Publications by authors named "Justien Cornelis"

14 Publications

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Measuring physical activity with activity monitors in patients with heart failure: from literature to practice. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology.

Eur J Heart Fail 2021 01 25;23(1):83-91. Epub 2020 Nov 25.

Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.

The aims of this paper were to provide an overview of available activity monitors used in research in patients with heart failure and to identify the key criteria in the selection of the most appropriate activity monitor for collecting, reporting, and analysing physical activity in heart failure research. This study was conducted in three parts. First, the literature was systematically reviewed to identify physical activity concepts and activity monitors used in heart failure research. Second, an additional scoping literature search for validation of these activity monitors was conducted. Third, the most appropriate criteria in the selection of activity monitors were identified. Nine activity monitors were evaluated in terms of size, weight, placement, costs, data storage, water resistance, outcomes and validation, and cut-off points for physical activity intensity levels were discussed. The choice of a monitor should depend on the research aims, study population and design regarding physical activity. If the aim is to motivate patients to be active or set goals, a less rigorously tested tool can be considered. On the other hand, if the aim is to measure physical activity and its changes over time or following treatment adjustment, it is important to choose a valid activity monitor with a storage and battery longevity of at least one week. The device should provide raw data and valid cut-off points should be chosen for analysing physical activity intensity levels. Other considerations in choosing an activity monitor should include data storage location and ownership and the upfront costs of the device.
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http://dx.doi.org/10.1002/ejhf.2035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8048426PMC
January 2021

Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: A discussion paper.

Health Policy 2020 10 27;124(10):1064-1073. Epub 2020 Aug 27.

KU Leuven-University of Leuven, Institute for Healthcare Policy, 3000, Leuven, Belgium. Electronic address:

Objective: The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges.

Methods: Based on a scan of the literature five cases were selected: England (UK), Ireland, California (USA), Victoria and Queensland (Australia). Information was gathered via a review of the grey and peer-reviewed literature. Country experts were consulted for additional information and to review country reports.

Results: The focus of safe staffing policies varies: increasing transparency about staffing decisions (England), matching actual and required staffing levels based on patient acuity measurement (Ireland), mandated patient-to-nurse ratios at the level of the nurse (California) or the ward (Victoria, Queensland). Calibration of the number of patients by the number of nurses varies across cases. Nevertheless, positive effects on the nursing workforce (increased bedside staffing) and staff well-being (increased job satisfaction) have been consistently documented. The impact on patient outcomes is promising but less well evidenced.

Conclusion: Countries will have to set safe staffing policies to tackle challenges such as the ageing population and workforce shortages. Various approaches may prove effective, but need to be accompanied by a comprehensive policy that enhances bedside nurse staffing in an evidence-based, objective and transparent way.
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http://dx.doi.org/10.1016/j.healthpol.2020.08.003DOI Listing
October 2020

Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology.

Eur J Heart Fail 2019 01 26;21(1):3-13. Epub 2018 Nov 26.

Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.

Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patient's functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patient's needs. Finally, gaps in our knowledge are discussed.
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http://dx.doi.org/10.1002/ejhf.1352DOI Listing
January 2019

Exercise Training in Heart Failure Patients With Persistent Atrial Fibrillation: a Practical Approach.

Card Fail Rev 2018 Aug;4(2):107-111

Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp Wilrijk, Belgium.

Persistent AF is present in at least 20 % of patients with chronic heart failure (CHF) and is related to a poor prognosis and more severe cardiac arrhythmias. CHF and AF share a common pathophysiology and can exacerbate one another. Exercise programmes for people with CHF have been shown to improve aerobic capacity, prognosis and quality of life. Given that patients with both CHF and AF show greater impairment in exercise performance, exercise training programmes have the potential to be highly beneficial. Optimal clinical evaluation using a cardiopulmonary exercise test should be performed before starting a training programme. Heart rate should be calculated over a longer period of time In patients with CHF and AF than those in sinus rhythm. The use of telemetry is advised to measure HR accurately during training. If telemetry is not available, patients can be safely trained based on the concomitant workload. An aerobic exercise training programme of moderate to high intensity, whether or not combined with strength training, is advised in patients with CHF and AF. Optimal training modalities and their intensity require further investigation.
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http://dx.doi.org/10.15420/cfr.2018.19.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125706PMC
August 2018

The effect of exercise training on exercise oscillatory ventilation in heart failure.

Eur J Prev Cardiol 2017 08 17;24(12):1283-1284. Epub 2017 May 17.

1 University of Antwerp (Faculty of Medicine and Health), Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium.

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http://dx.doi.org/10.1177/2047487317709824DOI Listing
August 2017

Development of a clinical applicable graphical user interface to automatically detect exercise oscillatory ventilation: The VOdEX-tool.

Int J Cardiol 2017 Aug 29;240:291-296. Epub 2016 Dec 29.

University of Antwerp (Faculty of Applied Engineering), Constrained Systems Lab (CoSys-Lab), Prinsstraat 13, B-2000 Antwerp, Belgium.

Background: Cardiopulmonary exercise testing (CPET) gained importance in the prognostic assessment of especially patients with heart failure (HF). A meaningful prognostic parameter for early mortality in HF is exercise oscillatory ventilation (EOV). This abnormal respiratory pattern is recognized by hypo- and hyperventilation during CPET. Up until now, assessment of EOV is mainly done upon visual agreement or manual calculation. The purpose of this research was to automate the interpretation of EOV so this prognostic parameter could be readily investigated during CPET.

Methods And Results: Preliminary, four definitions describing the original characteristics of EOV, were selected and integrated in the "Ventilatory Oscillations during Exercise-tool" (VOdEX-tool), a graphical user interface that allows automate calculation of EOV. A Discrete Meyer Level 2 wavelet transformation appeared to be the optimal filter to apply on the collected breath-by-breath minute ventilation CPET data. Divers aspects of the definitions i.e. cycle length, amplitude, regularity and total duration of EOV were combined and calculated. The oscillations meeting the criteria were visualised. Filter methods and cut-off criteria were made adjustable for clinical application and research. The VOdEX-tool was connected to a database.

Conclusions: The VOdEX-tool provides the possibility to calculate EOV automatically and to present the clinician an overview of the presence of EOV at a glance. The computerized analysis of EOV can be made readily available in clinical practice by integrating the tool in the manufactures existing CPET software. The VOdEX-tool enhances assessment of EOV and therefore contributes to the estimation of prognosis in especially patients with HF.
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http://dx.doi.org/10.1016/j.ijcard.2016.12.159DOI Listing
August 2017

Comparing exercise training modalities in heart failure: A systematic review and meta-analysis.

Int J Cardiol 2016 Oct 9;221:867-76. Epub 2016 Jul 9.

University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.

Exercise training (ET) is suggested to improve exercise capacity, prognosis, quality of life (QOL) and functional modifications of the heart in patients with heart failure (HF). However, it is not clear which modality is best. In order to assess the effectiveness of different ET modalities on prognostic cardiopulmonary exercise test (CPET) parameters, QOL and left ventricular remodeling, a systematic review and meta-analysis was performed. Randomized clinical trials (RCTs) were selected in three databases. The primary outcome data were peak oxygen uptake, ventilation over carbon dioxide slope, oxygen uptake efficiency slope, exercise oscillatory ventilation, rest and peak pulmonary end-tidal CO2. Secondary variables were QOL, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD). Twenty RCTs (n=811) met the a priori stated inclusion criteria. Studies were categorized into four different groups: "interval training (IT1) versus combined interval and strength training (IT1S)" (n=156), "continuous training (CT1) versus combined continuous and strength training (CT1S)" (n=130), "interval training (IT2) versus continuous training (CT2)" (n=501) and "continuous training (CT3) versus strength training (S3)" (n=24). No significant random effects of exercise modality were revealed assessing the CPET parameters. There was a significant improvement in QOL applying CT1S (P<0.001). Comparing IT2 with CT2, LVEDD and LVEF were significantly improved favoring IT2 (P<0.001). There is some evidence to support that interval training is more effective to improve LVEF and LVEDD. The fact that patients with HF are actively involved in any kind of ET program seems sufficient to improve the prognosis, QOL and anatomic function.
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http://dx.doi.org/10.1016/j.ijcard.2016.07.105DOI Listing
October 2016

Established Prognostic Exercise Variables in Heart Failure.

J Card Fail 2016 09 15;22(9):745-6. Epub 2016 Jul 15.

Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.

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http://dx.doi.org/10.1016/j.cardfail.2016.06.425DOI Listing
September 2016

Letter by Cornelis et al. regarding article, "Exercise oscillatory ventilation in heart failure".

Int J Cardiol 2016 Oct 29;220:759-60. Epub 2016 Jun 29.

University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, CDE S0.22, Universiteitsplein 1, B-2610 Wilrijk, Belgium; Antwerp University Hospital (Department of Cardiology), Wilrijkstraat 10, B-2650 Edegem, Belgium; University of Antwerp (Faculty of Medicine and Health Sciences), Department of Medicine, Universiteitsplein 1, B-2610 Wilrijk, Belgium.

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http://dx.doi.org/10.1016/j.ijcard.2016.06.289DOI Listing
October 2016

The Effect of Lifestyle Interventions on Excess Ectopic Fat Deposition Measured by Noninvasive Techniques in Overweight and Obese Adults: A Systematic Review and Meta-Analysis.

J Phys Act Health 2016 06 21;13(6):671-94. Epub 2015 Dec 21.

Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

Background: Reduction of ectopic fat accumulation plays an important role in the prevention of insulin resistance in people with overweight or obesity. This systematic review and meta-analysis summarizes the current evidence for the use of noninvasive weight loss interventions (exercise or diet) on ectopic fat.

Methods: A systematic literature search was performed according to the PRISMA statement. Clinical trials in PubMed, PEDro, and the Cochrane database were searched.

Results: All 33 included studies described the effect of lifestyle interventions on ectopic fat storage in internal organs (liver, heart, and pancreas) and intramyocellular lipids (IMCL), hereby including 1146, 157, 87, and 336 participants. Overall, a significant decrease of ectopic fat was found in liver (-0.53 Hedges' g, P < .001), heart (-0.72 Hedges' g, P < .001) and pancreas (-0.55 Hedges' g, P = .098) respectively. A trend toward decrease in IMCL was also observed. Meta-regression indicated a dose-response relationship between BMI reduction and decreased hepatic adiposity. Exercise alone decreased ectopic fat but the effect was greater when combined with diet.

Conclusion: Lifestyle interventions can reduce ectopic fat accumulation in the internal organs of overweight and obese adults. The results on IMCL should be interpreted with care, keeping the 'athlete's paradox' in mind.
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http://dx.doi.org/10.1123/jpah.2015-0560DOI Listing
June 2016

An overview of the applied definitions and diagnostic methods to assess exercise oscillatory ventilation--a systematic review.

Int J Cardiol 2015 15;190:161-9. Epub 2015 Apr 15.

University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.

The variable "exercise oscillatory ventilation" (EOV), assessed during cardiopulmonary exercise test (CPET), recently became a fundamental prognostic parameter in patients with heart failure. In literature, various definitions are suggested, but an uniformly accepted description to identify EOV still lacks. We performed a systematic review of the literature in order to determine the different definitions and diagnostic techniques to assess EOV. A systematic search strategy was established and executed in seven databases (PubMed, Google Scholar, Cochrane Clinical Trials, Science Direct, Pedro, Web Of Science library and Medline (Ovid)) resulting in 605 citations after de-duplication. Full-text articles (n=124) were assessed for eligibility, resulting in 75 citations. The review accounted 17,440 patients of whom 4,638 subjects presented EOV. Seven studies described EOV in a non-heart failure population accounting 168 EOV subjects. The definitions could be categorized in nine subdivisions of which four (n=43) referred to an original description. The other subdivisions were combinations of the original definitions (n=11), quantifications (n=4), computational (n=3), vaguely described (n=8) or not defined (n=6). Symptom limited maximal exercise tests were conducted to assess EOV, however the modes, protocols, software and data sampling were divers. Heterogeneity in the numerous definitions to identify EOV and the vaguely described assessment methods are hindering the evolution to a standardized uniformly accepted definition and technique to identify this abnormal breathing pattern. Unity in definition and international adopted assessment is warranted to strengthen its validity as a prognostic marker and could promote communication. It may facilitate clinical trials on pathophysiology and origin of EOV.
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http://dx.doi.org/10.1016/j.ijcard.2015.04.111DOI Listing
February 2016

Response to letter to the editor: "Exercise oscillatory ventilation - Perfusion abnormality in heart failure".

Int J Cardiol 2015 May 20;187:103. Epub 2015 Mar 20.

University of Antwerp (Faculty of Medicine and Health Sciences), Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.

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http://dx.doi.org/10.1016/j.ijcard.2015.03.295DOI Listing
May 2015

Prognostic respiratory parameters in heart failure patients with and without exercise oscillatory ventilation - a systematic review and descriptive meta-analysis.

Int J Cardiol 2015 Mar 13;182:476-86. Epub 2015 Jan 13.

Faculty of Medicine and Health Sciences, University of Antwerp, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, CDE S0.22, B-2610 Wilrijk, Belgium.

The purpose of this review was to describe the occurrence of prognostic variables as derived from cardiopulmonary exercise testing (CPET) in patients with heart failure (HF), presenting exercise oscillatory ventilation (EOV) compared to patients without EOV. The effect of EOV on peak oxygen consumption (VO2), minute ventilation/carbon dioxide production (VE/VCO2) slope, oxygen uptake efficiency slope (OUES), rest and peak pulmonary end-tidal carbon dioxide pressure (PETCO2) was meta-analysed. A systematic search strategy was performed in five databases (Pubmed, Cochrane Library, PEDro, Science Direct and Web of Science) assessing 252 articles for eligibility. Nineteen citations met the inclusion criteria totalling 3032 patients with HF (EOV=1111; non-EOV=1921). The risk of bias was assessed by two researchers. Extracted data were pooled using random or fixed effects meta-analysis, if appropriate. The level of significance was set at p≤0.05. Overall, the presentation of EOV significantly indicated aggravated prognostic markers. Subgroup analysis revealed left ventricular ejection fraction (LVEF) and mode of CPET protocol as independent factors, whereas defining EOV significantly influenced the results. A meta-analysis of studies reporting hazard ratios for cardiovascular events demonstrated that HF patients with EOV run a fourfold risk for an adverse event compared to HF patients without EOV. In general, these findings suggest that the presence of EOV in patients with HF is associated with a deterioration of the prognostic CPET parameters. Furthermore, EOV can occur in HF patients with reduced as well as preserved ejection fraction. Further research on defining and assessing EOV in a more accurate and reproducible way is required.
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http://dx.doi.org/10.1016/j.ijcard.2015.01.029DOI Listing
March 2015

The effect of ankle muscle strength and flexibility on dolphin kick performance in competitive swimmers.

Hum Mov Sci 2014 Aug 28;36:167-76. Epub 2014 Jun 28.

Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Ghent University Hospital, De Pintelaan 185, 3B3, 9000 Ghent, Belgium. Electronic address:

The velocity of a swimmer is determined by biomechanical and bioenergetics factors. However, little is known about the effect of ankle flexibility on dolphin kick performance. Next to this, scientific evidence is lacking concerning the influence of ankle muscle strength. Therefore, the aim of this study was to investigate the effect of ankle flexibility and muscle strength on dolphin kick performance in competitive swimmers. Ankle range of motion (ROM) and ankle muscle strength were measured in 26 healthy competitive swimmers. The effect of both was assessed on the swimmer's velocity and lower extremity joint angles during three maximal dolphin kick trials. Additionally, the effect of a flexibility restriction by a tape on the dolphin kick performance was assessed. Correlations were calculated between the flexibility, muscle strength and dolphin kick performance and differences were investigated between the unrestricted and restricted condition. Muscle strength of dorsal flexors and internal rotators were positively significantly correlated with the velocity. Active and passive plantar flexion ROM and internal rotation ROM were not significantly correlated. A plantar flexion-internal rotation restriction during the dolphin kick showed a significant decrease in velocity. This restriction was associated with a changed movement pattern in the knee towards more flexion. The results suggest that dolphin kick velocity might be enhanced by ankle muscle strength exercises and that subjects with a restricted ankle flexibility might profit from a flexibility program.
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http://dx.doi.org/10.1016/j.humov.2014.05.004DOI Listing
August 2014
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