| Study, country, study design and level of evidence, quality score | Population | Methods | Outcome | Additional notes | Interpretations |
|---|---|---|---|---|---|
| Notomi et al8 United States Pre-post = level 4 D&B score = 11/15 |
N = 20 (12 males) Mean age: 34 ± 7 yrs Characteristics: healthy volunteers |
El: submaximal supine bicycle (25 W start with 25 W increases every 2 minutes) MP: before and during exercise (HR = 100 bpm) OMs: LV systolic apical and basal rotation, twist, twisting rate, time to peak twist, diastolic untwisting rate, time to peak untwisting rate MT: Doppler tissue imaging |
LV systolic apical and basal rotation, twist, twisting rate and diastolic untwisting rate increased; time to peak untwisting rate decreased | No change in percentage of LV untwisting occurring prior to mitral valve opening | Submaximal exercise enhances LV systolic and diastolic twisting function |
| Burns et al18 Australia Pre-post = level 4 D&B score = 11/15 |
N = 14 (9 males) Mean age: old, 60 yrs; young, 40 yrs Characteristics: patients undergoing clinically indicated stress tests |
El: submaximal supine bicycle (50 W start with 25 W increases every 3 minutes) MP: before and at peak exercise OMs: LV twisting, twisting rate, diastolic untwisting rate MT: 2D echocardiogram with STA |
Old: no change in LV twist, diastolic untwisting rate, or time to peak untwisting rate Young: LV twist and diastolic untwisting rate increased; time to peak twist decreased |
Older population on various cardiac medications to treat hypertension and lipid problems | Submaximal exercise enhances twisting function in younger populations and impairs systolic and diastolic twisting function in older populations |
| Esch et al20 Canada Prospective controlled trial = level 2 D&B score = 10/15 |
N = 11 (all males, 6 old and 5 young) Mean age: old, 60 ± 9 yrs; young, 35 ± 8 yrs Characteristics: old = VO2peak = 36.3 ± 10.7 mL/kg/min; young = VO2peak = 51.1 ± 10.4 mL/kg/min |
El: submaximal semi-supine bicycle (20 minutes at 80% ventilatory threshold) MP: before and at peak exercise OMs: LV systolic apical and basal rotation, twist, twisting rate, diastolic untwisting rate MT: 2D echocardiogram with STA |
Old: no change in twist and diastolic untwisting rate Young: LV twist and diastolic untwisting rate increased; time to peak twist decreased |
Percentage of LV diastolic untwisting occurring prior to mitral valve opening decreased in old group, no change in young group Older population on various cardiac medications to treat hypertension and lipid problems |
Submaximal exercise enhances twisting function in younger populations and impairs systolic and diastolic twisting function in older populations |
| Tan et al21 United Kingdom Pre-post = level 4 D&B score = 12/15 |
N = 27 (8 males) Mean age: 70 ± 7 yrs Characteristics: no prior medical history and receiving no medications |
El: symptom limited, fatigue or dyspnea, submaximal semi-recumbent bicycle (to a maximum HR of 100 bpm) MP: before and during submaximal exercise OMs: LV systolic apical rotation, diastolic untwisting rate MT: 2D echocardiogram with STA |
LV systolic apical rotation and diastolic untwisting rate increased | No change in percentage of LV untwisting occurring prior to mitral valve opening Population was not on any medications |
Submaximal exercise enhances systolic and diastolic twisting function in older populations Disagreement potentially because of sampling of healthier older population |
| Doucende et al19 France Pre-post = level 4 D&B score = 11/15 |
N = 20 (all males) Mean age: 25 ± 9 yrs Characteristics: sedentary males, no reported regular training habits |
El: submaximal semi-supine bicycle (6-minute stages at 20% (Wl), 30% (W2), and 40% (W3) VO2max) MP: before exercise and during each stage (Wl, W2, W3) OMs: LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, time to peak twist, diastolic apical and basal rotation rate, untwisting rate, time to peak untwisting rate MT: 2D echocardiogram with STA |
LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, and untwisting rate increased with each stage | No change in percentage of LV untwisting occurring prior to mitral valve opening | “-Submaximal exercise does not result in changes to systolic and diastolic twisting function -Weak exercise stimulus potential reason for this finding” |
| Stöhr et al20 United Kingdom Pre-post = level 4 D&B score = 10/15 |
N= 10 (all males) Mean age: 21 ± 2 yrs Characteristics: recreationally active individuals |
El: submaximal unilateral knee extensor exercises (12 minutes at 21 ± 2 W) MP: before and during last 8 minutes of exercise OMs: LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, untwisting rate MT: 2D echocardiogram with STA |
No change in any LV systolic or diastolic twisting mechanic measurement | Exercise stimulus did not induce increases in stroke volume or ejection fraction | Submaximal exercise does not enhance systolic or diastolic twisting function Disagreement potentially due to weak exercise stimulus |
| Stöhr et al22 United Kingdom Pre-post = level 4 D&B score = 9/15 |
N = 9 (all males) Mean age: 26 ± 4 yrs Characteristics: recreationally active individuals |
El: submaximal supine bicycle (4-minute stages at 10%, 30%, 50%, 70%, and 90% peak power) MP: before and during each stage OMs: LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, time to peak twisting rate, diastolic apical and basal rotation rate, untwisting rate, time to peak untwisting rate MT: 2D echocardiogram with STA |
LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, and untwisting rate increased LV twist, twisting rate, and untwisting rate plateaued at ~50% peak power Time to peak diastolic apical rotation rate and untwisting rate decreased Time to peak diastolic basal rotation rate increased |
Stroke volume and end-diastolic volume plateaued at ~30% and ~50% peak power, respectively | The enhancement of systolic and diastolic twisting function during exercise plateaus at submaximal intensities |
| Stöhr et al23 United Kingdom Pre-post = level 4 D&B score = 10/15 |
N = 8 (all males) Mean age: 20 ± 2 yrs Characteristics: active individuals |
El: submaximal unilateral knee extensor exercises (15 minute at 23 ± 2 W) MP: before and during last 10 minutes of exercise OMs: LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, untwisting rate, time to peak untwisting rate MT: 2D echocardiogram with STA |
No change in any LV systolic or diastolic twisting mechanic measurement Time to peak untwisting rate increased |
Exercise stimulus did not induce an increase in stroke volume | Submaximal exercise does not result in changes to systolic and diastolic twisting function Weak exercise stimulus potential reason for this finding |
| Stöhr et al25 United Kingdom Pre-post = level 4 D&B score = 11/15 |
N = 28(all males, 14 ET and 14 NA) Mean age: ET, 21 ± 3 yrs; NA, 21 ± 2 yrs Characteristics: groups divided post hoc ET = VO2peak = 63 ± 7 mL/kg/min; NA = VO2peak = 49 ± 5 mL/kg/min |
El: submaximal supine bicycle (5 minutes at 40% peak power) MP: before and during last 3 minutes of exercise OMs: LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, untwisting rate MT: 2D echocardiogram with STA |
LV systolic apical and basal rotation, apical and basal rotation rate, twist, twisting rate, diastolic apical and basal rotation rate, and untwisting rate increased in both ET and NA subjects LV systolic apical rotation was lower at rest and during exercise in ET subjects than in NA subjects | Slightly lower LV twist at rest and during exercise in ET than NA subjects (P = 0.09) No between-group differences in LV structure, HR, or stroke volume |
ET individuals have reduced twisting function during submaximal exercise compared with NA individuals despite similar hemodynamics |
Abbreviations: 2D, two-dimensional; D&B score, Downs and Black13 score; El, exercise intervention; ET, endurance-trained individuals; HR, heart rate; MP, measurement period; MT, measurement technique; NA, normally active individuals; OM, outcome measure; STA, speckle tracking analysis; yrs, years; VO2, oxygen consumpion; VO2max, maximal aerobic power.