The 5th seminar on Exercise in medicine – summary day 1

For a long time we have been busy planning the 5th seminar in Exercise in Medicine here in Trondheim. The former seminars have given many good experinces, especially since this is a small-scale arrangement with a limited number of participants, providing great opportunities to socialize with possible research partners, exchanging ideas and getting to know each other better. Although the weather is rather dissapointing nowadays for those who wanted to see Norway from the best side, we believe that this year’s seminar is going to be just as interesting as the previous ones.

Wednesday evening there were two evening sessions, followed by delicious tapas for everyone. The first lesson was held by professor Jerome A Dempsey from the University of Wisconsin, USA. Dempsey is the director of the John Rankin Laboratory of Pulmonary Medicine and has for decades been investigating the aspects related to the regulation of breathing in various physiologic states in humans and animals. He is also former editor of the Journal of Applied Physiology. We got to hear a very interesting speech about the history of exercise physiology and future challenges.

Further, we had a lesson from professor Volker Adams from Heart Centre Leipzig, a well-known research partner through many years, among others from the SMARTEX-HF study. The lesson had the title “Impact of exercise training on striated muscle and endothelium in patients with cardiovascular disease”.

The varied and interesting program continued on Thursday. Professor Steven Keyetian from the University of Michigan, Detroit, has for several years been working with the ACTION-HF trial, and gave an overview of important clinical messages and lessons learned from the trial. 2331 heart failure patients from all over the US, Canada and France were randomized to usual care plus aerobic exercise training, consisting of 36 supervised sessions followed by home-based training, or usual care alone. Median follow-up time was 30 months. The main results were that exercise training resulted in nonsignificant reductions in the primary end point of all-cause mortality or hospitalization and in key secondary clinical end points. However, after adjustment for highly prognostic predictors of the primary end point, exercise training was associated with modest significant reductions for both all-cause mortality or hospitalization and cardiovascular mortality or heart failure hospitalization. According to prof. Keyetian, interval training would probably have been included as an intervention if the study was designed today. Further, the challenge of long-term adherence to exercise was addressed, and different measures to improve adherence were discussed in public.

Cardiopulmonary exercise testing (CPET) is a well-known test method, often used here in our group to measure different physiological parameters during exercise. Dr. and associate professor Marco Guazzi from the University of Milan and Sao Paolo told us how CPET variables reflect the degree of diastolic dysfunction in patients with heart failure with normal ejection fraction. This kind of heart failure is called Heart Failure with Preserved Ejection Fraction (HFPEF) and will be the main charasteric of the humans and animals included in the OptimEx study.

During the last decades, the fact that there are gender differences in mechanisms involved in cardiovascular disease has been highlighted. Professor and cardiologist Eva Gerdts presented results from different studies focusing on diastolic heart failure (HFPEF) in females. The main conclusion is that we don’t know enough about this topic, and this field needs further investiogation in the future.

The recent improvements in cardiac revascularization therapy have reduced death rates of myocardial infarction, but steadily increased the number of individuals developing cardiac remodeling and heart failure in the future. In this setting, approaches using microRNAs as novel diagnostic and therapeutic strategies for cardiac remodeling and heart failure are highlighted. Dr. Regella Kumarswamy from Hannover Medical School presented some of the results from his research in this field.

The last speaker of the day was dr. Nick Houstis from Harvard Medical School, Boston. His research focuses on transcriptional mechanisms regulating the response to cardiac exercise, and he presented some of the results from his studies, among others on hyperthrofic swimming mice.

At the end of the day the guests were brought on a tour on the CERG facilities: the microscope and mitochondrial labs, the training facilities of Generation 100 and a quick update on the SMARTEX-HF trial. More exciting experiences to come – this evening the seminar guests will get to know the storm “Ivar” better, as they will be taken by bus to dinner in an old barn on the countryside.