Moderate to high- intensity physical activity and Mediterranean Diet recommendations

Supervised high volume and high intensity interval training exercise group with Mediterranean Diet recommendations.
High-intensity [heart rate (HR) values up to second ventilatory threshold (VT2) to peak intensity] interval training and high-volume increasing gradually from 20 to 40 min and alternating high and moderate [HR values between first ventilatory threshold (VT1) and VT2] intensities at different protocols.

Supervised low volume and high intensity interval training exercise group with Mediterranean Diet recommendations.
High-intensity (HR values up to VT2 to peak intensity) interval training and low-volume (20 min) alternating high and moderate (HR values between VT1 and VT2) intensities at different protocols.

Myocardial Infarction

Supervised exercise two nonconsecutive days per week (day 1-on the treadmill, day 2-on the bike) for 16 weeks. High-intensity interval training (HIIT) protocol on the treadmill: 5-min warm-up at a moderate-intensity, before walking 2 intervals of 4 min at high-intensity interspersed with intervals of 3 min of walking at moderate-intensity. 1-4 min cool-down at moderate-intensity.
HIIT protocol on the bike: 5 to 10-min warm-up at moderate intensity. After that, 4 repetitions (1rep = 30 s high-intensity followed by 60 s moderate-intensity) and gradually increased to 16 repetitions in HV-HIIT week by week. 5-10 min cool-down at moderate-intensity

HIGH VOLUME (HV) Supervised exercise

Participants will be interviewed regarding their usual eating habits. They will receive practical information about which are the Mediterranean Diet (DMed) foods according to the model proposed in the "PREDIMED" trial. Medical doctors or nurses will give this information.
Before starting the program of intervention, participants will assist to an informative talk in which benefits for the health of the DMed will be exposed and general information about food composition, frequencies of consumption, etc. will be explained.
Nutritional management: Diet reviews and body mass control will be performed every two weeks to assess the body composition and adherence to treatment. In the event of poor compliance strategies will be addressed for its correction.

Mediterranean Diet Recommendations

Participants will be advised to perform, without supervision, moderate to high-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) 3-5 days per week, following an adequate warm-up of 5-15 min, at moderate to high intensity (below the ischemic threshold) for a period of 20 to 40 min (not including warm-up and cool-down) followed by a cool-down period of 5-10min. Participants will receive information related to heart rate values regarding moderate and high exercise intensity domains for the self monitoring of exercise intensity.

Physical Activity Recommendations

Supervised exercise two nonconsecutive days per week (one day on the treadmill, and the second one on the bike) for 16 weeks. HIIT protocol on the treadmill: 5-min warm-up at a moderate-intensity, before walking 2 intervals of 4 min at high-intensity interspersed with intervals of 3 min of walking at moderate-intensity. The training session will end with a 1-4 min cool-down period at moderate-intensity. Total exercise time of 20min HIIT protocol on the bike: 10-min warm-up at moderate intensity. After that, participants will cycle for 4 repetitions (1rep = 30 s high-intensity followed by 60 s moderate-intensity) and gradually increased to 8 repetitions in LV-HIIT week by week. The training session will end with a 5-10 min cool-down period at moderate-intensity.

LOW VOLUME (LW) Supervised exercise

Department of Physical Education and Sport. Faculty of Education and Sport-Physical Activity and Sport Section. University of the Basque Country

High Intensity Aerobic Interval Training With Mediterranean Diet Recommendations in Post-Myocardial Infarct Patients

Effects of Combined High Intensity Aerobic Interval Training Program and Mediterranean Diet Recommendations in Post-Myocardial Infarct Patients: INTERFARCT Controlled Trial

Direct cardio-respiratory fitness will be evaluated through objectives variables such as peak oxygen uptake and ventilatory thresholds with a cardio pulmonary exercise test.

Left ventricular function will focus on the assessment of cardiovascular hemodynamics by cardiac ultrasound, global cardiac mechanics in systole and diastole, and the relationship between the cardiac structure and regional myocardial function.

Medical doctors will ask for a biochemical analysis including all the below variables to analyze the lipid metabolism of participant:
Lipid metabolism: total cholesterol (mg/dL), low-density lipoprotein cholesterol (mg/dL), high-density lipoprotein cholesterol (mg/dL), Triglycerides (mg/dL).

Medical doctors will ask for a general biochemical analysis including all the below variables to analyze a general participant's profile related to:
General metabolism: urea (mg/dL), creatinine (mg/dL), glomerular filtrate (mL/min), basal glucose (mg/dL), HbA1c (%), insulin, homoeostasis model assessment index (HOMA), uric acid (mg/dL), ionogram, alanine aminotransferase (U/L), aspartate aminotransferase (U/L), blood count.

Medical doctors will ask for a general biochemical analysis including all the below variables to analyze a general participant's profile:
Myocardial damage: troponin T (ng/dL), total and creatine phosphokinase cardiac specific isoenzyme (MB) (U/mL).
Myocardial stress: brain natriuretic peptide (pg/mL). Neuro-hormonal state: renin, aldosterone (ng/dL). Systemic inflammation: protein C reactive (PCRus) (mg/dL), Interleukin 6 (IL-6) (pg/mL), Tumor necrosis factor-alpha (TNF-alpha) (pg/mL).
Procoagulant state: D-dimer (ng/mL), fibrinogen (mg/dL). Oxidative stress: ox-LDL (units/mL).

Participants' health-related quality of life will be determined using the 36-item Short Form Medical Outcome Questionnaire (SF-36).

Determination of carotid artery-intima-media thickness through carotid ultrasonography.

Dietary intake and habits will be assessed by subjective assessments using open-ended surveys such as dietary recalls or records

Dietary intake and habits will be assessed by subjective assessments using closed-ended surveys including food frequency questionnaires

Dietary intake and habits will be assessed by subjective assessments using Mediterranean Diet Adherence Screener questionnaire.

Measurements:waist and hip perimeters (cm).

Indirect cardiorespiratory fitness will be assessed through a fiel test called Modified Shuttle Walk Test

Self-assessment scale instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic: Hospital Anxiety & Depression Scale

Bioelectrical impedance analysis (BIA) is a commonly used method for estimating body composition, and in particular body fat, fat free body fat and water. All of them as a percentage of the total body mass

SARA MALDONADO-MARTIN

PhD Professor

Basque Country University

HOSPITAL SANTIAGO APOSTOL. MIRANDA DE EBRO. BURGOS. SPAIN

Sickle Cell Disease

Medical University of South Carolina, Storm Eye Institute

MUSC Storm Eye Institute

Spectralis HRA+OCT Imaging of the Retina With Autofluorescence in Sickle Cell Disease

The use of Spectralis HRA+OCT gives us visualization of the individual layers of the retina to determine if there are underlying changes not seen clinically in the gross ophthalmic posterior segment exam. This knowledge will aid the care of African-Americans with sickle cell disease to enable greater understanding of the ocular disease progression leading to earlier eye screenings, possible novel treatments and ultimately visual loss prevention

sea/infarction

High Intensity Aerobic Interval Training With Mediterranean Diet Recommendations in Post-Myocardial Infarct Patients

Spectralis HRA+OCT Imaging of the Retina With Autofluorescence in Sickle Cell Disease

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