The Effect of Exercise Training in Systolic and Diastolic Function

Fontes‐Carvalho, Ricardo; Vilela, Eduardo; Gonçalves-Teixeira, Pedro

doi:10.1016/b978-0-12-811279-3.00011-2

Cited by 7 publications

(23 citation statements)

References 82 publications

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“…In this observational study, a 1 ml/kg/min greater improvement in pVO 2 was associated with a 10% reduction in all-cause mortality [27]. As such, our data highlight the notion that EBCR presents a relevant intervention in this subgroup, characterised by a higher residual risk [1, 8, 28]. Although data show that in some series these patients are referred less often for EBCR, e.g.…”

Section: Discussionsupporting

confidence: 53%

“…The benefit in our patient cohort, and specifically its effect among those with a reduced EF, adds to the current evidence-base for EBCR [1, 8, 25, 26]. Given that individuals with a reduced EF present a worse prognosis after an AMI [3, 20], and taking into consideration the impact of the pVO 2 in terms of CV outcomes such as mortality, we believe these results are particularly relevant [8, 16]. Of note, the effect of EBCR was maintained after adjusting for several potential confounders, including baseline pVO 2 (which was significantly lower among patients with a reduced EF).…”

Section: Discussionmentioning

confidence: 84%

“…EBCR exerts several physiological effects by both cardiac and extra-cardiac mechanisms (namely in the peripheral vasculature, pulmonary and musculoskeletal function) [6–10]. These effects range from enhancements in cardiac contractility and chronotropic reserve to anti-inflammatory effects, improved endothelial relaxation and an overall improved aerobic capacity [2, 6, 8].…”

Section: Introductionmentioning

confidence: 99%

“…Although the importance of EBCR after an AMI is well established, several factors which pertain to its optimal application have not yet been fully ascertained [11, 12, 17]. Importantly, AMI survivors with a reduced ejection fraction (EF) represent a higher-risk subgroup [3] and in some series are referred less often for these programmes [8, 18, 19]. Additionally, the impact of EBCR across different ranges of EF has been the focus of heightened interest [8, 19].…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, AMI survivors with a reduced ejection fraction (EF) represent a higher-risk subgroup [3] and in some series are referred less often for these programmes [8, 18, 19]. Additionally, the impact of EBCR across different ranges of EF has been the focus of heightened interest [8, 19]. This stems from the fact that, although there are currently numerous parameters of potential interest in the prognostic assessment after an AMI, EF remains the most important parameter in terms of clinical decision-making and overall prognosis [3, 20].…”

Section: Introductionmentioning

confidence: 99%

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Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

et al. 2019

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Introduction Exercise-based cardiac rehabilitation (EBCR) is part of the management of patients who have suffered an acute myocardial infarction (AMI). Patients with a reduced ejection fraction (EF) comprise a higher-risk subgroup and are referred less often for these programmes. This study aimed at assessing the impact of the baseline EF on the functional benefits, as assessed by peak oxygen uptake (pVO 2 ) and exercise duration, of an EBCR programme in AMI survivors. Methods Observational, retrospective cohort study including all patients admitted to a tertiary centre due to an AMI who completed a phase II EBCR programme after discharge, between November 2012 and April 2017. Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. Results A total of 379 patients were included [40.9% with reduced EF (<50%) at discharge]. After the programme, pVO 2 and exercise duration increased significantly ( p < 0.001). Patients with a reduced EF had a lower pVO 2 and completed a shorter duration of exercise at the beginning and end of the programme. This group presented a higher increase in pVO 2 ( p = 0.001) and exercise duration ( p = 0.007). This was maintained after adjusting for age, gender, history of coronary artery disease, number of sessions, Killip classification, arterial hypertension, dyslipidaemia, diabetes mellitus, smoking status and baseline pVO 2 . Conclusion A phase II EBCR programme was associated with significant improvements in pVO 2 and exercise duration among AMI survivors, irrespective of baseline EF classification. Those with a reduced baseline EF derived an even greater improvement, highlighting the importance of EBCR in this subgroup of patients.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

et al. 2019

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Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring

Vilela,

Oliveira,

Oliveira

et al. 2023

Porto Biomedical Journal

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The cardiovascular response to exercise has long been a focus of interest. Over a century ago, the first descriptions of electrocardiographic changes occurring during exercise highlighted the possible relevance of this dynamic assessment. In this background, the inception of the Bruce protocol circa 60 years ago allowed for a major leap in this field by providing a standardized framework with which to address this issue, by means of an integrated and structured methodology. Since then, exercise stress testing with electrocardiographic monitoring (ExECG) has become one of the most widely appraised tests in cardiovascular medicine. Notably, past few decades have been profoundly marked by substantial advances in the approach to cardiovascular disease, challenging prior notions concerning both its physiopathology and overall management. Among these, the ever-evolving presentations of cardiovascular disease coupled with the development and implementation of several novel diagnostic modalities (both invasive and noninvasive) has led to a shifting paradigm in the application of ExECG. This technique, however, has continuously shown to be of added value across various momentums of the cardiovascular continuum, as depicted in several contemporary guidelines. This review provides a pragmatical reflexion on the development of ExECG, presenting a comprehensive overview concerning the current role of this modality, its challenges, and its future perspectives.

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Differential Impact of a Cardiac Rehabilitation Program on Functional Parameters in Elderly versus Non-Elderly Myocardial Infarction Survivors

et al. 2019

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Background: Exercise-based cardiac rehabilitation (EBCR) plays a pivotal role in the management of acute myocardial infarction (AMI). Studies have shown that older individuals have a worse prognosis after an AMI, attesting to the importance of risk reduction strategies. We aimed at assessing the impact of age (patients dichotomized as ≥65 years old or <65 years old) on the functional benefits of an EBCR program among AMI survivors. Design: Observational, retrospective cohort study. Participants: All patients admitted due to an AMI who completed a phase II EBCR program after discharge, between November 2012 and April 2017. Intervention: EBCR program. Measurements: Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. Results: A total of 379 patients were included (30% aged ≥65 years). After the EBCR program, peak oxygen uptake (pVO2) and exercise duration increased significantly. Patients aged ≥65 years presented with more comorbidities and a lower functional capacity. Those aged ≥65 years presented significantly smaller improvements in pVO2 (0.79 ± 2.61 vs. 1.60 ± 3.11 mL/kg/min, p = 0.016) and exercise duration [75 (59–120) vs. 120 s (60–180), p = 0.002]. This was maintained after adjusting for several potential confounders. Conclusion: Older patients have a worse functional capacity than their younger counterparts. Still, a contemporary EBCR program was associated with significant functional improvements among those aged ≥65 years. The smaller improvements even after adjustments for potential confounders suggest that physiological differences may contribute to this finding. These results highlight the relevance of EBCR among this higher-risk subgroup.

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The Effect of Exercise Training in Systolic and Diastolic Function

Cited by 7 publications

References 82 publications

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction

Sixty years of the Bruce protocol: reappraising the contemporary role of exercise stress testing with electrocardiographic monitoring

Differential Impact of a Cardiac Rehabilitation Program on Functional Parameters in Elderly versus Non-Elderly Myocardial Infarction Survivors

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