Invited Short Presentation
Dr. Musaad Al Hamzah, MBBS, MPH, University of Toronto
"Population and Peripheral arterial disease: the effect of an awareness campaign"
Despite the advancements in peripheral arterial disease (PAD) treatment modalities, the disease continues to have a significant impact on the quality of patients’ lives. Globally, PAD prevalence has increased 23% over the last decade. This pattern will likely continue due to the significant increase of the prevalence of PAD risk factors that include diabetes mellitus, hypertension, dyslipidemia, as well as the risk factors of these diseases (e.g. obesity). Major gaps in knowledge and practice among healthcare provide have been identified and thought to be a potential cause of underdiagnosis and undertreatment of PAD patients. In addition, studies have also shown that the public knowledge of PAD is generally poor, even in the developed nations. We present the outcomes of a simple intervention that aims to enhance PAD knowledge among a sample of the general public.
Featured Talk
Dr. Martine Duclos, University Teaching Hospital, Montpied, Clermont University
“A multilevel patient centered care promoting physical activity: form supervised exercise training to smartphone ”
To achieve recommended levels of Physical Activity (PA) in the management of chronic diseases, we use different approach in a patient-centered integrated care: 1) supervised exercise training in the department (hospital-university) for patients with type 2 diabetes (T2DM) and morbid obesity (3 sessions/week for 3 months), follow up every year). These sessions were dedicated to improve patient’s care through therapeutic education and self-care promotion via exercise training. For obese and T2DM compared to control subjects, PA was significantly increased one year and until 4 years after the end of the 3months of supervised PA with a significant improvement of their cardiometabolic parameters.
2) Identification of representations and beliefs with T2DM patients and their general practitioner’s (GP) regarding PA practice. Assuming that GPs’ promotion and prescription of PA influence actual practice in T2DM patients, we investigated the possible link between PA in T2DM patients and their GP’s attitude regarding PA promotion through a cross-sectional study on GPs and their T2DM patients measuring respectively barriers to prescribe and practice PA using the barriers to physical activity in diabetes (BAPAD) questionnaire. We demonstrated that T2DM diabetes patients with lower BAPAD score, thus lower barriers to physical activity, have a higher PA level and a better glycemic control. An important and deleterious cluster effect between GPs and their patients was demonstrated: the higher the GP’s BAPAD score, the higher the T2DM patients’ BAPAD score. This important cluster effect might designate GPs as a relevant lever for future interventions regarding patient’s education towards PA and T2DM management.
In the MOBILE study, we set out to examine active and inactive populations with T2DM and hypertension, and to look into the barriers and motivations to engage in PA as expressed by active and inactive patients and explored correlates for meeting the targets for glycemic and blood pressure control and to further investigate the role of the physicians. The main difference in the motivations expressed by the active vs. inactive cohorts lies in the role of the physician: his/her reassurance on perceived health issues and the active role they play in prescribing and monitoring PA as an integral part in managing T2DM and hypertension.
Thus these 2 studies show that physicians should take into account the motivations and barriers to PA of their patients and tailor advice to their specific needs, to reduce their perceived constraints to PA. Thus, physicians play a central role in PA counselling and should really consider PA prescription as seriously as any drug prescription, with the same need to monitor compliance and the response-effect. Strategies to promote and monitor PA should include additional measures beyond the physician-patient relationship, such as new interactive technologies, education and improved societal awareness.
3) Use the New Information and Communication Technologies (NICT) as a tool of investigation for Evaluation & Prevention of physical inactivity, sedentary living
The WellBeNet project is developed by a multi-disciplinary team and aims to study and improve the behaviors and health of people in free-living conditions through the creation of an interactive software suite at 3 entry points: physical activity, food intake, and emotions/sensations. The project has started with the design of prediction algorithms for the recognition of physical activity levels and for the assessment of energy expenditure from accelerometry data collected by smartphones. We have developed algorithms of physical activity prediction in terms of duration, intensity level (resting, low, moderate and vigorous), and energy expenditure from accelerometry and individual characteristics data. This project answers the major challenge relative to well-being and health improvement in general population by offering a daily interactive, user-friendly and scientifically validated tool. Thanks to the data collected by this tool in the ecological environment, the next step is to study physical activity interventions.
Invited Long Presentation
Dr. Christo El Morr, School of Health Policy and Management, York University
"Virtual communities (VCs) for PAD: a study of patient's readiness”
Virtual communities are groups of people with certain roles, connected online to fulfill a certain purpose. The idea of using virtual communities in health has recently received attention in the research community. This presentation will detail the advantages and challenges of using health VCs for PAD patients and present the findings of a survey regarding patient IT readiness to get connected online for health purposes.
Invited Long Presentation
Dr. Tara Haas, School of Kinesiology and Health Science, York University
“Defining molecular markers of angiogenesis in the ischemic muscle of PAD patients “
In patients with peripheral artery disease (PAD), skeletal muscle capillary number correlates positively with muscle function and overall health. However, the growth of new capillaries (angiogenesis) is minimal in the ischemic muscle of PAD patients despite the presence of angiogenic factors. Our research has focused on the identification of inhibitors of angiogenesis that are present within ischemic muscle, which may act as predictors of PAD disease severity and offer therapeutic targets to improve patient prognosis. Of particular relevance is the potential synergistic role of diabetic status in regulating anti-angiogenic factors, as it is known that insulin resistance/diabetes greatly increases the severity of PAD. Forkhead BoxO1 (FoxO1) transcription factor has emerged as one master regulator of angiogenic status in skeletal muscle. Our current knowledge of the role of FoxO1 in regulating angiogenesis will be discussed, including the application of bioinformatics tools to analyze both upstream regulators, and downstream targets, of FoxO1.
Invited Short Presentation
Dr. Alexis Le Faucheur, Department of Sport Sciences and Physical Education, ENS Rennes, Bruz, France
“Ambulatory assessment of physical activity and walking capacity in peripheral artery disease: clinical interest, practical considerations and future directions”
Measuring both functional impairment and physical activity (PA) is of importance in the management of patients with peripheral artery disease (PAD) for diagnosis, follow-up, and treatment purposes. The objective assessment of daily PA has become increasingly common in clinical practice. This trend also occurred in PAD, particularly since the mid-1990s. Interestingly, during the last 10 years, ambulatory devices that offer the opportunity to measure original parameters related to functional impairment in the community have also been made available. The aim of this presentation is to provide a comprehensive analysis and synthesis of the available studies that highlighted the clinical interests of the ambulatory assessment of PA and walking capacity in PAD patients. From a literature search we identified relevant articles published on this topic. Then we focused on various features of these studies to provide a classification regarding the clinical interest of ambulatory measurement of PA and walking capacity. Most of the available studies focused on the assessment of ambulatory-measured PA or related energy expenditure, using either accelerometers or pedometers. In contrast, ambulatory-measured outdoor walking capacity was performed in only a few studies, using Global Positioning System receivers. Despite the high capabilities offered by ambulatory devices for tracking PA and walking capacity in free-living conditions, we will discuss the various methodological and clinical challenges that remain to be overcome. PA and walking capacity are two distinct concepts. According to the objective of researchers and clinicians, this has important implications in both the choice of the ambulatory devices and the method in which they are used. Accordingly, we will present the main step-by-step recommendations, provided for the clinicians, to specifically assess PA or walking capacity in PAD. As a final objective, we will address the complex relationship between PA and walking capacity in PAD, from an epidemiological and a therapeutic perspective.
Keynote Lecture
Dr. Guillaume Mahé, University Teaching Hospital, Rennes, University of Rennes
“Lower extremity peripheral arterial disease: from diagnosis to rehabilitation”
Peripheral artery disease (PAD) of the lower extremities is a chronic and highly prevalent disease, with about 202 million people living with PAD in 2010 worldwide. The cardiovascular mortality of PAD patients at 5 years ranges between 15-30%. PAD is associated with functional impairment, and aggravation of the lesions can lead to critical limb ischemia and, at worst, amputation. Twenty to 50 % of patients are asymptomatic and PAD remains probably the most underdiagnosed atherosclerosis disease. One of the most known symptoms is the intermittent claudication. Intermittent claudication is, a fatigue, discomfort, or pain occurring in specific muscle groups during effort due to exercise-induced ischemia and which is relieved with rest. IC reduces the quality of life of patients and is a main cause of treatment demand from patients. For a patient, the first step is to determine whether or not the pain is of a vascular origin or not, and second to assess the maximal walking distance (MWD). Among other diagnosis test, we use the exercise transcutaneous oxygen pressure measurement, which is an original method to assess exercise-induced ischemia during walking on a treadmill. Furthermore MWD, which is an important criterion in the management, can be assessed by questionnaire, treadmill test and GPS technology. Several interventions have been proposed such as medical treatment, rehabilitation or surgery for the management of PAD patients.
Invited Featured Talk
Dr. Pierre Maret, University of Lyon-Saint Etienne
“Data and knowledge in self- and community-based health supervision”.
The medical community perceives the availability of vital data as an essential prerequisite to acquire objective information about patients. The patients themselves can show willingness to provide such data in order to be regularly monitored and to receive adequate support when sharing with different stakeholders. In this presentation, we will elicitate some issues in Information Technologies (IT) for the design of such systems: data base model design, knowledge extraction, semantic modeling, community support and privacy preserving. We will discuss these issues and show how they are addressed today. The presentation will provide specialists in health and health politics a better understanding of the added value of some IT techniques and their related constrains. Therefore the presentation shall help practitioner in their necessary dialog and cooperation with IT people in the elaboration of advanced health supervision systems.
Invited Long Presentation
Dr. Tami Martino, Centre for Cardiovascular Research, Biomedical Sciences, University of Guelph
“Molecular Circadian Biomarkers and Therapies for Cardiovascular Disease”.
Cardiovascular disease remains a leading cause of death worldwide, and new approaches in the management and treatment of heart disease are clearly warranted and can benefit patients clinically. In recent years the measurement of neurohormonal rhythms and the subsequent discovery of actual molecular circadian clocks that endow cells with the ability to anticipate physiological demands have opened a new opportunity, to investigate and apply the important field of circadian biology on clinical cardiology, and indeed medicine in general. The underlying foundation for circadian-cardiology stems from observations that biological processes in humans exhibit 24-hour daily rhythms, and these are controlled by the molecular circadian clock mechanism present in the heart, vasculature, and other organs. For example, cardiovascular physiology follows a rhythm, as heart rate, blood pressure, and cardiac contractility peak in the wake hours and reach a nadir during sleep. Indeed, many cardiovascular functions that oscillate over the 24 hour period are influenced by the circadian clock mechanism. Timing of onset of cardiac pathologies also follows a rhythm, such as onset of myocardial infarction (heart attack) and sudden cardiac death. Most recently these studies have led to a growing clinical appreciation that targeting circadian biology offers novel diagnostic and therapeutic approaches to cardiovascular disease. This seminar will describe leading-edge translational applications of circadian biology including 1) novel biomarkers of heart disease discovered by testing for genomic, proteomic, metabolomic, or other factors at different times of day and night (chronobiomarkers); and 2) timing of therapy to “omic” profiles to maximize efficacy in treating heart disease (chronotherapy). Considering the importance of circadian rhythms provides novel approaches to improving the management and treatment of heart disease in clinical settings.
Invited Long Presentation
Dr. Alexander Stewart, Department of Biochemistry, Microbiology and Immunology, University of Ottawa Heart Institute
“What genome-wide association studies have taught us about cardiovascular disease.”
Cardiovascular disease, principally resulting from atherosclerosis, is a complex composite of multiple risk factors. Hyperlipidemia, smoking, hypertension, obesity, and diabetes are the known "modifiable" risk factors. Ageing and genetics were considered to be unmodifiable risk factors, but this view is changing in light of data coming from large international consortia that have undertaken unbiased genome-wide screens of common genetic variants testing for their contribution to ageing and atherosclerosis and its associated risk factors. Common genetic variants have a modest effect on cardiovascular risk. Does that mean their effect is negligible? No, some common genetic variants contribute as much risk as cholesterol and high blood pressure. The surprise to come out of genome-wide association studies is that 2/3 of the variants do not visibly associate with any of the known risk factors. Efforts are underway to understand how these new mechanisms contribute to cardiovascular disease so that new therapies can be developed that target these mechanisms. A few examples will be presented that highlight the difficulty with discovering new pathways underpinning disease and how we might address these mechanisms to treat cardiovascular disease.
Invited Featured Talk
Dr. Sophie Visvikis-Siest, University of Lorraine, Nancy
"VEGF, a potential biomarker for systems medicine."
Vascular endothelial growth factor (VEGF) is implicated in angiogenesis, lymphangiogenesis, vascular permeability, and hematopoiesis. It is associated with numerous pathologies including cardiovascular diseases and several types of cancer.
We specifically developed an integrative systems biology strategy for clinical improvement of this biomarker.
A high heritability of this trait, 60%, was estimated in the STANISLAS cohort giving us the needed arguments to continue for a deep characterization of the genetic component of VEGF levels. Therefore, we searched, by a Genome Wide Association Study (GWAS), the VEGF genetic variants and the interconnexions of these biomarkers with other disease-associated molecules in healthy populations.
The GWAS was performed in 3,527 healthy participants (Framingham Heart Study) and the most significant results (P <5x10-8) were replicated in 1,727 individuals (STANISLAS Family Study, PIVUS study). Functional transcriptomic analyses were performed in peripheral blood mononuclear cells. Furthermore, in 403 healthy adults the associations between VEGF and adhesion/inflammation molecules were tested. Also, associations between VEGF and blood lipids were assessed in a discovery (n=1,006) and in a replication population (n=1,145) of healthy individuals.
Four polymorphisms (rs6921438, rs4416670, rs6993770, rs10738760) explaining ~50% of VEGF heritability were identified. These variants, directly or via gene x gene x environment interactions had significant effects on HDL, LDL, TNF-a, IL-6, E selectin and ICAM-1 plasma levels. rs6993770 was shown to increase VEGF121 mRNA levels and rs4416670 was associated with L-selectin expression.
Our integrative strategy resulted to significant results indicating molecular links between VEGF and cardiovascular disease biology and the importance of epistatic and gene x environment interactions. This example illustrates an improved strategy to be applied for every biomarker with high heritability levels, consequently with potential interest in Personalized Medicine, using familial design and the existing biobanks.
Young Scientist Invited Short Presentations
Chip Rowan, PhD (c), School of Kinesiology and Health Science, York Unviersity
"Prediabetes Detection and Physical Activity Intervention: Strategies and outcomes"
Despite current rising trends in type 2 diabetes prevalence and negative global impact, unfortunately, far less attention is paid to the concurrent rise in prediabetes. Detection and intervention targeting this known precursor to type 2 diabetes is vitally important considering the preventability of type 2 diabetes and its association with modifiable risk factors. Our work has primarily focused on community-based screening techniques as well as physical activity interventions both at the community level and in the laboratory setting. This presentation will highlight the risk factor and blood test results of the community-based screening process while discussing strategies for effective creation and delivery of community programming. Additionally, data from both the community-based and laboratory based physical activity interventions will be presented to describe the effectiveness of each approach with respect to measurable physiological outcomes relevant to persons with prediabetes such as hemoglobin A1C and fitness. These interventions include both “culturally preferred” group exercise classes as well as structured, more traditional approaches to aerobic and resistance training.
Loren Yavelberg, M.Sc. (c), School of Kinesiology and Health Science, York Unviersity
"The Accuracy of select Wearable Technology during varying exercise modalities and intensities"
Objective: To examine the accuracy of two wearble devices which will be used in future studies involving the Artificial Pancreas. The Bioharness by Zephyr and the Metria Armband by Vancive were used during varying exercise intensity ranges plus modalities. The variables of interest included heart rate (HR), breathing frequency (BF) and caloric expenditure (EE).
Method: All subjects (x=24.4±6.1 years, 4 males and 3 females) were outfitted with the Metria, Bioharness and Polar HR monitor. The subjects completed an incremental to maximal oxygen consumption (VO2max) protocol twice and were randomly assigned to complete 40 minutes of continuous aerobic exercise and calisthenic based circuit, once or twice. Oxygen consumption and BF were measured throughout each exercise session using the indirect calorimetry unit (Cosmed Fitmate or discrete system).
Result: The results of the incremental to VO2max protocol were categorized into the following exercise intensity ranges: light-to-moderate, moderate-to-vigorous and vigorous-to-maximum. Paired t-test analyses were performed using SPSS 21.0. Within all exercise intensities there were no differences in HR between the Bioharness and Polar monitor (p=0.713, 0.347, 0.785 respectively). Significant differences in BF were observed in both moderate-to-vigorous (p=0.01) and vigorous-to-maximum (p=0.000) exercise intensity ranges between the Bioharness and indirect calorimetry unit. Significant differences were also observed in the derived EE between the indirect calorimetry unit and the Metria during the vigorous-to-maximum exercise intensity range (p=0.000).
Conclusion: The preliminary findings indicate that the i) Bioharness HR is accurate at all exercise intensity ranges, ii) Bioharness BF is only valid during light-to-moderate exercise intensities and iii) Metria provides an acceptable estimation of EE for light-to-moderate and moderate-to-vigorous, but not vigorous-to-maximum exercise intensities.
Dessi Zaharieva, PhD (c), School of Kinesiology and Health Science, York Unviersity
"The effects of basal insulin adjustments on blood glucose concentrations during various exercise intensities in individuals with type 1 diabetes: Preliminary Data"
Type 1 diabetes (T1D) is an autoimmune disease that is affecting over 3 million Canadians to date. Exercise has been shown to improve overall self-esteem, increase insulin sensitivity, and decrease cardiovascular disease risk in T1D individuals. However, diabetes management during and post-exercise can be quite challenging and lead to drastic fluctuations in blood glucose concentrations. The goal of this study is to determine what basal insulin adjustments lead to better control during and following exercise for individuals with T1D. We recruited six participants with type 1 diabetes (T1D), using insulin pump therapy > 1 year, in fair-to-good glycemic control (HbA1c < 9.0%). All participants completed four visits at the Human Performance Laboratory including a test of maximal aerobic capacity (VO2max), two circuit exercise sessions, and one continuous, steady state exercise session on a treadmill. Blood glucose concentrations were measured every 10-minutes from 10-minutes prior to exercise until 1 hour post-exercise. Insulin dose adjustments were made on the insulin pump every 10-minutes during one of the circuit exercise sessions. During the following circuit exercise and continuous exercise session, insulin was stopped at the start of exercise and resumed to the regular rate immediately post-exercise. The delta change from the onset of exercise (time=0) to the end of exercise (time=40 minutes) was greatest in the continuous exercise session (p<0.05, circuit=0.03±1.77, continuous=3.4±1.87 at 40-minutes). Blood glucose concentrations remained fairly stable in the circuit exercise session with basal insulin adjustments. Overall, it appears that with continuous, steady state exercise, very minimal insulin is required during exercise and carbohydrate supplementation prior to exercise may be necessary to prevent low blood sugars.
