Christophe Van Laethem

Influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients

Objective: To investigate the influence of combined exercise training on indices of obesity, diabetes and cardiovascular risk in type 2 diabetes patients. Design: A double-blind randomized controlled trial with patients receiving either combination (COM), endurance (END) or no training (C). Setting: Sint-Jozef hospital (Belgium), general practice (Holland). Subjects: Forty-six type 2 diabetes patients (17 female, 29 male). Interventions: COM versus END and C. Patients exercised for three months, three times a week for 1 hour. Main measures: Six-minute walk test (6MW T), peak Vo2, strength in upper and lower limbs, sit-to-stand, height, weight, body mass index, fat mass, glycosylated haemoglobin (HbA1c), glycaemia, triglycerides, high-density lipoprotein (HDL), total cholesterol and quality of life (General Health Survey Short Form (SF-36)). Results: COM had significant better results on sit-to-stand (P<0.05), 6MW T (P<0.01), strength in upper (P<0.001) and lower limbs (P<0.001) compared with C. A different evolution among COM and C was found for HbA1c (P<0.05) and cholesterol (P<0.01), both decreased in COM and increased in C. HDL increased in COM and decreased in C (P<0.01). END had significant higher results on the 6MW T (P<0.01) compared with C. Compared with END, COM had significantly higher results on strength in upper (P<0.01) and lower limbs (P<0.01). The evolution of SF-36 items was not significantly different between the three groups. Conclusion: In diabetes type 2 patients, COM had significant better effects on indices of physical condition, diabetes and cardiovascular risk compared with C. Compared with END, COM gave a tendency towards better results, however more research with a larger number of participants is needed.

Response of the oxygen uptake efficiency slope to exercise training in patients with chronic heart failure.

The oxygen uptake efficiency slope (OUES) is a new exercise parameter that provides prognostic power in patients with CHF. Little is known about the effects of exercise training (ET) on OUES.

Influence of combined aerobic and resistance training on metabolic control, cardiovascular fitness and quality of life in adolescents with type 1 diabetes: a randomized controlled trial

Objective: To evaluate the effect of combined exercise training on metabolic control, physical fitness and quality of life in adolescents with type 1 diabetes. Design: A double-blind randomized controlled trial with patients receiving combined aerobic and strength or no training. Setting: University Hospital Ghent (Belgium). Subjects: Sixteen children with type 1 diabetes were randomized into a control group (n = 8) and an intervention group (n = 8). Interventions: Patients participated twice a week for 20 weeks in the combined aerobic and strength group. The control group continued their normal daily activities. Main measures: Before and after the intervention anthropometric variables (weight, length, BMI, body composition), metabolic control (glycaemia, HbA1c, daily insulin injected), aerobic capacity (peak V o 2, peak power, peak heart rate, 6-minute walk distance), strength (1 repetition maximum of upper and lower limb, hand grip strength, muscle fatigue resistance, sit-to-stand) and quality of life (SF-36) were assessed. Results: At baseline, none of the measured parameters differed significantly between the two groups. There was no significant evolution in the groups concerning anthropometric indices, glycaemia and HbA1c. However, the daily doses of insulin injected were significantly lowered in the training group (0.96 IU/kg.day pre versus 0.90 IU/kg.day post; P < 0,05), while it was increased in the control group. Physical fitness increased significantly in the training group. General health, vitality and role emotional had a tendency to improve. Conclusion: Combined exercise training seemed to lower daily insulin requirement and improve physical fitness, together with better well-being.

Intratest reliability and test–retest reproducibility of the oxygen uptake efficiency slope in healthy participants:

Background The oxygen uptake efficiency slope (OUES) is a newer ventilatory exercise parameter, used in the evaluation of healthy participants and patients with cardiovascular disease. However, few data about the reliability and reproducibility of OUES are available. Our study assessed intratest reliability and test-retest reproducibility of OUES in healthy participants. Design and methods Eighteen participants (age 28 ± 6 years, BMI 22.1 ± 1.9 kg/m2, 10 men) performed two identical maximal exercise tests on a bicycle ergometer. To assess test-retest reproducibility, we performed Bland-Altman analysis and calculated the coefficient of repeatability of the main ventilatory variables. Results OUES remained stable during the second part of the exercise test. Mean values varied 2.4 ± 4.0% between OUES calculated at 70% (OUES70) and at 100% of exercise duration. Mean variation decreased to 1.4 ± 2.3% when OUES was calculated at 90% of exercise duration (OUES90). The Bland-Altman 95% limits of agreement for OUES90 were +3 and –6%, those for OUES70 were +11 and –8%. The coefficient of repeatability for OUES was 597 ml/min or 18.7% of the average value of repeated OUES measurements. These results were similar to those of peak oxygen uptake and minute ventilation/carbon dioxide output. However, the test-retest reproducibility for submaximal-derived values of OUES was lower, as we noted higher coefficients of repeatability for OUES90 and OUES70, increasing up to 27% of the average of repeated values. Conclusion OUES shows excellent intratest reliability and has a test-retest reproducibility that is similar to that of peak oxygen uptake and minute ventilation/carbon dioxide output slope. However, its reproducibility becomes higher when it is calculated from increasing levels of achieved exercise intensity.

VE/Vco2 slope and oxygen uptake efficiency slope in patients with coronary artery disease and intermediate peakVo2

Background Peak exercise oxygen uptake (peakVo2) is a widely used prognosticator. Novel spirometric parameters, less affected by submaximal performance, such as the rate of increase of minute ventilation per unit decrease of carbon dioxide production (VE/Vco2 slope) and the oxygen uptake efficiency slope (OUES) have recently been introduced. Aim To evaluate the discriminative value of OUES, as compared to VE/Vco2 slope in patients with coronary artery disease (CAD) and intermediate peakVo2 values. Methods and results Bicycle spiroergometry was applied in 214 patients with CAD (age 67 ± 8 years, 85% men). OUES was strongly related to peakVo2 (r = 0.79). New York Heart Association (NYHA) class, 6-min walking distance, N-terminal probrain natriuretic peptide (NT-proBNP), inflammatory markers, left ventricular (LV) volumes and ejection fraction were evaluated. NT-proBNP levels predicted independently VE/Vco2-slope and OUES. Patients with intermediate peakVo2 (12–18 ml/kg per min) and increased VE/Vco2-slope (≥ 35) had higher NYHA class, lower walking distance, higher NT-proBNP levels and higher LV volumes as compared to patients with a similar peakVo2 but lower VE/Vco2-slope. Similar findings were found for patients with intermediate peakVo2 and high OUES/kg (median value > 15.3). Conclusion In CAD patients, OUES was strongly correlated with peakVo2. Both VE/Vco2 slope and OUES were independently associated with NT-proBNP levels. Both VE/Vco2 slope and OUES/kg were able to identify a subgroup of patients with an intermediate peakVo2 that was characterized by advanced remodelling and a higher degree of neurohumoral activation.

The Effect of Combined Exercise Training in Adolescents Who Are Overweight Or Obese With Intellectual Disability: The Role of Training Frequency

Elmahgoub, SS, Calders, P, Lambers, S, Stegen, SM, Van Laethem, C, and Cambier, DC. The effect of combined exercise training in Adolescents Who Are Overweight or Obese with intellectual disability: the role of training frequency. J Strength Cond Res 25(8): 2274-2282, 2011—Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

Chronic Kidney Disease is Associated With Decreased Exercise Capacity and Impaired Ventilatory Efficiency in Heart Transplantation Patients

PURPOSE Chronic kidney disease (CKD) is common after heart transplantation (HTx). This study assessed the influence of CKD on exercise capacity and ventilatory efficiency after HTx. METHODS This cross-sectional study included 79 HTx patients (age 64 +/- 10 years, 66 men) at 8.1 +/- 4.3 years post-HTx who underwent maximal exercise testing, cardiac function assessment, and blood analysis. According to estimated glomerular filtration rate (eGFR, ml/min/1.73 m(2)), patients were categorized as having severe (Group 1, GFR < or = 30; n = 15), moderate (Group 2, GFR 30-60; n = 40), and mild (Group 3, GFR > 60; n = 24) renal impairment. RESULTS Patients in Group 1 were older, had lower peakVO(2) and impaired ventilatory efficiency compared with Groups 2 and 3 (all p < 0.05) Peak Watts, peak ventilation, and peak heart rate were lower in Group 1 compared with Group 3 (all p < 0.05). Exercise-derived variables did not differ significantly between Groups 2 and 3. GFR correlated with peakVO(2)/kg (r = 0.47; p < 0.01) and peak Watts (r = 0.34, p < 0.01). GFR (adjusted r(2) = 0.34), mean arterial pulmonary pressure, and age were the strongest independent predictors of peakVO(2). The proposed model explained 48% of variability in peakVO(2). By receiver operator characteristic analysis, eGFR was superior in distinguishing patients with impaired from those with preserved exercise capacity (peakVO(2) < 18 vs > 18 ml/kg/min). CONCLUSION Chronic KD after HTx is associated with impaired maximal exercise capacity and decreased ventilatory efficiency. GFR is a strong independent non-exercise-derived predictor of peak VO(2) in these patients.

Effect of combined exercise training on physical and metabolic fitness in adults with mental retardation

Purpose: The purpose of this studywas to investigate disease specific and respiratory function measures that may influence physical activity levels and exercise capacity in people with Huntington’s disease. Relevance: Huntington’s disease (HD) is a neurodegenerative condition resulting in motor, cognitive and behavioural dysfunction. As with Parkinson’s disease and multiple sclerosis,physiotherapy management focuses on maintaining functional ability as long as possible. Ability to function and participate in activities of daily life will depend upon the pathophysiology of the condition as well as respiratory function. There is limited evidence concerning factors that influence physical activity levels and exercise capacity in people with HD. The results of this study will enable physiotherapists to use an evidence-based approach to the assessment and management of patients’ problems. Participants: Eighteen (7 female; mean (SD) age 51.2 (13.6) patients with HD were selected from a HD research and management clinic. Inclusion criteria were: symptomatic of HD;able to walk with or without assistance. Methods: A cross-sectional observational method was used. Descriptive data collected were: age; total functional capacity (TFC) from standardised questionnaire. Dependant variables measured were: physical activity level (MET-minutes/week)from International Physical Activity Questionnaire (IPAQ)short form; exercise capacity (meters) measured by six minute walk test (6 MWT). Independent variables measured were: Forced Vital Capacity in litres (FVC), a global measure of respiratory function measured following American Thoracic Society Guidelines; Unified Huntington’s Disease Rating Scale-Total Motor Score (UHDRS-TMS), a disease specific measure of motor function. Analysis: Data were analysed using Pearson’s correlations and where appropriate stepwise linear regression. Results: Descriptive data of all variables are as follows: mean (SD) TFC was 4.35 (2.4) (available range 0–14, higher scores indicate greater functional level); IPAQ median 328MET-minutes/week (low activity level); 6MWT mean (SD) was 191.95 meters (105.78); UHDRS-TMS mean (SD) 61.73 (12.02) (available range 0–120, higher scores indicating decreased motor function); FVC mean (SD) 2.19 L (1.00). FVC correlated with 6MWTand IPAQ (r = 0.44, 0.61 respectively); UHDRS correlated negatively with 6MWT and IPAQ (r =−0.63, r =−0.42 respectively). Linear regression results: UHDRS-TMS predicted 6MWT (R2 = 0.40, 6MWT= 536.1–5.6 (UHDRS-TMS), FVC was excluded; FVC predicted IPAQ (R2 = 0.37, IPAQ=−135.2 + 225.6 (FVC), UHDRS-TMS was excluded. Conclusions: In patients with HD, 6MWT is more influenced by UHDRS-TMS than respiratory function, however respiratory function predicted self-reported physical activity level. Slow gait due to motor function impairment may curtail 6MWTcompletion, while respiratory function may limit daily activities. Based on this study, it appears that the ability to function and participate in activities is multifactorial which requires consideration for physiotherapy management of people with neurodegenerative conditions. The results of this study are limited to patients who reported low activity levels and lowTFC scores; but are part of a larger study which will increase the power of the study. Implications: Ability to function and participate in activities is dependent on underlying disease process and respiratory function, and both elements should be considered when assessing and developing management strategies for people with neurodegenerative conditions.Purpose: To investigate the effects of three cueing devices (visual, auditory, and somatosensory) on movement and muscular control during gait initiation in people with Parkinson’s disease who experience freezing and to ascertain the acceptability of these cueing devices to novice users. Relevance: Over six million people worldwide are affected by Parkinson’s disease. It is estimated that thirty percent may experience freezing (an inability to produce effective steps) and have difficulty initiating gait, and maintaining gait whilst negotiating obstacles. This limits their capacity for physical activity and ability to participate in usual activities, and can result in social isolation. Various sensory cues have been shown to improve on-going gait in people with Parkinson’s Disease, but there is limited evidence on their effectiveness for people with gait initiation difficulties. Jiang and Norman (2006) found that transverse line visual cues improved gait initiation, while auditory cues had no effect. Dibble et al. (2004), using auditory and cutaneous cues during maximal speed gait initiation found an adverse effect on movement outcomes. Portable cueing devices are commercially available, however their influence in gait initiation and acceptability to users is currently unknown. InformaWPT2011, Research Report Abstracts eS773 tion on their effectiveness would enable physical therapists to provide better informed advice to potential purchasers. Participants: Twenty participants with idiopathic Parkinson’s disease and a history of freezing of gait (evaluated using item 14 of the Unified Parkinson’s Disease Rating Scale) were recruited; 14 males and 6 females, mean age 68 years and 11.5 years since diagnosis. Methods: An experimental trial of five randomised conditions: laser cane, sound metronome, vibrating metronome, walking stick and uncued. After using each cue participants’ opinions were obtained via a questionnaire. Motion data were collected using a 10 camera motion analysis system, force platforms and surface Electromyography. Analysis: Questionnaire responses from twelve participants who experienced freezing during testing were analysed using a Wilcoxon signed ranks test. Motion data from these participants were analysed using one-way ANOVA tests with post-hoc pair-wise comparisons to test for differences between conditions. Results: Significant differences were seen in step length, Centre of Mass and Centre of Pressure movement in the anterior/ posterior and medial/lateral directions between freezing and non-freezing episodes. The post hoc pair-wise comparisons showed significant improvements in the Centre of Mass and Centre of Pressure movement when using the laser cane and the walking stick and greater step length when using the laser cane. Participants rated the perceived effectiveness of the devices, theWilcoxon test showed a significant improvement in satisfaction when using the laser cane for both starting and maintaining walking (p < 0.05). Conclusions: The laser cane was overall the most effective cueing device for people with Parkinson’s disease and gait initiation difficulties in both user’s perception and efficacy tested in the gait laboratory. However the longer term effectiveness and acceptability of cueing devices at home and outdoors requires further investigation. Implications: This study would support the use of the laser cane as a relatively cheap intervention for people with Parkinson’s disease who experience spontaneous freezing.Purpose: This study investigated the effect of an elasticated tubular bandage and neutral patella taping on the threedimensional mechanics of the knee during slow step descent in a group of subjects suffering from Patellofemoral Pain Syndrome (PFPS). Relevance: A number of studies have demonstrated that subjects with patellofemoral pain syndrome have poor eccentric control at the knee. Most previous studies have focused on the use of taping, braces or neoprene knee sleeves; this is the first study to investigate the effect of the low cost alternative of an elasticated tubular bandage on eccentric control during step descent in a PFPS population. Participants: Ten subjects (4 men:6 women) with a diagnosis of patellofemoral pain syndrome referred to a Primary Care Musculoskeletal physiotherapy service (NHS Central Lancashire) for treatment were recruited (Mean: age = 28; Modified Functional Index Questionnaire score = 26; Visual Analogue Scale for Usual Pain in the past week = 29 mm). Inclusion criteria were; presence of traumatic or idiopathic peripatellar pain and pain provoked by deep squatting, kneeling, ascending or descending stairs; alone or in combination. Exclusion criteria; any history of knee surgery. Methods: Slow step descent was used to assess the control of the knee under three randomised conditions: (a) no intervention, (b) elasticated tubular bandage, and (c) neutral patella taping. Kinematic and kinetic data were collected using a ten camera Oqus (Qualisys) motion analysis system and two AMTI force platforms. The segments of the lower limbs were modelled in six-degrees of freedom and joint kinematics and moments were calculated at the knee. Post testing, subjects were asked to rank the test conditions in order of preference. Analysis: A repeated measures (RM) ANOVA was performed together with post hoc pairwise comparison for the coronal and transverse plane knee angles and moments about the knee, comparing the three randomised conditions. A further RMANOVA was conducted to investigate differences in the sagittal plane knee angular velocity in order to confirm that observed differences were not artefacts of descent velocity. Significance was set to P≤0.05. Results: The coronal plane knee range of motion was significantly reduced with taping (P = 0.032) and the tubular bandage (P = 0.006). No significant differences were seen in any other plane or for knee angular velocity or moments. Subjects ranking preference of the test conditionswas evenly split between the two interventions: neutral patella taping (N=5) and elasticated tubular bandage (N= 4); only one subject stated they would prefer to have nothing on their knee. Conclusions: The use of an elasticated tubular bandage and a neutral patella taping technique actually produced a measurable change in the control mechanism of the knee and resulted in subjects with PFPS demonstrating greater knee control and less pain during a step descent when compared to no intervention. The tubular bandage had the greatest mechanical effect, reducing movement in the coronal plane by 30% when compared to no intervention. Implications: An elasticated tubular bandage and neutral patellar taping may represent low cost, convenient interventions in the management of mild Patellofemoral Pain Syndrome.Purpose: Patients with juvenile idiopathic arthritis (JIA) are less physically active than healthy peers. Therefore we developed an internet-based intervention to improve physical activity (PA). The aim of the study was to examine the effectiveness of the program in improving PA. Relevance: Evidence is accumulating that PA is effective in the primary and secondary prevention of several chronic conditions. PA is also associated with a reduction in all-cause mortality. There is evidence that in youth aged 6-16 years, PA controls body weight, reduces blood pressure in hypertensive youth, improves aerobic capacity, muscular strength, endurance and skeletal health, reduces anxiety and depression and improves self concept. PA also has a positive effect on academic performance, concentration, memory and classroom behavior. For children with JIA and other chronic diseases it is recognized that they could take advantage of the same health benefits. Participants: All patients with JIA, registered in the University Medical Center Groningen, the Netherlands and aged 8-12 years, were selected for this study. Inclusion criteria were a diagnosis of JIA, a good comprehension of the Dutch language and the availability of a home-based computer with an internet connection. Methods: PA was determined by activity-related energy expenditure (AEE), PA level, time spent on moderate to vigorous PA and the number of days with 1 hour or more of moderate to vigorous PAand was assessed with a 7-day activity diary. Aerobic exercise capacity was assessed by means of a Bruce treadmill test and recorded as maximum endurance time. Disease activity was assessed by using the JIA core set. Adherence was electronically monitored. Analysis: Descriptive statistics were used for patients characteristics. The Kolmogorov-Smirnov test was used to test variables for normality of distribution. Paired samples t-test was used for within group differences. Results: Out of 59 patients 33 eligible patients were included and randomized in an intervention (n = 17, mean±SD age 10.6±1.5 years) and control waiting list group (n = 16, mean±SD age 10.8±1.4 years). All patients completed baseline and t = 1 testing. PA significantly improved in both groups. Maximum endurance time significantly improved in the intervention but not in the control group. In a subgroup analysis for patients with low PA (intervention n = 7 and control n = 5), PA improved in the intervention but not in the control group. The intervention was safe, feasible and showed a good adherence. Conclusions: An internet-based program for children with JIA, aged 8-12 years, directed at promoting PA in daily life, effectively improves PA in those patients with low PA levels. It can also improve endurance while it is safe, feasible and has a good adherence. Implications: PA in JIA can be improved through internet based interventions. Similar programs can be developed for other chronic conditions.Purpose: The specific objectives were to: 1) describe the level of pain intensity, disability, activity limitation, kinesiophobia and physical capacity in patients with predominantly peripherally m ...

Heart rate reserve is an important determinant of exercise capacity in heart failure with normal ejection fraction

P208 Heart rate reserve is an important determinant of exercise capacity in heart failure with normal ejection fraction S Sofie Pardaens, C Van Laethem, J Bartunek, N Van De Veire, M Vanderheyden, AM Willems, J De Sutter Ghent University, Ghent, Belgium, OLV Hospital Aalst, Cardiovascular Center, Aalst, Belgium, AZ Maria Middelares Hospital, Ghent, Belgium Topic: Heart Failure (Sports Cardiology) Background Diastolic dysfunction is a common form of heart failure, in particular in the elderly. Just like in patients with systolic heart failure (SHF), heart failure patients with a normal ejection fraction (HFNEF) have a reduced exercise performance which has prognostic implications. In contrast to SHF, determinants of exercise capacity in patients with a normal ejection fraction have not been studied yet. Purpose To investigate which variables are major determinants of exercise parameters such as peak oxygen uptake (pVO2), ventilation-carbon dioxide slope (VE/VCO2 slope) and the oxygen uptake efficiency slope (OUES). Methods Demographic and clinical data were registered in 71 patients diagnosed with HFNEF (age 64 12 years, left ventricular ejection fraction (LVEF) 63 9%, 70% men). All patients performed bicycle cardiopulmonary exercise testing until exhaustion. Results 15 variables were included in a multivariable linear regression analysis: gender, age, body mass index, heart rate reserve (HRR), LVEF, smoking status, the presence of: ischemia, chronic obstructive pulmonary disease, diabetes, arterial hypertension, atrial fibrillation, left bundle branch block or pacemaker and a prior history of ischemic events or CHF. HRR, a prior history of ischemic events, age, smoking status and gender predicted pVO2 (R HRR= 0.301, total R= 0.669, p<0.001). VE/VCO2 slope was only explained by the HRR (R HRR= 0.086, total R= 0.086, p=0.013). OUES was predicted by HRR, a prior history of ischemic events, gender and diabetes (R HRR= 0.280, total R= 0.593, p<0.001). Conclusion In patients with HFNEF, HRR is the most important clinical determinant of exercise capacity measured by spiroergometry. This suggests that HRR could be a major target of improvement of symptoms of exercise intolerance in these patients.