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Papers by Ross Arena

Resistance exercise (RE) is an important part of cardiac rehabilitation. However, it is not know ... more Resistance exercise (RE) is an important part of cardiac rehabilitation. However, it is not know about the low intensity of RE training that could modify the heart rate variability (HRV), muscular strength and endurance in patients with coronary artery disease (CAD). To investigate the effects of high repetition/low load resistance training (HR/LL--RT) program on HRV and muscular strength and endurance in CAD patients. Randomized and controlled trial. Patients seen at the Cardiopulmonary Physical Therapy Laboratory between May 2011 to November 2013. Twenty male patients with CAD were randomized to a training group (61.3±5.2 years) or control group (61±4.4 years). 1 repetition maximum (1--RM) maneuver, discontinuous exercise test on the leg press (DET--L), and resting HRV were performed before and after 8 weeks of HR/LL--RT on a 45° leg press. RMSSD, SD1, mean HR and ApEn indices were calculated. The HR/LL--RT program consisted of a lower limb exercise using a 45° leg press; 3 sets of 20 repetitions, two times a week. The initial load was set at 30% of the 1--RM load and the duration of the HR/LL--RT program was performed for 8 weeks. After 8 weeks of HR/LL--RT there were significant increases of RMSSD and SD1 indices in the training group only (p<0.05). There was a significant decrease in mean HR after HR/LL--RT in the training group (p<0.05). There was a significantly higher ApEn after in the training group (p<0.05). There were significantly higher values in the training group in contrast to the control group (p<0.05). Theses results indicate positively change on HRV, as well as muscle strength and endurance in CAD patients. 8 weeks of HR/LL--RT is an effective sufficient to beneficially modify important outcomes as HRV, muscle strength and endurance in CAD patients.

Chest, Jan 29, 2015

Pulmonary hypertension is of poor prognosis in heart failure (HF), and this is related to right v... more Pulmonary hypertension is of poor prognosis in heart failure (HF), and this is related to right ventricular (RV) failure. Increased ventilatory response and exercise oscillatory ventilation (EOV) have also a negative impact. We hypothesized that severity classification of HF and risk prediction could be improved by combining functional capacity, with cardiopulmonary exercise testing (CPET) and RV-pulmonary circulation coupling, evaluated by the tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) relationship. 459 HF patients were assessed with Doppler echocardiography and CPET and tracked for outcome. Subjects were followed for major cardiac events [cardiac mortality, left ventricular assist device (LVAD) implantation, or heart transplantation]. Cox regression and Kaplan-Meier analyses were performed with TAPSE and PASP as individual measures and combining them in a ratio form. TAPSE/PASP was the strongest predictor whereas NYHA and EOV added...

European Heart Journal, 2014

Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group... more Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients. Patients were stratified into six age categories: <40 (n = 876), 40-49 (n = 2638), 50-59 (n = 6894), 60-69 (n = 12 071), 70-79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40-49, and 50-59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively. Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.

Heart failure clinics, 2015

Heart failure (HF) is a clinical syndrome of breathlessness, lower extremity swelling, fatigue, a... more Heart failure (HF) is a clinical syndrome of breathlessness, lower extremity swelling, fatigue, and exercise intolerance affecting a large portion of the population worldwide, and associated with premature death. Despite improvement in the management of HF, many patients remain unable to complete activities of daily living without experiencing exertional symptoms. Although prevention of death in patients with HF is imperative, treatment of symptoms and improving functional capacity are equally important goals. This article discusses treatments (medical and surgical) associated with improved functional capacity in HF.

International journal of cardiology, Jan 20, 2015

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise in... more Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance and/or congestion, in the presence of a left ventricular (LV) ejection fraction within the normal limits (i.e. LVEF>50%). Determining the presence of impaired LV relaxation and/or filling (diastolic dysfunction) in HFpEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF. There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFpEF yet tailored therapies are lacking. Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFpEF, which prognosis remains poor. This review will discuss the challenges inherent to the use of diagnostic criteria for HFpEF, differential diagnosis, prognostic evaluation, and treatment, highlighting the need for more research in this field.

Physiotherapy Theory and Practice, 2015

The American Journal of Cardiology, 2014

The purpose of this study was to evaluate the influence of a home-based walking program on erecti... more The purpose of this study was to evaluate the influence of a home-based walking program on erectile function and the relation between functional capacity and erectile dysfunction (ED) in patients with recent myocardial infarctions. Patients with acute myocardial infarctions deemed to be at low cardiovascular risk were randomized into 2 groups: (1) a home-based walking group (n = 41), instructed to participate in a progressive outdoor walking program, and (2) a control group (n = 45), receiving usual care. Functional capacity was determined by the 6-minute walk test and evaluation of sexual function by the International Index of Erectile Function questionnaire; the 2 tests were performed at hospital discharge and 30 days later. In the overall cohort, 84% of patients reported previous ED at hospital discharge. After 30 days, ED had increased by 9% in the control group in relation to baseline (p = 0.08). However, the home-based walking group had a significant decrease of 71% in reported ED (p <0.0001). The 6-minute walk distance was statistically significant higher in the home-based walking group compared with the control group (p = 0.01). There was a significant negative correlation between 6-minute walk distance and ED 30 days after hospital discharge (r = -0.71, p <0.01). In conclusion, an unsupervised home-based progressive walking program led to significant improvements in functional capacity in men at low cardiovascular risk after recent acute myocardial infarctions. In addition, this intervention demonstrated a link between functional capacity and exercise training and erectile function improvement.

Lasers in Surgery and Medicine, 2014

Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large perc... more Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team.

Resistance exercise (RE) is an important part of cardiac rehabilitation. However, it is not know ... more Resistance exercise (RE) is an important part of cardiac rehabilitation. However, it is not know about the low intensity of RE training that could modify the heart rate variability (HRV), muscular strength and endurance in patients with coronary artery disease (CAD). To investigate the effects of high repetition/low load resistance training (HR/LL--RT) program on HRV and muscular strength and endurance in CAD patients. Randomized and controlled trial. Patients seen at the Cardiopulmonary Physical Therapy Laboratory between May 2011 to November 2013. Twenty male patients with CAD were randomized to a training group (61.3±5.2 years) or control group (61±4.4 years). 1 repetition maximum (1--RM) maneuver, discontinuous exercise test on the leg press (DET--L), and resting HRV were performed before and after 8 weeks of HR/LL--RT on a 45° leg press. RMSSD, SD1, mean HR and ApEn indices were calculated. The HR/LL--RT program consisted of a lower limb exercise using a 45° leg press; 3 sets of 20 repetitions, two times a week. The initial load was set at 30% of the 1--RM load and the duration of the HR/LL--RT program was performed for 8 weeks. After 8 weeks of HR/LL--RT there were significant increases of RMSSD and SD1 indices in the training group only (p<0.05). There was a significant decrease in mean HR after HR/LL--RT in the training group (p<0.05). There was a significantly higher ApEn after in the training group (p<0.05). There were significantly higher values in the training group in contrast to the control group (p<0.05). Theses results indicate positively change on HRV, as well as muscle strength and endurance in CAD patients. 8 weeks of HR/LL--RT is an effective sufficient to beneficially modify important outcomes as HRV, muscle strength and endurance in CAD patients.

Chest, Jan 29, 2015

Pulmonary hypertension is of poor prognosis in heart failure (HF), and this is related to right v... more Pulmonary hypertension is of poor prognosis in heart failure (HF), and this is related to right ventricular (RV) failure. Increased ventilatory response and exercise oscillatory ventilation (EOV) have also a negative impact. We hypothesized that severity classification of HF and risk prediction could be improved by combining functional capacity, with cardiopulmonary exercise testing (CPET) and RV-pulmonary circulation coupling, evaluated by the tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) relationship. 459 HF patients were assessed with Doppler echocardiography and CPET and tracked for outcome. Subjects were followed for major cardiac events [cardiac mortality, left ventricular assist device (LVAD) implantation, or heart transplantation]. Cox regression and Kaplan-Meier analyses were performed with TAPSE and PASP as individual measures and combining them in a ratio form. TAPSE/PASP was the strongest predictor whereas NYHA and EOV added...

European Heart Journal, 2014

Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group... more Our understanding of heart failure in younger patients is limited. The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) database, which consisted of 24 prospective observational studies and 7 randomized trials, was used to investigate the clinical characteristics, treatment, and outcomes of younger patients. Patients were stratified into six age categories: <40 (n = 876), 40-49 (n = 2638), 50-59 (n = 6894), 60-69 (n = 12 071), 70-79 (n = 13 368), and ≥80 years (n = 6079). Of 41 926 patients, 2.1, 8.4, and 24.8% were younger than 40, 50, and 60 years of age, respectively. Comparing young (<40 years) against elderly (≥80 years), younger patients were more likely to be male (71 vs. 48%) and have idiopathic cardiomyopathy (63 vs. 7%). Younger patients reported better New York Heart Association functional class despite more severe left ventricular dysfunction (median ejection fraction: 31 vs. 42%, all P < 0.0001). Comorbidities such as hypertension, myocardial infarction, and atrial fibrillation were much less common in the young. Younger patients received more disease-modifying pharmacological therapy than their older counterparts. Across the younger age groups (<40, 40-49, and 50-59 years), mortality rates were low: 1 year 6.7, 6.6, and 7.5%, respectively; 2 year 11.7, 11.5, 13.0%; and 3 years 16.5, 16.2, 18.2%. Furthermore, 1-, 2-, and 3-year mortality rates increased sharply beyond 60 years and were greatest in the elderly (≥80 years): 28.2, 44.5, and 57.2%, respectively. Younger patients with heart failure have different clinical characteristics including different aetiologies, more severe left ventricular dysfunction, and less severe symptoms. Three-year mortality rates are lower for all age groups under 60 years compared with older patients.

Heart failure clinics, 2015

Heart failure (HF) is a clinical syndrome of breathlessness, lower extremity swelling, fatigue, a... more Heart failure (HF) is a clinical syndrome of breathlessness, lower extremity swelling, fatigue, and exercise intolerance affecting a large portion of the population worldwide, and associated with premature death. Despite improvement in the management of HF, many patients remain unable to complete activities of daily living without experiencing exertional symptoms. Although prevention of death in patients with HF is imperative, treatment of symptoms and improving functional capacity are equally important goals. This article discusses treatments (medical and surgical) associated with improved functional capacity in HF.

International journal of cardiology, Jan 20, 2015

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise in... more Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of exercise intolerance and/or congestion, in the presence of a left ventricular (LV) ejection fraction within the normal limits (i.e. LVEF>50%). Determining the presence of impaired LV relaxation and/or filling (diastolic dysfunction) in HFpEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF. There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFpEF yet tailored therapies are lacking. Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFpEF, which prognosis remains poor. This review will discuss the challenges inherent to the use of diagnostic criteria for HFpEF, differential diagnosis, prognostic evaluation, and treatment, highlighting the need for more research in this field.

Physiotherapy Theory and Practice, 2015

The American Journal of Cardiology, 2014

The purpose of this study was to evaluate the influence of a home-based walking program on erecti... more The purpose of this study was to evaluate the influence of a home-based walking program on erectile function and the relation between functional capacity and erectile dysfunction (ED) in patients with recent myocardial infarctions. Patients with acute myocardial infarctions deemed to be at low cardiovascular risk were randomized into 2 groups: (1) a home-based walking group (n = 41), instructed to participate in a progressive outdoor walking program, and (2) a control group (n = 45), receiving usual care. Functional capacity was determined by the 6-minute walk test and evaluation of sexual function by the International Index of Erectile Function questionnaire; the 2 tests were performed at hospital discharge and 30 days later. In the overall cohort, 84% of patients reported previous ED at hospital discharge. After 30 days, ED had increased by 9% in the control group in relation to baseline (p = 0.08). However, the home-based walking group had a significant decrease of 71% in reported ED (p <0.0001). The 6-minute walk distance was statistically significant higher in the home-based walking group compared with the control group (p = 0.01). There was a significant negative correlation between 6-minute walk distance and ED 30 days after hospital discharge (r = -0.71, p <0.01). In conclusion, an unsupervised home-based progressive walking program led to significant improvements in functional capacity in men at low cardiovascular risk after recent acute myocardial infarctions. In addition, this intervention demonstrated a link between functional capacity and exercise training and erectile function improvement.

Lasers in Surgery and Medicine, 2014

Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large perc... more Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team.