BACKGROUND:Study heterogeneity limits the certainty of evidence for exercise prehabilitation. This is contributed to by type of supervision because its impact on patient outcomes has yet to be elucidated. This review aimed to compare fitness and clinical outcomes of supervised and unsupervised aerobic exercise. METHODS:This review was prospectively registered on PROSPERO (CRD42023409883) and performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies prospectively compared one primary outcome of supervised or unsupervised moderate-to-high-intensity exercise and controls among adult clinical populations. Primary outcomes were changes in peak oxygen consumption (V˙ O2peak, ml min-1 kg-1) and 6-Minute Walk Test (6MWT, metres) distance and incidence of postoperative complications. RESULTS:Thirty supervised and 12 unsupervised studies, including 3157 and 1848 patients, respectively, were analysed. No study directly compared supervised and unsupervised exercise. Unsupervised exercise was only significantly associated with 6MWT distance (cumulative mean difference 0.51 m, 95% confidence interval [CI] 0.14-0.87 m, P=0.016). Supervised exercise was significantly associated with V˙ O2peak (cumulative mean difference 0.88 ml min-1 kg-1, 95% CI 0.49-1.27 ml min-1 kg-1, P<0.001), 6MWT (cumulative mean difference 0.39 m, 95% CI 0.07-0.70 m, P=0.025), and complications (odds ratio 0.60, 95% CI 0.39-0.93, P=0.026) which were further reduced with high-intensity exercise (odds ratio 0.53, 95% CI 0.30-0.92, P=0.030) and low risks for bias and therapeutic ineffectiveness (odds ratio 0.41, 95% CI 0.22-0.76, P=0.019). CONCLUSIONS:Both supervised and unsupervised exercise improved 6MWT distance. Supervised high-intensity exercise programmes significantly reduced postoperative complications. Findings were limited by lack of direct comparisons between exercise groups, necessitating further research. SYSTEMATIC REVIEW PROTOCOL:PROSPERO (CRD42023409883).

BackgroundLow cardiorespiratory fitness predicts worse postoperative outcomes, exacerbated by age and frailty. Preoperative High-Intensity Interval Training (HIIT) improves cardiorespiratory fitness and postoperative outcomes but is challenging to implement in frailty due to perceived risks.PurposeThe aim of this case report was to demonstrate feasibility of HIIT in a patient with frailty and multimorbidity.Case presentationAn 83-year-old frail male with atrial fibrillation and limited mobility presenting with locally advanced rectal cancer was assessed as unfit for major surgery unless his cardiorespiratory fitness improved. Initial cardiopulmonary exercise testing demonstrated low cardiorespiratory fitness (peak oxygen consumption ($\dot V$V(center dot)O2peak) of 11.45 mLmin-1kg-1). He subsequently underwent 15 supervised HIIT sessions targeting a Rating of Perceived Exertion >= 15.OutcomesThe patient demonstrated initial substantial improvements in his physical condition, increasing maximal work rate from 27.5 W to 55 W. However, there was no additional progress following session eight. At his post-exercise CPET he rapidly fatigued, resulting in a $\dot V$V(center dot)O2peak of 7.4 mLmin-1kg-1. Clinical investigations revealed a worsening anemia with a hemoglobin of 92 g/L caused by an undiagnosed synchronous cecal tumor which was corrected preoperatively. Postoperatively, the patient recovered without complications and was successfully discharged home.ConclusionPersonalized HIIT improved exercise duration and work rate and was associated with positive postoperative outcomes in this patient with frailty and multimorbidity. A unique feature of this case was the unexpected loss of training progress and $\dot V$V(center dot)O2peak deterioration post-HIIT, which prompted further clinical investigations. These identified a worsening anemia and resulted in important changes in both the preoperative and intraoperative treatment.

AbstractPatients undergoing cardiopulmonary bypass procedures require inotropic support to improve hemodynamic function and cardiac output. Current inotropes such as dobutamine, can promote arrhythmias, prompting a demand for improved inotropes with little effect on intracellular Ca2+ flux. Low‐dose carbon monoxide (CO) induces inotropic effects in perfused hearts. Using the CO‐releasing pro‐drug, oCOm‐21, we investigated if this inotropic effect results from an increase in myofilament Ca2+ sensitivity. Male Sprague Dawley rat left ventricular cardiomyocytes were permeabilized, and myofilament force was measured as a function of ‐log [Ca2+] (pCa) in the range of 9.0–4.5 under five conditions: vehicle, oCOm‐21, the oCOm‐21 control BP‐21, and levosimendan, (9 cells/group). Ca2+ sensitivity was assessed by the Ca2+ concentration at which 50% of maximal force is produced (pCa50). oCOm‐21, but not BP‐21 significantly increased pCa50 compared to vehicle, respectively (pCa50 5.52 vs. 5.47 vs. 5.44; p < 0.05). No change in myofilament phosphorylation was seen after oCOm‐21 treatment. Pretreatment of cardiomyocytes with the heme scavenger hemopexin, abolished the Ca2+ sensitizing effect of oCOm‐21. These results support the hypothesis that oCOm‐21‐derived CO increases myofilament Ca2+ sensitivity through a heme‐dependent mechanism but not by phosphorylation. Further analyses will confirm if this Ca2+ sensitizing effect occurs in an intact heart.

IMPORTANCE Preoperative high-intensity interval training (HIIT) is associated with improved cardiorespiratory fitness (CRF) and may improve surgical outcomes. OBJECTIVE To summarize data from studies comparing the association of preoperative HIIT vs standard hospital care with preoperative CRF and postoperative outcomes. DATA SOURCES Data sources included Medline, Embase, Cochrane Central Register of Controlled Trials Library, and Scopus databases with no language constraints, including abstracts and articles published before May 2023. STUDY SELECTION The databases were searched for randomized clinical trials and prospective cohort studies with HIIT protocols in adult patients undergoing major surgery. Thirty-four of 589 screened studiesmet initial selection criteria. DATA EXTRACTION AND SYNTHESIS Ameta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data were extracted by multiple independent observers and pooled in a random-effects model. MAIN OUTCOMES AND MEASURES The primary outcome was change in CRF, as measured by either peak oxygen consumption (V(over dot)O-2 peak) or 6-MinuteWalk Test (6MWT) distance. Secondary outcomes included postoperative complications; hospital length of stay (LOS); and changes in quality of life, anaerobic threshold, and peak power output. RESULTS Twelve eligible studies including 832 patients were identified. Pooled results indicated several positive associations for HIIT when compared with standard care either on CRF (V(over dot)O-2 peak, 6MWT, anaerobic threshold, or peak power output) or postoperative outcomes (complications, LOS, quality of life), although there was significant heterogeneity in study results. In 8 studies including 627 patients, there was moderate-quality evidence of significant improvement in V. O2 peak (cumulative mean difference, 2.59 mL/kg/min; 95% CI, 1.52-3.65 mL/kg/min; P <.001). In 8 studies including 770 patients, there was moderate-quality evidence of a significant reduction in complications (odds ratio, 0.44; 95% CI, 0.32-0.60; P <.001). There was no evidence that HIIT differed from standard care in hospital LOS (cumulative mean difference, -3.06 days; 95% CI, -6.41 to 0.29 days; P =.07). The analysis showed a high degree of heterogeneity in study outcomes and an overall low risk of bias. CONCLUSIONS AND RELEVANCE The results of this meta-analysis suggest that preoperative HIIT may be beneficial for surgical populations through the improvement of exercise capacity and reduced postoperative complications. These findings support including HIIT in prehabilitation programs before major surgery. The high degree of heterogeneity in both exercise protocols and study results supports the need for further prospective, well-designed studies.

Acute decompensated heart failure patients require inotropic support to improve haemodynamic function and cardiac output. Inotropes increase contractile force by enhancing cytosolic Ca2+ cycling, which consequently promote arrhythmias, prompting a demand for inotropes with little effect on intracellular Ca2+ flux. Low-dose carbon monoxide (CO) induces a positive inotropic effect in perfused hearts. Although this mechanism remains unclear, CO can interact with myofilament proteins such as troponin C. Using the CO-releasing prodrug oCOm-21, it was proposed that the inotropic effect may result from a CO-mediated increase in myofilament Ca2+ sensitivity. Skinned left ventricular (LV) rat cardiomyocytes were attached to a force transducer within a micro-organ bath (15 °C). Force was measured as a function of pCa (-log [Ca2+]) in the range of pCa 9.0–4.5 under three conditions: vehicle, or oCOm-21 at 3 μM and 10 μM (nine cells/group). The Ca2+ concentration at which 50% of maximal force is produced (pCa50) was derived and used to measure changes in Ca2+ sensitivity to oCOm-21. Additionally, cardiac function was examined in isolated Langendorff-perfused rat hearts treated with either vehicle or 10 μM oCOm-21 (five/treatment). oCOm-21 (10 μM) significantly increased myofilament pCa50 compared with vehicle (pCa50 5.52 vs 5.44; p<0.01) and increased LV developed pressure compared with vehicle (103 mmHg vs 72 mmHg; p<0.01), respectively. These results support the hypothesis that oCOm-21-derived CO increases contractile filament Ca2+ sensitivity. Further analyses will identify the interaction of CO and the contractile filament and confirm whether the Ca2+ sensitising effect is conserved after pre-treating the heart.

Systolic and diastolic dysfunction in diabetes have frequently been associated with abnormal calcium (Ca 2+ ) regulation. However, there is emerging evidence that Ca 2+ mishandling alone is insufficient to fully explain diabetic heart dysfunction, with focus shifting to the properties of the myofilament proteins. Our aim was to examine the effects of diabetes on myofilament Ca 2+ sensitivity and Ca 2+ handling in left ventricular tissues isolated from the same type 2 diabetic rat hearts. We measured the force-pCa relationship in skinned left ventricular cardiomyocytes isolated from 20-week-old type 2 diabetic and non-diabetic rats. Myofilament Ca 2+ sensitivity was greater in the diabetic relative to non-diabetic cardiomyocytes, and this corresponded with lower phosphorylation of cardiac troponin I (cTnI) at ser23/24 in the diabetic left ventricular tissues. Protein expression of sarco/endoplasmic reticulum Ca 2+ -ATPase (SERCA), phosphorylation of phospholamban (PLB) at Ser16, and SERCA/PLB ratio were lower in the diabetic left ventricular tissues. However, the maximum SERCA Ca 2+ uptake rate was not different between the diabetic and non-diabetic myocardium. Our data suggest that impaired contractility in the diabetic heart is not caused by SERCA Ca 2+ mishandling. This study highlights the important role of the cardiac myofilament and provides new insight on the pathophysiology of diabetic heart dysfunction.

The cardiovascular benefits of regular exercise are unequivocal, yet patients with type 2 diabetes respond poorly to exercise due to a reduced cardiac reserve. The contractile response of diabetic cardiomyocytes to β-adrenergic stimulation is attenuated, which may result in altered myofilament calcium sensitivity and posttranslational modifications of cardiac troponin I (cTnI). Treadmill running increases myofilament calcium sensitivity in nondiabetic rats, and thus we hypothesized that endurance training would increase calcium sensitivity of diabetic cardiomyocytes and alter site-specific phosphorylation of cTnI. Calcium sensitivity, or pCa50, was measured in Zucker diabetic fatty (ZDF), nondiabetic (nDM), and diabetic (DM) rat hearts after 8 wk of either a sedentary (SED) or progressive treadmill running (TR) intervention. Skinned cardiomyocytes were connected to a capacitance-gauge transducer and a torque motor to measure force as a function of pCa (-log[Ca2+]). Specific phospho-sites on cTnI and O-GlcNAcylation were quantified by immunoblot and total protein phosphorylation by fluorescent gel staining (ProQ Diamond). The novel finding in this study was that training increased pCa50 in both DM and nDM cardiomyocytes (P = 0.009). Phosphorylation of cTnI amino acid residues Ser23/24, a crucial protein kinase A site, and Threonine (Thr)144 was lower in DM hearts, but there was no effect of training on site-specific phosphorylation. In addition, total phosphorylation and O-GlcNAcylation levels were not different between SED and TR groups. These findings suggest that regular exercise may benefit the diabetic heart by specifically targeting myofilament contractile function.NEW & NOTEWORTHY We examined the effects of training on the myofilament calcium in diabetic rat hearts. After 8 wk of treadmill running, both nondiabetic and diabetic cardiomyocytes had increased myofilament calcium sensitivity compared with their sedentary counterparts, but there was no effect of training on the phosphorylation or O-GlcNAcylation status of myofilament proteins measured in this study. These data highlight one potential mechanism capable of reversing, in part, reduced cardiac reserve in the diabetic heart.

PurposeImproving cardiopulmonary reserve, or peak oxygen consumption( O2peak), may reduce postoperative complications; however, this may be difficult to achieve between diagnosis and surgery. Our primary aim was to assess the efficacy of an approximate 14‐session, preoperative high‐intensity interval training(HIIT) program to increase O2peak by a clinically relevant 2 ml·kg−1·min−1. Our secondary aim was to document clinical outcomes.MethodologyIn this prospective study, participants aged 45–85 undergoing major abdominal surgery were randomized to standard care or 14 sessions of HIIT over 4 weeks. HIIT sessions involved approximately 30 min of stationary cycling. Interval training alternated 1 min of high (with the goal of reaching 90% max heart rate at least once during the session) and low/moderate‐intensity cycling. Cardiopulmonary exercise testing(CPET) measured the change in O2peak from baseline to surgery. Clinical outcomes included postoperative complications, length of stay(LOS), and Short Form 36 quality of life questionnaire(SF‐36).ResultsOf 63 participants, 46 completed both CPETs and 50 completed clinical follow‐up. There was a significant improvement in the HIIT group's mean ± SD O2peak (HIIT 2.87 ± 1.94 ml·kg1·min−1 vs standard care 0.15 ± 1.93, with an overall difference of 2.73 ml·kg1·min−1 95%CI [1.53, 3.93] p < 0.001). There were no statistically significant differences between groups for clinical outcomes, although the observed differences consistently favored the exercise group. This was most notable for total number of complications (0.64 v 1.16 per patient, p = 0.07), SF‐36 physical component score (p = 0.06), and LOS (mean 5.5 v 7.4 days, p = 0.07).ConclusionsThere was a significant improvement in O2peak with a four‐week preoperative HIIT program. Further appropriately powered work is required to explore the impact of preoperative HIIT on postoperative clinical outcomes.

Purpose Cardiovascular disease, often secondary to chemotherapy, is the leading cause of death in BC survivors. Increased aerobic capacity improves post-rehabilitation survival; however, many cancer rehabilitation programs are limited to lower intensity training. High-intensity interval training (HIIT) is associated with the largest improvements in aerobic capacity; therefore, this study aimed to determine whether HIIT would cause a greater increase in VO(2)peak than continuous moderate-intensity (MICT) exercise in previously trained BC survivors. Methods Twenty BC survivors who had completed a low/moderate-intensity exercise rehabilitation program performed a VO(2)peak test and received a dual-energy X-ray absorptiometry (DXA) scan at baseline and after randomization into a 12-week HIIT or MICT program. ANOVA with repeated measures determined the effects of the different training programs on aerobic capacity and body composition. Results Both groups began the training program near or above age- and sex-matched VO(2)peak norms. Pre- to post-intervention improvements in VO(2)peak (P = 0.006) and waist circumference (P = 0.007) were found in both groups; however, there were no between-group differences. Minute ventilation and peak workload increased in the HIIT group (P < 0.05) but not the MICT group. Body composition was not different after either training program. Conclusions These data suggest that transitioning from low/moderate-intensity exercise to moderate/high-intensity exercise causes further clinically relevant increases in VO(2)peak in previously trained BC survivors. HIIT did not cause a significantly greater improvement in VO(2)peak than MICT; however, future studies with greater intensity and frequency of training are encouraged.

O-GlcNAcylation is a ubiquitous post-translational modification that is extremely labile and plays a significant role in physiology, including the heart. Sustained activation of cardiac O-GlcNAcylation is frequently associated with alterations in cellular metabolism, leading to detrimental effects on cardiovascular function. This is particularly true during conditions such as diabetes, hypertension, cardiac remodelling, heart failure and arrhythmogenesis. Paradoxically, transient elevation of cardiac protein O-GlcNAcylation can also exert beneficial effects in the heart. There is compelling evidence to suggest that a complex interaction between O-GlcNAcylation and phosphorylation also exists in the heart. Beyond direct functional consequences on cardiomyocytes, O-GlcNAcylation also acts indirectly by altering the function of transcription factors that affect downstream signalling. This review focuses on the potential cardioprotective role of protein O-GlcNAcylation during ischaemia-reperfusion injury, the deleterious consequences of chronically elevated O-GlcNAc levels, the interplay between O-GlcNAcylation and phosphorylation in the cardiomyocytes and the effects of O-GlcNAcylation on other major non-myocyte cell types in the heart.

In secondary analyses of a randomised controlled trial of exercise during pregnancy, we examined associations between mid-pregnancy maternal body mass index (BMI) and excessive gestational weight gain (GWG) with offspring health. Follow-up data were available on 57 mother–child pairs at 1-year and 52 pairs at 7-year follow-ups. Clinical assessments included body composition and fasting blood tests. At age 1 year, increased maternal BMI in mid-gestation was associated with greater weight standard deviation scores (SDS) in the offspring (p = 0.035), with no observed associations for excessive GWG. At age 7 years, greater maternal BMI was associated with increased weight SDS (p < 0.001), BMI SDS (p = 0.005), and total body fat percentage (p = 0.037) in their children. Irrespective of maternal BMI, children born to mothers with excessive GWG had greater abdominal adiposity (p = 0.043) and less favourable lipid profile (lower HDL-C and higher triglycerides). At 7 years, maternal BMI and excessive GWG had compounded adverse associations with offspring adiposity. Compared to offspring of mothers with overweight/obesity plus excessive GWG, children of normal-weight mothers with adequate and excessive GWG were 0.97 and 0.64 SDS lighter (p = 0.002 and p = 0.014, respectively), and 0.98 and 0.63 SDS leaner (p = 0.001 and p = 0.014, respectively). Both greater maternal BMI in mid-pregnancy and excessive GWG were independently associated with increased adiposity in offspring at 7 years.

Abstract Background The diabetic heart has impaired systolic and diastolic function independent of other comorbidities. The availability of calcium is altered, but does not fully explain the cardiac dysfunction seen in the diabetic heart. Thus, we explored if myofilament protein regulation of contraction is altered. Methods Calcium sensitivity (pCa50) was measured in Zucker Diabetic Fatty (ZDF) rat hearts at the initial stage of diabetes (12-week-old) and after 8 weeks of uncontrolled hyperglycaemia (20-week-old) and in non-diabetic (nDM) littermates. Skinned cardiomyocytes were connected to a capacitance-gauge transducer and a torque motor to measure force as a function of pCa (-log[Ca2+]). Fluorescent gel stain (ProQ Diamond) was used to measure total protein phosphorylation. Specific phospho-sites on cardiac troponin I (cTnI) and total cTnI O-GlcNAcylation were quantified using immunoblot. Results pCa50 was greater in both 12- and 20-week-old diabetic (DM) rats compared to nDM littermates (p = 0.0005). Total cTnI and cTnI serine 23/24 phosphorylation were lower in DM rats (p = 0.003 & p = 0.01, respectively), but cTnI O-GlcNAc protein expression was not different. pCa50 is greater in DM rats and corresponds with an overall reduction in cTnI phosphorylation. Conclusions These findings indicate that myofilament calcium sensitivity is increased and cTnI phosphorylation is reduced in ZDF DM rats, which suggests an important role for cTnI phosphorylation in the DM heart.

New Findings What is the central question of this study? In Zucker Diabetic Fatty rats, does cardiomyocyte myofilament function change through the time course of diabetes and what are the mechanisms behind alterations in calcium sensitivity? What is the main finding and its importance? Zucker Diabetic Fatty rats had increased myofilament calcium sensitivity and reduced phosphorylation at cardiac troponin I without differential O‐GlcNAcylation. AbstractThe diabetic heart has impaired systolic and diastolic function independent of other comorbidities. The availability of calcium is altered, but does not fully explain the cardiac dysfunction seen in the diabetic heart. Thus, we explored if myofilament calcium regulation of contraction is altered while also categorizing the levels of phosphorylation and O‐GlcNAcylation in the myofilaments. Calcium sensitivity (pCa50) was measured in Zucker Diabetic Fatty (ZDF) rat hearts at the initial stage of diabetes (12 weeks old) and after 8 weeks of uncontrolled hyperglycaemia (20 weeks old) and in non‐diabetic (nDM) littermates. Skinned cardiomyocytes were connected to a capacitance‐gauge transducer and a torque motor to measure force as a function of pCa (−log[Ca2+]). Fluorescent gel stain (ProQ Diamond) was used to measure total protein phosphorylation. Specific phospho‐sites on cardiac troponin I (cTnI) and total cTnI O‐GlcNAcylation were quantified using immunoblot. pCa50 was greater in both 12‐ and 20‐week‐old diabetic (DM) rats compared to nDM littermates (P = 0.0001). Total cTnI and cTnI serine 23/24 phosphorylation were lower in DM rats (P = 0.003 and P = 0.01, respectively), but cTnI O‐GlcNAc protein expression was not different. pCa50 is greater in DM rats and corresponds with an overall reduction in cTnI phosphorylation. These findings indicate that myofilament calcium sensitivity is increased and cTnI phosphorylation is reduced in ZDF DM rats and suggests an important role for cTnI phosphorylation in the DM heart.

PURPOSE: Improving cardiopulmonary reserve, or peak oxygen consumption (VO2peak) measured during cardiopulmonary exercise testing (CPET), may reduce complications after surgery. This feasibility study determined the effectiveness of a supervised, preoperative High Intensity Interval Training (HIIT) program in increasing VO2peak by 2ml/kg/min. Clinical outcomes were documented to determine the endpoint most sensitive to improved fitness. METHODS: In this prospective study, participants aged 50-85 undergoing major abdominal surgery were randomised to standard care or 14 sessions of HIIT over 4-6 weeks. HIIT sessions involved approximately thirty minutes of stationary cycling (5 warm-up, 20 interval training, 5 cool-down). Interval training alternated 1 minute of high and low intensity pedalling, with the goal of reaching 90% maximum heart rate during the session. Clinical outcomes included complications, postoperative morbidity survey, length of stay, and Short Form-36 quality of life questionnaire (SF-36). RESULTS: Of 63 participants, 46 completed both CPETs and 51 completed clinical follow-up. On per protocol analysis, mean VO2peak increased 14%, from 20.3-23.2ml/kg/min in the exercise group and 0.7%, from 21.8-22.0 ml/kg/min in the control group. Change in VO2peak was 2.87 vs. 0.14 ml/kg/min (p<.001). Exercisers increased peak work rate by 25 watts. Although there were no significant differences in the clinical outcomes, those most responsive to improved fitness with exercise were: the total number of postoperative complications (0.64 in exercisers vs. 1.16 in controls per patient, p=.07) and the physical component score of the SF-36 (p=.07), with the greatest difference six weeks after surgery indicating a quicker postoperative recovery. CONCLUSION: There was a significant improvement in VO2peak and peak work rate with preoperative HIIT. We also noted a trend towards fewer postoperative complications and a more rapid recovery after surgery. Preoperative HIIT results in a clinically important improvement in cardiopulmonary reserve for patients undergoing abdominal surgery.

OBJECTIVE:Cardiovascular disease is the leading cause of death in breast cancer survivors. While evidence shows circuit resistance training (CRT) is effective for improving muscle and cardiorespiratory fitness, whether CRT is an efficacious therapy for decreasing cardiovascular risk in cancer survivors is unclear.METHODS:Fifty-one breast cancer survivors were recruited to either 12 weeks CRT (n = 26), or a non-exercising wait-list control (n = 25). Two supervised 60 min CRT sessions per week were undertaken, comprising resistance and functional exercises, and aerobic exercise stations. Primary outcome measure was the gold-standard assessment of arterial stiffness, aortic pulse wave velocity (PWV). Secondary outcomes included: cardiorespiratory fitness (CRF), upper and lower body strength, arterial wave reflections, central blood pressure and rate pressure product.RESULTS:Compared to the control group, the CRT group had a statistically significant medium effect decrease in PWV 0.9 m/s (95% CI: 0.1, 1.7). There were large effect improvements in VO2 max (4.3 ml kg-1  min-1 , 95% CI: 5.8, 2.8), upper and lower body strength (3.7 kg, 95% CI: 1.9, 5.6 and 10.4 kg, 1.6, 19.1) respectively.CONCLUSION:Findings support the existing literature demonstrating that 12 weeks CRT improves muscle and cardiorespiratory fitness and is also an effective strategy for decreasing a proven cardiovascular risk factor in breast cancer survivors.

Breast cancer treatment may increase non-cancer related mortality risk due to unintended cardiovascular consequences. The aim of this study was to investigate the strongest correlate of cardiovascular health (CVH) in female breast cancer survivors, cardiorespiratory fitness or fatness. Fifty-one women (59 ± 9 years, BMI 26.4 ± 4.8 kg/m2) previously diagnosed and treated for primary breast cancer were assessed using pulse wave analysis to determine central arterial wave reflection (augmentation index, AIx) and central systolic blood pressure (cSBP). A composite Z score calculated which incorporated central double product and AIx, as an indicator of CVH. Dual energy X-ray absorptiometry was used to obtain total body fat percentage (BF%). Cardiorespiratory fitness was determined using the single-stage walk test to predict maximal oxygen uptake ( $$V{\text{O}}_{2\hbox{max} }$$ ). Linear regression analysis revealed that fitness was associated with AIx after adjusting for BF %, age and time post-treatment completion (β = − 0.271, p = 0.010). A significant association between BF% and AIx after adjusting for fitness and age was found (β = 0.166, p = 0.0005); however, this association was lost when time post-treatment was included in the model (β = 0.166, p = 0.167). Both fitness (β = − 0.347, p = 0.0005) and BF% (β = 0.333, p = 0.013) were independently associated with CVH in the fully adjusted model. This study provides evidence for an association between cardiorespiratory fitness and cardiovascular health in female breast cancer survivors. While fatness may be associated with cardiovascular health, it appears to be more strongly associated with age.

Purpose In New Zealand, prostate cancer (PCa) is the most commonly diagnosed cancer in men and the third most common cause of male cancer deaths. Among these patients, the most common non-cancer related cause of death is cardiovascular disease (CVD). Aortic arterial stiffness may be clinically viable solution for detecting and tracking CVD risk factor in PCa survivors. The aim of the study was to determine whether aortic arterial stiffness is increased in PCa survivors compared to age-matched controls. Methods Participants recruited for this prospective comparative study were PCa survivors who had completed treatment (other than endocrine therapy) or were on active surveillance compared, or were age-matched non-cancer controls. During a single 1-h appointment, all participants had measures of aortic arterial stiffness, arterial wave reflection, central blood pressure and body composition taken. Results Ninety-eight men were recruited, 51 PCa survivors and 47 controls. There was no significant between group difference for aortic arterial stiffness [12.0 m/s (SD: 1.7) vs. 12.0 m/s (SD: 1.9), P = 0.953, d = 0.0]. Fat free mass [60.7 kg (SD: 4.9) vs. 65.1 kg (SD: 8.3), P = 0.007, d = 0.6] and skeletal muscle index [8.6 kg/m 2 (SD: 0.6) vs. 9.0 kg/m 2 (SD: 0.9), P = 0.050, d = 0.5] were lower in the PCa group. Conclusions Aortic arterial stiffness is not increased (worse) in men with PCa who receive various treatments, compared to age-matched controls. These findings may indicate that factors other than increased aortic arterial stiffness contribute to heightened risk of cardiovascular events in this population.

Type 2 diabetes is associated with reduced left ventricular reserve. It is unclear whether exercise training improves left ventricular function in people with type 2 diabetes. PURPOSE:This study aimed to determine whether 3 months of high-intensity interval training (HIIT) improves left ventricular function during exercise in adults with type 2 diabetes. METHODS:Participants performed a V˙O2peak test and received a DXA scan and total blood volume measurement at baseline. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular stroke volume (LVSV) were then measured at rest and during low- and moderate-intensity semirecumbent exercise in adults with type 2 diabetes before and after 3 months of HIIT (n = 11) or no training (control) (n = 5). The effects of HIIT were determined using repeated-measures ANOVA. RESULTS:HIIT increased V˙O2peak by approximately 15% (P < 0.002) but did not change body composition or total blood volume. LVESV decreased and LVEDV and LVSV increased from rest to moderate-intensity exercise in both groups at baseline (all P < 0.01). Three months of HIIT increased LVEDV (P = 0.008) and LVSV (P = 0.02) at all conditions, but there was no difference in controls (all P > 0.05). HIIT augmented the reduction in LVESV from rest to moderate-intensity exercise (P < 0.04), but LVESV was unchanged in controls. Increased LVEDV explained 51% of the change in LVSV after HIIT intervention. Mitral inflow parameters and mitral annular velocities were unaffected by HIIT (all P > 0.05). CONCLUSIONS:HIIT training increased the LVSV response to exercise in adults with type 2 diabetes. These data suggest that HIIT can improve LV filling and emptying during exercise and reverse early cardiac consequences of type 2 diabetes.

Scandinavian Journal of Medicine & Science in SportsVolume 29, Issue 11 p. 1841-1841 LETTER TO THE EDITOR What is the minimal dose of HIIT required to achieve pre-operative benefit John C. Woodfield, Corresponding Author John C. Woodfield John.woodfield@otago.ac.nz Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand Correspondence John C. Woodfield, Department of Surgical Sciences, PO Box 913, Dunedin 9054, New Zealand. Email: John.woodfield@otago.ac.nzSearch for more papers by this authorJames C. Baldi, James C. Baldi Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this authorKari Clifford, Kari Clifford orcid.org/0000-0002-4908-7413 Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this author John C. Woodfield, Corresponding Author John C. Woodfield John.woodfield@otago.ac.nz Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand Correspondence John C. Woodfield, Department of Surgical Sciences, PO Box 913, Dunedin 9054, New Zealand. Email: John.woodfield@otago.ac.nzSearch for more papers by this authorJames C. Baldi, James C. Baldi Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this authorKari Clifford, Kari Clifford orcid.org/0000-0002-4908-7413 Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New ZealandSearch for more papers by this author First published: 13 August 2019 https://doi.org/10.1111/sms.13538Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume29, Issue11November 2019Pages 1841-1841 RelatedInformation

The multifactorial linear regression model (aR 2 ¼0.559, p<0.001) indicated Ns (B¼6.9460.92,b¼0.72; h<0.001) and mBP (B¼0.41760.057,b¼0.696; h¼0.001) as independent predictors of the NT plasma level in rats.Conclusions: 1) The blood pressure elevation in rats is accompanied by increased expression both of nNOS and iNOS, whereas the eNOS level remained unchanged.2) The changes stated above are accompanied by increased expression of mRNA of all NOS isoforms, including eNOS, which may be an evidence of the eNOS high demand in myocardium.3) Considering the progressive decrease of the nitrates concentration in myocardium homogenates and the simultaneous plasma nitrotyrosine level increase, which are correspond to the mean blood pressure elevation, all the stated above may be considered as development of changes in myocardium, which are identical to endothelial dysfunction, including eNOS uncoupling with the shift of its activity to peroxynitrite production despite of NO.