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Functional Evaluation and Exercise Prescription in Chronic Diseases

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 21208

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Special Issue Editors

Dr. Andrea Ermolao

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Guest Editor

Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: cardiopulmonary exercise testing; cardiovascular screening; functional evaluation; exercise prescription; chronic diseases; exercise physiology; high altitude physiology

Dr. Daniel Neunhaeuserer

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Assistant Guest Editor

Sport and Exercise Medicine Division, Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: cardiopulmonary exercise testing; functional evaluation in health and disease; physical exercise training in chronic disease; effectiveness of different exercise modalities; sports and exercise medicine; exercise physiology; high-altitude medicine
Special Issues, Collections and Topics in MDPI journals

Dr. Francesca Battista

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Assistant Guest Editor

Department of Medicine, University of Padova, 35122 Padova, Italy
Interests: functional evaluation; physical activity; exercise prescription; cardiovascular risk; cardiovascular prevention; chronic diseases; cardiopulmonary exercise testing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

The literature clearly demonstrates that cardiorespiratory fitness is a main predictor for patients’ all-cause mortality risk and that physical exercise training is one of the most important medical treatment options we have for different chronic diseases. However, in a real-world setting and in clinical routine, the “exercise pill” still remains an unfilled prescription. Moreover, this medical therapy must be individually prescribed with regard to training modality, intensity, dosage, and frequency, just as with drug prescriptions. Thus, specific professional education and training is needed to perform adequate functional evaluations and subsequent exercise training prescription. Indeed, professional knowledge with regard to physical exercise and training prescription must be integrated with know-how in internal medicine, cardiology, and pneumology as well as in conservative orthopedics. Furthermore, the aging of society, the increasing prevalence of chronic diseases, and the economical need for cost-effective treatment modalities will lead to a huge request for medical professionals who engage in the prevention and cost-saving treatment of chronic diseases. Thus, functional evaluation and exercise prescription will become more and more important in the immediate future, because physical exercise training is an important pillar of an evidence-based disease prevention strategy and a highly effective and cost-saving treatment option in different chronic diseases.

Dr. Andrea Ermolao
Dr. Daniel Neunhaeuserer
Dr. Francesca Battista
Guest Editors

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Keywords

physical activity
endurance training
strength training
flexibility
balance
cardiopulmonary exercise testing
aging
cost-effectiveness

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Published Papers (6 papers)

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Research

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10 pages, 351 KiB

Open AccessArticle

Recreational Exercising and Self-Reported Cardiometabolic Diseases in German People Living with HIV: A Cross-Sectional Study

by Camilo Germán Alberto Pérez-Chaparro, Felipe B. Schuch, Philipp Zech, Maria Kangas, Michael A. Rapp and Andreas Heissel

Int. J. Environ. Res. Public Health 2021, 18(21), 11579; https://doi.org/10.3390/ijerph182111579 - 4 Nov 2021

Cited by 1 | Viewed by 1996

Abstract

Exercise is known for its beneficial effects on preventing cardiometabolic diseases (CMDs) in the general population. People living with the human immunodeficiency virus (PLWH) are prone to sedentarism, thus raising their already elevated risk of developing CMDs in comparison to individuals without HIV. The aim of this cross-sectional study was to determine if exercise is associated with reduced risk of self-reported CMDs in a German HIV-positive sample (n = 446). Participants completed a self-report survey to assess exercise levels, date of HIV diagnosis, CD4 cell count, antiretroviral therapy, and CMDs. Participants were classified into exercising or sedentary conditions. Generalized linear models with Poisson regression were conducted to assess the prevalence ratio (PR) of PLWH reporting a CMD. Exercising PLWH were less likely to report a heart arrhythmia for every increase in exercise duration (PR: 0.20: 95% CI: 0.10–0.62, p < 0.01) and diabetes mellitus for every increase in exercise session per week (PR: 0.40: 95% CI: 0.10–1, p < 0.01). Exercise frequency and duration are associated with a decreased risk of reporting arrhythmia and diabetes mellitus in PLWH. Further studies are needed to elucidate the mechanisms underlying exercise as a protective factor for CMDs in PLWH. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

11 pages, 966 KiB

Open AccessArticle

Analysis of Fractal Correlation Properties of Heart Rate Variability during an Initial Session of Eccentric Cycling

by Bruce Rogers, Thomas Gronwald and Laurent Mourot

Int. J. Environ. Res. Public Health 2021, 18(19), 10426; https://doi.org/10.3390/ijerph181910426 - 3 Oct 2021

Cited by 3 | Viewed by 2711

Abstract

Eccentric cycling (ECC) has attracted attention as a method to improve muscle strength and aerobic fitness in populations unable to tolerate conventional methods. However, agreement on exercise prescription targets have been problematic. The current report is an initial exploration of a potentially useful tool, a nonlinear heart rate (HR) variability (HRV) index based on the short-term scaling exponent alpha1 of detrended fluctuation analysis (DFA a1), which has been previously shown to correspond to exercise intensity. Eleven male volunteers performed 45 min of concentric (CON) cycling and ECC separated by 1 month. Work rates were matched for HR (~50% of the maximal HR) during the first 5 min and remained stable thereafter. HRV, HR, oxygen consumption (VO₂), and cycling power were monitored and evaluated at elapsed times of 10 (T10) and 45 (T45) minutes duration. HR significantly increased between ECC T10 and ECC T45 (p = 0.003, d = 1.485), while DFA a1 significantly decreased (p = 0.004, d = 1.087). During CON, HR significantly increased (p < 0.001 d = 1.570) without significant DFA a1 change (p = 0.48, d = 0.22). Significantly higher HR was observed at T45 in ECC than in CON (p = 0.047, d = 1.059). A session of unaccustomed ECC lead to decreased values of DFA a1 at T45 in comparison to that seen with CON at similar VO₂. ECC lead to altered autonomic nervous system balance as reflected by the loss of correlation properties compared to CON. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

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11 pages, 685 KiB

Open AccessArticle

Effectiveness of Text Messaging as an Incentive to Maintain Physical Activity after Cardiac Rehabilitation: A Randomized Controlled Pilot Study

by Giulia Foccardi, Marco Vecchiato, Daniel Neunhaeuserer, Michele Mezzaro, Giulia Quinto, Francesca Battista, Federica Duregon, Roberto Carlon and Andrea Ermolao

Int. J. Environ. Res. Public Health 2021, 18(12), 6645; https://doi.org/10.3390/ijerph18126645 - 21 Jun 2021

Cited by 11 | Viewed by 2850

Abstract

Although the efficacy of cardiac rehabilitation (CR) is proven, the need to improve patients’ adherence has emerged. There are only a few studies that have investigated the effect of sending text messages after a CR period to stimulate subjects’ ongoing engagement in regular physical activity (PA). A randomized controlled pilot trial was conducted after CR, sending a daily PA text message reminder to an intervention group (IG), which was compared with a usual care control group (CG) during three months of follow-up. Thirty-two subjects were assessed pre- and post-study intervention with GPAQ, submaximal iso-watt exercise testing, a 30 s sit-to-stand test, a bilateral arm curl test, and a final survey on a seven-point Likert scale. A statistically significant difference in the increase of moderate PA time (Δ 244.7 (95% CI 189.1, 300.4) minutes, p < 0.001) and in the reduction of sedentary behavior time (Δ −77.5 (95% CI 104.9, −50.1) minutes, p = 0.004) was shown when the IG was compared with the CG. This was associated with an improvement in heart rate, blood pressure, and patients’ Borg rating on the category ratio scale 10 (CR10) in iso-watt exercise testing (all p < 0.05). Furthermore, only the IG did not show a worsening of the strength parameters in the follow-up leading to a change of the 30 s sit-to-stand test with a difference of +2.2 (95% CI 1.23, 3.17) repetitions compared to CG (p = 0.03). The telemedical intervention has been appreciated by the IG, whose willingness to continue with regular PA emerged to be superior compared to the CG. Text messages are an effective and inexpensive adjuvant after phase 2 CR that improves adherence to regular PA. Further studies are needed to confirm these results in a larger patient population and in the long term. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

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12 pages, 1113 KiB

Open AccessArticle

Nonresponders of Physical Activity on Prescription (PAP) Can Increase Their Exercise Capacity with Enhanced Physiotherapist Support

by Tom Martinsson Ngouali, Mats Börjesson, Åsa Cider and Stefan Lundqvist

Int. J. Environ. Res. Public Health 2021, 18(9), 4795; https://doi.org/10.3390/ijerph18094795 - 30 Apr 2021

Cited by 1 | Viewed by 3125

Abstract

Swedish physical activity on prescription (PAP) is an evidence-based method to promote physical activity. However, few studies have investigated the effect of Swedish PAP on physical fitness, in which better cardiorespiratory fitness is associated with lower risks of all-cause mortality and diagnose-specific mortality. Direct measures of cardiorespiratory fitness, usually expressed as maximal oxygen uptake, are difficult to obtain. Hence, exercise capacity can be assessed from a submaximal cycle ergometer test, taking the linear relationship between heart rate, work rate, and oxygen uptake into account. The aim of this study was to evaluate exercise capacity in the long term, following PAP treatment with enhanced physiotherapist support in a nonresponding patient cohort. In total, 98 patients (48 women) with insufficient physical activity levels, with at least one component of the metabolic syndrome and nonresponding to a previous six-month PAP treatment, were randomized to PAP treatment with enhanced support from a physiotherapist and additional exercise capacity tests during a two-year period. A significant increase in exercise capacity was observed for the whole cohort at two-year follow-up (7.6 W, p ≤ 0.001), with a medium effect size (r = 0.34). Females (7.3 W, p = 0.025), males (8.0 W, p = 0.018) and patients ≥58 years old (7.7 W, p = 0.002) improved significantly, whereas a nonsignificant increase was observed for patients <58 years old (7.6 W, p = 0.085). Patients with insufficient physical activity levels who did not respond to a previous six-month PAP treatment can improve their exercise capacity following PAP treatment with enhanced support from a physiotherapist during a two-year period. Future studies should include larger cohorts with a control group to ensure valid estimations of exercise capacity and PAP. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

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12 pages, 719 KiB

Open AccessArticle

Hemodynamic Response to High- and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: A Randomized, Crossover Clinical Trial

by Tim Kambic, Vedran Hadžić and Mitja Lainscak

Int. J. Environ. Res. Public Health 2021, 18(8), 3905; https://doi.org/10.3390/ijerph18083905 - 8 Apr 2021

Cited by 11 | Viewed by 3677

Abstract

Low-load resistance exercise (LL-RE) is recommended as an adjunct therapy to aerobic exercise during cardiac rehabilitation in patients with coronary artery disease. The safety and hemodynamic response to high-load (HL) RE remain unknown. The aim of this study was to evaluate the hemodynamic response during both HL-RE and LL-RE prior to cardiac rehabilitation. Forty-three patients with coronary artery disease and/or percutaneous coronary intervention performed three sets of leg-press exercise using HL-RE (eight repetitions at the intensity of 80% of one repetition maximum (1-RM)) and LL-RE (16 repetitions at the intensity of 40% 1-RM) in a randomized crossover sequence. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and rating of perceived exertion were measured at baseline, after each set of RE and post-exercise. No clinically relevant changes in HR and BP or in patient-reported symptoms were recorded during HL-RE or LL-RE. Compared with baseline, HR and SBP increased during LL-RE (from 66 bpm to 86 bpm, time effect: p < 0.001; from 129 mmHg to 146 mmHg, time effect: p < 0.001) and HL-RE (from 68 bpm to 86 bpm, time effect: p < 0.001; from 130 mmHg to 146 mmHg, time effect: p < 0.001). Compared with HL-RE, the increase in HR was greater after the final set of LL-RE (32% vs. 28%, p = 0.015), without significant differences in SBP and DBP between LL-RE and HL-RE. Rating of perceived exertion was higher after the 1st set of HL-RE compared with LL-RE (median (interquartile range): 6 (5–7) vs. 6 (5–6), p = 0.010). In patients with coronary artery disease, both HL-RE and LL-RE were safe and well-tolerated. Hemodynamic changes were similar and within the physiological response to RE. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

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Review

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13 pages, 1840 KiB

Open AccessReview

Six-Minute Walk Distance in Breast Cancer Survivors—A Systematic Review with Meta-Analysis

by Jasna But-Hadzic, Mirza Dervisevic, Damir Karpljuk, Mateja Videmsek, Edvin Dervisevic, Armin Paravlic, Vedran Hadzic and Katja Tomazin

Int. J. Environ. Res. Public Health 2021, 18(5), 2591; https://doi.org/10.3390/ijerph18052591 - 5 Mar 2021

Cited by 35 | Viewed by 5197

Abstract

The six-minute walk test (6MWT) is a widely used test for the indirect measurement of cardiorespiratory fitness in various cancer populations. Although the 6MWT is a simple test, there are no normative values for breast cancer survivors (BCS) or comparisons of results with healthy counterparts. A systematic review with a meta-analysis was carried out, which included studies from 2007 to 2020. Ninety-one studies were found, 21 of which were included in the quantitative synthesis. Among them were 9 randomized controlled trials (RCT), 8 prospective cohort studies and 4 cross-sectional studies. A total of 1084 BCS were included. Our results revealed that healthy subjects (n = 878) covered a significantly greater distance than BCS during the 6MWT (589.9 m vs. 477.4 m, p < 0.001), and the results of the meta-regression analysis showed that the 6MWD was predicted by the participants’ BMI (p < 0.001), but not by their age (p = 0.070). After adjustment for BMI, the healthy subjects also covered greater distances than the BCS (103 m; p < 0.001). The normative values of 6MWT were presented for BCS. Besides, 6MWT distances distinguish between their healthy counterparts, therefore, the 6MWT distance is a relevant parameter for the assessment and monitoring of cardiorespiratory fitness in medical and exercise interventions for BCS. Full article

(This article belongs to the Special Issue Functional Evaluation and Exercise Prescription in Chronic Diseases)

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