Ross Arena

University of Illinois at Chicago | UIC · Department of Physical Therapy

Impaired lung function, respiratory muscle weakness and exercise intolerance are present in COPD and contribute to poor prognosis. However, the contribution of the combination of these manifestations to define prognosis in COPD is still unknown. This study aimed to define cut-off points for both inspiratory and expiratory muscle strength (MIP and M...

Background Cardiac rehabilitation (CR) is a multicomponent intervention to reduce adverse outcomes from coronary artery disease, but its mechanisms are not fully understood. The aims of this study were to examine the impact of CR on survival and cardiovascular risk factors, and to determine potential mediators between CR attendance and reduced mort...

Background: A high minute ventilation/rate of carbon dioxide production (V̇ E /V̇CO 2 ) slope during exercise (i.e., ventilatory ineffciency) is more common in patients with cardiovascular disease and is prognostic of cardiovascular mortality. Interestingly, recent data in adults with obesity suggest that V̇ E /V̇CO 2 slopes are lower with higher b...

Background: Ventilatory ineffciency (high minute ventilation/rate of carbon dioxide production [V̇ E /V̇CO 2 ] slope) during exercise is more common in patients with metabolic syndrome and cardiovascular disease, and is prognostic of cardiovascular mortality. Interestingly, new data suggest that adults with controlled or untreated, but not uncontro...

BACKGROUND: Cardiorespiratory fitness (CRF), measured by peak oxygen uptake (VO2peak), is a strong predictor of mortality. Despite its widespread clinical use, current reference equations for VO2peak show distorted calibration in obese individuals. Using data from the Fitness Registry and the Importance of Exercise National Database (FRIEND), we so...

The six-minute step test (6MST) has been shown to be effective in assessing exercise capacity in individuals with COPD regardless of severity and, despite its easy execution, accessibility and validity, information on the prognostic power of this test remains uncertain. The aim of this study is to investigate whether the 6MST can predict the occurr...

Cardiorespiratory fitness (CRF), heavily influenced by physical activity (PA), represents a strong and independent risk factor for a wide range of health conditions, most notably, cardiovascular disease. Substantial disparities in CRF have been identified between white and non-white populations. These disparities may partly account for group differ...

Background Insufficient sleep can increase the risk of health problems and chronic conditions including cognitive problems, increased inflammation, diabetes and cardiovascular disease, and overall mortality. In this report, insufficient sleep, as a cultural experience, was tracked across the United States according to the American Nations model of...

While the majority of individuals with coronavirus disease 2019 (COVID-19) recover completely, a significant percentage experience persistent symptom, which has been characterized as Long COVID and may be associated with cardiac and autonomic dysfunction. We evaluated heart rate variability (HRV) at rest and during deep-breathing (M-RSA) in patient...

Introduction An adequate level of cardiorespiratory fitness (CRF) is critical for firefighters to perform the strenuous and physiologically demanding work of firefighting safely and effectively. The coronavirus disease 2019 (COVID-19) has been shown to negatively impact CRF in both the acute phase and longer-term following infection. This study aim...

Background ST segment elevation myocardial infarction (STEMI) elicits an intense inflammatory response which is thought to contribute to subsequent maladaptive myocardial healing and remodeling, ultimately leading to heart failure (HF). The interleukin-1 (IL-1) blocker anakinra administered during the first 14 days after STEMI patients has been sho...

Background Patients with heart failure with preserved ejection fraction (HFpEF) are a heterogeneous clinical population and might respond differently to pharmacologic therapies based on their baseline left ventricular EF (LVEF) (50-59% vs. ≥60%). Interleukin-1 (IL-1) is a key pro-inflammatory cytokine being explored as a therapeutic target in HFpEF...

Spanning several decades, numerous studies have emphasized the critical roles of physical activity (PA), exercise training (ET) and, especially, cardiorespiratory fitness (CRF) in the primary and secondary prevention of cardiovascular diseases (CVD), including coronary heart disease (CHD) and heart failure (HF) [1–3]. More recently, studies have al...

Heart failure (HF) is a complex syndrome that remains a leading cause of morbidity and mortality worldwide. Abundant evidence suggests inflammation plays a key role in the development and perpetuation of HF, but there are currently no anti-inflammatory treatments approved for use in HF. Interleukin-1 (IL-1), the prototypical pro-inflammatory cytoki...

The physical inactivity (PI) and obesity pandemics in the United States (U.S.) have undauntingly persisted in recent history. We have previously demonstrated differences in PI, obesity, socioeconomics, race, and regional culture according to county-level results for the 2020 presidential election. This commentary extends this analysis by considerin...

Purpose of review: Cardiopulmonary exercise testing (CPET) is the gold standard for directly assessing cardiorespiratory fitness (CRF) and has a relatively new and evolving role in evaluating atherosclerotic heart disease, particularly in detecting cardiac dysfunction caused by ischemic heart disease. The purpose of this review is to assess the cu...

Efforts to reverse the physical inactivity (PI) and obesity pandemics in the United States (U.S.) have been unsuccessful. This commentary provides a view of PI and obesity in the U.S. from the intersection of politics, socioeconomics, race, and culture. On a national level, counties where the Democratic candidate received more votes compared to the...

This review emphasizes the importance of cardiopulmonary exercise testing (CPET) in patients diagnosed with hypertrophic cardiomyopathy (HCM). In contrast to standard exercise testing and stress echoes, which are limited due to the ECG changes and wall motion abnormalities that characterize this condition, CPET allows for the assessment of the comp...

Abstract Background Patients treated for hematologic malignancy often experience reduced exercise capacity and increased fatigue; however whether this reduction is related to cardiac dysfunction or impairment of skeletal muscle oxygen extraction during activity is unknown. Cardiopulmonary exercise testing (CPET) coupled with stress cardiac magnetic...

Aims: Interleukin-1 (IL-1) blockade may improve exercise capacity in patients with heart failure (HF) patients. The extent of the improvement and its persistence beyond discontinuation of IL-1 blockade is unknown. Methods and results: The primary objective was to determine changes in cardiorespiratory fitness and cardiac function on-treatment wi...

Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6...

Background: Weber classification stratifies cardiac patients based on peak oxygen consumption (V̇O2), the gold-standard measure of exercise capacity. Objective: To determine if Weber classification is a useful tool to discriminate clinical phenotypes in COPD patients and to evaluate if disease severity and other clinical measures can predict V̇O...

While the majority of individuals with coronavirus disease 2019 (COVID-19) recovercompletely, a significant percentage experience persistent symptoms, which has beencharacterized as Long COVID and may be associated with cardiac and autonomicdysfunction. We evaluated heart rate variability (HRV) at rest and during deep-breathing(M-RSA) in patients w...

Purpose: To describe the relationship between mortality and measures of low intensity physical activity (LIPA) as well as sedentary behavior (SB), and cardiorespiratory fitness (CRF). Methods: Study selection was performed through multiple database searches from 1/1/2000 until 5/1/2023. Seven LIPA studies, 9 SB studies, and 8 studies CRF studies...

Background: Exercise oscillatory ventilation (EOV) is considered an important variable for predicting poor prognosis in patients with heart failure (HF) with reduced left ventricular ejection fraction (HFrEF). However, there are no studies evaluating EOV presence in the coexistence chronic obstructive pulmonary disease (COPD) and HFrEF. Aims: I)...

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state...

Cardiovascular (CV) disease (CVD) is the leading cause of global morbidity and mortality, and low levels of physical activity (PA) is a leading independent predictor of poor CV health and associated with an increased prevalence of risk factors that predispose to CVD development. In this review, we evaluate the benefits of exercise on CV health. We...

This article underscores the critical role of the health sector in promoting inclusive democratic practices and outlines several action steps that are necessary to strengthen civic and voter participation to advance health equity and population health outcomes.

Cardiovascular disease (CVD) is the leading non-communicable disease and cause of premature mortality globally. Despite well-established evidence of a cause-effect relationship between modifiable lifestyle behaviours and the onset of risk of chronic disease, preventative approaches to curtail increasing prevalence have been ineffective. This has un...

Purpose: Maximal heart rate (HRmax) continues to be an important measure of adequate effort during an exercise test. The aim of this study was to improve the accuracy of HRmax prediction using a machine learning (ML) approach. Methods: We used a sample from the Fitness Registry of the Importance of Exercise National Database, which included 17 3...

Background: To retrospectively characterize and compare the dose of exercise training (ET) within a large cohort of patients demonstrating different levels of improvement in exercise capacity following a cardiac rehabilitation (CR) program. Methods: A total of 2310 patients who completed a 12-week, center-based, guidelines-informed CR program be...

Background: We sought to assess whether noninvasive ventilation (NIV) as an adjunct with high-intensity exercise (HIEx) is more effective than exercise alone or exercise + sham on respiratory and peripheral oxygenation and vascular function in subjects with coexisting COPD and heart failure (HF). Methods: On separate days, subjects performed inc...

Despite some indicators of a localized curtailing of cardiovascular disease (CVD) prevalence, CVD remains one of the largest contributors to global morbidity and mortality. While the magnitude and impact of the coronavirus disease 2019 (COVID-19) pandemic have yet to be realized in its entirety, an unquestionable impact on global health and well-be...

The economic and social impact that coronavirus disease 2019 (COVID-19) can bring is undeniable since high numbers of active workers in production and service provision are being contaminated. In addition, those infected may have long-term sequelae, impairing their functional capacity, and consequently, their work activities. It considers that inte...

Background: Low-frequency electrical stimulation (LFES) is an adjuvant method for heart failure (HF) patients with restrictions to start an exercise. However, the impact on molecular changes in circulating is unknown. We investigated the effects of 10 weeks of home-based LFES on plasma cytokines profile, redox biomarkers, metalloproteinases (MMPs)...

Background: Previous studies have shown that patients with heart failure with reduced ejection fraction (HFrEF) and anemia have reduced peak oxygen consumption (VO 2 ). Black or African American (B-AA) patients have a higher prevalence of anemia and are underrepresented in clinical studies of HFrEF. The aim of this study was to determine the contr...

Curtailing elite sports during the coronavirus disease 2019 (COVID-19) pandemic was necessary to prevent widespread viral transmission. Now that elite sport and international competitions have been largely restored, there is still a need to devise appropriate screening and management pathways for athletes with a history of, or current, COVID-19 inf...

In March 2020, the Coronavirus disease 2019 (COVID-19) outbreak was officially declared a global pandemic, leading to closure of public facilities, enforced social distancing and stay-at-home mandates to limit exposures and reduce transmission rates. While the severity of this “lockdown” period varied by country, the disruptions of the pandemic on...

The purpose of this paper is to put forward some evidence-based lessons that can be learned from how to respond to a Pandemic that relate to healthy living behaviours (HLB). A 4-step methodology was followed to conduct a narrative review of the literature and to present a professional practice vignette. The narrative review identified 8 lessons: 1)...

The severe health consequences of the corona virus disease 2019 (COVID-19) pandemic have been exacerbated by the prevalence of cardiovascular disease (CVD) risk factors, such as physical inactivity, obesity, hypertension, and diabetes. Further, policy decisions during the pandemic augmented unhealthy lifestyle behaviors and health inequalities, lik...

The coronavirus disease 2019 (COVID-19) pandemic necessitated the implementation and prioritizing of strict public health strategies to mitigate COVID-19 transmission and infection over all else. As we enter a 'recovery' phase in which the impact of the virus recedes (but does not relent), we ask, "How do we develop a game plan that considers preve...

Background: Evidence supports the benefit of managing atrial fibrillation (AF) specific risk factors in secondary prevention of AF. However, a comprehensive summary of the effect of multifactorial risk factor interventions on outcomes of patients with AF over long-term is lacking. Methods: We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRA...

Background/aim: Despite technological advances in diagnosis and treatment, in-hospital mortality with acute aortic dissection type B is still about 11%. The purpose of this study was to assess the risk factors for early and long-term adverse outcomes in patients with acute aortic dissection type B treated medically or with conventional open surger...

Introduction One in ten people will develop Long COVID (LC) following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite broad-ranging and episodic symptomology, there are no data that demonstrate changes in functional status (FS), respiratory muscle strength and lung function over time. We conducted a sixteen-week...

Introduction: Interleukin-1 (IL-1) blockade may improve exercise capacity in the subset of heart failure (HF) patient with high inflammation. Accordingly, modulating systemic inflammation with IL-1 inhibition could result in physiologic adaptations that have a beneficial effect on exercise capacity in this population. Hypothesis: Primary objective...

Introduction: Cardiorespiratory fitness (CRF) is now considered a vital sign. Cardiopulmonary exercise testing (CPET) is the gold-standard assessment of CRF; peak oxygen consumption (VO2) and the minute ventilation/carbon dioxide production (VE/VCO2) slope are considered primary CPET measures of CRF. More work is needed to determine the role of th...

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory mu...

Background In cardiac rehabilitation programs, cardiorespiratory fitness is commonly estimated (eCRF) from the maximum workload achieved on a graded exercise test. This study compared four well-established eCRF equations in their ability to predict mortality in patients with cardiovascular disease (CVD). Methods A total of 7269 individuals with CV...

Purpose: The objective of this study was to characterize the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing cardiac rehabilitation (CR). Methods: This cohort study included data from patients with a history of cardiovascular disease (CVD) completing a 12-wk CR program between January 1996 and Mar...

Purpose: Nonexercise predictions of peak oxygen uptake (V˙o2peak) are used clinically, yet current equations were developed from cohorts of apparently healthy individuals and may not be applicable to individuals with cardiovascular disease (CVD). Our purpose was to develop a CVD-specific nonexercise prediction equation for V˙o2peak. Methods: Par...

Background: Sarcopenia impairs cardiorespiratory fitness (CRF) in patients with heart failure with reduced ejection fraction (HFrEF). Obesity has also been shown to impair CRF; however, the effects of sarcopenia on CRF in patients with obesity and HFrEF are unknown. The aim of this analysis was to examine differences in CRF between patients with s...

With the acute burden of novel coronavirus 2019 (COVID-19) winding down in many parts of the world, there is an increased appreciation for those living with COVID-19 sequelae. Clavario and colleagues 1 found almost a third of COVID-19 survivors with functional limitations identified from cardiopulmonary exercise testing (CPX). This illustrates the...

Cardiorespiratory fitness (CRF) has been proposed as a vital sign for the past several years, supported by a wealth of evidence demonstrating its significance as a predictor of health trajectory, exercise/functional capacity, and quality of life. According to the Fick equation, oxygen consumption (VO2) is the product of cardiac output (CO) and arte...

Introduction: Peak rating of perceived exertion (RPE) is measured during clinical cardiopulmonary exercise testing (CPX) and is commonly used as a subjective indicator of maximal effort. However, no study to date has reported reference standards or the distribution of peak RPE across a large cohort of apparently healthy individuals. Purpose: To...

The challenges that patients and their families experience to access care for chronic health conditions often make the health professionals responsible for their care feel powerless. At times, it may be convenient to lay the blame for these challenges on a singular group, such as policymakers or the health insurance system. However, the true reason...

Background Limited data are available examining the effects of both moderate- and vigorous-intensity physical activity (MVPA) and sedentary behavior (SB) on longevity among patients with heart failure (HF). This study examined the associations of MVPA and SB with all-cause mortality in HF patients using a nationally representative survey data. Met...

The goal of the present study was to compare pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) performance in COVID-19 survivors with a control group (CG). This was a cross-sectional study. Patients diagnosed with COVID-19, without severe signs and symptoms, were evaluated one month after the infection. Healthy volunteers match...

Tragically, the Unites States (US) surpassed one million documented deaths due to the coronavirus disease 2019 (COVID-19) pandemic. A convincing association between unhealthy lifestyle behaviors and poorer outcomes associated with COVID-19 infection has already been demonstrated and communicated by the Centers for Disease Control and Prevention in...

We have been amid unhealthy living and related chronic disease pandemics for several decades. These longstanding crises have troublingly synergized with the coronavirus disease 2019 (COVID-19) pandemic. The need to establish research priorities in response to COVID-19 can be used to address broad health and wellbeing, social and economic impacts fo...