|Year : 2019 | Volume
| Issue : 2 | Page : 63-66
Correlation between cardiorespiratory fitness and modifiable anthropometric parameters in chronic heart failure patients
Rohit Sane1, Gurudatta Amin2, Snehal Dongre3, Rahul Mandole4
1 Founder and Head, Department of Research and Development, Madhavbaug Hospital, Khopoli, Maharashtra, India
2 Chief Medical Officer, Clinical Operations, Madhavbaug Hospital, Khopoli, Maharashtra, India
3 Medical Head, Madhavbaug Hospital, Khopoli, Maharashtra, India
4 Senior Research Associate, Madhavbaug Hospital, Khopoli, Maharashtra, India
|Date of Submission||26-Mar-2019|
|Date of Decision||05-Apr-2019|
|Date of Acceptance||27-May-2019|
|Date of Web Publication||03-Oct-2019|
Dr. Rahul Mandole
Department of Research and Development, Madhavbaug Hospital, Khopoli, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: A decrease in cardiorespiratory function is associated with increased body mass index (BMI) in normal individuals according to scientific evidence. However, the relationship has not been studied in patients with chronic heart failure (CHF). Hence, we planned to evaluate the relationship between modifiable anthropometric measurements and cardiorespiratory parameters in CHF patients. Methodology: This research was a retrospective study conducted utilizing the data of CHF patients who had visited the Madhavbaug clinics in Maharashtra for consultation, between July 2018 and December 2018. The correlation between the modifiable anthropometric measurements (BMI and abdominal girth) and the exercise indices ([INSIDE:1] and metabolic equivalents [METs]) was calculated. Results: Of the 147 patients included in the study, 74.15% were males with mean age of 59.15 ± 10.28 years. Mean BMI and abdominal girth were 26.69 ± 4.97 kg/m2 and 98.82 ± 12.74 cm, respectively. Mean [INSIDE:1] and METs were calculated to be 17.1 ± 6.78 ml/kg/min and 5.99 ± 2.01 units. The correlation coefficients (R) between [INSIDE:1] and the anthropometric variables were indicative of negligible correlation (R = 0.01 with BMI and R = −0.05 with abdominal girth, P > 0.05). However, the correlation between METs and the anthropometric variables was found to indicate moderate negative correlation, which was also statistically significant (R = −0.23 with BMI and R = −0.33 with abdominal girth, P < 0.05). Conclusion: Higher BMI and abdominal girth in CHF patients were found to have a negative correlation with METs, indicating higher energy expenditure on physical activities. Lifestyle modifications will help improve the cardiorespiratory fitness in CHF patients and have a positive impact on METs.
Keywords: Abdominal girth, body mass index, chronic heart failure, maximum aerobic capacity, metabolic equivalent
|How to cite this article:|
Sane R, Amin G, Dongre S, Mandole R. Correlation between cardiorespiratory fitness and modifiable anthropometric parameters in chronic heart failure patients. Res Cardiovasc Med 2019;8:63-6
|How to cite this URL:|
Sane R, Amin G, Dongre S, Mandole R. Correlation between cardiorespiratory fitness and modifiable anthropometric parameters in chronic heart failure patients. Res Cardiovasc Med [serial online] 2019 [cited 2019 Oct 18];8:63-6. Available from: http://www.rcvmonline.com/text.asp?2019/8/2/63/268479
| Introduction|| |
Cardiovascular diseases (CVDs) are considered as few of the most common causes leading to morbidity as well as mortality worldwide, and India is no exception to this scenario. In fact, CVD has now become the most common cause for death in the country. Chronic heart failure (CHF), one of the most frequently found CVDs, is a clinical syndrome that is characterized by a reduction in the capacity of the heart to pump the blood efficiently in the systemic circulation or incompetence to fill itself aptly with blood. Scientific literature reveals that about 8–10 million Indians are victims of CHF, with an approximate prevalence being 1%.
The role of obesity as one of the risk factors involved in CHF development is extensively debated. According to the frequently quoted Framingham study, there is a greater risk of CHF development in the population who have body mass index (BMI) above the normal range (5% risk in men and 7% risk in women for every rising point of BMI). Obesity has not been looked as a solitary risk factor in the CHF development or prognosis most times, but it is proven knowledge that obesity is associated either indirectly or directly in the development of various noncommunicable diseases such as hypertension (HTN), Type II diabetes mellitus (DM), and dyslipidemia, all of which are sure-shot risk factors for CHF progression as well as development.
Cardiorespiratory fitness is another important modifiable risk factor for cardiovascular morbidity as well as mortality. Maximal oxygen uptake, also known as or the maximal aerobic capacity (MAC), denotes the maximum rate of oxygen consumption which is attained during the exercise. is a variable which is globally accepted and is considered the first choice for measurement of an individual's cardiopulmonary status. Individuals having a greater can exercise longer and more intensely than those who have lower MAC levels. A decreased cardiopulmonary fitness level is related with an elevated chance of developing CVD as well as more chances of mortality in patients already suffering from CVD.
The modifiable risk factors for the CVDs are influenced by cardiorespiratory fitness. The body fat is estimated by measuring the BMI and the abdominal girth, which give the best measures of obesity. Studies have shown that decrease in cardiorespiratory function is associated with increased BMI in normal individuals., However, the relationship has not been studied in patients with CHF, one of the most common CVD worldwide. Hence, we planned a study to evaluate the relationship between modifiable anthropometric measurements and the cardiorespiratory parameters in CHF patients to know whether the inverse relationship holds true in the CHF patients too, like it does in healthy individuals according to scientific evidence.
| Methodology|| |
This research was a retrospective study conducted utilizing the data of CHF patients who had visited the Madhavbaug clinics in Maharashtra for consultation, between July 2018 and December 2018. The CHF patients are generally evaluated at the Madhavbaug clinics with respect to their anthropometric measurements which include weight, height, and abdominal girth. In addition, the exercise indices for these patients are also evaluated, which include and metabolic equivalents (METs). The baseline data of the patients were screened for the availability of information on demography, anthropometric parameters as well as exercise indices, and data of only those patients were included whose complete relevant data were accessible.
The weight of the patients was assessed using digital weighing machine and the height of the patient in erect position using a measuring tape. The BMI was then calculated using the formula: weight in kilograms/(height in meters). The abdominal girth of CHF patients was measured with the help of the measuring tape at the level of the navel and noted down in medical records.
At the Madhavbaug clinics, the patients endured cardiac stress tests, which were based on the Modified Bruce Protocol. The maximum workload was calculated in the units of METs which indicates a real-world, concrete, and easy-to-understand way to state the expenditure of energy for various physical activities, which is specified in relation to the resting metabolic rate. The calculated MET was multiplied by a value of 3.5 to calculate the peak , which is also known as the MAC. Data were entered in Microsoft Excel chart, and GraphPad Instat V3.0 software (San Diego, California, GraphPad Software) was used to analyze the noted data. Categorical data were denoted in the numerical form while the continuous data were expressed as mean ± standard deviation. The correlation between the anthropometric measurements (BMI and abdominal girth) and the exercise indices ( and METs) was calculated using Pearson's correlation coefficient test, and P < 0.05 was considered a statistically significant finding.
| Results|| |
Data of 147 CHF patients were included in the study after considering the screening criteria. Majority of these patients were males (74.15%), and the mean age of these patients was found to be 59.15 ± 10.28 years [Table 1].
The mean weight and mean height were calculated along with the mean BMI of all the patients. The mean abdominal girth was also measured, as one of the parameters to assess anthropometry. The mean as well as the mean METs were also noted down, as parameters representing the cardiorespiratory fitness of the CHF patients [Table 2].
|Table 2: Mean anthropometric and exercise indices in chronic heart failure patients (n=147)|
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The correlation between and anthropometric parameters (BMI and abdominal girth) as well as between METs and the anthropometric variables were calculated. The correlation coefficients (R) between and the anthropometric variables were indicative of negligible correlation. However, the correlation coefficients (R) between METs and the anthropometric variables were found to indicate moderate negative correlation, which was also found to be statistically significant [Table 3] and [Table 4]. [Figure 1], [Figure 2], [Figure 3], [Figure 4] give a graphical representation of the calculated correlations.
|Table 3: Correlation between maximal oxygen uptake and anthropometric parameters in chronic heart failure patients (n=147)|
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|Table 4: Correlation between metabolic equivalents and anthropometric parameters in patients of chronic heart failure|
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|Figure 1: R = 0.01 derived by Pearson's correlation test, P = 0.93 considered not statistically significant|
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|Figure 2: R = −0.05 derived by Pearson's correlation test, P = 0.62 considered not statistically significant|
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|Figure 3: R = −0.23 derived by Pearson's correlation test, P = 0.11 considered not statistically significant|
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|Figure 4: R = −0.33 derived by Pearson's correlation test, P = 0.03 considered statistically significant|
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| Discussion|| |
Obesity is an important risk factor for various CVDs including coronary artery disease and CHF. BMI is a crucial indicator of sedentary and lethargic lifestyle as well as impending or rampant obesity. Many studies have found that CHF patients having a high BMI are at an elevated risk of future mortality., Abdominal obesity which is designated by abdominal girth is associated with the development of various metabolic disorders such as HTN and DM, which are important risk factors for both, the occurrence and the prognosis of CHF. Hence, measurement of the anthropometric obesity indicators BMI and abdominal girth is a crucial element in predicting the development as well as the prognosis of CHF.
In the general population, the capacity for executing aerobic exercise depends on the heart's ability to increase its output for the exercising muscles along with the capacity of the muscles to use oxygen from the blood which is delivered. An important feature of CHF is the decreased ability of performing aerobic exercise. The decreased aerobic capacity is due to the inadequate blood supply to the skeletal muscles, secondary to the compromised cardiac output., CHF patients may be able to attain <50% of the cardiac output which can be maximally achieved by healthy people at the peak of exercise. The exercise indices which are commonly measured to evaluate the aerobic capacity of an individual are and MET. Functional capacity is the capability of an individual to execute his routine activities which involve physical exertion. , also called MAC, implies the maximum rate of oxygen consumption calculated during exercise. It is the most widely acknowledged indicator of aerobic fitness. A decrease in the is symbolic of a reduction in the cardiorespiratory function and vice versa.
A MET is the metabolic rate at rest and symbolizes the quantity of oxygen which is consumed. It represents the energy spending of physical activities, measured as a multiple of the resting metabolic rate. In case of exercise testing, as the intensity of exercise is steadily increased, the surges in intensity from stage to stage is typically at least by 1–2 METs in normal individuals. However, the increase is insignificant in functionally compromised individuals, like those suffering from CHF. Like , any increase in the MET is indicative of improvement in the cardiorespiratory function and exercise capacity.
Although studies have shown the inverse correlation between and anthropometric measurements, the participants in these published studies had no comorbidity and were healthy. Furthermore, studies have not evaluated the relationship of METs, an important variable to assess physical activities, with BMI or abdominal girth. Hence, it was decided to study the correlation of both and METs with anthropometric measurements (BMI and abdominal girth) in CHF patients. On statistical evaluation, it was found that though the correlation between and the anthropometric variables was negligible, there was statistically significant moderately negative correlation (P < 0.05) between the METs and the anthropometric measurements. This clearly indicates that if an individual with CHF has higher BMI or abdominal girth, the expenditure of energy on physical activities will also be higher. However, the , which indicates the maximum rate of oxygen consumption, seems to be unrelated to the BMI or abdominal girth in this set of CHF patients, which seems a different finding as compared to that found in the normal individual.
Considering the implication of anthropometric measurements on METs in this study, controlling the BMI and the abdominal girth within the normal range seems a crucial part of maintaining the cardiorespiratory fitness in CHF patients. The study had a few limitations. The sample size was small, and the study was done only in the patients from the western part of India. Taking into consideration, a larger sample size which represents the whole country in future studies may help in creating a more robust evidence in the future.
| Conclusion|| |
In CHF patients, increase in the BMI and the abdominal girth was found to have a negative correlation with METs, indicating higher energy expenditure on physical activities. The correlation between the anthropometric measurements and the was found to be negligible in CHF patients. Lifestyle modifications will help improve the cardiorespiratory fitness in the CHF patients and have a positive impact on METs.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: Current epidemiology and future directions. Circulation 2016;133:1605-20.
Coronel R, de Groot JR, van Lieshout JJ. Defining heart failure. Cardiovasc Res 2001;50:419-22.
Kenchaiah S, Evans JC, Levy D, Wilson PW, Benjamin EJ, Larson MG, et al.
Obesity and the risk of heart failure. N Engl J Med 2002;347:305-13.
Gierach M, Gierach J, Ewertowska M, Arndt A, Junik R. Correlation between body mass index and waist circumference in patients with metabolic syndrome. ISRN Endocrinol 2014;2014:514589.
Wilmore JH, Costill DL. Physiology of Sport and Exercise. 3rd
ed. Champaign, IL: Human Kinetics; 2005.
Chatterjee S, Chatterjee P, Bandyopadhyay A. Validity of queen's college step test for estimation of maximum oxygen uptake in female students. Indian J Med Res 2005;121:32-5.
Praveen G, Srinivasa BS. Profile and clinical features of HIV positive patients attending integrated counseling and testing centre in a medical college hospital of Hassan, Karnataka. Int J Med Sci Public Health 2013;2:300-4.
Laxmi CC, Udaya IB, Vinutha SS. Effect of body mass index on cardiorespiratory fitness in young healthy males. Int J Sci Res Publ 2014;4:1-4.
Nanayakkara S, Kaye DM. Management of heart failure with preserved ejection fraction: A review. Clin Ther 2015;37:2186-98.
Jetté M, Sidney K, Blümchen G. Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 1990;13:555-65.
Martinez SC, Byku M, Novak EL, Cedars AM, Eghtesady P, Ludbrook PA, et al.
Increased body mass index is associated with congestive heart failure and mortality in adult fontan patients. Congenit Heart Dis 2016;11:71-9.
Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al.
Body mass index, abdominal fatness, and heart failure incidence and mortality: A systematic review and dose-response meta-analysis of prospective studies. Circulation 2016;133:639-49.
Wilson JR, Martin JL, Schwartz D, Ferraro N. Exercise intolerance in patients with chronic heart failure: Role of impaired nutritive flow to skeletal muscle. Circulation 1984;69:1079-87.
Sullivan MJ, Cobb FR. Central hemodynamic response to exercise in patients with chronic heart failure. Chest 1992;101:340S-6S.
Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al.
Assessment of functional capacity in clinical and research settings: A scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the council on clinical cardiology and the council on cardiovascular nursing. Circulation 2007;116:329-43.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]