Chantal Verkindt

Cardiac Rehabilitation in Chronic Heart Failure: Effect of an 8-Week, High-Intensity Interval Training Versus Continuous Training

OBJECTIVE To compare the effects of an 8-week, high-intensity interval training protocol versus continuous training. DESIGN Randomized controlled trial. SETTING Cardiac rehabilitation center. PARTICIPANTS Patients (N=26; mean age ± SD, 54±12y) with chronic heart failure were enrolled in a cardiac rehabilitation program for 8 weeks. INTERVENTIONS Patients were randomly assigned into 2 groups that performed either interval training (IT) or continuous training (CT). IT consisted of 3 sessions of 12 repetitions of 30 seconds of exercise at very high intensity, followed by 60 seconds of complete rest. The CT group performed CT exercises, which consisted of 45 minutes of aerobic exercise. MAIN OUTCOME MEASURES Parameters of gas exchanges: peak oxygen consumption (Vo(2)peak), first ventilator threshold (VT1), distance at six-minute walk test (6MWT), and level of anxiety and depression were measured. RESULTS The IT group increased significantly their Vo(2)peak, the duration of the exercise test, the oxygen pulse, oxygen consumption at the VT1, and the distance walked during the 6MWT. The CT group only increased the time at the VT1 and the distance performed at the 6MWT. The improvement in the time at the VT1 was significantly higher for the IT group than for the CT group. CONCLUSIONS This study shows that IT at very high intensity for patients with heart failure appears to be more effective than CT in improving indices of submaximal exercise capacity.

Pelvis morphology, trunk posture and standing imbalance and their relations to the Cobb angle in moderate and severe untreated AIS.

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and usually affects young girls. Studies mostly describe the differences between scoliotic and non-scoliotic girls and focus primarily on a single set of parameters derived from spinal and pelvis morphology, posture or standing imbalance. No study addressed all these three biomechanical aspects simultaneously in pre-braced AIS girls of different scoliosis severity but with similar curve type and their interaction with scoliosis progression. The first objective of this study was to test if there are differences in these parameters between pre-braced AIS girls with a right thoracic scoliosis of moderate (less than 27°) and severe (more than 27°) deformity. The second objective was to identify which of these parameters are related to the Cobb angle progression either individually or in combination of thereof. Forty-five scoliotic girls, randomly selected by an orthopedic surgeon from the hospital scoliosis clinic, participated in this study. Parameters related to pelvis morphology, pelvis orientation, trunk posture and quiet standing balance were measured. Generally moderate pre-brace idiopathic scoliosis patients displayed lower values than the severe group characterized by a Cobb angle greater than 27°. Only pelvis morphology and trunk posture were statistically different between the groups while pelvis orientation and standing imbalance were similar in both groups. Statistically significant Pearson coefficients of correlation between individual parameters and Cobb angle ranged between 0.32 and 0.53. Collectively trunk posture, pelvis morphology and standing balance parameters are correlated with Cobb angle at 0.82. The results suggest that spinal deformity progression is not only a question of trunk morphology distortion by itself but is also related to pelvis asymmetrical bone growth and standing neuromuscular imbalance.

Individualized Exercise Training at Maximal Fat Oxidation Combined with Fruit and Vegetable-Rich Diet in Overweight or Obese Women: The LIPOXmax-Réunion Randomized Controlled Trial

Objectives Lifestyle combined interventions are a key strategy for preventing type-2 diabetes (T2DM) in overweight or obese subjects. In this framework, LIPOXmax individualized training, based on maximal fat oxidation [MFO], may be a promising intervention to promote fat mass (FM) reduction and prevent T2DM. Our primary objective was to compare three training programs of physical activity combined with a fruit- and vegetable-rich diet in reducing FM in overweight or obese women. Design and setting A five months non-blinded randomized controlled trial (RCT) with three parallel groups in La Réunion Island, a region where metabolic diseases are highly prevalent. Subjects One hundred and thirty-six non-diabetic obese (body mass index [BMI]: 27–40 kg/m2) young women (aged 20–40) were randomized (G1: MFO intensity; G2: 60% of VO2-peak intensity; G3: free moderate-intensity at-home exercise following good physical practices). Outcomes Anthropometry (BMI, bodyweight, FM, fat-free mass), glucose (fasting plasma glucose, insulin, HOMA-IR) and lipid (cholesterol and triglycerides) profiles, and MFO values were measured at month-0, month-3 and month-5. Results At month-5, among 109 women assessed on body composition, the three groups exhibited a significant FM reduction over time (G1: -4.1±0.54 kg; G2: -4.7±0.53 kg; G3: -3.5±0.78 kg, p<0.001, respectively) without inter-group differences (p = 0.135). All groups exhibited significant reductions in insulin levels or HOMA-IR index, and higher MFO values over time (p<0.001, respectively) but glucose control improvement was higher in G1 than in G3 while MFO values were higher in G1 than in G2 and G3. Changes in other outcome measures and inter-group differences were not significant. Conclusion In our RCT the LIPOXmax intervention did not show a superiority in reducing FM in overweight or obese women but is associated with higher MFO and better glucose control improvements. Other studies are required before proposing LIPOXmax training for the prevention of T2DM in overweight or obese women. Trial Registration ClincialTrials.gov NCT01464073

Effect of Long-Term Physical Activity Practice after Cardiac Rehabilitation on Some Risk Factors.

The objective of this study was to evaluate the effects of long-term physical activity practice after a cardiac rehabilitation program on weight, physical capacity and arterial compliance. The Dijon Physical Activity Score was used to identify two groups: sedentary and active. Weight, distance at the 6-min walk test and the small artery elasticity indice were measured at the beginning, at the end of the rehabilitation program and at 18.3±5.3 months after. After the cardiac rehabilitation, sedentary patients showed a significant increase in weight and a significant reduction in distance on the 6-min walk test and in the arterial compliance. Active patients did not show any alteration in these parameters. We concluded that, after a cardiac rehabilitation program, the sedentary lifestyle has a negative influence on weight, physical capacity and arterial compliance, which are major markers of risk factors. In contrast, the practice of physical activity preserves these parameters.

Energy Expenditure in People with Diabetes Mellitus: A Review

Physical activity (PA) is an important non-therapeutic tool in primary prevention and treatment of diabetes mellitus (DM). To improve activity-based health management, patients need to quantify activity-related energy expenditure and the other components of total daily energy expenditure. This review explores differences between the components of total energy expenditure in patients with DM and healthy people and presents various tools for assessing the energy expenditure in subjects with DM. From this review, it appears that patients with uncontrolled DM have a higher basal energy expenditure (BEE) than healthy people which must be considered in the establishment of new BEE estimate equations. Moreover, studies showed a lower activity energy expenditure in patients with DM than in healthy ones. This difference may be partially explained by patient with DMs poor compliance with exercise recommendations and their greater participation in lower intensity activities. These specificities of PA need to be taken into account in the development of adapted tools to assess activity energy expenditure and daily energy expenditure in people with DM. Few estimation tools are tested in subjects with DM and this results in a lack of accuracy especially for their particular patterns of activity. Thus, future studies should examine sensors coupling different technologies or method that is specifically designed to accurately assess energy expenditure in patients with diabetes in daily life.

The influence of variable resistance moment arm on knee extensor performance

Abstract To enhance muscular strength, resistance training machines with a cam, incorporating a variable resistance moment arm, are widely used. However, little information is available about the influence of the variable resistance moment arm on torque, velocity, and power during muscle contraction. To address this, a knee extensor machine was equipped with a cam or with a semi-circular pulley that imposed a variable or a constant resistance moment arm, respectively. Fourteen physically active men performed two full knee extensions against loads of 40–80 kg in both conditions. Participants developed significantly higher torque with the pulley than with the cam (P < 0.001). The relative differences between pulley and cam conditions across all loads ranged from 8.72% to 19.87% (P < 0.001). Average knee extension velocity was significantly higher in the cam condition than in the pulley condition. No differences were observed in average and peak power, except at 50 and 55 kg. Torque–velocity and power–velocity relationships were modified when the resistance moment arm was changed. In conclusion, whatever the link, namely cam or pulley, the participants produced similar power at each load. However, the torque–velocity and power–velocity relationships were different in the cam and pulley conditions. The results further suggest that the influence of the machines mechanism on muscular performance has to be known when prescribing resistance exercises.

310 Effect of the long term physical activity practice following cardiac rehabilitation program on the arterial compliance, physical capacity and weight

Pursuing a regular physical activity following a rehabilitation program seems necessary to maintain its acquired benefits. Although rehabilitation benefits are many and well documented, there is little information on the fate of patients after rehabilitation. So the aim of this study was to examine the influence of maintaining the recommended physical activity after cardiac rehabilitation on arterial compliance, physical capacity and weight.