Browsing by Author "Myers, Jonathan (57203646752)"

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individual's health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of one's movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professional's ability to prescribe movement as medicine is competency in assessing an individual's risk for untoward events if physical exertion was increased. The ability to appropriately assess one's risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individual's readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program. © 2018 Elsevier B.V.

Background Revascularization appears to be beneficial only in patients with high levels of ischemia. This study examined the utility of gas analysis during the recovery phase of cardiopulmonary exercise testing (CPET) in predicting coronary artery disease (CAD) severity and prognosis. Methods 40 Caucasian patients (21.2% females), mean age 63.5 ± 7.6 with significant coronary artery lesions (≥ 50%) were studied. Within two months of coronary angiography, CPET on a treadmill (TM) and recumbent ergometer (RE) were performed on two visits 2–4 days apart; subjects were subsequently followed 32 ± 10 months. Myocardial wall motion was recorded by echocardiography at rest and peak exercise. Ischemia was quantified by the wall motion score index (WMSI). Results Mean ejection fraction was 56.7 ± 9.6%. Patients with 1–2 stenotic coronary arteries (SCA) showed a poorer CPET response during the recovery phase than patients with 3-SCA. ROC analysis revealed the change of carbon-dioxide output (∆ VCO2) recovery/peak (area under ROC curve 0.77, p = 0.02, Sn = 87.5%, Sp = 70.4%) and oxygen uptake (∆ VO2) recovery/peak during TM CPET (area under ROC curve 0.76, p = 0.03, Sn 75.0%, Sp 77.8%) were significant in distinguishing between 1-2-SCA and 3-SCA. The same variables predicted ΔWMSI peak/rest on univariate analysis (p < 0.05). Multivariate Cox analysis revealed a high predictive value of ∆ VO2 recovery/peak obtained during TM CPET for composite endpoint of cumulative cardiac events (HR = 1.27, CI = 1.07–1.51, p = 0.008). Conclusions The current study suggests CPET parameters in recovery hold predictive value for CAD severity and prognosis. TM testing seems to be a better approach in the assessment of CAD severity and prognosis. © 2017 Elsevier B.V.