Jacqueline L. Hay

Objective: Early mobility after cardiac surgery in the intensive care unit improves patient outcomes, yet implementation by clinicians remains inconsistent. To inform interventions to increase adoption, this study sought to explore clinicians’ perspectives on the definition of early mobility in the cardiac surgery intensive care unit and describe perceived barriers and facilitators to implementation. Design: This qualitative study was guided by interpretive description. Setting: A tertiary hospital that performs 1000 cardiac surgeries annually. Participants: A total of 26 clinicians, including nurses, physicians, healthcare aides, respiratory therapists, and physiotherapists, participated. Main Measures: The nine focus groups and four individual interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Three themes and 13 categories were created from the data: (1) Incongruent operationalization and conceptualization (across micro, meso, and macro levels), (2) uncertainty, and (3) inconsistency in mobilization practices. Themes were rooted in ambiguous definitions of “early” and “mobility,” discrepancy between conceptualization and implementation of timing, varied interpretations of success, and perceived safety concerns. In addition, 4 barriers and 4 facilitators were identified and categorized into patient-care and clinician-related. Conclusion: Developing early mobility protocols and education informed by clinicians may enhance its implementation in the cardiac surgery intensive care unit. Incorporating the perspectives of clinicians into early mobility protocol development is essential to support behaviour change and provide this beneficial care.

The cardiac rehabilitation quality indicators (CRQIs) developed by the Canadian Cardiovascular Society provide a means to standardize program assessment and identify sex-related inequities. No formal evaluation of the CRQIs has been conducted in Manitoba. An environmental scan for the CRQIs was performed using data in the electronic medical record at two cardiac rehabilitation (CR) sites in Winnipeg for 2016–2019 referrals. Of the 8116 referrals, 7758 (5491 males and 2267 females) had geographical access and were eligible for CR. The Manitoba Centre for Health Policy Data Quality Framework informed the data quality assessment. Thirteen CRQIs were available; four were considered high quality; nine demonstrated moderate to significant missing data. In addition to missing values, potential misclassification of risk (CR-4) and physiologically implausible and invalid dates were assessed and identified (CR-13 and CR-17). Each site had a physician medical director (CR-31) and a documented emergency response strategy (CR-32). Only high-quality data were evaluated for sex-related differences using chi-square and median tests. Women had lower enrollment (CR-3), and more women enrolled after the median of 41 days (CR-2b). Engagement with CR partners, including frontline staff, and utilizing strategies to assess and limit physiologically implausible values and dates will enhance data capture and quality.

This study determined the interindividual variation in the cardiometabolic response to 6 months of moderate or vigorous intensity exercise training (ET) among youth at risk for type 2 diabetes mellitus. Youth were randomized to moderate intensity ET (45–55% heart rate reserve; n = 31), vigorous intensity ET (70–85% heart rate reserve; n = 37), or control (n = 36). Only those attending ≥70% of ET sessions were included. Cardiometabolic measures included insulin sensitivity, hepatic triglyceride content, visceral adipose area, and cardiorespiratory fitness. The contribution of ET to interindividual variation was determined using the standard deviation of individual responses (SD_IR) and considered meaningful if the SD_IR surpassed the smallest worthwhile difference (SWD), calculated as 0.2 × the standard deviation of the control group baseline values. ET meaningfully contributed to the interindividual variation among changes in peak oxygen uptake following moderate (SD_IR: 2.04) and vigorous (SD_IR: 3.43) ET (SWD: 1.17 mL·kg fat free mass⁻¹·min⁻¹), body fat percentage and hepatic triglyceride content following moderate-intensity ET (SD_IR: 1.64, SWD: 1.05%; SD_IR: 10.08, SWD: 1.06%, respectively), and visceral fat mass following vigorous ET (SD_IR: 11.06, SWD: 7.13 cm²). Variation in the changes in insulin sensitivity were not influenced by ET. The contribution of ET to interindividual variation appears to be influenced by the desired outcome and prescribed intensity. Trial registration at ClinicalTrials.gov (identifier no.: NCT00755547). Novelty: The contribution of exercise to interindividual variation following training depends on the outcome and exercise intensity. Increasing exercise intensity does not systematically reduce non-response among youth at risk for type 2 diabetes.

Introduction Children with severe neurodisability and tone disorders can present with debilitating symptoms and declining growth. Gastrointestinal dystonia (GID) describes the clinical manifestations of: pain behaviour; hypertonicity; retching; vomiting; vagal phenomena; abdominal distension and straining attributable to the GI tract in the context of severe neurodisability.¹Blended diet (BD) has an emerging role in the nutritional management of patients with neurodisability, however we are unaware of data pertaining to BD specifically in patients with GID. Aim A tertiary centre review of outcomes of patients with GID receiving BD. Method Patients who commenced BD between 07/2017 and 02/2020 were identified from prospectively gathered complex enteral nutrition (CEN) and specialist dietetic databases. BD was initiated with specialist paediatric dietetic support within the CEN clinic or in other clinics. Data gathered included: demographics; primary diagnosis; enteral feeding plan; fundoplication; weight standard deviation z score at 0, 6, 12 and 18 months prior to and from commencing BD; medications at 0 and 6, 12, 18 months; reasons if BD discontinued; parenteral nutrition (PN) requirement. Results 29 children met criteria for GID and commenced BD.¹ 18 were male. 14 had a fundoplication. Feeding method prior to BD: gastric bolus 17; gastric continuous 8; jejunal 4. Mean age BD commenced was 7 years. Follow up ranged 8 to 40 months. 25 patients continue BD to date. 4 discontinued BD within 1–2 months citing increased GI symptoms or device blockage. Of the 25 who continue BD, median weight z scores declined from -1.77 at 12 months prior to BD, -1.86 at 6 months prior, -1.94 at 0 months, then rose to -1.54 at 12 months, and -1.40 at 18 months. Mean weight z scores were maintained at -1.97 (CI -0.85 to -3.09) at 0 months, -1.97 (CI -0.27 to -3.02) at 12 months and -1.79 (CI -0.34 to -3.25) at 18 months [figure 1]. This trend was more significant in a subset of 6 patients, z score -2.06 (CI -1.46 to -2.67) at 0 months, -1.13 (CI -0.59 to -1.67) at 12 months (p = 0.018) and -0.84 (CI -0.46 to -1.21) at 18 months (p = 0.003) [figure 2]. 9 of the 25 were able to discontinue one GI medication, 4 discontinued two GI medications. Tone medications: 3 reduced; 20 unchanged; 2 increased. No patients received PN during the study. Weight z scores of children with GID receiving BD Weight z scores of subset with GID receiving BD Conclusion GID represents the severest end point of gastrointestinal symptoms in neurodisability, with progressive decline often a feature. Our data show children with GID receiving BD continue to track their weight trajectory, whilst some experience significantly improved growth. No patients required trial on PN during the study. The authors advocate for BD’s role in minimizing the need for invasive treatments in GID whilst addressing symptoms and maintaining nutritional status² and growth superiorly to formula feeds alone. Improvements in symptomatology and quality of life will be better described by prospective survey of patients commencing BD for GID. The authors are currently gathering this data. References McConnell N, et al. JPGN;66(supp2):1002; 2018 Hay J, et al. (presented BSPGHAN 2020)

This study examined whether immediate post-exercise systolic blood pressure (SBP) is associated with arterial compliance in middle-aged and older normotensive females. A total of 548 normotensive, non-frail females aged 55 years and older with no previous history of cardiovascular disease (CVD) participated in this cross-sectional study. Large and small arterial compliance were assessed by pulse wave analysis. Reduced arterial compliance was defined based on age and sex cutoffs. SBP was measured at rest and immediately following a 3-min moderate step-test. CVD risk factors were also assessed (e.g. resting systolic and diastolic BP, fasting glucose, triglycerides, cholesterol, body mass index). A total of 15.1% and 44.0% of the participants showed reduced large and small artery compliance, respectively. Immediate post-exercise SBP was associated with reduced large (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.01–1.04; p = 0.010) and small (OR 1.02 per 1 mmHg increase in post-exercise SBP, 95%CI 1.00–1.03; p = 0.008) arterial compliance. Participants with highest immediate post-exercise SBP (quartile 4; i.e. ≥ 165 mmHg) showed increased odds ratios for reduced large (2.67, 95%CI 1.03–6.94; p = 0.043) and small (2.27, 95%CI 1.22–4.21; p = 0.010) arterial compliance compared to those with the lowest immediate post-exercise SBP (quartile 1; i.e. ≤ 140 mmHg), independent of other established CVD risk factors. Immediate post-exercise SBP following a brief moderate step-test seems to be able to discriminate reduced arterial compliance in middle-aged and older normotensive females.

The aim of this study was to determine whether self-compassion—orientation to care for oneself during challenges—helps people at risk of cardiovascular disease deal with emotional reactions and assist with self-regulating health behaviors. This observational study recruited women ( N = 102) who attended three research visits over 3 weeks to gather information on emotions, intentions, and engagement in health behaviors after women received news they were at risk of cardiovascular disease. Self-compassion negatively associated with emotional responses and associated with intentions and engagement in health behaviors after receiving news of their cardiovascular disease risk. Self-compassion was associated with adaptive lifestyle behaviors.

Our team examined the characteristics of patient engagement (PE) practices in exercise-based randomized trials in type 1 diabetes (T1D), and facilitated T1D stakeholders in determining the top 10 list of priorities for exercise research. Two methodological approaches were employed: a scoping review and a modified James Lind Alliance priority-setting partnership. Published (Medline, Embase, CINAHL and Central databases) and grey literature (www.clinicaltrials.gov) were searched to identify randomized controlled trials of exercise interventions lasting minimum 4 weeks and available in English. We extracted information on PE and patient-reported outcomes (PROs) to identify if patient perspectives had been implemented. Based on results, we set out to determine exercise research priorities as a first step towards a patient-engaged research agenda. An online survey was distributed across Canada to collect research questions from patients, caregivers and healthcare providers. We qualitatively analyzed submitted questions and compiled a long list that a 12-person stakeholder steering committee used to identify the top 10 priority research questions. Of 9962 identified sources, 19 published trials and 4 trial registrations fulfilled inclusion criteria. No evidence of PE existed in any included study. Most commonly measured PROs were frequency of hypoglycemia (n=7) and quality of life (n=4). The priority-setting survey yielded 194 submitted research questions. Steering committee rankings identified 10 priorities focused on lifestyle factors and exercise modifications to maintain short-term glycemic control. Recent exercise-based randomized trials in T1D have not included PE and PROs. Patient priorities for exercise research have yet to be addressed with adequately designed clinical trials.

Costa, EC, Kent, DE, Boreskie, KF, Hay, JL, Kehler, DS, Edye-Mazowita, A, Nugent, K, Papadopoulos, J, Stammers, AN, Oldfield, C, Arora, RC, Browne, RAV, and Duhamel, TA. Acute effect of high-intensity interval versus moderate-intensity continuous exercise on blood pressure and arterial compliance in middle-aged and older hypertensive women with increased arterial stiffness. J Strength Cond Res 34(5): 1307–1316, 2020—Hypertension and arterial stiffness are common in middle-aged and older women. This study compared the acute effect of high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) on blood pressure (BP) and arterial compliance in middle-aged and older hypertensive women with increased arterial stiffness. Nineteen women (67.6 ± 4.7 years) participated in this randomized controlled crossover trial. Subjects completed a control, MICE (30 minutes at 50–55% of heart rate reserve [HRR]), and HIIE (10 × 1 minute at 80–85% of HRR, 2 minutes at 40–45% of HRR) session in random order. Blood pressure and large and small arterial compliance (radial artery pulse wave analysis) were measured at baseline and 30, 60, 90, and 120 minutes after sessions. A p < 0.05 was considered statistically significant. Systolic BP was reduced in ∼10 mm Hg after MICE at 30 minutes and after HIIE at all time points (30, 60, 90, and 120 minutes) after exercise compared with the control session (p < 0.05). Only HIIE showed lower systolic BP levels at 60, 90, and 120 minutes after exercise compared with the control session (∼10 mm Hg; p < 0.05). No changes were observed in diastolic BP, or in large and small arterial compliance (p > 0.05). High-intensity interval exercise elicited a longer systolic postexercise hypotension than MICE compared with the control condition, despite the absence of acute modifications in large and small arterial compliance.