Papers by Andrew Maiorana
Estimating exercise intensity using heart rate in adolescents and adults with congenital heart disease: Are established methods valid?
International Journal of Cardiology Congenital Heart Disease, 2022
International Journal of Environmental Research and Public Health, 2022
High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identific... more High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ...
Original Research
Australian perspective regarding recommendations for physical activity and exercise rehabilitatio... more Australian perspective regarding recommendations for physical activity and exercise rehabilitation in pulmonary arterial hypertension
Background and evidence base for recommendations
and the Medical Issues Advisory Committees. The Working Group, which has expertise in physical ac... more and the Medical Issues Advisory Committees. The Working Group, which has expertise in physical activity, cardiovascular exercise physiology, cardiology, epidemiology, public health medicine, health promotion, general practice, and secondary prevention of coronary heart disease, prepared an initial evidence-based draft statement, which was circulated for comment. Comments were incorporated into a second draft, which was then circulated more widely and discussed at an open forum held on 28 February 2005. Reviews published since the 1996 report by the United States Surgeon General on physical activity and health1 were identified by searching PubMed, the Cochrane Library and PsycINFO, using the search terms exercise, physical activity, cardiovascular disease (CVD), heart disease, coronary heart disease, coronary artery disease, heart failure, stroke, peripheral vascular disease, peripheral arterial disease, claudication and diabetes mellitus. Limits of humans,
Characterising running economy and change of direction economy between soccer players of different playing positions, levels and sex
European Journal of Sport Science, 2021
ABSTRACTTraditional movement economy (ME) measures the energetic cost of in-line running. However... more ABSTRACTTraditional movement economy (ME) measures the energetic cost of in-line running. However, it is debatable whether such a measure is representative of movement efficiency for team sport athletes who are required to run and change direction repeatedly. This study evaluated ME during both in-line running and runs with directional changes and provided a preliminary exploration as to whether these abilities discriminate soccer players according to playing position, level, and sex. Forty-three soccer players were assessed for ME as extrapolated from oxygen uptake during in-line running (RE) and running with changes of directions (using 20 m and 10 m shuttle runs [SRE20 and SRE10]) at 8.4 km/h mean speed. ME worsened with change of direction frequency (p<0.001). Coefficient of determination was high between RE and SRE20 (r2=0.601) but dropped below 0.5 for RE and SRE10 (r2=0.280) as change of direction frequency increased. No significant differences were observed between different player positions, however centre midfielders reported the best ME across any position and running mode, with the largest differences observed in centre backs over SRE10 (41.9 ± 2.7 ml/kg/min [centre midfielders] vs 45 ± 1.8 ml/kg/min [centre backs]; ES=1.19). No significant differences were observed for ME over any running condition for male players of different playing levels. Female players exhibited better ME than male players with significant differences observed for SRE10 (41.5 ± 2.6 ml/kg/min [females] vs 44 ± 2.6 ml/kg/min [males]; p=0.013; ES=0.94). RE does not adequately account for efficiency during activities that involve changes of direction. SRE10 is a stronger discriminator of ME between soccer players of different position and sex.
BACKGROUND Telemonitoring enables care providers to remotely support outpatients in self-managing... more BACKGROUND Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but little is known about the usability and patients’ willingness to engage with this technology. OBJECTIVE This study aims to evaluate feedback from patients with CHF following participation in the Innovative Telemonitoring Enhanced Care program for CHF (ITEC-CHF) study. METHODS The telemonitoring intervention consisted of three components: remote weight monitoring, structured telephone support, and nurse-led collaborative care. Participants were provided with electronic weighing scales (W550; ForaCare), and a computer tablet (Galaxy Tab A; Samsung). They were asked to weigh themselves on the provided scales daily. Telemonitoring was integrated with a personal assistance call service and a nurse care service according to their workflows in usual care. Feedback on the usability of ITEC-CHF was collected via survey from study participants following 6 months o...
Oxford Textbook of Geriatric Medicine, 2017
Cardiac rehabilitation is a multifactorial approach to supporting patients in their recovery from... more Cardiac rehabilitation is a multifactorial approach to supporting patients in their recovery from a cardiovascular event and reducing their risk of recurrent events (secondary prevention) through risk factor modification and adherence to evidence-based therapy. Although the incidence of cardiovascular disease increases with age, and the ageing demographic of industrialized societies means that many older people are living with cardiovascular disease, older people have historically been underrepresented in cardiac rehabilitation programmes. A challenge faced by contemporary cardiac rehabilitation providers is to offer flexible options to suit the requirements of different patient groups, including older people. This chapter explores best-practice cardiac rehabilitation and how it can be applied to suit the requirements of the geriatric patient, as well as the important role that physicians hold as an essential member of the multidisciplinary cardiac rehabilitation team.
Move your mind: embedding accredited exercise physiology services within a hospital-based mental health service
Australasian Psychiatry, 2020
Objective: Despite support for the role of exercise in improving physical and mental health for v... more Objective: Despite support for the role of exercise in improving physical and mental health for various psychiatric disorders, few service implementation evaluations within diverse hospital environments exist. This study presents the feasibility and implementation of a clinical exercise physiology service within a hospital mental health service. Method: Feasibility and service data were collected from databases and self-report (consumer and staff) for 6 months from the commencement of new exercise services (gym and group sessions) for community and inpatients (one secure and three open wards). Results: One hundred and twenty consumers engaged with exercise services with 70 direct referrals over the 6-month audit period (mean age 40 ± 13 years (19–69); 41% male). The overwhelming reason for referral was related to weight loss/management (65.7%), with the majority of patients (51%) presenting with schizophrenia spectrum and other psychotic disorders. Further, 549 exercise service inte...
SSRN Electronic Journal, 2019
We propose a method for constructing a generalized fuzzy Hausdorff distance on the set of the non... more We propose a method for constructing a generalized fuzzy Hausdorff distance on the set of the nonempty compact subsets of a given generalized fuzzy metric space in the sence of George-Veeramni and Tian-Ha-Tian. Next, we define the generalized fuzzy fractal spaces. Morever, we obtain a fixed point theorem of a class of generalized fuzzy contractions and present an application in integranl equation.
Effect of a comprehensive heart failure management program on functional status of patients referred to a cardiac transplant unit
Australian Journal of Advanced Nursing, 2021
Objective: To evaluate the effects of a communitybased chronic heart failure management program, ... more Objective: To evaluate the effects of a communitybased chronic heart failure management program, delivered by nurse practitioners, on self-care behaviour, quality of life and hospital readmissions. Background: Chronic heart failure is a complex condition associated with high rates of hospital readmissions. However, many hospitalisations in patients with chronic heart failure are potentially preventable with better self-management and access to specialised healthcare support. Nurse practitioners have an advanced scope of practice, making them well credentialed to support patients with chronic heart failure. Study design and methods: This study compared self-care behaviour and quality of life in patients who had attended a nurse-practitioner led chronic heart failure management service (SmartHeart) (n=58) compared with patients receiving usual care (n=58), but no nurse practitioner support. Self-care behaviour was assessed using the Self Care Heart Failure Index and quality of life was assessed using the Short Form-36 and Minnesota Living with Heart Failure Questionnaire. Hospitalisation records were extracted from medical records using data-linkage. Results: Patients who received nurse-practitioner support had better self-care behaviour (p<0.05), mental component summary of the Short Form-36 (p<0.05) and heart failure specific quality of life (p<0.05). All-cause hospitalisations were delayed (p<0.05) and length of stay was shorter (p<0.05) in the group receiving nurse practitioner support, but there were no differences in chronic heart failure related admissions. Discussion: A chronic heart failure support program, operating in a community setting and delivered by nurse practitioners, enhanced self-care, improved psychosocial health and reduced time in hospital. Conclusion: Chronic heart failure management delivered by nurse practitioners can improve self-care behaviour and quality of life, and reduced hospital admissions, compared with usual care.
Effect of circuit weight training on vascular function in patients with heart failure
Information for Action: Improving the Heart Health Story for Aboriginal People in Western Australia (BAHHWA Report)
This report finds that Aboriginal people experience both illness and death from heart disease at ... more This report finds that Aboriginal people experience both illness and death from heart disease at higher rates and at a much earlier average age than non-Aboriginal people, underscoring the urgency to direct efforts ‘upstream’ towards primary prevention and earlier, community-based detection and intervention. Overview This report primarily draws on research looking at disparities between Aboriginal and non-Aboriginal Western Australians in cardiovascular health and health care, conducted with funding from three research grants, the most recent known as the Bettering Aboriginal Heart Health in WA project. The methods used have included interviews, reviews of hospital records, analyses of linked hospital and mortality data, and literature reviews. Part I of the report primarily comprises summaries of the studies along with Key Findings and Recommendations arising from the research, while Part II details ‘Strategies for Action’ incorporating input from stakeholders and other strategic documents. The research initially centred on coronary heart disease, with statistical analysis of state-wide WA data, to determine the occurrence, comorbidities and outcomes for Aboriginal people, including age, sex, and geographic distributions. The team is now also studying other heart conditions such as heart failure and abnormalities of heart rhythm (dysrhythmias). Key heart conditions covered in this report are briefly explained in boxes in the relevant sections. Qualitative research was undertaken on the experiences of both the Aboriginal people affected by these illnesses and the health professionals involved in their care. This research aimed to understand the barriers and enablers of quality care provision and to promote optimal models of care. These original research projects were supplemented with critical reviews of published literature, resulting in stand-alone publications on the topics of interest. The BAHHWA project has had significant input from a number of key partnerships, including with the Heart Foundation, and the Cardiovascular Health Network and Aboriginal Health Division of the WA Department of Health.
661 Estimating Exercise Intensity Using Heart Rate in Adolescents and Adults With Congenital Heart Disease: Are Established Methods Valid?
Heart, Lung and Circulation, 2020
Twelve weeks of water-based circuit training exercise improves fitness, body fat and leg strength in people with stable coronary heart disease: a randomised trial
Journal of Physiotherapy, 2021
QUESTION In people with stable coronary heart disease, what are the effects of water-based circui... more QUESTION In people with stable coronary heart disease, what are the effects of water-based circuit training exercise on aerobic capacity, strength and body composition? How do these effects compare with those of gym-based exercise? DESIGN Parallel group, randomised controlled trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS Fifty-two participants with stable coronary heart disease. INTERVENTIONS Twelve weeks of: three 1-hour sessions per week of moderate-intensity water-based circuit training exercise with alternating aerobic and resistance stations (WEX); three 1-hour sessions per week of moderate-intensity gym-based circuit training exercise (GEX); or continuing usual activities (control). OUTCOME MEASURES Aerobic capacity (VO2peak), upper and lower limb one repetition maximum strength (biceps curl, latissimus dorsi pulldown, hamstring curl and leg press), anthropometry (weight, body mass index and girth) and dual energy x-ray absorptiometry. RESULTS Forty-five participants completed the study (WEX n = 15, GEX n = 18, control n = 12). Both training groups significantly improved VO2peak compared with control: WEX by 2.5 ml/kg/min (95% CI 0.6 to 4.4) and GEX by 2.3 ml/kg/min (95% CI 0.6 to 4.0). WEX and GEX improved hamstring strength compared with control: WEX by 6.3 kg (95% CI 1.2 to 11.3) and GEX by 7.6 kg (95% CI 2.9 to 12.2). Compared with control, GEX increased leg press strength by 15.5 kg (95% CI 5.7 to 25.3), whereas the effect of WEX was less clear (MD 7.1 kg, 95% CI -3.5 to 17.7). Only GEX improved latissimus dorsi pulldown strength. Compared with control, total body fat was reduced with WEX (-1.1 kg, 95% CI -2.3 to 0.0) and GEX (-1.2 kg, 95% CI -2.3 to -0.1). There were negligible between-group differences in weight or waist circumference. CONCLUSION WEX was well tolerated and improved aerobic capacity, leg strength and body fat to a similar degree as GEX in people with coronary heart disease. These findings suggest that WEX is an effective exercise training alternative to GEX for people with coronary heart disease. TRIAL REGISTRATION ANZCTR12616000102471.
Hypertension, 2021
Endothelial function, assessed using brachial artery flow-mediated dilation (FMD), predicts futur... more Endothelial function, assessed using brachial artery flow-mediated dilation (FMD), predicts future cardiovascular disease (CVD) risk. This study established age- and sex-specific reference intervals for brachial artery FMD in healthy individuals and examined the relation with CVD risk factors. In a retrospective study design, we pooled brachial artery FMD (acquired according to expert-consensus guidelines for FMD protocol and analysis) and participant characteristics/medical history from 5362 individuals (4–84 years; 2076 females). Healthy individuals (n=1403 [582 females]) were used to generate age-/sex-specific percentile curves. Subsequently, we included individuals with CVD risk factors, without overt disease (unmedicated n=3167 [1247 females] and medicated n=792 [247 females]). Multiple linear regression tested the relation of CVD risk factors (body mass index, blood pressure, cholesterol, diabetes, dyslipidemia, and smoking) with FMD. Healthy males showed a negative, curviline...
European Journal of Preventive Cardiology, 2020
Single-leg cycling increases limb specific blood flow without concurrent increases in normalised power output when compared with double-leg cycling in healthy middle-aged adults
European Journal of Sport Science, 2019
Abstract This study examined the acute performance, cardiovascular and local muscular responses t... more Abstract This study examined the acute performance, cardiovascular and local muscular responses to perceived exertion-based high-intensity interval exercise using either double- or single-leg cycling. Fifteen healthy middle-aged adults completed, on separate occasions, ten 30-s double-leg intervals interspersed with 60 s passive recovery and twenty (ten with each leg) 30-s single-leg intervals interspersed with 60 s passive recovery. Impedance cardiography, blood pressure, muscle oxygenation and total haemoglobin content (near-infrared spectroscopy), oxygen consumption and power output were measured throughout each session. Normalised to the lean mass used during each trial, single-leg cycling resulted in lower power output (single-leg: 8.92 ± 1.74 W kg−1 and double-leg: 10.41 ± 3.22 W kg−1; p < 0.05) but greater oxygen consumption (single-leg: 103 ± 11 mL kg−1 min−1 and double-leg: 84 ± 21 mL kg−1 min−1; p < 0.01) and cardiac output (single-leg: 1407 ± 334 mL kg−1 min−1 and double-leg: 850 ± 222 mL kg−1 min−1; p < 0.01), compared with double-leg cycling. Mean arterial pressure (double-leg: 108 ± 11 mmHg and single-leg: 102 ± 10 mmHg), change in total haemoglobin content (double-leg: 8.76 ± 10.65 µM cm s−1 and single-leg: 13.42 ± 4.10 µM cm s−1) and change in tissue oxygenation index (double-leg: −4.51 ± 3.56% and single-leg: −3.97 ± 3.91%) were not different between double-leg and single-leg cycling. When compared to double-leg cycling, single-leg cycling elicited a higher cardiac output relative to the lean mass, but this did not result in greater power output. The dissociation between blood availability and power output is consistent with an ageing model characterised by a decrease in local oxygen delivery and distribution capability.
Is early oxygen uptake recovery altered in children born very preterm?
Clinical Respiratory Physiology, Exercise and Functional Imaging, 2017
Introduction: Delayed early oxygen uptake (VO2) recovery reflects disease severity in chronic lun... more Introduction: Delayed early oxygen uptake (VO2) recovery reflects disease severity in chronic lung or heart disease, linked to delayed recovery of muscle energy stores. No previous studies have investigated this in children born very preterm where altered lung structure may impair recovery Hypothesis: Children born preterm have a delayed early VO2 recovery associated with worse neonatal lung disease. Methods: Children born very preterm ( Results: 61 preterm children (27 with bronchopulmonary dysplasia) and 28 controls were assessed. There were no differences in peak VO2 of preterm compared with term children (46.4±, 6.8 vs 47.7 ±5. mL.min−1.kg−1), nor between VO2 recovery at 1 min (85 ±, 0.1 vs 86 ±, 0.1%), 2min (22.8 ± 0.07 vs 24.5 ± 0.06%) or 5min (16.5 ±0.04 vs 18.8 ± 0.07%). Time to 50% peak VO2 was similar between preterm and term children (51.0± 11.9 vs 51.8 ± 12.8s). There were no associations between VO2 recovery and GA or O2 use in the neonatal period. Conclusion: Children born preterm have normal early oxygen uptake recovery following a maximal exercise test. This is consistent with the well preserved aerobic capacity observed in this group.
Heart, Lung and Circulation, 2017
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Papers by Andrew Maiorana