Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson's disease. A secondary analysis from a randomized controlled trial.

BACKGROUND: In the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson's disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort. METHODS: Climb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2-3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test. RESULTS: Compared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking. CONCLUSIONS: Sport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson's disease. Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020).

Climb up! Head up! Climbing improves posture in Parkinson's disease. A secondary analysis from a randomized controlled trial.

OBJECTIVE: To investigate the effect of sport climbing on a biomechanical marker of axial posture in patients with Parkinson's disease, as well as its association with age, body mass index and health-related quality-of-life outcome measures. DESIGN: Pre-planned secondary analysis of our randomized controlled, semi-blind trial (unblinded patients, blinded assessors) comparing sport climbing to unsupervised exercise. SETTING: Single-centre study conducted at the Department of Neurology of the Medical University of Vienna, Austria. PARTICIPANTS: Forty-eight Parkinson's disease patients (aged 64 ± 8 years, Hoehn & Yahr stage 2-3) were included. INTERVENTION: Sport climbers (n = 24) followed a 12-week, 90 min/week supervised top-rope sport climbing course in an indoor climbing gym. The unsupervised training group (n = 24) independently followed the 'European Physiotherapy Guidelines for Parkinson's Disease' and World Health Organization recommendations for an active lifestyle for 12 weeks. MAIN MEASURES: Posture was assessed with the horizontal distance of the seventh cervical vertebra to the wall at baseline and after the intervention. RESULTS: Participating in the sport climbing group significantly predicted the biomechanical marker of axial posture (P = 0.044). The improvement in the biomechanical marker did not affect the quality of life, depression, fatigue, physical activity or fear of falling. Participants in the sport climbing group showed a significantly decreased horizontal distance of the seventh cervical vertebra to the wall after the intervention (-1.7 cm (95%CI [-2.6, -0.8]). In the unsupervised training group, no difference was found (-0.5 cm; 95%CI -1.3, 0.2]). CONCLUSIONS: We conclude that sport climbing improves a biomechanical marker of axial posture in Parkinson's disease.

Effects of high-intensity interval training on trajectories of gas-exchange measures and blood lactate concentrations during cardiopulmonary exercise tests in cardiac rehabilitation-A randomized controlled trial.

BACKGROUND: The optimal allocation of training time to different intensities in cardiac rehabilitation is still under debate. The objective of this study was to explore whether in a 12-week cardiac rehabilitation program, replacement of two of four usual continuous endurance training (CET) sessions per week with energy expenditure-matched high-intensity interval training (HIIT) affects the trajectories of cardiopulmonary exercise test (CPET) variables such as ventilatory equivalents for O2 (EqO2 ) and CO2 (EqCO2 ), and blood lactate (BLa) during CPET. METHODS: Eighty-two male patients undergoing outpatient cardiac rehabilitation after an acute coronary syndrome were randomized to CET (age [mean ± SD] 61.7 ± 9.8 years, body mass index [BMI] 28.1 ± 3.4) or HIIT+CET (60.0 ± 9.4 years, BMI 28.5 ± 3.5). CPET was performed at baseline, after 6 and after 12 weeks. HIIT consisted of ten 60-s bouts of cycling at an intensity of 100% of the maximal power output (Pmax ) achieved in an incremental test to exhaustion, interspersed with 60 s at 20% Pmax . CET was performed at 60% Pmax with equal duration. Training intensities were adjusted after 6 weeks to account for the training-induced improvement in cardiorespiratory fitness. The entire functions defining the relationship between EqO2 , EqCO2 , and BLa, with power output were modeled using linear mixed models to assess how these trajectories are affected by HIIT. RESULTS: After 6 and 12 weeks, Pmax increased to 112.9% and 117.5% of baseline after CET, and to 113.9% and 124.7% after HIIT+CET (means). Twelve weeks of HIIT+CET elicited greater reductions of EqO2 and EqCO2 than CET alone (p < 0.0001 each) in a range above 100% baseline Pmax . Specifically, at 100% of baseline Pmax , least squares arithmetic mean EqO2 values of CET and HIIT+CET patients were 36.2 versus 33.5. At 115% and 130% of baseline Pmax , EqO2 values were 41.2 versus 37.1 and 47.2 versus 41.7. Similarly, corresponding EqCO2 values of CET and HIIT+CET patients were 32.4 versus 31.0, 34.3 versus 32.2, and 37.0 versus 34.0. Conversely, mean BLa levels (mM) were not differently affected (p = 0.64). At 100%, 115%, and 130% of baseline Pmax after 12 weeks, BLa levels did not differ to a relevant extent (least squares geometric means, 3.56 vs. 3.63, 5.59 vs. 5.61, 9.27 vs. 9.10). CONCLUSIONS: While HIIT+CET reduced ventilatory equivalents more effectively than CET alone, specifically when patients were approaching their maximal performance during CPET, both training strategies were equally effective in reducing BLa levels.

The therapeutic effects of climbing: A systematic review and meta-analysis.

OBJECTIVE: Several recent studies show a growing popularity of therapeutic climbing (TC) for patients with various conditions. This could be an attempt to fill the gap left by traditional exercises that do not always address physical, mental, and social well-being. This review provides an overview of the physical, mental, and social effects and safety aspects of climbing for different indications. LITERATURE SURVEY: A literature search was conducted on July 8, 2020 (update search August 26, 2021). We searched MEDLINE via Ovid, Embase, and PubMed and bibliographies of included studies, and we conducted a manual search. METHODOLOGY: Two independent reviewers evaluated the quality of the studies using appropriate Risk of Bias (RoB) tools, and the level of evidence for each domain was graded. Study characteristics and effectiveness data for TC were extracted and synthesized. Meta-analyses were conducted for the three dimensions (physical/mental/social health), using a random-effects model. SYNTHESIS: A total of 112 publications were reviewed, and 22 full-text articles were assessed regarding the eligibility criteria, of which 18 trials involving 568 patients were included. TC is safe and positively affects physical (e.g., fitness, motor control, movement velocity, dexterity, strength), mental (e.g., depressiveness, somatisation, psychoticism, emotion regulation, body perception, self-esteem, fatigue), and social (e.g., social functioning, trust, communication, sense of responsibility) health for individuals with neurological, orthopedic, psychiatric, and pediatric ailments. The meta-analysis showed a statistically significant improvement in the physical dimension favoring the climbing group. Improvements that were not statistically significant were found for the mental/social dimensions in the climbing group. The heterogeneity of data was moderate/high (social/mental dimension), and for the physical dimension, data were homogenous. CONCLUSIONS: The studies investigating TC outline its positive effects in various patient groups. TC is a safe and effective treatment for improving physical/mental/social well-being. This review is based on the best available evidence; however, significant gaps remain in providing sufficiently strong evidence.

Therapeutic climbing in Parkinson's disease: Differences in self-reported health and well-being, feasibility and clinical changes.

BACKGROUND: Therapeutic climbing (TC) is a whole-body workout that stimulates and improves physical and psychosocial abilities. It has been used in neurological rehabilitation, but there is scarce evidence of specific benefits for people with Parkinson's (PwP). OBJECTIVE: To investigate and evaluate self-reported differences in health and well-being among trial participants, the overall feasibility of TC and clinical changes caused as a rehabilitation measure for PwP. METHODS: A 3-level Likert scale survey was completed by 26 PwP (100% response rate) after a TC course (mean 16 sessions) at the Neurological Rehabilitation Center assessing self-perceived differences in health and well-being in terms of physical, psychological, and social parameters. We investigated the feasibility of TC in terms of adherence, practicability and acceptability during a multidisciplinary inpatient rehabilitation program and determined several clinical outcomes (10-meter distance and 2-minute duration walking tests, Functional Gait Assessment, Nine-Hole-Peg tests, and Tinetti Assessment Tool). RESULTS: Improvements are based on self-reported perceptions of PwP. We observed an improvement of overall physical (average 65%), psychological (average 59%) and social (average 39%) aspects after TC. PwP improved strength (96%), balance (88%), range of motion (88%), body awareness (85%), physical well-being (77%), and fatigue (75%). Furthermore, they self-reported admiration in their social surrounding (42%) and felt more sociable and outgoing (40%). Concerning adherence, practicability and acceptability, TC seems to be feasible for PwP. Treatment adherence was 100%, 70% declared motivation to continue TC, and 96% intended to recommend TC to peers. Furthermore, PwP showed statistically significant improvements in 10-meter walking tests (T0: 7.5 (1.1-13.9), T1: 6.5 (0.1-12.9); p < .01; n = 16), 2-minute walking tests (T0: 149.5 (-111.0-410.0), T1: 177.0 (-140.7-494.7); p < .01; n = 19), Functional Gait Assessment (T0: 26.0 (-24.8-76.8), T1: 28.0 (2.6-53.4); p < .01; n = 15), and Nine-Hole-Peg tests (left: T0: 26.5 (24.3-28.7), T1: 24.1 (22.0-26.3); p < .01; n = 15; right: T0: 26.7 (24.1-29.2), T1: 23.3 (20.8-25.7); p < .01; n = 15). CONCLUSION: The preliminary findings suggest that TC offers an effective and feasible training method that may positively affect PwP overall perceptions of physical and psychosocial health status. The methodological limitations and small sample size limit the study's interpretability. More research is needed to definitely show the scientifically significant benefits of TC to PwP.

Self-reported Resistance Training Is Associated With Better HR-pQCT-derived Bone Microarchitecture in Vegan People.

CONTEXT: A plant-based lifestyle is a global trend; lower bone mineral density and increased fracture risk in vegan people are reported. OBJECTIVE: The primary objective was to assess trabecular and cortical bone microarchitecture in vegans and omnivores. Secondary objectives were to evaluate relationships between bone microarchitecture, nutrition parameters, and physical activity. METHODS: This was an observational study at the Medical Department II, St. Vincent Hospital (tertiary referral center for gastrointestinal, metabolic, and bone diseases, and teaching hospital of the Medical University of Vienna), including 43 healthy nonobese female and male subjects on a plant-based diet for at least 5 years, and 45 healthy nonobese female and male subjects on an omnivore diet for at least 5 years. The main outcome measures were the parameters of trabecular and cortical bone microarchitecture (high-resolution peripheral quantitative computed tomography), serum markers of bone turnover, nutrient intake (nutrition protocol), and self-reported resistance training (physical activity questionnaires). RESULTS: In the vegan group, trabecular and cortical structure were altered compared with omnivores. Vegans not reporting resistance training had diminished bone microarchitecture compared with omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar. In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrient intake and bone microarchitecture were observed without a conclusive pattern. CONCLUSION: Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrient uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle.

A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson's disease.

Physical activity is of prime importance in non-pharmacological Parkinson's disease (PD) treatment. The current study examines the effectiveness and feasibility of sport climbing in PD patients in a single-centre, randomised controlled, semi-blind trial. A total of 48 PD patients without experience in climbing (average age 64 ± 8 years, Hoehn & Yahr stage 2-3) were assigned either to participate in a 12-week sport climbing course (SC) or to attend an unsupervised physical training group (UT). The primary outcome was the improvement of symptoms on the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III). Sport climbing was associated with a significant reduction of the MDS-UPDRS-III (-12.9 points; 95% CI -15.9 to -9.8), while no significant improvement was to be found in the UT (-3.0 points; 95% CI -6.0 to 0.1). Bradykinesia, rigidity and tremor subscales significantly improved in SC, but not in the unsupervised control group. In terms of feasibility, the study showed a 99% adherence of participants to climbing sessions and a drop-out rate of only 8%. No adverse events occurred. This trial provides class III evidence that sport climbing is highly effective and feasible in mildly to moderately affected PD patients.

How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review.

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.

Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: A nationwide registry.

AIM: Cardiac rehabilitation (CR) is a key component of the treatment of cardiac diseases. The Austrian outpatient CR model is unique, as it provides patients with an extended professionally supervised, multidisciplinary program of 4-6 weeks of phase II (OUT-II) and 6-12 months of phase III (OUT-III) CR. The aim of this analysis was to assess the efficacy of the Austrian outpatient CR model using a nationwide registry. METHODS: Data of all consecutive patients (N = 7560) who completed OUT-II and/or OUT-III between 1 January 2005 and 31 December 2015 were entered prospectively into a registry. OUT-III patients were analyzed separately according to whether the preceding phase II was performed as outpatient (OUT-II/OUT-III, N = 2403) or in-patient (IN-II/OUT-III, N = 2789). All patients underwent assessment of anthropometry, resting blood pressure, lipid profile, fasting blood glucose, exercise capacity, quality of life, anxiety and depression. RESULTS: During OUT-II, patients significantly improved their metabolic risk factor profile and increased exercise capacity by 14.3%. OUT-II/OUT-III patients achieved an additional increase in exercise capacity by 10%, further improvement in high-density lipoprotein (HDL) and stabilization of the remaining risk factors. IN-II/OUT-III patients increased their maximal exercise capacity by 18.4% and there was improvement in blood pressure, HDL, low-density lipoprotein and glucose levels. CONCLUSION: Extended, professionally supervised, multidisciplinary outpatient CR in a large nationwide registry of consecutive patients consistently improved maximal exercise capacity and relevant modifiable cardiovascular risk factors beyond effects seen after IN- or OUT-II alone.

Effects of high-intensity interval training on platelet function in cardiac rehabilitation: a randomised controlled trial.

OBJECTIVE: To compare effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on platelet function in patients undergoing cardiac rehabilitation, as hyper-reactive platelets are involved in atherogenesis and atherothrombosis. METHODS: In this single-centre parallel group randomised controlled trial, male patients after an acute coronary syndrome under dual antiplatelet therapy performed MICT or HIIT+MICT for 12 weeks. Main outcome was platelet reactivity measured by the half-maximal concentration (EC50) of platelet agonist thrombin receptor-activating peptide-6 (TRAP-6) in terms of P-selectin expression. EC50 was determined at baseline, after 6 and 12 weeks, each time at physical rest and on exertion. RESULTS: 82 patients were randomised to MICT or HIIT+MICT. Mean (95% CI) baseline EC50values at physical rest were 6.7 µM (6.3 µM to 7.0 µM) TRAP-6. After 6/12 weeks, 36/33 MICT and 34/28 HIIT+MICT patients were examined. HIIT+MICT patients had 0.9 µM (0.4 µM to 1.4 µM)/0.5 µM (-0.1 µM to 1.0 µM) higher EC50values than MICT ones, and the propensity of their platelets to form aggregates with monocytes was significantly lower after 12 weeks. Short-term strenuous physical exertion was generally associated with platelet activation and an EC50reduction of 0.7 µM (0.6 µM to 0.8 µM). HIIT+MICT patients tended to be fitter after 12 weeks. No serious harms were observed. CONCLUSIONS: Including HIIT in cardiac rehabilitation seems to confer additional benefits compared with MICT alone, which should be confirmed in clinical trials with hard endpoints. Exertion-induced platelet activation and hyper-reactivity occur despite dual antiplatelet therapy. TRIAL REGISTRATION NUMBER: NCT02930330; Results.

Exercise-based cardiac rehabilitation is associated with a normalization of the heart rate performance curve deflection.

The heart rate (HR) rises with increased power output, whereby in most healthy individuals, the slope of HR levels off with higher intensity. This corresponds to a downward deflection of the heart rate performance curve (HRPC). Conversely, in patients after myocardial infarction, an upward HRPC deflection is frequently observed that is especially pronounced in patients with compromised left ventricular ejection fraction. To investigate whether regular endurance training during cardiac rehabilitation might normalize HRPC, data of 128 male patients were analyzed. All patients performed three exercise tests: at baseline, after 6 weeks, and after 1 year. Ninety-six patients exercised regularly according to guidelines for 1 year (training group, TG), and 32 stopped after 6 weeks (control group, CG). Similarly, upward-deflected HRPCs were observed at baseline and after 6 weeks in both groups. After 1 year, TG patients had less upward-deflected HRPCs compared with CG ones, corresponding to a partial normalization. Greater changes in HRPC deflection were associated with larger improvements in cardiorespiratory fitness. Our results might indicate improved myocardial function due to long-term rehabilitation. Further, HRPC alterations over time should be considered when prescribing exercise intensities using a target HR, as deflection flattening might render the intensity of corresponding exercise insufficient.

Correlation between Cardiorespiratory Fitness and Platelet Function in Healthy Women.

PURPOSE: Low cardiorespiratory fitness (CRF) represents a major risk factor for atherosclerosis, and platelets play a key role in the development of this chronic inflammatory disease. Therefore, the purpose of this study was to assess the relationship between CRF and platelet function. METHODS: CRF and different aspects of platelet function were assessed in healthy, young, nonsmoking women. Results were compared between groups of low (LF), medium (MF) and high CRF (HF). Measurements were repeated in group LF after a supervised endurance training program lasting two menstrual cycles and obtained results were compared with groups MF and HF. CRF was quantified by maximal oxygen consumption (V˙O2max) determined by an incremental treadmill exercise test. V˙O2max criteria for groups were (mL·min·kg bodyweight): LF < 45, MF 45-55, HF > 55. Platelet activation state and platelet reactivity were assessed by basal and agonist-induced surface expression of CD62P and CD40L as well as the intraplatelet amount of reactive oxygen species. RESULTS: In group LF, basal platelet activation as well as agonist-induced platelet reactivity were increased compared with groups MF and HF. Between groups MF and HF parameters of platelet function were roughly equal despite a pronounced difference regarding CRF. Exercise training improved CRF in group LF and aligned platelet function to levels observed in groups MF and HF, although CRF still markedly differed. CONCLUSIONS: Low levels of CRF favor a proinflammatory platelet phenotype. A relatively low dose of exercise is sufficient to normalize platelet function, whereas superior levels of physical activity and CRF do not provide any further substantial benefit, but also no appreciable adverse effects.

Physiological Demands of Simulated Off-Road Cycling Competition.

The purpose of the study was to measure the demands of off-road cycling via portable spirometry, leg-power output (PO), heart rate (HR) and blood lactate (BLa) concentration. Twenty-four male competitive cyclists (age: 29±7.2 yrs, height: 1.79 ± 0.05 m, body mass: 70.0 ± 4.9 kg, VO2peak: 64.9 ± 7.5 ml·kg(-1)·min(-1)) performed simulated mountain bike competitions (COMP) and laboratory tests (LabT). From LabT, we determined maximal workload and first and second ventilatory thresholds (VT1, VT2). A high-performance athlete (HPA) was used for comparison with three groups of subjects with different sport-specific performance levels. Load profiles of COMP were also investigated during uphill, flat and downhill cycling. During the COMP, athletes achieved a mean oxygen uptake (VO2COMP) of 57.0 ± 6.8 ml·kg(-1)·min(-1) vs. 71.1 ml·kg(-1)·min(-1) for the HPA. The POCOMP was 2.66±0.43 W·kg(-1) and 3.52 W·kg(-1) for the HPA. POCOMP, VO2COMP and HRCOMP were compared to corresponding variables at the VT2 of LabT. LabT variables correlated with racing time (RTCOMP) and POCOMP (p < 0.01 to <0.001; r-0.59 to -0.80). The VO2peak (LabT) accounted for 65% of variance of a single COMP test. VO2COMP, POCOMP and also endurance variables measured from LabTs were found as important determinants for cross-country performance. The high average VO2COMP indicates that a high aerobic capacity is a prerequisite for successful COMP. Findings derived from respiratory gas measures during COMPs might be useful when designing mountain bike specific training. Key pointsCross- country cycling is characterized by high oxygen costs due to the high muscle mass simultaneously working to fulfill the demands of this kind of sports.Heart rate and blood lactate concentration measures are not sensitive enough to assess the energy requirements of COMP. Therefore, respiratory gas and power output measures are helpful to provide new information to physiological profile of cross- country cycling.An excellent cycling-specific capacity is a prerequisite for successful off-road cycling.Data determined from LabT might be utilized to describe semi-specific abilities of MB- athletes on a cycle ergometer, while data originating from COMP might be useful when designing a mountain bike specific training.

Effects of hiking at moderate and low altitude on cardiovascular parameters in male patients with metabolic syndrome: Austrian Moderate Altitude Study.

OBJECTIVE: Physical activity is a cornerstone in therapy for patients with metabolic syndrome. Walking and hiking in a mountain scenery represents an ideal approach to make them move. The Austrian Moderate Altitude Study (AMAS) 2000 main study is a randomized controlled trial to investigate the cardiovascular effects of hiking at moderate altitude on patients with metabolic syndrome compared with a control group at low altitude, to assess a potential altitude-specific effect. METHODS: Seventy-one male patients with metabolic syndrome were randomly assigned to a moderate altitude group (at 1700 m), with 36 participants, or to a low altitude group (at 200 m), with 35 participants. The 3-week vacation program included 12 hiking tours (4 per week, average duration 2.5 hours, intensity 55% to 65% of heart rate maximum). Physical parameters, performance capacity, 24-hour blood pressure, and heart rate profiles were obtained before, during, and after the stay. RESULTS: In both groups, we found a significant mean weight loss of -3.13 kg; changes in performance capacity were minor. Systolic, diastolic, and mean arterial pressures and circadian heart rate profiles were significantly reduced in both groups, with no differences between them. Consequently, the pressure-rate product was reduced as well. All study participants tolerated the vacation well without any adverse events. CONCLUSIONS: A 3-week hiking vacation at moderate or low altitude is safe for patients with metabolic syndrome and provides several improvements in their cardiovascular parameters. The cardiovascular benefits achieved are more likely to be the result of regular physical activity than the altitude-specific effect of a mountain environment.

Long-term effects of outpatient cardiac rehabilitation in Austria: a nationwide registry.

AIM: Our Working Group on Out-Patient Cardiac Rehabilitation (AGAKAR) has previously published guidelines, which were endorsed by the Austrian Society of Cardiology. It was the aim of this study to assess the short-term (phase II) and long-term (phase III) effects of these guidelines by use of a nationwide registry. METHODS: All Austrian out-patient rehabilitation facilities entered data into a database of all consecutive patients who completed phase II (4-6 weeks) and/or III (6-12 months) rehabilitation between 1.1.2009-30.11.2011. RESULTS: Data of 1432 phase II and 1390 phase III patients were assessed. Despite the wide spectrum of cardiac diseases patients' exercise capacity improved during phase II by 20 (-193 to 240) watts; 91.0% reached a systolic blood pressure <140 mmHg; 68.1% an LDL <100 mg/dl; 69.8% triglycerides <150 mg/dl, and 66.2% of male patients had a waist circumference <102 cm. During phase III improvement in cardiovascular risk factors, quality of life, anxiety, and depression were further improved in an increasing number of patients. CONCLUSIONS: Our data demonstrate beneficial short- and long-term effects of the Austrian model of out-patient cardiac rehabilitation and provide support for comprehensive long-term rehabilitation programs. Furthermore, our model might be helpful for those who are at the verge of initiating or modifying their programs. It is also hoped that these data will motivate colleagues to refer their patients to out-patient cardiac rehabilitation facilities and that our results may stimulate insurance companies to grant further and comprehensive contracts to provide access for all suitable patients.

Myocardial dimensions and hemodynamics during 24-h ultraendurance ergometry.

PURPOSE: This study aimed to evaluate cardiorespiratory and hemodynamic responses during 24 h of continuous cycle ergometry in ultraendurance athletes. METHODS: Eight males (mean ± SD; age = 39 ± 8 yr, height = 179 ± 7 cm, body weight [Wt] = 77.1 ± 6.0 kg) were monitored during 24 h at a constant workload,∼25% below the first lactate turn point at 162 ± 23 W. Measurements included Wt, HR, oxygen consumption (V˙O2), cardiac output (Q), and stroke volume (SV) determined by a noninvasive rebreathing technique (Innocor; Innovision, Odense, Denmark). Myocardial dimensions were evaluated using a two-dimensional echocardiogram. [M-mode measurement]-left atrial (LAD), ventricular end-diastolic (LVEDD), and end-systolic diameters (LVESD) were obtained over the left parasternal area. Venous blood samples were analyzed for hematocrit (Hct%), albumin (g·L(-1)), aldosterone (pg·mL(-1)), CK, CK-MB (U·L(-1)), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (pg·mL(-1)). RESULTS: HR (bpm) significantly increased (P < 0.01) from 1 h (132 ± 11) to 6 h (143 ± 10) and significantly decreased (P < 0.001) from 6 to 24 h (116 ± 10). V˙O2 and (Q were unchanged during the 24 h. Wt (76.6 ± 5.6 vs 78.7 ± 5.4), SV (117 ± 13 vs 148 ± 19), LVEDD (4.9 ± 0.3 vs 5.6 ± 0.2), and LAD (3.6 ± 0.5 vs 4.3 ± 0.7) significantly increased between 6 and 24 h (P < 0.001). No significant changes were observed for LVESD. Hct (45.1 ± 1.3 vs 41.3 ± 1.2) significantly decreased (P < 0.05) and CK (181 ± 60/877 ± 515), aldosterone (48 ± 17 vs 661 ± 172), and NT-proBNP (23 ± 13 vs 583 ± 449) significantly increased (P < 0.05). The increase in SV (ΔSV) was significantly related to changes in Wt (ΔWt), and HR (ΔHR) and ΔWt were significantly related to ΔLAD and ΔLVEDD. CONCLUSION: Our findings suggest that the decrease in HR during 24 h of ultraendurance exercise was due to hypervolemia and the associated ventricular loading, increasing left ventricular diastolic dimensions because of increased SV and LVEDD, resulting in an increase in NT-proBNP.

Outpatient cardiac rehabilitation: the Austrian model.

Over the past decades undisputable evidence has accumulated identifying the panoply of beneficial effects of exercise training, smoking cessation, blood pressure lowering, glycaemic and lipid control, as well as psycho-social interventions on cardiovascular risk factors, the well-being, morbidity and mortality of patients with cardiac diseases with or without acute events. Nevertheless, despite all the evidence, insurance companies are more than hesitant to provide patients with an adequate infrastructure to allow outpatient cardiac rehabilitation in their community. Whereas some countries still favour in-hospital rehabilitation, others are on the verge of introducing cardiac rehabilitation for the first time. Thanks to the efforts of the Working Group of Outpatient Cardiac Rehabilitation of the Austrian Cardiac Society, detailed guidelines for outpatient cardiac rehabilitation have been introduced, which not only include aims, contents and duration of outpatient cardiac rehabilitation, but also requirements for staff, quality of care and infrastructure. As a result cardiac rehabilitation in Austria is currently undergoing a transition process from exclusive in-hospital cardiac rehabilitation to a more open approach of granting patients a choice between in-hospital and outpatient rehabilitation. Experience gained appears relevant to a great number of colleagues in many countries Europe - as well as worldwide. Since these guidelines were and still are the basis for implementing outpatient cardiac rehabilitation, they are presented in great detail, so that they may either be applied as is or simply stimulate discussion.

[Resistance training for patients with cardiovascular diseases]. / Bedeutung des Krafttrainings zur Prävention und Rehabilitation internistischer Erkrankungen : Konsensuspapier der AG Kardiologische Rehabilitation und Sekundärprävention der Österreichischen kardiologischen Gesellschaft.

Physical training is part of the recommendations for prevention and rehabilitation of cardiovascular and metabolic diseases. The main focus was on endurance training for a long time. However, a positive effect of strength training has also been found for patients with with a wide spectrum of diseases. Beside the improvement of muscle strength similar positive effects as with endurance training have been documented. Moreover, improvements of quality of life and mobility have been found, mainly for older patients. Resistance training is safe and can be recommended to a wide range of patients including those with reduced left ventricular function.

A single nucleotide polymorphism associates with the response of muscle ATP synthesis to long-term exercise training in relatives of type 2 diabetic humans.

OBJECTIVE: Myocellular ATP synthesis (fATP) associates with insulin sensitivity in first-degree relatives of subjects with type 2 diabetes. Short-term endurance training can modify their fATP and insulin sensitivity. This study examines the effects of moderate long-term exercise using endurance or resistance training in this cohort. RESEARCH DESIGN AND METHODS: A randomized, parallel-group trial tested 16 glucose-tolerant nonobese relatives (8 subjects in the endurance training group and 8 subjects in the resistance training group) before and after 26 weeks of endurance or resistance training. Exercise performance was assessed from power output and oxygen uptake (VO(2)) during incremental tests and from maximal torque of knee flexors (MaxT(flex)) and extensors (MaxT(ext)) using isokinetic dynamometry. fATP and ectopic lipids were measured with (1)H/(31)P magnetic resonance spectroscopy. RESULTS: Endurance training increased power output and VO(2) by 44 and 30%, respectively (both P < 0.001), whereas resistance training increased MaxT(ext) and MaxT(flex) by 23 and 40%, respectively (both P < 0.001). Across all groups, insulin sensitivity (382 ± 90 vs. 389 ± 40 mL · min(-1) · m(-2)) and ectopic lipid contents were comparable after exercise training. However, 8 of 16 relatives had 26% greater fATP, increasing from 9.5 ± 2.3 to 11.9 ± 2.4 µmol · mL(-1) · m(-1) (P < 0.05). Six of eight responders were carriers of the G/G single nucleotide polymorphism rs540467 of the NDUFB6 gene (P = 0.019), which encodes a subunit of mitochondrial complex I. CONCLUSIONS: Moderate exercise training for 6 months does not necessarily improve insulin sensitivity but may increase ATP synthase flux. Genetic predisposition can modify the individual response of the ATP synthase flux independently of insulin sensitivity.

Blood lactate concentration at the maximal lactate steady state is not dependent on endurance capacity in healthy recreationally trained individuals.

The aim of the study was to investigate the independent relationship between maximal lactate steady state (MLSS), blood lactate concentration [La] and exercise performance as reported frequently. Sixty-two subjects with a wide range of endurance performance (MLSS power output 199 ± 55 W; range: 100-302 W) were tested on an electronically braked cycle ergometer. One-min incremental exercise tests were conducted to determine maximal variables as well as the respiratory compensation point (RCP) and the second lactate turn point (LTP2). Several continuous exercise tests were performed to determine the MLSS. Subjects were divided into three clusters of exercise performance. Dietary control was employed throughout all testing. No significant correlation was found between MLSS [La] and power output at MLSS. Additionally, the three clusters of subjects with different endurance performance levels based on power output at MLSS showed no significant difference for MLSS [La]. MLSS [La] was not significantly different between men and women (average of 4.80 ± 1.50 vs. 5.22 ± 1.52 mmol l(-1)). MLSS [La] was significantly related to [La] at RCP, LTP2 and at maximal power. The results of this study support previous findings that MLSS [La] is independent of endurance performance. Additionally, MLSS [La] was not influenced by sex. Correlations found between MLSS [La] and [La] at maximal power and at designated anaerobic thresholds indicate only an association of [La] response during incremental and MLSS exercise when utilizing cycle ergometry.