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Resumo Fundamento A pandemia da COVID-19 teve um impacto sobre os programas de reabilitação cardiovasculares (RC) no Brasil. Objetivos Descrever características dos programas de RC no Brasil, os impactos da primeira onda epidemiológica da COVID-19 (primeiros 60 dias) sobre os programas, e apresentar as iniciativas usadas para superar esses impactos. Métodos Este estudo transversal e retrospectivo usou um questionário online específico. Os participantes eram coordenadores de programas de RC. As variáveis foram apresentadas por região geográfica do Brasil, como as seguintes categorias: característica demográficas, clínicas e operacionais. O nível de significância estatística foi definido em 5%. Resultados Cinquenta e nove programas de RC atendiam 5349 pacientes, dos quais somente 1817 eram pacientes após eventos cardiovasculares agudos, o que correspondia a 1,99% dos pacientes internados no mês anterior à pesquisa (n=91.231). O maior impacto foi a suspensão das atividades presenciais, o que ocorreu de maneira similar em áreas com as taxas mais altas e áreas com as taxas mais baixas de COVID-19 no período. Quarenta e quatro (75%) programas foram interrompidos de forma breve, e três (5%) foram encerrados. Todos os 42 programas que já utilizavam estratégias de reabilitação remota notaram aumento substancial nas atividades, baseadas principalmente no uso da mídia e chamadas por vídeo. Somente três (5%) consideraram seguro atender pacientes durante os primeiros 60 dias. Conclusões Houve redução no número de programas de RC devido a pandemia da COVID-19. Atividades de telerreabilitação aumentaram durante os primeiros dois meses da pandemia da COVID-19, mas que não foi suficiente para superar a redução nas atividades dos programas de RC no Brasil. Abstract Background The COVID-19 pandemic had an impact on cardiovascular rehabilitation (CR) programs in Brazil. Objectives To describe the characteristics of CR programs in Brazil, the impacts of the first epidemiological wave of COVID-19 (first 60 days) on the programs and present the initiatives used to overcome the impacts. Method This cross-sectional and retrospective study utilized a specific online survey. Participants were coordinators of CR programs. Variables were presented by Brazilian geographic region and as the following categories: demographic, clinical and operational characteristics. The significance level for statistical analysis was set at 5%. Results Fifty-nine CR programs were responsible for 5,349 patients, of which only 1,817 were post-acute cardiovascular events, which corresponded to 1.99% of hospitalized patients in the month prior to the survey (n=91,231). The greatest impact was the suspension of on-site activities, which occurred similarly in areas with the highest and the lowest rates of COVID-19 in the period. Forty-five programs (75%) were shortly interrupted, while three (5%) were ended. All 42 programs that already used remote rehabilitation strategies noticed a substantial increase in activities, based primarily on the use of media and video calling. Only three (5%) considered safe to see patients during the first 60 days. Conclusions There was a reduction in the number of CR programs with the COVID-19 pandemic. Telerehabilitation activities increased during the first two months of the COVID-19 pandemic, but this was not enough to overcome the reduction in CR program activities across Brazil.

Background: Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Objectives: Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. Method: PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results: Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Conclusion: Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. Clinical implications: A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Aims: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by heightened blood glucose levels. Prevention of DM complications relies heavily on self-management, including frequent monitoring of blood glucose levels. The goal of this study was to investigate psychological and physiological correlates of blood glucose monitoring frequency (BGM frequency) in DM patients using a continuous blood glucose monitoring sensor connected to a electronic reading system. Methods: Fifty-nine DM patients (26 women; 49 DM type 1) wearing a continuous blood glucose monitoring sensor filled out the Hospital Anxiety and Depression Scale, the Need for Controllability and Predictability Questionnaire, and the Action and Acceptance in Diabetes Questionnaire. The number of glucose sensor readings was recorded daily from the monitoring system for three months. Results: Sixty-three percent of patients had an HbA1c value over 7. Anxiety, depression, and traumatic experiences levels were overall low in our sample (10% had a HADS depression score > 12, and 12% had a HADS anxiety score > 12). On average, patients read out their blood glucose levels 7.83 times per day (SD = 3.60). BGM frequency was negatively correlated with HbA1c levels (r = -0.355, p = 0.018). No associations between (BGM frequency) on the one hand and depression, anxiety, need for control, or experiential avoidance on the other hand, were found. Conclusion: Patients who measured their glucose levels more frequently had lower HbA1c values, and thus better long- term glucose control. Frequency of blood glucose measuring was unrelated to the psychological variables included in this study.

In recent years, patient care has partially shifted from the hospital to the patients' homes. 1 This evolution is also seen in cardiac rehabilitation, in which a growing number of patients is participating in cardiac telereh-abilitation programmes. At present, a limiting factor in offering fully remote care is the need for assessing and reassessing the patient's physical fitness at predefined intervals in order to adjust the training programme. Currently, assessing physical fitness is done by either performing a cardiopulmonary exercise test (CPET), which assesses maximal exercise capacity, or a 6-min walking test (6 MWT), which assesses submaximal exercise capacity. 2 This study aimed to investigate a new tool that allows patients to self-test their submaximal exercise capacity in a flexible way by a smartphone-based random walk 6 MWT. This study is a subanalysis of a study that was previously published by our group. 3 In this paper, multiple algorithms were used for performing the 6 MWT, and the best algorithm was determined. This best algorithm is the algorithm that is used for this sub-analysis. The study demonstrated that an algorithm based on the Google Fit step count with the smartphone worn in a strap around the patient's arm performed the best when considering both accuracy and reliability. 3 Seventy-six patients were recruited after performing a standard CPET in the setting of a cardiac rehabilitation programme. All patients then performed two additional tests. In the first test patients performed a 6 MWT outdoors in a park along a flat, straight and fixed 30-meter path. The distance walked was measured by the researcher (as in a standardized 6 MWT). At the same time, the patient wore a smartphone recording the 6 MWT. In the second test, the free walk in the park 6 MWT (FWP-6 MWT), the same setup was applied, but patients were now instructed to walk freely in the park for 6 min. The primary outcome for this study was the correlation between the FWP-6 MWT and the peak oxygen consumption (VO 2); secondary outcomes included the correlation between the FWP-6 MWT and other CPET variables. The mean age was 65.7 ± 10.4 years; most participants were male (75%). Additional baseline characteristics can be found in Appendix. In our previous study it was already demonstrated that FWP-6 MWT is significantly correlated with standard 6 MWT distance (r = 0.929, P < 0.001). This subanalysis revealed a moderate correlation of FWP-6 MWT distance with peak VO 2 (r = 0.558, P < 0.001), VO 2 at ventilatory threshold 2 (r = 0.550, P < 0.001), and with peak power (r = 0.596, P < 0.001). There was no significant difference in the correlation between patients with low 6 MWT distance and higher 6 MWT distance. Multiple linear regression analysis showed that 58.1% of the variance in VO 2 max could be explained by using the free walk smartphone-registered 6 MWT distance, gender, presence of diabetes mellitus and the HDL level. Additional results are depicted in Table 1. In our previous study it was demonstrated that there is a high correlation between the 6 MWT distance measured by a standard 6 MWT and a smartphone-based 6 MWT while performing a free walk in the park. 3 While different aspects of physical fitness are measured by CPET and 6 MWT (maximal exercise capacity and submaximal exercise capacity respectively), a moderate correlation between measures of both tests has also been demonstrated in previous studies. 4,5 However, a study has demonstrated that in certain population such as severe heart failure a 6 MWT could be near to maximal effort. 6 The only moderate correlation could also be explained by the fact that the CPET was performed on a bicycle ergometer. Studies have already demonstrated differences in cardiopulmonary measures be

This scoping review seeks to identify the specific inflammatory biomarkers implicated in tinnitus, explore the impact of short- and long-term exercise on these biomarkers, and evaluate the potential of exercise as a therapeutic approach for tinnitus.

Supplemental material, sj-docx-1-jtt-10.1177_1357633X231166159 for Do we need to rethink the determination of exercise-related energy expenditure in cardiac telerehabilitation interventions? by Toshiki Kaihara, Dominique Hansen, Supraja Sankaran, Martijn Scherrenberg, Maarten Falter, Linqi Xu, Karin Coninx and Paul Dendale in Journal of Telemedicine and Telecare

After a cardiac event, secondary prevention is recommended to foster recovery and reduce the risk of recurrent events. European guidelines and EAPC position statements on prevention of cardiovascular diseases recommend a holistic approach that actively engages patients by using shared decision making (SDM). It has been demonstrated that telerehabilitation can be a feasible and effective add-on or alternative compared to conventional in-hospital secondary prevention. However, till date, there is no eHealth solution that offers a holistic approach for secondary prevention that includes SDM. In this paper, we present the CoroPrevention-SDM approach, a technology-supported shared decision making approach for a comprehensive secondary prevention program for cardiac patients. The CoroPrevention Tool Suite consists of three applications that support patients and caregivers in following this approach: 1) a caregiver dashboard that includes decision support systems and supports SDM, 2) a patient mobile application that supports patients in making behaviour changes in their daily life, and 3) an extended ePRO application that collects patient reported outcomes and patient preferences. In a formative usability study, we assessed patients’ and caregivers’ opinion about our approach. The study indicated that both are willing to use our proposed approach to collaboratively set behavioural goals during SDM encounters. publishedVersion

Increasing evidence links changes in epigenetic systems, such as DNA methylation, histone modification, and non-coding RNA expression, to the occurrence of cardiovascular disease (CVD). These epigenetic modifications can change genetic function under influence of exogenous stimuli and can be transferred to next generations, providing a potential mechanism for inheritance of behavioural intervention effects. The benefits of exercise and nutritional interventions in the primary and secondary prevention of CVD are well established, but the mechanisms are not completely understood. In this review, we describe the acute and chronic epigenetic effects of physical activity and dietary changes. We propose exercise and nutrition as potential triggers of epigenetic signals, promoting the reshaping of transcriptional programmes with effects on CVD phenotypes. Finally, we highlight recent developments in epigenetic therapeutics with implications for primary and secondary CVD prevention. This work was supported by the Swiss National Science Foundation (Grant PRIMA 24 PR00P3_179861 to EO and grant number 310030_197557 to FP); Swiss Heart Foundation (to EO, and grant numbers FF21076 and FF20045 to FP). TSB was supported by the Medical Research Council (MRC) UK (MR/S025472/1) We thank the late Dr Romualdo Belardinelli for stimulating ideas related to the role of epigenetics in CVD prevention [125] . Parts of Figure 1 and Figure 2 by Servier Medical Art (http://smart.servier.com), licensed under CC-BY-3.0 unported license.

Increasing evidence links changes in epigenetic systems, such as DNA methylation, histone modification, and non-coding RNA expression, to the occurrence of cardiovascular disease (CVD). These epigenetic modifications can change genetic function under influence of exogenous stimuli and can be transferred to next generations, providing a potential mechanism for inheritance of behavioural intervention effects. The benefits of exercise and nutritional interventions in the primary and secondary prevention of CVD are well established, but the mechanisms are not completely understood. In this review, we describe the acute and chronic epigenetic effects of physical activity and dietary changes. We propose exercise and nutrition as potential triggers of epigenetic signals, promoting the reshaping of transcriptional programmes with effects on CVD phenotypes. Finally, we highlight recent developments in epigenetic therapeutics with implications for primary and secondary CVD prevention., European Journal of Preventive Cardiology, 29 (17), ISSN:2047-4873, ISSN:2047-4881

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: A part of the research work provided by the group of UHasselt was supported by the Research Foundation Flanders (FWO-ICA grant: G0F4220N). The other authors received no financial support for the research, authorship, and/or publication of this article. Neunhaeuserer, D (corresponding author), Via Giustiniani 2, I-35128 Padua, Italy. daniel.neunhaeuserer@unipd.it

Introduction Exercise training is strongly recommended as a therapeutic approach to treat individuals with heart failure. High-intensity exercise training modalities still controversial in this population. The study aims to preliminary assess the consequences of high-intensity exercise training modalities, aerobic interval training (HIIT) and progressive high circuit-resistance training (CRT), on primarily endothelial function and cardiorespiratory fitness, and secondly on muscle strength and physical performance in heart failure patients.Methods This preliminary multicentric randomized controlled trial comprised 23 heart failure patients, aged 56 10 years old, mainly New York Heart Association classification I and II (%), hemodynamically stable, who compromise at least 36 exercise sessions of a randomly assigned intervention (HIIT, CRT or control group). Endothelial function, cardiopulmonary exercise testing, muscle strength and physical performance were completed at baseline and post-intervention.Results Although no effects on endothelial function; both HIIT and CRT modalities were able to produce a positive effect on VO2 peak (HIIT = +2.16.5, CRT = +3.0 +/- 4.2 and control group = -0.1 +/- 5.3 mL/kg/min, time*group p-value1.8, CRT = +0.9 +/- 1.2 and control group = 0 +/- 1.6, time*group p-value55.8, CRT = 0.0 +/- 60.7 and control group = 1.6 +/- 57.6 Nm) matched p-value3.1, CRT = -3.3 +/- 3.2 and control group = -0.3 +/- 2.5 s, matched p-value

Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual's clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.

Pacientes com doença cardiovascular e fatores de risco para doença cardiovascular (DCV) têm sido afetados com mais frequência e mais gravemente pelo novo coronavírus. Isso agravou o cenário anterior de subutilização dos programas de reabilitação cardiovascular (RCV) antes da pandemia, exigindo alternativas otimizadas de RCV, como por exemplo aquelas baseadas em aplicativos móveis (mHeath), não apenas por gerar benefícios bem estabelecidos, mas agora também para manter esses pacientes clinicamente estáveis, diminuindo a chance de eventos cardiovasculares e risco de contaminação naqueles não infectados pelo vírus, bem como tratando dos sobreviventes da COVID-19, tendo em vista as disfunções adicionais que tem sido descritas nos sistemas respiratório, cardiovascular e muscular. Serão realizados dois estudos: o estudo 1, qualitativo, de concordância e reprodutibilidade. Criação aplicativo baseado em tecnologia móvel (mHealth), para dar suporte a um programa otimizado (capaz de avaliar após COVID-19) de reabilitação cardiovascular (RCV) em ambiente domiciliar, desenvolvido pela Universidade do Luxemburgo (Centro 4), integrando instrumentos reconhecidos internacionalmente, como o EXPERT Tool, Hasselt University (Centro 3) e PACERProject, University of Miami (Centro 2). O aplicativo será testado e avaliado por profissionais de saúde nos dois centros colaboradores do estudo (Centro 2 e Centro 3) e na instituição executora - Universidade de Brasília (Centro 1).

International audience

This report is based on the discussions and presentations that took place at the Workshop on Sustainable Software Sustainability (www.software.ac.uk/wosss19) in April 2019 (WOSSS19). It captures the state of the art for a range of Software Sustainability themes that were brought up by the organisers and attendees of the workshop.

Topic(s): e­Cardiology ­ Other Citation: Funding Acknowledgements: Special Research Fund (BOF) of Hasselt University BACKGROUND: Determination of the appropriate intensity of exercise training is critical to achieve the benefits of cardiac rehabilitation. Clinical guidelines and decision support systems (e.g. EXPERT tool) assist clinicians in selecting appropriate exercise intensities for patients. However, a recent study indicated that guideline­based intensity domains for CVD patients seem inconsistent. PURPOSE: We aim to investigate the applicability and suitability of the exercise guidelines for the calculation of personalized exercise targets and progress monitoring in a telerehabilitation setting. METHODS: In an app­based telerehabilitation program, we prescribed guideline­based personalized exercise targets with the EXPERT tool. The targets were converted into Metabolic Equivalent of Task (MET) values using the guideline­based exercise intensity domains and ACSM's guidelines for exercise testing and prescription. Patients could log cardio (e.g. walking) and non­cardio (e.g. gardening) physical activities in the app. Progress towards the targets was determined using ACSM's guidelines and activity specific MET values from the Compendium of Physical Activities. We evaluated our approach in a crossover trial with 32 coronary artery disease patients who used the app for 7­10 weeks. Application logs and CPET data (collected before and after using the app) were analysed. RESULTS: During the crossover trial, 4 patients dropped out and 4 patients did not log any activities. Of the remaining 24 patients, 83% achieved their minimum exercise targets every week and 8% reached their maximum targets at all times. In general, 63% of patients achieved their maximum exercise targets for at least half of the weeks. However, amongst patients who reached their maximal targets 70% of the time there was no significant difference in VO2 max (P=0.268). For example, one patient exceeded his maximum exercise target at all time, but still did not improve VO2 max. Furthermore, 46% of the patients reported mostly non­cardio physical activities, including household chores, gardening, and mowing the lawn. We found a significant difference in achieving the minimum (P=0.018) / maximum (P=0.001) exercise target when considering only cardio activities or all physical activities logged in the app. CONCLUSION: The guideline­based intensity domains and activity specific MET values from the Compendium of Physical Activity seem non­optimal for determining personalized exercise targets to improve maximal exercise capacity. Patients often overachieved their prescribed exercise targets and yet failed to gain a significant increase in maximal exercise capacity. Therefore, the approach of this relatively short study was not sufficient to increase maximal exercise capacity but may be sufficient to have a positive effect on health and submaximal exercise capacity.

Background The effect of exercise on cardiac function/structure in type 2 diabetes mellitus (T2DM) with or without diabetic cardiomyopathy (DCM) is not yet completely understood. To date, results of studies have been controversial with variable outcomes due to the variety of exercise modalities. Objectives The aim of the present review was to examine the impact of exercise intervention, and different types of exercise, on cardiac function and structure in T2DM through a systematic literature review, combining both pre-clinical and clinical studies. Methods A systematic literature search was performed on PubMed, Web of Science, and PEDro to identify studies up to 2 April 2018. Articles were included when well-defined exercise protocols were provided, and cardiac function in T2DM patients or validated animal models was examined. Results In diabetic animals, improvements in both diastolic and systolic function through exercise therapy were mainly attributed to reduced collagen deposition. In T2DM patients, improvements were observed in diastolic function, but not consistently in systolic function, after endurance (and combined resistance) exercise training. Different exercise intervention modalities and exercise types seemed equally effective in improving cardiac structure and function. Conclusion Exercise training elicits significant improvements in diastolic function and beneficial remodeling in T2DM and DCM animal models, but not necessarily improvements in systolic function and left ventricular structure, regardless of exercise type. Therefore, exercise intervention should be a cornerstone in the treatment of T2DM patients not only to improve glycemic control but also to specifically enhance cardiac function. No sources of funding were used to assist in the preparation of this article. Funding was provided by BOF-scholarship from Hasselt University (Grant no. 15NI06-BOF).

The vocational reintegration of patients after an acute coronary syndrome is a crucial step towards complete convalescence from the social as well as the individual point of view. Return to work rates are determined by medical parameters such as left ventricular function, residual ischaemia and heart rhythm stability, as well as by occupational requirement profile such as blue or white collar work, night shifts and the ability to commute (which is, in part, determined by physical fitness). Psychosocial factors including depression, self-perceived health situation and pre-existing cognitive impairment determine the reintegration rate to a significant extent. Patients at risk of poor vocational outcomes should be identified in the early period of rehabilitation to avoid a reintegration failure and to prevent socio-professional exclusion with adverse psychological and financial consequences. A comprehensive healthcare pathway of acute coronary syndrome patients is initiated by cardiac rehabilitation, which includes specific algorithms and assessment tools for risk stratification and occupational restitution. As the first in its kind, this review addresses determinants and legal aspects of reintegration of patients experiencing an acute coronary syndrome, and offers practical advice on reintegration strategies particularly for vulnerable patients. It presents different approaches and scientific findings in the European countries and serves as a recommendation for action.

Introduction. Every current guideline underlines physical activity cardinal role in both prevention and rehabilitation of patients with cardiovascular diseases (CVD). Despite exercise guidelines are available, the EAPC (European Association of Preventive Cardiology) EXPERT (Exercise Prescription in Everyday practice & Rehabilitative Training) working group recently described a large variance in exercise prescription between clinicians involved in CV rehabilitation. Therefore, the EXPERT tool, a digital training and decision support system, was developed. Purpose. The aim of this pilot study is to analyse Italian primary care physicians’ clinical routine on prescribing exercise training in patients with CV risk factors. Methods. A standard survey is submitted to primary care physicians (PCP): participants are requested to provide their professional experience, to report the number of CV patients they weekly examine, and if they regularly assess physical activity level. The survey explores how exercise prescription is carried out and if the compliance is verified. Finally, CPC are asked to evaluate their current exercise prescriptions and the possible utility of a guidelinesbased tool. Results. Currently, 20 PCP (55% males, age 58.2±10.4, years of work 25.5±13.4) who regularly manage CV patients replied to the survey. 100% of PCP consider exercise prescription useful, 85% assess the physical activity level of patients and 95% regularly prescribe exercise training. 37% based their prescription on specific tests (43% exercise testing, 14% CPET, 43% a combination of different tests), and only 11% provide it in written format. 90% of CPC declare to tailor exercise prescription to patients specifying weekly frequency (73.7%), session duration (78.9%) and descriptive intensity (59.7%). On the other hand, the type of exercise, heart ratebased intensity and program duration are stated in less than half of cases; strength training is rarely promoted (5%). Patients’ compliance is verified in 89% but a clinical revaluation is only performed in 12%. 63% of PCP adjust the prescription during followup. Overall, more than 79% of PCP acknowledged clinical benefits of their exercise prescriptions, but 95% considered their current prescription as, at best, sufficient and 90% would welcome a guidelinesbased digital tool. Conclusions. This ongoing study emphasises that Italian primary care physicians believe in the cornerstone role of exercise training in CV patients. On the other hand, the current management of exercise prescription and its adherence are variegated and considered inadequate by PCP. Our preliminary data stress out the need for specific education and standardized prescription methods. Within the next months we aim to considerably increase the sample. Subsequent steps will request CPC to prescribe exercise to standardized clinical cases, evaluating the interphysician variance and thus the usefulness of the EXPERT tool as training support.

Objectives Alzheimer’s disease is associated with atrophy of the brain volume. Brain-derived neurotrophic factor (BDNF), a neurotrophin highly expressed in the hippocampus, has a protective effect on neuronal survival and maintenance in adulthood. Therefore, it plays an important role in preservation of brain function and size. The goal of this meta-analysis was to analyse the impact of aerobic and/or strength exercise training on BDNF concentrations in older adults (≥60 years). Methods This meta-analysis was completed in accordance with the PRISMA protocol. Inclusion criteria were: (i) studies with subjects (men and women) ≥ 60 years (ii) participation in a single exercise bout or an exercise program with (iii) measurements of blood BDNF; (iv) a comparison between (a) an intervention group and a control group or (b) two intervention groups, or (c) pre and post measurements of an exercise intervention without a control group. Studies with specific interest in known comorbidities such as diabetes, chronic pulmonary/cardiovascular diseases, musculoskeletal injuries or brain diseases affecting the peripheral and/or central nervous system, except for dementia, were excluded. Results Blood BDNF concentrations increased significantly in the exercise versus control group, both after a single exercise bout (Z=2.21, P=0.03) as well as after an exercise intervention (Z=4.72, P

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = −0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC. We acknowledge the support of the European Respiratory Society - ERS Short-Term Research Fellowship October 2018 (STRTF201810-00469).

Congestion (i.e., backward failure) is an important culprit mechanism driving disease progression in heart failure. Nevertheless, congestion remains often underappreciated and clinicians underestimate the importance of congestion on the pathophysiology of decompensation in heart failure. In patients, it is however difficult to study how isolated congestion contributes to organ dysfunction, since heart failure and chronic kidney disease very often coexist in the so-called cardiorenal syndrome. Here, we review the existing relevant and suitable backward heart failure animal models to induce congestion, induced in the left- (i.e., myocardial infarction, rapid ventricular pacing) or right-sided heart (i.e., aorta-caval shunt, mitral valve regurgitation, and monocrotaline), and more specific animal models of congestion, induced by saline infusion or inferior vena cava constriction. Next, we examine critically how representative they are for the clinical situation. After all, a relevant animal model of isolated congestion offers the unique possibility of studying the effects of congestion in heart failure and the cardiorenal syndrome, separately from forward failure (i.e., impaired cardiac output). In this respect, new treatment options can be discovered. Bijzonder Onderzoeksfonds (BOF) from UHasselt/BIOMED

Objective: Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta-analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population. Methods: A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Clinical trials that assessed ectopic fat deposition and included study arms with diet and/or exercise were searched in PubMed, PEDro and the Cochrane database. Results: Hepatic fat content and intramyocellular lipid content were described in nine studies and three studies, respectively. Most studies included teenagers, and study duration ranged between 3 and 12 months without follow-up. Using random-effects weights, the standardized mean difference of the change in hepatic adiposity (totalling 320 subjects) was -0.54 Hedges' g (95% confidence interval: -0.69 to -0.38 with p

Natriuretic peptides have long been known for their cardiovascular function. However,a growing body of evidence emphasizes the role of natriuretic peptides in human substrate and energy metabolism, thereby connecting the heart with several insulin-sensitive organs like adipose tissue, skeletal muscle and liver. Obesity may be associated with an impaired regulation of the natriuretic peptide system, also indicated as a natriuretic handicap. Evidence points towards a contribution of this natriuretic handicap to the development of obesity, type 2 diabetes mellitus and cardiometabolic complications, although the causal relationship is not fully understood. Nevertheless, targeting the natriuretic peptide pathway may improve metabolic health in obesity and type 2 diabetes mellitus. This review will focus on current literature regarding the metabolic roles of natriuretic peptides with emphasis on lipid metabolism and insulin sensitivity. Furthermore, it will be discussed how exercise and lifestyle intervention may modulate the natriuretic peptide-related metabolic effects. The research in the authors’ laboratories is funded by inter-nal resources from Maastricht University and Hasselt University.

Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.

The realization of the proof of concept of the EXPERT tool was supported by an UHasselt IOF PoC project