Measure It Super Simple (MISS) activity tracker: (re)design of a user-friendly interface and evaluation of experiences in daily life.

PURPOSE: The purposes of this study were, first, to (re)design the user-interface of the activity tracker known as the MOX with the help of input from elderly individuals living independently and, second, to assess the use of and experiences with the adapted Measure It Super Simple (MISS) activity tracker in daily life. METHODS: The double diamond method, which was used to (re)design the user-interface, consists of four phases: discover, define, develop, and deliver. As a departure point, this study used a list of general design requirements that facilitate the development of technology for the elderly. Usage and experiences were assessed through interviews after elderly individuals had used the activity tracker for 2 weeks. RESULTS: In co-creation with thirty-five elderly individuals (65 to 89-years-old) the design, feedback system, and application were further developed into a user-friendly interface: the Measure It Super Simple (MISS) activity. Twenty-eight elderly individuals (65 to 78-years-old) reported that they found the MISS activity easy to use, needed limited help when setting the tracker up, and required limited assistance when using it during their daily lives. CONCLUSIONS: This study offers a generic structured methodology and a list of design requirements to adapt the interface of an existing activity tracker consistent with the skills and needs of the elderly. The MISS activity seemed to be successfully (re)designed, like the elderly who participated in this pilot study reported that anyone should be able to use it.IMPLICATIONS FOR REHABILITATIONThis study provides an overview of important characteristics of the activity tracker interface for elderly individuals that can be used when choosing an appropriate activity tracker.This study can serve as a model that demonstrates how to adapt other eHealth and mHealth tools to improve the user-centred design.The MISS activity seems to be an elderly-friendly activity tracker that can facilitate a meaningful experience.

Optimization and Validation of an Adjustable Activity Classification Algorithm for Assessment of Physical Behavior in Elderly.

Due to a lack of transparency in both algorithm and validation methodology, it is difficult for researchers and clinicians to select the appropriate tracker for their application. The aim of this work is to transparently present an adjustable physical activity classification algorithm that discriminates between dynamic, standing, and sedentary behavior. By means of easily adjustable parameters, the algorithm performance can be optimized for applications using different target populations and locations for tracker wear. Concerning an elderly target population with a tracker worn on the upper leg, the algorithm is optimized and validated under simulated free-living conditions. The fixed activity protocol (FAP) is performed by 20 participants; the simulated free-living protocol (SFP) involves another 20. Data segmentation window size and amount of physical activity threshold are optimized. The sensor orientation threshold does not vary. The validation of the algorithm is performed on 10 participants who perform the FAP and on 10 participants who perform the SFP. Percentage error (PE) and absolute percentage error (APE) are used to assess the algorithm performance. Standing and sedentary behavior are classified within acceptable limits (±10% error) both under fixed and simulated free-living conditions. Dynamic behavior is within acceptable limits under fixed conditions but has some limitations under simulated free-living conditions. We propose that this approach should be adopted by developers of activity trackers to facilitate the activity tracker selection process for researchers and clinicians. Furthermore, we are convinced that the adjustable algorithm potentially could contribute to the fast realization of new applications.

Monitoring Parkinson's disease symptoms during daily life: a feasibility study.

Parkinson's disease symptoms are most often charted using the MDS-UPDRS. Limitations of this approach include the subjective character of the assessments and a discrepant performance in the clinic compared to the home situation. Continuous monitoring using wearable devices is believed to eventually replace this golden standard, but measurements often lack a parallel ground truth or are only tested in lab settings. To overcome these limitations, this study explores the feasibility of a newly developed Parkinson's disease monitoring system, which aims to measure Parkinson's disease symptoms during daily life by combining wearable sensors with an experience sampling method application. Twenty patients with idiopathic Parkinson's disease participated in this study. During a period of two consecutive weeks, participants had to wear three wearable sensors and had to complete questionnaires at seven semi-random moments per day on their mobile phone. Wearable sensors collected objective movement data, and the questionnaires containing questions about amongst others Parkinson's disease symptoms served as parallel ground truth. Results showed that participants wore the wearable sensors during 94% of the instructed timeframe and even beyond. Furthermore, questionnaire completion rates were high (79,1%) and participants evaluated the monitoring system positively. A preliminary analysis showed that sensor data could reliably predict subjectively reported OFF moments. These results show that our Parkinson's disease monitoring system is a feasible method to use in a diverse Parkinson's disease population for at least a period of two weeks. For longer use, the monitoring system may be too intense and wearing comfort needs to be optimized.

Planarians Customize Their Stem Cell Responses Following Genotoxic Stress as a Function of Exposure Time and Regenerative State.

Aiming to in vivo characterize the responses of pluripotent stem cells and regenerative tissues to carcinogenic stress, we employed the highly regenerative organism Schmidtea mediterranea. Its broad regenerative capacities are attributable to a large pool of pluripotent stem cells, which are considered key players in the lower vulnerability toward chemically induced carcinogenesis observed in regenerative organisms. Schmidtea mediterranea is, therefore, an ideal model to study pluripotent stem cell responses with stem cells residing in their natural environment. Including microenvironmental alterations is important, as the surrounding niche influences the onset of oncogenic events. Both short- (3 days) and long-term (17 days) exposures to the genotoxic carcinogen methyl methanesulfonate (50 µM) were evaluated during homeostasis and animal regeneration, two situations that render altered cellular niches. In both cases, MMS-induced DNA damage was observed, which provoked a decrease in proliferation on the short term. The outcome of DNA damage responses following long-term exposure differed between homeostatic and regenerating animals. During regeneration, DNA repair systems were more easily activated than in animals in homeostasis, where apoptosis was an important outcome. Knockdown experiments confirmed the importance of DNA repair systems during carcinogenic exposure in regenerating animals as knockdown of rad51 induced a stem cell-depleted phenotype, after regeneration was completed.

Stem cell proliferation patterns as an alternative for in vivo prediction and discrimination of carcinogenic compounds.

One of the major challenges in the development of alternative carcinogenicity assays is the prediction of non-genotoxic carcinogens. The variety of non-genotoxic cancer pathways complicates the search for reliable parameters expressing their carcinogenicity. As non-genotoxic and genotoxic carcinogens have different cancer risks, the objective of this study was to develop a concept for an in vivo test, based on flatworm stem cell dynamics, to detect and classify carcinogenic compounds. Our methodology entails an exposure to carcinogenic compounds during the animal's regeneration process, which revealed differences in proliferative responses between non-genotoxic and genotoxic carcinogens during the initial stages of the regeneration process. A proof of concept was obtained after an extensive study of proliferation dynamics of a genotoxic and a non-genotoxic compound. A pilot validation with a limited set of compounds showed that the proposed concept not only enabled a simple prediction of genotoxic and non-genotoxic carcinogens, but also had the power to discriminate between both. We further optimized this discrimination by combining stem cell proliferation responses with a phenotypic screening and by using specific knockdowns. In the future, more compounds will be tested to further validate and prove this concept.

Altered gas-exchange at peak exercise in obese adolescents: implications for verification of effort during cardiopulmonary exercise testing.

BACKGROUND: Cardiopulmonary exercise testing is advised ahead of exercise intervention in obese adolescents to assess medical safety of exercise and physical fitness. Optimal validity and reliability of test results are required to identify maximal exercise effort. As fat oxidation during exercise is disturbed in obese individuals, it remains an unresolved methodological issue whether the respiratory gas exchange ratio (RER) is a valid marker for maximal effort during exercise testing in this population. METHODS: RER during maximal exercise testing (RERpeak), and RER trajectories, was compared between obese and lean adolescents and relationships between RERpeak, RER slope and subject characteristics (age, gender, Body Mass Index [BMI], Tanner stage, physical activity level) were explored. Thirty-four obese (BMI: 35.1±5.1 kg/m²) and 18 lean (BMI: 18.8±1.9 kg/m²) adolescents (aged 12-18 years) performed a maximal cardiopulmonary exercise test on bike, with comparison of oxygen uptake (VO2), heart rate (HR), expiratory volume (VE), carbon dioxide output (VCO2), and cycling power output (W). RESULTS: RERpeak (1.09±0.06 vs. 1.14±0.06 in obese vs. lean adolescents, respectively) and RER slope (0.03±0.01 vs. 0.05±0.01 per 10% increase in VO2, in obese vs. lean adolescents, respectively) was significantly lower in obese adolescents, and independently related to BMI (P<0.05). Adjusted for HRpeak and VEpeak, RERpeak and RER slope remained significantly lower in obese adolescents (P<0.05). RER trajectories (in relation to %VO2peak and %Wpeak) were significantly different between groups (P<0.001). CONCLUSIONS: RERpeak is significantly lowered in obese adolescents. This may have important methodological implications for cardiopulmonary exercise testing in this population.

Redox-Related Mechanisms to Rebalance Cancer-Deregulated Cell Growth.

A delicate balance exists between the process of carcinogenesis and tissue regeneration. A number of malignant tumours are considered the outcome of an impaired or incomplete regeneration process, resulting in persistently dividing cells. Regeneration-competent tissues and animals are able to prevent and counteract growth abnormalities and seem to have a low vulnerability to chemical carcinogenesis. Cancer cell survival depends, among other things, on various redox-related mechanisms, which are targets of currently developed therapies. Disadvantages of these therapies are a lack of specificity and drug resistance. As the majority of these redox-related mechanisms also play an important role in successful and coordinated cell functioning and reproduction, the regeneration process offers a unique parallel context for modern cancer research. This review focuses on the interconnections between regeneration and carcinogenesis and how an understanding of regenerative forces and redox-controlled mechanisms could contribute to the identification of new therapeutic targets to block the growth and survival of cancer cells.

Reactive Oxygen Species in Planarian Regeneration: An Upstream Necessity for Correct Patterning and Brain Formation.

Recent research highlighted the impact of ROS as upstream regulators of tissue regeneration. We investigated their role and targeted processes during the regeneration of different body structures using the planarian Schmidtea mediterranea, an organism capable of regenerating its entire body, including its brain. The amputation of head and tail compartments induces a ROS burst at the wound site independently of the orientation. Inhibition of ROS production by diphenyleneiodonium (DPI) or apocynin (APO) causes regeneration defaults at both the anterior and posterior wound sites, resulting in reduced regeneration sites (blastemas) and improper tissue homeostasis. ROS signaling is necessary for early differentiation and inhibition of the ROS burst results in defects on the regeneration of the nervous system and on the patterning process. Stem cell proliferation was not affected, as indicated by histone H3-P immunostaining, fluorescence-activated cell sorting (FACS), in situ hybridization of smedwi-1, and transcript levels of proliferation-related genes. We showed for the first time that ROS modulate both anterior and posterior regeneration in a context where regeneration is not limited to certain body structures. Our results indicate that ROS are key players in neuroregeneration through interference with the differentiation and patterning processes.

Exercise improves cardiac function and attenuates insulin resistance in Dahl salt-sensitive rats.

BACKGROUND: The development of heart failure (HF) secondary to hypertension is a complex process related to a series of physiological and molecular factors including glucose dysregulation. The overall objective of this study was to investigate whether exercise training could improve cardiac function and insulin resistance in a rat model of hypertensive HF. METHODS: Seven week old Dahl salt-sensitive rats received either 8% NaCl (n = 30) or 0.3% NaCl (n = 18) diet. After a 5-week diet, animals were randomly assigned to exercise training (treadmill running at 18 m/min, 5% inclination for 60 min, 5 days/week) or kept sedentary for 6 additional weeks. 2D echocardiography was used to calculate left ventricular (LV) dimensions, volumes and global functional parameters. LV global deformation parameters were measured with speckle tracking echocardiography. Insulin resistance was assessed using 1h oral glucose tolerance testing. RESULTS: High salt diet led to cardiac hypertrophy and HF, characterized by increased wall thicknesses and LV volumes as well as reduced deformation parameters. In addition, high salt diet was associated with the development of insulin resistance. Exercise training improved cardiac function, reduced the extent of interstitial fibrosis and reduced insulin levels 60 min post-glucose administration. CONCLUSIONS: Even if not fully reversed, exercise training in HF animals improved cardiac function and insulin resistance. Adjusted modalities of exercise training might offer new insights not only as a preventive strategy, but also as a treatment for HF patients.

Impact of 24 Weeks of Resistance and Endurance Exercise on Glucose Tolerance in Persons with Multiple Sclerosis.

BACKGROUND: Recently, the authors reported an elevated prevalence of impaired glucose tolerance in individuals with multiple sclerosis (MS), compared with matched healthy controls, indicating metabolic defects that may increase comorbidity. MS also leads to a more inactive lifestyle, increasing the likelihood to develop fat accumulation, muscle wasting/weakness, and exercise intolerance. In other populations, these health complications can partly be reversed by physical exercise. OBJECTIVE: The aim of this study was to determine the impact of a mild-to-moderate-intensity exercise program on glucose tolerance, ranging between normal and impaired, in persons with MS. DESIGN: Persons with MS (mean expanded disability status scale, 3.3 ± 0.2; mean age, 48 ± 15 yrs) were randomized to an exercise group (n = 29) or a nonexercise control group (n = 15). Glucose tolerance, as well as muscle strength, exercise tolerance, and body composition to validate the applied exercise program, was determined in both groups at baseline and after 6, 12, and 24 wks of mild-to-moderate-intensity combined endurance and resistance training. RESULTS: No effects on blood glucose and serum insulin were detected. However, 6 mos of exercise improved muscle strength, exercise tolerance, and lean tissue mass within the intervention group as compared with baseline. In the control group, no changes were detected. CONCLUSION: Twenty-four weeks of mild-to-moderate-intensity combined endurance and resistance training was not able to improve glycemic control in this cohort of persons with MS. Future research is warranted to investigate the influence of higher exercise intensities on glucose tolerance, in an attempt to remediate metabolic deficits and to decrease the prevalence of comorbidities in MS.

Exercise training improves insulin release during glucose tolerance testing in stable chronic heart failure patients.

PURPOSE: Chronic heart failure (CHF) patients often present with (pre)diabetes, which negatively influences prognosis. Unlike the proven effect of exercise on glucose regulation in the general population, its effect in CHF is unclear. Therefore, this study aimed at investigating the effect of exercise training on glucose regulation in stable CHF patients. METHODS: Twenty-two CHF patients were randomized into training (EX, n = 15) and control (CON, n = 7) groups. Before and after a 12-week training intervention involving endurance and resistance training, glucose tolerance (2-hour oral glucose tolerance test), exercise tolerance (cardiopulmonary exercise test), muscle strength (isokinetic dynamometer), heart function (echocardiography), glycated hemoglobin, body composition (dual-energy x-ray absorptiometry), and quality of life (EQ5D) were assessed. RESULTS: At baseline, glucose levels 2 hours after glucose intake were elevated in both groups. Whereas area under the glucose curve did not change, area under the insulin curve decreased following training (EX, -13 ± 23% vs CON, +22 ± 33%; P < .05). Changes in the ratio of mitral peak velocity of early filling/early diastolic mitral annular velocity and waist-to-hip fat mass ratio were related to changes in the insulin curve. Exercise training resulted in improved oxygen uptake at the second ventilatory threshold (EX, +10 ± 5% vs CON, -8 ± 5%; P < .05) and isokinetic strength endurance of the upper leg (EX, +25 ± 9% vs CON, -6 ± 5%; P < 0.05). Lean body tissue was increased by 2.2 ± 0.5% in EX versus 0.2 ± 0.6% in CON (P < .05). CONCLUSION: Our data suggest that exercise training attenuates worsening of glucose regulation typically seen in a stable CHF population.

Toxicity profiles and solvent-toxicant interference in the planarian Schmidtea mediterranea after dimethylsulfoxide (DMSO) exposure.

To investigate hydrophobic test compounds in toxicological studies, solvents like dimethylsulfoxide (DMSO) are inevitable. However, using these solvents, the interpretation of test compound-induced responses can be biased. DMSO concentration guidelines are available, but are mostly based on acute exposures involving one specific toxicity endpoint. Hence, to avoid solvent-toxicant interference, we use multiple chronic test endpoints for additional interpretation of DMSO concentrations and propose a statistical model to assess possible synergistic, antagonistic or additive effects of test compounds and their solvents. In this study, the effects of both short- (1 day) and long-term (2 weeks) exposures to low DMSO concentrations (up to 1000 µl l(-1) ) were studied in the planarian Schmidtea mediterranea. We measured different biological levels in both fully developed and developing animals. In a long-term exposure set-up, a concentration of 500 µl l(-1) DMSO interfered with processes on different biological levels, e.g. behaviour, stem cell proliferation and gene expression profiles. After short exposure times, 500 µl l(-1) DMSO only affected motility, whereas the most significant changes on different parameters were observed at a concentration of 1000 µl l(-1) DMSO. As small sensitivity differences exist between biological levels and developmental stages, we advise the use of this solvent in concentrations below 500 µl l(-1) in this organism. In the second part of our study, we propose a statistical approach to account for solvent-toxicant interactions and discuss full-scale solvent toxicity studies. In conclusion, we reassessed DMSO concentration limits for different experimental endpoints in the planarian S. mediterranea.

Mandatory oral glucose tolerance tests identify more diabetics in stable patients with chronic heart failure: a prospective observational study.

BACKGROUND: Many patients with chronic heart failure (CHF) are believed to have unrecognized diabetes, which is associated with a worse prognosis. This study aimed to describe glucose tolerance in a general stable CHF population and to identify determinants of glucose tolerance focusing on body composition and skeletal muscle strength. METHODS: A prospective observational study was set up. Inclusion criteria were diagnosis of CHF, stable condition and absence of glucose-lowering medication. Patients underwent a 2 h oral glucose tolerance test (OGTT), isometric strength testing of the upper leg and dual energy x-ray absorptiometry. Health-related quality of life and physical activity level were assessed by questionnaire. RESULTS: Data of 56 participants were analyzed. Despite near-normal fasting glucose values, 55% was classified as prediabetic, 14% as diabetic, and 20% as normal glucose tolerant. Of all newly diagnosed diabetic patients, 79% were diagnosed because of 2 h glucose values only and none because of HbA1c. Univariate mixed model analysis revealed ischaemic aetiology, daily physical activity, E/E', fat trunk/fat limbs and extension strength as possible explanatory variables for the glucose curve during the glucose tolerance test. When combined in one model, only fat trunk/fat limbs and E/E' remained significant predictors. Furthermore, fasting insulin was correlated with fat mass/height2 (r = 0.51, p < 0.0001), extension strength (r = -0.33, p < 0.01) and triglycerides (r = 0.39, p < 0.01). CONCLUSIONS: Our data confirm that a large majority of CHF patients have impaired glucose tolerance. This glucose intolerance is related to fat distribution and left ventricular end-diastolic pressure.

Physiological and molecular characterisation of cadmium stress in Schmidtea mediterranea.

The planarian Schmidtea mediterranea is a well-studied model organism for developmental research, because of its stem cell system. This characteristic also provides a unique opportunity to study stress management and the effect of stress on stem cells. In this study, we characterised the stress signature at different levels of biological organization. The carcinogenic metal cadmium was used as a model chemical stressor. We focused on stem cell activity and its interaction with other known stress parameters. Here, we have found that S. mediterranea is able to cope with high internal levels of cadmium. At endpoints such as size and mobility, cadmium-related stress effects were detected but all of these responses were transient. Correspondingly, cadmium exposure led to an elevated mitotic activity of the neoblasts, at the same time points when the other responses disappeared. At the molecular level, we observed redox-related responses that can be linked with both repair as well as proliferation mechanisms. Together, our results suggest that these animals have a high plasticity. The induction of stem cell activity may underlie this 'restoring' effect, although a carcinogenic outcome after longer exposure times cannot be excluded.

Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: a critical re-appraisal of current evidence.

In the care of coronary artery disease (CAD) patients, the benefits of exercise therapy are generally established. Even though the selected endurance exercise intensity might affect medical safety, therapy adherence and effectiveness in the rehabilitation of CAD patients in how to determine endurance exercise intensity properly remains difficult. The aim of this review is to describe the available methods for endurance exercise intensity determination in the rehabilitation of CAD patients, accompanied with their (dis)advantages, validity and reproducibility. In general, endurance exercise intensity can objectively be determined in CAD patients by calculating a fraction of maximal exercise tolerance and/or determining ventilatory threshold after execution of a cardiopulmonary exercise test with ergospirometry. This can be translated to a corresponding training heart rate (HR) or workload. In the absence of ergospirometry equipment, target exercise HR can be calculated directly by different ways (fraction of maximal HR and/or Karvonen formula), and/or anaerobic threshold can be determined. However, the use of HR for determining exercise intensity during training sessions seems complicated, because many factors/conditions affect the HR. In this regard, proper standardization of the exercise sessions, as well as exercise testing, might be required to improve the accuracy of exercise intensity determination. Alternatively, subjective methods for the determination of endurance exercise intensity in CAD patients, such as the Borg ratings of perceived exertion and the talk test, have been developed. However, these methods lack proper validity and reliability to determine endurance exercise intensity in CAD patients. In conclusion, a practical and systematic approach for the determination of endurance exercise intensity in CAD patients is presented in this article.

Measures of exercise capacity in adults with congenital heart disease.

BACKGROUND: Exercise capacity in grown-ups with congenital heart disease (GUCH) is mostly reported by peak oxygen consumption (peak VO(2)). Our aim was to evaluate the maximal character of exercise tests, and to investigate submaximal measures of exercise capacity. METHODS: Adults with Coarctation of the Aorta (COA, n=155), Tetralogy of Fallot (TOF, n=98), dextro-Transposition of the Great Arteries (dTGA, n=68) and Univentricular Heart (UVH, n=10), and 122 healthy adults performed cardiopulmonary exercise testing until exhaustion. Gas exchange was measured breath by breath. The maximal performance of the test was evaluated by respiratory exchange ratio (RER), ventilatory equivalent for oxygen and Borg scale. Oxygen uptake efficiency slope (OUES), VE/VCO(2) slope and VO(2)/WR slope were calculated and ventilatory anaerobic threshold (VAT) was defined. Correlations of these measures with peak VO(2) were calculated. RESULTS: GUCH showed significantly lower peak VO(2) than controls (p<0.001), declining from 80% in COA, 74% in TOF, 64% in dTGA, to 55% in UVH. Compared to suggested criteria, mean peak RER and median Borg scale indicated a maximal effort in GUCH, however these results were significantly lower than controls (p<0.05). OUES, VO(2)/WR slope and VAT were significantly lower in patients compared to controls. OUES (r=0.853) and VAT (r=0.840) correlated best with peak VO(2); VO(2)/WR slope (r=0.551) and VE/VCO(2) slope (r=-0.421) correlated to a lesser degree (p<0.001). CONCLUSION: The investigated GUCH show reduced exercise tolerance compared to controls, related to the underlying heart defect. Different expressions of exercise tolerance clearly reveal the same differences in exercise capacity across groups of GUCH.

The future of adult patients after Mustard or Senning repair for transposition of the great arteries.

BACKGROUND: After Mustard or Senning repair for transposition of the great arteries (d-TGA), qualitative assessment of the systemic right ventricle remains difficult. We wanted to evaluate the relationship between demographic and echocardiographic variables, and exercise performance. METHODS: In 22 consecutive d-TGA patients (9 Mustard and 13 Senning) a standard transthoracic echocardiogram was performed. Peak oxygen consumption (peak VO2, ml/kg/min) was obtained by a bicycle stress test. Cardiac index (CI) at rest, 50 W, and 100 W was calculated from cardiac output, obtained by CO2 rebreathing. RESULTS: The group of patients consisted in 15 male and 7 female with a median age of 21 (range 17-34) years. On echocardiographic evaluation, right ventricular function was normal in one, slightly impaired in 11, moderately impaired in 9, and severely impaired in one. Peak VO2 was 27.4+/-7.9 ml/kg/min, which was 64+/-16% of predicted values in normals. CI at rest, 50 Watt, and 100 Watt, were 2.7+/-0.5, 5.6+/-1.2, and 6.8+/-1.1 l/min/m2, respectively. No relationship between echocardiographic parameters and exercise capacity was found. Age correlated significantly with CI at 50 and 100 W (rho=-0.44, P=0.045 and rho=-0.77, P=0.0001, respectively). Finally, simple regression analysis identified a linear relationship between age and CI at 100 W (bèta=-0.54 and R2=0.29, P=0.014). CONCLUSIONS: Maximal exercise capacity is reduced in adult patients after Mustard or Senning repair. Standard echocardiographic 2D-measurements are insufficient to determine the reduction in their functional capacity. The inverse relationship between age and the cardiac indices suggests an age dependent and progressive diminution of systemic ventricular function.

Changes in QRS duration are associated with maximal exercise capacity in adult patients with repaired tetralogy of Fallot.

OBJECTIVE: In adult patients with repaired tetralogy of Fallot (TF) QRS duration at rest seems to be a predictor of maximal exercise. We examined the relationship between QRS duration during exercise and exercise performance. DESIGN: In 57 consecutive TF patients QRS duration in V1 (ms) was measured at rest, at maximal exercise (Wmax, W), and at peak oxygen consumption (peak VO2, ml/min). Stroke volume (SV) was calculated from cardiac output, obtained by CO2 rebreathing. Spearman rank correlation was used to describe the relationship between QRS duration and exercise performance. Statistical significance was defined as P<0.05. RESULTS: Seven patients, who didn't pass the anaerobic threshold, and one outlier (Wmax=340 W) were excluded, resulting in a sample of 49 patients (75.5% male; median age=24 years, range 16-43 years). QRS duration at rest (median=160 ms, range 78-194 ms) and at maximal exercise (median=153 ms, range 80-193 ms) did not differ significantly. The median change of QRS duration during exercise was -5 ms (range -31 to +83 ms). This was negatively correlated with Peak VO2 (2081+/-577 ml/min; rho=-0.33, P=0.02) and Wmax (182+/-53 Watt; rho=-0.33, P=0.02). In patients with QRS shortening peak VO2 and the exercise induced increase in SV were significantly higher than in patients with QRS shortening. CONCLUSIONS: This study indicates that QRS shortening during exercise in TF patients is related with a better exercise performance. Lower increase in stroke volumes may be responsible for this difference. Further research is needed to elaborate these findings.

Determinants of the effects of physical training and of the complications requiring resuscitation during exercise in patients with cardiovascular disease.

BACKGROUND: Benefits of cardiac rehabilitation with exercise therapy are well-established, although individual reactions are heterogeneous. The identification of determinants of training effects is useful from a prognostic point of view, but data regarding this are scarce. Furthermore, limited data exist on the determinants of complications during exercise in cardiac patients. This study aimed to investigate the determinants (1) of training effects in cardiac rehabilitation and (2) of complications requiring resuscitation during exercise activities at the hospital and during continued exercise at a sports club for cardiac patients. DESIGN: Clinical association study. METHODS: Determinants of changes in peak oxygen uptake (VO2) after 3 months of cardiac rehabilitation were determined by multiple regression analysis (n=1909). Determinants of events requiring resuscitation (n=21) were assessed by logistic regression analysis. RESULTS: Improvements in peak VO2 and exercise duration averaged 26%. Eighteen per cent of the variance in absolute improvements of peak VO2 was explained, with age and training characteristics as the strongest determinants. Twenty-one per cent of the variation in relative improvements was explained, with baseline exercise performance and training characteristics being the strongest determinants. The intake of anti-arrhythmics (odds ratio=5.5; P<0.001) and the presence of ST-segment depression (> or =1 mm) at baseline exercise testing (odds ratio=1.6; P<0.001) were predictive for serious complications. The occurrence of events requiring resuscitation was higher at the sports club (1/16,533 versus 1/29,214 patient-hours). CONCLUSIONS: Age, baseline exercise performance and training characteristics were predictive for training effects in cardiac rehabilitation. Anti-arrhythmics and ST-segment depression at baseline exercise testing were predictive for complications.