Hanne Rasmusen

To evaluate the effects of prolonged endurance exercise on the thin‐walled chambers of the right ventricle (RV) and left atrium (LA), and heart rate (HR) in young (YA) and older (OA) athletes. Seven YA and seven OA (30 ± 5 and 65 ± 6 years; V̇O₂max: 61.5 ± 2.2 and 46.8 ± 4.1 mL/min/kg, respectively) were studied before, during, and after a 15‐day cycling journey from Copenhagen (CPH) to Palermo (PMO) (~3000 km). Transthoracic echocardiography (TTE) was performed in both groups, and additional stress echocardiography (SE) in OA. Speckle‐tracking echocardiography was applied for RV free‐wall strain, LA global peak‐atrial longitudinal strain (PALS), and contraction strain (PACS). Assessments were made at baseline (CPH), at arrival (PMO), and for OA six months post‐intervention (CPH+6). RV size and function were similar between YA and OA at baseline and remained unchanged at rest post‐intervention. In OA, SE revealed decreased RV function during exercise at PMO, normalizing at CPH+6. LA size remained unchanged, but OA showed higher baseline filling pressure (E/e′), PACS, and LA stiffness index with lower PALS than YA. Post‐intervention, PALS decreased (p < 0.01) while E/e′, PACS, and LA stiffness index remained stable. Resting HR increased in OA (p = 0.002) but not in YA. V̇O₂max was higher in YA and decreased in OA post‐intervention (p = 0.056). Although RV size and resting function were unaffected, RV exercise‐induced dysfunction was observed in OA, potentially due to increased LA stiffness. These findings suggest age‐related cardiac fatigue and extended recovery time in OA.

Objective: Our objective was to evaluate the effects of long-term reduced training on the left atrium (LA) in elite endurance athletes and to elucidate sex-specific differences in LA detraining patterns. Methods: In this long-term longitudinal echocardiographic study of 50 active elite endurance athletes a follow-up examination was performed 7 years after retirement from the elite programme. All echocardiographic measurements were indexed for body surface area. We analysed the changes between baseline and follow-up measures using analysis of covariance models adjusted for baseline level, sex and enrolment age as covariates. Results are reported as least squares means with two-sided 95% CIs. Results: LA enlargement (left atrial maximum volume index) remained unchanged from baseline (change from baseline: 1.4mL/m², 95% CI: −0.7 to 3.5 mL/m²) despite significant reductions in VO₂max (change from baseline: −864mL/min, 95% CI: −1091 to −637 mL/min). In contrast, left ventricular (LV) end-diastolic volume was reduced (change from baseline: −8mL/m², 95% CI: −11 to −5 mL/m²), consistent with reduced VO₂max. LA contraction strain was increased (change from baseline: 1.4%, 95% CI: 0.4% to 2.5%), while LV filling pressure increased (E/e’ change from baseline: 0.4, 95% CI: 0.1 to 0.7). Conclusions: 7 years of reduced training does not reverse exercise-induced LA enlargement in former elite endurance athletes. LA contractile function improved with higher LV filling pressure, suggesting that age-related LV pressure increases may contribute to chronic LA dilation, though irreversible adaptations like fibrosis cannot be ruled out. Trial registration number: NCT05555849.

BACKGROUND: Patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction commonly experience reduced exercise capacity. Physical training improves exercise capacity in these patients, but whether the underlying effects of exercise are a result of central hemodynamic or peripheral improvement is unclear. This study assessed whether exercise training reduces left ventricular filling pressure measured during exercise in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction. METHODS: Between March 2019 and June 2022, patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction were randomly assigned (1:1) to a 12-week (3 h/wk) supervised, moderate-intensity exercise training program or continued usual activity. The primary outcome was the change in invasively measured pulmonary capillary wedge pressure during mild exercise (25 W) from baseline to week 12. Pressure tracings were analyzed offline by a blinded investigator. Secondary outcomes included changes in peak oxygen consumption, cardiac index, quality of life, echocardiographic indices of diastolic function, and natriuretic peptides. RESULTS: Of 59 patients randomized (mean age, 58.1 [12.2] years; 27% women), 51 (86%) completed all follow-up assessments. At week 12, the change in 25-W pulmonary capillary wedge pressure was –2.8 (6.8) mm Hg in the exercise group, compared with +1.2 (4.9) mm Hg in the usual-activity group (between-group difference, 4.0 mm Hg [95% CI, 0.7–7.3]; P =0.018). Peak oxygen consumption improved by +1.8 (2.0) mL·kg⁻¹·min⁻¹ in the exercise group versus –0.3 (3.1) mL·kg⁻¹·min⁻¹ in the usual-activity group ( P =0.005). Exercise training improved the ventilatory efficiency (V _E /VCO ₂ ) slope compared with usual activity (between-group difference, 2.0 [95% CI, 0.6–3.5]; P =0.006). Peak cardiac index improved by +0.38 (1.38) L·min⁻¹·m⁻² in exercise versus –0.85 (1.20) L·min⁻¹·m⁻² in the usual-activity group ( P =0.002). Change in overall Kansas City Cardiomyopathy Questionnaire score was similar between groups. However, the change in physical limitation scores (+8.4 [12.0] points in exercise versus +0.7 [6.8] points in usual-activity group; P =0.034) and quality-of-life scores (+8.7 [18.0] points in exercise versus 0.7 [4.0] points in usual-activity group; P =0.01) differed significantly. There were no significant changes in diastolic function assessed by echocardiography or in natriuretic peptides. CONCLUSIONS: In patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction, a 12-week moderate-intensity exercise training program resulted in reduced left ventricular filling pressures at mild exertion and improved exercise performance. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03537183.

Background: Elite endurance training is characterised by a high-volume load of the heart and has been associated with atrial fibrillation (AF) in middle-aged men. We compared left atrial (LA) remodelling among elite athletes engaged in sports, categorised as having low, intermediate, and high cardiac demands. Methods: This cross-sectional echocardiographic study of healthy elite athletes evaluated LA size and function measured as LA maximum volume (maxLAVi) and contraction strain. Athletes were grouped according to the cardiac demands of their sport (low, intermediate, high). Morphological measures were indexed to body surface area and reported as least square means; differences between groups were reported with 95% CIs. Results: We included 482 elite athletes (age 21±5 years (mean±SD), 39% women). MaxLAVi was larger in the high group (28.4 mL/m²) compared with the low group (20.2 mL/m²; difference: 8.2, CI 5.3 to 11.1 mL/m²; p2 vs 24.7 mL/m²; difference 1.6 mL/m²; CI 0.3 to 2.9 mL/m²; p=0.0175). In the high group, LA contraction strain was lower compared with the low group (−10.1% vs −12.9%; difference: 2.8%; CI 1.3 to 4.3%; p<0.001), and men had less LA contraction strain compared with women (−10.3% vs −11.0%; difference 0.7%; CI 0.0 to 1.4%; p=0.049). Years in training did not affect maxLAVi or LA contraction strain. Conclusion: MaxLAVi was higher while LA contraction strain was lower with increased cardiac demands. MaxLAVi was larger, and LA contraction was lower in men compared with women. Whether these sex-based differences in LA remodelling are a precursor to pathological remodelling in male athletes is unknown.

Background. In patients undergoing ascending aortic surgery (AAS), postsurgical physical exercise with a safe and effective exercise prescription is recommended. Resistance training is associated with blood pressure (BP) elevations that may increase the risk of new aortic dissection or rupture. However, the acute hemodynamic response to resistance training for this patient group is unknown. Aim. The aim of this study was to investigate peak systolic BP (SBP) increases in AAS patients during moderate intensity resistance training. Methods. SBP was measured continuously beat-to-beat with a noninvasive method during three sets of leg presses at moderate intensity. A 15-repetition maximum strength test was performed to estimate the maximal amount of resistance a participant could manage 15 times consecutively (equivalent to approximately 6065 of their maximum strength). Results. The study had 48 participants in total, i.e., 24 cases and 24 controls. Both groups consisted of 10 females (42) and 14 males (58). The case group had a mean age of 60.0 (SD11.9) years and a mean of 16.3months since surgery (minimum 4.4 and maximum 39.6months). 22 of the 24 cases received antihypertensive medication. The median baseline BP was 119/74mmHg among cases and 120/73mmHg among controls. During the first set of leg presses, the median peak SBP was 152mmHg, in the second set 154mmHg, and in the third set 165mmHg. Corresponding values in controls were 170mmHg, 181mmHg, and 179mmHg. The highest peak SBP registered in an AAS patient was 190mmHg and in any healthy control was 287mmHg. Conclusion. The findings indicate that AAS patients in control of their BP have the endurance to perform 3 sets of resistance training at moderate intensity as their SBP increases with a maximum of 39 from the baseline compared to the 51 increase in the control group.

Background The aim was to investigate the effect of prolonged endurance exercise on adipose tissue inflammation markers and mitochondrial respiration in young and old men. Methods Young (aged 30 years, n = 7) and old (aged 65 years, n = 7) trained men were exposed to an exercise intervention of 15 consecutive days biking 7-9 hours/day at 63% and 65% of maximal heart rate (young and old, respectively), going from Copenhagen, Denmark to Palermo, Italy. Adipose tissue was sampled from both the gluteal and abdominal depot before and after the intervention. Mitochondrial respiration was measured by high-resolution respirometry and adipose inflammation was assessed by immunohistochemical staining of paraffin embedded sections. Results An increased number of CD163 + macrophages was observed in both the gluteal and abdominal depot (P < 0.01). In addition, an increased mitochondrial respiration was observed in the abdominal adipose tissue from the young group with complex I (CI_p) stimulated respiration, complex I + II (CI + II_p) stimulated respiration and the capacity of the electron transport system (ETS)(P < 0.05), and in the old group an increase in CI_p and CI + II_p stimulated respiration (P < 0.05) was found. Conclusion Overall, we found a positive effect of prolonged endurance exercise on adipose tissue inflammation markers and mitochondrial respiration in both young and old trained men, and no sign of attenuated function in AT with age.

To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses. Graphical summary of the method and main findings of the present study. HADS, hospital anxiety and depression scale; HeartQoL, heart-related quality of life.

COVID-19 can cause cardiopulmonary involvement. Physical activity and cardiac complications can worsen prognosis, while pulmonary complications can reduce performance. To determine the prevalence and clinical implications of SARS-CoV-2 cardiopulmonary involvement in elite athletes. An observational study between 1 July 2020 and 30 June 2021 with the assessment of coronary biomarkers, electrocardiogram, echocardiography, Holter-monitoring, spirometry, and chest X-ray in Danish elite athletes showed that PCR-tested positive for SARS-CoV-2. The cohort consisted of male football players screened weekly (cohort I) and elite athletes on an international level only tested if they had symptoms, were near-contact, or participated in international competitions (cohort II). All athletes were categorized into two groups based on symptoms and duration of COVID-19: Group 1 had no cardiopulmonary symptoms and duration ≤7 days, and; Group 2 had cardiopulmonary symptoms or disease duration >7 days. In total 121 athletes who tested positive for SARS-CoV-2 were investigated. Cardiac involvement was identified in 2/121 (2%) and pulmonary involvement in 15/121 (12%) participants. In group 1, 87 (72%), no athletes presented with signs of cardiac involvement, and 8 (7%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. In group 2, 34 (28%), two had myocarditis (6%), and 8 (24%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. These clinically-driven data show no signs of cardiac involvement among athletes who tested positive for SARS-CoV-2 infection without cardiopulmonary symptoms and duration <7 days. Athletes with cardiopulmonary symptoms or prolonged duration of COVID-19 display, exercise-limiting cardiopulmonary involvement.

Background: The upper rates of energy expenditure (EE) and the corresponding regulation of energy intake (EI), as described in younger trained subject