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Tag: Exercise

  • Running helps to prevent weight or fat gain in the long-term, study shows

    Running helps to prevent weight or fat gain in the long-term, study shows

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    Recently, some media outlets have highlighted that it is a myth that running will help you lose weight/fat. There is certainly convincing scientific evidence that after an initial loss in fat mass from engaging in an exercise regime, the body lowers its overall energy expenditure to conserve energy and ultimately its fat mass stores. This is nature’s insurance policy developed by our ancestors to prevent starvation during times of restricted food availability. A new study, however, showed that running prevents increases in body fat in the long-term.

    Don’t be discouraged if, after a promising start, you can’t get your weight down by running. Recent work from the University of Jyväskylä, Finland, (https://jyx.jyu.fi/handle/123456789/91853#) has shown that running helps to prevent weight or fat gain in those that continue to run. Hopefully this helps to maintain motivation throughout the up-coming months once the fast gains have waned.

    Our data clearly shows that lifelong running exercise, be it long-distance or repeated short-distance sprinting, maintains lower fat mass levels than a typical physically active lifestyle and also more than participating in competitive strength sports.”


    Dr. Simon Walker, a Docent in Exercise Physiology, Faculty of Sport and Health Sciences, University of Jyväskylä

    The older sprinters and endurance athletes in the study even had lower fat mass than young strength athletes and physically active controls.

    “Absolutely this result motivates me to continue running. I’d certainly be happy with a fat percentage of 16-18% when I’m in my 70s and 80s”, continues Dr. Walker.

    Lifelong strength training is best for maintaining muscle mass

    The same study showed that individuals participating in lifelong resistance training maintained muscle mass better than those competing in sprint and long-distance running sports. Additionally, the older strength trainers had a similar amount of muscle mass as their young counterparts.

    Dr. Walker suggests a combined training approach may be most beneficial for optimizing body composition throughout the lifespan:

    “In terms of enhancing body composition through both heightened muscle mass and maintenance of a non-health affecting fat mass, it seems that a combined approach is recommendable. We know that both tissues, fat and muscle, influence overall health and function opposingly. Therefore, the best strategy would be to optimize both.

    Walker suggests that two-to-three sessions of endurance and the same for resistance exercise (i.e. 4-6 sessions per week), depending on your preference, mood, motivation, or taking into account seasonal variation should lead to the same kinds of results seen in the athletes in the study.

    “The key is perhaps to prevent a rise in fat mass or loss in muscle mass in the first place and maintain exercise throughout the lifespan. Thus, lifelong engagement in regular exercise does help to maintain a healthy body composition. That is no myth.”

    The present study was performed using data from larger cohort studies (ATHLAS and CALEX-family cohorts) led by Dr. Marko Korhonen and Emer. Prof. Sulin Cheng, respectively. It includes males aged 20-39 and 70-89 years who were competitive sprinters, endurance runners and strength athletes, and also controls who were physically active but did not compete in sports.

    “While we studied males only, I see no reason why our results would not be applicable for females too, especially considering the effects of menopause and other age-related effects.”

    Source:

    University of Jyväskylä

    Journal reference:

    Walker, S., et al. (2023). Body composition in male lifelong trained strength, sprint and endurance athletes and healthy age-matched controls. Frontiers in Sports and Active Living. doi.org/10.3389/fspor.2023.1295906.

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  • Exercise shapes our gut health, study finds

    Exercise shapes our gut health, study finds

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    In a recent study published in the journal EBioMedicine,  a team of scientists investigated the association between physical activity levels and gut microbiota using accelerometer-based assessments of sedentary, moderate, and vigorous physical activity levels.

    Study: Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS. Image Credit: Zhanna Mendel / ShutterstockStudy: Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS. Image Credit: Zhanna Mendel / Shutterstock

    Background

    A growing body of evidence shows that optimal levels of physical activity lower the risk of type 2 diabetes, cardiovascular disease, and mental health conditions such as depression. Furthermore, sedentary habits involving activities that include extensive periods of sitting or lying down have been known to increase the risk of cardiovascular mortality and type 2 diabetes, and these risks can be lowered through high-intensity exercise. Recent studies have also shown that the positive effects of exercise on health might be mediated through gut microbiome changes.

    Substantial research also indicates that the gut microbiome plays a significant role in developing various diseases and mental health problems. Apart from the interactions with the host in the gastrointestinal tract, the gut microbiota is also thought to produce neurotransmitters that can influence the immune system, central nervous system, and brain homeostasis through various neuronal pathways and the microbiota-gut-brain axis. Physical activity and resulting changes in circulation, enterohepatic movement of bile acids, intestinal permeability, and gut immunity can influence the gut microbiota.

    About the study

    In the present study, the researchers used data from a cardiopulmonary bioimage study from Sweden to determine if sedentary, moderate, and vigorous levels of physical activity were associated with gut microbiome changes. While quite a few previous studies have examined this association, most of them have used self-reported levels of physical activity, which is subject to bias. Furthermore, the authors believe that the taxonomic resolution of the gut microbes had been limited in these studies.

    This study used data from a hip-worn accelerometer to obtain a more reliable and accurate measure of physical activity levels. Additionally, the use of deep shotgun metagenomics was thought to provide high-resolution taxonomic information about the gut microbial communities.

    The participants in the study were required to answer a detailed questionnaire about health and medical history, diet, and lifestyle habits. They underwent a series of physical and clinical examinations such as lungs, coronary artery, and abdominal computed tomography (CT). Participants also provided fecal samples that were used for the gut microbiome analysis. An accelerometer was worn on the hip by all the participants for one week, at all hours except while involved in water-based activities or sleeping.

    The data from the accelerometer was converted to counts per minute, which was then used to define sedentary, low, moderate, and vigorous levels of physical activity according to cut-offs validated from previous studies. Deoxyribonucleic acid (DNA) extraction was carried out for all the fecal samples, and the extracted DNA was then used to identify the metagenomic species.

    Various indices of species diversity, such as the inverse Simpson index, Shannon diversity index, and species richness, were calculated to determine the alpha diversity. Additionally, the dissimilarity in the microbe composition between the samples was determined by calculating the beta diversity.

    Results

    The results showed that the association between sedentary habits or very low levels of physical activity and the abundance of various gut microbe species was converse to the association between moderate or vigorous physical activity levels and the abundance of gut microbiome species.

    The abundance of Escherichia coli was found to be high in association with sedentary physical activity levels, while moderate physical activity levels were linked to a lower abundance of E. coli. The abundance of butyrate-producing bacteria such as those belonging to the Roseburia genus, and Faecalibacterium prausnitzii was high in individuals with moderate and vigorous physical activity levels.

    Furthermore, differences were also observed in the abundance of species, such as Prevotella copri, between individuals with moderate physical activity levels and those in the vigorous physical activity group. The abundance of P. copri was higher in association with moderate levels of exercise, but vigorous exercise showed no association with P. copri abundance.

    The functional potential of the gut microbiome was also found to differ in association with differing physical activity levels. Moderate levels of physical activity were found to be associated with higher acetate and butyrate synthesis. Vigorous exercise was found to be linked to higher propionate synthesis, and sedentary activity levels were associated with a lower capacity for carbohydrate degradation by the gut microbiota.

    Conclusions

    Overall, the findings suggested that physical activity levels were strongly linked to the abundance of specific gut microbes. Furthermore, the diversity and abundance of the gut microbiota, and subsequently its functional potential, changed according to different levels of physical activity. Sedentary habits and higher levels of physical activity exhibited converse associations with gut microbiome abundance and diversity.

    Journal reference:

    • Baldanzi, G., Sayols-Baixeras, S., Ekblom-Bak, E., Ekblom, Ö., Dekkers, K. F., Hammar, U., Nguyen, D., Ahmad, S., Ericson, U., Arvidsson, D., Börjesson, M., Johanson, P. J., Gustav, S. J., Bergström, G., Lind, L., Engström, G., Ärnlöv, J., Kennedy, B., Orho-Melander, M., & Fall, T. (2024). Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS. EBioMedicine, 100. DOI: 10.1016/j.ebiom.2024.104989, https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(24)00024-0/fulltext

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  • Dance mat-style game helps stop older people falling

    Dance mat-style game helps stop older people falling

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    People were encouraged to play the game, called smart±step, for at least 2 hours a week for one year

    NeuRA

    A dance mat-style game that prompts players to step on different arrows prevents falls among older people, probably by improving their strength, balance and reflexes.

    Our balance naturally declines with age, with falls being a common cause of serious injury among older people. Vision problems, muscle weakness and conditions such as dementia, heart disease and low blood pressure can also raise the risk.

    To help prevent falls, Daina Sturnieks at…

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  • How self-monitoring and motivation fuel online weight loss success

    How self-monitoring and motivation fuel online weight loss success

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    A recent BMC Public Health study analyzes self-monitoring data from Chinese adults who participated in a group weight loss intervention using a mixed-methods approach.

    Study: Why more successful? An analysis of participants’ self-monitoring data in an online weight loss intervention. Image Credit: Ground Picture / Shutterstock.com Study: Why more successful? An analysis of participants’ self-monitoring data in an online weight loss intervention. Image Credit: Ground Picture / Shutterstock.com

    Background

    According to the World Health Organization (WHO), over 1.9 billion adults were overweight in 2016. This global public health problem has reached alarming proportions in China, which significantly increases the risks of several diseases, including cancer, diabetes, and cardiovascular diseases. 

    Self-monitoring, which enhances self-awareness, promotes desired behaviors, and reduces unwarranted behaviors, can be achieved through setting specific targets and logging progress. Changes in body weight, exercise, and dietary intake are regularly monitored by participants of weight loss interventions. In fact, obese individuals who periodically monitor their diet and body weight have experienced more beneficial responses to interventions.

    Researchers have both quantitatively and qualitatively analyzed the self-monitoring behaviors of dieters; however, few have utilized a mixed-methods approach for this purpose. Notable advantages of the mixed-methods approach include its ability to elucidate the association between weight loss and different self-monitoring indicators and reduce bias to ultimately develop reliable insights into self-monitoring.

    About the study

    Self-monitoring data from 61 Chinese adults who participated in a five-week online weight loss intervention group were analyzed in the current study. In addition to providing information on their weight loss motivation and body mass index (BMI) values, the study participants also engaged in daily quantitative monitoring, which included parameters like caloric intake and sedentary behavior, as well as qualitative self-monitoring, which involved a daily log of weight loss progress. 

    A scoring rule assessed the timeliness of the data. A one-way repeated measurement ANOVA was used to analyze the dynamics of self-monitoring indicators.

    Regression and correlation analyses were performed to explore the relationship between weight change, self-monitoring indicators, and baseline data. Participants were grouped into three categories based on their weight loss outcomes, and their qualitative data was assessed using content analysis. 

    Key findings

    Some fluctuation in self-monitoring data was observed throughout the intervention. Furthermore, some baseline characteristics of participants and self-monitoring behaviors were positively associated with their final weight loss outcomes. Across the weight loss categories, heterogeneity in qualitative self-monitoring data was observed. 

    During the weight loss process, a gradual decrease in caloric intake was observed, thus suggesting the learning behavior among participants. During the last week, participants exhibited some variation in commitment levels, which led to concerns about a rebound in caloric intake.

    Weight loss satisfaction was highest in the first week and gradually declined. This decline in satisfaction was consistent with their weight loss, highlighting the link between effort and outcome. 

    Weight loss motivation, baseline BMI, and timeliness of daily self-monitoring data completion predicted final weight loss. The relationship between weight loss, daily physical activity expenditure, and daily caloric intake was insignificant. Furthermore, no significant relationship was observed between weight loss and daily mood. 

    The qualitative analysis of participants’ daily logs revealed four categories: eating behavior, weight loss awareness, physical activity, and perception of change, the latter of which was most frequently mentioned. This was followed by the mention of weight loss awareness, eating behavior, and physical activity.

    Inconsistencies were noted in the probability distribution of participants’ daily log frequencies. Poor and moderate weight loss groups reported lower observed frequencies across all four categories than the excellent group. The excellent group reported a higher frequency of adjustments in eating habits, self-awareness, disadvantages, and demonstrating greater patience.

    Conclusions

    An inconsistent pattern in the self-monitoring behavior among individuals undergoing a group weight loss intervention was observed. More specifically, a higher level of self-monitoring was identified during the initial weeks of weight loss, followed by a slow decline.

    More significant weight loss was attained by individuals with higher levels of motivation, higher baseline BMI, and those who regularly self-monitored. Furthermore, more detailed and frequent content was reported in the texts submitted by successful participants.

    These findings imply that weight loss motivation and adherence to self-monitoring should be emphasized. The use of digital technologies could be beneficial, as they could facilitate greater weight loss awareness and promote healthy dietary habits.

    In the future, more studies with larger sample sizes and precise measurement tools are needed to evaluate daily calorie expenditure and intake. 

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  • Nerve stimulation plus physical rehabilitation may boost recovery of arm and hand function

    Nerve stimulation plus physical rehabilitation may boost recovery of arm and hand function

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    Combining brain stimulation with intense physical rehabilitation helped stroke survivors recover movement in their arms and hands and maintain these improvements for one year, according to a study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    The recovery of arm and hand function after a stroke often stalls or even declines, leaving many patients with chronic motor deficits that limit their independence and quality of life. New treatments that can boost the benefits of physical rehabilitation are desperately needed.”


    Teresa J. Kimberley, Ph.D., study’s lead author, professor of rehabilitation science and physical therapy at MGH Institute of Health Professions in Boston

    Vagus nerve stimulation is the first approved neuromodulation device to aid in chronic stroke recovery. It was approved by the U.S. Food and Drug Administration in 2021 to treat moderate to severe upper extremity motor function deficits (physical movement and coordination of arms and hands) associated with chronic stroke.

    “This is the first time that brain stimulation combined with rehabilitation therapy for stroke is available outside of a clinical trial. It could set the stage for even more advancements in recovery from other impairments beyond the arm,” Kimberley said. “This is a watershed moment for rehabilitation science.”

    This study represents one-year outcomes in the VNS-REHAB pivotal trial, which studied people who had a stroke resulting in moderate to severe upper extremity impairment.

    Two groups of participants (108 total people) -; a control group and an experimental group -; completed six weeks of in-clinic, intense rehabilitation paired with active or sham vagus nerve stimulation. All participants were implanted with the nerve stimulation device and then randomized to receive either real nerve stimulation or a sham stimulation that only turned on for a few pulses. The in-clinic therapy was followed by a three-month home exercise program for both groups. The active vagus nerve stimulation group continued the home exercise program for a year. After the six-week period of sham stimulation, the control group crossed over and received six weeks of active vagus nerve stimulation followed by a year of the home exercise program.

    Before and after the stimulation and rehabilitation therapies, motor function was assessed with the Fugl-Meyer Assessment-Upper Extremity, which assesses motor impairment, and the Wolf Motor Function Test, which is a time-based method to evaluate upper extremity motor ability while providing a better understanding of joint-specific and total limb movements.

    The final study results represent outcomes for arm and hand function in 74 stroke survivors after one year of physical rehabilitation treatment. Data was unavailable for the remaining 34 participants mainly due to the COVID-19 pandemic.

    This analysis found:

    • At one-year, upper limb function improved by 5.3 points in the Fugl-Meyer Assessment-Upper Extremity and by 0.51 points in the Wolf Motor Function Test when compared to baseline.

    • Vagus nerve stimulation therapy improved hand and arm function by 2-3 times more than intense rehabilitation alone.

    “The pairing of rehabilitation therapy with vagus nerve stimulation likely helps the brain strengthen new neural pathways – like building a bridge to bypass a damaged area,” Kimberley said.

    “These long-term, pivotal results mirror our long-term results from an earlier pilot study where we found that patients continue to improve or maintain their gains up to three years after starting vagus nerve stimulation therapy paired with rehabilitation,” she said. “As a clinician, it is surprising to see someone with chronic stroke – stroke that in many ways is a progressive disease – continue to improve and not show a decline.”

    Study details and background:

    • The vagus nerve stimulation device in this study included a pacemaker connected to a lead that wraps around the vagus nerve in the neck region. There’s one vagus nerve on each side of the body; each one runs from the lower part of the brain through the neck to the chest and stomach.

    • VNS-REHAB trial participants were between the ages of 22-80 and had a stroke nine months to 10 years prior to study enrollment.

    • Study participants in the experimental group were 64% male and 36% female; 79% white, 17% African American adults, 2% Asian, Indian or other adults, and 1% did not have any race reported. The control group was 65% male and 35% female; 78% white, 16% African American adults, 7% Asian, Indian or other adults, and 1% did not have any race reported.

    • The study took five years to complete: 2017-2019 for enrollment, and the study ended in 2021.

    • The study was triple-blinded, meaning neither the participants, the researchers testing participants nor the health care professionals treating participants knew which intervention group participants were in.

    Study limitations included the small sample size and lack of details about the rehabilitation therapy regimens followed by each participant over the one-year period, which were variable.

    Future studies and an ongoing clinical registry will explore the long-term impact of active vagus nerve stimulation in real-world settings.

    “Often after a stroke, people don’t seek additional treatment, thinking that their current impairments are permanent. This is not true! Paired vagus nerve stimulation opens a new avenue and new hope for these patients. I’m also excited about future research that will investigate vagus nerve stimulation paired with rehabilitation for other conditions, such as gait and speech impairments after stroke,” Kimberley said.

    “These are encouraging findings,” said Joel Stein, M.D., FAHA, chair of the writing group for the American Heart Association’s/American Stroke Association’s 2021 Clinical Performance Measures for Stroke Rehabilitation and the Simon Baruch Professor and chair of the department of rehabilitation and regenerative medicine at Columbia University’s Vagelos College of Physicians and Surgeons; professor and chair of the department of rehabilitation medicine at Weill Cornell Medicine; and physiatrist-in-chief at NewYork-Presbyterian Hospital. “These results demonstrate the durability of the effects of vagus nerve stimulation, an important finding that supports the use of this modality to enhance recovery post-stroke. There is some evidence for lasting improvement with continued use outside of a formal exercise program, which is intriguing, although further research is needed to confirm this finding and clarify who is likely to experience ongoing improvements.” Dr. Stein was not involved in this study.

    Source:

    American Heart Association

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  • Stroke survivors in gym-rich neighborhoods more likely to stay physically active

    Stroke survivors in gym-rich neighborhoods more likely to stay physically active

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    Stroke survivors were more likely to remain physically active or even exercise more after their stroke if they lived in neighborhoods with easy access to recreational centers and gyms, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    We know that stroke survivors need to be physically active as part of their recovery. Our findings suggest that it’s important to have a conversation with stroke patients about physical activity resources available in their area so they are able to continue their recovery after hospital discharge. If their neighborhood does not offer fitness resources, neurologists should consider discharging the patient to a rehabilitation facility where they can participate in physical activities.”


    Jeffrey Wing, Ph.D., M.P.H., lead study author, assistant professor of epidemiology at The Ohio State University in Columbus, Ohio

    In this study, researchers examined the potential link between available fitness/exercise centers, pools and gyms and physical activity among 333 people living in New York City who had a mild stroke.The data was geocoded, assigned to the U.S. census tracts, and merged with data from the National Neighborhood Data Archive (collects information about the number of physical activity resources at the census tract level). Geocoding is the process of transforming a description of a location -; such as an address or a name of a place -; to a location on the earth’s surface. Researchers then examined the association between the number of fitness and recreational centers, such as pools, gyms and skating rinks per square mile, and the self-reported change in physical activity levels -; more active, about the same or less active -; one year after stroke.

    The analysis found:

    • About 17% of participants reported being more physically active one year after stroke, and 48% reported having about the same level of physical activity as before the stroke.

    • The odds of being more active were 57% higher among participants who lived in areas with more recreational and fitness resources (about 58 fitness resources) compared to people living in neighborhoods with fewer or no fitness resources, after controlling for age, gender, race, ethnicity, education, health insurance and body mass index.

    • Similarly, the odds of reporting the same level of physical activity one year after stroke were 47% higher in participants who lived in areas with more recreational centers and fitness resources compared to those who lived in areas with fewer or no resources available.

    Previous research has shown that even moderate physical activity is beneficial for stroke recovery and can include walking, Wing said. “However, it’s important to recognize the availability or limited availability of exercise resources in a person’s immediate neighborhood and to be able to feel safe while participating in exercise activities.”

    Previous research has found that the characteristics of the built environment of a neighborhood, such as access to healthy food or recreational spaces promoting physical activity, were also linked to lower incidence of stroke, Wing noted.

    “The takeaway from this analysis is that it’s not that people should move to a location where there are more resources to engage in physical activity, but to urge people to find ways to be active in their own neighborhood,” said study co-author Julie Strominger, a Ph.D. student of epidemiology at The Ohio State University. “It’s the action that will lead to better outcomes, so just the action of being physically active is what really matters.”

    “This study is consistent with prior research on the importance of physical activity for optimal health. The new aspect is the focus on stroke survivors,” said American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor of epidemiology and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston. “It’s important for health care professionals to discuss maintaining physical activity with stroke survivors: find out if they know of a safe place to exercise, and if they do not, have that information readily available.” Lackland was not involved in the study.

    Study details and background:

    • The analysis included 333 adults hospitalized for mild stroke and enrolled in the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) study.

    • The DESERVE study was a randomized clinical trial of 546 stroke survivors and conducted in New York City from 2012-2016.

    • Participants were 52% women, with an average age of 65 years; they self-identified as 35% Hispanic adults, 31% Black adults, 28% white adults and 6% as “other” race.

    The main limitations of the study, according to the authors, are that the findings may not be generalizable to non-urban neighborhoods in the U.S. In addition, the data was extracted from a clinical trial that included only stroke survivors who had a mild stroke, therefore, this association may not hold true for survivors of severe stroke. Also, while people in certain neighborhoods reported more physical activity, that does not necessarily mean that they used the fitness and recreational resources in their neighborhood.

    Source:

    American Heart Association

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  • CT scans may be better first step for evaluating chest pain

    CT scans may be better first step for evaluating chest pain

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    Previous studies have found less than 40% of patients with stable chest pain undergoing invasive coronary angiography are found to have obstructive coronary artery disease. Recent randomized clinical trials have demonstrated a benefit to using computed tomography angiography (CTA) first in evaluation of these patients, and a new study being presented at the American College of Cardiology Cardiovascular Summit lends credence to this strategy, finding that CT was associated with a higher likelihood of revascularization compared to other imaging modalities or no testing.

    Stable angina is a type of chest discomfort that occurs when the heart muscle needs more oxygen than usual-;such as during stress, exercise or cold weather-;but it’s not getting it, often due to blocked coronary arteries. Patients with stable angina are often treated with guideline-directed medical therapy and lifestyle changes but may also need a coronary revascularization procedure to restore adequate blood flow to resolve their symptoms.

    Right now, when a patient presents to their primary care physician or cardiologist with symptoms suspicious for angina, they are commonly referred for additional testing.”


    Markus Scherer, MD, Director of Cardiac CT and Structural Heart Imaging at Atrium Health-Sanger Heart & Vascular Institute and study’s senior author

    Between October 2022 and June 2023, researchers at Atrium Health-Sanger Heart & Vascular Institute in Charlotte, North Carolina, assessed 786 patients who had no prior diagnosis of coronary artery disease and underwent elective invasive coronary angiography (ICA) for the evaluation of suspected angina. The pre-ICA testing strategies were: no noninvasive testing with direct referral to ICA (44%), stress echocardiogram (3%), stress myocardial perfusion imaging (15%), stress MRI (2%) and coronary CTA (36%). The study cohort had a mean age of 66 years, was 63% male, 37% female, 81% White, 13% Black, 1% Asian, 1% Hispanic and 1% other.

    The researchers compared rates of subsequent revascularization between patients whose initial evaluation was coronary CTA versus stress testing or clinical judgement (no testing). The “CT first” strategy was associated with subsequent revascularization in 62% of patients compared to 34% for the combination of other modalities or direct ICA referral.

    The 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain suggests either non-invasive functional imaging or coronary CTA as the initial test without specifying a preference for one or the other.

    According to the researchers, there are a multitude of reasons health systems don’t currently use a CT first approach, including the availability of high-quality CT scanners; availability of qualified cardiac CT interpreting physicians; and challenges in transitioning to a newer approach after decades of pre-established patterns (i.e. stress testing). Furthermore, a CT first approach is predominately advocated for patients with unestablished coronary artery disease and does not apply to all, as some patient factors may reduce the accuracy and utility of coronary CTA. 

    “While care must be individualized, for patients with unknown or unestablished coronary artery disease, the transition to a ‘CT first’ strategy should be a high priority for cardiovascular care providers,” Scherer said. “The non-invasive approach has a lower risk and cost than a diagnostic heart catheterization and, for the CT approach-;but not stress testing-;provides information on the absence, presence and extent of coronary atherosclerosis and whether or not there are high risk plaques as well as vessel blockages, which helps streamline patient management and risk reduction.”

    Since coronary CTA is less expensive than both nuclear myocardial perfusion imaging and ICA, there is a direct cost saving to patients and third-party payers with the CT first approach, according to Scherer. From the perspective of a health system, the most financially efficient evaluation approach becomes more important during the transition to a value-oriented health care system.

    According to the authors, the study demonstrates “real world” credence to the randomized trials showing similar benefits to a “CT first” strategy and should promote increased adoption of this strategy for the evaluation of patients with chest pain and an unestablished history of coronary artery disease.

    “Cardiac catheterization labs are a capital and human resource intensive care environment. Using them for their maximum potential of treating disease, rather than diagnosing it, bring the highest yield for these resources to the health care system,” Scherer said.

    The full results of the study and other studies will be presented at the ACC Cardiovascular Summit 2024 in Washington, on February 1-3, 2024. The ACC Cardiovascular Summit 2024 will examine innovative strategies and emerging trends in CV care, assess operational efficiencies to enhance the effectiveness of the CV service line, and adopt customizable approaches that support economic sustainability.

    Source:

    American College of Cardiology

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