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ObjectivesBalance quickly diminishes after the mid-50s increasing the risk for falls and other adverse health outcomes. Our aim was to assess whether the ability to complete a 10- s one-legged stance (10-second OLS) is associated with all-cause mortality and whether it adds relevant prognostic information beyond ordinary demographic, anthropometric and clinical data.MethodsAnthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020. Log-rank and Cox modelling were used to compare survival curves and risk of death according to ability (YES) or inability (NO) to complete the 10-s OLS test.ResultsOverall, 20.4% of the individuals were classified as NO. During a median follow-up of 7 years, 7.2% died, with 4.6% (YES) and 17.5% (NO) on the 10-s OLS. Survival curves were worse for NO 10-s OLS (log-rank test=85.6; p<0.001)) for NO individuals. Adding 10-s OLS to a model containing established risk factors was associated with significantly improved mortality risk prediction as measured by differences in −2 log likelihood and integrated discrimination improvement.ConclusionsWithin the limitations of uncontrolled variables such as recent history of falls and physical activity, the ability to successfully complete the 10-s OLS is independently associated with all-cause mortality and adds relevant prognostic information beyond age, sex and several other anthropometric and clinical variables. There is potential benefit to including the 10-s OLS as part of routine physical examination in middle-aged and older adults.

Background: Exercise tests are an important tool in the investigation of myocardial ischemia. The ramp protocol has gained increasing importance in clinical practice because of the possibility of individualizing its exercise intensity. Objective: To assess and compare the sensitivity, specificity, and accuracy of Bruce and ramp protocols for exercise testing in the diagnosis of myocardial ischemia considering myocardial perfusion scintigraphy as the reference standard. Secondary objectives included the assessment of hemodynamic profiles, functional capacity, and the incidence of arrhythmias in each of the protocols. Methods: Participants underwent exercise testing using the ramp and Bruce protocols, and the tests’ diagnostic power was assessed. For testing the difference between data provided by both protocols, we used a paired Student's t-test or Wilcoxon test, depending on the assumption of data normality. The level of significance adopted for all tests was 5%. Results: The ramp protocol showed sensitivity, specificity, and accuracy values of 55.6%, 82.4%, and 76.7%, respectively, whereas the Bruce protocol had results of 77.8%, 64.7%, and 67.4%, respectively. The maximum heart rate and double product at peak exercise were significantly higher in the Bruce protocol (p = 0.043 and p = 0.040, respectively). No differences were observed between the incidence of arrhythmias in both protocols. Conclusion: The Bruce protocol presented higher sensitivity for detecting ischemia on the exercise test, while the ramp protocol presented higher specificity and accuracy.

PURPOSE Medically supervised exercise programs (MSEPs) are equally recommended for men and women with cardiovascular disease (CVD). Aware of the lower CVD mortality in women, we hypothesized that among patients attending a MSEP, women would also have better survival. METHODS Data from men and women, who were enrolled in a MSEP between 1994 and 2018, were retrospectively analyzed. Sessions included aerobic, resistance, flexibility and balance exercises, and cardiopulmonary exercise test was performed. Date and underlying cause of death were obtained. Kaplan-Meier methods and Cox proportional hazards regression were used for survival analysis. RESULTS A total of 2236 participants (66% men, age range 33-85 yr) attended a median of 52 (18, 172) exercise sessions, and 23% died during 11 (6, 16) yr of follow-up. In both sexes, CVD was the leading cause of death (39%). Overall, women had a more favorable clinical profile and a longer survival compared to men (HR = 0.71: 95% CI, 0.58-0.85; P < .01). When considering those with coronary artery disease and similar clinical profile, although women had a lower percentage of sex- and age-predicted maximal oxygen uptake at baseline than men (58 vs 78%; P < .01), after adjusting for age, women still had a better long-term survival (HR = 0.68: 95% CI, 0.49-0.93; P = .02). CONCLUSION Survival after attendance to a long-term MSEP was better among women, despite lower baseline cardiorespiratory fitness. Future studies should address whether men and women would similarly benefit when participating in an MSEP.

Background Physical inactivity has been shown to be associated with all-cause mortality in both healthy and unhealthy middle-aged and older individuals. While regular exercise is equally recommended for men and women, it is virtually unknown if sex influences the long-term survival among participants of a medically-supervised exercise program (MSEP). Purpose To evaluate if cardiovascular and all-cause mortality differs between men and women who participates in a MSEP. Methods Retrospective data from an open cohort of individuals aged 36 to 85 years old (66% men) who participated in a private MSEP between March 1994 and December 2018 were analyzed. The participants were free to attend the exercise sessions anytime from 6 a.m. to 9:30 p.m. (Monday to Friday) or 7 a.m. to 4 p.m. (Saturday). In median, the participants completed 47 sessions (1 to 5992 sessions) and attended for 6 months. Exercise sessions last between 60–80 minutes on average and included aerobic, muscle power, flexibility and balance exercises for all participants. Depending on clinical condition, gross and fine motor coordination, inspiratory muscle and isometric handgrip training were also performed under direct supervision of a multiprofessional team. Before each exercise session, the participant was briefly assessed by the exercise physician amd the aerobic exercise part was individually prescribed based on pre-participation evaluation/previous session data. Kaplan-Meier survival curves were separately determined for men and women - cardiovascular and all-cause mortality - and statistically compared by log rank test. Results Men and women had identical mean ages of 62.5 years-old (p>0.99) and median follow-up was 11 years, ranging from 0.1 to 24.8 years. From a total of 2,238 participants wit different disorders (68% with coronary artery disease), 465 died (21%), with almost three times higher death rate for men (15.1%) as compared to women (5.7%) (p Conclusion Long-term cardiovascular and all-cause mortality were much higher in men than women that participated in a MSEP and these differences could not be explained by age. Future studies are needed to explain these findings and to analyze if men and women in MSEP would need similar dose of exercise for better survival benefit. Acknowledgement/Funding CNPq/FAPERJ/Health State Secretary

Background: Cardiorespiratory (aerobic) fitness is strongly and directly related to major health outcomes, including all-cause mortality. Maximum oxygen uptake (VO2max), directly measured by maximal cardiopulmonary exercise test (CPET), represents the subject’s aerobic fitness. However, as CPET is not always available, aerobic fitness estimation tools are necessary. Objectives: a) to propose the CLINIMEX Aerobic Fitness Questionnaire (C-AFQ); b) to validate C-AFQ against measured VO2max; and c) to analyze the influence of some potentially relevant variables on the error of estimate. Methods: We prospectively studied 1,000 healthy and unhealthy subjects (68.6% men) aged from 14 to 96 years that underwent a CPET. The two-step C-AFQ describes physical activities with corresponding values in metabolic equivalents (METs) - ranging from 0.9 to 21 METs. Results: Application of C-AFQ took less than two minutes. Linear regression analysis indicated a very strong association between estimated (C-AFQ) and measured (CPET) maximal METs - r2 = 0.83 (Sy.x = 1.63; p < .001) - with median difference of only 0.2 METs between both values and interquartile range (percentiles 25 and 75) of 2 METs. The difference between estimated and measured METs was not influenced by age, sex, body mass index, clinical condition, ß-blocker use or sitting-rising test scores. Conclusion: C-AFQ is a simple and valid tool for estimating aerobic fitness when CPET is unavailable and it is also useful in planning individual ramp protocols. However, individual error of estimate is quite high, so C-AFQ should not be considered a perfect substitute for CPET’s measured VO2max.

Background: Maximal oxygen consumption (VO2max) and ventilatory threshold (VT) obtained during a cardiopulmonary exercise test (CPX) are used in the evaluation of athletes. However, the identification of these variables may sometimes be unreliable, which limits their use. In contrast, the cardiorespiratory optimal point (COP) is a submaximal variable derived from CPX with objective measurement and prognostic significance. However, its behavior in athletes is unknown. Objective: To describe the behavior of COP in professional soccer players and its association with VO2max and VT. Methods: VO2max, VT and COP were obtained retrospectively from 198 soccer players undergoing maximal treadmill CPX using ramp protocol. COP was defined as the lowest value of the ventilation/oxygen consumption ratio in a given minute of the CPX. The soccer players were stratified according to their field position: goalkeeper, center-defender, left/right-back, midfielder and forwarder. Continuous variables were compared using unpaired Student t test or ANOVA, or Mann-Whitney test or Kruskal-Wallis test depending on their distribution, and categorical variables were compared using chi-square test. Pearson correlation was used to test the association between COP and other ventilatory variables. A level of 5% was used for statistical significance. Results: COP (mean ± SD) was 18.2 ± 2.1 and was achieved at a speed 4.3 ± 1.4 km.h-1 lower than that achieved at the VT. While VO2max (62.1 ± 6.2 mL.kg-1.min-1) tended to be lower in goalkeepers (p < 0.05), the COP did not vary according to field position (p = 0.41). No significant association was observed between COP and VO2max (r = 0.032, p = 0.65) or between COP and VT (r = -0.003, p = 0.96). Conclusion: COP can be easily determined during submaximal exercise performed with incremental speed in soccer players and does not vary according to the athlete’s field position. The absence of association with VO2max and VT indicates that COP provides distinct and complementary information to these variables. Future studies are needed to determine the practical implications of COP in assessing athletes. (Int J Cardiovasc Sci. 2018; [online].ahead print, PP.0-0)

Consideracoes preliminares Os animais livres sempre foram e serao seres fisicamente ativos, sendo o confinamento ou o sedentarismo condicoes antinaturais. O homem, tal como e conhecido hoje, foi capaz de partir de regioes centrais e, por seus proprios meios de locomocao (exercicio), espalhar-se por longinquas areas do planeta. Buscar alimento e agua e fugir de predadores, da infância ate a senilidade, sempre estiveram atrelados ao exercicio. De fato, o sedentarismo e muito recente na historia da humanidade. Antes de discutir [...]

Background: Physiological reflexes modulated primarily by the vagus nerve allow the heart to decelerate and accelerate rapidly after a deep inspiration followed by rapid movement of the limbs. This is the physiological and pharmacologically validated basis for the 4-s exercise test (4sET) used to assess the vagal modulation of cardiac chronotropism. Objective: To present reference data for 4sET in healthy adults. Methods: After applying strict clinical inclusion/exclusion criteria, 1,605 healthy adults (61% men) aged between 18 and 81 years subjected to 4sET were evaluated between 1994 and 2014. Using 4sET, the cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two RR intervals in the electrocardiogram: 1) after a 4-s rapid and deep breath and immediately before pedaling and 2) at the end of a rapid and resistance-free 4-s pedaling exercise. Results: CVI varied inversely with age (r = -0.33, p < 0.01), and the intercepts and slopes of the linear regressions between CVI and age were similar for men and women (p > 0.05). Considering the heteroscedasticity and the asymmetry of the distribution of the CVI values according to age, we chose to express the reference values in percentiles for eight age groups (years): 18–30, 31–40, 41–45, 46–50, 51–55, 56–60, 61–65, and 66+, obtaining progressively lower median CVI values ranging from 1.63 to 1.24. Conclusion: The availability of CVI percentiles for different age groups should promote the clinical use of 4sET, which is a simple and safe procedure for the evaluation of vagal modulation of cardiac chronotropism.