Leonard A. Kaminsky

Guide to the Assessment of Physical Activity: Clinical and Research Applications A Scientific Statement From the American Heart Association

The deleterious health consequences of physical inactivity are vast, and they are of paramount clinical and research importance. Risk identification, benchmarks, efficacy, and evaluation of physical activity behavior change initiatives for clinicians and researchers all require a clear understanding of how to assess physical activity. In the present report, we have provided a clear rationale for the importance of assessing physical activity levels, and we have documented key concepts in understanding the different dimensions, domains, and terminology associated with physical activity measurement. The assessment methods presented allow for a greater understanding of the vast number of options available to clinicians and researchers when trying to assess physical activity levels in their patients or participants. The primary outcome desired is the main determining factor in the choice of physical activity assessment method. In combination with issues of feasibility/practicality, the availability of resources, and administration considerations, the desired outcome guides the choice of an appropriate assessment tool. The decision matrix, along with the accompanying tables, provides a mechanism for this selection that takes all of these factors into account. Clearly, the assessment method adopted and implemented will vary depending on circumstances, because there is no single best instrument appropriate for every situation. In summary, physical activity assessment should be considered a vital health measure that is tracked regularly over time. All other major modifiable cardiovascular risk factors (diabetes mellitus, hypertension, hypercholesterolemia, obesity, and smoking) are assessed routinely. Physical activity status should also be assessed regularly. Multiple physical activity assessment methods provide reasonably accurate outcome measures, with choices dependent on setting-specific resources and constraints. The present scientific statement provides a guide to allow professionals to make a goal-specific selection of a meaningful physical activity assessment method.

The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry A Policy Statement From the American Heart Association

The recent 2012 update of the Heart Disease and Stroke Statistics from the American Heart Association (AHA) emphasizes the continuing burden of cardiovascular disease (CVD) in the United States, with a prevalence of CVD nearing 40% in those approaching 60 years of age and exceeding 70% in older ages.1 Direct and indirect costs of CVD in the United States exceeded

Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association

300 billion in 2008, and the projected total costs of CVD in 2015 and 2030 are more than

Aerobic exercise training improves whole muscle and single myofiber size and function in older women

500 billion and nearly

Aerobic exercise training induces skeletal muscle hypertrophy and age-dependent adaptations in myofiber function in young and older men

1200 billion, respectively.2 Recently, the AHA developed year 2020 impact goals to achieve ideal cardiovascular health, which is influenced greatly by key health behaviors of being physically active, maintaining appropriate dietary habits, and not smoking.3 The obesity epidemic in the United States has been a substantial contributor to the CVD burden, with current estimates of obesity prevalence being ≈20% in US children and adolescents and >33% in adults 20 to 74 years of age. It is well accepted that for most people, obesity is a direct outcome of an energy-rich diet, lack of sufficient physical activity (PA), or both. Another consequence of both obesity and insufficient PA is a reduction in cardiorespiratory (or aerobic) fitness (CRF) levels. Collectively, this evidence emphasizes that an individual’s health behaviors have a major role in the prevention of CVD, which is of critical importance in the United States and worldwide from a medical and economic perspective. Increasing attention is being given to the importance of PA and physical fitness (PF), both muscular fitness and especially CRF, for decreasing chronic diseases, promoting overall cardiovascular and general health, improving quality of life, and delaying CVD and mortality in the US population.4,5 Clearly, PF and CRF in particular are an underpinning for academic achievement, job productivity, and overall maintenance …

Predictors of over- and underachievement of age-predicted maximal heart rate

Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of epidemiological and clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve risk prediction, and suggest future directions in research. Although the statement is not intended to be a comprehensive review, critical references that address important advances in the field are highlighted. The underlying premise of this statement is that the addition of CRF for risk classification presents health professionals with unique opportunities to improve patient management and to encourage lifestyle-based strategies designed to reduce cardiovascular risk. These opportunities must be realized to optimize the prevention and treatment of cardiovascular disease and hence meet the American Heart Association’s 2020 goals.

Core Competencies for Cardiac Rehabilitation/Secondary Prevention Professionals: 2010 Update: Position Statement of the American Association of Cardiovascular and Pulmonary Rehabilitation

To comprehensively assess the influence of aerobic training on muscle size and function, we examined seven older women (71 +/- 2 yr) before and after 12 wk of cycle ergometer training. The training program increased (P < 0.05) aerobic capacity by 30 +/- 6%. Quadriceps muscle volume, determined by magnetic resonance imaging (MRI), was 12 +/- 2% greater (P < 0.05) after training and knee extensor power increased 55 +/- 7% (P < 0.05). Muscle biopsies were obtained from the vastus lateralis to determine size and contractile properties of individual slow (MHC I) and fast (MHC IIa) myofibers, myosin light chain (MLC) composition, and muscle protein concentration. Aerobic training increased (P < 0.05) MHC I fiber size 16 +/- 5%, while MHC IIa fiber size was unchanged. MHC I peak power was elevated 21 +/- 8% (P < 0.05) after training, while MHC IIa peak power was unaltered. Peak force (Po) was unchanged in both fiber types, while normalized force (Po/cross-sectional area) was 10% lower (P < 0.05) for both MHC I and MHC IIa fibers after training. The decrease in normalized force was likely related to a reduction (P < 0.05) in myofibrillar protein concentration after training. In the absence of an increase in Po, the increase in MHC I peak power was mediated through an increased (P < 0.05) maximum contraction velocity (Vo) of MHC I fibers only. The relative proportion of MLC(1s) (Pre: 0.62 +/- 0.01; Post: 0.58 +/- 0.01) was lower (P < 0.05) in MHC I myofibers after training, while no differences were present for MLC(2s) and MLC(3f) isoforms. These data indicate that aerobic exercise training improves muscle function through remodeling the contractile properties at the myofiber level, in addition to pronounced muscle hypertrophy. Progressive aerobic exercise training should be considered a viable exercise modality to combat sarcopenia in the elderly population.

Validity of rating of perceived exertion during graded exercise testing in apparently healthy adults and cardiac patients.

To examine potential age-specific adaptations in skeletal muscle size and myofiber contractile physiology in response to aerobic exercise, seven young (YM; 20 ± 1 yr) and six older men (OM; 74 ± 3 yr) performed 12 wk of cycle ergometer training. Muscle biopsies were obtained from the vastus lateralis to determine size and contractile properties of isolated slow [myosin heavy chain (MHC) I] and fast (MHC IIa) myofibers, MHC composition, and muscle protein concentration. Aerobic capacity was higher (P < 0.05) after training in both YM (16 ± 2%) and OM (13 ± 3%). Quadriceps muscle volume, determined via MRI, was 5 ± 1 and 6 ± 1% greater (P < 0.05) after training for YM and OM, respectively, which was associated with an increase in MHC I myofiber cross-sectional area (CSA), independent of age. MHC I peak power was higher (P < 0.05) after training for both YM and OM, while MHC IIa peak power was increased (P < 0.05) with training in OM only. MHC I and MHC IIa myofiber peak and normalized (peak force/CSA) force were preserved with training in OM, while MHC I peak force/CSA and MHC IIa peak force were lower (P < 0.05) after training in YM. The age-dependent adaptations in myofiber function were not due to changes in protein content, as total muscle protein and myofibrillar protein concentration were unchanged (P > 0.05) with training. Training reduced (P < 0.05) the proportion of MHC IIx isoform, independent of age, whereas no other changes in MHC composition were observed. These data suggest relative improvements in muscle size and aerobic capacity are similar between YM and OM, while adaptations in myofiber contractile function showed a general improvement in OM. Training-related increases in MHC I and MHC IIa peak power reveal that skeletal muscle of OM is responsive to aerobic exercise training and further support the use of aerobic exercise for improving cardiovascular and skeletal muscle health in older individuals.

Promoting Health and Wellness in the Workplace: A Unique Opportunity to Establish Primary and Extended Secondary Cardiovascular Risk Reduction Programs

The age-predicted maximal heart rate (PMHR) formula, 220--age, is frequently used for identifying exercise training intensity, as well as determining endpoints for submaximal exercise testing. This study was designed to identify variables discriminating those with actual maximal heart rates considerably above or below that predicted from the 220--age equation. Subjects included 2010 men and women ranging in age from 14 to 77 yr. Stepwise discriminant analysis was performed using maximal heart rate error groups as the dependent variable, and selected preexercise test characteristics as predictors. The HR error groups were based on the difference between the measured and PMHR as follows: below (> or = 15 beats.min-1 below PMHR), within (+/- 14 beats.min-1 of PMHR), and above (> or = 15 beats.min-1 above PMHR). A contrast of the below and above groups identified age, resting HR, body weight, and smoking status as predictors of group membership (P < 0.01) for both men and women. The overall canonical correlation was 0.282 and 0.294 for the men and women, respectively. Older age, higher resting HR, lower weight, and non-smoking were related to the above group, while the inverse was related to the below group. Standardized coefficients suggest that age and resting heart rate for the men, and age and smoking status for the women were the most potent variables for discriminating extreme deviations between measured and PMHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Molecular adaptations to aerobic exercise training in skeletal muscle of older women.

Cardiac rehabilitation/secondary prevention (CR/SP) services are typically delivered by a multidisciplinary team of health care professionals. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recognizes that to provide high-quality services, it is important for these health care professionals to possess certain core competencies. This update to the previous statement identifies 10 areas of core competencies for CR/SP health care professionals and identifies specific knowledge and skills for each core competency. These core competency areas are consistent with the current list of core components for CR/SP programs published by the AACVPR and the American Heart Association and include comprehensive cardiovascular patient assessment; management of blood pressure, lipids, diabetes, tobacco cessation, weight, and psychological issues; exercise training; and counseling for psychosocial, nutritional, and physical activity issues.