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Heart failure with preserved ejection fraction (HFpEF) is associated with exercise intolerance, with respiratory muscle dysfunction as a contributing factor. Patients with HFpEF have exaggerated cardiovascular responses to respiratory muscle metaboreflex activation. In this study, we determined the impact of inspiratory muscle training (IMT) on the respiratory muscle metaboreflex in HFpEF. We found that 8 wk of IMT improved inspiratory muscle strength and attenuated the respiratory muscle metaboreflex-mediated cardiovascular responses in patients with HFpEF.

This cohort study examines changes in oxygen consumption among patients with multiple morbidities undergoing cardiac rehabilitation.

Introduction: An elevated blood pressure (mean arterial pressure, MAP) response to exercise is an independent predictor of hypertension (HTN) development. HTN is highly prevalent in postmenopausal females. Postmenopausal, compared to premenopausal, females have a higher MAP at rest and during exercise primarily due to higher systemic vascular resistance (SVR). Studies using small muscle mass exercise have suggested that postmenopausal females have augmented increases in MAP from rest to exercise. However, it is unclear if postmenopausal females have augmented MAP responses from rest to exercise during whole-body exercise. Hypothesis: We hypothesized that postmenopausal females would have greater increases in MAP and smaller decreases in SVR from rest to peak exercise than premenopausal females. Methods: Normotensive premenopausal (n=16; age: 30±7 yrs; BMI: 23±4 kg/m 2 ) and postmenopausal (n=14; age: 57±7 yrs; BMI: 27±4 kg/m 2 ) female participants performed an incremental cycling test until task failure. Blood pressure was measured by manual sphygmomanometry, cardiac output (Q) via open-circuit acetylene wash-in technique, and SVR was calculated. Data are reported at rest and peak oxygen uptake (VO 2 ). Data are also reported as % change from rest to VO 2 peak. Results: Postmenopausal females had higher MAP and SVR at rest and at VO 2 peak than premenopausal females (all, p<0.05). Postmenopausal, compared to premenopausal, females had lower Q at VO 2 peak commensurate with the lower achieved VO 2 peak (p<0.01). Resting MAP was positively related to MAP at VO 2 peak in postmenopausal females (r=0.85, p<0.01), but not premenopausal females (p=0.22). % change in MAP from rest to VO 2 peak was not different between groups (Post: 18±8 vs. Pre: 18±9%) (p=0.94). However, postmenopausal females had smaller % decreases in SVR from rest to VO 2 peak (Post: -44±7 vs. Pre: -54±8%) and smaller % increases in Q compared to premenopausal females (Post: 113±31 vs. Pre: 162±50%) (both, p<0.01). Conclusion: Our findings indicate that postmenopausal and premenopausal females have similar increases in MAP from rest to VO 2 peak; however, the mechanisms contributing to the MAP response differed by menopausal status. Postmenopausal females relied on smaller decreases in SVR, whereas premenopausal females had greater increases in Q. These findings provide important insight into the mechanisms contributing to the clinically relevant higher MAP response during exercise in postmenopausal females.

Background: Cardiac rehabilitation (CR) patients demonstrate a high burden of chronic conditions (CC). Both multimorbidity (MM; ≥2 coexisting CC) and aging negatively impact functional capacity, whereas CR improves performance. Age-related difference in cardiorespiratory fitness (CRF, peak oxygen uptake (VO 2 )) in CR patients with MM has not been studied. Hypothesis: We hypothesized improvement in CRF will be attenuated by MM with increasing age in CR patients. Aims: We aimed to identify age-related differences in CRF improvement in CR patients with MM. Methods: Patients ≥18 yrs old who attended ≥1 CR sessions from 1999-2017 and completed cardiopulmonary exercise stress test before and after CR were included. The prevalence of CC was assessed using Rochester Epidemiology Project records-linkage system. Age categories included: Younger (18-49 yrs), Midlife (50-64 yrs) and Older (≥65 yrs). CRF categories included: <0%, 0-8% and >8%. Analysis included Kruskal-Wallis and Chi-squared. Results: Of 622 patients, 75.4% were male. Mean age: 62.9±11.2 yrs; Younger (n=70) age: 42.7±6.8 yrs, 67.1% male; Midlife (n=283) age: 58.3±4.3 yrs, 78.8% male; Older (n=269) age: 73.0±5.2 yrs, 74.0% male. BMI was 29.9±5.4 kg/m 2 (Younger: 30.0±6.7, Midlife: 30.4±5.6, Older: 29.3±4.7; p<.05). Median (Q1, Q3) no. of CR sessions attended was 33(22, 35), with lower attendance in the Younger group: 25(16,34) vs Midlife: 33(20,35) and Older: 34 (29,35), p<.05. Overall, percent change in peak VO 2 was 11.5±21.6% (Younger: 18.8±22.8%, Midlife: 11.6±19.5%, Older: 9.4±23.1%; p<.01). The median number of CC was 7(5,8) with significant differences across groups: Younger: 5(3,7), Midlife: 6(5,8), Older: 7(6,9), p<.01. Number of CC increased with age across all CRF categories (p<.01, Fig. 1). However, there was no difference in number of CC within age groups across categories of CRF, Table 1. Conclusions: Our results suggest that MM increases with age in patients attending CR; however, within a given age group, improvement in CRF does not appear dependent on MM. The impact of age appears to have a greater impact than MM on CRF improvement. Individualized treatment plans should focus on the impact of age-related disparities on CRF improvement among CR patients with MM.

Abstract Background Patients enrolled in cardiac rehabilitation (CR) demonstrate a greater burden of co-occurring chronic conditions (CC) compared to the general population. Studies have shown that the prevalence of multimorbidity among noninstitutionalized, civilian US adults is higher among women compared to men. These CC are often grouped and categorized as Cardiometabolic, Somatic, and Mental Health based on the origin and organ system the condition affects. Importantly, sex differences between categorizations of CC in patients undergoing CR has not been examined. Purpose Because patients enrolled in CR are known to have multiple Cardiometabolic conditions, the aim of this study is to examine sex differences in the prevalence of non-cardiometabolic conditions in the CR population. Methods We extracted data on all 21 CC defined by the US Department of Health and Human Services using the local Epidemiology Project records-linkage system. Our study population included participants who attended (≥1) CR sessions from 1995 to 2019. The CC were categorized into cardiometabolic (CMC), Somatic, and Mental health groups (Table 1), and as CMC only, CMC + Somatic only, CMC + Mental health only, and CMC + Somatic + Mental health groups (Table 2). The sex differences in the number of CC within these groups were analyzed by Kruskal-Wallis test and prevalence were analyzed by Pearson’s Chi-squared test, where p&lt;0.05 was significant. Results We identified 13,056 CR patients (68.5% males) who were ≥18 years old with a mean age of 65.7±12.7 yrs (67.6±13.6 yrs in females and 64.8±12.1 yrs in males). Median [Q1, Q3] number of CC was 7 [5,9], with females having a greater number (7 [5, 9]) than males (6 [5,8]), p&lt;0.001. Both sexes had at least 1 CMC with a median of 5 [3,5] CMC and no differences between sexes (p&gt;0.05); however, females demonstrated more somatic and mental health conditions compared to males (p&lt;0.001, for both, Table 1). When grouping categories of CC, females demonstrated a higher number of CC in CMC + Somatic + Mental health as well as CMC + Somatic only groups (p&lt;0.001, for both, Table 2), with a higher prevalence in the former group only. While the number of CC in CMC + Mental health group was similar between sexes, the prevalence was lower in females. In contrast, the CMC only grouping demonstrated a higher number of CC and prevalence among males (p&lt;0.05). Conclusion Our data suggest that females enrolled in CR demonstrate a significantly higher number of CC compared to males. Although males have a higher prevalence of CMC, the prevalence of Somatic ± Mental health conditions in addition to CMC is significantly greater in females. These data demonstrate the importance of considering sex differences in the prevalence of non-CMC when formulating individualized treatment plans for CR patients.