P13
the influence of habitual physical activity on endothelial function and systemic inflammation in patients with the metabolic syndrome
M Polovina, V Giga, T Potpara, M Ostojic
Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia
Topic: Physical activity
Purpose: exercise training has a favorable effect on cardiovascular health, but the importance of leisure-time physical activity for endothelial function and markers of chronic inflammation in patients (pts) with the metabolic syndrome (MS) is less well established.
Methods: we determined measures of flow-mediated dilation (FMD) and systemic inflammation (high-sensitivity C-reactive protein, CRP) in 2 groups of MS pts (revised Adult Treatment Panel III criteria) age 20 to 69 yrs and a control group comprising of age- and sex-matched healthy individuals. Controls (n=74, 36 male) and MS pts in Group 1 (n= 67; 36 male; 33 pts 20 to 39 yrs, 34 pts 40 to 69 yrs) were physically active with at least 30 min. of self-reported daily continuous brisk walking ± recreational sports and MS pts in Group 2 (n=72; 39 male; 34 pts 20 to 39 yrs, 38 pts 40 to 69 yrs) were sedentary (<30 min. of daily physical activity). CRP levels were measured in all participants and maximal FMD value (FMD%) and FMD time-course (time to the maximal endothelium-dependent dilation) were determined using high-resolution vascular ultrasound, with off-line digital measurements of brachial artery diameter every 10 seconds, 0 to 240 seconds after cuff release.
Results: in comparison with healthy controls, both MS groups achieved maximal endothelium-dependent dilation slower (Group 1: 74.4±15.8 vs Group 2: 81.8±27.2 vs Controls: 62.2±14.4 seconds; p=0.003), had lower FMD% (Group 1: 5.3±1.6 vs Group 2: 4.3±1.0 vs Controls: 7.9±1.9 %; p<0.001) and higher CRP values (Group 1: 2.3±0.8 vs Group 2: 3.1±0.9 vs Controls: 1.2±0.3 mg/L; p<0.001). Physically active MS pts had higher FMD% (p<0.001) and lower CRP levels (p=0.009), whereas there was no difference regarding FMD time course. After adequate adjustments in the multivariate analysis, =30 min. of daily physical activity was a multivariate predictor of both FMD% (b=9.7, p=0.016) and CRP levels (b=-1.7, p<0.001) in MS pts age 20 to 39 yrs, whereas =60 min. of daily physical activity was necessary in older pts for an independent positive effect on FMD% (b=8.3, p=0.024) and CRP levels (b=—2.3, p=0.011).
Conclusions: habitual physical activity in MS pts has a positive effect on cardiovascular risk profile. As little as 30 min. of continuous daily exercise has an independent beneficial effect on endothelial function and systemic inflammation in younger pts, whereas older pts should have at least 60 min. of continuous daily leisure-time activity.
P530
Medical students awareness of the links between physical activity and health before physical activity tutorials
S Mandic1, M Clark-Grill1, H Wilson1, D O'neill2
1
University of Otago, Dunedin, New Zealand, 2Ministry of Health, Wellington, New Zealand
Topic: Physical activity
Purpose: Physicians effectiveness in providing physical activity (PA) advice is influenced by their understanding of the links between PA and health and their own PA habits. the purpose of this study was to evaluate baseline knowledge, skills and attitudes toward PA advising as well as personal PA habits among third year medical students before exposure to tutorials on PA advising.
Methods: A total of 234 students (age 20.9±2.9 years; 46% males; body mass index 22.7(2.8); participation rate 99%) completed a set of questionnaires. the questionnaires assessed students awareness of the current PA guidelines, benefits of PA, and attitudes toward PA advising. Perceived competence and importance of physical activity advising skills were assessed using a validated Exercise and Physical Activity Competence Questionnaire. the questionnaire assessed students competence to perform physical exam, determine maximal heart rate and body mass index, assess daily nutritional needs, calculate training heart rate and design exercise prescription. Personal PA habits were assessed using New Zealand Physical Activity Questionnaire.
Results: Majority of students were aware of the benefits of PA and Green Prescription Initiative in New Zealand (84%). Less students were aware of New Zealand PA guidelines (43%) and ACSM guidelines (2%). Students perceived PA advising as high priority in general practice (79%) but only 37% felt confident in their ability to provide PA advice. Exercise and Physical Activity Competence Questionnaire showed that medical students perceived exercise prescription to be important (composite score: 28.5±4.9 out of 36), yet perceived themselves to be only moderately competent in providing patient-oriented exercise prescription (composite score: 18.8±4.8 out of 36). Motivations for PA advising versus personal reasons for engaging in regular PA were different. Most students engaged in >300 min of moderate PA in a previous week (79%) and 51% were regularly active in the maintenance stage. Regularly active students felt more confident in providing PA advice (3.0±0.9 vs. 3.3±0.9, p=0.009).
Conclusion: third year medical students are generally active and have a good understanding of the links between PA and health, but were lacking skills for PA advising and knowledge of specific PA guidelines. therefore, future tutorials on PA advising should focus on those areas and further encourage PA among medical students.
P531
Pilates training for patients with heart failure
G Guimaraes, VM Davila, VO Carvalho, EG Ciolac, SA Ferreira, VS Issa, JFC Belli, EA Bocchi
Heart Institute (InCor) - University of Sao Paulo, Faculty of Medicine Clinics Hospital, Sao Paulo, Brazil
Topic: Physical activity
Background: Traditional cardiac rehabilitation program consist of 15 min of warm-up, 30 min of aerobic exercise and followed by 15 min light resistance exercise, stretching and calisthenics. Pilates is another popular form of mind-body exercise focusing controlled movement, posture and breathing. the Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure.
Purpose: To examine the effects of a 12-week mat Pilates program on physical capacity in patients with heart failure.
Methods: Sixteen patients with heart failure, left ventricular ejection fraction 23 ± 7%, age 44 ± 13 years; NYHA class I-III were randomly assigned to receive usual care (n=8), which included pharmacologic therapy and traditional cardiac rehabilitation program, or 12 weeks of 30 min of mat Pilates training followed by 30 min of aerobic exercise (n=8) in addition to usual care. the intensity of aerobic exercise of both groups was prescribed individually at the aerobic threshold level as measured by treadmill exercise test using expiratory gas analysis. the exercise sessions both groups were performed twice weekly. the mat Pilates sessions were: exercises muscle strength and endurance, flexibility, posture and balance, with additional focus on breathing and concentration while performing the exercises. In the mat Pilates, patients did the exercise sitting or standing and used gravity to help stabilize the powerhouse.
Results: At 12 weeks, patients in the mat Pilates group and traditional group showed significantly increase on physical capacity (peak VO2 20.5±4 to 25.3±4 and 19.3±3 to 23.5±3 ml/kg/min, exercise time 13±4 to 18±4 and 11±3 to 14±4 min, respectively). the Pilates group did not show significantly increased when compared with patients in the traditional group. However, only the Pilates group increase significantly the ventilation from 56±20 to 69±17 l/min, p=0.02. the mat Pilates training was well tolerated, and there were no differences in the participation of the patients in exercise session between groups (95±5% and 89±10%, respectively).
Conclusions: the result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with heart failure who are already receiving standard medical therapy.
P532
Erection quality and physical activity in patients with ischemic heart disease
D Kalka1, M Sobieszczanska1, A Chorebala2, W Marciniak3, A Bielous-Wilk4, M Daszkiewicz1, J Adamus3, W Pilecki4
1
Division of Cardiovascular Disease Prevention, Wroclaw Medical University, Wroclaw, Poland, 2Department of Cardiac Rehabilitation, Promedis, Lux Med Group, Wroclaw, Poland, 3Cardiology Department, Ostrobramska Medical Center, Magodent, Warszawa, Poland, 4Department of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
Topic: Physical activity
there is a strongly proved correlation between erectile dysfunctions (ED) and risk factors of atherosclerosis, especially low level of physical activity. A goal was to assess an interaction between physical capacity and quality of erection in men with ischemic heart disease. A study group consisted of 148 male patients with the mean age of 66.46±2.61 years, who underwent invasive procedures (PTCA-112, and CABG − 36). All the patients were retired since 3.65±2.23 years and were in long-standing, constant relationship with the only sexual partner. the patients fulfilled the IIEF-5 questionnaire (max. scores less than 21) and the Framingham questionnaire, and manifested no ST-T abnormalities in the treadmill exercise testing (min. exercise load = 5 MET). In the examined group, the mean level of physical capacity was 6.7± 1.32 MET, and of physical activity 18.72±2.62 MET/h. the mean score obtained from the IIEF-5 questionnaire was 11.01±5.55. In accordance to the scores, the patients were divided to the four ED categories: severe (41.22% of the group), medium severe (11.49%), medium (29.05%) and mild (18.24%). there was found no significant correlation between ED level and physical capacity (r=0.013) and statistically significant correlation between ED level and intensity of physical activity (r=0.663). the study allowed to form two
Conclusions: (1) Intensive every-day physical activity is related to better quality of male erection. (2) Physical capacity manifested by the patients with IHD is not connected with quality of erection.
P533
Can physical training improve the ambulatory blood pressure monitoring parameters?
M Iurciuc1, C Avram2, S Iurciuc1, M Dumitrasciuc1, A Vlad1, A Schiller1, D Duda-Seiman1, D Gaita1
1
University of Medicine, Timisoara, Romania, 2West University, Timisoara, Romania
Topic: Cardiovascular rehabilitation
Background: cardiovascular events have their greatest prevalence in the morning period. this is thought to be associated with and dependent on morning surge of blood pressure (MBPS) Purpose: We want to show that in hypertensive patients exercise training, part of the cardiovascular rehabilitation, may improve some of the hemodynamic parameters of the ambulatory blood pressure monitoring and the MBPS.
Methods: We selected 158 patients with essential hypertension, aged 45–70 years. they were under unchanged medication at least 2 months and at target blood pressure value (ESH/ESC guideline 2007). We evaluate these patients before and after an physical training program of 3 months. this patients where evaluated clinically, by laboratory tests and by ambulatory blood pressure monitoring/24h. We also study the hemodynamic parameters at brachial artery (bilateral). the studied hemodynamic parameter were: Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), pulse pressure (PP), heart rate (HR), ambulatory arterial stiffness index (AASI) defined as 1-α (α = regression slope between TAD and TAS), MBPS 1 = mean SBP in the first 2h after awaken the average of the lowest 3 nocturnal values, MBPS 2 = mean SBP in the first 2h after awaken mean SBP value in the first 2h preawake (before awake), daytime SBP nighttime SBP (D-NSBP).
Results: after a 3 month physical training we obtained the following Results: the SBP has decreased from 128,52 to 124,13 mmHg (p, 0031); the DBP has decreased from 72,44 to 72,25 mmHg (p, 1525); the MBP has decreased from 91,16 to 89,57 mmHg (p, 0436); the PP has decreased from 56,18 to 51,98 mmHg (p, 0012); the HR/24h has decreased from 70,29 to 64,39 beats per minute (p, 0011); the AASI has decreased from 0,68 to 0,58 (p, 0066); MABS 1 has decreased from 13,98 to 10.16 mmHg (p, 0015); MABS 2 has decreased from 11,59 to 7,29 mmHg (p, 0008), D-NSBP has decreased from 15,98 to 13.37 mmHg (p, 0029). the mumber of smokers has decreased from: 21 to 7.
Conclusion: Physical training is a good method to improve some of the hemodynamic parameters. the higher the intensity of effort, and the longer the period of exercise training; the better are the results. Other parameters witch describe arterial stiffness such is: AASI and PP can also be improved with controlled exercise training. Physical training, part of the cardiovascular rehabilitation, plays an important role in decreasing morning surge of blood pressure at patients with essential hypertension. We noticed no statistical improvement in: DBP, MBP and the daytime/nighttime blood pressure.
P534
the assessment of influence of seniors physical activity to cardio-vascular parameters
A Folga, T Chomiuk, SM Pilkowski, D Sliz, A Mamcarz
Medical University of Warsaw, 3rd Department of Internal Medicine and Cardiology, Warsaw, Poland
Topic: Cardiovascular rehabilitation
Aging is a growing problem in Europe. the reduction of physical condition is tightly connected with aging. Regular physical activity is a basic element of proper functions of the human body at all age. It improves tolerance of effort, cognitive functions and decreases episodes of depression.
Aims: 1. An assessment of a possibility to master techniques of Nordic Walking by people in advanced age; 2. An assessment of the influence of a regular 6-weeks aerobic effort on cardiovascular parameters estimated in ergospirometry and the 6-minutes walking test; 3. the influence of a regular physical activity on the quality of life.
Methods: 50 people (mean age 70.7 [65–84]) were included into the active group (A). During the screening period the following investigations were conducted: physical examination, ECG, echocardiography, ergospirometry, the 6-minut walking test. the active group took part in 6-week Nordic Walking training limited by heart rate. Trainings took part 3 times a week and included 10 minutes of warming up, 30 minutes of walking and additional 10 minutes of a cool down. the training heart rate was estimated at 60–70% of maximum heart rate achieved during ergospirometry test. the results were then compared to the control group (C) consisting of 18 people (mean age 69.9 [65–81]), who did not participate in the training sessions. During the follow-up visit both groups underwent control physical examination, ECG, ergospirometry and the 6-minute walking test.
Results: 6-week Nordic Walking training in seniors group statistically significantly improved results in ergospirometry: time of exercise (C: –0.62 vs A: +1.02 [min.], p=0.0001), maximal effort (C: –6.11 vs A +10.68 [Wat], p=0.0001), VO2max (C: –0.27 vs A: +2.1 [ml/kg/min], p=0.022) and the distance in the 6-minutes walking test (C: +2.39 vs A: +75.04 [m.], p=0.00001). Quality of life estimated by Visual Analogue Scale also improved (C: –1.39 vs A: +7.3, p=0.006). Other cardio-vascular parameters did not reach significant change levels.
Conclusions: 1. Nordic Walking is an easy technique to teach senior citizens, 2. Regular physical activity improved the distance in the 6-minute walking test and parameters assessed in ergospirometry: time of exercise, maximal effort and VO2max, 3. Improvement of the seniors quality of life was also noticed.
P535
the effects of body position and gender on heart rate recovery
GC Donovan, DG Jakovljevic, D Nunan, DA Brodie
Buckinghamshire New University, Uxbridge, Middlesex, United Kingdom
Topic: Exercise physiology, testing and training
Background: Delayed heart rate (HR) recovery during the first two minutes post peak exercise is an independent predictor of all-cause mortality. A seated recovery, following clinical exercise stress testing, is commonly used within the National Health Service, in the United Kingdom. However, comparisons across studies are problematic due to differing body positions and the lack of information regarding gender responses to each position. the purpose of this study was to compare HR recovery responses to different recovery protocols in groups separated by gender, but matched for peak oxygen uptake.
Methods: Following institutional ethics committee approval and written informed consent, 20 healthy, sedentary adults (11 males, mean age 39.9±10.6 years; 9 females, mean age 40.6±11.6 years) undertook three peak treadmill cardiopulmonary exercise tests (CPET), one week apart, followed in random order by either a supine, seated or active (two mph, 1.5% gradient) cool-down recovery. HR recovery was defined as the difference (change score, bpm) in HR between peak exercise and selected time points during five minutes of recovery.
Results: A repeated measures, mixed design analysis of variance (gender and position and time) found significant overall differences between each recovery protocol, regardless of gender F (2,32) = 4.735, p = 0.016. Planned contrasts demonstrated the biggest effect for supine vs. active recovery F (1, 16), = 12.269, p = 0.03, r = 0.44. Post hoc paired t-tests, with Bonferroni correction, demonstrated significant differences supine for vs. active (mean 13.2, s = 2.4 b. min–1, p= 0.01), supine vs. seated (mean 7.3, s = 0.7 b. min–1, p = 0.01) and but not seated vs. active (mean 5.9, s = 0.9 b. min–1, p = 0.053) protocols, one minute into recovery. Significant differences (p = 0.014) occurred for minutes two - four and (p = 0.032) for minute five, between each recovery position. the main effects for gender were not significant F (2, 32), p = 0.091, or for gender interaction with position and time. However, a non-significant trend towards gender differences was observed for the supine position, minutes two to five, F (1,16) = 4.351, p = 0.053, r = 0.21.
Conclusion: this study extends previous findings for significant differences in the effect of supine and active body positions on heart rate recovery, to include seated recovery. Overall, gender responses to body position were not significantly different in this cohort, but future research should be directed to include those with clinical conditions, particularly if using a supine recovery.
P536
Physical fitness in school children - impact of body weight and fat free mass on sex differences
UM Mueller, K Fikenzer, K Machalica, GC Schuler, C Walther
University of Leipzig, Heart Center, Leipzig, Germany
Topic: Exercise physiology, testing and training
Background: Maximal oxygen consumption (VO2max) is an established standard method to objectively measure exercise capacity in children and adolescents. Maximal oxygen consumption varies between boys and girls and depends on body composition.
Aim of the present study was to investigate VO2max in children (age 10 12 years) in relation to body weight and fat free mass.
Methods: 699 treadmill exercise tests from 391 students in the age of 10 to 12 years were analysed. Body composition was assessed using bioimpedance analysis. Maximal oxygen consumption was determined via a maximal treadmill exercise test with spirometry using the modified Bruce protocol for children. VO2max was then related to body weight (VO2max/KG) and fat free mass (VO2max/FFM).
Results: With increasing age boys showed a significant increase of their weight related VO2max/KG (10 years: 39.1 ± 7.3 ml/min/kg, 11 years: 43.8 ±9.0 ml/min/kg, 12 years: 47.0 ± 9.6 ml/min/kg; p<0.01) and their VO2max related to fat free mass (10 years: 50.2 ±8.8 ml/min/kgFFM, 11
years: 55.0 ± 10.6 ml/min/kgFFM, 12 years: 59.2 ± 9.8 ml/min/kgFFM; p<0.01). Regarding weight related VO2max/KG in girls we did not detect any significant differences (10 years: 38.9 ± 6.9 ml/min/kg, 11 years: 41.7 ± 8.6 ml/min/kg, 12 years: 41.6 ± 7.8 ml/min/kg). However when related to fat free mass (VO2max/FFM) also girls showed a significant increase of their exercise capacity with increasing age (10 years: 46.5 ± 7.0 ml/min/kgFFM, 11 years: 53.8 ± 10.3 ml/min/kgFFM, 12 years: 55.7 ± 9.3 ml/min/kgFFM; p<0.01).
Conclusion: During adolescence changes of body mass indices of boys and girls are accompanied by changes of fat free mass. When relating VO2max to fat free mass girls demonstrate an increase in their exercise capacity during adolescence, similar to that observed in boys. therefore VO2max/FFM seems to be a better reference parameter for exercise capacity compared to VO2max/KG, especially in girls.
