Wearable-Derived Training Load and Coronary Atherosclerosis in Middle-Aged and Older Athletes and Physically Active Controls: A New Perspective From the Master@Heart Study

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  Figure 1.. Flow chart of the study design. CAD indicates coronary artery disease; CCTA, coronary computed tomography angiography; eTRIMP, Edwards training impulse; MET-min/week, metabolic equivalents of task multiplied by minutes of training per week; and TL, training load.

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  Figure 2.. The relationship between objectively measured training load by eTRIMP and coronary artery disease. Unadjusted global P values were derived from chi-square tests and are shown in the figure. Adjusted odds ratios comparing Q4 versus Q1 (adjusted for age, body mass index, systolic and diastolic blood pressure, HbA1c, low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), family history of coronary artery disease, and years of endurance exercise) and corresponding P values are presented in Table 2. Quartiles were defined as follows: Q1, 80–477 AU; Q2, 478–908 AU; Q3, 919–1276 AU; and Q4, 1293–4574 AU. AU indicates arbitrary units; CAC, coronary artery calcification; eTRIMP, Edwards training impulse; and Q, quartile.

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  Figure 3.. Association between relative time spent in high-intensity zones and coronary artery disease. Unadjusted global P values were derived from chi-square tests and are shown in the figure. Adjusted odds ratios comparing Q4 versus Q1 (adjusted for age, body mass index, systolic and diastolic blood pressure, HbA1c, low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), family history of coronary artery disease, and years of endurance exercise) and corresponding P values are presented in Table 2. Models were in addition adjusted for objectively measured training duration (continuous). Although the highest-intensity quartile showed elevated odds for proximal plaque and CAC percentile ≥75 compared with the lowest, no consistent dose-response pattern was observed across quartiles. Quartiles were defined as follows: Q1, 0%–12%; Q2, 12%–20%; Q3, 20%–31%; and Q4, 32%–89% of total exercise time spent in zones 4 and 5. High-intensity zones were based on a 5-zone heart rate model derived from percentages of maximum heart rate (HRmax): zone 1 (50%–59%), zone 2 (60%–69%), zone 3 (70%–79%), zone 4 (80%–89%), and zone 5 (90%–100%). CAC indicates coronary artery calcification; and Q,…

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  Figure 4.. Relationship between continuous training load (TL) parameters and coronary artery disease (CAD). Logistic regression with penalized smoothing splines was used to model potential nonlinear associations, adjusted for age, body mass index, systolic and diastolic blood pressure, HbA1c, low-density lipoprotein cholesterol, triglycerides, lipoprotein(a), family history of coronary artery disease, and years of endurance exercise. The model of objective training duration was in addition adjusted for exercise intensity (the continuous percentage of time spent in high-intensity exercise zones 4 and 5). All relationships were linear on the logit scale. Odds ratios (ORs) with 95% CIs and P values are described for each relationship. Graphs are presented with 95% CIs. eTRIMP was divided by 100 and MET-min/week by 60, such that the ORs represent the change in odds per 100 AU increase in eTRIMP or per 60 MET-min/week increase, respectively, for easier interpretation. Data from 1 study participant with an eTRIMP of 4574 AU and 26.5 objective training hours was excluded from the objective training load analysis because it was an extreme outlier. A, A significant association was observed between…