Background: An exercise-based Cardiac Rehabilitation Programme (CRP) is established as adjuvant therapy in heart failure (HF), nevertheless it is underutilized, especially in the elderly. While the functional and hemodynamic effects of CRP are well known, its underlying molecular mechanisms have not been fully clarified. The present study aims to evaluate the effects of a well-structured 4-week CRP in patients with stable HF from a molecular point of view. Results: A prospective longitudinal observational study was conducted on patients consecutively admitted to cardiac rehabilitation. In fifty elderly HF patients with preserved ejection fraction (HFpEF), levels of sirtuin 1 (Sirt1) in peripheral blood mononuclear cells (PBMCs) and of its targets, the antioxidants catalase (Cat) and superoxide dismutase (SOD) in serum were measured before (Patients, P) and at the end of the CRP (Rehabilitated Patients, RP), showing a rise of their activities after rehabilitation. Endothelial cells (ECs) were conditioned with serum from P and RP, and oxidative stress was induced using hydrogen peroxide. An increase of Sirt1 and Cat activity was detected in RP-conditioned ECs in both the absence and presence of oxidative stress, together with a decrease of senescence, an effect not observed during Sirt1 and Cat inhibition.

Objectives: Coronary heart disease is frequent in the working-age population. Traditional outcomes, such as mortality and hospital readmission, are useful for evaluating prognosis. Fit-for-work is an emerging outcome with clinical as well as socioeconomic significance. We describe the possible benefit of a cardiac rehabilitation (CR) program for return to work (RTW) after acute coronary syndrome (ACS). Material and Methods: We evaluated 204 patients with recent ACS. They were divided into 4 groups on the basis of their occupational work load: very light (VL), light (L), moderate (M), and heavy (H). Work-related outcomes were assessed with the Work Performance Scale (WPS) of the Functional Status Questionnaire and as "days missed from work" (DMW) in the previous 4 weeks. The variables considered for outcomes were percent ejection fraction, functional capacity expressed in metabolic equivalents (METs), and participation or non-participation in the CR program (CR+ and CR-). Results: One hundred thirty (66%) patients took part in the CR program. Total WPS scores for CR+ and CR-subgroups were VL group: 18±4 vs. 14±4 (p < 0.001), L group: 18±3 vs. 14±3 (p < 0.0001), M group: 19±3 vs. 16±3 (p < 0.003), and H group: 20±4 vs. 17±3 (p < 0.006). Fewer DMW were reported by the CR+ group. Conclusions: Non-participation in CR was a consistent cause of poorer work-related outcomes. Our findings indicate that CR and occupational counseling play a very important role in worker recovery and subsequent reintegration in the workplace, in particular among clerical workers. resistance training, and aerobic exercise. The education and counseling session (four 50-min counseling sessions for 1 month) consisted of advice on healthy nutrition, physical activity, maintaining a healthy body weight, and issues related to quitting smoking and alcohol consumption. Exclusion criteria were age > 65 years, severe concomitant non-cardiac diseases such as cancer, renal dysfunction (serum creatinine > 3 mg/dl), liver dysfunction (alanine aminotransferase/aspartate aminotransferase > 1.5 times the upper normal limit), and dementia, any systemic disease limiting exercise, and inability to participate in a prospective study for logistical reasons. The average energy requirement for the patients' work activities was estimated with the aid of pre-existing, specific tables [13] that classify the various tasks on the basis of metabolic equivalents (METs): < 3 METs -very INTRODUCTIONCoronary heart disease (CHD) is the main cause of death worldwide, accounting for 31% of mortality [1]. In fact, in the working population (aged < 65), CHD is the single most important cause of death in men, and in women it is preceded only by breast cancer [2][3]. It is both a medical and a socio-economic problem. Returning to work after a coronary event produces economic benefits for the community and patients alike, improving the quality of life of their families too [4][5]. It is generally recognized that the return to work is not a simple function of clinical status...

The collagen content (measured as myocardial concentration of hydroxyproline) and dry weight (expressed as ventricle weight to body weight ratio) were determined in the left ventricle of male Sprague-Dawley rats (200--220 g b.wt.) exposed to a simulated altitude of 7,000 m for 18 h a day for 10 days in a hypobaric chamber. Hypoxia resulted in a significant increase (P less than 0.001) in the mass of the left ventricle with a concomitant significantly increased collagen concentration (P less than 0.001). The data indicate that hypoxia effects the synthesis of a significant amount of connective tissue in the left ventricle, which is the ventricle not exposed to pressure load. These results may be related to clinical, hemodynamic, and pathologic observations showing the left ventricular dysfunction in patients with chronic respiratory insufficiency. Since the amount of collagen in the left ventricle might interfere with contractile function, it is suggested that the hypoxia in these patients could affect the left ventricular myocardium via a direct action on the connective metabolism.

No abstract

Development of bilateral ventricular hypertrophy in animals exposed to sustained hypoxia is demonstrated. Female Sprague-Dawley rats (180–200 g) were subjected to acute (0.40 atm/24 h) or chronic intermittent (0.40 atm/18 h/day/7 days) hypobaric hypoxia. Control animals were maintained at room pressure. The changes in ventricular mass (right ventricle and left ventricle including the septum) were evaluated on the basis of the dry weight values immediately at the end of hypoxic stimulus. Data show that both acute and chronic hypobaric hypoxia allow rats to develop a significant degree of hypertrophy in the left as well as in the right ventricle. The factors involved in the genesis of the left ventricular hypertrophy in hypoxic conditions are presented.