Annmarie Jaghab - Academia.edu (original) (raw)

Papers by Annmarie Jaghab

Neuromodulation: Technology at the Neural Interface

Case Reports in Oncological Medicine, 2019

This is a case of an elderly female who presented for follow-up ultrasound of the right breast af... more This is a case of an elderly female who presented for follow-up ultrasound of the right breast after routine mammogram revealed a small benign mass. A subsequent ultrasound detected a small nodular mass that was described as benign in appearance. Although the patient was asymptomatic, a fine-needle biopsy was performed to rule out malignancy. Results from immunohistochemistry and FISH studies of the biopsy were positive for diffuse large B-cell lymphoma (DLBCL). The patient underwent surgery for lumpectomy and removal of breast implants. Intraoperative tissue samples were analyzed by pathology using both flow cytometry and microscopy, and results confirmed DLBCL. With total tumor resection and implant removal completed, the patient did not require additional treatments as the prognosis of DLBCL status post implant removal is excellent. She returned for follow-up six months later and has since had no signs of reoccurrence.

Medicine and Science in Sports and Exercise, May 1, 2017

Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and m... more Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and metabolic abnormalities that includes hypertension, dyslipidemia, and blood vessel dysfunction. These outcomes can negatively influence hemodynamics (HDYN) via a decrease in myocardial efficiency due to increased afterload and/or decreased vascular elasticity. Studies have reported changes in HDYN during and following acute exercise in clinical populations. However, there is a paucity of information on how high-velocity circuit resistance training (CRT) compared to continuous treadmill exercise (TM) affects these parameters at rest. PURPOSE: To compare the effects of CRT, TM and no exercise (CONT) on HDYN variables at rest in older adults with multiple CMS risk factors. METHODS: Eleven women (66.4 ± 6.4 years) participated in 12-weeks of CRT or TM. Stroke volume (SV), cardiac index (CI), systemic vascular resistance (SVR), enddiastolic volume (EDV), ejection fraction (EF), and oxygen consumption (rV02) were measured by impedance electrocardiography and indirect calorimetry before and after training. RESULTS: A within-group analysis revealed significant increases in CI (MD= 0.257, SE= .092, p=.023) and EDV (MD= 31.10, SE= 11.96, p=.032), a trend towards an increase in SV (MD=8.63, SE=4.28 p=.07) and a decrease in SVR (MD=-154.15, SE=71.07, p=.06) for CRT. TM resulted in significant increases in CI (MD=.218, SE=.080, p=.026) and EDV (MD=26.16, SE=10.36, p=.035); however, increases were not comparative to those seen with CRT. The CONT group showed a significant decrease in rVO2 (MD=-1.60, SE=.64, p=.03). No significant differences were observed for EF. At post-testing CONT resulted in a decrease in rVO2 approaching significance compared to TM (MD=-3.10, SE=1.12, p=.07). CRT demonstrated more favorable changes in SV, CI, SVR and EDV than TM or CONT. However, these changes did not reach statistical significance. CONCLUSION: These preliminary results indicate that CRT and TM lead to significant favorable changes in CI and EDV, however, CRT showed greater improvements in each and a trend towards improvements in HDYN when compared to TM and CONT. It is expected that completion of testing on existing subjects will further strengthen our results.

Applied Physiology, Nutrition, and Metabolism, Aug 1, 2018

The presence of cardiometabolic syndrome (CMS) infers an increased risk for cardiovascular incide... more The presence of cardiometabolic syndrome (CMS) infers an increased risk for cardiovascular incidence and mortality, and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied; no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 F; 8 M) were randomly assigned to one of three groups: HVCRT, TM, or control. Participants in exercise groups attended training 3 days/wk for a total of 12 weeks. Of the thirty participants who began the study, twenty-four (19 F; 5 M) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL. All variables were measured pre-and post-intervention. CMS z score significantly decreased for HVCRT (p=0.03), with no significant changes for TM or control. FRS significantly decreased in HVCRT compared to TM (p= 0.03) and control (p=0.03). Significant decreases in systolic (p<0.01) and diastolic blood pressures (p<0.01) for HVCRT accompanied significant increases from baseline in stroke volume (p=0.03) and end-diastolic volume (p<0.01). Systemic vascular resistance significantly decreased (p=0.05) for HVCRT compared to control. Emotional well-being significantly improved following HVCRT and TM compared to control (p=0.04; p=0.03). HVCRT represents a novel training modality that improved factors in each of the three components assessed.

Experimental Gerontology, Oct 1, 2018

Objectives: Cognition, along with aerobic and muscular fitness, declines with age. Although resea... more Objectives: Cognition, along with aerobic and muscular fitness, declines with age. Although research has shown that resistance and aerobic exercise may improve cognition, no consensus exists supporting the use of one approach over the other. The purpose of this study was to compare the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on cognition, and to examine its relationships to aerobic fitness and neuromuscular power. Methods: Thirty older adults were randomly assigned to one of three groups: HVCRT, TM, or control. Exercise groups attended training 3 days/wk for 12 weeks, following a 2 week adaptation period. The NIH Cognitive Toolbox was used to assess specific components of cognition and provided an overall fluid composite score (FCS). The walking response and inhibition test (WRIT) was specifically used to assess executive function (EF) and provided an accuracy (ACC), reaction time (RT) and global score (GS). Aerobic power (AP) and maximal neuromuscular power (MP) were measured pre-and post-intervention. Relationships between variables using baseline and mean change scores were assessed. Results: Significant increases were seen from baseline in ACC (MD = 14.0, SE = 4.3, p = .01, d = 1.49), GS (MD = 25.6, SE = 8.0, p = .01, d = 1.16), and AP (MD = 1.4, SE = 0.6, p = .046, d = 0.31) for HVCRT. RT showed a trend toward a significant decrease (MD = −0.03, SE = 0.016, p = .068, d = 0.32) for HVCRT. No significant within-group differences were detected for TM or CONT. Significant correlations were seen at baseline between AP and FCS, as well as other cognitive domains; but none were detected among change scores. Although no significant correlation was evident between MP and FCS or GS, there was a trend toward higher MP values being associated with higher FCS and GS scores. Conclusions: Our results support the use of HVCRT over TM for improving cognition in older persons, although the precise mechanisms that underlie this association remain unclear.

Medicine and Science in Sports and Exercise, May 1, 2017

Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of li... more Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of life (QoL) while reducing depression and anxiety. Unfortunately women are less likely than men to participate in CR, despite research showing women benefit from CR, more than men. Similarly, women who complete CR have a 64% reduction in mortality rate, compared to those who don't complete CR. Research on the efficacy of CR in elderly women is lacking and research is needed to assess exercise-based CR's role in physical health and quality of life post cardiac event. PURPOSE: This study sought to examine the effectiveness of an exercise-based cardiac rehabilitation program on CRF, self-reported QoL, depression and anxiety in elderly women with CVD. METHODS: Participants (n=30) with CVD (71.2 ± 5.2 yrs) were referred to an exercise-based CR program located in Auckland, NZ. All participants underwent baseline and follow-up assessment which included a ramped ECG monitored maximal exercise test with gas analysis, a QoL (Short Form-36), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants completed 3 weekly sessions of aerobic (40-70% VO 2 R), resistance (1-2 sets; 12-15 reps at 40-80% 1RM) and balance and flexibility exercise, totalling approximately 60 minutes/session. Significantly different (p<.05) pre-vs. post-program values were identified by dependent t-tests. Data are the mean ± SD. RESULTS: Post-program CRF significantly increased (18.5 ± 6.3 to 21.1 ± 7.5 ml.kg-1 .min-1) despite no significant increase in HRpeak (131.9 ± 28.7 to 132.1 ± 40.1 bpm) and respiratory exchange ratio (1.03 ± 0.1 to 1.03 ± 0.2) during maximal exercise testing. Resting heart rate decreased significantly (72.4 ± 11.8 to 68.6 ± 10.8 bpm), whilst no change in systolic (126.3 ± 24.2 to 129.8 ± 16.0 mmHg) or diastolic blood pressure (82.0 ± 16.0 to 79.2 ± 8.2) was observed. SF36 component scores for physical (49.4 ± 41.5 to 72.6 ± 37.3) and mental health (74.9 ± 15.9 to 82.8 ± 10.1) increased significantly while the HADs anxiety (5.6 ± 3.4 to 3.6 ± 2.3) and depression (2.9 ± 2.4 to 1.8 ± 1.8) scores were significantly lower post-program. CONCLUSIONS: Twelve weeks of exercise-based exercise CR is safe and effective for increasing CRF, and QoL while reducing depression and anxiety in elderly women.

Applied Physiology, Nutrition, and Metabolism, 2018

The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disea... more The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disease (CVD) and mortality and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied, no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 females, 8 males) were randomly assigned to 1 of 3 groups: HVCRT, TM, or control. Participants in the exercise groups attended training 3 days/week for a total of 12 weeks. Of the 30 participants who began the study, 24 (19 females, 5 males) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL....

Medicine & Science in Sports & Exercise, 2017

Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of li... more Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of life (QoL) while reducing depression and anxiety. Unfortunately women are less likely than men to participate in CR, despite research showing women benefit from CR, more than men. Similarly, women who complete CR have a 64% reduction in mortality rate, compared to those who don't complete CR. Research on the efficacy of CR in elderly women is lacking and research is needed to assess exercise-based CR's role in physical health and quality of life post cardiac event. PURPOSE: This study sought to examine the effectiveness of an exercise-based cardiac rehabilitation program on CRF, self-reported QoL, depression and anxiety in elderly women with CVD. METHODS: Participants (n=30) with CVD (71.2 ± 5.2 yrs) were referred to an exercise-based CR program located in Auckland, NZ. All participants underwent baseline and follow-up assessment which included a ramped ECG monitored maximal exercise test with gas analysis, a QoL (Short Form-36), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants completed 3 weekly sessions of aerobic (40-70% VO 2 R), resistance (1-2 sets; 12-15 reps at 40-80% 1RM) and balance and flexibility exercise, totalling approximately 60 minutes/session. Significantly different (p<.05) pre-vs. post-program values were identified by dependent t-tests. Data are the mean ± SD. RESULTS: Post-program CRF significantly increased (18.5 ± 6.3 to 21.1 ± 7.5 ml.kg-1 .min-1) despite no significant increase in HRpeak (131.9 ± 28.7 to 132.1 ± 40.1 bpm) and respiratory exchange ratio (1.03 ± 0.1 to 1.03 ± 0.2) during maximal exercise testing. Resting heart rate decreased significantly (72.4 ± 11.8 to 68.6 ± 10.8 bpm), whilst no change in systolic (126.3 ± 24.2 to 129.8 ± 16.0 mmHg) or diastolic blood pressure (82.0 ± 16.0 to 79.2 ± 8.2) was observed. SF36 component scores for physical (49.4 ± 41.5 to 72.6 ± 37.3) and mental health (74.9 ± 15.9 to 82.8 ± 10.1) increased significantly while the HADs anxiety (5.6 ± 3.4 to 3.6 ± 2.3) and depression (2.9 ± 2.4 to 1.8 ± 1.8) scores were significantly lower post-program. CONCLUSIONS: Twelve weeks of exercise-based exercise CR is safe and effective for increasing CRF, and QoL while reducing depression and anxiety in elderly women.

Medicine & Science in Sports & Exercise, 2017

Previous studies report that increases in aerobic capacity produce improvements in cognition. How... more Previous studies report that increases in aerobic capacity produce improvements in cognition. However, the effects of power training on cognitive domains are not well understood. PURPOSE: To compare the effects of high-velocity circuit resistance (CRT), treadmill (TM) training and no exercise (CONT) on cognitive domains and power output in older adults. METHODS: Fifteen subjects (2M, 13F; 71.3 ± 2.5 yr) participated in 12-wks of CRT, TM or CONT. Executive function (EF)/attention, EF, episodic memory, working memory, processing speed and overall cognition were measured by the flanker (FL), dimensional card sort (DCS), picture sequence (PS), list sorting (LS), pattern comparison (PC), and composite score (CS), respectively, using the NIH Cognition Battery. The walking response and inhibition test (WRIT) also assessed EF. A global score (GS) was determined by the WRIT. Aerobic power (AP) was determined from a peak oxygen consumption test, and lower body power (MP) by a chair stand. RESULTS: A between-groups analysis revealed significant decreases in MP (MD= -269.3, SE= 91.6, p=.04) for TM compared to CONT and a decrease approaching significance compared to CRT (MD= -213.7, SE= 81.9, p=.07). There was a significant main effect for AP (p=.05, n2p=.448) with a trend towards an increase for TM compared to CONT (MD=2.4, SE=1.0, p=.09) and CRT compared to CONT (MD=2.5, SE=1.0, p=.07). No significant interactions were present for cognitive measures. Withingroup analyses revealed a significant increase in PC (MD=12.6, SE=4.9, p=.04), a decrease in MP (MD=-205.3, SE=56.9, p=.01), and a trend towards an increase in LS (MD=9.8, SE=4.7, p=.08) and GS (MD=33.1, SE=16.2, p=.07) for TM. For CONT, there was a significant decrease in PC (MD=-12.8, SE=4.9, p=.04) and AP (MD=-2.4, SE=.8, p=.02). Correlation analyses revealed a strong positive association between AP and FL (r=.99, p=.008), MP and GS (r=.97, p=.03), and an inverse correlation between MP and AP (r=-.97, p=.03) and MP and FL (r=-.93, p=.02) for CRT. A strong positive correlation was observed for AP and FL (r=.96, p=.03) for TM, and an inverse correlation between MP and FL (r=-.99, p=.04) for CONT. CONCLUSION: TM and CRT resulted in an increase in AP compared to CONT that corresponded to improvements in EF and WRIT performance, however, only TM exhibited significant decreases in MP.

Medicine & Science in Sports & Exercise, 2017

Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and m... more Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and metabolic abnormalities that includes hypertension, dyslipidemia, and blood vessel dysfunction. These outcomes can negatively influence hemodynamics (HDYN) via a decrease in myocardial efficiency due to increased afterload and/or decreased vascular elasticity. Studies have reported changes in HDYN during and following acute exercise in clinical populations. However, there is a paucity of information on how high-velocity circuit resistance training (CRT) compared to continuous treadmill exercise (TM) affects these parameters at rest. PURPOSE: To compare the effects of CRT, TM and no exercise (CONT) on HDYN variables at rest in older adults with multiple CMS risk factors. METHODS: Eleven women (66.4 ± 6.4 years) participated in 12-weeks of CRT or TM. Stroke volume (SV), cardiac index (CI), systemic vascular resistance (SVR), enddiastolic volume (EDV), ejection fraction (EF), and oxygen consumption (rV02) were measured by impedance electrocardiography and indirect calorimetry before and after training. RESULTS: A within-group analysis revealed significant increases in CI (MD= 0.257, SE= .092, p=.023) and EDV (MD= 31.10, SE= 11.96, p=.032), a trend towards an increase in SV (MD=8.63, SE=4.28 p=.07) and a decrease in SVR (MD=-154.15, SE=71.07, p=.06) for CRT. TM resulted in significant increases in CI (MD=.218, SE=.080, p=.026) and EDV (MD=26.16, SE=10.36, p=.035); however, increases were not comparative to those seen with CRT. The CONT group showed a significant decrease in rVO2 (MD=-1.60, SE=.64, p=.03). No significant differences were observed for EF. At post-testing CONT resulted in a decrease in rVO2 approaching significance compared to TM (MD=-3.10, SE=1.12, p=.07). CRT demonstrated more favorable changes in SV, CI, SVR and EDV than TM or CONT. However, these changes did not reach statistical significance. CONCLUSION: These preliminary results indicate that CRT and TM lead to significant favorable changes in CI and EDV, however, CRT showed greater improvements in each and a trend towards improvements in HDYN when compared to TM and CONT. It is expected that completion of testing on existing subjects will further strengthen our results.

The Journal of the American Osteopathic Association, 2019

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown... more Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown origin, characterized by profound postexertional malaise and fatigue, unrefreshing sleep, cognitive impairments, immune dysfunction, pain, autonomic dysfunction, and neuroendocrine symptoms. Although ME/CFS is well documented within the medical literature, it remains difficult to diagnosis and manage. Some of the current challenges include an absence of diagnostic markers, differing diagnostic criteria, and an overall lack of awareness within the medical community. As a result, patients are often frustrated by the difficulties in acquiring a diagnosis and from the overall lack of available treatments. In an effort to increase awareness, this review discusses disease pathophysiology, clinical presentation, and treatment options, while also highlighting the benefits of an osteopathic approach.

Neuromodulation: Technology at the Neural Interface

Case Reports in Oncological Medicine, 2019

This is a case of an elderly female who presented for follow-up ultrasound of the right breast af... more This is a case of an elderly female who presented for follow-up ultrasound of the right breast after routine mammogram revealed a small benign mass. A subsequent ultrasound detected a small nodular mass that was described as benign in appearance. Although the patient was asymptomatic, a fine-needle biopsy was performed to rule out malignancy. Results from immunohistochemistry and FISH studies of the biopsy were positive for diffuse large B-cell lymphoma (DLBCL). The patient underwent surgery for lumpectomy and removal of breast implants. Intraoperative tissue samples were analyzed by pathology using both flow cytometry and microscopy, and results confirmed DLBCL. With total tumor resection and implant removal completed, the patient did not require additional treatments as the prognosis of DLBCL status post implant removal is excellent. She returned for follow-up six months later and has since had no signs of reoccurrence.

Medicine and Science in Sports and Exercise, May 1, 2017

Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and m... more Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and metabolic abnormalities that includes hypertension, dyslipidemia, and blood vessel dysfunction. These outcomes can negatively influence hemodynamics (HDYN) via a decrease in myocardial efficiency due to increased afterload and/or decreased vascular elasticity. Studies have reported changes in HDYN during and following acute exercise in clinical populations. However, there is a paucity of information on how high-velocity circuit resistance training (CRT) compared to continuous treadmill exercise (TM) affects these parameters at rest. PURPOSE: To compare the effects of CRT, TM and no exercise (CONT) on HDYN variables at rest in older adults with multiple CMS risk factors. METHODS: Eleven women (66.4 ± 6.4 years) participated in 12-weeks of CRT or TM. Stroke volume (SV), cardiac index (CI), systemic vascular resistance (SVR), enddiastolic volume (EDV), ejection fraction (EF), and oxygen consumption (rV02) were measured by impedance electrocardiography and indirect calorimetry before and after training. RESULTS: A within-group analysis revealed significant increases in CI (MD= 0.257, SE= .092, p=.023) and EDV (MD= 31.10, SE= 11.96, p=.032), a trend towards an increase in SV (MD=8.63, SE=4.28 p=.07) and a decrease in SVR (MD=-154.15, SE=71.07, p=.06) for CRT. TM resulted in significant increases in CI (MD=.218, SE=.080, p=.026) and EDV (MD=26.16, SE=10.36, p=.035); however, increases were not comparative to those seen with CRT. The CONT group showed a significant decrease in rVO2 (MD=-1.60, SE=.64, p=.03). No significant differences were observed for EF. At post-testing CONT resulted in a decrease in rVO2 approaching significance compared to TM (MD=-3.10, SE=1.12, p=.07). CRT demonstrated more favorable changes in SV, CI, SVR and EDV than TM or CONT. However, these changes did not reach statistical significance. CONCLUSION: These preliminary results indicate that CRT and TM lead to significant favorable changes in CI and EDV, however, CRT showed greater improvements in each and a trend towards improvements in HDYN when compared to TM and CONT. It is expected that completion of testing on existing subjects will further strengthen our results.

Applied Physiology, Nutrition, and Metabolism, Aug 1, 2018

The presence of cardiometabolic syndrome (CMS) infers an increased risk for cardiovascular incide... more The presence of cardiometabolic syndrome (CMS) infers an increased risk for cardiovascular incidence and mortality, and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied; no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 F; 8 M) were randomly assigned to one of three groups: HVCRT, TM, or control. Participants in exercise groups attended training 3 days/wk for a total of 12 weeks. Of the thirty participants who began the study, twenty-four (19 F; 5 M) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL. All variables were measured pre-and post-intervention. CMS z score significantly decreased for HVCRT (p=0.03), with no significant changes for TM or control. FRS significantly decreased in HVCRT compared to TM (p= 0.03) and control (p=0.03). Significant decreases in systolic (p<0.01) and diastolic blood pressures (p<0.01) for HVCRT accompanied significant increases from baseline in stroke volume (p=0.03) and end-diastolic volume (p<0.01). Systemic vascular resistance significantly decreased (p=0.05) for HVCRT compared to control. Emotional well-being significantly improved following HVCRT and TM compared to control (p=0.04; p=0.03). HVCRT represents a novel training modality that improved factors in each of the three components assessed.

Experimental Gerontology, Oct 1, 2018

Objectives: Cognition, along with aerobic and muscular fitness, declines with age. Although resea... more Objectives: Cognition, along with aerobic and muscular fitness, declines with age. Although research has shown that resistance and aerobic exercise may improve cognition, no consensus exists supporting the use of one approach over the other. The purpose of this study was to compare the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on cognition, and to examine its relationships to aerobic fitness and neuromuscular power. Methods: Thirty older adults were randomly assigned to one of three groups: HVCRT, TM, or control. Exercise groups attended training 3 days/wk for 12 weeks, following a 2 week adaptation period. The NIH Cognitive Toolbox was used to assess specific components of cognition and provided an overall fluid composite score (FCS). The walking response and inhibition test (WRIT) was specifically used to assess executive function (EF) and provided an accuracy (ACC), reaction time (RT) and global score (GS). Aerobic power (AP) and maximal neuromuscular power (MP) were measured pre-and post-intervention. Relationships between variables using baseline and mean change scores were assessed. Results: Significant increases were seen from baseline in ACC (MD = 14.0, SE = 4.3, p = .01, d = 1.49), GS (MD = 25.6, SE = 8.0, p = .01, d = 1.16), and AP (MD = 1.4, SE = 0.6, p = .046, d = 0.31) for HVCRT. RT showed a trend toward a significant decrease (MD = −0.03, SE = 0.016, p = .068, d = 0.32) for HVCRT. No significant within-group differences were detected for TM or CONT. Significant correlations were seen at baseline between AP and FCS, as well as other cognitive domains; but none were detected among change scores. Although no significant correlation was evident between MP and FCS or GS, there was a trend toward higher MP values being associated with higher FCS and GS scores. Conclusions: Our results support the use of HVCRT over TM for improving cognition in older persons, although the precise mechanisms that underlie this association remain unclear.

Medicine and Science in Sports and Exercise, May 1, 2017

Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of li... more Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of life (QoL) while reducing depression and anxiety. Unfortunately women are less likely than men to participate in CR, despite research showing women benefit from CR, more than men. Similarly, women who complete CR have a 64% reduction in mortality rate, compared to those who don't complete CR. Research on the efficacy of CR in elderly women is lacking and research is needed to assess exercise-based CR's role in physical health and quality of life post cardiac event. PURPOSE: This study sought to examine the effectiveness of an exercise-based cardiac rehabilitation program on CRF, self-reported QoL, depression and anxiety in elderly women with CVD. METHODS: Participants (n=30) with CVD (71.2 ± 5.2 yrs) were referred to an exercise-based CR program located in Auckland, NZ. All participants underwent baseline and follow-up assessment which included a ramped ECG monitored maximal exercise test with gas analysis, a QoL (Short Form-36), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants completed 3 weekly sessions of aerobic (40-70% VO 2 R), resistance (1-2 sets; 12-15 reps at 40-80% 1RM) and balance and flexibility exercise, totalling approximately 60 minutes/session. Significantly different (p<.05) pre-vs. post-program values were identified by dependent t-tests. Data are the mean ± SD. RESULTS: Post-program CRF significantly increased (18.5 ± 6.3 to 21.1 ± 7.5 ml.kg-1 .min-1) despite no significant increase in HRpeak (131.9 ± 28.7 to 132.1 ± 40.1 bpm) and respiratory exchange ratio (1.03 ± 0.1 to 1.03 ± 0.2) during maximal exercise testing. Resting heart rate decreased significantly (72.4 ± 11.8 to 68.6 ± 10.8 bpm), whilst no change in systolic (126.3 ± 24.2 to 129.8 ± 16.0 mmHg) or diastolic blood pressure (82.0 ± 16.0 to 79.2 ± 8.2) was observed. SF36 component scores for physical (49.4 ± 41.5 to 72.6 ± 37.3) and mental health (74.9 ± 15.9 to 82.8 ± 10.1) increased significantly while the HADs anxiety (5.6 ± 3.4 to 3.6 ± 2.3) and depression (2.9 ± 2.4 to 1.8 ± 1.8) scores were significantly lower post-program. CONCLUSIONS: Twelve weeks of exercise-based exercise CR is safe and effective for increasing CRF, and QoL while reducing depression and anxiety in elderly women.

Applied Physiology, Nutrition, and Metabolism, 2018

The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disea... more The presence of cardiometabolic syndrome (CMS) confers an increased risk for cardiovascular disease (CVD) and mortality and is associated with reduced health-related quality of life (HRQoL). Although the effects of exercise on biomarkers, HRQoL, and future risk have been studied, no study has measured the effects on all three components. The present study compared the effects of steady-state, moderate-intensity treadmill training (TM) and high-velocity circuit resistance training (HVCRT) on biological markers, HRQoL, and overall CVD risk in adults with CMS and CVD risk factors. Thirty participants (22 females, 8 males) were randomly assigned to 1 of 3 groups: HVCRT, TM, or control. Participants in the exercise groups attended training 3 days/week for a total of 12 weeks. Of the 30 participants who began the study, 24 (19 females, 5 males) were included in the final analysis. Primary outcome measures included CMS criteria, hemodynamic measures, Framingham Risk Score (FRS), and HRQoL....

Medicine & Science in Sports & Exercise, 2017

Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of li... more Post-event cardiac rehabilitation (CR) improves cardiorespiratory fitness (CRF) and quality of life (QoL) while reducing depression and anxiety. Unfortunately women are less likely than men to participate in CR, despite research showing women benefit from CR, more than men. Similarly, women who complete CR have a 64% reduction in mortality rate, compared to those who don't complete CR. Research on the efficacy of CR in elderly women is lacking and research is needed to assess exercise-based CR's role in physical health and quality of life post cardiac event. PURPOSE: This study sought to examine the effectiveness of an exercise-based cardiac rehabilitation program on CRF, self-reported QoL, depression and anxiety in elderly women with CVD. METHODS: Participants (n=30) with CVD (71.2 ± 5.2 yrs) were referred to an exercise-based CR program located in Auckland, NZ. All participants underwent baseline and follow-up assessment which included a ramped ECG monitored maximal exercise test with gas analysis, a QoL (Short Form-36), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants completed 3 weekly sessions of aerobic (40-70% VO 2 R), resistance (1-2 sets; 12-15 reps at 40-80% 1RM) and balance and flexibility exercise, totalling approximately 60 minutes/session. Significantly different (p<.05) pre-vs. post-program values were identified by dependent t-tests. Data are the mean ± SD. RESULTS: Post-program CRF significantly increased (18.5 ± 6.3 to 21.1 ± 7.5 ml.kg-1 .min-1) despite no significant increase in HRpeak (131.9 ± 28.7 to 132.1 ± 40.1 bpm) and respiratory exchange ratio (1.03 ± 0.1 to 1.03 ± 0.2) during maximal exercise testing. Resting heart rate decreased significantly (72.4 ± 11.8 to 68.6 ± 10.8 bpm), whilst no change in systolic (126.3 ± 24.2 to 129.8 ± 16.0 mmHg) or diastolic blood pressure (82.0 ± 16.0 to 79.2 ± 8.2) was observed. SF36 component scores for physical (49.4 ± 41.5 to 72.6 ± 37.3) and mental health (74.9 ± 15.9 to 82.8 ± 10.1) increased significantly while the HADs anxiety (5.6 ± 3.4 to 3.6 ± 2.3) and depression (2.9 ± 2.4 to 1.8 ± 1.8) scores were significantly lower post-program. CONCLUSIONS: Twelve weeks of exercise-based exercise CR is safe and effective for increasing CRF, and QoL while reducing depression and anxiety in elderly women.

Medicine & Science in Sports & Exercise, 2017

Previous studies report that increases in aerobic capacity produce improvements in cognition. How... more Previous studies report that increases in aerobic capacity produce improvements in cognition. However, the effects of power training on cognitive domains are not well understood. PURPOSE: To compare the effects of high-velocity circuit resistance (CRT), treadmill (TM) training and no exercise (CONT) on cognitive domains and power output in older adults. METHODS: Fifteen subjects (2M, 13F; 71.3 ± 2.5 yr) participated in 12-wks of CRT, TM or CONT. Executive function (EF)/attention, EF, episodic memory, working memory, processing speed and overall cognition were measured by the flanker (FL), dimensional card sort (DCS), picture sequence (PS), list sorting (LS), pattern comparison (PC), and composite score (CS), respectively, using the NIH Cognition Battery. The walking response and inhibition test (WRIT) also assessed EF. A global score (GS) was determined by the WRIT. Aerobic power (AP) was determined from a peak oxygen consumption test, and lower body power (MP) by a chair stand. RESULTS: A between-groups analysis revealed significant decreases in MP (MD= -269.3, SE= 91.6, p=.04) for TM compared to CONT and a decrease approaching significance compared to CRT (MD= -213.7, SE= 81.9, p=.07). There was a significant main effect for AP (p=.05, n2p=.448) with a trend towards an increase for TM compared to CONT (MD=2.4, SE=1.0, p=.09) and CRT compared to CONT (MD=2.5, SE=1.0, p=.07). No significant interactions were present for cognitive measures. Withingroup analyses revealed a significant increase in PC (MD=12.6, SE=4.9, p=.04), a decrease in MP (MD=-205.3, SE=56.9, p=.01), and a trend towards an increase in LS (MD=9.8, SE=4.7, p=.08) and GS (MD=33.1, SE=16.2, p=.07) for TM. For CONT, there was a significant decrease in PC (MD=-12.8, SE=4.9, p=.04) and AP (MD=-2.4, SE=.8, p=.02). Correlation analyses revealed a strong positive association between AP and FL (r=.99, p=.008), MP and GS (r=.97, p=.03), and an inverse correlation between MP and AP (r=-.97, p=.03) and MP and FL (r=-.93, p=.02) for CRT. A strong positive correlation was observed for AP and FL (r=.96, p=.03) for TM, and an inverse correlation between MP and FL (r=-.99, p=.04) for CONT. CONCLUSION: TM and CRT resulted in an increase in AP compared to CONT that corresponded to improvements in EF and WRIT performance, however, only TM exhibited significant decreases in MP.

Medicine & Science in Sports & Exercise, 2017

Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and m... more Cardiometabolic syndrome (CMS) is classified as a combination of maladaptive cardiovascular and metabolic abnormalities that includes hypertension, dyslipidemia, and blood vessel dysfunction. These outcomes can negatively influence hemodynamics (HDYN) via a decrease in myocardial efficiency due to increased afterload and/or decreased vascular elasticity. Studies have reported changes in HDYN during and following acute exercise in clinical populations. However, there is a paucity of information on how high-velocity circuit resistance training (CRT) compared to continuous treadmill exercise (TM) affects these parameters at rest. PURPOSE: To compare the effects of CRT, TM and no exercise (CONT) on HDYN variables at rest in older adults with multiple CMS risk factors. METHODS: Eleven women (66.4 ± 6.4 years) participated in 12-weeks of CRT or TM. Stroke volume (SV), cardiac index (CI), systemic vascular resistance (SVR), enddiastolic volume (EDV), ejection fraction (EF), and oxygen consumption (rV02) were measured by impedance electrocardiography and indirect calorimetry before and after training. RESULTS: A within-group analysis revealed significant increases in CI (MD= 0.257, SE= .092, p=.023) and EDV (MD= 31.10, SE= 11.96, p=.032), a trend towards an increase in SV (MD=8.63, SE=4.28 p=.07) and a decrease in SVR (MD=-154.15, SE=71.07, p=.06) for CRT. TM resulted in significant increases in CI (MD=.218, SE=.080, p=.026) and EDV (MD=26.16, SE=10.36, p=.035); however, increases were not comparative to those seen with CRT. The CONT group showed a significant decrease in rVO2 (MD=-1.60, SE=.64, p=.03). No significant differences were observed for EF. At post-testing CONT resulted in a decrease in rVO2 approaching significance compared to TM (MD=-3.10, SE=1.12, p=.07). CRT demonstrated more favorable changes in SV, CI, SVR and EDV than TM or CONT. However, these changes did not reach statistical significance. CONCLUSION: These preliminary results indicate that CRT and TM lead to significant favorable changes in CI and EDV, however, CRT showed greater improvements in each and a trend towards improvements in HDYN when compared to TM and CONT. It is expected that completion of testing on existing subjects will further strengthen our results.

The Journal of the American Osteopathic Association, 2019

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown... more Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating syndrome of unknown origin, characterized by profound postexertional malaise and fatigue, unrefreshing sleep, cognitive impairments, immune dysfunction, pain, autonomic dysfunction, and neuroendocrine symptoms. Although ME/CFS is well documented within the medical literature, it remains difficult to diagnosis and manage. Some of the current challenges include an absence of diagnostic markers, differing diagnostic criteria, and an overall lack of awareness within the medical community. As a result, patients are often frustrated by the difficulties in acquiring a diagnosis and from the overall lack of available treatments. In an effort to increase awareness, this review discusses disease pathophysiology, clinical presentation, and treatment options, while also highlighting the benefits of an osteopathic approach.