Background Maximal oxygen pulse (O₂ pulse) mirrors the stroke volume response to exercise, and should therefore be a strong predictor of mortality. Limited and conflicting data are, however, available on this issue. Methods Nine hundred forty-eight participants, classified as those with cardiopulmonary disease (CPD) and those without (non-CPD), underwent cardiopulmonary exercise testing (CPX) for clinical reasons between 1993 and 2003. The ability of maximal O₂ pulse and maximal oxygen uptake (peak VO₂) to predict mortality was investigated using proportional hazards and Akaike information criterion analyses. All-cause mortality was the endpoint. Results Over a mean follow-up of 6.3 ± 3.2 years, there were 126 deaths. Maximal O₂ pulse, expressed in either absolute or relative to age-predicted terms, and peak VO₂ were significant and independent predictors of mortality in those with and without CPD (P < 0.04). Akaike information criterion analysis revealed that the model including both maximal O₂ pulse and peak VO₂ had the highest accuracy for predicting mortality. The optimal cut-points for O₂ pulse and peak VO₂ (< 12; ≥ 12 ml/beat and < 16; ≥ 16 ml/(kg · min) respectively) were established by the area under the receiver-operating-characteristic curve. The relative risks of mortality were 3.4 and 2.2 (CPD and non-CPD, respectively) among participants with both maximal O₂ pulse and peak VO₂ responses below these cut-points compared with participants with both responses above these cut-points. Conclusion These results indicate that maximal O₂ pulse is a significant predictor of mortality in patients with and without CPD. The addition of absolute and relative O₂ pulse data provides complementary information for risk-stratifying heterogeneous participants referred for CPX and should be routinely included in the CPX report.

A 91-year-old sedentary man presenting exhaustion, lower-limb weakness, hypertension, and history of multiple falls was diagnosed with sarcopenia - appendicular skeletal muscle mass index (ASM) of 7.10 kg/m2. To investigate the effects of strength training performed with low intensity in isolation (LI) or with blood flow restriction (LI-BFR) on strength, muscle mass, IGF-1, endothelial function, microcirculation, inflammatory biomarkers, and oxidative stress. In the first 3 months, LI was performed with intensity corresponding to 30% of 1 repetition maximum, followed by 1 month of inactivity, and another 3 months of LI-BFR (similar load than LI concomitant to BFR equivalent to 50% of resting systolic blood pressure). LI-BFR, but not LI improved muscle mass, ASM, handgrip strength, isokinetic peak torque, IL-6, and IGF-1. Endothelial function, red blood cell velocity, and concentrations of C-reactive protein, and soluble intercellular adhesion molecules-1 improved after both LI and LI-BFR. Endothelin-1 and oxidative stress increased after LI-BFR, and lowered after LI. LI-BFR, but not LI improved strength, muscle mass, IGF-1, endothelial function, and selected inflammatory markers in a nonagenarian sarcopenic patient. These results are promising and suggest that LI-BFR should be considered as an alternative to prevent muscle loss and improve functional fitness in frail older populations.

Exercise oxygen pulse (O₂ pulse), a surrogate for stroke volume and arteriovenous oxygen difference, has emerged as an important variable obtained during cardiopulmonary exercise testing. We hypothesized that the O₂ pulse curve pattern response to a maximal cycling ramp protocol exhibits a stable linear pattern in subjects reevaluated under the same clinical conditions. We retrospectively studied 100 adults (80 males), mean age at baseline of 59 + 12 years, who performed two cardiopulmonary exercise testings (median interval was 15 months), for clinical and/or exercise prescription reasons. The relative O₂ pulse was calculated by dividing its absolute value by body weight. Subjects were classified into quintiles of relative O₂ pulse. Cardiopulmonary exercise testing results and the O₂ pulse curve pattern, expressed by its slope and intercept, were compared among quintiles of relative O₂ pulse at both cardiopulmonary exercise testings. After excluding the first minute of CPX (rest-exercise transition), the relative O₂ pulse curve exhibited a linear increase, as demonstrated by high coefficients of determination (R² from 0.75 to 0.90; p < 0.05 for all quintiles). Even though maximum oxygen uptake and relative O₂ pulse were significantly higher in the second cardiopulmonary exercise testing for each quintile of relative O₂ pulse (p < 0.05 for all comparisons), no differences were found when slopes and intercepts were compared between the first and second cardiopulmonary exercise testings (p > 0.05 for all comparisons; except for intercept in the 5th quintile). Excluding the rest-exercise transition, the relative O₂ pulse exhibited a stable linear increase throughout maximal exercise in adults that were retested under same clinical conditions.

The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity.

Objective: Blood flow restriction training (BFRT) has been proposed to induce muscle hypertrophy, but its safety remains controversial as it may increase mean arterial pressure (MAP) due to muscle metaboreflex activation. However, BFR training also causes metabolite accumulation that may desensitize type III and IV nerve endings, which trigger muscle metaboreflex. Then, we hypothesized that a period of BFR training would result in blunted hemodynamic activation during muscle metaboreflex. Methods: 17 young healthy males aged 18–25 yrs enrolled in this study. Hemodynamic responses during muscle metaboreflex were assessed by means of postexercise muscle ischemia (PEMI) at baseline (T0) and after 1 month (T1) of dynamic BFRT. BFRT consisted of 3-min rhythmic handgrip exercise applied 3 days/week (30 contractions per minute at 30% of maximum voluntary contraction) in the dominant arm. On the first week, the occlusion was set at 75% of resting systolic blood pressure (always obtained after 3 min of resting) and increased 25% every week, until reaching 150% of resting systolic pressure at week four. Hemodynamic measurements were assessed by means of impedance cardiography. Results: BFRT reduced MAP during handgrip exercise (T1: 96.3 ± 8.3 mmHg vs. T0: 102.0 ± 9.53 mmHg, p = 0.012). However, no significant time effect was detected for MAP during the metaboreflex activation (P > 0.05). Additionally, none of the observed hemodynamic outcomes, including systemic vascular resistance (SVR), showed significant difference between T0 and T1 during the metaboreflex activation (P > 0.05). Conclusion: BFRT reduced blood pressure during handgrip exercise, thereby suggesting a potential hypotensive effect of this modality of training. However, MAP reduction during handgrip seemed not to be provoked by lowered metaboreflex activity.