Epidemiological assessment of the role of physical activity and fitness in development of cardiovascular disease

Hematopoietic stem cell transplantation (HCT) is a curative treatment option for patients with hematologic conditions but presents many complications that must be managed as a complex, chronic condition. Mobile health applications (mHealth apps) may permit tracking of symptoms in HCT. In seeking strategies to manage the complexities of HCT, our team collaborated with Sicklesoft, Inc., to develop an mHealth app specifically for HCT patients to allow for daily evaluation of patient health, Technology Recordings to better Understand Bone Marrow Transplantation (TRU-BMT). The primary value of this application is that of potentially enhancing the monitoring of symptoms and general health of patients undergoing HCT, with the ultimate goal of allowing earlier detection of adverse events, earlier intervention, and improving outcomes. To first evaluate patient interest in mHealth apps, we designed and administered an interest survey to patients at the 2017 BMT-InfoNet reunion. As a follow-up to the positive feedback received, we began testing the TRU-BMT app in a Phase 1 pilot study. Thirty patients were enrolled in this single-arm study and were given the TRU-BMT mHealth app on a smartphone device in addition to a wearable activity tracker. Patients were followed for up to 180 days, all the while receiving daily app monitoring. Adherence to TRU-BMT was approximately 30% daily and 44% weekly, and greater adherence was associated with increased meal completion, decreased heart rate, and shorter hospital stay. TRU-BMT assessments of symptom severity were significantly associated with duration of hospital stay and development of chronic graft-versus-host disease. Our findings suggest that using TRU-BMT throughout HCT is feasible for patients and established a proof-of-concept for a future randomized control trial of the TRU-BMT application in HCT.

© 2021 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

A high cardiorespiratory fitness (CRF) level is recommended to promote healthy aging. However, the association between CRF and very-long-term prognosis is unclear, and reverse causation may bias results in studies with shorter follow-up.

This study investigated the association between CRF and mortality in middle-aged, employed men free of cardiovascular disease (CVD).

Participants from the Copenhagen Male Study, established in 1970 to 1971, were included and stratified into 4 age-adjusted maximal oxygen consumption (Vo₂max) categories: below the lower limit of normal (lowest 5%); low normal (45%); high normal (45%); and above the upper limit of normal (top 5%). Vo₂max was estimated by using a bicycle ergometer. Multivariable restricted mean survival time models were performed for all-cause and cardiovascular mortality using Danish national registers.

A total of 5,107 men with a mean age of 48.8 ± 5.4 years were included in the study. During the 46 years of follow-up, 4,700 (92%) men died; 2,149 (42.1%) of the men died of CVD. Compared with below the lower limit of normal CRF, low normal CRF was associated with 2.1 years (95% confidence interval [CI]: 0.7 to 3.4; p = 0.002), high normal with 2.9 years (95% CI: 1.5 to 4.2; p < 0.001), and above upper limit of normal with 4.9 years (95% CI: 3.1 to 6.7; p < 0.001) longer mean life expectancy. Each unit increase in Vo₂max was associated with a 45-day (95% CI: 30 to 61; p < 0.001) increase in longevity. Estimates for cardiovascular mortality were similar to all-cause mortality. Results were essentially unchanged when excluding individuals who died within the first 10 years of follow-up, suggesting a minimal role of reverse causation.

CRF was significantly related to longevity over the course of 4 decades in middle-aged, employed men free of CVD. The benefits of higher midlife CRF extend well into the later part of life.

The authors sought to determine the association between physical inactivity (characterized by exercise and television watching levels) and long-term rates of community-acquired sepsis.

The study utilized a population-based cohort of 30,183 adult (≥ 45 years) community dwelling adults. Subjects reported weekly exercise (low = none, medium = 1–3 times/week, high = ≥ 4 times/week) and daily television watching (low = < 1 h/day, medium = 1–3 h/day, high = ≥ 4 h/day) levels. The authors evaluated the association between exercise, television watching and rates of sepsis, defined as hospital treatment for a serious infection with ≥ 2 Systemic Inflammatory Response Syndrome (SIRS) criteria.

Among 30,183 participants, 1500 experienced a sepsis event. Reported weekly exercise was: high 8798 (29.2%), medium 10,695 (35.4%), and low 10,240 (33.9%). Where available, reported daily television watching was: low 4615 (19.6%), medium 11,587 (49.3%) and high 7317 (31.1%). Decreased weekly exercise was associated with increased adjusted sepsis rates (high — referent; medium — HR 1.02, 95% CI 0.96–1.20; low — 1.33, 1.13–1.56). Daily television watching was not associated with sepsis rates. Sepsis rates were highest among those with both low exercise and high television watching levels (HR 1.49, 95% CI: 1.10–2.01).

Physical inactivity may be associated with increased long-term rates of community-acquired sepsis.

The aim of this study is to assess the association between peak oxygen uptake (VO₂ peak), determined using a perceptually regulated 1-km walking test (1 k-TWT), and all-cause mortality in cardiac patients.

1255 male patients, aged 25–85 years, completed a moderate 1 k-TWT to estimate VO₂ peak. Subjects were followed for all-cause mortality for up to 10 years. Cox proportional hazard models were employed to determine variables associated with mortality. Based on the estimated VO₂ peak, the sample was subdivided into quartiles and mortality risks were calculated. To assess the discriminatory accuracy of the estimated VO₂ peak for estimating survival, receiver-operating-characteristics curves were constructed.

During a median 8.2 year follow-up, a total of 141 deaths from any cause occurred, yielding an average annual mortality of 1.4%. The strongest predictor of all-cause mortality was the estimated VO₂ peak (c-statistic 0.71, 95% confidence intervals: 0.69–0.74, P < 0.0001). Survival decreased in a graded fashion from the highest estimated VO₂ peak quartile to the lowest quartile. Compared to the lowest quartile, the hazard ratios (95% confidence intervals) for the second, third, and fourth quartiles were 0.77 (0.35–1.33), 0.43 (0.20–0.91), and 0.16 (0.05–0.54) respectively (P for trend < 0.0001). An 89% reduction in mortality risk was observed among a subset of subjects in the fittest quartile who improved their estimated VO₂ peak over the follow-up period relative to subjects in the least fit quartile who did not improve.

VO₂ peak estimated by a novel 1 k-TWT predicts survival in subjects with stable cardiovascular disease.