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We sought to update norms for peak systolic blood pressure (SBP) on the graded exercise test and examine its prognostic value in patients without baseline cardiovascular disease. Mayo graded exercise test data (1993–2010) were reviewed for nonimaging tests using Bruce protocol, selecting Minnesota residents 30 to 79 years without baseline cardiovascular disease. We formed a pure cohort of patients without factors significantly affecting peak SBP to determine peak SBP percentile norms by age and sex. Then we divided the full cohort of patients into 5 groups based on peak SBP percentiles: low (90th). The relationship between peak SBP and mortality was tested using Cox regression adjusting for age, sex, and comorbidities affecting peak SBP or mortality. We identified 20 760 eligible patients with 7313 females (35%) and mean age 51.5±10.7 years. Our pure cohort included 7810 patients. Over 12.5±5.0 years follow-up, there were 1582 deaths, including 541 cardiovascular deaths. In the fully adjusted model, low-peak SBP was associated with increased total mortality (heart rate, 1.41 [1.19–1.66], P P =0.001), while borderline low-peak SBP was associated with increased cardiovascular mortality only (heart rate, 1.36 [1.02–1.81], P =0.027). High peak SBP was associated with increased total mortality only in the age-sex adjusted model (heart rate, 1.18 [1.02–1.36], P =0.026), not after full adjustment. We conclude that low exercise peak SBP is an independent predictor of higher total and cardiovascular mortality.

Purpose: High-intensity interval training (HIIT) is gaining popularity as a training approach for patients attending cardiac rehabilitation (CR). While the literature has focused on the efficacy of HIIT for improving cardiorespiratory fitness (CRF), particularly when compared with moderate intensity exercise, less emphasis has been placed on adherence to HIIT. The aim of this review was to summarize the current literature regarding adherence to HIIT in CR patients with coronary artery disease. Review Methods: A review identified 36 studies investigating HIIT in CR patients with coronary artery disease. Methods and data were extracted for exercise or training adherence (to attendance, intensity, and duration), feasibility of protocols, and CRF. The review summarizes reporting of adherence; adherence to HIIT and comparator/s; the influence of adherence on changes in CRF; and feasibility of HIIT. Summary: Adherence to the attendance of HIIT sessions was high and comparable with moderate-intensity exercise. However, adherence to the intensity and duration of HIIT was variable and underreported, which has implications for determining the treatment effect of the exercise interventions being compared. Furthermore, additional research is needed to investigate the utility of home-based HIIT and long-term adherence to HIIT following supervised programs. This review provides recommendations for researchers in the measurement and reporting of adherence to HIIT and other exercise interventions to facilitate a sufficient and consistent approach for future studies. This article also highlights strategies for clinicians to improve adherence, feasibility, and enjoyment of HIIT for their patients.

Background Type 2 myocardial infarction (T2MI) is commonly encountered in clinical practice, yet little is known about this challenging condition. Outpatient cardiac rehabilitation (CR) is an integral component in the care of patients with MI. However, specific recommendations for CR, information on the feasibility of participation, and outcome measures for patients with T2MI are lacking. Clinical considerations The frequency of T2MI is markedly variable and depends on the studied population, disease definition, adjudication process, cardiac troponin assays, and cutoff values used to make the diagnosis of T2MI. Clinically, it is difficult to distinguish T2MI from type 1 MI or myocardial injury. Type 2 myocardial infarction occurs due to myocardial oxygen supply-demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses. Currently, there are substantial gaps in knowledge regarding T2MI and there are no clear guidelines for the optimal management of these patients. Summary In this article, we present important current concepts surrounding T2MI including the definition, pathophysiology, epidemiology, diagnosis, prognosis, and management. We also discuss referral patterns to CR and participation rates and provide our experience with a case series of 17 patients. Very few patients with T2MI are referred to and participate in CR. Our small case series indicated that patients with T2MI respond favorably to CR and that exercise training following standard guidelines appears safe and is well tolerated.

Background There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence‐based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). Methods and Results This is an historical cohort study of all patients who had coronary artery disease and who initiated supervised CR between 2002 and 2012 from a single major CR center. CR dose was defined as number of visits including exercise and patient education. Follow‐up was performed using record linkage from the Rochester Epidemiology Project. MACEs included acute myocardial infarction, unstable angina, ventricular arrhythmias, stroke, revascularization, or all‐cause mortality. Dose was analyzed in several ways, including tertiles, categories, and as a continuous variable. Cox models were adjusted for factors associated with dose and MACE. The cohort consisted of 2345 patients, who attended a mean of 12.5±11.1 of 36 prescribed sessions. After a mean follow‐up of 6 years, 695 (29.65%) patients had a MACE, including 231 who died. CR dose was inversely associated with MACE (hazard ratio, 0.66 [95% CI]; 0.55–0.91) in those completing ≥20 sessions, when compared with those not exposed to formal exercise sessions (≤1 session; log‐rank P =0.007). We did not find evidence of nonlinearity ( P ≥0.050), suggesting no minimal threshold nor ceiling. Each additional session was associated with a lower rate of MACE (fully adjusted hazard ratio, 0.98 [95% CI, 0.97–0.99]). Greater session frequency was also associated with lower MACE risk (fully adjusted hazard ratio, 0.74 [95% CI, 0.58–0.94]). Conclusions CR reduces MACEs, but the benefit appears to be linear, with greater risk reduction with higher doses, and no upper threshold.

Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO2peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.

Objective: The objective of the study was to assess the physical activity (PA) and exercise patterns among participants in a large multinational spontaneous coronary artery dissection (SCAD) registry. Patients and Methods: Participants with SCAD enrolled from March 2011 to November 2019 completed surveys including details regarding PA and exercise habits prior to SCAD, and PA counseling received from their provider after SCAD. Demographics and clinical characteristics were collected by electronic record review. Exercise prescribed to patients after SCAD was categorized according to exercise components: type, intensity, frequency, time/session, and extreme environmental conditions.Results: We included 950 participants; mean ± age was 46.8 ± 9.5 years old at the time of first SCAD; most (96.3%) were women and (77.0%) attended ≥1 cardiac rehabilitation session. Hyperlipidemia (34.3%), hypertension (32.8%), and elevated body weight (overweight = 27.0%; obesity = 20.0%) were the most common comorbidities. Prior to SCAD, 48.5% performed aerobic exercise ≥3 times/week, and only 32.0% performed strength-building exercise regularly. PA counseling details after SCAD in 299/950 participants showed that most (93.3%) patients received some form of counseling including exercise prescription (EXP), non-specific recommendations, and discouraged from any exercise. Limits regarding exercise type and intensity were the most common advice among participants who received EXP.Conclusion: Insights from our study suggest that only 48% of the patients performed some aerobic exercise three or more times per week, and 32.0% performed strength-building exercises, which suggest that most of them may not be as active as assumed. Furthermore, 70% of the SCAD patients have ≥1 cardiovascular risk factors. We suggest guiding patients based on individual assessment, taking into consideration baseline PA habits, treatment, and risk factors. SCAD-tailored PA guidelines are needed for optimal EXP without compromising patient safety.

BACKGROUND Functional aerobic capacity (FAC) determined by treadmill exercise testing (TMET) is associated with cardiovascular (CV) disease mortality independent of traditional CV risk factors and is a potentially underutilized tool. The purpose of this study was to determine added prognostic value of reduced FAC and other exercise test abnormalities beyond CV risk factors for predicting total and CV mortality. METHODS The TMET database was queried for Minnesota patients (≥30 years) without baseline CV disease from September 21, 1993, through December 20, 2010. Risk factors and exercise abnormalities including low FAC (

OBJECTIVE: To examine the effect on continuously monitored blood glucose (CGM) among participants with impaired fasting glucose (IFG) who used a height-adjustable desk while working. METHODS: The study was a repeated measures pilot study in overweight or obese women who had IFG (blood glucose [BG] >100 mg/dL) and a sedentary job. Blood glucose was monitored with CGM devices during two 1-week periods at work; 1 week in the seated position and 1 week using alternate bouts of sitting and standing (by adjusting their desks) throughout the workday. RESULTS: Ten women completed the study. Sedentary time significantly predicted BG independently of diet and overall physical activity (P=.02). Dietary carbohydrates, protein, and fat were significant predictors of BG (P

Introduction: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in otherwise healthy and most times presumably fit young women. In the absence of evidence for benefit or harm, exercise prescription (EXP) after SCAD remains arbitrary. We assessed EXP patterns among participants in a large multinational SCAD registry. Methods: Participants with SCAD as confirmed by coronary angiography completed surveys detailing exercise (EX) habits prior to SCAD (initial survey), and EXP from their provider on initial and subsequent visits after SCAD (follow-up survey). Demographic and clinical characteristics were collected by electronic health record review by trained nurse abstractors. EXP was categorized according to EX components that include: type, intensity, frequency, time/session, and external conditions. Results: Among 950 participants, mean ± age was 46.8 ± 9.5 years, 96% were women and 77% reported attending ≥1 Cardiopulmonary Rehabilitation session. Prior to SCAD, 49% were aerobically exercising ≥ 3times per week, and only 32% performed strength-building EX regularly. Initial and subsequent post-SCAD visit details in 299/950 participants showed that most (93%) patients received some form of EX (Figure 1-A) counseling, namely: EXP, unspecific advice or were discouraged from any EX (Figure 1-B) . Limits regarding EX type and intensity were the most common advice received among EXP group (Figure 1-C) . Conclusions: Insights from our study show that only 40% of patients were achieving current exercise recommendations for adults prior to SCAD (vs 53% adult U.S population; CDC, 2018) which suggests that SCAD patients may not be as active as previously described. Most patients receive some form of EX counseling after SCAD; however, a structured EXP is needed to avoid overly cautious approaches that could lead to uncertainty, deconditioning, impaired quality of life, or increase risks associated with a sedentary lifestyle.

Introduction: Body fat (BF) content better predicts adiposity-related cardiovascular risk than the body mass index (BMI). Accurate and accepted methods to assess BF are complex, expensive, and accessible only in clinical settings. Multi-sensor 3D body volume (3D-BV) measurement technology has been shown to accurately estimate BF. We assessed the hypothesis that 3D models generated from biplane imaging (i.e., front and side facing photographs) using mobile devices (App), could be used to predict body volume measurements and derive BF. Methods: We prospectively enrolled 196 subjects, who underwent 3D-BV (gold standard for body volume) within 24 hours, dual-energy X-ray Absorptiometry (iDEXA) (gold standard for BF) and photographs taken with an Ipad® App at a predefined distance and pose. These photos were post-processed with a computer-assisted algorithm to estimate body length, girth, and volume. These were used to calculate body density (BD) using the bicompartmental principles of body composition (BD=Body Mass/Volume) and derive BF% using the Siri equation [(4.95/BD-4.50) X 100]. Correlation indexes and residual plots were created to compare 3D-BV and iDEXA with the App. Mean differences were compared using a paired t-test. Results: Mean ±SD age was 31.9±9.15 years, 53% were women, weight 72.8±14.1 kg, BMI was 25.5±4.5 kg/m 2 .The App volume correlated with 3D-BV (R 2 =0.95,95%CI 0.90,0.95, pFigure 1-A ) ; average difference between App volume vs 3D-BV volume was -1.2 Liters, 95%CI,0.03, 2.42, p=0.06, ( Figure 1-B ). App BF% correlated with iDEXA BF% (R 2 =0.92, 95%CI 0.90,0.94, pFigure 1-C ) ; while average difference between App BF% vs iDEXA BF% was -0.13 %, 95%CI -0.6,0.4, p=0.6, ( Figure 1-D ). Conclusion: BF can be estimated using volume measurements obtained by biplane imaging from mobile devices and could serve as a home-based, portable, scalable, cost-effective, and convenient measure to assess BF and track changes in body composition over time.

Background Exercise intolerance is the cardinal manifestation of heart failure (HF), yet its underlying mechanism(s) remain poorly understood. Measures of ventricular function such as ejection fraction often have no relationship with exercise capacity in HF. 2D-STE has proved to be more reliable method to evaluate myocardial mechanical function. Our hypothesis is Resistance exercise training (Resist-HFpEF) will improve exercise tolerance and exertional symptoms in patients with HFpEF. Purpose The study aims to evaluate myocardial mechanical function by strain imaging during resistance exercise training in Heart Failure patients with Preserved Ejection Fraction (HFpEF) Methods This is a single centre prospective pilot study. 24 HFpEF patients were enrolled and their baseline comorbidities were recorded. Baseline 2D-STE imaging was performed at rest and during exercise (Visit 1). Patients were then randomized to either a novel resistance exercise training program for 36 sessions (3 sessions per week for 12 weeks) or a standard of care control group. 2D STE imaging was then repeated at follow-up (Visit 2). Peak Global Longitudinal strain (GLS), systolic strain rate (SSR), early diastolic strain rate (SRe) were measured offline. Results Mean age of the Rehab cohort was 68.57±10.52 years and the control cohort was 68.1±6.47 years. 23 study subjects were male (96%). 17% of the study subjects were hypertensive, 63% were diabetic, 42% had NYHA I, 46% had NYHA II and 13% had NYHA III of heart failure. The mean LV ejection fraction in the control and Rehab group after the training program at rest was 61.88±2.26% & 54.74±2.07% (p-value 0.04) and during exercise was 59.90±2.05% and 53.13±2.05% (p-value 0.04). The peak GLS was −18.80±4.29% and −17.7±2.21% in controls during rest and exercise at Visit 1 (p-value 0.27) while the rehab cohort had −18.71±4.7% and −20.82±2.4% respectively (p-value 0.0268). The peak GLS was −17.40±3.05% and −17.96±2.65% in controls during rest and exercise at Visit 2 (p-value 0.3430) while rehab cohort had −17.97±6.21% and −16.57±3.82% respectively (p-value 0.67). (Figure 1a and 1b shows GLS, SRS, SRe at Baseline and after exercise program respectively) Conclusion This pilot study suggest systolic and diastolic reserve can be measured reliably during low grade exercise. These results could reflect improvement in clinical status and exercise tolerance. Figure 1. Comparison of peak GLS, SSR, SRe amongst HFpEF patients at rest and during exercise before and after the rehab training program. Funding Acknowledgement Type of funding source: None

Calf muscle pump (CMP) promotes venous return from the lower extremity and contributes to preload and cardiac output. Impaired CMP function may reflect a measure of frailty or cumulative disease burden or may impede cardiac function. The study objective was to test the hypothesis that impaired CMP negatively impacts survival. Consecutive adult patients who underwent venous strain gauge plethysmography at the Mayo Clinic Gonda Vascular Laboratory (January 1, 1998 – December 31, 2011) were assessed for overall survival. Patients with venous incompetence, venous obstruction or unilateral calf pump dysfunction were excluded. Risk of mortality was assessed with Cox proportional hazard ratios and after adjusting for Charlson Comorbidity Index variables. Over the study period, 2728 patients were included in the analysis. Compared to patients with normal CMP, those with impaired CMP were older ( p < 0.001), predominantly female ( p = 0.01) and had higher mean Charlson scores ( p < 0.001). Patients with impaired CMP had a higher mortality rate at 5 (8.9% vs 2.4%), 10 (17.5% vs 5.9%), and 15 years (22.8% vs 8.3%) compared to those with normal CMP ( p < 0.001 for each comparison). Of patients with heart failure, those with impaired CMP had worse survival at each 5-year increment compared to those with normal CMP ( p < 0.05 at each increment). In conclusion, impaired CMP appears to be an independent predictor of poor outcomes after adjusting for variables within the Charlson Comorbidity Index. The association between impaired CMP, heart failure, and mortality may represent a negative impact on circulatory function or a surrogate measure of frailty.

Background Right bundle‐branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding. However, some studies have suggested increased risk of cardiovascular morbidity and mortality. We sought to evaluate risk attributable to incidental RBBB in patients without prior diagnosis of cardiovascular disease (CVD). Methods and Results We reviewed the Mayo Clinic Integrated Stress Center database for exercise stress tests performed from 1993 to 2010. Patients with no known CVD—defined as absence of coronary disease, structural heart disease, heart failure, or cerebrovascular disease—were selected. Only Minnesota residents were included, all of whom had full mortality and outcomes data. There were 22 806 patients without CVD identified; 220 of whom (0.96%) had RBBB, followed for 6 to 23 years (mean 12.4±5.1). There were 8256 women (36.2%), mean age was 52±11 years; and 1837 deaths (8.05%), including 645 cardiovascular‐related deaths (2.83%), occurred over follow‐up. RBBB was predictive of all‐cause (hazard ratio [HR], 1.5; 95% CI, 1.1–2.0; P =0.0058) and cardiovascular‐related mortality (HR,1.7; 95% CI, 1.1–2.8; P =0.0178) after adjusting for age, sex, diabetes mellitus, hypertension, obesity, current and past history of smoking, and use of a heart rate‐lowering drug. Patients with RBBB exhibited more hypertension (34.1% versus 23.7%, P P P P Conclusions Patients with RBBB without CVD have increased risk of all‐cause mortality, cardiovascular‐related mortality, and lower exercise tolerance. These data suggest RBBB may be a marker of early CVD and merit further prospective evaluation.

To determine the risk of long-term major adverse cardiovascular events (MACE) when sleep-disordered breathing (SDB) and decreased cardiorespiratory fitness (CRF) co-occur.We included consecutive patients who underwent symptom-limited cardiopulmonary exercise tests between January 1, 2005, and January 1, 2010, followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-to-severe SDB (apnea/hypopnea index ≥15 per hour) and decreased CRF defined as70% predicted peak oxygen consumption (VOOf 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5 to 10.3 years). After adjusting for age, sex, beta blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking, and use of positive airway pressure (PAP), decreased CRF alone (hazard ratio [HR]=1.91, 95% confidence interval [CI], 1.15 to 3.18; P=.01), but not SDB alone (HR=1.26, 95% CI, 0.75 to 2.13, P=.39) was associated with increased risk of MACE. Those with SDB and decreased CRF had greater risk of MACE compared with patients with decreased CRF alone (HR=1.85; 95% CI, 1.21 to 2.84; P.005) after accounting for these confounders. The risk of MACE was attenuated in those with reduced CRF alone after additionally adjusting for adequate adherence to PAP (HR=1.59; 95% CI, 0.77 to 3.31; P=.21).The incidence of MACE, especially mortality, was high in this sample. Moderate-to-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of possibly including CRF in the risk assessment of patients with SDB and, conversely, that of screening for SDB in patients with low peak VO

Body mass index (BMI) does not differentiate fat and lean mass or the distribution of adipose tissue. The purpose of this study was to examine the prevalence of metabolic syndrome (MetS) among patients entering outpatient cardiac rehabilitation (CR) across fat mass index (FMI) categories compared with BMI. This retrospective cross-sectional study evaluated dual-energy x-ray absorptiometry in 483 CR patients from 1 January 2014, through 31 December 2017. Clinical data were extracted from the electronic health record. Patients were grouped by FMI and BMI categories. Mean (SD) age of patients was 64.3 (14) years. The normal FMI category had 15 patients, excess fat, 74, and obese, 384. In contrast, 93, 174, and 216 were in the normal, overweight, and obese BMI categories, respectively. Prevalence of MetS was 0 (0%) in normal, 5 (1%) in excess fat, and 167 (54%) in obese FMI, with 97% in the obese category. MetS prevalence was 4 patients (0.8%) in normal, 39 (8%) in overweight, and 129 (27%) in obese BMI categories, with 75% of MetS in the obese category. FMI more accurately classified CR patients with metabolically abnormal fat (p &lt, 0.001). FMI is a more sensitive index than BMI for metabolically abnormal fat of outpatient CR patients.

Background: Empirical evidence indicates that yogic practices may be beneficial for the management of type 2 diabetes. The purpose of this review is to analyze and synthesize recent experimental trials examining the effect of yoga asana-based interventions on blood glucose, HbA1C, and anthropometric measures among individuals with type 2 diabetes. This review focuses on clinically relevant findings that support the prescription of yogic asana practices to this population.Methods: Electronic searches of several databases were performed for experimental studies through December 2015. Studies were included if they were in English, peer reviewed, included asana-based yoga interventions among adults with type 2 diabetes, and reported relevant outcomes.Results: The search identified 19 experimental studies. A majority of the studies found improvements in blood glucose measures, hemoglobin A1c, and/or anthropometric measures. Style of yoga, duration of yogic interventions, and type of control group varied across studies.Conclusion: These studies suggest that regular yoga practice may lead to improvements in blood glucose measures, hemoglobin A1c, body weight, and body mass index. Further research is warranted to confirm these preliminary findings and better understand how yoga interventions can be implemented into clinical settings.

Introduction Sleep disordered breathing (SDB) is associated with adverse cardiovascular outcomes and decreased cardiorespiratory fitness (CRF). The risk of long-term major adverse cardiovascular events (MACE) when SDB and decreased CRF co-occur has not been determined. Methods We included consecutive patients that underwent a symptom-limited cardiopulmonary exercise test followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-severe SDB (apnea/hypopnea index ≥15/hour) and decreased CRF defined as Results Of 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5-10.3 years). After adjusting for age, sex, beta-blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking and positive airway pressure (PAP) usage, decreased CRF alone (HR=1.91, 95%CI=1.15-3.18, p=0.012), but not SDB alone (HR=1.26, 95%CI=0.75-2.13, p=0.389) was associated with increased risk of MACE. Those with SDB and decreased CRF had increased risk of MACE compared to patients with decreased CRF alone (HR=1.85, 95%CI=1.21-2.84, p Conclusion The incidence of MACE, including mortality, was high in this sample. Moderate-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of including CRF in the risk assessment of patients with SDB, and conversely, that of screening for SDB in patients with low peak VO2. Support None.

Background The benefits of aerobic exercise are well-studied; there is no consensus on the association between resistance training and major adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to address this issue. Design and methods We searched for randomized trials and cohort studies that evaluated the association between resistance training and mortality and cardiovascular events. Two investigators screened the identified abstracts and full-texts independently and in duplicate. Cochrane tools were used to assess the risk of bias. We calculated hazard ratios and 95% confidence intervals using random effect models. Results From the 1430 studies identified, 11 (one randomized trial and 10 cohort studies) met the inclusion criteria, totaling 370,256 participants with mean follow-up of 8.85 years. The meta-analysis showed that, compared with no exercise, resistance training was associated with 21% (hazard ratio (95% confidence interval (CI)), 0.79 (0.69–0.91)) and 40% (hazard ratio (95% CI), 0.60 (0.49–0.72)) lower all-cause mortality alone and when combined with aerobic exercise, respectively. Furthermore, resistance training had a borderline association with lower cardiovascular mortality (hazard ratio (95% CI), 0.83 (0.67–1.03)). In addition, resistance training showed no significant association with cancer mortality. Risk of bias was low to intermediate in the included studies. One cohort study looked at the effect of resistance training on coronary heart disease events in men and found a 23% risk reduction (risk ratio, 0.77, CI: 0.61–0.98). Conclusion Resistance training is associated with lower mortality and appears to have an additive effect when combined with aerobic exercise. There are insufficient data to determine the potential beneficial effect of resistance training on non-fatal events or the effect of substituting aerobic exercise with resistance training.

Spontaneous second-degree atrioventricular block induced by exercise (Ex2AVB) is rare, but it can cause profound exercise intolerance.We sought to determine the frequency of Ex2AVB in our exercise testing practice and to describe characteristics of patients with Ex2AVB. We hypothesized that the number of patients would be small, but they would require invasive treatment.We reviewed the Mayo Clinic Integrated Stress Center database for nonimaging tests performed from 2006 through 2010. All exercise tests coded as "second-degree atrioventricular block" were captured and reviewed. Tests were excluded if results showed evidence of second-degree atrioventricular block at rest.From 40,715 tests performed, definite Ex2AVB was found in only 19 patients (0.05%; 5 women and 14 men). Ex2AVB occurred as a Mobitz type II block in 4 patients and as a Mobitz type I block in 15. In 3 patients, Ex2AVB occurred only in recovery. Ex2AVB was intermittent in 11 patients and persistent in 8. Mean peak heart rate was higher with intermittent Ex2AVB than with persistent Ex2AVB (126 ± 39 vs 88 ± 28 bpm, P .01), as was mean functional aerobic capacity (87% ± 20% vs 59% ± 14%, P .01). Seven patients with persistent Ex2AVB received a permanent pacemaker; 1 underwent pacemaker adjustment.Ex2AVB is uncommon but can cause exercise intolerance that requires pacemaker implantation. Structural or ischemic heart disease and resting conduction abnormalities are common findings in patients with Ex2AVB. Intervention is seldom required for intermittent Ex2AVB.

Cardiopulmonary exercise testing (CPX) is recommended to determine the need of aortic valve replacement (AVR) in patients with severe asymptomatic aortic stenosis (ASAS). Important exercise variables include abnormal systolic blood pressure (SBP) response. Our aim was to determine the significance

Prior studies show limited utility of ST segment changes to identify ischemia in patients with good exercise performance. Our aim was to examine long-term prognosis in such patients. Mayo Clinic stress test database was reviewed from 1993–2010 for Minnesota residents without prior CAD. We defined

Some baseline characteristics and stress test findings are predictors of cardiovascular (CV) mortality; however, they are not as well-studied for cancer (CA) mortality. We reviewed our stress test database from 1993 to 2010. Patients with baseline cancer or cardiovascular disease were excluded.

Sleep disordered breathing (SDB) is associated with cardiovascular outcomes and decreased exercise capacity including low functional capacity (LFC). The risk of long-term major adverse cardiovascular events (MACE) when SDB and LFC co-occur has not been determined. Our sample included patients who

High-intensity interval training (HIIT) is more effective at reducing body adiposity than moderate intensity continuous training (MICT) in overweight individuals. The present study examined the efficacy of HIIT on body composition in cardiac rehabilitation (CR) patients with metabolic syndrome (MetS

Aortic valve replacement (AVR) in patients with severe aortic valve disease is the only effective treatment to relieve symptoms and improve survival. We sought to describe clinical and echocardiographic (echo) correlates of exercise performance and outcomes following AVR We retrospectively

Indications for aortic valve replacement (AVR) in patients with asymptomatic severe AS (ASAS) are currently not well defined ObjectiveTo investigate the potential role of cardiopulmonary exercise testing (CPX) for identifying candidates for AVR in ASAS We reviewed CPX tests from November 2007-April

Hypertension (HTN), diabetes (DM), and smoking are known cardiovascular disease risk factors that lead to increased mortality, as do low functional aerobic capacity (FAC), abnormal heart rate recovery (AbnHRR), and abnormal exercise electrocardiogram (AbnECG). We reviewed the Mayo Integrated Stress

Research indicates that exercise is an efficacious intervention for depression among adults; however, little is known regarding its efficacy for preventing postpartum depression. The Healthy Mom study was a randomized controlled trial examining the efficacy of an exercise intervention for the prevention of postpartum depression. Specifically, postpartum women with a history of depression or a maternal family history of depression (n=130) were randomly assigned to a telephone-based exercise intervention or a wellness/support contact control condition each lasting six months. The exercise intervention was designed to motivate postpartum women to exercise based on Social Cognitive Theory and the Transtheoretical Model. The primary dependent variable was depression based on the Structured Clinical Diagnostic Interview (SCID). Secondary dependent variables included scores on the Edinburgh Postnatal Depression Scale, the PHQ-9, and the Perceived Stress Scale. The purpose of this paper is to describe the study design, methodology, and baseline data for this trial. Upon completion of the trial, the results will yield important information about the efficacy of exercise in preventing postpartum depression.