High-intensity interval training improves cardiorespiratory fitness in cancer patients and survivors : a meta-analysis
- Authors: Wallen, Matthew , Hennessy, Declan , Brown, Stephen , Evans, Luke , Rawstorn, Jonathan , Wong Shee, Anna , Hall, Adrian
- Date: 2020
- Type: Text , Journal article , Review
- Relation: European Journal of Cancer Care Vol. 29, no. 4 (2020), p.
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- Description: Objective: The primary objective of this systematic review and meta-analysis was to compare the effects of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) and usual care (UC) on cardiorespiratory fitness (peak V̇O2) in cancer patients and survivors. Secondary objectives were to compare the effects of HIIT versus MICT and UC on other cardiopulmonary exercise testing (CPET) indices. Safety and adherence to HIIT were also evaluated. Methods: A systematic review and meta-analysis of controlled trials were undertaken using eligible studies from electronic database searching (inception—December 2019). Mean differences (MD) with 95% confidence intervals (CI) were compared and heterogeneity assessed using Cochran's Q and I2 statistic. Results: Twelve eligible studies included 516 participants with post-intervention CPET data. No serious adverse events occurred. Adherence to HIIT ranged between 71.2% and 95.6%. HIIT had significantly higher peak V̇O2 compared with UC (MD = 2.11 ml kg−1 min−1, 95% CI 0.75–3.47, p =.002). No significant difference was found between HIIT and MICT (MD = 2.03 ml kg−1 min−1, 95%CI −0.75–4.83, p =.15). HIIT was more effective than UC to improve peak oxygen pulse (MD = 1.59 ml/beat, 95%CI 0.06–3.12, p =.04). Conclusions: Quantitative assessment of HIIT studies indicates good compliance, with a significant effect on peak V̇O2 and peak oxygen pulse compared with UC in cancer patients and survivors. HIIT demonstrates a comparable effect with MICT to improve peak V̇O2. © 2020 John Wiley & Sons Ltd
- Description: Western Alliance Academic Health Science Centre , WA-739501
Impact of beta-blockers on cardiopulmonary exercise testingin patients with advanced liver disease
- Authors: Wallen, Matthew , Hall, Adrian , Dias, Katrin , Ramos, Joyce , Keating, Shelley , Woodward, Aidan , Skinner, Tina , Macdonald, Graeme , Arena, Ross , Coombes, Jeff
- Date: 2017
- Type: Text , Journal article
- Relation: Alimentary Pharmacology and Therapeutics Vol. , no. (2017), p. 1-7
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- Description: Summary Background: Patients with advanced liver disease may develop portal hypertensionthat can result in variceal haemorrhage. Beta-blockers reduce portal pressure andminimise haemorrhage risk. These medications may attenuate measures of car-diopulmonary performance, such as the ventilatory threshold and peak oxygenuptake measured via cardiopulmonary exercise testing. Aim: To determine the effect of beta-blockers on cardiopulmonary exercise testingvariables in patients with advanced liver disease. Methods: This was a cross-sectional analysis of 72 participants who completed acardiopulmonary exercise test before liver transplantation. All participants remainedon their usual beta-blocker dose and timing prior to the test. Variables measuredduring cardiopulmonary exercise testing included the ventilatory threshold, peakoxygen uptake, heart rate, oxygen pulse, the oxygen uptake efficiency slope and theventilatory equivalents for carbon dioxide slope. Results: Participants taking beta-blockers (n = 28) had a lower ventilatory threshold(P <.01) and peak oxygen uptake (P = .02), compared to participants not takingbeta-blockers. After adjusting for age, the model of end-stage liver-disease score,liver-disease aetiology, presence of refractory ascites and ventilatory thresholdremained significantly lower in the beta-blocker group (P = .04). The oxygen uptakeefficiency slope was not impacted by beta-blocker use. Conclusions: Ventilatory threshold is reduced in patients with advanced liver dis-ease taking beta-blockers compared to those not taking the medication. This mayincorrectly risk stratify patients on beta-blockers and has implications for patientmanagement before and after liver transplantation. The oxygen uptake efficiencyslope was not influenced by beta-blockers and may therefore be a better measureof cardiopulmonary performance in this patient population.
Is post-transplant metabolic syndrome associated with pre-liver transplant visceral adipose tissue area?
- Authors: Woodward, Aidan , Wallen, Matthew , Ryan, John , Hall, Adrian , Ward, Leigh , Coombes, Jeff , Macdonald, Graeme
- Date: 2020
- Type: Text , Journal article
- Relation: Clinical Nutrition ESPEN Vol. 39, no. (2020), p. 61-66
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- Description: Background: Post-liver transplant metabolic syndrome (PTMS) is a significant independent risk factor for the development of cardiovascular disease. The impact of pre-transplant body composition on the risk of developing PTMS has not been evaluated and was the aim of this study. Methods: Seventy-five consecutive adult patients listed for liver transplant were included in the analysis. Anthropometric and metabolic data were collected pre-transplant and at three months post-transplant. Metabolic syndrome was defined in accordance with international guidelines. Skeletal muscle area (SMA), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) areas were derived from computed tomography. Results: Ten patients (13%) developed de novo PTMS by 3 months post-transplant. Patients who developed PTMS had higher pre-transplant body mass index (BMI) (P = 0.01), VAT (P = 0.001) and SAT (P = 0.008). Univariate logistic regression found that BMI, VAT and SAT were significant predictors for the development of PTMS. After stepwise multivariate analysis, only VAT remained a significant predictor (OR 1.02, 95%CI 1.01–1.04; P = 0.04). Conclusions: Higher pre-transplant VAT is independently associated with the development of metabolic syndrome three months post-transplant. Body composition analysis using cross-sectional imaging prior to liver transplant can assist with identifying patients at greatest risk for developing PTMS. © 2020 European Society for Clinical Nutrition and Metabolism
Poor cardiorespiratory fitness is a risk factor for sepsis in patients awaiting liver transplantation
- Authors: Wallen, Matthew , Woodward, Aidan , Hall, Adrian , Skinner, Tina , Coombes, Jeff , Macdonald, Graeme
- Date: 2019
- Type: Text , Journal article
- Relation: Transplantation Vol. , no. 103(3) (2019), p.529-535
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- Description: Background Patients with advanced liver disease are at increased risk of infection and other complications. A significant proportion of patients also have poor fitness and low muscle mass. The primary aim of this study was to investigate if cardiorespiratory fitness and body composition are risk factors for sepsis and other complications of advanced liver disease. Methods Patients being listed for liver transplantation underwent cardiopulmonary exercise testing to determine ventilatory threshold (VT). Computed tomography was used to measure skeletal muscle and subcutaneous and visceral adipose tissue indexes. All unplanned hospital admissions, deaths or delistings prior to transplantation were recorded. Results Eighty-two patients [aged 55.1 (50.6–59.4) years, median (interquartile range); male 87%] achieved a median VT of 11.7 (9.7–13.4) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1. Their median MELD-Na score was 18 (14–22); and 37 had hepatocellular carcinoma. There were 50 admissions in 31 patients; with 16 admissions for sepsis in 13 patients. Patients with sepsis had a significantly lower VT [sepsis 9.5 (7.8–11.9), no sepsis 11.8 (10.5–13.8) mL[BULLET OPERATOR]kg-1[BULLET OPERATOR]min-1; P=0.003]. No body composition variables correlated with sepsis, nor were there any significant associations between VT and unplanned admissions for other indications. Multivariate logistic regression demonstrated that VT was independently associated with a diagnosis of sepsis (P=0.03). Poisson regression revealed that VT was a significant predictor for the number of septic episodes (P=0.02); independent of age, MELD-Na score, hepatocellular carcinoma diagnosis, presence of ascites, and beta-blocker use. Conclusion Poor cardiorespiratory fitness is an independent risk factor for the development of sepsis in advanced liver disease.
Safety, adherence and efficacy of exercise training in solid-organ transplant candidates: A systematic review
- Authors: Wallen, Matthew , Skinner, Tina , Pavey, Toby , Hall, Adrian , Macdonald, Graeme , Coombes, Jeff
- Date: 2016
- Type: Text , Journal article
- Relation: Transplantation Reviews Vol. 30, no. 4 (2016), p. 218-226
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- Description: Background Patients awaiting solid-organ transplantation may be encouraged to undertake exercise training to improve pre- and post-transplant outcomes. However, the safety, adherence and efficacy of exercise training in this population remain unclear. Methods All randomized, non-randomized and non-controlled trials of exercise training interventions in solid-organ transplant candidates were included. The Cochrane risk of bias tool and a modified Newcastle–Ottawa scale were used to assess procedural quality. Safety was defined as the number of reported adverse events during exercise training. Adherence was evaluated from session attendance, and efficacy as changes in cardiorespiratory fitness (CRF), exercise capacity, muscular strength, health-related quality of life (HR-QoL) and lung function. Results Eleven studies involving 874 patients were included: four randomized controlled, one non-randomized controlled and six non-controlled trials. Six studies included heart transplant candidates and five involved patients awaiting lung transplantation. Three trials included aerobic-only training, one incorporated resistance-only exercise and seven combined modalities. Twelve adverse events were reported with four due to exercise, although methods to collect these data were often omitted. Exercise adherence ranged from 82.5% to 100%, but was poorly described. No significant between-group changes attributable to exercise training were demonstrated. However, significant within-group improvements in CRF, exercise capacity, muscular strength, lung function and HR-QoL were observed. Conclusions Patients awaiting heart or lung transplant appear to tolerate exercise training despite the larger number of adverse events compared to other high-risk populations. Exercise training demonstrated within-group benefits for several outcomes, with no significant between-group differences. Randomized controlled trials with sufficient statistical power are required for all solid-organ transplant candidates. © 2016 Elsevier Inc.