https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)62167-9.pdf

Frailty in elderly people

SUMMARYACSM Position Stand on The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Adults. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 975-991, 1998. The combination of frequency, intensity, and duration of chr

http://myweb.facstaff.wwu.edu/chalmers/pdfs/acsm position stand - quantity and quality of exercise.pdf

ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults

The purpose of this report is to provide revised standards and guidelines for the exercise testing and training of individuals who are free from clinical manifestations of cardiovascular disease and those with known cardiovascular disease. These guidelines are intended for physicians, nurses, exercise physiologists, specialists, technologists, and other healthcare professionals involved in exercise testing and training of these populations. This report is in accord with the “Statement on Exercise” published by the American Heart Association (AHA).1

These guidelines are a revision of the 1995 standards of the AHA that addressed the issues of exercise testing and training.2 An update of background, scientific rationale, and selected references is provided, and current issues of practical importance in the clinical use of these standards are considered. These guidelines are in accord with the American College of Cardiology (ACC)/AHA Guidelines for Exercise Testing.3

### The Cardiovascular Response to Exercise

Exercise, a common physiological stress, can elicit cardiovascular abnormalities that are not present at rest, and it can be used to determine the adequacy of cardiac function. Because exercise is only one of many stresses to which humans can be exposed, it is more appropriate to call an exercise test exactly that and not a “stress test.” This is particularly relevant considering the increased use of nonexercise stress tests.

### Types of Exercise

Three types of muscular contraction or exercise can be applied as a stress to the cardiovascular system: isometric (static), isotonic (dynamic or locomotory), and resistance (a combination of isometric and isotonic).4,5 Isotonic exercise, which is defined as a muscular contraction resulting in movement, primarily provides a volume load to the left ventricle, and the response is proportional to the size of the working muscle mass and the intensity of exercise. Isometric exercise is defined as a muscular contraction without movement (eg, handgrip) and imposes greater pressure than volume …

Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association

The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale.

Guidelines for the Primary Prevention of Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

OBJECTIVE: To investigate the effects of long term (> 10 years) endurance training and submaximal exercise on the phagocytic activity of circulating neutrophil granulocytes. METHODS: The ability of stimulated blood neutrophils isolated from well trained cyclists [n = 8; VO2max 61.0(SD 8.8) ml.kg-1.min-1; age 38(4) years] and age matched sedentary controls [n = 8; VO2max 37.4 (6.6) ml.kg-1.min-1] to ingest nitroblue tetrazolium was assessed at rest and following a standardised submaximal bout of exercise on a cycle ergometer. RESULTS: Trained subjects had a lower resting blood neutrophil count (P < 0.01). Acute exercise caused a rise (P < 0.01) in the blood neutrophil count irrespective of training status, but the magnitude of the rise was smaller in the trained subjects (P < 0.05). The circulating neutrophil phagocytic capacity was approximately 70% lower in trained individuals at rest compared with the control subjects (P < 0.01). Acute submaximal exercise increased this variable in both groups, but phagocytic capacity remained substantially lower in the trained subjects compared with the controls (P < 0.05) despite the observation that a higher proportion of the circulating neutrophils were stimulated to undergo phagocytosis in the trained subjects [57(14)% v 32(7)%; P < 0.01). CONCLUSIONS: Although neutrophil phagocytic activity is only one variable that contributes to immunological status, prolonged periods of endurance training may lead to increased susceptibility to opportunistic infections by diminishing this activity at rest.

https://bjsm.bmj.com/content/bjsports/30/2/125.full.pdf

Effects of submaximal cycling and long-term endurance training on neutrophil phagocytic activity in middle aged men.

Davison, Glen, et al., 'Antioxidant supplementation and immunoendocrine responses to prolonged exercise', Medicine and Science in Sports and Exercise, (2007) 39(4) pp.645-652 RAE2008

/pdf/antioxidant-supplementation-and-immunoendocrine-responses-to-34ymvyh4lk.pdf

Antioxidant supplementation and immunoendocrine responses to prolonged exercise

The influence of four isolated periods of dietary manipulation upon high intensity exercise capacity was investigated in six healthy male subjects. Subjects consumed their 'normal' (N) diet (45 +/- 2% carbohydrate (CHO), 41 +/- 3% fat, 14 +/- 3% protein) for four days after which they exercised to voluntary exhaustion at a workload equivalent to 100% VO2max. Three further four-day periods of dietary manipulation took place; these were assigned in a randomised manner and each was followed by a high intensity exercise test. The dietary treatments were: a low CHO (3 +/- 1%), high fat (71 +/- 5%), high protein (26 +/- 3%) diet (HFHP); a high CHO (73 +/- 2%), low fat (12 +/- 2%), normal protein (15 +/- 1%) diet (HCLF); and a normal CHO (47 +/- 3%), low fat (27 +/- 2%), high protein (26 +/- 2%) diet (LFHP). Acid-base status and blood lactate concentration were measured on arterialised-venous blood at rest prior to dietary manipulation on each day of the different diets, immediately prior to exercise and at 2, 4, 6, 10 and 15 min post-exercise. Other metabolite concentrations were measured in the blood samples obtained prior to dietary manipulation and immediately prior to exercise. Exercise time to exhaustion after the HFHP diet (179 +/- 63 s) was shorter when compared with the N (210 +/- 65 s; p less than 0.01) and HCLF (219 +/- 69 s; p less than 0.05) diets.(ABSTRACT TRUNCATED AT 250 WORDS)

Diet-induced metabolic acidosis and the performance of high intensity exercise in man

Ingesting carbohydrate (CHO) beverages during heavy exercise is associated with smaller changes in the plasma concentrations of several cytokines. The influence of dietary CHO availability on these responses has not been determined. Therefore, the present study investigated the influence of pre-exercise CHO status on plasma interleukin (IL)-6, IL-10, and IL-1 receptor antagonist (IL-1ra) responses to prolonged cycling. Seven trained male cyclists performed a glycogen-lowering bout of cycling and were randomly assigned to follow a diet ensuring either greater than 70% (HIGH) or less than 10% (LOW) of daily energy intake from CHO for the next 3 days. On day 4 subjects performed an exercise test that comprised cycling for 1 hour at 60% Wmax immediately followed by a time-trial (TT) ensuring an energy expenditure equivalent to cycling for 30 min at 80% Wmax. Subjects repeated the protocol after 7 days, this time following the second diet. The order of the trials was counterbalanced. At 1 and 2 hours post-TT, ...

Pre-Exercise Carbohydrate Status and Immune Responses to Prolonged Cycling: II. Effect on Plasma Cytokine Concentration

The influence of a 24 h fast on endurance performance and the metabolic response to maximal cycle exercise was investigated in 6 healthy men (mean±SD: age = 21±7 years; weight = 73±10 kg;\(\dot V_{O_{2\max } }\) = 46±10 ml·kg−1·min−1) Subjects performed in randomised order two exercise bouts to exhaustion separated by one week Test rides were performed in fasted (F) and post-absorptive (normal-diet, ND) conditions on an electrically braked cycle ergometer at a workload equivalent to 100% of\(\dot V_{O_{2\max } }\) Acid-base status and selected metabolites were measured on arterialised venous blood at rest prior to exercise and at intervals for 15 mins following exercise Exercise time to exhaustion was shorter after F compared with ND (p<001) Pre-exercise blood bicarbonate (HCO3−) concentration,\(P_{CO_2 }\) and base excess (BE) were lower after F compared with ND (p<005) Prior to exercise, circulating concentrations of free fatty acids (FFA), gb-hydroxybutyrate (B-HB) and glycerol were higher after F compared with ND (p<001) but blood glucose and lactate concentration were not different On the F treatment, after exercise, blood pH, HCO3−, and BE were all significantly higher (p<001) than on ND; blood lactate concentration was significantly lower for the whole of the post-exercise period after F compared with ND (p<001) Circulating levels of FFA and B-HB after exercise on the F treatment fell but levels of these substrates were not altered by exercise after ND Blood glucose and glycerol concentrations increased following exercise on both treatments The present study provides evidence that a 24 h fast is detrimental to high-intensity exercise performance and possibly influences the metabolic response following maximal cycle exercise These changes may be related to the altered pre-exercise acid-base status and/or a change in the pattern of substrate utilisation

Michael Gleeson

Papers

Effects of submaximal cycling and long-term endurance training on neutrophil phagocytic activity in middle aged men.

Antioxidant supplementation and immunoendocrine responses to prolonged exercise

Diet-induced metabolic acidosis and the performance of high intensity exercise in man

Pre-Exercise Carbohydrate Status and Immune Responses to Prolonged Cycling: II. Effect on Plasma Cytokine Concentration

Influence of a 24 h fast on high intensity cycle exercise performance in man