Publications by authors named "Dominique Hansen"

130 Publications

The importance of ventilatory thresholds to define aerobic exercise intensity in cardiac patients and healthy subjects.

Scand J Med Sci Sports 2021 Jun 25. Epub 2021 Jun 25.

Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.

Background: Although structured exercise training is strongly recommended in cardiac patients, uncertainties exist about the methods for determining exercise intensity (EI) and their correspondence with effective EI obtained by ventilatory thresholds. We aimed to determine the first (VT ) and second ventilatory thresholds (VT ) in cardiac patients, sedentary subjects, and athletes comparing VT and VT with EI defined by recommendations.

Methods: We prospectively enrolled 350 subjects (mean age: 50.7±12.9 years; 167 cardiac patients, 150 healthy sedentary subjects, and 33 competitive endurance athletes). Each subject underwent ECG, echocardiography, and cardiopulmonary exercise testing. The percentages of peak VO , peak heart rate (HR), and HR reserve were obtained at VT and VT and compared with the EI definition proposed by the recommendations.

Results: VO at VT corresponded to high rather than moderate EI in 67.1% and 79.6% of cardiac patients, applying the definition of moderate exercise by the previous recommendations and the 2020 guidelines, respectively. Most cardiac patients had VO  values at VT corresponding to very-high rather than high EI (59.9% and 50.3%, by previous recommendations and 2020 guidelines, respectively). A better correspondence between ventilatory thresholds and recommended EI domains was observed in healthy subjects and athletes (90% and 93.9%, respectively).

Conclusions: EI definition based on percentages of peak HR and peak VO  may misclassify the effective EI, and the discrepancy between the individually determined and the recommended EI is particularly relevant in cardiac patients. A ventilatory threshold-based rather than a range-based approach is advisable to define an appropriate level of EI.
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http://dx.doi.org/10.1111/sms.14007DOI Listing
June 2021

Cycling: how can we activate care-dependent older adults with a mild cognitive impairment?

Disabil Rehabil Assist Technol 2021 Jun 8:1-8. Epub 2021 Jun 8.

REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.

Purpose: In residential care, 50% of older adults are sedentary in most of their time, regardless of the positive impact of physical exercise on health. This study analysed whether television images positively impact the motivation and exercise intensity of cycling exercises of older adults in residential care.

Methods: In this randomised controlled cross-over study, 10 residential older adults (mean age 85.0 ± 5.7 years) with Mild Cognitive Impairment (MCI) participated in 3 different cycling exercise interventions (TV off, TV turned on the National Geographic channel (NG) and TV with MemoRide software (Activ84Health, Leuven, Belgium) (MR) (cybercycling)) compared with a rest condition.

Results: The participants cycled significantly more distance during NG compared with TVoff ( = 0.024). In comparison to the rest condition, the mean heart rate was significantly higher in all exercise conditions while the maximal heart rate was only higher during NG ( = 0.022). There was no difference in the Borg scale between the different exercise interventions. Interest and enjoyment scored significantly higher during NG ( = 0.014) and MR ( = 0.047) compared to the rest condition and in the NG versus TVoff ( = 0.018). No significant differences were observed in the emotions of the participants.

Conclusions: This study has shown indications that the addition of television images may increase the exercise intensity and motivation to exercise in residential older adults with MCI. However, the overall levels of physical activity were insufficient to meet the recommendations for moderate-intense aerobic exercise according to the International Association of Gerontology and Geriatrics and Global Ageing Research Network.Implications for rehabilitationCycling in front of a television increases the exercise volume and motivation to exercise in residential (pre)frail older adults with MCICybercycling had no additional effect in comparison to television images not linked to the exercise.Even with television images (pre)frail older adults with MCI did not meet the recommendations for moderate-intense aerobic exercise for residential older adults according to the IAGG-GARN.
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http://dx.doi.org/10.1080/17483107.2021.1936665DOI Listing
June 2021

Exercise intensity assessment and prescription in cardiovascular rehabilitation and beyond: why and how: a position statement from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2021 Jun 2. Epub 2021 Jun 2.

Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy.

A proper determination of the exercise intensity is important for the rehabilitation of patients with cardiovascular disease (CVD) since it affects the effectiveness and medical safety of exercise training. In 2013, the European Association of Preventive Cardiology (EAPC), together with the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation, published a position statement on aerobic exercise intensity assessment and prescription in cardiovascular rehabilitation (CR). Since this publication, many subsequent papers were published concerning the determination of the exercise intensity in CR, in which some controversies were revealed and some of the commonly applied concepts were further refined. Moreover, how to determine the exercise intensity during resistance training was not covered in this position paper. In light of these new findings, an update on how to determine the exercise intensity for patients with CVD is mandatory, both for aerobic and resistance exercises. In this EAPC position paper, it will be explained in detail which objective and subjective methods for CR exercise intensity determination exist for aerobic and resistance training, together with their (dis)advantages and practical applications.
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http://dx.doi.org/10.1093/eurjpc/zwab007DOI Listing
June 2021

Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA).

Eur J Prev Cardiol 2021 Jan 26. Epub 2021 Jan 26.

Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.

Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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http://dx.doi.org/10.1093/eurjpc/zwaa121DOI Listing
January 2021

Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation.

J Clin Med 2021 Apr 15;10(8). Epub 2021 Apr 15.

Department of Translational Medical Sciences, "Federico II" University of Naples, 80131 Naples, Italy.

Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual's clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting.
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http://dx.doi.org/10.3390/jcm10081696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071180PMC
April 2021

Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study.

Can J Diabetes 2021 Jan 23. Epub 2021 Jan 23.

Faculty of Rehabilitation Sciences, Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium; Faculty of Medicine and Life Sciences, Biomedical Research Centre, Hasselt University, Diepenbeek, Belgium; Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.

Objectives: Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity.

Methods: Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO).

Results: VO and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration.

Conclusions: Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.
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http://dx.doi.org/10.1016/j.jcjd.2021.01.010DOI Listing
January 2021

Computerized decision support for exercise prescription in cardiovascular rehabilitation: high hopes…but still a long way to go.

Eur J Prev Cardiol 2021 May;28(5):569-571

EDM-Expertise centre for Digital Media, Hasselt University, Wetenschapspark 2, 3590 Diepenbeek, Belgium.

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http://dx.doi.org/10.1093/eurjpc/zwaa105DOI Listing
May 2021

Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era.

Eur J Prev Cardiol 2021 05;28(5):541-557

IHF - Institut für Herzinfarktforschung, Ludwigshafen, Germany.

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from -5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 'for' and 10 'against' respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.
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http://dx.doi.org/10.1093/eurjpc/zwaa080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717287PMC
May 2021

Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients.

Eur J Prev Cardiol 2020 Nov 20. Epub 2020 Nov 20.

Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.

Aims: Type 2 diabetes mellitus (T2DM) is associated with reduced exercise capacity and cardiovascular diseases, both increasing morbidity and risk for premature death. As exercise intolerance often relates to cardiac dysfunction, it remains to be elucidated to what extent such an interplay occurs in T2DM patients without overt cardiovascular diseases. Design: Cross-sectional study, NCT03299790.

Methods And Results: Fifty-three T2DM patients underwent exercise echocardiography (semi-supine bicycle) with combined ergospirometry. Cardiac output (CO), left ventricular longitudinal strain (LS), oxygen uptake (O2), and oxygen (O2) extraction were assessed simultaneously at rest, low-intensity exercise, and high-intensity exercise. Glycaemic control and lipid profile were assessed in the fasted state. Participants were assigned according to their exercise capacity being adequate or impaired (EXadequate: O2peak <80% and EXimpaired: O2peak ≥80% of predicted O2peak) to compare O2 extraction, CO, and LS at all stages. Thirty-eight participants (EXimpaired: n = 20 and EXadequate: n = 18) were included in the analyses. Groups were similar regarding HbA1c, age, and sex (P > 0.05). At rest, CO was similar in the EXimpaired group vs. EXadequate group (5.1 ± 1 L/min vs. 4.6 ± 1.4 L/min, P > 0.05) and increased equally during exercise. EXimpaired patients displayed a 30.7% smaller increase in O2 extraction during exercise compared to the EXadequate group (P = 0.016) which resulted in a lower O2 extraction at high-intensity exercise (12.5 ± 2.8 mL/dL vs. 15.3 ± 3.9 mL/dL, P = 0.012). Left ventricular longitudinal strain was similar at rest but increased significantly less in the EXimpaired vs. EXadequate patients (1.9 ± 2.5% vs. 5.9 ± 4.1%, P = 0.004).

Conclusions: In asymptomatic T2DM patients, an impaired exercise capacity is associated with an impaired response in oxygen extraction and myocardial deformation (LS).

Trial Registry: Effect of High-intensity Interval Training on Cardiac Function and Regulation of Glycemic Control in Diabetic Cardiomyopathy (https://clinicaltrials.gov/ct2/show/NCT03299790).
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http://dx.doi.org/10.1093/eurjpc/zwaa007DOI Listing
November 2020

The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Jul 3. Epub 2020 Jul 3.

Faculty of Medicine and Life Sciences, UHasselt - Hasselt University, Belgium.

The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
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http://dx.doi.org/10.1177/2047487320939671DOI Listing
July 2020

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Apr 7. Epub 2020 Apr 7.

REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark.

Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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http://dx.doi.org/10.1177/2047487320913379DOI Listing
April 2020

Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance.

J Sport Health Sci 2021 Jan 30. Epub 2021 Jan 30.

Rehabilitation Research Centre (REVAL), Faculty of Rehabilitation Sciences, Hasselt University, Hasselt 3500, Belgium; Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt 3500, Belgium.

Background: Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing, which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular events. It is unknown whether cardiac chronotropic incompetence (CI) during maximal exercise is already present in obese adolescents and, if so, how that relates to cardiometabolic health.

Methods: Sixty-nine obese adolescents (body mass index standard deviation score = 2.23 ± 0.32, age = 14.1 ± 1.2 years; mean ± SD) and 29 lean adolescents (body mass index standard deviation score = -0.16 ± 0.84, age = 14.0 ± 1.5 years) performed a maximal cardiopulmonary exercise testing from which indicators for peak performance were determined. The resting heart rate and peak heart rate were used to calculate the maximal chronotropic response index. Biochemistry (lipid profile, glycemic control, inflammation, and leptin) was studied in fasted blood samples and during an oral glucose tolerance test within obese adolescents. Regression analyses were applied to examine associations between the presence of CI and blood or exercise capacity parameters, respectively, within obese adolescents.

Results: CI was prevalent in 32 out of 69 obese adolescents (46%) and 3 out of 29 lean adolescents (10%). C-reactive protein was significantly higher in obese adolescents with CI compared to obese adolescents without CI (p = 0.012). Furthermore, peak oxygen uptake and peak cycling power output were significantly reduced (p < 0.05) in obese adolescents with CI vs. obese adolescents without CI. The chronotropic index was independently related to blood total cholesterol (standardized coefficient β = -0.332; p = 0.012) and C-reactive protein concentration (standardized coefficient β = -0.269; p = 0.039).

Conclusion: CI is more common in the current cohort of obese adolescents, and is related to systemic inflammation and exercise intolerance.
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http://dx.doi.org/10.1016/j.jshs.2021.01.010DOI Listing
January 2021

Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise.

Eur J Appl Physiol 2021 Mar 8;121(3):929-940. Epub 2021 Jan 8.

REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.

Background And Purpose: The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls.

Methods And Results: Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (V̇O) and workload (W) were similar between groups (p > 0.05). Diastolic (E, e', E/e') and systolic function (left ventricular ejection fraction) were similar at rest and during exercise between groups (p > 0.05). LS (absolute values) was significantly lower at rest and during exercise in T2DM vs. HC (17.0 ± 2.9% vs. 19.8 ± 2% and 20.8 ± 4.0% vs. 23.3 ± 3.3%, respectively, p < 0.05). The response in myocardial deformation (the change in LS from rest up to peak exercise) was similar between groups (+ 3.8 ± 0.6% vs. + 3.6 ± 0.6%, in T2DM vs. HC, respectively, p > 0.05). Multiple regression revealed that HDL-cholesterol, fasted insulin levels and exercise tolerance accounted for 30.5% of the variance in response of myocardial deformation in the T2DM group (p = 0.002).

Conclusion: Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise.

Trial Registration: NCT03299790, initially released 09/12/2017.
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http://dx.doi.org/10.1007/s00421-020-04557-5DOI Listing
March 2021

Frailty is highly prevalent in specific cardiovascular diseases and females, but significantly worsens prognosis in all affected patients: A systematic review.

Ageing Res Rev 2021 03 14;66:101233. Epub 2020 Dec 14.

REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; BIOMED, Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.

Cardiologists are more often confronted with older (>60 years) cardiovascular disease (CVD) patients. These patients have particular needs in clinical care because, for example, of frailty. However, it remains to be established what is the prevalence of frailty in different CVD's and how it relates to mortality. In this systematic review studies were included if they: (i) examined subjects (men and women) aged ≥60 years who suffered from any CVD with or without cardiac surgery, (ii.) examined the presence of frailty with a well-defined frailty tool and (iii.) reported prevalence rates of frailty. From thirty studies comprising 96.841 participants, it is found that 1. Frailty is highly common in older patients with CVD (in particular in females (approximately 1.6 times more than in males), in heart failure (up to 80 % of patients) and aortic valve disease (up to 74 % of patients)), and 2. Frailty is related to a 2.5-3.5-fold elevated mortality risk, even in patients with less severe CVD (e.g. percutaneous coronary intervention). Moreover, there is a lack of consistency on how to assess frailty as up to 20 different tools/assessment batteries are currently used. It is concluded that frailty should be assessed in all older CVD patients in a uniform manner to enhance clinical care and outcomes.
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http://dx.doi.org/10.1016/j.arr.2020.101233DOI Listing
March 2021

Critical Reappraisal of the Role and Importance of Exercise Intervention in the Treatment of Obesity in Adults.

Sports Med 2021 Mar;51(3):379-389

REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Building A, 3590, AgoralaanDiepenbeek, Belgium.

In the treatment of obesity in adults, exercise intervention is recommended and some people with obesity even prefer exercise above dietary intervention as a single weight-loss strategy. However, evidence is accumulating that the long-term body weight and adipose tissue mass loss ​as a result of exercise intervention in these individuals is disappointingly small. Although this could be related to various clinical reasons, more recent evidence reveals that also (patho)physiological abnormalities are involved which cannot be remediated by exercise intervention, especially in metabolically compromised patients. As a result, the role and importance of exercise intervention in the treatment of obesity deserve significant reconsideration to avoid confusion and disappointment amongst clinicians, patients and society. Hence, to reduce adipose tissue mass and body weight, dietary intervention is much more effective than exercise intervention, and is, therefore, of key importance in this endeavour. However, dietary interventions must be supplemented by exercise training to induce clinically relevant changes in specific cardiovascular or metabolic risk factors like blood pressure, blood triglycerides and high-density lipoprotein cholesterol concentrations, as well as visceral adipose tissue mass, physical fitness, muscle mass and strength, quality of life and life expectancy. This allows individuals with obesity to preserve their cardiometabolic health or to shift from a metabolically unhealthy phenotype to a metabolically healthy phenotype. Signifying the true clinical value of exercise interventions might lead to a better understanding and appreciation of the goals and associated effects when implemented in the multidisciplinary treatment of obesity, for which a proper tailoring of exercise prescription is required.
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http://dx.doi.org/10.1007/s40279-020-01392-8DOI Listing
March 2021

Response.

Med Sci Sports Exerc 2020 09;52(9):2054

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http://dx.doi.org/10.1249/MSS.0000000000002366DOI Listing
September 2020

High Intensity Training to Treat Chronic Nonspecific Low Back Pain: Effectiveness of Various Exercise Modes.

J Clin Med 2020 Jul 27;9(8). Epub 2020 Jul 27.

Hasselt University, REVAL-Rehabilitation Research Center, BIOMED, Faculty of Rehabilitation Sciences, 3500 Hasselt, Belgium.

High-intensity training (HIT) improves rehabilitation outcomes such as functional disability and physical performance in several chronic disorders. Promising results were also found in chronic nonspecific low back pain (CNSLBP). However, the impact of different exercise modes on HIT effectiveness in CNSLBP remains unclear. Therefore, this study evaluated the effectiveness of various HIT exercise modes and compared differences between these modes, on pain intensity, disability, and physical performance, as a therapeutic intervention for persons with CNSLBP. In a randomized comparative trial, consisting of a 12-week program, persons with CNSLBP were divided into four HIT groups, i.e., cardiorespiratory interval training coupled with either general resistance training, core strength training, combined general resistance and core strength training, or mobility exercises. Before and after the program, the Numeric Pain Rating Scale (NPRS), Modified Oswestry Disability Index (MODI), and Patient Specific Functioning Scale (PSFS) were recorded, and a cardiopulmonary exercise test (VOmax, cycling time) and isometric trunk strength test (maximum muscle torque) were performed. Eighty participants (mean age: 44.0 y, 34 males) were included. Improvements were found within all groups after the HIT programs and ranged from -39 to -57% on the NPRS, +27 to +64% on the MODI, +38 to +89% on the PSFS, +7 to +14% on VOmax, and +11 to +18% on cycling time. No differences between groups were found. High-intensity cardiorespiratory interval training improves CNSLBP rehabilitation outcomes when performed with other HIT exercise modes or mobility exercises. Hence, when setting up an exercise therapy program in CNSLBP rehabilitation, various HIT modes can be considered as therapy modalities.
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http://dx.doi.org/10.3390/jcm9082401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465397PMC
July 2020

The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Jul 2:2047487320939671. Epub 2020 Jul 2.

Faculty of Medicine and Life Sciences, UHasselt - Hasselt University, Belgium.

The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.
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http://dx.doi.org/10.1177/2047487320939671DOI Listing
July 2020

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2020 Mar 30:2047487320913379. Epub 2020 Mar 30.

REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark.

Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
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http://dx.doi.org/10.1177/2047487320913379DOI Listing
March 2020

The importance of improving health literacy to lower cardiovascular risk in type 2 diabetes.

EClinicalMedicine 2020 Jan 4;18:100223. Epub 2019 Dec 4.

Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Hasselt, Belgium.

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http://dx.doi.org/10.1016/j.eclinm.2019.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978198PMC
January 2020

Towards Optimized Care After Bariatric Surgery by Physical Activity and Exercise Intervention: a Review.

Obes Surg 2020 Mar;30(3):1118-1125

Department of Abdominal Surgery, KU Leuven, Leuven, Belgium.

Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
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http://dx.doi.org/10.1007/s11695-020-04390-xDOI Listing
March 2020

Endurance Exercise Intervention Is Beneficial to Kidney Function in a Rat Model of Isolated Abdominal Venous Congestion: a Pilot Study.

J Cardiovasc Transl Res 2020 10 17;13(5):769-782. Epub 2019 Dec 17.

BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.

In this study, the effects of moderate intense endurance exercise on heart and kidney function and morphology were studied in a thoracic inferior vena cava constricted (IVCc) rat model of abdominal venous congestion. After IVC surgical constriction, eight sedentary male Sprague-Dawley IVCc rats (IVCc-SED) were compared to eight IVCc rats subjected to moderate intense endurance exercise (IVCc-MOD). Heart and kidney function was examined and renal functional reserve (RFR) was investigated by administering a high protein diet (HPD). After 12 weeks of exercise training, abdominal venous pressure, indices of body fat content, plasma cystatin C levels, and post-HPD urinary KIM-1 levels were all significantly lower in IVCc-MOD versus IVCc-SED rats (P < 0.05). RFR did not differ between both groups. The implementation of moderate intense endurance exercise in the IVCc model reduces abdominal venous pressure and is beneficial to kidney function.
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http://dx.doi.org/10.1007/s12265-019-09947-5DOI Listing
October 2020
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