Publications by authors named "Evangelia Kouidi"

62 Publications

A Novel mHealth Monitoring System during Cycling in Elite Athletes.

Int J Environ Res Public Health 2021 Apr 30;18(9). Epub 2021 Apr 30.

Sports Medicine Laboratory, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, 57001 Thessaloniki, Greece.

Background: Cycling is a very demanding physical activity that may create various health disorders during an athlete's career. Recently, smart mobile and wearable technologies have been used to monitor physiological responses and possible disturbances during physical activity. Thus, the application of mHealth methods in sports poses a challenge today. This study used a novel mobile-Health method to monitor athletes' physiological responses and to detect health disorders early during cycling in elite athletes.

Methods: Sixteen high-level cyclists participated in this study, which included a series of measurements in the laboratory; health and performance assessments; and then application in the field of mHealth monitoring in two training seasons, at the beginning of their training period and in the race season. A field monitoring test took place during 30 min of uphill cycling with the participant's heart rate at the ventilatory threshold. During monitoring periods, heart rate, oxygen saturation, respiratory rate, and electrocardiogram were monitored via the mHealth system. Moreover, the SpO was estimated continuously, and the symptoms during effort were reported.

Results: A significant correlation was found between the symptoms reported by the athletes in the two field tests and the findings recorded with the application of the mHealth monitoring method. However, from the pre-participation screening in the laboratory and from the spiroergometric tests, no abnormal findings were detected that were to blame for the appearance of the symptoms.

Conclusions: The application of mHealth monitoring during competitive cycling is a very useful method for the early recording of cardiac and other health disorders of athletes, whose untimely evaluation could lead to unforeseen events.
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http://dx.doi.org/10.3390/ijerph18094788DOI Listing
April 2021

Arterial Function after a 246 km Ultra-marathon Running Race.

Int J Sports Med 2021 Apr 26. Epub 2021 Apr 26.

Department of Physical Education & Sports Science, Aristotle University of Thessaloniki, Sports Medicine Laboratory, Thermi, Greece.

There is little research about the effects of ultra-endurance exercise on arterial morphological and functional properties. The aim was to assess the acute changes of the carotid-femoral pulse wave velocity and carotid doppler-derived parameters following an ultra-marathon race as well as the intima-media thickness of the carotid artery in ultra-marathon runners. Twenty athletes were examined at baseline and within 10 mins after a 246 km running race. Measurements included carotid-femoral pulse wave velocity, peak-systolic and end-diastolic velocities of carotid artery blood flow, pulsatility and resistivity indices and blood biochemical parameters. The intima-media thickness of the right and left carotid artery was measured before the race. Arterial stiffness and carotid artery intima media thickness at rest remained within known normal limits. The ultra-marathon race significantly increased carotid-femoral pulse wave velocity by 22.6% and pulsatility index by 10.2%. There was a decrease in body weight by 3.35% and an increase of all biochemical markers of muscle damage after the race. Additionally, C-reactive protein was correlated with both pulsatility and resistivity indices post-race. This study shows that immediately after a 246 km ultra-marathon running race, acute increase of arterial stiffness and vascular resistance were evident. The carotid artery thickness of ultra-marathon runners was within normal range.
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http://dx.doi.org/10.1055/a-1467-6508DOI Listing
April 2021

Long-Term Effect of an Exercise Training Program on Physical Functioning and Quality of Life in Pulmonary Hypertension: A Randomized Controlled Trial.

Biomed Res Int 2021 26;2021:8870615. Epub 2021 Feb 26.

Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

The aim of this study was to evaluate the effects of a 6-month combined aerobic and strength exercise training program on functional and psychological aspects and health-related quality of life in patients with PH and to evaluate its longer-term impact. In total, 22 stable patients (mean age 53.9 ± 13.8, 13 female) with pulmonary hypertension of World Health Organization (WHO) class I-III participated in a nine-month study. They were randomly assigned into two groups: Group A participated in a 6-month combined aerobic and strength exercise training program, whereas Group B remained untrained. All patients underwent physical and psychological assessment at baseline and at month 6 (after completing the exercise program) and physical assessment after 9 months (3 months posttraining). After the 6-month exercise training program, patients of Group A significantly improved their physical (6MWD, STS 10 rep, STS 20 rep, TUG, lower limb strength, cardiopulmonary exercise time, METs, peak VO, VCO, and VE/VCO slope) and psychological aspects (SF-36, STAI, and BDI). Between the two groups, differences were observed at the 6MWD (95% CI: 36.2-64.6, = 0.72), STS 10 rep (95% CI: 6.6-2.2, = 0.4), STS 20 rep (95% CI: 10.8-2.4, = 0.34), lower limb strength (95% CI: 7.2-3.6, = 0.38), cardiopulmonary exercise time (95% CI: 0.1-3.3, = 0.2), and VCO (95% CI: 0.1-0.5, = 0.2). Additionally, psychological changes were noted at SF-36, PCS (95% CI: 3.6-14.8, = 0.35), MCS (95% CI: 1.3-16.1, = 0.22), TCS (95% CI: 1.3-16.1, = 0.22), and STAI (95% CI: 1.8-28.2, = 0.18). The favorable results of exercise were maintained at the 3-month posttraining follow-up assessment. No exercise-induced complications were observed throughout the study. In conclusion, a long-term exercise training program is a safe and effective intervention to improve functional status, psychological aspects, and health-related quality of life in patients with PH.
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http://dx.doi.org/10.1155/2021/8870615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936903PMC
February 2021

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

Eur J Prev Cardiol 2020 Nov 5. Epub 2020 Nov 5.

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
November 2020

The role of cardiac computed tomography in pre-participation screening of mature athletes.

Eur J Sport Sci 2021 Feb 28:1-14. Epub 2021 Feb 28.

Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece.

The overwhelming majority of sports-related sudden cardiac deaths in mature athletes is attributed to coronary artery disease (CAD). Coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be more stable and less likely to be associated with an acute coronary event. Cardiac computed tomography (CT), including unenhanced CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography, is characterized by very high negative predictive value to rule out CAD. Cardiac CT has been shown to have additional diagnostic value for detection of CAD in athletes over and above exercise electrocardiogram. Moreover, measurement of CACS possibly enables a more precise cardiovascular risk stratification of mature athletes. The main advantage of cardiac CT is its noninvasive nature. Although cardiac CT appears to increase the overall cost of cardiac examinations, this additional cost is much lower than the cost of unnecessary invasive coronary angiographies that would be performed in case of false positive results of exercise electrocardiograms. Radiation exposure may not be a major concern for the application of this modality to pre-participation screening of athletes, since recent technical advancements have resulted in low radiation dose of cardiac CT. Coronary computed tomography angiography can be used in pre-participation screening of mature athletes to increase the negative predictive value for excluding coronary artery disease.The identification of coronary artery calcium score = 0 in an athlete can improve risk stratification, since this athlete can be reasonably managed as an individual with low cardiovascular risk.
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http://dx.doi.org/10.1080/17461391.2021.1883125DOI Listing
February 2021

Sudden cardiac death in sports: could we save Pheidippides?

Acta Cardiol 2021 Jan 8:1-15. Epub 2021 Jan 8.

Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.
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http://dx.doi.org/10.1080/00015385.2020.1867388DOI Listing
January 2021

Comparative study of cardiorespiratory adaptations in elite basketball players of different age groups.

J Sports Med Phys Fitness 2020 12 3. Epub 2020 Dec 3.

Laboratory of Sports Medicine, Department of Physical Education & Sport Science, Aristotle University of Thessaloniki, Thermi, Greece.

Background: Systematic training of basketball causes morphological cardiac and cardiorespiratory adaptations. Previous studies have mainly focused either on only cardiac or respiratory changes. However, the extent of these cardiac adaptations and their relationship with aerobic capacity remain unclear in basketball athletes of different ages.

Methods: Eighty male basketball players participated in the experimental group and 80 healthy and sedentary male individuals served as controls. All participants underwent to athletic history, anthropometric measurements, 12-lead resting electrocardiogram (ECG), echocardiography, resting spirometry and cardiopulmonary exercise stress test.

Results: Left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic internal dimension (LVIDd), end-diastolic volume (EDV), stroke volume (SV) and interventricular septal thickness at diastole (IVSd) were significantly higher in all groups of athletes compared to controls (p<0.05). End-diastolic volume index (EDVI) was significant higher only in adult players compared to controls (p<0.05). Posterior wall thickness at diastole (PWd) was significantly greater in groups of children and adult players compared to controls (p<0.05). Maximal oxygen uptake (V̇ O2max) in relative values was higher in all groups of athletes compared to controls (P< 0.05).

Conclusions: The increased LVM is attributed to concentric hypertrophy. This is further supported by the finding that there was no relationship between V̇ O2max and echo parameters. The results of the present study indicate that the cardiorespiratory adaptations caused by basketball training are mainly formed in the early age stages without further increase throughout the years of action.
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http://dx.doi.org/10.23736/S0022-4707.20.11660-8DOI Listing
December 2020

The effects of an integrative training program on elite young soccer players' physical performance.

J Sports Med Phys Fitness 2021 Mar 30;61(3):335-342. Epub 2020 Jul 30.

Laboratory of Evaluation of Human Biological Performance, Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Background: The aim of this study was to investigate the effects of a short duration and low weekly frequency integrative program on sprint, agility and jump performance in elite youth soccer players.

Methods: Twenty-eight elite youth soccer players, members of two professional clubs, playing in the U19 developmental championship participated in this study. They were divided into 2 groups: the intervention group (EG, N.=15) and the control group (CG, N.=13). The duration of the intervention program was 8 weeks with a frequency of twice per week. The performance of the participants in the 10 meters and 30 meters speed, countermovement jump (CMJ), squat jump (SJ) and agility (Illinois agility test, Arrowhead agility test) was measured at the beginning and the end of the 8-week study.

Results: There was no statistically significant difference in any performance measured between the two groups.

Conclusions: The results of the present study indicate that the addition of allowing frequency and short duration training intervention program did not enhance the physical fitness indicators, in high-level young soccer players.
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http://dx.doi.org/10.23736/S0022-4707.20.11195-2DOI Listing
March 2021

Exploring the determinants of the cardiac changes after ultra-long duration exercise: The echocardiographic Spartathlon study.

Eur J Prev Cardiol 2020 09 3;27(14):1467-1477. Epub 2020 Feb 3.

Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Greece.

Aim: The investigation of the pathophysiological determinants of cardiac changes following ultra-long duration exercise.

Methods: Twenty-seven runners who finished a 246 km running race were examined both before and after the finish of the race. Examinations included echocardiography and measurement of body weight and blood biochemical parameters.

Results: Exercise increased left ventricular end-diastolic interventricular septum thickness (LVIVSd) ( < 0.001) and posterior wall thickness (LVPWTd) ( = 0.001) and right ventricular end-diastolic area ( = 0.005), while reduced tricuspid annular plane systolic excursion (TAPSE) ( = 0.004). A minor decrease in the peak absolute values of both left ventricular (from -20.9 ± 2.3% to -18.8 ± 2.0%,  = 0.009) and right ventricular (from -22.9 ± 3.6% to -21.2 ± 3.0%,  = 0.040) global longitudinal strains occurred. There was decrease in body weight ( < 0.001) and increase in both circulating high-sensitivity troponin I ( = 0.028) and amino-terminal pro-B type natriuretic peptide (NT-proBNP) ( = 0.018). The change in the sum of LVIVSd and LVPWTd correlated negatively with percentage change of body weight ( = -0.416,  = 0.049). The only independent determinant of post-exercise NT-proBNP was pulmonary artery systolic pressure ( = 0.797,  = 0.002). Post-exercise NT-proBNP correlated positively with percentage changes of basal (RVbas) ( = 0.582,  = 0.037) and mid-cavity (RVmid) ( = 0.618,  = 0.043) right ventricular diameters and negatively with percentage change of TAPSE ( = -0.720,  = 0.008). Similar correlations with RVbas, RVmid and TAPSE were found for pulmonary artery systolic pressure. Post-exercise high-sensitivity troponin I correlated negatively with percentage change of body weight ( = -0.601,  = 0.039), but was not associated with any cardiac parameter.

Conclusion: The main cardiac effects of ultra-long duration exercise were the decrease in left ventricular end-diastolic dimensions and increase in left ventricular wall thickness, as well as minimal dilatation and alteration in systolic function of right ventricle, possibly due to the altered exercise-related right ventricular afterload.
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http://dx.doi.org/10.1177/2047487319898782DOI Listing
September 2020

Nature of Cardiac Rehabilitation Around the Globe.

EClinicalMedicine 2019 Aug 4;13:46-56. Epub 2019 Jul 4.

State Hospital for Cardiology, Gyógy tér 2, Balatonfüred 8230, Hungary.

Background: Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region.

Methods: In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models.

Findings: 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05).

Interpretation: This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.
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http://dx.doi.org/10.1016/j.eclinm.2019.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733999PMC
August 2019

Cardiac Rehabilitation Availability and Density around the Globe.

EClinicalMedicine 2019 Aug 3;13:31-45. Epub 2019 Jul 3.

State Hospital for Cardiology, Balatonfüred, Gyógy tér 2, 8230, Hungary.

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density.

Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed.

Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p < .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources.Median capacity (i.e., number of patients a program serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally.

Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.
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http://dx.doi.org/10.1016/j.eclinm.2019.06.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737209PMC
August 2019

Cardiac autonomic function during intradialytic exercise training.

Postgrad Med 2019 Sep 15;131(7):539-545. Epub 2019 Sep 15.

Department of Physical Education & Sport Science, University of Thessaly , Trikala , Greece.

: Cardiac autonomic nervous system (ANS) dysfunction is a common feature in patients receiving hemodialysis (HD) therapy, whilst is associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The aim of this study is to investigate and compare the hemodynamic changes and responses of ANS function in HD patients using pupillometry and Heart Rate Variability (HRV) parameters. : Sixteen chronic kidney diseases (CKD) patients receiving HD (52.18 ± 17.7 years) underwent both pupillometric measurements using a portable handheld pupil-measuring device and standard HRV analysis pre HD, every hour and 30 min post-HD session under two different scenarios: at rest while the patient resting at HD bed and when the patient performed a single bout of intradialytic aerobic exercise lasting for 45 min during the second hour of the HD therapy. : No significant changes in ANS values were observed in neither of the pupillometric and the HRV values pre HD, for each hour and post-HD session. HRV parameters were significantly correlated with pupillometric parameters at pre HD and immediately after the single bout of intradialytic exercise. ANS activity did not differ during the conventional HD session and during the session included intradialytic exercise. Moreover, sympatho-vagal balance indices deriving from pupillometric assessment showed beneficial changes after the exercise event. : Pupillometry is a promising and robust technique with fewer artifacts compared to HRV especially in studies involving exercise sessions. Thus, pupillometry can be used as a complementary tool in the evaluation of cardiac autonomic dysfunction.
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http://dx.doi.org/10.1080/00325481.2019.1663707DOI Listing
September 2019

Attitudes of hemodialysis patients, medical and nursing staff towards patients' physical activity.

Int Urol Nephrol 2019 Jul 3;51(7):1249-1260. Epub 2019 Jun 3.

Sports Medicine Laboratory, School of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece.

Purpose: Patients with end-stage renal disease (ESRD) seem to have a negative attitude towards physical activity, which is mainly favored by the lack of counseling provided by the medical and nursing staff. The aim of this study was to investigate the attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity and identify the obstacles that discourage patients' involvement in intervention programs.

Study Design: Subjective assessment questionnaires and the International Physical Activity Questionnaire were administrated to hemodialysis patients and medical staff, to investigate the association between patient's barriers to physical activity, the total intensity level of physical activity, and attitudes of both ESRD patients and medical staff on the participation and promotion of physical activity.

Results: A total of 103 ESRD patients (61 men, 59.2%), 20 nephrologists (12 men, 60.0%), and 72 nurses (61 women, 84.7%) participated in the study. Most commonly reported patient's barriers were fatigue on dialysis (97.4%) and non-dialysis days (55.1%). Healthcare staff showed positive attitude towards renal rehabilitation exercise programs. However, most of physicians (85.0%) and nurses (83.3%) did not have previous experience with interventional exercise rehabilitation programs. Binary logistic regression revealed significant association between patients' inactivity, demographic data, and barriers towards physical activity, such as fatigue and pain in dialysis and non-dialysis days (p < 0.05), family's and physician's concern (p < 0.05), too many medical problems (p < 0.05), the fear of getting hurt (p = 0.01), and unwillingness for exercise (p < 0.05). Interestingly, healthcare staff's negative attitudes toward patient's physical activity seem to be strongly associated with patient's inactivity status.

Conclusion: Healthcare staff negative attitudes and multiple related barriers especially fatigue on dialysis and non-dialysis days, towards ESRD patient's physical activity, suppress desire for exercise and active patients' status, leading them to abstain from it.
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http://dx.doi.org/10.1007/s11255-019-02179-1DOI Listing
July 2019

"OPTImAL": an ontology for patient adherence modeling in physical activity domain.

BMC Med Inform Decis Mak 2019 04 25;19(1):92. Epub 2019 Apr 25.

Lab of Computing, Medical Informatics & Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Background: Maintaining physical fitness is a crucial component of the therapeutic process for patients with cardiovascular disease (CVD). Despite the known importance of being physically active, patient adherence to exercise, both in daily life and during cardiac rehabilitation (CR), is low. Patient adherence is frequently composed of numerous determinants associated with different patient aspects (e.g., psychological, clinical, etc.). Understanding the influence of such determinants is a central component of developing personalized interventions to improve or maintain patient adherence. Medical research produced evidence regarding factors affecting patients' adherence to physical activity regimen. However, the heterogeneity of the available data is a significant challenge for knowledge reusability. Ontologies constitute one of the methods applied for efficient knowledge sharing and reuse. In this paper, we are proposing an ontology called OPTImAL, focusing on CVD patient adherence to physical activity and exercise training.

Methods: OPTImAL was developed following the Ontology Development 101 methodology and refined based on the NeOn framework. First, we defined the ontology specification (i.e., purpose, scope, target users, etc.). Then, we elicited domain knowledge based on the published studies. Further, the model was conceptualized, formalized and implemented, while the developed ontology was validated for its consistency. An independent cardiologist and three CR trainers evaluated the ontology for its appropriateness and usefulness.

Results: We developed a formal model that includes 142 classes, ten object properties, and 371 individuals, that describes the relations of different factors of CVD patient profile to adherence and adherence quality, as well as the associated types and dimensions of physical activity and exercise. 2637 logical axioms were constructed to comprise the overall concepts that the ontology defines. The ontology was successfully validated for its consistency and preliminary evaluated for its appropriateness and usefulness in medical practice.

Conclusions: OPTImAL describes relations of 320 factors originated from 60 multidimensional aspects (e.g., social, clinical, psychological, etc.) affecting CVD patient adherence to physical activity and exercise. The formal model is evidence-based and can serve as a knowledge tool in the practice of cardiac rehabilitation experts, supporting the process of activity regimen recommendation for better patient adherence.
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http://dx.doi.org/10.1186/s12911-019-0809-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485069PMC
April 2019

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology.

Eur J Prev Cardiol 2019 07 20;26(11):1131-1146. Epub 2019 Feb 20.

2 Department of Kinesiology and Health Sciences, York University, Canada.

Aims: The aims of this study were to establish cardiac rehabilitation availability and density, as well as the nature of programmes, and to compare these by European region (geoscheme) and with other high-income countries.

Methods: A survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using global burden of disease study ischaemic heart disease incidence estimates. Four high-income countries were selected for comparison ( = 790 programmes) to European data, and multilevel analyses were performed.

Results: Cardiac rehabilitation was available in 40/44 (90.9%) European countries. Data were collected in 37 (94.8% country response rate). A total of 455/1538 (29.6% response rate) programme respondents initiated the survey. Programme volumes (median 300) were greatest in western European countries, but overall were higher than in other high-income countries ( < 0.001). Across all Europe, there was on average only 1 CR spot per 7 IHD patients, with an unmet regional need of 3,449,460 spots annually. Most programmes were funded by social security ( = 25, 59.5%; with significant regional variation,  < 0.001), but in 72 (16.0%) patients paid some or all of the programme costs (or ∼18.5% of the ∼€150.0/programme) out of pocket. Guideline-indicated conditions were accepted in 70% or more of programmes (lower for stable coronary disease), with no regional variation. Programmes had a multidisciplinary team of 6.5 ± 3.0 staff (number and type varied regionally; and European programmes had more staff than other high-income countries), offering 8.5 ± 1.5/10 core components (consistent with other high-income countries) over 24.8 ± 26.0 hours (regional differences,  < 0.05).

Conclusion: European cardiac rehabilitation capacity must be augmented. Where available, services were consistent with guidelines, but varied regionally.
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http://dx.doi.org/10.1177/2047487319827453DOI Listing
July 2019

Arterial adaptations in athletes of dynamic and static sports disciplines - a pilot study.

Clin Physiol Funct Imaging 2019 May 11;39(3):183-191. Epub 2018 Nov 11.

Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Background: Structural and functional arterial adaptations with regard to the type and level of training in young athletes are understudied. Our research aimed at evaluating them in two types of exercise (dynamic and static) and two levels of engagement (high and recreational).

Methods: A total of 76 volunteers formed five groups. Group A included 17 high-level dynamic sports athletes 30·9 ± 6·4 years old, group B 14 recreational ones aged 28·7 ± 6·2 years, group C 15 high-level static sports athletes 26·4 ± 3·9 years old and group D 16 recreational ones, aged 25·8 ± 4·8 years. Fourteen sedentary men 30 ± 3·8 years old formed control group E. Structural indices of left cardiac chambers and thoracic aorta were echographically obtained, as well as common carotid intima-media thickness (cIMT). Furthermore, applanation tonometry was conducted, at rest and during a handgrip strength test, for the acquisition of central arterial pressure parameters, carotid-femoral pulse wave velocity (cfPWV) and total arterial compliance (C ).

Results: No significant differences in structural arterial markers were observed. However, group A obtained the highest handgrip central systolic pressure values (13·1% compared to group D, P<0·05). Resting cfPWV was lower in group B by 13·8% (P<0·05) than C and by 16·7% (P<0·01) than E, whereas C was higher in group Β by 33·3% than C (P<0·05) and by 40·9% than E (P<0·01).

Conclusion: Functional arterial exercise-induced adaptations become apparent at an early age, without being in conjunction with structural ones. Recreational dynamic exercise results in the most favourable arterial characteristics.
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http://dx.doi.org/10.1111/cpf.12554DOI Listing
May 2019

Relationships between abdominal aortic calcification, glomerular filtration rate, and cardiovascular risk factors in patients with non-dialysis dependent chronic kidney disease
.

Clin Nephrol 2018 Dec;90(6):380-389

Background: Abdominal aortic calcification (AAC) is an established risk factor for cardiovascular events in patients with chronic kidney disease (CKD). We hypothesized that AAC is associated with a decline in glomerular filtration rate (GFR) as well as with some other cardiovascular risk factors.

Materials And Methods: This is a cross-sectional analysis of baseline data from a randomized controlled clinical trial (RENEXC). A total of 151 patients (aged 66 ± 14 years) with an average measured GFR (mGFR) of 22.5 ± 8.2 mL/min/1.73m2, not on renal replacement therapy, irrespective of number of comorbidities, were included. GFR was measured with iohexol clearance and estimated using cystatin C- and creatinine-based equations (eGFR). AAC was evaluated with lateral lumbar X-ray using the scoring system described by Kauppila. All patients underwent laboratory analyses, 24-hour ambulatory blood pressure monitoring, and standard echocardiography. Multiple linear regression analyses controlling for sex, age, cardiovascular comorbidities, and hypertension were performed.

Results: The prevalence of AAC in this group of patients was 73%, and 47% had severe calcification (AAC score ≥ 7). More men (76%) had AAC than women (69%). AAC score was associated with mGFR (p = 0.03), eGFR (p = 0.006), plasma albumin (p = 0.006), plasma phosphate (p = 0.01), pulse pressure (p = 0.004), left ventricular mass (LVM) (p = 0.02), left atrial volume (LAV; p < 0.001), and left atrial volume index (LAVI; p = 0.001).

Conclusion: AAC was highly prevalent in CKD. The degree of calcification in the abdominal aorta was strongly associated with a decline in GFR, a decrease in plasma albumin, an increase in plasma phosphate, an increase in pulse pressure, and cardiac structural changes, such as an increase in LVM, LAV, and LAVI.
.
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http://dx.doi.org/10.5414/CN109441DOI Listing
December 2018

Computerized decision support for beneficial home-based exercise rehabilitation in patients with cardiovascular disease.

Comput Methods Programs Biomed 2018 Aug 1;162:1-10. Epub 2018 May 1.

Institute of Applied Biosciences, Centre for Research and Technology Hellas, Greece; Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Greece.

Background: Exercise-based rehabilitation plays a key role in improving the health and quality of life of patients with Cardiovascular Disease (CVD). Home-based computer-assisted rehabilitation programs have the potential to facilitate and support physical activity interventions and improve health outcomes.

Objectives: We present the development and evaluation of a computerized Decision Support System (DSS) for unsupervised exercise rehabilitation at home, aiming to show the feasibility and potential of such systems toward maximizing the benefits of rehabilitation programs.

Methods: The development of the DSS was based on rules encapsulating the logic according to which an exercise program can be executed beneficially according to international guidelines and expert knowledge. The DSS considered data from a prescribed exercise program, heart rate from a wristband device, and motion accuracy from a depth camera, and subsequently generated personalized, performance-driven adaptations to the exercise program. Communication interfaces in the form of RESTful web service operations were developed enabling interoperation with other computer systems.

Results: The DSS was deployed in a computer-assisted platform for exercise-based cardiac rehabilitation at home, and it was evaluated in simulation and real-world studies with CVD patients. The simulation study based on data provided from 10 CVD patients performing 45 exercise sessions in total, showed that patients can be trained within or above their beneficial HR zones for 67.1 ± 22.1% of the exercise duration in the main phase, when they are guided with the DSS. The real-world study with 3 CVD patients performing 43 exercise sessions through the computer-assisted platform, showed that patients can be trained within or above their beneficial heart rate zones for 87.9 ± 8.0% of the exercise duration in the main phase, with DSS guidance.

Conclusions: Computerized decision support systems can guide patients to the beneficial execution of their exercise-based rehabilitation program, and they are feasible.
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http://dx.doi.org/10.1016/j.cmpb.2018.04.030DOI Listing
August 2018

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group.

Sports Med 2018 08;48(8):1781-1797

UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.

Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.
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http://dx.doi.org/10.1007/s40279-018-0930-4DOI Listing
August 2018

Computerised decision support in physical activity interventions: A systematic literature review.

Int J Med Inform 2018 Mar 17;111:7-16. Epub 2017 Dec 17.

Institute of Applied Biosciences, Centre for Research and Technology Hellas, Greece; Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Greece.

Background: The benefits of regular physical activity for health and quality of life are unarguable. New information, sensing and communication technologies have the potential to play a critical role in computerised decision support and coaching for physical activity.

Objectives: We provide a literature review of recent research in the development of physical activity interventions employing computerised decision support, their feasibility and effectiveness in healthy and diseased individuals, and map out challenges and future research directions.

Methods: We searched the bibliographic databases of PubMed and Scopus to identify physical activity interventions with computerised decision support utilised in a real-life context. Studies were synthesized according to the target user group, the technological format (e.g., web-based or mobile-based) and decision-support features of the intervention, the theoretical model for decision support in health behaviour change, the study design, the primary outcome, the number of participants and their engagement with the intervention, as well as the total follow-up duration.

Results: From the 24 studies included in the review, the highest percentage (n = 7, 29%) targeted sedentary healthy individuals followed by patients with prediabetes/diabetes (n = 4, 17%) or overweight individuals (n = 4, 17%). Most randomized controlled trials reported significantly positive effects of the interventions, i.e., increase in physical activity (n = 7, 100%) for 7 studies assessing physical activity measures, weight loss (n = 3, 75%) for 4 studies assessing diet, and reductions in glycosylated hemoglobin (n = 2, 66%) for 3 studies assessing glycose concentration. Accelerometers/pedometers were used in almost half of the studies (n = 11, 46%). Most adopted decision support features included personalised goal-setting (n = 16, 67%) and motivational feedback sent to the users (n = 15, 63%). Fewer adopted features were integration with electronic health records (n = 3, 13%) and alerts sent to caregivers (n = 4, 17%). Theoretical models of decision support in health behaviour to drive the development of the intervention were not reported in most studies (n = 14, 58%).

Conclusions: Interventions employing computerised decision support have the potential to promote physical activity and result in health benefits for both diseased and healthy individuals, and help healthcare providers to monitor patients more closely. Objectively measured activity through sensing devices, integration with clinical systems used by healthcare providers and theoretical frameworks for health behaviour change need to be employed in a larger scale in future studies in order to realise the development of evidence-based computerised systems for physical activity monitoring and coaching.
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http://dx.doi.org/10.1016/j.ijmedinf.2017.12.012DOI Listing
March 2018

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

Eur J Prev Cardiol 2017 07 18;24(10):1017-1031. Epub 2017 Apr 18.

2 BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium.

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.
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http://dx.doi.org/10.1177/2047487317702042DOI Listing
July 2017

Diagnosis and Treatment of Dyslipidaemias in Athletes.

Curr Vasc Pharmacol 2017 ;15(3):238-247

Laboratory of Physiology, Medical School, University of Ioannina, 45110 Ioannina, Greece.

The beneficial effects of chronic exercise training on lipoprotein metabolism include a considerable increase in serum high density lipoprotein-cholesterol and a reduction in serum triglyceride levels. These changes are mostly reported in athletes participating in dynamic sports, especially in the endurance ones. Diagnosis and treatment of dyslipidaemias in athletes should follow the main principles of management of dyslipidaemias for the general population, while specific considerations for athletes should be taken into account. Dyslipidaemias in athletes are usually characterized by a significant genetic predisposition. Clinicians who evaluate the lipoprotein profile of athletes should keep in mind the possibility of an illegal use of performance-enhancing drugs, which can influence lipoprotein metabolism. Lifestyle intervention should be the cornerstone of treatment of dyslipidaemias in athletes, but it should be tailored to the needs of individual athletic activity. Hypolipidaemic medications may not be well-tolerated by competitive athletes and should be reserved only for athletes with inadequate response to lifestyle measures. The treatment of dyslipidaemias in athletes should aim at reducing cardiovascular risk without compromising athletic performance.
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http://dx.doi.org/10.2174/1570161115666170127162526DOI Listing
December 2017

Exercise-based cardiac rehabilitation in twelve European countries results of the European cardiac rehabilitation registry.

Int J Cardiol 2017 02 11;228:58-67. Epub 2016 Nov 11.

Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland.

Aim: Results from EuroCaReD study should serve as a benchmark to improve guideline adherence and treatment quality of cardiac rehabilitation (CR) in Europe.

Methods And Results: Data from 2.054 CR patients in 12 European countries were derived from 69 centres. 76% were male. Indication for CR differed between countries being predominantly ACS in Switzerland (79%), Portugal (62%) and Germany (61%), elective PCI in Greece (37%), Austria (36%) and Spain (32%), and CABG in Croatia and Russia (36%). A minority of patients presented with chronic heart failure (4%). At CR start, most patients already were under medication according to current guidelines for the treatment of CV risk factors. A wide range of CR programme designs was found (duration 3 to 24weeks; total number of sessions 30 to 196). Patient programme adherence after admission was high (85%). With reservations that eCRF follow-up data exchange remained incomplete, patient CV risk profiles experienced only small improvements. CR success as defined by an increase of exercise capacity >25W was significantly higher in young patients and those who were employed. Results differed by countries. After CR only 9% of patients were admitted to a structured post-CR programme.

Conclusions: Clinical characteristics of CR patients, indications and programmes in Europe are different. Guideline adherence is poor. Thus, patient selection and CR programme designs should become more evidence-based. Routine eCRF documentation of CR results throughout European countries was not sufficient in its first application because of incomplete data exchange. Therefore better adherence of CR centres to minimal routine clinical standards is requested.
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http://dx.doi.org/10.1016/j.ijcard.2016.11.059DOI Listing
February 2017

Pathophysiological mechanisms of noncardiac syncope in athletes.

Int J Cardiol 2016 Dec 21;224:20-26. Epub 2016 Aug 21.

Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address:

Objective: The investigation of the differences in orthostatic responses of individuals with a history of noncardiac syncope(NCS) between athletes and nonathletes.

Methods: A passive tilt test for 30min was performed in 133 athletes (54 with NCS, 79 without NCS) and 48 nonathletes (15 with NCS, 33 without NCS). We performed measurement of haemodynamic, heart rate variability and baroreflex sensitivity parameters. All comparisons were adjusted for age, gender and body mass index(BMI).

Results: Athletes with NCS had increased heart rate(HR) (90±11 vs 81±10bpm, p=0.001) and decreased total peripheral resistance index(TPRI) (2227±408 vs 2918±733dynesm/cm, p=0.039) and baroreflex effectiveness index(BEI) [70.16(37.42-89.71) vs 72.19(48.49-91.35)%, p=0.016] compared with athletes without NCS. After applying backward stepwise logistic regression analysis to predict history of NCS in athletes, the final model included age, gender, BMI, HR and TPRI. Nonathletes with NCS had increased HR (95±24 vs 83±11bpm, p=0.024) and TPRI (3744±1606 vs 2937±880dynesm/cm, p=0.030) and decreased stroke index(SI) (25.4±7.6 vs 33.0±7.5mL/m, p=0.003) compared with nonathletes without NCS. After applying backward stepwise logistic regression analysis to predict history of NCS in nonathletes, the final model included SI and HR. Among individuals with NCS, athletes had increased SI and BEI and decreased HR and TPRI compared with nonathletes. Among individuals without NCS, a positive result of tilt test was less frequent in athletes compared with nonathletes (p=0.031).

Conclusions: The possible main underlying mechanism for NCS during upright standing in athletes is the decreased TPRI, while the inadequate preservation of SI in nonathletes.
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http://dx.doi.org/10.1016/j.ijcard.2016.08.308DOI Listing
December 2016

Impact of traditional Greek dancing on jumping ability, muscular strength and lower limb endurance in cardiac rehabilitation programmes.

Eur J Cardiovasc Nurs 2017 02 8;16(2):150-156. Epub 2016 Jul 8.

1 Laboratory of Sports Medicine, Aristotle University, Greece.

Aims: The objective of this study was to evaluate the effect of a training programme based on traditional Greek dance on the jumping ability, muscle strength and lower limb endurance in patients with chronic heart failure (CHF).

Patients And Methods: Forty Greek patients with CHF graded as NYHA ⩽ II and aged 73.2±4.7 years were randomly divided into two groups. Group A ( n=20) participated in a three-month physical rehabilitation programme based on Greek traditional dances, whereas group B ( n=20) remained untrained and served as the control group. All patients were studied before and after the 12-week exercise training programme. At baseline and follow-up the exercise capacity of the patients was evaluated by the six-minute walking test, their lower extremity muscle strength was evaluated by an isokinetic dynamometer and their jumping ability by the Myotest-Pro test, which includes three types of jumps (plyometric, countermovement and squat jumps).

Results: No significant difference was observed between the two groups at the baseline evaluation. At follow-up, group A showed significant improvements in walking distance calculated from the six-minute walking test (10.0% improvement; p<0.05), in lower limb strength (10.32% improvement; p<0.05), and in countermovement jump speed (6.9%; p<0.05) and squat jump speed (5.8%; p<0.05). Group A also increased their jump plyometry height by 13.86% ( p<0.05), their counter jump height by 10.68% ( p<0.05) and their squat jump height by 10.45% ( p<0.05). Group A had a 6.85% ( p<0.05) increased force of counter jump compared with group B.

Conclusion: The design and implementation of cardiac rehabilitation programmes using Greek traditional dances in patients with CHF are both safe and effective in improving lower limb function.
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http://dx.doi.org/10.1177/1474515116636980DOI Listing
February 2017

Relationship between declining glomerular filtration rate and measures of cardiac and vascular autonomic neuropathy.

Nephrology (Carlton) 2016 Dec;21(12):1047-1055

Department of Clinical Chemistry and Pharmacology, Institution of Laboratory Medicine, Lund University, Sweden.

Aim: Cardiac and vascular autonomic neuropathy contributes to increased morbidity and mortality in patients with chronic kidney disease. The aim of this study was to analyze the effects of a decline in glomerular filtration rate (GFR) on heart rate variability (HRV) and nocturnal blood pressure dipping.

Methods: This cross-sectional study comprises 124 patients (46 women, 78 men; age 66 ± 14 years) with chronic kidney disease (CKD) 3-5, not on renal replacement therapy. GFR was measured with iohexol clearance, HRV with 24 h Holter electrocardiogram (ECG) and nocturnal dipping with 24 hour ambulatory blood pressure.

Results: The GFR was 22.5 ± 8.5 mL/min per 1.73 m . The main finding was a significant curvilinear association between the 24 h standard deviation of NN interval (24SDNN) in the HRV analysis and GFR (P = 0.01), logGFR (P = 0.006), diabetes mellitus (P = 0.05) and beta blocker treatment (0.03), respectively. The effect of diabetes mellitus on 24SDNN corresponded to a decline in GFR from 30 to 12 mL/min per 1.73 m . There were significant curvilinear associations between systolic nocturnal dipping (P = 0.02) and diastolic nocturnal dipping (P = 0.05), respectively, and diabetes mellitus but not with GFR or logGFR.

Conclusion: In conclusion, cardiac sympathetic overdrive and decreased vagal control appear during CKD 4 and 5. The association with GFR is curvilinear. Diabetes mellitus was significantly associated with both cardiac and vascular autonomic neuropathy, as measured by heart rate variability and nocturnal blood pressure dipping, respectively. Knowing that arrhythmias, often due to sympathetic hyperactivity, are an important cause of sudden death in the dialysis population, this study contributes important knowledge on possible intervention thresholds.
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http://dx.doi.org/10.1111/nep.12706DOI Listing
December 2016

A novel strategy for evaluating tilt test in athletes with syncope.

Eur J Prev Cardiol 2016 06 12;23(9):1003-10. Epub 2015 Aug 12.

Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Greece

Background: The tilt test is used for the diagnosis of reflex syncope (RS) and is characterized by low sensitivity, especially in athletes. The objective of the study was the implementation of a novel diagnostic strategy for the tilt test without pharmacologic provocation in athletes based on haemodynamic criteria.

Methods: A passive tilt test for 30 min was performed in 132 athletes (53 with a history of RS, 79 without RS). Measurement of haemodynamic, heart rate variability (HRV) and baroreflex sensitivity parameters was performed.

Results: Tilt testing yielded 34% sensitivity and 94% specificity. Among negative tilt test responders, the ones with RS had increased heart rate (HR) (89 ± 11 vs 81 ± 10 bpm, p < 0.001), stroke index (SI) (40.2 ± 7.1 vs 35.5 ± 9.7 ml/m(2), p = 0.013), cardiac index (CI) (3.5 ± 0.6 vs 2.8 ± 0.8 l/(min·m(2)), p < 0.001) and decreased total peripheral resistance index (TPRI) (2230 ± 362 vs 2965 ± 725 dyne·s m(2)/cm(5), p < 0.001), low frequency component of HRV (76.2% (49.0-88.4) vs 79.7% (10.2-91.1), p = 0.045) during head-up tilt, compared with those without RS. Receiver-operating characteristic (ROC) curve analysis showed that among athletes with a negative tilt test the area under the curve (AUC) values were 0.727 (0.626-0.828) for HR (p < 0.001), 0.707 (0.611-0.804) for SI (p = 0.001), 0.847 (0.774-0.920) for CI (p < 0.001), 0.830 (0.754-0.905) for TPRI (p < 0.001). Further stratification of negative tilt test responders, characterizing their results as positive when TPRI <2800 dyne·s m(2)/cm(5) and CI >3 l/(min·m(2)), resulted in 85% sensitivity and 76% specificity.

Conclusion: Our results provide supportive evidence that a novel stratification based on haemodynamic criteria can improve the sensitivity of the tilt test for the diagnosis of RS in athletes.
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http://dx.doi.org/10.1177/2047487315600168DOI Listing
June 2016

Effect of Moderate Aerobic Exercise Training on Endothelial Function and Arterial Stiffness in CKD Stages 3-4: A Randomized Controlled Trial.

Am J Kidney Dis 2015 Aug 8;66(2):285-96. Epub 2015 May 8.

Department of Nephrology, Antwerp University Hospital, Edegem, Belgium.

Background: Evidence of a beneficial effect of exercise training on mediators of vascular disease is accumulating in chronic kidney disease (CKD), but its effect on vascular function in vivo still has to be established. The present study was designed to investigate whether a formal aerobic exercise training program improves peripheral endothelial function in patients with CKD stages 3 to 4.

Study Design: Randomized controlled trial with a parallel-group design.

Setting & Participants: 48 patients with CKD stages 3 to 4 without established cardiovascular disease were randomly assigned to either an exercise training program or usual care. 40 patients completed the study (exercise training, 19; usual care, 21).

Intervention: The 3-month home-based aerobic training program consisted of 4 daily cycling sessions of 10 minutes each at a target heart rate, calculated as 90% of the heart rate achieved at the anaerobic threshold. Patients in the usual-care group were given standard therapy.

Outcomes: The primary outcome was peripheral endothelial function. Secondary outcomes were aerobic capacity, arterial stiffness, numbers of endothelial (EPCs) and osteogenic progenitor cells (OPCs), migratory function of circulatory angiogenic cells, and health-related quality of life.

Measurements: Endothelial function was assessed with flow-mediated dilation of the brachial artery, aerobic capacity by peak oxygen uptake (VO(2peak)), arterial stiffness by carotid-femoral pulse wave velocity, numbers of EPCs and OPCs by flow cytometry, circulatory angiogenic cell function by an in vitro migratory assay, and quality of life by the Kidney Disease Quality of Life-Short Form questionnaire.

Results: Exercise training significantly improved VO(2peak) and quality of life, but not in vivo vascular function (flow-mediated dilation and carotid-femoral pulse wave velocity) or cellular markers for vascular function (EPC and OPC count and circulatory angiogenic cell migratory function).

Limitations: Short duration and intermittent nature of the exercise intervention.

Conclusions: In patients with CKD stages 3 to 4 without overt cardiovascular disease, 3 months of aerobic exercise training improved VO(2peak) and quality of life, without altering endothelial function or arterial stiffness.
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http://dx.doi.org/10.1053/j.ajkd.2015.03.015DOI Listing
August 2015

Vascular effects of exercise training in CKD: current evidence and pathophysiological mechanisms.

Clin J Am Soc Nephrol 2014 Jul 15;9(7):1305-18. Epub 2014 May 15.

Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; and Cardiology, Antwerp University Hospital, Edegem, Belgium;

Cardiovascular disease remains the main cause of morbidity and mortality in patients with CKD, an observation that cannot be explained by the coexistence of traditional risk factors alone. Recently, other mechanisms, such as alterations in nitric oxide bioavailability, impaired endothelial repair mechanisms, inflammation, and oxidative stress (all characteristic in CKD), have gained much attention as mediators for the increased cardiovascular risk. Regular physical training is a valuable nonpharmacological intervention for primary and secondary prevention of cardiovascular disease. Likewise, the benefits of exercise training on exercise capacity and quality of life are increasingly recognized in patients with CKD. Furthermore, exercise training could also influence potential reversible mechanisms involved in atherosclerosis and arteriosclerosis. After discussing briefly the general concepts of vascular disease in CKD, this review provides an overview of the current evidence for the effects of exercise training at both clinical and preclinical levels. It concludes with some practical considerations on exercise training in this specific patient group.
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http://dx.doi.org/10.2215/CJN.13031213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078973PMC
July 2014