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CLINICAL UTILITY OF PRE-EXERCISE SCREENING USING EXERCISE STRESS TESTING IN PEOPLE WITH DIABETES
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medications which would impact or alter the cardiometabolic parametres assessed in this study or their ability to perform burst exercise. RESULTS: 76 patients were randomized with an average age of 65 years, an average BMI of 31 kg/m2 and an average Haemoglobin A1C (HBA1C) of 8.2%; 68% of study participants were male. Patients prescribed the burst regimen exercised on average 27% more than the control group (p<0.01). Burst exercise patients also showed a 2.3 fold greater improvement in HbA1c (0.25% improvement in the control group versus 0.81% improvement in the intervention group, p<0.01). In addition, there was significantly greater improvement in lipid parametres: LDL improving 0.16 mmol/L in the control group compared to 0.37 mmol/L in the burst exercise group and HDL improving 0.021 mmol/L compared to 0.14 mmol/L in the burst exercise group. The intervention group also improved more in their triglycerides, BMI and cardiopulmonary fitness. Even among patients who exercised similar number of minutes per day, greater relative improvements in biochemical parameters were noted in those randomized to burst exercise. CONCLUSION: Burst exercise appeared to significantly improve the cardiometabolic status of newly diagnosed diabetic patients. This regimen may represent a simple and effective way to improve diabetes rehabilitation but requires longer-term validation of clinical outcomes in larger and more diverse populations.
391 CLINICAL UTILITY OF PRE-EXERCISE SCREENING USING EXERCISE STRESS TESTING IN PEOPLE WITH DIABETES M Armstrong, D Rabi, D Southern, A Nanji, W Ghali, R Sigal Calgary, Alberta BACKGROUND:
Several professional organizations suggest that pre-exercise stress testing be considered for asymptomatic individuals with diabetes who want to initiate an exercise program, however the need for pre-exercise stress testing in people with diabetes remains controversial. The objective of this study was to examine the clinical impact of pre-exercise stress testing in a sample of patients with diabetes initiating a supervised exercise program. METHODS: We completed a retrospective cohort study evaluating patients with diabetes who initiated a supervised exercise program in Calgary between March 2007 and February 2012. Data from clinical and administrative databases were extracted and linked. Outcomes of interest included catheterization and revascularization procedures, cardiovascular-related hospital admissions, mortality, and change in care. RESULTS: Among 1,705 people with diabetes, 40% (n¼676) were referred for pre-exercise stress testing as they
Canadian Journal of Cardiology Volume 31 2015
were previously sedentary and had > one cardiovascular risk factor other than diabetes. Within one year, more revascularization procedures were performed in patients who were referred for stress testing compared to those who were not (2.1% vs. 0.8%, p¼0.027), but over the entire follow-up period (mean 3.4 years) the proportions of patients who underwent a revascularization procedure were not different between the groups. At one year and over the entire follow-up period there was no difference between the groups on any other cardiovascular outcomes. The one-year rate for combined cardiovascular death and myocardial infarction was 0.7%, with an average of 0.88% per year over the entire study period. Among patients who completed a pre-exercise stress test, a change in care was documented in only 4.6% of cases. Among patients who experienced a cardiovascular outcome within one year of the exercise intake session all had the following risk factors: previous myocardial event, known arrhythmia, known diabetes complication (nephropathy, neuropathy, and/or retinopathy), severe pulmonary disease, chest pain on testing, and age over 80. CONCLUSION: Referral for pre-exercise stress testing was associated with higher rates of cardiac revascularization within the first year, but not during longer-term follow-up. Importantly, the rate of cardiovascular outcomes was very low in both groups, and referral for stress testing did not result in a change of care for most patients. Minimizing the need for pre-exercise stress testing through better risk stratification may help manage costs and improve access to supervised exercise programs.
392 EFFECTS OF HIGH INTENSITY INTERVAL TRAINING ON HEART RATE RECOVERY, HEART RATE VARIABILITY AND ARRHYTHMIAS IN PATIENTS POST-ACUTE CORONARY SYNDROME M Boidin, M Gayda, R Amoussou, D Hayami, M Juneau, C Henri, É Thorin, J Tardif, J Lambert, A Nigam Montréal, Québec BACKGROUND:
Heart rate recovery (HRR) and heart rate variability (HRV) are important predictors of mortality in patients post-acute coronary syndrome (PACS). High intensity interval exercise (HIIE) decreases the prevalence of arrhythmias and increases HRV in heart failure patients. However, the effects of high intensity interval training (HIIT) on HRR, HRV and arrhythmias in PACS patients are not documented. Our aims were to compare the effects of 12-weeks of HIIT vs. moderate intensity continuous exercise training (MICET) on HRR, HRV and arrhythmias in PACS patients. METHODS: Thirty-one PACS patients from the Montréal Heart Institute (MHI) were randomly assigned to either
medications which would impact or alter the cardiometabolic parametres assessed in this study or their ability to perform burst exercise. RESULTS: 76 patients were randomized with an average age of 65 years, an average BMI of 31 kg/m2 and an average Haemoglobin A1C (HBA1C) of 8.2%; 68% of study participants were male. Patients prescribed the burst regimen exercised on average 27% more than the control group (p<0.01). Burst exercise patients also showed a 2.3 fold greater improvement in HbA1c (0.25% improvement in the control group versus 0.81% improvement in the intervention group, p<0.01). In addition, there was significantly greater improvement in lipid parametres: LDL improving 0.16 mmol/L in the control group compared to 0.37 mmol/L in the burst exercise group and HDL improving 0.021 mmol/L compared to 0.14 mmol/L in the burst exercise group. The intervention group also improved more in their triglycerides, BMI and cardiopulmonary fitness. Even among patients who exercised similar number of minutes per day, greater relative improvements in biochemical parameters were noted in those randomized to burst exercise. CONCLUSION: Burst exercise appeared to significantly improve the cardiometabolic status of newly diagnosed diabetic patients. This regimen may represent a simple and effective way to improve diabetes rehabilitation but requires longer-term validation of clinical outcomes in larger and more diverse populations.
391 CLINICAL UTILITY OF PRE-EXERCISE SCREENING USING EXERCISE STRESS TESTING IN PEOPLE WITH DIABETES M Armstrong, D Rabi, D Southern, A Nanji, W Ghali, R Sigal Calgary, Alberta BACKGROUND:
Several professional organizations suggest that pre-exercise stress testing be considered for asymptomatic individuals with diabetes who want to initiate an exercise program, however the need for pre-exercise stress testing in people with diabetes remains controversial. The objective of this study was to examine the clinical impact of pre-exercise stress testing in a sample of patients with diabetes initiating a supervised exercise program. METHODS: We completed a retrospective cohort study evaluating patients with diabetes who initiated a supervised exercise program in Calgary between March 2007 and February 2012. Data from clinical and administrative databases were extracted and linked. Outcomes of interest included catheterization and revascularization procedures, cardiovascular-related hospital admissions, mortality, and change in care. RESULTS: Among 1,705 people with diabetes, 40% (n¼676) were referred for pre-exercise stress testing as they
Canadian Journal of Cardiology Volume 31 2015
were previously sedentary and had > one cardiovascular risk factor other than diabetes. Within one year, more revascularization procedures were performed in patients who were referred for stress testing compared to those who were not (2.1% vs. 0.8%, p¼0.027), but over the entire follow-up period (mean 3.4 years) the proportions of patients who underwent a revascularization procedure were not different between the groups. At one year and over the entire follow-up period there was no difference between the groups on any other cardiovascular outcomes. The one-year rate for combined cardiovascular death and myocardial infarction was 0.7%, with an average of 0.88% per year over the entire study period. Among patients who completed a pre-exercise stress test, a change in care was documented in only 4.6% of cases. Among patients who experienced a cardiovascular outcome within one year of the exercise intake session all had the following risk factors: previous myocardial event, known arrhythmia, known diabetes complication (nephropathy, neuropathy, and/or retinopathy), severe pulmonary disease, chest pain on testing, and age over 80. CONCLUSION: Referral for pre-exercise stress testing was associated with higher rates of cardiac revascularization within the first year, but not during longer-term follow-up. Importantly, the rate of cardiovascular outcomes was very low in both groups, and referral for stress testing did not result in a change of care for most patients. Minimizing the need for pre-exercise stress testing through better risk stratification may help manage costs and improve access to supervised exercise programs.
392 EFFECTS OF HIGH INTENSITY INTERVAL TRAINING ON HEART RATE RECOVERY, HEART RATE VARIABILITY AND ARRHYTHMIAS IN PATIENTS POST-ACUTE CORONARY SYNDROME M Boidin, M Gayda, R Amoussou, D Hayami, M Juneau, C Henri, É Thorin, J Tardif, J Lambert, A Nigam Montréal, Québec BACKGROUND:
Heart rate recovery (HRR) and heart rate variability (HRV) are important predictors of mortality in patients post-acute coronary syndrome (PACS). High intensity interval exercise (HIIE) decreases the prevalence of arrhythmias and increases HRV in heart failure patients. However, the effects of high intensity interval training (HIIT) on HRR, HRV and arrhythmias in PACS patients are not documented. Our aims were to compare the effects of 12-weeks of HIIT vs. moderate intensity continuous exercise training (MICET) on HRR, HRV and arrhythmias in PACS patients. METHODS: Thirty-one PACS patients from the Montréal Heart Institute (MHI) were randomly assigned to either