ECSS Paris 2023: CP-MH06
INTRODUCTION: Supervised exercise therapy (SET) is a first-line recommendation for improving walking performance in people with peripheral artery disease (PAD) and intermittent claudication (IC) [1]. However, low adherence and limited availability [2] often mean that home-based exercise therapy (HBET), usually consisting of basic walking advice, is recommended instead. Whilst SET leads to greater improvements in functional outcomes than HBET [3], recent studies have explored structured HBET interventions that incorporate more prescriptive walking advice and technology such as phone applications or smartwatches to track adherence and progress. In this systematic review and meta-analysis, we provide an update of the literature on the comparative efficacy of SET vs. HBET on maximal and pain-free walking outcomes. Within HBET, we further compare structured programmes to simple walking advice. METHODS: A systematic literature search was conducted using Embase, Web of Science, and PubMed. Studies were included if they evaluated SET or HBET interventions lasting 12 weeks and reported outcomes related to maximal or pain-free walking distance or time. Structured HBET was defined as a home-based programme that included prescriptive walking advice, with or without additional support such as a fitness tracker or phone application. RESULTS: A total of 27 studies were included in this review: 20 compared SET to HBET, 5 compared structured to unstructured HBET, and 2 compared all three interventions. 631 participants were included in the SET group and 509 in HBET. To further compare different types of HBET interventions, 197 participants were included in the structured HBET group and 191 participants were in the unstructured group. The mean age of participants was 65.7 years (65.9% men). Compared with HBET, SET significantly improved maximal walking distance by a mean difference (MD) of 155.9 m [95% CI 110.8–201.0, p<0.001]. Pain-free walking distance increased by an MD of 112.0 m [95% CI 73.9–150.1, p<0.001]. When comparing the two types of HBET, structured HBET led to significantly greater improvements in maximal walking distance (MD: 53.5 m [95% CI 5.8–101.2], p=0.03), but showed no significant difference in pain-free walking distance (p=0.09). CONCLUSION: Although SET remains the gold standard for improving functional outcomes in patients with PAD and IC, structured HBET programmes incorporating prescriptive walking advice and technology resulted in greater maximal walking improvements than unstructured programmes. These findings highlight structured HBET as a practical alternative to SET and its potential to help close the gap in functional outcomes between the two types of exercise programmes. Future research should prioritise optimising and scaling structured HBET interventions. REFERENCES: [1] Gornik, H.L. et al. J Am Coll Cardiol 2024, 83, pp.2497−2604. [2] Haque, A. Ann R Coll Surg Engl 2021, 104, pp.130−137. [3] Hageman, D. et al. CDSR 2018, 4, CD005263.
Read CV Tim McDonaldECSS Paris 2023: CP-MH06
INTRODUCTION: The prevalence of virtually all cardiovascular diseases are elevated in females with polycystic ovary syndrome (PCOS). While the pathophysiology of cardiovascular diseases in PCOS continue to be elucidated, a number of cardiovascular risk factors have been well-established as being common to PCOS. These include elevated blood pressures (BP), impaired endothelial function, and greater adiposity. Although these cardiovascular risk factors are effectively managed with exercise in other populations, short-term (e.g. 12-16 week) exercise intervention studies show conflicting results in females with PCOS. Thus, we used a cross-sectional approach to examine whether established differences in cardiovascular risk persist between females with and without PCOS (i.e. CTRL) who undertake habitual exercise training, defined as a minimum of 5 hours of structured moderate-vigorous physical activity weekly over the last year. METHODS: Females with PCOS (n=7) and CTRL (n=7) were matched by age (24 ± 5 vs. 23 ± 6 yrs, respectively) and body mass index ([BMI]; 22.6 ± 2.2 vs. 22.6 ± 2.2 kg/m2, respectively). Blood pressure was assessed via manual sphygomomanometry, endothelial function was quantified as %FMD according to standardized methodology, and body composition was assessed using dual X-ray absorptiometry. RESULTS: Systolic BP (109 ± 6 vs. 105 ± 4 mmHg, P=0.22), and diastolic BP (69 ± 6 vs. 65 ± 4 mmHg, P=0.26) were not different between PCOS and CTRL. Likewise, %FMD was not different between PCOS and CTRL (7.6 ± 2.5 vs. 8.8 ± 2.2%, P=0.34). Similarly, neither android fat (1.00 ± 0.36 vs. 0.94 ± 0.37 kg, P=0.76), gynoid fat (3.59 ± 0.94 vs. 3.40 ±1.08 kg, P=0.73), android/gynoid ratio (0.28 ± 0.06 vs.0.28 ± 0.07 g, P=0.96), or whole-body fat (29.86 ± 4.02 vs. 27.57 ± 5.29 %, P=0.40) were different between PCOS and CTRL CONCLUSION: These preliminary findings suggest that habitual physical activity may be effective in mitigating the established negative cardiovascular consequences of PCOS. Future research is warranted in investigating the most effective type and frequency of physical activity in reducing cardiovascular risk amongst females with PCOS.
Read CV Will HuckinsECSS Paris 2023: CP-MH06
INTRODUCTION: Exercise-induced acute kidney injury (Also known as EIAKI or ALPE) is a significant, yet underrecognised and understudied cause of acute renal failure following exercise. It can be distinguised from rhabdomyolysis by normal or only mildly raised serum creatine kinase levels (CK) and is typically seen in activities that are predominantly anaerobic such as sprinting, weightlifting or military fitness testing and can be career ending. Dialysis is required in up to 20% of those with EIAKI and it is closely linked to renal hypouricaemia which has a reported prevalence between 0.15-1.39% in Asian countries like Japan and South Korea. Therefore an understanding of the pathophysiology, diagnosis, management and prevention of EIAKI is of the utmost importance to clinicans. A review of the literature was done to summarise the current knowlege of this condition. METHODS: A literature review on Pubmed using the search terms "exercise induced acute kindey inury", "renal hypouricaemia" & "Acute Renal Failure with Severe Loin Pain and Patchy Renal Ischemia after Anaerobic Exercise ". Case reports and reviews detailing the management and prevention of the condition were collected, with the results summarised below. RESULTS: There were no randomised-controlled trials looking at the management of EIAKI found in the literature. However a case-report described an improvement in renal function in 2 cases after intravenous continuous infusion of 2 µg/kg/min dopamine. Another study reported that EIAKI was prevented in 5 patients with renal hypouricaemia by taking 300mg of allopurinol for 5 days. Management and preventioon strategies in other studies included maintaining adequate hydration, avoiding NSAIDs, having a good baseline fitness and if feasible, avoiding the aggravating exercise. Most patients had a spontaneous recovery in their renal function after 3 days and 25% of patients had at least one recurrence. There was no data on long-term ability to return to exercise or long-term effects on kidney function. CONCLUSION: Exercise-induced Acute Kidney Injury (EIAKI) or Acute Renal Failure with Severe Loin Pain and Patchy Renal Ischemia after Anaerobic Exercise (ALPE) is marked by a significant rise in creatinine after intense anaerobic exercise, normal or mildly elevated CK levels and back or loin pain. Diagnosis is supported by a Computed Tomography (CT) scan showing wedged-shaped infarcts on the kidney. The majority of patients with EIAKI have been found to have hereditary renal hypouricaemia and it is thought to be caused by either renal vasoconstriction due to oxidative stress which uric acid normally inhibits or uric acid nephropathy due to increased excretion by the kidneys. No definitive management strategy exists for EIAKI but dopamine infusion may reverse the vasocontriction caused by anaerobic exercise, and allopurinol as a Xanthine oxidase inhibitor may prevent the formation and excretion of uric acid . Further research is required to better optimise the management of this condition.
Read CV Kaesi OparaECSS Paris 2023: CP-MH06