https://www.hse.ru/data/816/479/1225/Oct%2019%20Cited%20%231%20Manage%20THE%20THEORY%20OF%20PLANNED%20BEHAVIOR.pdf

The theory of planned behavior

Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols--PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols.

/pdf/preferred-reporting-items-for-systematic-review-and-meta-mgb1uy0yle.pdf

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation.

Objective. —To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants. —A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence. —The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus Process. —Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion. —Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. ( JAMA . 1995;273:402-407)

https://jamanetwork.com/journals/JAMA/articlepdf/386766/jama_273_5_029.pdf

Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine

ABI
: ankle–brachial index
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation
AGREE
: Appraisal of Guidelines Research and Evaluation
AHA
: American Heart Association
apoA1
: apolipoprotein A1
apoB
: apolipoprotein B
CABG
: coronary artery bypass graft surgery
CARDS
: Collaborative AtoRvastatin Diabetes Study
CCNAP
: Council on Cardiovascular Nursing and Allied Professions
CHARISMA
: Clopidogrel for High Athero-thrombotic Risk and Ischemic Stabilisation, Management, and Avoidance
CHD
: coronary heart disease
CKD
: chronic kidney disease
COMMIT
: Clopidogrel and Metoprolol in Myocardial Infarction Trial
CRP
: C-reactive protein
CURE
: Clopidogrel in Unstable Angina to Prevent Recurrent Events
CVD
: cardiovascular disease
DALYs
: disability-adjusted life years
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Trial
ED
: erectile dysfunction
eGFR
: estimated glomerular filtration rate
EHN
: European Heart Network
EPIC
: European Prospective Investigation into Cancer and Nutrition
EUROASPIRE
: European Action on Secondary and Primary Prevention through Intervention to Reduce Events
GFR
: glomerular filtration rate
GOSPEL
: Global Secondary Prevention Strategies to Limit Event Recurrence After MI
GRADE
: Grading of Recommendations Assessment, Development and Evaluation
HbA1c
: glycated haemoglobin
HDL
: high-density lipoprotein
HF-ACTION
: Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing
HOT
: Hypertension Optimal Treatment Study
HPS
: Heart Protection Study
HR
: hazard ratio
hsCRP
: high-sensitivity C-reactive protein
HYVET
: Hypertension in the Very Elderly Trial
ICD
: International Classification of Diseases
IMT
: intima-media thickness
INVEST
: International Verapamil SR/Trandolapril
JTF
: Joint Task Force
LDL
: low-density lipoprotein
Lp(a)
: lipoprotein(a)
LpPLA2
: lipoprotein-associated phospholipase 2
LVH
: left ventricular hypertrophy
MATCH
: Management of Atherothrombosis with Clopidogrel in High-risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke
MDRD
: Modification of Diet in Renal Disease
MET
: metabolic equivalent
MONICA
: Multinational MONItoring of trends and determinants in CArdiovascular disease
NICE
: National Institute of Health and Clinical Excellence
NRT
: nicotine replacement therapy
NSTEMI
: non-ST elevation myocardial infarction
ONTARGET
: Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial
OSA
: obstructive sleep apnoea
PAD
: peripheral artery disease
PCI
: percutaneous coronary intervention
PROactive
: Prospective Pioglitazone Clinical Trial in Macrovascular Events
PWV
: pulse wave velocity
QOF
: Quality and Outcomes Framework
RCT
: randomized clinical trial
RR
: relative risk
SBP
: systolic blood pressure
SCORE
: Systematic Coronary Risk Evaluation Project
SEARCH
: Study of the Effectiveness of Additional Reductions in Cholesterol and
SHEP
: Systolic Hypertension in the Elderly Program
STEMI
: ST-elevation myocardial infarction
SU.FOL.OM3
: SUpplementation with FOlate, vitamin B6 and B12 and/or OMega-3 fatty acids
Syst-Eur
: Systolic Hypertension in Europe
TNT
: Treating to New Targets
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use
VITATOPS
: VITAmins TO Prevent Stroke
VLDL
: very low-density lipoprotein
WHO
: World Health Organization

### 1.1 Introduction

Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has …

/pdf/european-guidelines-on-cardiovascular-disease-prevention-in-4z4nw4311i.pdf

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)

The purpose of this Position Stand is to provide guidance to professionals who counsel and prescribe individualized exercise to apparently healthy adults of all ages. These recommendations also may apply to adults with certain chronic diseases or disabilities, when appropriately evaluated and advised by a health professional. This document supersedes the 1998 American College of Sports Medicine (ACSM) Position Stand, "The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults." The scientific evidence demonstrating the beneficial effects of exercise is indisputable, and the benefits of exercise far outweigh the risks in most adults. A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults. The ACSM recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for ≥30 min·d on ≥5 d·wk for a total of ≥150 min·wk, vigorous-intensity cardiorespiratory exercise training for ≥20 min·d on ≥3 d·wk (≥75 min·wk), or a combination of moderate- and vigorous-intensity exercise to achieve a total energy expenditure of ≥500-1000 MET·min·wk. On 2-3 d·wk, adults should also perform resistance exercises for each of the major muscle groups, and neuromotor exercise involving balance, agility, and coordination. Crucial to maintaining joint range of movement, completing a series of flexibility exercises for each the major muscle-tendon groups (a total of 60 s per exercise) on ≥2 d·wk is recommended. The exercise program should be modified according to an individual's habitual physical activity, physical function, health status, exercise responses, and stated goals. Adults who are unable or unwilling to meet the exercise targets outlined here still can benefit from engaging in amounts of exercise less than recommended. In addition to exercising regularly, there are health benefits in concurrently reducing total time engaged in sedentary pursuits and also by interspersing frequent, short bouts of standing and physical activity between periods of sedentary activity, even in physically active adults. Behaviorally based exercise interventions, the use of behavior change strategies, supervision by an experienced fitness instructor, and exercise that is pleasant and enjoyable can improve adoption and adherence to prescribed exercise programs. Educating adults about and screening for signs and symptoms of CHD and gradual progression of exercise intensity and volume may reduce the risks of exercise. Consultations with a medical professional and diagnostic exercise testing for CHD are useful when clinically indicated but are not recommended for universal screening to enhance the safety of exercise.

/pdf/quantity-and-quality-of-exercise-for-developing-and-1fohxlhqop.pdf

Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

This review focuses on the response of "stress" hormones to heat, exercise (single or repeated bouts), and combinations of these stimuli, with particular reference to their impact upon immune function. Very hot conditions induce a typical stress response, with secretion of catecholamines and cortisol. The catecholamines induce a demargination of leukocytes, and cortisol subsequently causes cells to migrate to lymphoid tissue. Sustained exercise, even in a thermally comfortable environment, induces a larger hormonal response than moderate thermal stress. With moderate exercise, increases in leukocyte numbers are related mainly to plasma norepinephrine concentrations, but with more intense exercise epinephrine concentrations assume a major importance. As exercise continues, plasma cortisol levels also rise, inducing an influx of neutrophils from bone marrow and an efflux of other leukocyte subsets. A combination of exercise and heat stress augments both hormonal and leukocyte responses. But these changes seem to be reversed if temperatures are clamped by exercising in cold water. If a second bout of exercise is performed with an inter-test interval of 30-45 min, neither hormone concentrations nor immune responses show any great cumulative effect under temperate conditions. However, in a hot environment the second exercise bout induces a larger and more persistent neutrophilia. Training influences these various responses mainly by decreasing the stress imposed when exercising at a given absolute work-rate.

Stress Hormones and the Immunological Responses to Heat and Exercise

Most of the available data on the aging of muscle function are cross-sectional in type. Static and dynamic muscle strength seem well preserved to about 45 years of age, but performance deteriorates by about 5% per decade thereafter. There is a parallel loss of lean tissue. Because muscle biopsy specimens are not always representative of an entire muscle, it is unclear whether there is a general hypotrophy or atrophy of the muscle fibres or a selective hypoplasia and degeneration of type II fibres associated with a loss of terminal sprouting. Other influences may include a deterioration of end-plate structures with impaired excitation-contraction coupling and impaired fibre recruitment. Both contraction time and half-relaxation time are prolonged with aging, and there is a decrease of maximal contraction velocity, more marked in the legs than in the arms. On the other hand, endurance at a fixed fraction of maximal force is increased. Potential factors leading to the enhanced endurance include a poorer maximal effort and an increased proportion of type I fibres; however, there is little evidence that muscle capillarity is altered. The loss of function is generally less in the arms than in the legs, but it remains unclear whether this is an inherent biological difference, or merely a reflection of differential changes in activity patterns between the upper and the lower limbs. The male/female strength ratio does not seem to change with age, but substantial slowing or reversal of the aging process is possible through appropriate activity programmes. The preservation of muscle function has important implications for the quality of life in the frail elderly, counteracting dyspnoea, stabilising joints and extending the period of independent living by up to 20 years.

Aging and muscle function.

Our main purpose was to examine the influence of personal attributes and family environment upon the exercise intentions of students in grades 7 to 9. Fishbein's (1967) psychosocial model was applied. This predicts intentions from attitudes and subjective norms. The subjects were 698 students of both sexes attending grades 7 to 9 at two junior high schools in Metro Toronto. The results do not fully support Fishbein's concepts that external variables increase the prediction of exercise intentions relative to variables normally included in his model. Attitudes, current physical activity habits, and prior experience of exercise all contributed significantly to explaining the variance in exercise intentions. Nevertheless, over 50% of the total variance in exercise intentions remained unexplained. Since more variance of exercise intentions could be explained in students who had personal experience of physical activity early in childhood, our results support the value of early socialization towards phy...

Psychosocial Factors Influencing Intentions to Exercise of Young Students from Grades 7 to 9.

Synopsis: The determinants of endurance effort vary, depending upon the extent of the muscle mass that is activated. Large muscle work, such as treadmill running, is halted by impending circulatory failure; lack of venous return may compound the bask problem of an excessive cardiac work-load. If the task calls for use of a smaller muscle mass, there is ultimately difficulty in perfusing the active muscles, and glycolysis is halted by an accumulation of acid metabolites. Simple field tests of endurance, such as Cooper’s 12-minute run and the Canadian Home Fitness Test, have some value in the rapid screening of large populations, but like other submaximal tests of human performance they lack the precision needed to advise the individual. The directly measured maximum oxygen intake (VO2max) varies with the type of exercise. The highest values are obtained during uphill treadmill running, but well trained athletes often approach these values during performance of sport-specific tasks. Limitations of methodology and wide interindividual variations of constitutional potential limit the interpretation of maximum oxygen intake data in terms of personal fitness, exercise prescription and the monitoring of training responses. The main practical value of VO2max measurement is in the functional assessment of patients with cardiorespiratory disease, since changes are then large relative to the precision of the test. Determinants of Endurance Effort: During treadmill exercise, maximum effort is halted by central circulatory failure. It is less clear whether the limitation is imposed by a deficiency of venous return or an inability of the heart to develop an adequate stroke volume in the face of a rising peripheral resistance. Activities that depend upon the use of a relatively small muscle group (e.g. cycle ergometry, and especially arm ergometry) undoubtedly have some peripheral limitation, but this reflects difficulty in perfusing vigorously contracting muscles rather than any problem with utilisation of oxygen by the active fibres. Evidence of a cellular limitation of effort offered by Kaijser (1970) is disputed. VO2max varies somewhat with the type of exercise, but this reflects the difficulty in perfusing small muscles rather than an intracellular enzyme deficiency. Variations of ambient pressure cause the changes of VO2max predicted for a circulatory limitation, if due allowance is made for possible limitation of exercise by CO2 poisoning. While there is some specificity of training when conditioning is based upon small muscle groups, treadmill training apparently improves cardiac performance, and thus VO2max, in many other types of endurance activity. Changes of maximum cardiac output induced by heat or (β-blocking drugs do not modify oxygen transport, but this is because a varying proportion of the total blood flow is directed to tissue other than muscle. Cooling reduces VO2max, but this could reflect a circulatory change rather than a lowering of tissue enzyme activity. Training increases the aerobic enzyme content of muscles, but the cellular response does not develop in parallel with VO2max; its main ’purpose’ is to encourage the utilisation of fat. Impending loss of consciousness undoubtedly reflects failing blood flow to the brain, but muscle weakness is due to an inhibition of glycolysis. Factors contributing to the latter include deficient oxygen transport, a slow diffusion oflactate and, to a lesser extent, an accumulation of hydrogen ions within the working tissue. Assessment of Endurance Performance: Simple field tests of endurance may help in screening large populations for the constitutionally well-endowed. Cooper’s 12-minute run is the best known ofthese procedures, and works reasonably well in highly motivated young adults. If the intent is to discover potential athletes, tests need to be event-specific. Moreover, in many activities (such as swimming) skill has a major impact on score. The Canadian Home Fitness Test is a simple stepping procedure, paced by a longplaying gramophone record. The safety of subjects is assured by preliminary questioning, an adequate warm-up and conservative submaximal pulse ceilings. Originally devised as a motivational tool, it can also be used to test fitness in the community, having about the same accuracy as other submaximal tests. The basic assumptions of most submaximal predictions of VO2max include a linear heart rate/oxygen consumption relationship, a known maximum heart rate, and a known mechanical efficiency. Systematic errors of up to 10%, and random errors of ± 10% limit the value of the information that can be obtained through such prediction procedures. Direct measurements of VO2max depend upon careful technique (both preparation of the patient and biological calibration of the equipment). Increasing use is now made of sport-specific techniques, e.g. a flume for swimmers, rowing ergometers or rowing tanks for oarsmen, and roller-mounted racing cycles for cycling enthusiasts. Well-trained performers usually approach their treadmill VO2max during performance of the sport-specific task. The treadmill is the most popular of laboratory testing devices. The cycle ergometer generally yields a smaller and peripherally limited VO2max. although it has the advantage that it is easier to make ancillary measurements on a seated subject. A maximum effort step test remains a useful possibility for field locations, while various forms of arm ergometer are available for the testing of wheelchair athletes. Given one preliminary attempt, most adult volunteers can reach a classical plateau of oxygen consumption. Attempts to characterise the quality of an individual’s effort on subsidiary maximal criteria remain problematical. If good technical assistance is not available, fitness can be judged from the endurance of a progressive treadmill protocol, although such tests must be carried to complete exhaustion of the subject. Details of test protocol are less important than might be imagined. Factors contributing to a large VO2max score include a preliminary warm-up, running rather than walking, and possibly a schedule of effort which is intermittent rather than continuous. Interpretation: For most purposes, data are best expressed per kg of body mass, although absolute units are preferred for some weight-supported sports. Unusual results call for a critical review of both the technique and the population sampling procedures. Wide interindividual variations of constitutional potential and limitations of methodology limit the value of fitness assessment in the individual. Test scores give some guidance in work classification but in many sports the element of skill is more important than a large maximum oxygen intake. At best, exercise prescriptions based on VO2max are crude, and they need fine tuning by the individual or the coach. Likewise, the training response is usually small relative to methodological errors, so that there is limited scope for VO2max as a means of monitoring conditioning. The greatest potential of endurance testing probably lies in the overall functional assessment of cardiorespiratory disease, since many clinical conditions give rise to a gross impairment of VO2max.

Tests of Maximum Oxygen Intake A Critical Review

OBJECTIVE: To examine the long-term benefits and safety of aerobic training in patients with chronic heart failure. DESIGN: Non-randomised control trial with 52 weeks follow up. SETTING: Outpatient cardiac rehabilitation referral centre. PATIENTS: Patients with compensated chronic heart failure (mean (SD) age 62 (6) years, New York Heart Association stage III, initial resting ejection fraction 22 (7)%). Experimental group of 17 men, 4 women; control group 8 men, 1 woman. INTERVENTIONS: Experimental group: progressive, supervised aerobic walking programme for 52 weeks. Control group: standard medical treatment. MAIN OUTCOME MEASURES: Six-minute walk distance, progressive cycle ergometer test to subjective exhaustion, disease-specific quality of life questionnaire, and standard gamble test, all measured at entry, 4, 8, 12, 16, 26, and 52 weeks. RESULTS: Control data showed no changes except a small trend to improved emotional function (P = 0.02 at 12 weeks only). Fifteen of the 21 patients completed all 52 weeks of aerobic training; two withdrew for non-cardiac reasons (16, 52 weeks). Three were withdrawn because of worsening cardiac failure unrelated to their exercise participation (4, 4, 8 weeks), and one had a non-fatal cardiac arrest while shopping (16 weeks). Gains of cardiorespiratory function plateaued at 16-26 weeks, with 10-15% improvement in six-minute walk, peak power output, and peak oxygen intake linked to gains in oxygen pulse and ventilatory threshold and reductions in resting heart rate. Marked improvements in quality of life followed a parallel course. CONCLUSIONS: Aerobic training is safe and beneficial in compensated chronic heart failure. Gains in aerobic function and quality of life persisted over a programme lasting 52 weeks.

https://heart.bmj.com/content/heartjnl/76/1/42.full.pdf

Roy J. Shephard

Papers

Stress Hormones and the Immunological Responses to Heat and Exercise

Aging and muscle function.

Psychosocial Factors Influencing Intentions to Exercise of Young Students from Grades 7 to 9.

Tests of Maximum Oxygen Intake A Critical Review

Quality of life and cardiorespiratory function in chronic heart failure: effects of 12 months' aerobic training.