Cardiac rehabilitation is an important component in the continuum of care for individuals with cardiovascular disease, providing a multidisciplinary education and exercise programme to improve morbidity and mortality risk. Internationally, cardiac rehabilitation programmes are implemented through various models. This review compared cardiac rehabilitation guidelines in order to identify any differences and/or consensus in exercise testing, prescription and monitoring. Guidelines, position statements and policy documents for cardiac rehabilitation, available internationally in the English language, were identified through a search of electronic databases and government and cardiology society websites. Information about programme delivery, exercise testing, prescription and monitoring were extracted and compared. Leading cardiac rehabilitation societies in North America and Europe recommend that patients progress from moderate- to vigorous-intensity aerobic endurance exercise over the course of the programme, with resistance training included as an important adjunct, for maintaining independence and quality of life. North American and European guidelines also recommend electrocardiograph-monitored exercise stress tests. Guidelines for South America and individual European nations typically include similar recommendations; however, those in the United Kingdom, Australia and New Zealand specify lower-intensity exercise and less technical assessment of functional capacity. Higher-intensity aerobic training programmes, supplemented by resistance training, have been recommended and deemed safe for cardiac rehabilitation patients by many authorities. Based on research evidence, this may also provide superior outcomes for patients and should therefore be considered when developing an international consensus for exercise prescription in cardiac rehabilitation.

Objective. To investigate the relationship of muscular strength and cardiorespiratory fitness (CRF) to insulin resistance. Methods. In a cross sectional study of 126 volunteers (10–15 years) we measured insulin, glucose, lipids, body mass, height, waist circumference (WC), strength and CRF. Linear and logistic regression models assessed the relationships between these factors and estimated insulin resistance (Homeostasis Assessment Model2; HOMA2-IR). Results. Greater insulin resistance was associated with greater adiposity, lower CRF, and strength. Upper body strength and WC were the only independent predictors of insulin resistance, accounting for 39% of the variance (p < 0.001). Children in the highest and middle tertiles of absolute upper body strength were 98% less likely to have high insulin resistance than those with the lowest strength, adjusted for maturation and central adiposity, body mass (OR = 0.019; p = 0.003). Similar trends were present for high vs. low CRF. Conclusion. Muscular strength has been identified for the first time as an independent and powerful predictor of better insulin sensitivity in children. Lower strength, CRF and higher central adiposity are highly predictive of higher levels of insulin resistance in this cohort, and should be considered potential targets for interventions designed to enhance metabolic fitness in children and adolescents.

Over the last two decades, the understanding of adipose tissue has undergone radical change. The perception has evolved from an inert energy storage tissue to that of an active endocrine organ. Adipose tissue releases a cluster of active molecules named adipokines. The severity of obesity-related diseases does not necessarily correlate with the extent of body fat accumulation but is closely related to body fat distribution, particularly to visceral localization. There is a distinction between the metabolic function of central obesity (visceral abdominal) and peripheral obesity (subcutaneous) in the production of adipokines. Visceral fat accumulation, linked with levels of some adipokines, induces chronic inflammation and metabolic disorders, including glucose intolerance, hyperlipidaemia, and arterial hypertension. Together, these conditions contribute to a diagnosis of metabolic syndrome, directly associated with the onset of cardiovascular disease. If it is well known that adipokines contribute to the inflammatory profile and appetite regulation, this review is novel in synthesising the current state of knowledge of the role of visceral adipose tissue and its secretion of adipokines in cardiovascular risk.

An emerging public health strategy is to enhance children’s opportunities to be physically active during school break periods. The aim of this study was to evaluate the effects of the Lunchtime Enjoyment Activity and Play (LEAP) school playground intervention on primary school children’s quality of life (QOL), enjoyment and participation in physical activity (PA).