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

Athletes undergoing intensive training schedules have chronic exposure to stress-induced hormones such as cortisol that can depress immune function. We compared the circulating levels of T cell receptor excision circles (TREC), a marker of recent thymic emigrants, as well as the levels of naive and memory subsets in a group of elite endurance athletes and in controls. The athletes showed a reduction in absolute numbers of naive T cells, particularly in CD4 T cells. In contrast, memory cells were increased. TREC levels in the athletes were significantly reduced compared to age-matched controls. Such changes resemble premature ageing of the T cell component of the immune system. Since thymic production of T cells naturally decline with age, these results raise the concern that prolonging high intensity exercise into the 4th decade of life may have deleterious consequences for athletes’ health.

/pdf/reduced-thymic-output-in-elite-athletes-51i13mqaea.pdf

Reduced thymic output in elite athletes

The purpose of this study was to determine the effect of pre-exercise high carbohydrate meals with high glycemic index (HGI) or low glycemic index (LGI) on blood leukocyte redistribution during subsequent endurance exercise. Eight male subjects performed a 90-min run on a treadmill at 70% VO2max 3 h after ingesting an isocaloric HGI or LGI meal with GI values of 77 and 37, respectively. Blood counts of leukocytes, and neutrophils and the neutrophil/lymphocyte ratio were significantly lower in LGI than HGI at 90 min of exercise (P < 0.05). The plasma glucose concentrations were significantly higher in LGI than HGI between 15 min and 45 min of exercise. There were, however, no differences in plasma cortisol, growth hormone, and interleukin-6 concentrations between trials. Thus, the GI of a pre-exercise meal influences leukocyte trafficking and plasma glucose but has limited effects on circulating stress hormone and cytokine responses to exercise.

The Effects of Pre-Exercise High Carbohydrate Meals with Different Glycemic Indices on Blood Leukocyte Redistribution, IL-6, and Hormonal Responses during a Subsequent Prolonged Exercise

Purpose
To determine how immune markers are affected by acute hypoxic exercise at the same relative intensity.

/pdf/effect-of-acute-exercise-and-hypoxia-on-markers-of-systemic-4r4tyw5qni.pdf

Effect of acute exercise and hypoxia on markers of systemic and mucosal immunity

Respiratory adjustments of the unanaesthetized chicken, Gallus domesticus, to elevated metabolism elicited by 2,4-dinitrophenol or cold exposure

The purpose of this study was to examine the influence of previous infection with cytomegalovirus (CMV) or Epstein Barr virus (EBV) on the incidence, severity and duration of upper respiratory tract infections (URTIs) in endurance athletes during a 4-month winter training period. Blood samples were obtained from 236 subjects (166 males and 70 females, aged 18–35 years) at the start of the study period. Plasma samples were analysed for CMV and EBV serostatus. Weekly training and daily illness logs were kept for the next 16 weeks. With regard to CMV/EBV serostatus, the results indicated that athletes with previous CMV infection (n = 58, 25 % of cohort) had significantly fewer URTI symptom days (median 2 vs. 4 days, p = 0.033) during the study period than those with no previous infection (n = 178, 75 %), whereas positive EBV serostatus (n = 197, 84 %) had no influence on URTI episode incidence, severity or duration. Moreover, we found that athletes with prior infection of both CMV and EBV (n = 50, 21 %) had 50 % fewer URTI episodes (p = 0.04) and symptom days (median 2 vs 8 days, p = 0.01) than athletes who were seronegative for both CMV and EBV (n = 31, 13 %). Previous coinfection with CMV and EBV might promote protective immune surveillance to lower the risk of URTI. Further research is required to clarify why previous CMV and EBV infection reduces the incidence of URTI.

/pdf/influence-of-cmv-ebv-serostatus-on-respiratory-infection-h1vlkuiesa.pdf

Michael Gleeson

Papers

Reduced thymic output in elite athletes

The Effects of Pre-Exercise High Carbohydrate Meals with Different Glycemic Indices on Blood Leukocyte Redistribution, IL-6, and Hormonal Responses during a Subsequent Prolonged Exercise

Effect of acute exercise and hypoxia on markers of systemic and mucosal immunity

Respiratory adjustments of the unanaesthetized chicken, Gallus domesticus, to elevated metabolism elicited by 2,4-dinitrophenol or cold exposure

Influence of CMV/EBV serostatus on respiratory infection incidence during 4 months of winter training in a student cohort of endurance athletes