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Hypertension poorly responsive to medications is defined resistant hypertension. We have previously shown that 1-year of guided walking is followed by highly significant reduction of systolic blood pressure in hypertensive subjects. Aim of this study was to assess the effect of a 1-year of guided walking on the blood pressure of sedentary hypertensive subjects including patients with resistant hypertension. Two hundred and fifty-nine sedentary subjects with systolic pressure ≥130 mmHg were subdivided in a group without blood pressure medications and in a group taking three or more antihypertensive drugs, including diuretics. Blood pressure, body weight, body mass index, waist circumference, and walking speed were determined at enrollment and after 1-year of walking, supervised by exercise physiologists. At baseline, systolic pressure was significantly higher in the subjects under therapy (144.6 ± 12.2 vs. 140.2 ± 10.7). Two hundred and three subjects (124 without and 79 with therapy) completed the program. During the 1-year program each subject walked ~220 h. After 1-year a significant decrease (P

The study has compared the effects of a program of guided walking (GW) and of a program of suggested walking (SW) on the blood pressure and on the lifestyle of sedentary hypertensive subjects. Participants were sedentary and had a systolic pressure ≥ 140 mmHg. They were divided in a group of GW (n = 93) and of SW (n = 99). Blood pressure, weight, BMI, waist circumference and walking speed were assessed at enrollment and after 6 months. Sixteen months after the end of the project, the subjects were contacted to check if they were maintaining the walking activity. During the 6 months, the weekly walking time was 300 min in the GW group and 120 in the SW group. Seventy subjects of the GW group and 88 of the SW group completed the program. Significantly decrease in weight, BMI and waist circumference was observed in both groups. Systolic and diastolic pressure decreased by 7.5 and 1.9 mmHg in the GW group and by 4.1 and 2.1 mmHg in the WS. The decrease in systolic pressure was significantly higher in the subjects of GW group. Sixteen months after the end of the study, 54 subjects of the WG and 30 of the SG declared to maintain a walking habit. Both programs resulted in significant reductions of systolic and diastolic pressure. The reduction of systolic pressure was significantly higher in the subjects who followed the GW program. The GW program was also more effective than the SW program in modifying the lifestyle of the participants.

Low levels of cardiorespiratory fitness are associated with a high risk of cardiovascular disease (CVD) and all-cause mortality in women. The aim of this study was to determine the validity of a 500-m moderate treadmill-walking test for estimating peak oxygen uptake (VO2peak) in older women with CVD. Fifty-three women with stable CVD (age 70.4 ± 8.2 years) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patient completed a maximal cardiopulmonary exercise test, and a moderate and self-paced (11–13/20 on the Borg scale) 500-m treadmill-walking test. Treadmill walk time, age, weight, height, and heart rate during the test were entered into prediction equations previously validated for VO2peak estimation in male patients. Measured and estimated VO2peak values were not different (20.8 ± 4.3 vs 21.3 ± 4.6 mL/kg/min, P = 0.12). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.92 (SEE = 1.3 mL/kg/min, P

Objectives To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD). Design Population-based prospective study. Methods A total of 1442 male patients aged 25–85 years at baseline, underwent a moderate perceptually-regulated (11–13 on the 6–20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VO 2 peak). %PRED was derived from ACSM, Ades et al, Morris et al, and the Wasserman/Hansen equations, and their prognostic performance was assessed. Overall mortality was the end point. Participants were divided into quartiles of %PRED, and mortality risk was estimated using a Cox regression model. Results During a median 8.2 year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44–1.29, p = 0.29), 0.67 (95% CI 0.38–1.18, p = 0.17), and 0.37 (95% CI 0.10–0.78, p = 0.009), respectively (p for trend Conclusions The percent-predicted VO 2 peak determined by Wasserman/Hansen equations applied to the 1k-TWT is inversely and significantly related to survival in cardiac outpatients. The 1k-TWT is a simple and useful tool for stratifying mortality risk in patients participating in secondary prevention programs.

To analyze the change in risk factors for cardiovascular diseases in sedentary subjects following 1 year of guided walking and check the maintenance of the walking habit 16 months after the end of the project. A total of 650 sedentary subjects (442 women, 208 men) were admitted to the project. Body mass index (BMI), waist circumference, systolic and diastolic blood pressure, and walking speed were determined at enrollment and redetermined after 1 year in the subjects completing the project. Daily groups of guided walking were organized. In the 326 subjects completing the project, highly significant reduction in body weight, BMI, waist circumference, systolic and diastolic blood pressure and increase in walking speed were documented. Out of the 326 finishers, 266 answered a questionnaire on the minutes of walking they were doing each week, 16 months after the end of the project: 258 declared 170 ± 110 min while eight declared to be back to inactivity. Guided walking was followed by highly significant reduction in risk factors for cardiovascular diseases and improved walking speed. Seventy-seven percent of the finishers were maintaining the walking practice 16 months after the end of the project, indicating that guided walking programs can be effective in permanently modifying the lifestyle of sedentary subjects.

To determine the relationship between walking speed (WS) maintained during a 1 km test and its improvement on hospitalisation in cardiac outpatients who were referred to an exercise-based secondary prevention programme.Hospitalisation was assessed in 1791 patients 3 years after enrolment and related to the WS achieved during a 1 km walk at moderate intensity on a treadmill. Hospitalisation was also assessed during the fourth-to-sixth years as function of improvement in WS in 1111 participants who were re-evaluated 3 years after baseline.Three-year hospitalisation rate across tertiles of baseline WS was 50% for the slow walkers (2.7±0.6 km/hour), 41% for the moderate (4.1±0.3 km/hour) and 25% for the fast walkers (5.2±0.5 km/hour) (p for trend0.0001), with adjusted HRs (95% CI) of 0.93 (0.74 to 1.17, p=0.53) for intermediate and 0.58 (0.43 to 0.78, p=0.0003) for fast. Every 1 km/hour increase in WS was associated with a 21% reduction in hospitalisation (p0.0001). Hospitalisation from the fourth-to-sixth years was lower across tertiles of improved WS, with 44% for the low (0.2±0.4 km/hour), 34% for the intermediate (0.8±0.2 km/hour) and 30% for the high tertile (1.6±0.4 km/hour) (p for trend0.0001). Adjusted HRs were 0.68 (p=0.002) for the intermediate and 0.58 (p0.0001) for the high tertile. Every 1 km/hour increase in WS was associated with a 35% reduction in hospitalisation (p0.0001).Improvement in WS is associated with a significant, dose-dependent lower rate of all-cause hospitalisation in cardiac outpatients. WS is a simple, easily applied and clinically useful tool for cardiac patients undergoing secondary prevention.

Background The walking speed maintained during a moderate 1-km treadmill walk (1k-TWT) has been demonstrated to be a valid tool for estimating peak oxygen uptake (VO2peak), and to be inversely related to long-term survival and hospitalization in outpatients with cardiovascular disease (CVD). We aimed to examine whether 500-meters and 1-k moderate treadmill-walking tests equally estimate VO2peak in male outpatients with CVD. Methods One hundred forty-two clinically stable male outpatients with CVD, aged 34-92 years, referred to an exercise-based secondary prevention program, performed a moderate and perceptually-regulated (11-13/20 on the Borg Scale) 1k-TWT. Age, height, weight, time to walk 500-meter and the entire 1000-meter, and the corresponding heart rates were entered into validated equations to estimate VO2peak. Results VO2peak estimated from the 500-meters test was not different from that estimated from the 1k test (25.2±5.1 vs. 25.1±5.2 mL/kg/min). The correlation coefficient between the two was 0.98. The slope and the intercept of the relationship between the 500-meter and 1k tests were not different from the line of identity. Bland-Altman analysis demonstrated that 96% of the data points were within two standard deviations (from -1.9 to 1.7 mL/kg/min). Conclusions The 500-meter treadmill-walking test is a reliable method for estimating VO2peak in stable male outpatients with CVD. A shorter version of the test, 500-meter, provides similar information as that from the original 1k test, but is more time efficient. These findings have practical implications in the context of transitioning patients from clinically based and supervised programs to fitness facilities or self-guided exercise programs.

Background The aim of the study was to assess the effects of walking on the blood pressure in sedentary adults with differing degrees of systolic blood pressure (SBP). Methods A total of 529 subjects with SBP above 120 mmHg were enrolled. Blood pressure, body weight, body mass index, waist circumference and walking speed were determined at enrolment and after six months. Walking sessions were supervised by exercise physiologists. Results The weekly walking time of the subjects completing the project was uniform and reached 300 minutes by the second month. 56% of participants completed the 6 months intervention (182 women 59.6 ± 9.0 years, and 114 men, 65.4 ± 8.6 years) 27 had a baseline SBP >160 mm Hg, 35 between 150–159, 70 between 140–149, 89 between 130–139 and 75 between 120–129 mmHg. Following six months of supervised walking, SBP was significantly reduced in all subgroups (p 160 and the smallest reduction (−2.6 mmHg) occurring in subjects with baseline SBP of 120–129 mmHg. Diastolic blood pressure, body weight, body mass index and waist circumference were also significantly reduced following the walking intervention (p Discussion In a large group of sedentary adults with varying degrees of SBP, 6 months of supervised walking elicited a marked reduction in systolic blood pressure with the largest reductions in pressure occurring in individuals with higher baseline SBP.

Background Maximal cardiopulmonary exercise testing (CPX) is the gold-standard for cardiorespiratory fitness assessment in chronic heart failure (CHF) patients. However, high costs, required medical supervision, and safety concerns make maximal exercise testing impractical for evaluating mobility-impaired adults. Thus, several submaximal walking protocols have been developed and currently used to estimate peak oxygen consumption (VO2peak) in CHF patients. However, these tests have to be performed at close to maximum exercise intensity. The aim of this study was to examine the validity of a 500-m treadmill-walking test carried out at moderate intensity for estimating VO2peak in community-dwelling adult and elderly patients with CHF and reduced left ventricular ejection fraction (HFrEF). Methods Forty-three clinically stable men with HFrEF (age 67.7 ± 9.2 years, and left ventricular ejection fraction, LVEF 38% ± 6%) underwent exercise testing during an outpatient cardiac rehabilitation/secondary prevention program. Each patients completed a CPX, and a moderate and self-paced (11–13/20 on the Borg scale) 500-m treadmill-walking test. Age, weight, height, walk time, and heart rate during the 500-m test were entered into prediction equations previously validated for VO2peak estimation from a 1000-m walking test in patients with cardiovascular disease and preserved LVEF. Results Directly measured and estimated VO2peak values were not different (21.6 ± 4.9 vs 21.7 ± 4.6 mL/kg/min). The comparison between measured and estimated VO2peak values yielded a correlation of R = 0.97 (SEE = 0.7 mL/kg/min, P

To determine the prognostic ability of established percent-predicted equations of peak oxygen consumption (%PRED) estimated by a moderate submaximal walking test in a large cohort of outpatients with cardiovascular disease (CVD).Population-based prospective study.A total of 1442 male patients aged 25-85 years at baseline, underwent a moderate perceptually-regulated (11-13 on the 6-20 Borg scale) treadmill walk (1k-TWT) for peak oxygen consumption estimation (VODuring a median 8.2year follow-up, 167 all-cause deaths occurred. The Wasserman/Hansen equation provided the highest prognostic value. Mortality rate was lower across increasing quartiles of %PRED. Compared to the first quartile, after adjustment for confounders, the mortality risk decreased for the second, third, and fourth quartiles, with HRs of 0.75 (95% CI 0.44-1.29, p=0.29), 0.67 (95% CI 0.38-1.18, p=0.17), and 0.37 (95% CI 0.10-0.78, p=0.009), respectively (p for trend0.0001). Each 1% increase in %PRED conferred a 4% improvement in survival.The percent-predicted VO

INTRODUCTION The aim of this study was to determine whether the 1-km treadmill walking test, previously developed to predict peak oxygen uptake ((Equation is included in full-text article.)O2peak) in stable cardiac outpatients, could be reproduced outdoors. METHODS Fifty male cardiac outpatients performed the 1-km walking test on a treadmill and on a flat track within 1 week. (Equation is included in full-text article.)O2peak was estimated for both testing conditions considering age, height, weight, walking speed, and heart rate. RESULTS Average walking speed was slightly higher during outdoor conditions (5.73 ± 0.77 km/h vs 5.55 ± 0.84 km/h), whereas mean heart rates were similar for both testing conditions (102 ± 18 beats/min vs 103 ± 16 beats/min). (Equation is included in full-text article.)O2peak values for treadmill and outdoor tests were not significantly different (26.4 ± 4.1 mL/kg/min vs 26.8 ± 4.5 mL/kg/min) and were strongly correlated (r = 0.93, P < .0001). The slope and the intercept of the (Equation is included in full-text article.)O2peak values were not different from the line of identity. CONCLUSIONS This moderate and perceptually regulated 1-km walking test administered outdoors gives similar results compared with a similar test performed on a treadmill. Therefore, (Equation is included in full-text article.)O2peak can be reasonably estimated using both testing modalities. This suggests that the outdoor 1-km test can be applied for indirect estimations of cardiorespiratory fitness in an outpatient setting.

Purpose Maximal oxygen uptake ((Equation is included in full-text article.)O2) and ventilatory threshold (VT) are widely used to assess cardiorespiratory fitness in healthy people, as well as in patients with various clinical conditions. The aim of this study was to determine whether an attenuation of (Equation is included in full-text article.)O2 occurs above the VT in patients with stable coronary artery disease. Methods A total of 33 male patients participating in an outpatient cardiac rehabilitation/secondary prevention program underwent maximal incremental cycle ergometry at increasing pedaling cadences up to the limit of tolerance. Ventilatory gas-exchange variables were measured breath by breath while work rate was recorded continuously. Ventilatory threshold was determined by a dual linear regression model (V-slope analysis). Results Four patients were excluded from the analysis because they were unable to pedal at the increasing cadences required by the protocol. The remaining 29 patients successfully completed the test without complications or evidence of significant ST segment depression. The slope of the (Equation is included in full-text article.)O2/work rate relationship above the VT decreased significantly (-44.6% on average) in 23 of the 26 patients in which VT was able to be determined. (Equation is included in full-text article.)O2 at the start of (Equation is included in full-text article.)O2 attenuation ((Equation is included in full-text article.)O2att) and at VT were highly correlated and in strong agreement (1637 ± 451 mL/min vs 1650 ± 473 mL/min, r = 0.96, P Conclusions (Equation is included in full-text article.)O2att does occur and coincides with the VT in the majority of patients tested with stable coronary artery disease.

Cardiopulmonary exercise testing is widely used in clinical assessment and exercise prescription. However, significant differences in physiological responses can occur depending on testing protocol. The aim of this study was to evaluate the cardiopulmonary responses to different incremental cycle pedaling cadences in cardiac patients.Eleven men with coronary artery disease (CAD) and 12 men with chronic heart failure (CHF) performed 2 maximal cycle tests at constant cadence (60-70 rpm, at fixed cadence) and at progressive cadence. Peak values for oxygen uptake (V(O(2)peak)), workload (W(peak)), and heart rate (HR(peak)); ventilatory threshold (VT); and the oxygen uptake (VO2) per unit work rate (WR) increment (ΔV(O(2))/ΔWR) obtained using 2 protocols were determined.V(O(2)peak) and W(peak), respectively, were higher during increasing cadence (INCR) compared with fixed cadence (FIX) protocol both in patients with CAD (32.7 ± 5.4 vs 28.1 ± 7.0 mL · kg(-1) · min(-1), P = .01; 214 ± 42 vs 150 ± 28 W, P = .001) and in patients with CHF (20.3 ± 7.4 vs 17.2 ± 5.5 mL · kg(-1) · min(-1), P = .006; 133 ± 45 vs 104 ± 33 W, P = .005). No differences were seen in HR(peak). Both in patients with CAD and in patients with CHF, V(O(2)) (21.7 ± 5.5 vs 16.8 ± 5.3 and 12.3 ± 7.4 vs 9.3 ± 2.8 mL · kg(-1) · min(-1)) and HR (114 ± 14 vs 98 ± 13 and 92 ± 17 vs 80 ± 17 bpm) at VT were significantly higher in INCR than in FIX protocol. No differences were seen in workload at VT. ΔV(O(2))/ΔWR during INCR protocol were higher in patients with CAD (13.4 ± 1.8 vs 9.5 ± 2.6 mL · kg(-1) · W(-1), P = .006) and patients with CHF (13.6 ± 4.1 vs 8.7 ± 1.9 mL · kg(-1) · W(-1), P = .006).These findings indicate that in tests at fixed cadence, there occurs an earlier activation of the anaerobic mechanisms leading to a premature exhaustion before a cardiopulmonary endpoint has been achieved.

The purposes of this study were to compare the patterns of the work rate (WR)-Vo2 and WR-heart rate (HR) relationships in incremental cycling, to ascertain the occurrence of a Vo2 deflection (Vo2def) coinciding with the HR deflection point (HRdef ), and to determine whether the Vo2def, if present, coincides with the ventilatory anaerobic threshold (VT). Twenty-four professional cyclists performed a maximal incremental test on a wind-load cycle ergometer. Work rate, HR, Vo2, and Vco2 were recorded. The WR-Vo2 relationships obtained were linear up to submaximal WR and curvilinear thereafter and thus described a Vo2def. The WR and Vo2 at Vo2def were mathematically determined for all subjects. The ratio of DeltaWR.DeltaVo2 up to Vo2def was significantly lower than that above Vo2def (90 +/- 11 W.L.min versus 133 +/- 35 W.L.min, p < 0.0001). The WR-HR relationships obtained were linear up to submaximal WR and curvilinear thereafter. The WR and HR at HRdef were mathematically determined for all subjects. The WR values at Vo2def and at HRdef (329 +/- 32 W and 326 +/- 34 W) were significantly correlated (R = 0.96, p < 0.0001) and in good concordance (limits of agreement from -4.7% to 3.2%, Bland-Altman analysis). The Vo2 at VT was then determined for all subjects. The Vo2 values at Vo2def and at VT were significantly correlated (R = 0.99, p < 0.0001) and in strong concordance (limits of agreement from -1.9% to 1.0%, Bland-Altman analysis). In conclusion, a Vo2def coinciding with HRdef and VT was shown. This confirms that the determination of the WR-HR relationship and of HRdef is a practical and noninvasive means of identifying anaerobic threshold.

Background Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E). Methods and Results A total of 143 patients with claudication (117 men, average age 68±10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise heart rates (HR), systolic/diastolic brachial pressure (SBP/DBP), ankle pressure (AP), ankle-brachial index (ABI). Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital. Tr-E involved 20-30 min of daily walking at self-selected speeds up to pain tolerance. A total of 126 patients (Ti-To, n=74; Tr-E, n=52) completed the program. Ti-To induced better relief from claudication (p=0.001). Functional parameters improved significantly for both groups (p

Objective. To evaluate a new treadmill test, determining pain threshold speed (PTS) for use in assessment and measuring rehabilitation of patients with intermittent claudication. Methods and design. Twenty-nine patients with claudication were evaluated, and the ankle-brachial index (ABI) was assessed. PTS was determined with a treadmill protocol based on level walking, low starting speed, and progressive increments at a predetermined distance up to the onset of pain. Repeatability and equivalence with a time-based protocol were verified. PTS was compared to pain-free walking distance, 6-minute walking distance, and ABI. Results. PTS was measured in all patients (3.6±1.1 km/h). Repeatability and equivalence between established tests were demonstrated. PTS showed a significant correlation with pain-free walking distance (r=0.833; P=0.0001), with 6-minute walking distance (r=0.724; P=0.005), and with ABI in the more ischemic limb (r=0.641; P=0.0001). Conclusions. PTS is a reliable parameter that correlates well with other established measures. It is useful for determining the degree of functional handicap and for designing and guiding rehabilitation protocols.

The purpose of this study was to develop a test for identifying the speed of onset of claudication, or pain threshold speed (PTS), in 16 patients affected by intermittent claudication. An echo-Doppler examination and the ankle-brachial index (ABI) determination were also performed. Test repeatability was evaluated in 10 patients retested within a few days. All 16 patients underwent the incremental walking test 3 times during a 6-month rehabilitation training program to verify the test's sensitivity in detecting the expected functional modifications. PTS was identified in all patients examined and the test-retest correlation coefficient (R) for PTS was 0.98. During the 6-month rehabilitation period, the ABI rose from 0.43 +/-0.16 to 0.72+/-0.15 for the worst limb and PTS also rose significantly from 3.9+/-1.4 km/h to 6.1+/-1.1 km/h. The average increments of ABI and PTS were significantly correlated. An incremental walking test for the identification of the walking speed at which claudication occurs has been developed. The PTS is a reproducible parameter that can be combined with other test results to establish the severity of the disease and to check any modifications that occur during rehabilitation.

Objectives The aims of the study were to organise a program of guided walking for sedentary subjects, to analyse the changes of some risk factors for cardiovascular diseases after one year of walking and to check the permanence of unsupervised walking practice months after the program was over. Methods 650 adults and elderly subjects, declaring only occasional physical activity, were enrolled. Weight, height, waist circumference, systolic and diastolic blood pressure and walking speed (measured on a 100 metres course, at an intensity of 12-14 on the Borg scale) were determined at enrolment. Subjects were invited to walk as frequently as possible alone or with one of the several walking groups organised for the project. Walking groups were active five days a week with walking sessions of approximately one hour. The variables measured at enrolment were re-determined after one year. Sixteen month after the end of the project the participants completing the program fill in a questionnaire on the weekly walking hours they were still doing. Results 326 subjects (212 women and 114 men) walked from three to seven days a week and completed the one-year project. After 12 months of walking, highly significant reductions of body weight, BMI, waist circumference, systolic and diastolic blood pressure and highly significant increase in walking speed were documented1(Table 1). Identical results were obtained for both women and men. Sixteen months after the end of the project 258 subjects declared 170 ± 110 minutes a week of independent walking (Figure 1), a time superimposable to the one indicated by the 2008 Physical Activity Guidelines for Americans. Conclusions One year of guided walking has been followed by highly significant reductions of some risk factors for cardiovascular diseases and by a highly significant improvement of the walking speed. Sixteen months after the end of the project, 77% of the participants were independently maintaining the walking practice, indicating that guided walking is effective in permanently modifying the lifestyle of sedentary subjects. Acknowledgments Supported by the Italian Ministry of Education and Scientific Research and the Ministry of Sport. References Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials. Prev Med. 2007;44(5):377–85.

Background/Aim Cardiovascular diseases (CVD) are the leading cause of mortality in the world and 9produce immense global health and economic burdens9, mostly attributable to hospital costs.1 The determination of peak oxygen consumption (VO2peak) is used for assessing disease severity, predicting prognosis, and examining the effectiveness of training programs for individuals with CVD.2 Aim of the study was to determine the association between VO2peak estimated by a moderate 1-km treadmill walk (1km-TWT)3 and all-cause hospitalization in cardiac outpatients. Methods We studied 1308 men aged 25-85 years at baseline, referred to our Center for an exercise-based secondary prevention programme. Participants were instructed to select a walking pace at a perceived intensity of 11-13 on the 6-20 Borg Scale to be maintained during the 1-km-TWT. The equation for VO2peak estimation was applied considering age, BMI, heart rate, and time to complete the 1-km3. All-cause hospitalization was checked 3 years after enrollment. Results Patients were subdivided into tertiles of VO2peak. Estimated VO2peak resulted 19.62.4, 23.81.1, and 29.03.0 mL/kg/min for the first (n=436, LOW FIT), second (n=436, MODERATE FIT), and third (n=436, HIGH FIT) tertile, respectively. During the following 3 years, hospitalizations were 203 for LOW FIT group (47% of the sample), 151 for MODERATE FIT group (35% of the sample), and 109 for HIGH FIT group (25% of the sample) (Figure). Compared to the LOW FIT group, the fully-adjusted hazard ratios for hospitalization were 0.79 (95%CI 0.59 to 1.05, P=0.10) for the MODERATE FIT group, and 0.53 (95%CI 0.35 to 0.79, P=0.002) for the HIGH FIT group (P for trend ≥0.0001). Hospital stay was 3654, 1963, and 1090 days for LOW, MODERATE, and HIGH FIT groups, respectively. The mean healthcare costs for hospitalization during the 3-years tracking period were 36% and 64% lower in the HIGH FIT and MODERATE FIT groups versus LOW FIT group (1.74, 1.11, and 0.63 million euros respectively). Conclusions An inverse association was found between exercise capacity and all-cause hospitalization in stable outpatients with cardiovascular disease. The lower VO2peak was associated with higher rates of hospitalization, independently of traditional cardiovascular risk factors and disease severity. The higher the baseline VO2peak, the lower the hospitalization rate, the shorter the length of hospital stay, and the lower the corresponding healthcare costs. The 1km-TWT represents a simple tool for assessing cardiorespiratory fitness and for predicting prognosis in patients with CVD. References Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update. A Report From the American Heart Association. Circulation 2015;131:e29–e322. Arena R, Myers J, Williams A, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation 2007;116(3):329–43. Chiaranda G, Myers J, Mazzoni G, et al. Peak oxygen uptake prediction from a moderate, perceptually regulated, 1-km treadmill walk in Male cardiac patients. J Cardiopulm Rehabil Prev 2012;32:262–9.

Many transmeridian travellers, including top athletes, regularly take melatonin to reduce negative jet lag symptoms. Standard (rather than individually tailored) doses are often used. We examined the effects of a standard dose of melatonin on the body temperature rhythms of 12 elite biathletes (eight men and four women) after an eastward transmeridian flight to an international competition. The different effects on body temperature rhythms in men versus women underscore the need for personalized dosing schedules to avoid potential undesirable consequences.

Objective To determine whether the walking speed maintained during a 1 km treadmill test at moderate intensity predicts survival in patients with cardiovascular disease. Design Population-based prospective study. Setting Outpatient secondary prevention programme in Ferrara, Italy. Participants 1255 male stable cardiac patients, aged 25–85 years at baseline. Main outcome measures Walking speed maintained during a 1 km treadmill test, measured at baseline and mortality over a median follow-up of 8.2 years. Results Among 1255 patients, 141 died, for an average annual mortality of 1.4%. Of the variables considered, the strongest predictor of all-cause mortality was walking speed (95% CI 0.45 to 0.75, p

The aim of this study is to assess the association between peak oxygen uptake (VO2 peak), determined using a perceptually regulated 1-km walking test (1k-TWT), and all-cause mortality in cardiac patients.1255 male patients, aged 25-85 years, completed a moderate 1k-TWT to estimate VO2 peak. Subjects were followed for all-cause mortality for up to 10 years. Cox proportional hazard models were employed to determine variables associated with mortality. Based on the estimated VO2 peak, the sample was subdivided into quartiles and mortality risks were calculated. To assess the discriminatory accuracy of the estimated VO2 peak for estimating survival, receiver-operating-characteristics curves were constructed.During a median 8.2 year follow-up, a total of 141 deaths from any cause occurred, yielding an average annual mortality of 1.4%. The strongest predictor of all-cause mortality was the estimated VO2 peak (c-statistic 0.71, 95% confidence intervals: 0.69-0.74, P0.0001). Survival decreased in a graded fashion from the highest estimated VO2 peak quartile to the lowest quartile. Compared to the lowest quartile, the hazard ratios (95% confidence intervals) for the second, third, and fourth quartiles were 0.77 (0.35-1.33), 0.43 (0.20-0.91), and 0.16 (0.05-0.54) respectively (P for trend0.0001). An 89% reduction in mortality risk was observed among a subset of subjects in the fittest quartile who improved their estimated VO2 peak over the follow-up period relative to subjects in the least fit quartile who did not improve.VO2 peak estimated by a novel 1k-TWT predicts survival in subjects with stable cardiovascular disease.

to involve a group of general practitioners (GPs) in a programme for prescribing physical activity (PhA) for patients with type 2 diabetes; to document, for each patient, the amount of physical activity carried out and the modifications in biomedical variables and in the medical expenses possibly occurring after the PhA programme.48 GPs joined the project. The beneficial effects of regular PhA on diabetes were presented to each patient enrolled. Walking daily for at least 15 minutes was suggested. A booklet with specific instructions and a step meter were given to each patient. Diet programmes were not modified.average daily PhA; values of Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, blood glucose and HbA1c, blood cholesterol (total, LDL, HDL) and triglycerides determined before and at the end of the programme; pharmaceutical expenses attributed to the enrolled patients in 2008 (the year preceding the PhA programme) and in 2010 (the year of end of the PhA programme).of the 1,005 patients enrolled, 766 indicated their daily PhA. In all patients, and especially in those who presented values outside the norm in the variables considered at the start of the programme, improvements up to normalization were observed. A reduction in pharmaceutical expenses proportional to the PhA carried out was documented in the more active group of patients, who walked 1 km or more daily.the domiciliary PhA recommended by 48 GPs for 1,005 patients with type 2 diabetes enrolled in the programme was carried out by 766 subjects. The biomedical improvements and the reduction in pharmaceutical expenses, proportional to the PhA carried out, are in keeping with other reports in the literature. The major finding of this project is that GPs can effectively prescribe PhA to their patients who suffer form sport-sensitive diseases, such as type 2 diabetes.

The purposes of this study were to compare the patterns of the work rate (WR)-Vo2 and WR-heart rate (HR) relationships in incremental cycling, to ascertain the occurrence of a Vo2 deflection (Vo2def) coinciding with the HR deflection point (HRdef ), and to determine whether the Vo2def, if present, coincides with the ventilatory anaerobic threshold (VT). Twenty-four professional cyclists performed a maximal incremental test on a wind-load cycle ergometer. Work rate, HR, Vo2, and Vco2 were recorded. The WR-Vo2 relationships obtained were linear up to submaximal WR and curvilinear thereafter and thus described a Vo2def. The WR and Vo2 at Vo2def were mathematically determined for all subjects. The ratio of DeltaWR.DeltaVo2 up to Vo2def was significantly lower than that above Vo2def (90 +/- 11 W.L.min versus 133 +/- 35 W.L.min, p0.0001). The WR-HR relationships obtained were linear up to submaximal WR and curvilinear thereafter. The WR and HR at HRdef were mathematically determined for all subjects. The WR values at Vo2def and at HRdef (329 +/- 32 W and 326 +/- 34 W) were significantly correlated (R = 0.96, p0.0001) and in good concordance (limits of agreement from -4.7% to 3.2%, Bland-Altman analysis). The Vo2 at VT was then determined for all subjects. The Vo2 values at Vo2def and at VT were significantly correlated (R = 0.99, p0.0001) and in strong concordance (limits of agreement from -1.9% to 1.0%, Bland-Altman analysis). In conclusion, a Vo2def coinciding with HRdef and VT was shown. This confirms that the determination of the WR-HR relationship and of HRdef is a practical and noninvasive means of identifying anaerobic threshold.

Exercise training reduces walking disability in peripheral arterial disease (PAD). This non-randomized study evaluates the effects on walking ability and hemodynamic parameters of a novel approach to home-based rehabilitation, the test in -train out program (Ti-To), compared with the traditional home-based free walking exercise (Tr-E).A total of 143 patients with claudication (117 men, average age 68+/-10 years), were included in a Ti-To (n=83) or Tr-E program (n=60). Evaluations, which were carried out upon entry and at 1, 2, 3, 4 and 6 months, included: self-reported claudication, walking ability (ie, absolute claudication distance, pain threshold speed), resting/exercise heart rates (HR), systolic/diastolic brachial pressure (SBP/DBP), ankle pressure (AP), ankle-brachial index (ABI). Ti-To involved 2 daily 10-min home walking sessions at maximal asymptomatic speed and the patient attending monthly check-ups at hospital. Tr-E involved 20-30 min of daily walking at self-selected speeds up to pain tolerance. A total of 126 patients (Ti-To, n=74; Tr-E, n=52) completed the program. Ti-To induced better relief from claudication (p=0.001). Functional parameters improved significantly for both groups (p0.0001) with significant intergroup difference for Ti-To (p0.0001). SBP and exercise HR decreased significantly in both groups, with Ti-To improving resting HR (p=0.0002), DBP (p=0.003), lowest AP worse limb (p=0.004) and ABI worse limb (p=0.0002).In patients with PAD, a Ti-To program had more positive effects on perceived claudication, and functional and hemodynamic parameters than did a Tr-E program.

Objective: To assess the effectiveness of domiciliary physical fitness programmes in obese individuals. Design: Nine-month randomized controlled trial. Setting: Home-based intervention with outpatient visits. Subjects: Morbidly obese subjects (body mass index (BMI) ≥30) aged 25—65 years suitable for physical activities at home. Intervention: At the end of a preliminary one-month in-hospital rehabilitation programme (baseline), 52 patients were randomly assigned either to a structured educational programme (intervention group) of daily incremental physical activity at home (walking and skeletal muscle resistance training, with booklets and written instructions) or to a programme of general advice (control group) regarding exercise and long-term fitness. Main measures: Both groups were evaluated at baseline and every three months for: (1) time, metabolic equivalents (METs), and heart rate reserve (HRR) during a standardized 2-km walking test (2kmWT); (2) anthropometric measures (body weight, BMI, abdominal and neck circumference); (3) the Polar Fitness Test index (PFTI), and (4) time to exhaustion while sustaining consecutive isoload extensions in the dominant leg (isoload LE). Time during 2kmWT was the study primary outcome. Results: Body weight, BMI and abdominal circumference improved significantly (P Conclusion: This structured domiciliary fitness programme is feasible and provides sustained anthropometric and physiological benefits in some morbidly obese individuals.

Summary Three TaqI restriction fragment length polymorphisms (RFLP) detected by the central portion of von Willebrand factor cDNA, which recognizes the true gene and in addition pseudogenic sequences, were characterized and mapped. Small cDNA fragments which hybridized with DNA from families with von Willebrand disease were used. Two of the RFLP, recognized by 1.7 and 0.45 kb cDNA fragments, are not in linkage either with von Willebrand disease or with RFLP located in the von Willebrand factor (vWF) gene, which indicates their pseudogenic location. These markers located in 22q11, near to the bcr gene, provide new tools for the study of several somatic and constitutional alterations affecting this chromosomal region. The third RFLP is recognized by a cDNA fragment corresponding to the N-terminal portion of mature vWF and is localized in the true gene. Since significant linkage disequilibrium with other informative RFLP is not present, this marker contributes to the definition of family haplotypes associated with von Willebrand disease.

Increased frequency of the homozygous II ACE genotype in Italian Olympic endurance athletes

The protocol for the determination of the speed/heart rate relationship during incremental exercise previously described (so-called Conconi test) has been refined and in part modified during 12 years of application. The new protocol calls for time-based increments in exercise intensity that are uniform up to submaximal speeds and progressively greater in the final phase. As in the original article (18), the speed/heart rate relationship is linear at low to moderate speed and curvilinear from submaximal to maximal speeds. A method is presented for the mathematical definition of this relationship, with the calculation of the straight-line equation of the linear phase and the identification of the point of transition from the linear to the curvilinear phase (deflection point or heart rate break-point). Analysis of 300 tests selected at random from those in our data base (more than 5,000 tests) has enabled us to show that the speed at which the deflection point occurs is significantly lower (p < 0.001) than that at which the acceleration of the final phase begins. This fact demonstrates that the break-point is not brought on by the final acceleration called for in the test protocol. Analysis of the speed/heart rate relationship allows for the determination of the following additional functional indices: 1) maximal heart rate (in 21 athletes the maximal heart rate attained in the test and that attained while racing were equal); 2) range of heart beats defining the linear part of the speed/heart rate relationship; 3) range of heart beats from the deflection point to maximal heart rate; and 4) maximal aerobic exercise intensity, obtained through extrapolation of the straight-line equation to maximal heart rate. Data are provided on the conditions of the test subject that modify his speed/heart rate relationship, such as incomplete recovery from previous efforts, inadequate warm-up, or inadequate test procedure with too rapid increments in exercise intensity. Finally, criteria for test acceptability are presented.

An abnormal von Willebrand factor (vWF) gene restriction pattern has been found in a patient with von Willebrand disease. Because this gene alteration is not present in his parents or in 50 normal and 25 affected subjects, and the restriction fragment length polymorphism haplotypes are inherited normally in the patient's family, we suggest that a de novo mutation is present. Bands with reduced intensity and additional fragments, observed in several restriction digests, hybridize with noncontiguous copy DNA (cDNA) portions, thus indicating the presence of a heterozygous gene deletion. The deletion removes a genomic region containing at least codons 1147 through 1854 and corresponding to the D3-A3 homologous protein domains. The extent of the vWF pseudogene on chromosome 22 is roughly similar to that of the deleted area. However, the pseudogenic nature of the deletion is excluded by the mapping of bands with reduced intensity in the patient to the true vWF gene. The vWF antigen levels are one fourth of normal and ristocetin cofactor activity is severely impaired. The reduction of high molecular weight multimers in plasma and platelets and the altered triplet morphology are compatible with the presence of a dominant variant of type II von Willebrand disease.

The purpose of this study was to update and standardize the test for determining the power output/heart rate (PO/HR) relationship in cycling.The current protocol was developed in the laboratory using a wind-load cycling simulator. Five hundred incremental tests were carried out by 290 male cyclists during a 2-yr period (1995-1997). The subjects' own bicycles, equipped with a standard crankset with a built-in power measuring system, were used for testing. The test protocol consisted of time-based increments in cadence that were uniform up to submaximal speeds and progressively greater in the final phase.The PO/HR relationship obtained was linear at low to submaximal PO and curvilinear from submaximal to maximal PO. A method was developed for the mathematical identification of the point of transition from the linear to the curvilinear phase (deflection point or heart rate break point). In 484 of the 500 tests performed, the deflection was independent of the final acceleration (PO at deflection 318.4 +/- 42.4 W, PO at final acceleration 351.6 +/- 43.2 W, P0.001), whereas in 16 tests the deflection and the start of the final acceleration coincided. To evaluate test repeatability and precision, 15 subjects repeated the test twice within a few days. No significant differences were found for the heart rate at deflection, power output at deflection, or slope of the linear part of the PO/HR relationship obtained in the two tests.It is concluded that the deflection point obtained by determining the PO/HR relationship on a wind-load simulator is not an artifact dependent on the incremental test protocol but rather a repeatable physiological phenomenon.

Serum testosterone concentration was determined before and after physical activities of different duration. The subjects under study were: (1) 7 competitive walkers before and after a 20-km race (average race time 1 h 30 min); (2) 9 middle-distance runners before and after 1-h training; (3) 16 marathon runners before and after a marathon run (average running time 2 h 33 min); (4) 30 ultramarathon runners before and after a 107-km race (average running time 14 h). Serum testosterone increased by 51.8% (NS) in competitive walkers, by 38.2% (P less than 0.05) in middle-distance runners, and by 44.9% (P less than 0.01) in marathon runners; it decreased by 31.9% (P less than 0.001) in the ultramarathon runners. These findings, and similar variations of serum testosterone observed in an ultramarathon runner during a 6-h training session, suggest that serum testosterone increases during physical activities lasting up to 3 h and decreases to or even below the pre-exercise values for longer physical efforts. The possible mechanisms responsible for these differences are discussed.

The relationship between running speed (RS) and heart rate (HR) was determined in 210 runners. On a 400-m track the athletes ran continuously from an initial velocity of 12–14 km/h to submaximal velocities varying according to the athlete's capability. The HRs were determined through ECG. In all athletes examined, a deflection from the expected linearity of the RS-HR relationship was observed at submaximal RS. The test-retest correlation for the velocities at which this deflection from linearity occurred (Vd) determined in 26 athletes was 0.99. The velocity at the anaerobic threshold (AT), established by means of blood lactate measurements, and Vd were coincident in 10 runners. The correlation between Vd and average running speed (mean RS) in competition was 0.93 in the 5,000 m (mean Vd = 19.13 +/- 1.08 km/h; mean RS = 20.25 +/- 1.15 km/h), 0.95 in the marathon (mean Vd = 18.85 +/- 1.15 km/h; mean RS = 17.40 +/- 1.14 km/h), and 0.99 in the 1-h race (mean Vd = 18.70 +/- 0.98 km/h; mean RS = 18.65 +/- 0.92 km/h), thus showing that AT is critical in determining the running pace in aerobic competitive events.