when considering the increased energy expenditure of exercise (ExEE). This is due to energy compensation in response to ExEE, which may include increases in energy intake (EI) and decreases in non-exercise physical activity (NEPA). We examined the degree of energy compensation in healthy young men and women in response to interval training. METHODS: Data were examined from a prior study in which 24 participants (mean age, BMI, & VO2max = 28 yrs, 27.7 kg•m-2, and 32 mL∙kg-1∙min-1) completed either 4 weeks of sprint-interval training or high-intensity interval training. Energy compensation was calculated from changes in body composition (air displacement plethysmography) and exercise energy expenditure was calculated from mean heart rate based on the heart rate-VO2 relationship. Differences between high (≥ 100%) and low (< 100%) levels of energy compensation were assessed. Linear regressions were utilized to determine associations between energy compensation and ΔVO2max, ΔEI, ΔNEPA, and Δresting metabolic rate. RESULTS: Very large individual differences in energy compensation were noted. In comparison to individuals with low levels of compensation, individuals with high levels of energy compensation gained fat mass, lost fat-free mass, and had lower change scores for VO2max and NEPA. Linear regression results indicated that lower levels of energy compensation were associated with increases in ΔVO2max (p < 0.001) and ΔNEPA (p < 0.001). CONCLUSIONS: Considerable variation exists in response to short-term, low dose interval training. In agreement with prior work, increases in ΔVO2max and ΔNEPA were associated with lower energy compensation. Future studies should focus on identifying if a dose-response relationship for energy compensation exists in response to interval training, and what underlying mechanisms and participant traits contribute to the large variation between individuals.

Perceptual Changes in Response to Two Regimens of Interval Training in Sedentary Women.

This study examined acute and chronic changes in perceptual measures (rating of perceived exertion [RPE], affect, and arousal) in response to 2 regimens of high-intensity interval training (HIIT). Twenty-three healthy sedentary women (mean ± SD age and V[Combining Dot Above]O2max = 23.0 ± 5.7 years and 30.1 ± 4.4 ml·kg·min, respectively) were randomized to complete 12 weeks of one of 2 HIIT regimes, whereas an additional 7 women served as sedentary controls. Training was performed 3 days per week on a cycle ergometer and consisted of up to ten 1-minute bouts at moderate (60-80%Wmax = moderate intensity [MOD]) or more intense (80-90%Wmax = HI) workloads separated by active recovery. At baseline and every 3 weeks, RPE, affect, and arousal were measured during training using validated scales. Repeated measures analysis of variance was used to examine acute and chronic changes in these variables to HIIT. Data revealed significant (p < 0.001) increases in RPE and arousal and decreases (p < 0.001) in affect during acute HIIT, with RPE responses differing (p ≤ 0.05) between HI and MOD. However, acute changes in affect and arousal were similar in HI and MOD. Training led to a significant reduction in RPE, whereas both affect and arousal were unchanged (p > 0.05) after HIIT. Completion of moderate or more intense interval training reduces perceptions of RPE during training yet does not alter arousal or affect. RPE was reduced via training, yet large dependence on anaerobic metabolism during HIIT may minimize training-induced changes in affect.

Magnitude and time course of changes in maximal oxygen uptake in response to distinct regimens of chronic interval training in sedentary women.

PURPOSE: This study aimed to compare changes in maximal oxygen uptake (VO2max) in response to two regimens of chronic interval training. METHODS: Twenty healthy sedentary women (mean ± SD age and VO2max = 23.0 ± 5.7 years and 30.1 ± 4.4 mL kg(-1) min(-1), respectively) were randomized to complete 12 weeks of one of two interval training regimes, while an additional seven women served as controls. Training was performed 3 days week(-1) on a cycle ergometer and consisted of 6-10 bouts of 1 min duration at lower (60-80 % W max = LO, n = 10) or more intense (80-90 % W max = HI, n = 10) workloads separated by a brief recovery. Every 3 weeks, measures of VO2max and W max were repeated to assign new training intensities. Changes in blood pressure and body composition were also examined. RESULTS: Data revealed significant (p < 0.001) improvements in VO2max in LO (22.3 ± 6.9 %) and HI (21.9 ± 11.6 %) that were similar (p > 0.05) between groups. Approximately 60 % of the increase in VO2max in HI was observed in the initial 3 weeks, compared to only 20 % in LO. No change (p > 0.05) in body weight or body composition was revealed in response to training. Results demonstrate that a relatively prolonged regimen of moderate or more intense interval training induces similar improvements in cardiorespiratory fitness, although HI induced greater increases in VO2max early on in training than LO. Completion of more intense interval training may be an effective means to expedite increases in VO2max soon after initiation of exercise training.

Effect of two doses of interval training on maximal fat oxidation in sedentary women.

INTRODUCTION: The primary aim of the current study was to determine the effect of two doses of chronic high-intensity interval training (HIT) on changes in maximal fat oxidation (MFO) and body composition. METHODS: Sedentary women (N = 23, age and V˙O2max = 24.2 ± 6.2 yr and 30.3 ± 5.2 mL·kg-1·min-1, respectively) completed either high (HI) (80%-90% maximal workload) or moderate (MOD) intensity (60%-80% maximal workload) HIT on a cycle ergometer 3 d·wk-1 for 12 wk consisting of 6-10 sixty-second bouts interspersed with active recovery. Seven women of similar age and fitness level served as controls. Every 3 wk, substrate oxidation was assessed during progressive exercise via indirect calorimetry to determine MFO and minimum fat oxidation, and body composition was assessed every 6 wk. Repeated-measures ANOVA was used to examine changes in substrate oxidation in response to training, with training group used as a between-subjects variable. RESULTS: Results revealed improved MFO (P = 0.04, 19%-25%) and minimum fat oxidation (P = 0.001, 22-24 W) in response to HIT, yet the magnitude of improvement was similar (P > 0.05) between training paradigms. No change (P > 0.05) in body weight, percent body fat, or waist-hip circumference was revealed with training. CONCLUSION: These data suggest that 12 wk of either moderate or more strenuous interval training similarly enhance fat oxidation in sedentary women but do not alter body weight or body composition.