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Results according to diastolic blood pressure response A.Exercise test results by diastolic blood pressure response Normal DBP response, N = 11,254 (54%) Borderline DBP response, N = 6,042 (29%) Abnormal DBP response, N = 3,463 (17%)

Results according to diastolic blood pressure response A.Exercise test results by diastolic blood pressure response Normal DBP response, N = 11,254 (54%) Borderline DBP response, N = 6,042 (29%) Abnormal DBP response, N = 3,463 (17%)

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Background: A decrease in diastolic blood pressure (DBP) with exercise is considered normal, but the significance of an increase in DBP has not been validated. Our aim was to determine the relationship of DBP increasing on a stress test regarding comorbidities and mortality. Methods: Our database was reviewed from 1993-2010 using the first stres...

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... were 7,314 females (35%). Their demographic and clinical data stratified by DBP response, along with the long-term outcome data are shown in Table 1. ...
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... test data by DBP response are provided in part A of the Table 1. Because of the large sample size, even minor differences, such as in resting HR or highest rating of perceived exertion reached statistical significance, though some age trends were pronounced. ...
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... DBP was lower in patients with abnormal DBP response, while their peak DBP was higher. Resting SBP was not different between borderline and abnormal DBP groups, but the SBP of abnormal response group was higher with a lower peak HR. Table 1 part B shows the rates of obesity, hypertension, diabetes, and current smoking along with odds ratios (95% confidence intervals) for borderline and abnormal vs. normal DBP response. Patients with borderline and abnormal DBP response had more obesity, hypertension, diabetes and were more likely to be current smokers compared with patients with normal DBP response. ...
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... with the exclusion of baseline CV disease and residence in a state (Minnesota) with low CV mortality, the overall and CV death rates (557, 2.7%) were low. In the Table 1 part C hazard ratios (95% confidence intervals) for death and CV death are shown. Although there was a trend of increas- ing total and CV death rates with borderline and abnor- mal DBP response, hazard ratios were not significant after minimal adjustment for age, sex, and pre-exercise DBP or after full adjustment for clinical risk factors and other exercise test abnormalities. ...

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... Potential mechanisms associated with the hypertensive response of post-Bruce DBP can be explained by the excessive elevation of the double product that can result in global subendocardial ischemia due to an inability to maintain myocardial oxygen supply and demand (Ha et al., 2002). On the other hand, Sydó et al. (2018) point out that the etiology of an increase in DBP after physical exercise is not fully elucidated in the literature; possible risk factors or cardiovascular disease may not be associated with increased DBP. The same authors suggest that the central focus of analysis should be on cardiorespiratory capacity and recovery heart rate, although the present study did not identify a difference in HR during the 15 min of measurement. ...
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The present study aimed to evaluate the body composition and cardiorespiratory fitness of overweight or obese people after COVID-19. 171 volunteers of both sexes (men, n = 93 and women, n = 78) between 19 and 65 years old were allocated into three groups according to the severity of their symptoms of COVID-19: non-hospitalized people/mild symptoms (n = 61), hospitalized (n = 58), and hospitalized in an intensive care unit-ICU (n = 52). Two laboratory visits were carried out 24 h apart. First, a medical consultation was carried out, with subsequent measurement of body weight and height (calculation of body mass index) and body composition assessment via electrical bioimpedance. After 24 h, a cardiorespiratory test was performed using the Bruce protocol, with a direct gas exchange analysis. Hospitalized individuals had significantly higher values for fat mass and body fat percentage than non-hospitalized individuals (p < 0.05). Significantly higher values were found for heart rate (HR) and peak oxygen consumption (VO2peak) for individuals who were not hospitalized when compared to those hospitalized in the ICU (p < 0.05). Significantly higher values for distance, ventilation, and the relationship between respiratory quotient were found for non-hospitalized individuals compared to hospitalized individuals and those in the ICU (p < 0.05). After the cardiorespiratory test, higher values for peripheral oxygen saturation (SpO2) were observed for non-hospitalized individuals than for all hospitalized individuals (p < 0.05). Diastolic blood pressure was significantly higher at the tenth and fifteenth minute post-Bruce test in hospitalized than in non-hospitalized participants (p < 0.05). Based on these results, proposals for cardiopulmonary rehabilitation are indispensable for hospitalized groups considering the responses of blood pressure. Monitoring HR, SpO2, and blood pressure are necessary during rehabilitation to avoid possible physical complications. Volume and intensity of exercise prescription should respect the physiologic adaptation. Given lower physical conditioning among all the groups, proposals for recovering from health conditions are urgent and indispensable for COVID-19 survivors.
... However, other studies investigating the prognostic value of abnormal DBP responses to exercise did not demonstrate any significant association with mortality. For example, Sydó et al. (35) studied 20,000 patients with no previous history of cardiovascular diseases and found no association between DBP . ...
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Background The identification of variables obtained in the exercise test (ET) associated with increased risk of death is clinically relevant and would provide additional information for the management of Chagas disease (CD). The objective of the present study was to evaluate the association of ET variables with mortality in patients with chronic CD. Methods This retrospective longitudinal observational study included 232 patients (median age 46.0 years; 50% women) with CD that were followed at the Evandro Chagas National Institute of Infectious Diseases (Rio de Janeiro, Brazil) and performed an ET between 1989 and 2000. The outcome of interest was all-cause mortality. Results There were 103 deaths (44.4%) during a median follow-up of 21.5 years (IQR 25–75% 8.0–27.8), resulting in 24.5 per 1,000 patients/year incidence rate. The ET variables associated with mortality after adjustments for potential confounders were increased maximal (HR 1.02; 95% CI 1.00–1.03 per mmHg) and change (HR 1.03; 95% CI 1.01–1.06 per mmHg) of diastolic blood pressure (DBP) during ET, ventricular tachycardia at rest (HR 3.95; 95% CI 1.14–13.74), during exercise (HR 2.73; 95% CI 1.44–5.20), and recovery (HR 2.60; 95% CI 1.14–5.91), and premature ventricular complexes during recovery (HR 2.06; 1.33–3.21). Conclusion Our findings suggest that ET provides important prognostic value for mortality risk assessment in patients with CD, with hemodynamic (increased DBP during exercise) and electrocardiographic (presence of ventricular arrhythmias) variables independently associated with an increased mortality risk in patients with CD. The identification of individuals at higher mortality risk can facilitate the development of intervention strategies (e.g., close follow-up) that may potentially have an impact on the longevity of patients with CD.
... However, other studies investigating the prognostic value of abnormal DBP responses to exercise did not demonstrate any significant association with mortality. For example, Sydó et al. (35) studied 20,000 patients with no previous history of cardiovascular diseases and found no association between DBP . ...
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Background: The identification of variables obtained in the exercise test (ET) associated with increased risk of death is clinically relevant and would provide additional information for the management of Chagas disease (CD). The objective of the present study was to evaluate the association of ET variables with mortality in patients with chronic CD. Methods: This retrospective longitudinal observational study included 232 patients (median age 46.0 years; 50% women) with CD that were followed at the Evandro Chagas National Institute of Infectious Diseases (Rio de Janeiro, Brazil) and performed an ET between 1989 and 2000. The outcome of interest was all-cause mortality. Results: There were 103 deaths (44.4%) during a median follow-up of 21.5 years (IQR 25–75% 8.0–27.8), resulting in 24.5 per 1,000 patients/year incidence rate. The ET variables associated with mortality after adjustments for potential confounders were increased maximal (HR 1.02; 95% CI 1.00–1.03 per mmHg) and change (HR 1.03; 95% CI 1.01–1.06 per mmHg) of diastolic blood pressure (DBP) during ET, ventricular tachycardia at rest (HR 3.95; 95% CI 1.14–13.74), during exercise (HR 2.73; 95% CI 1.44–5.20), and recovery (HR 2.60; 95% CI 1.14–5.91), and premature ventricular complexes during recovery (HR 2.06; 1.33–3.21). Conclusion: Our findings suggest that ET provides important prognostic value for mortality risk assessment in patients with CD, with hemodynamic (increased DBP during exercise) and electrocardiographic (presence of ventricular arrhythmias) variables independently associated with an increased mortality risk in patients with CD. The identification of individuals at higher mortality risk can facilitate the development of intervention strategies (e.g., close follow-up) that may potentially have an impact on the longevity of patients with CD.
... Patients with severe lung damage, such as chronic obstructive pulmonary disease, exhibit a higher heart rate after exercise (6-min walk test) when wearing an N95 respirator compared to without, which could be interpreted as a compensatory mechanism for impaired lung capacity [29]. Since a gradual decrease in diastolic blood pressure with exercise is considered normal in healthy individuals and adds no prognostic value of stress tests [30,31], our focus was on systolic blood pressure. In line with previous studies, masks were not associated with changes in systolic blood pressure at exhaustion [7,9]. ...
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Background During the COVID-19 pandemic, compulsory masks became an integral part of outdoor sports such as jogging in crowded areas (e.g. city parks) as well as indoor sports in gyms and sports centers. This study, therefore, aimed to investigate the effects of medical face masks on performance and cardiorespiratory parameters in athletes. Methods In a randomized, cross-over design, 16 well-trained athletes (age 27 ± 7 years, peak oxygen consumption 56.2 ± 5.6 ml kg ⁻¹ min ⁻¹ , maximum performance 5.1 ± 0.5 Watt kg ⁻¹ ) underwent three stepwise incremental exercise tests to exhaustion without mask (NM), with surgical mask (SM) and FFP2 mask (FFP2). Cardiorespiratory and metabolic responses were monitored by spiroergometry and blood lactate (BLa) testing throughout the tests. Results There was a large effect of masks on performance with a significant reduction of maximum performance with SM (355 ± 41 Watt) and FFP2 (364 ± 43 Watt) compared to NM (377 ± 40 Watt), respectively ( p < 0.001; ηp ² = 0.50). A large interaction effect with a reduction of both oxygen consumption ( p < 0.001; ηp ² = 0.34) and minute ventilation ( p < 0.001; ηp ² = 0.39) was observed. At the termination of the test with SM 11 of 16 subjects reported acute dyspnea from the suction of the wet and deformed mask. No difference in performance was observed at the individual anaerobic threshold ( p = 0.90). Conclusion Both SM and to a lesser extent FFP2 were associated with reduced maximum performance, minute ventilation, and oxygen consumption. For strenuous anaerobic exercise, an FFP2 mask may be preferred over an SM.
... This finding is concordant to a larger study conducted in 20,726 patients, in which subjects with an abnormal DBP response during exercise have a lower functional aerobic capacity and cardiorespiratory fitness compared to those with normal and borderline DBP [41]. Therefore, elevated peak DBP is a consequence of impaired peripheral vascular resistances, which also cause a reduction in peripheral oxygen extraction and in peak oxygen uptake, according to Fick law [42]. ...
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AimTo evaluate the incidence and clinical significance of impaired cardiorespiratory fitness (CRF) and the association with baseline blood pressure (BP) levels and hypertensive response to exercise (HRE).MethodsA cross-sectional study was conducted on a total sample of 2058 individuals with a mean age of 38 ± 9 years, enrolled for the first time at the Ferrari corporate wellness program “Formula Benessere”, including a maximal exercise stress testing (EST). BP and heart rate (HR) values were obtained from EST at rest, during exercise and recovery time. CRF was arbitrarily classified according to estimated VO2 max in optimal, normal, mildly and moderately reduced.ResultsOne-hundred and thirty-nine individuals of 2058 (6.7%) showed a moderate CRF reduction assessed by EST. Subjects with elevated resting and/or exercise BP showed a worse CRF than those with normal BP levels, also after the adjustment for age, sex, body mass index, smoking habits, peak SBP and DBP. Seventy-seven individuals (3.7%) showed an HRE during EST, with normal baseline BP levels.Conclusion About 7% of a corporate population showed a significantly reduced CRF, assessed by EST. Individuals with lower levels of CRF have higher resting and/or peak exercising BP values after adjusting for co-variables. This study expands the role of EST outside of traditional ischemic CVD evaluation, towards the assessment of reduced CRF and HRE in the general population, as a possible not evaluated CV risk factor.
... We did not address exercise diastolic BP, as our prior report indicates a lack of association with outcomes. 32 Strengths of our study include a large cohort and long-term follow-up with 100% mortality ascertainment and tested in a single facility, which reduces technical variabilities. Furthermore, several important baseline characteristics and comorbidities, use of antihypertensives and statins, and other exercise responses, including CRF, exercise HR, and exercise ECG abnormalities, were adjusted for in Cox regression models. ...
Article
We sought to update norms for peak systolic blood pressure (SBP) on the graded exercise test and examine its prognostic value in patients without baseline cardiovascular disease. Mayo graded exercise test data (1993–2010) were reviewed for nonimaging tests using Bruce protocol, selecting Minnesota residents 30 to 79 years without baseline cardiovascular disease. We formed a pure cohort of patients without factors significantly affecting peak SBP to determine peak SBP percentile norms by age and sex. Then we divided the full cohort of patients into 5 groups based on peak SBP percentiles: low (<10th), borderline low (10th–25th), referent (25th–75th), borderline high (75th–90th), and high (>90th). The relationship between peak SBP and mortality was tested using Cox regression adjusting for age, sex, and comorbidities affecting peak SBP or mortality. We identified 20 760 eligible patients with 7313 females (35%) and mean age 51.5±10.7 years. Our pure cohort included 7810 patients. Over 12.5±5.0 years follow-up, there were 1582 deaths, including 541 cardiovascular deaths. In the fully adjusted model, low-peak SBP was associated with increased total mortality (heart rate, 1.41 [1.19–1.66], P <0.0001) and cardiovascular mortality (heart rate, 1.54 [1.16–2.03], P =0.001), while borderline low-peak SBP was associated with increased cardiovascular mortality only (heart rate, 1.36 [1.02–1.81], P =0.027). High peak SBP was associated with increased total mortality only in the age-sex adjusted model (heart rate, 1.18 [1.02–1.36], P =0.026), not after full adjustment. We conclude that low exercise peak SBP is an independent predictor of higher total and cardiovascular mortality.