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Exercise Capacity (exercise + capacity)
Selected AbstractsThe Effect of Erythropoietin on Exercise Capacity, Left Ventricular Remodeling, Pressure-Volume Relationships, and Quality of Life in Older Patients With Anemia and Heart Failure With Preserved Ejection FractionCONGESTIVE HEART FAILURE, Issue 3 2010Rose S. Cohen MD A prospective, open-label, 3-month study was conducted to evaluate the feasibility and short-term clinical effect of subcutaneous erythropoietin injections in patients with anemia and heart failure with preserved ejection fraction (ejection fraction, 55%±2%). Using a dose-adjusted algorithm to effect a rate of rise in hemoglobin not to exceed 0.4 g/dL,/wk, hemoglobin (10.8±0.3 to 12.2±0.3 g/dL) and red blood cell volume (1187±55 to 1333±38 mL) increased with an average weekly dose of 3926 units. Functional measures increased from baseline (6-minute walk test [289±24 to 331±22 m], exercise time [432±62 to 571±51 s], and peak oxygen consumption [8.2±0.7 to 9.4±0.9 mL/kg/min], all P<.05). End-diastolic volume declined significantly (8% volumetric decrease, 108±3 to 100±3 mL, P =.03), but there were no significant changes in left ventricular mass or estimated left ventricular end-diastolic pressure. Pressure-volume analysis demonstrated a reduction in ventricular capacitance at an end-diastolic pressure of 30 mm Hg without significant changes in contractile state. Congest Heart Fail. 2010;16:96,103. © 2009 Wiley Periodicals, Inc. [source] Acute and Chronic Oral Magnesium Supplementation: Effects on Endothelial Function, Exercise Capacity, and Quality of Life in Patients With Symptomatic Heart FailureCONGESTIVE HEART FAILURE, Issue 1 2006Johanna C. Fuentes MD Endothelial dysfunction is an important pathophysiologic mechanism in the progression of heart failure. The objective of the present study was to determine the effects of acute and chronic oral magnesium supplementation on endothelial function in patients with symptomatic heart failure. Twenty-two symptomatic chronic heart failure patients were randomized to receive 800 mg oral magnesium oxide daily or placebo for 3 months. Data collected included large and small arterial elasticity/compliance, hemodynamic parameters, exercise capacity, and quality-of-life score at baseline, 1 week, and 3 months. Patients who received magnesium had improved small arterial compliance at 3 months from baseline compared with placebo. This study suggests that chronic supplementation with oral magnesium is well tolerated and could improve endothelial function in symptomatic heart failure patients. [source] Impact of Right Ventricular Pacing Sites on Exercise Capacity during Ventricular Rate Regularization in Patients with Permanent Atrial FibrillationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 12 2009HUNG-FAT TSE M.D., Ph.D. Background:The deleterious effects of right ventricular apical (RVA) pacing may offset the potential benefit of ventricular rate (VR) regularization and rate adaptation during an exercise in patient's atrial fibrillation (AF). Methods:We studied 30 patients with permanent AF and symptomatic bradycardia who receive pacemaker implantation with RVA (n = 15) or right ventricular septal (RVS, n = 15) pacing. All the patients underwent an acute cardiopulmonary exercise testing using VVI-mode (VVI-OFF) and VVI-mode with VR regularization (VRR) algorithm on (VVI-ON). Results:There were no significant differences in the baseline characteristics between the two groups, except pacing QRS duration was significantly shorter during RVS pacing than RVA pacing (138.9 ± 5 vs 158.4 ± 6.1 ms, P = 0.035). Overall, VVI-ON mode increased the peak exercise VR, exercise time, metabolic equivalents (METs), and peak oxygen consumption (VO2max), and decreased the VR variability compared with VVI-OFF mode during exercise (P < 0.05), suggesting that VRR pacing improved exercise capacity during exercise. However, further analysis on the impact of VRR pacing with different pacing sites revealed that only patients with RVS pacing but not patients with RVA pacing had significant increased exercise time, METs, and VO2max during VVI-ON compared with VVI-OFF, despite similar changes in peaked exercise VR and VR variability. Conclusion:In patients with permanent AF, VRR pacing at RVS, but not at RVA, improved exercise capacity during exercise. [source] The Effects of Rate-Adaptive Atrial Pacing Versus Ventricular Backup Pacing on Exercise Capacity in Patients with Left Ventricular DysfunctionPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009M.S.C.E., ROD PASSMAN M.D. Background: Atrial rate-adaptive pacing may improve cardiopulmonary reserve in patients with left ventricular dysfunction. Methods: A randomized, blinded, single-crossover design enrolled dual-chamber implantable defibrillator recipients without pacing indications and an ejection fraction ,40% to undergo cardiopulmonary exercise treadmill stress testing in both atrial rate-adaptive pacing (AAIR) and ventricular demand pacing (VVI) pacing modes. The primary endpoint was change in peak oxygen consumption (VO2). Secondary endpoints were changes in anaerobic threshold, perceived exertion, exercise duration, and peak blood pressure. Results: Ten patients, nine males, eight with New York Heart Association class I, mean ejection fraction 24 ± 7%, were analyzed. Baseline VO2 was 3.6 ± 0.5 mL/kg/min. Heart rate at peak exercise was significantly higher during AAIR versus VVI pacing (142 ± 18 vs 130 ± 23 bpm; P = 0.05). However, there was no difference in peak VO2 (AAIR 23.7 ± 6.1 vs VVI 23.8 ± 6.3 mL/kg/min; P = 0.8), anaerobic threshold (AAIR 1.3 ± 0.3 vs VVI 1.2 ± 0.2 L/min; P = 0.11), rate of perceived exertion (AAIR 7.3 ± 1.5 vs VVI 7.8 ± 1.2; P = 0.46), exercise duration (AAIR 15 minutes, 46 seconds ± 2 minutes, 54 seconds vs VVI 16 minutes, 3 seconds ± 2 minutes, 48 seconds; P = 0.38), or peak systolic blood pressure (AAIR 155 ± 22 vs VVI 153 ± 21; P = 0.61) between the two pacing modes. Conclusion: In this study, AAIR pacing did not improve peak VO2, anaerobic threshold, rate of perceived exertion, or exercise duration compared to VVI backup pacing in patients with left ventricular dysfunction and no pacing indications. [source] Large Artery Stiffness: Implications For Exercise Capacity And Cardiovascular RiskCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 3 2002Bronwyn A Kingwell SUMMARY 1. Large artery stiffness, or its inverse, compliance, determines pulse pressure, which, in turn, influences myocardial work capacity and coronary perfusion, both of which impact on exercise capacity and cardiovascular risk. 2. In support of a role for arterial properties in exercise performance, aerobically trained athletes (aged 30,59 years) have lower arterial stiffness than their sedentary counterparts. Furthermore, in healthy older subjects (aged 57,80 years), time to exhaustion on treadmill testing correlated positively with arterial compliance. 3. Arterial stiffness is more closely linked to exercise capacity and myocardial risk in patients with coronary disease where, independently of degree of coronary disease, those with stiffer proximal arteries have a lower exercise-induced ischaemic threshold. 4. Moderate aerobic training elevates resting arterial compliance by approximately 30%, independently of mean pressure reduction, in young healthy individuals but not in isolated systolic hypertensive patients. Rat training studies support a role for exercise training in structural remodelling of the large arteries. 5. High-resistance strength training is associated with stiffer large arteries and higher pulse pressure than matched controls. 6. Large artery stiffness is an important modulator of the myocardial blood supply and demand equation, with significant ramifications for athletic performance and ischaemic threshold in coronary disease patients. Moderate aerobic training, but not high-resistance strength training, reduces large artery stiffness in young individuals whereas older subjects with established isolated systolic hypertension are resistant to such adaptation. [source] Functional capacity in children and young adults with sickle cell disease undergoing evaluation for cardiopulmonary disease,AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2009Robert I. Liem Although cardiopulmonary disease is associated with decreased functional capacity among adults with sickle cell disease (SCD), its impact on functional capacity in children with SCD is unknown. We evaluated 6-min walk (6MW) distance in 77 children and young adults with SCD undergoing screening for cardiopulmonary disease. Of 30 subjects who also underwent cardiopulmonary exercise testing, we found evidence for decreased exercise capacity in a significant proportion. Exercise capacity was related to baseline degree of anemia and was significantly lower in subjects with a history of recurrent acute chest syndrome. We found that 6MW distance adjusted for weight and body surface area was shorter in subjects with restrictive lung disease but that only 6MW adjusted for weight remained significantly shorter when we controlled for baseline hemoglobin. Exercise capacity was not significantly different in subjects with and without cardiopulmonary disease. We conclude that restrictive lung disease is associated with shorter 6MW distances in children and young adults with SCD, but that variables associated with decreased exercise capacity, other than anemia, remain unclear. Our study underscores the importance of further delineating the direct pathophysiologic processes that contribute to decreased exercise capacity observed among individuals with SCD and cardiopulmonary disease. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Blunting of rapid onset vasodilatation and blood flow restriction in arterioles of exercising skeletal muscle with ageing in male miceTHE JOURNAL OF PHYSIOLOGY, Issue 12 2010Dwayne N. Jackson Exercise capacity and skeletal muscle blood flow are diminished with ageing but little is known of underlying changes in microvascular haemodynamics. Further, it is not clear how the sympathetic nervous system affects the microcirculation of skeletal muscle with ageing or whether sex differences prevail in the regulation of arteriolar diameter in response to muscle contractions. In the gluteus maximus muscle of C57BL/6 mice, we tested the hypothesis that ageing would impair ,rapid onset vasodilatation' (ROV) in distributing arterioles (second-order, 2A) of old (20-month) males (OM) and females (OF) relative to young (3-month) males (YM) and females (YF). Neither resting (,17 ,m) nor maximum (,30 ,m) 2A diameters differed between groups. In response to single tetanic contractions at 100 Hz (duration, 100,1000 ms), ROV responses were blunted by half in OM relative to OF, YM or YF. With no effect in YM, blockade of ,-adrenoreceptors with phentolamine (1 ,m) restored ROV in OM. Topical noradrenaline (1 nm) blunted ROV in YM and YF to levels seen in OM and further suppressed ROV in OM (P < 0.05). To evaluate arteriolar blood flow, red blood cell velocity was measured in 2A of OM and YM; respective heart rates (353 ± 22 vs. 378 ± 15 beats min,1) and carotid arterial blood pressures (76 ± 3 vs. 76 ± 1 mmHg) were not different. Blood flows at rest (0.6 ± 0.1 vs. 1.6 ± 0.2 nl s,1) and during maximum dilatation (2.0 ± 0.8 vs. 5.4 ± 0.8 nl s,1) with sodium nitroprusside (10 ,m) were attenuated >60% (P < 0.05) in OM. Blood flow at peak ROV was blunted by 75,80% in OM vs. YM (P < 0.05). In response to 30 s of rhythmic contractions at 2, 4 and 8 Hz, progressive dilatations did not differ with age or sex. Nevertheless, resting and peak blood flows in YM were 2- to 3-fold greater (P < 0.05) than OM. We suggest that ageing blunts ROV and restricts blood flow to skeletal muscle of OM through subtle activation of ,-adrenoreceptors in microvascular resistance networks. [source] Exercise capacity and cardiovascular changes in patients with ,-thalassaemia majorCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 6 2006Filippo Tocco Summary Despite the introduction of deferoxamine, 50% of thalassaemia major patients die before the age of 35 years predominantly from iron induced heart failure. Indeed, the assessment of myocardial performance may be of particular interest since it can reveal an early myocardial dysfunction. By using impedance cardiography and mass spectrometry, we studied the cardiac function and the oxygen extraction ratio (O2ER) of 14 thalassaemic patients and 15 control healthy subjects during an incremental cycle-ergometer test. The achieved mechanical power output and the relative O2 uptake did not reach any significant difference between groups. At the highest workload, O2ER reached significantly higher values in thalassaemic patients versus control subjects while the relationship between cardiac index (CI) and O2ER (CI/O2ER) decreased showing a lower contribution of cardiovascular system to maintain O2 uptake. Results of this study imply that CI/O2ER allows an early diagnosis of the iron induced myocardial dysfunction, whereas it is not clinically patent yet. To our knowledge, this is the first study revealing an O2ER pivotal role as compensatory mechanism to maintain a normal working capacity in subjects suffering from thalassaemia major. [source] Fitness testing of pediatric liver transplant recipientsLIVER TRANSPLANTATION, Issue 3 2001Viswanath B. Unnithan PhD Liver transplantation is accepted as the standard management for end-stage liver disease in children. Pediatric heart and heart-lung transplant recipients have shown significantly diminished exercise capacities compared with age-matched, able-bodied, control subjects. The primary aim of this study is to compare the fitness levels of a group of pediatric liver transplant (LT) recipients (LT group, 20 boys, 9 girls; age, 8.9 ± 4.8 years; 56 ± 35 months posttransplantation) with a group of able-bodied control subjects (22 boys, 12 girls; age, 8.4 ± 3.8 years). The secondary aim is to compare the performance of the LT group against the Fitnessgram criterion standards. We assessed muscular endurance by means of a partial curl-up, flexibility by means of the back-saver sit and reach, and cardiorespiratory fitness by means of the progressive aerobic cardiovascular endurance run (PACER). The only significant (P < .05) difference between the 2 groups was the number of shuttles run in the PACER (control, 16.8 ± 9.8 v LT, 11.5 ± 8.4 shuttles). Other differences between the 2 groups were not significant. With regard to satisfying the Fitnessgram criterion standards, only 35% of the LT group achieved the standards for the partial curl-up, 88% of the LT group achieved the criterion standards for flexibility, and 0% achieved the standards for the PACER. These results indicate that the LT group has diminished exercise capacity. The origins of exercise limitations deserve further investigation. [source] Blunted Hemodynamic Response and Reduced Oxygen Delivery With Exercise in Anemic Heart Failure Patients With Systolic DysfunctionCONGESTIVE HEART FAILURE, Issue 2 2007Jennifer Listerman MD Anemic heart failure patients with systolic dysfunction are known to have reduced exercise capacity. Whether this is related to poor hemodynamic adaptation to anemia is not known. Peak exercise oxygen consumption (VO2) and hemodynamics at rest and peak exercise were assessed among 209 patients and compared among those who were (n=90) and were not (n=119) anemic. Peak VO2 was significantly lower among anemic patients (11.7±3.3 mL/min/kg vs 13.4±3.1 mL/min/kg; P=.01). At rest, right atrial pressure was higher (10±5 mm Hg vs 8±4 mm Hg; P=.02) and venous oxygen saturation lower (62%±8% vs 58%±10%; P<.01) among anemic patients. At peak exercise, anemic patients had a higher wedge pressure (27±9 mm Hg vs 24±10 mm Hg; P=.04). No significant differences in stroke volume, cardiac index, systemic vascular resistance, or oxygen saturation were noted between the 2 groups. In conclusion, the relative hemodynamic response to exercise among anemic heart failure patients appears blunted and may contribute to worse exercise tolerance. [source] Acute and Chronic Oral Magnesium Supplementation: Effects on Endothelial Function, Exercise Capacity, and Quality of Life in Patients With Symptomatic Heart FailureCONGESTIVE HEART FAILURE, Issue 1 2006Johanna C. Fuentes MD Endothelial dysfunction is an important pathophysiologic mechanism in the progression of heart failure. The objective of the present study was to determine the effects of acute and chronic oral magnesium supplementation on endothelial function in patients with symptomatic heart failure. Twenty-two symptomatic chronic heart failure patients were randomized to receive 800 mg oral magnesium oxide daily or placebo for 3 months. Data collected included large and small arterial elasticity/compliance, hemodynamic parameters, exercise capacity, and quality-of-life score at baseline, 1 week, and 3 months. Patients who received magnesium had improved small arterial compliance at 3 months from baseline compared with placebo. This study suggests that chronic supplementation with oral magnesium is well tolerated and could improve endothelial function in symptomatic heart failure patients. [source] Is Functional Capacity Related to Left Atrial Contractile Function in Nonobstructive Hypertrophic Cardiomyopathy?CONGESTIVE HEART FAILURE, Issue 5 2005Yukitaka Shizukuda MD The mechanisms underlying reduced exercise capacity in patients with nonobstructive hypertrophic cardiomyopathy (NHCM) could include perturbations of ventricular relaxation, diastolic compliance, or compensatory atrial systolic function. We hypothesized that a loss of atrial contractility in NHCM patients leads to reduced functional capacity. To test this hypothesis, we compared resting noninvasive left atrial ejection phase indices in 49 consecutive patients with NHCM (ages 36±10 years; 41% female) and normal left ventricular ejection fraction (mean, 68%±8%) with objective metabolic exercise parameters. Left atrial active emptying fraction, ejection force, and kinetic energy failed to predict exercise capacity. Only left atrial total and active emptying volumes correlated weakly with minute volume/CO2 production slope (r=0.31 and r=0.33; p<0.05 for both). Furthermore, when subjects were stratified by New York Heart Association symptomatology, exercise parameters,but not atrial contractility,differed between groups. These data, obtained at rest, fail to suggest that NHCM-related heart failure symptoms are due to an atrial myopathy. [source] Cerebral oxygenation is reduced during hyperthermic exercise in humansACTA PHYSIOLOGICA, Issue 1 2010P. Rasmussen Abstract Aim:, Cerebral mitochondrial oxygen tension (PmitoO2) is elevated during moderate exercise, while it is reduced when exercise becomes strenuous, reflecting an elevated cerebral metabolic rate for oxygen (CMRO2) combined with hyperventilation-induced attenuation of cerebral blood flow (CBF). Heat stress challenges exercise capacity as expressed by increased rating of perceived exertion (RPE). Methods:, This study evaluated the effect of heat stress during exercise on PmitoO2 calculated based on a Kety-Schmidt-determined CBF and the arterial-to-jugular venous oxygen differences in eight males [27 ± 6 years (mean ± SD) and maximal oxygen uptake (VO2max) 63 ± 6 mL kg,1 min,1]. Results:, The CBF, CMRO2 and PmitoO2 remained stable during 1 h of moderate cycling (170 ± 11 W, ,50% of VO2max, RPE 9,12) in normothermia (core temperature of 37.8 ± 0.4 °C). In contrast, when hyperthermia was provoked by dressing the subjects in watertight clothing during exercise (core temperature 39.5 ± 0.2 °C), PmitoO2 declined by 4.8 ± 3.8 mmHg (P < 0.05 compared to normothermia) because CMRO2 increased by 8 ± 7% at the same time as CBF was reduced by 15 ± 13% (P < 0.05). During exercise with heat stress, RPE increased to 19 (19,20; P < 0.05); the RPE correlated inversely with PmitoO2 (r2 = 0.42, P < 0.05). Conclusion:, These data indicate that strenuous exercise in the heat lowers cerebral PmitoO2, and that exercise capacity in this condition may be dependent on maintained cerebral oxygenation. [source] Effects of aerobic fitness on hypohydration-induced physiological strain and exercise impairmentACTA PHYSIOLOGICA, Issue 2 2010T. L. Merry Abstract Aim:, Hypohydration exacerbates cardiovascular and thermal strain and can impair exercise capacity in temperate and warm conditions. Yet, athletes often dehydrate in exercise, are hypervolaemic and have less cardiovascular sensitivity to acute hypervolaemia. We tested the hypothesis that trained individuals have less cardiovascular, thermoregulatory and performance affect of hypohydration during exercise. Methods:, After familiarization, six trained [O2 peak = 64 (SD 8) mL kg,1 min,1] and six untrained [O2 peak = 45 (4) mL kg,1 min,1] males cycled 40 min at 70%O2 peak while euhydrated or hypohydrated by 1.5,2.0% body mass (crossover design), before a 40-min work trial with euhydration or ad libitum drinking (in Hypohydration trial), in temperate conditions (24.3,°C, RH 50%, va = 4.5 m s,1). Baseline hydration was by complete or partial rehydration from exercise+heat stress the previous evening. Results:, During constant workload, heart rate and its drift were increased in Hypohydration compared with Euhydration for Untrained [drift: 33 (11) vs. 24 beats min,1 h,1 (10), 95% CI 5,11] but not Trained [14 (3) vs. 13 beats min,1 h,1 (3), CI ,2 to 3; P = 0.01 vs. Untrained]. Similarly, rectal temperature drift was faster in Hypohydration for Untrained only [by 0.57,°C h,1 (0.25); P = 0.03 vs. Trained], concomitant with their reduced sweat rate (P = 0.05) and its relation to plasma osmolality (P = 0.03). Performance power tended to be reduced for Untrained (,13%, CI ,35 to 2) and Trained (,7%, CI: ,16 to 1), without an effect of fitness (P = 0.38). Conclusion:, Mild hypohydration exacerbated cardiovascular and thermoregulatory strain and tended to impair endurance performance, but aerobic fitness attenuated the physiological effects. [source] Cerebral oxygenation decreases during exercise in humans with beta-adrenergic blockadeACTA PHYSIOLOGICA, Issue 3 2009T. Seifert Abstract Aim:, Beta-blockers reduce exercise capacity by attenuated increase in cardiac output, but it remains unknown whether performance also relates to attenuated cerebral oxygenation. Methods:, Acting as their own controls, eight healthy subjects performed a continuous incremental cycle test to exhaustion with or without administration of the non-selective beta-blocker propranolol. Changes in cerebral blood flow velocity were measured with transcranial Doppler ultrasound and those in cerebral oxygenation were evaluated using near-infrared spectroscopy and the calculated cerebral mitochondrial oxygen tension derived from arterial to internal jugular venous concentration differences. Results:, Arterial lactate and cardiac output increased to 15.3 ± 4.2 mm and 20.8 ± 1.5 L min,1 respectively (mean ± SD). Frontal lobe oxygenation remained unaffected but the calculated cerebral mitochondrial oxygen tension decreased by 29 ± 7 mmHg (P < 0.05). Propranolol reduced resting heart rate (58 ± 6 vs. 69 ± 8 beats min,1) and at exercise exhaustion, cardiac output (16.6 ± 3.6 L min,1) and arterial lactate (9.4 ± 3.7 mm) were attenuated with a reduction in exercise capacity from 239 ± 42 to 209 ± 31 W (all P < 0.05). Propranolol also attenuated the increase in cerebral blood flow velocity and frontal lobe oxygenation (P < 0.05) whereas the cerebral mitochondrial oxygen tension decreased to a similar degree as during control exercise (delta 28 ± 10 mmHg; P < 0.05). Conclusion:, Propranolol attenuated the increase in cardiac output of consequence for cerebral perfusion and oxygenation. We suggest that a decrease in cerebral oxygenation limits exercise capacity. [source] Self glucose monitoring and physical exercise in diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2009G. Pugliese Abstract Cardiorespiratory fitness, which is determined mainly by the level of physical activity, is inversely related to mortality in the general population as well as in subjects with diabetes, the incidence of which is also increased by low exercise capacity. Exercise is capable of promoting glucose utilization in normal subjects as well as in insulin-deficient or insulin-resistant diabetic individuals. In diabetic subjects treated with insulin or insulin secretagogues, exercise may also result in complications, with too much insulin causing hypoglycaemia and not enough insulin leading to hyperglycaemia and possibly ketoacidosis; both complications may also occur several hours after exercise. Therefore, self-monitoring of blood glucose before, during (for exercise duration of more than 1 h) and after physical exercise is highly recommended, and also carbohydrate supplementation may be required. In the Italian Diabetes Exercise Study (IDES), measurement of blood glucose and systolic and diastolic blood pressure levels before and after supervised sessions of combined (aerobic + resistance) exercise in type 2 diabetic subjects with the metabolic syndrome showed significant reductions of these parameters, though no major hypoglycaemic or hypotensive episode was detected. The extent of reduction of blood glucose was related to baseline values but not to energy expenditure and was higher in subjects treated with insulin than in those on diet or oral hypoglycaemic agents (OHA). Thus, supervised exercise training associated with blood glucose monitoring is an effective and safe intervention to decrease blood glucose levels in type 2 diabetic subjects. Copyright © 2009 John Wiley & Sons, Ltd. [source] Psychiatric morbidity and the presence and absence of angiographic coronary disease in patients with chest painACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2001M. Valkamo Objective: ,To assess psychiatric morbidity in coronary angiogram patients. Method: ,A psychiatric assessment of 200 consecutive chest-pain patients was performed the day before coronary angiography in a double-blind study design. The sample included 132 men (mean age 57.2 years, SD 9.5) and 68 women (mean age 59.8 years, SD 8.9). A Structured Clinical Interview for DSM-III-R was used to obtain psychiatric diagnosis. The 21-item Beck Depression Inventory, the 20-item Toronto Alexithymia Scale and a four-item Life Satisfaction Scale were used to assess mental symptoms. A coronary angiography with obstruction of a coronary artery by more than 50% was considered to indicate angiographic coronary disease. Results: ,Mental disorders were found in 28% (95% CI 14,41) of the patients with normal angiographic findings (n=47) and in 24% (95% CI 17 , 30) of the patients with angiographic coronary disease (n=153). Furthermore, no difference was found between these two groups in other rating scales assessing mental symptoms even when adjusted for the New York Heart Association class, duration of chest-pain symptoms or exercise capacity. Conclusion: ,Psychiatric morbidity may not be associated with angiographic findings in patients with chest pain. [source] Screening for the calstabin-ryanodine receptor complex stabilizers JTV-519 and S-107 in doping control analysisDRUG TESTING AND ANALYSIS, Issue 1 2009Mario Thevis Abstract Recent studies outlined the influence of exercise on the stability of the skeletal muscle calstabin1-ryanodine receptor1-complex, which represents a major Ca2+ release channel. The progressive modification of the type-1 skeletal muscle ryanodine receptor (RyR1) combined with reduced levels of calstabin1 and phosphodiesterase PDE4D3 resulted in a Ca2+ leak that has been a suggested cause of muscle damage and impaired exercise capacity. The use of 1,4-benzothiazepine derivatives such as the drug candidates JTV-519 and S-107 enhanced rebinding of calstabin1 to RyR1 and resulted in significantly improved skeletal muscle function and exercise performance in rodents. Due to the fact that the mechanism of RyR1 remodelling under exercise conditions were proven to be similar in mice and humans, a comparable effect of JTV-519 and S-107 on trained athletes is expected, making the compounds relevant for doping controls. After synthesis of JTV-519, S-107, and a putative desmethylated metabolite of S-107, target compounds were characterized using nuclear magnetic resonance spectroscopy and electrospray ionization (ESI),high-resolution/high-accuracy Orbitrap mass spectrometry. Collision-induced dissociation pathways were suggested based on the determination of elemental compositions of product ions and H/D-exchange experiments. The most diagnostic product ion of JTV-519 was found at m/z 188 (representing the 4-benzyl-1-methyl piperidine residue), and S-107 as well as its desmethylated analog yielded characteristic fragments at m/z 153 and 138 (accounting for 1-methoxy-4-methylsulfanyl-benzene and 4-methoxy-benzenethiol residues, respectively). The analytes were implemented in existing doping control screening procedures based on liquid chromatography, multiple reaction monitoring and simultaneous precursor ion scanning modes using a triple quadrupole mass spectrometer. Validation items such as specificity, recovery (68,92%), lower limit of detection (0.1,0.2 ng/mL), intraday (5.2,18.5%) and interday (8.7,18.8%) precision as well as ion suppression/enhancement effects were determined. Copyright © 2009 John Wiley & Sons, Ltd. [source] Ten-Year Echo/Doppler Determination of the Benefits of Aerobic Exercise after the Age of 65 YearsECHOCARDIOGRAPHY, Issue 1 2010Alexander J. Muster M.D. As the human lifespan becomes progressively extended, potential health-related effects of intense aerobic exercise after age 65 need evaluation. This study evaluates the cardiovascular (CV), pulmonary, and metabolic effects of competitive distance running on age-related deterioration in men between 69 (±3) and 77 (±2) years (mean ± SD). Twelve elderly competitive distance runners (ER) underwent oxygen consumption and echo/Doppler treadmill stress testing (Balke protocol) for up to 10 years. Twelve age-matched sedentary controls (SC) with no history of CV disease were similarly tested and the results compared for the initial three series of the study. CV data clearly separated the ER from SC. At entry, resting and maximal heart rate, systolic/diastolic blood pressure, peak oxygen consumption (VO2max), and E/A ratio of mitral inflow were better in the ER (P < 0.05 vs. SC). With aging, ER had a less deterioration of multiple health parameters. Exceptions were VO2max and left ventricular diastolic function (E/A, AFF, IVRT) that decreased (P < 0.05, Year 10 vs. Year 1). Health advantages of high-level aerobic exercise were demonstrated in the ER when compared to SC. Importantly, data collected in ER over 10 years confirm the benefit of intensive exercise for slowing several negative effects of aging. However, the normative drop of exercise capacity in the seventh and eighth decades reduces the potential athleticism plays in prevention of CV events. (Echocardiography 2010;27:5-10) [source] Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery DiseaseECHOCARDIOGRAPHY, Issue 1 2009Francesca Innocenti M.D. Background: The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). Methods: The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged ,75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). Results: During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 ± 1.6 METs in G1 vs. 5 ± 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351,0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559,16.833, P = 0.007), viability (HR 3.354, CI 1.162,9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114,0.945, P = 0.039) predicted hard cardiac events. Conclusion: In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE. [source] Increased expression of VEGF following exercise training in patients with heart failureEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 4 2001T. Gustafsson Background and aims During the last decades several angiogenic factors have been characterized but so far it is unknown whether local muscle exercise training increases the expression of these factors in patients with moderate heart failure. Expression of the major putative angiogenic factor vascular endothelial growth factor (VEGF) at the level of messneger RNA (mRNA) and/or protein was therefore studied before and after 8 weeks of training in patient with chronic heart failure. Methods VEGF mRNA and protein concentrations were determined in skeletal muscle biopsies before and after 8 weeks of one-legged knee extension training in patients with chronic heart failure (New York Heart Association II,III). Results Exercise training increased the citrate synthase activity and peripheral exercise capacity by 46% and 36%, respectively, in parallel with a two-fold increase in VEGF at both the mRNA (P = 0·03) and protein (P = 0·02) levels Conclusion The increase in VEGF gene expression in response to exercise training indicates VEGF to be one possible mediator in exercise-induced angiogenesis and may therefore regulate an important and early step in adaptation to increased muscle activity in patient with chronic heart failure. [source] Treatment of congestive heart failure , current status of use of digitoxinEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue S2 2001G. G. Belz Digitalis glycosides exert a positive inotropic effect, i.e. an increase in myocardial contractility associated with a prolongation of relaxation period, and glycosides lower the heart rate (negative chronotropic), impede stimulus conduction (negative dromotropic) and promote myocardial excitability (positive bathmotropic). They seem to influence the activities of both the vagal and the sympathetic systems. Digitalis glycosides that belong to different substance classes are closely comparable concerning pharmacodynamics but differ substantially in regard to pharmacokinetics. Digoxin and its derivatives are less lipophilic, show lower protein binding and shorter half-life, are mainly eliminated via the kidney and accumulate rather rapidly in cases of insufficient kidney function. Digitoxin is highly lipophilic and extensively bound to plasma proteins, has a longer half-life, is mainly eliminated in the metabolized state via urine and faeces and does not accumulate in kidney dysfunction. As a result of a more stable pharmacokinetic profile, the incidence of toxic side effects seems to be lower with digitoxin than with digoxin. Since the beginning of the 1990s, the antagonists of the RAAS qualified as the standard treatment for congestive heart failure, often in combination with diuretics, vasodilators or ,-antagonists. However, the important role of digitalis glycosides as therapeutic comedication or alternative was never denied, especially in atrial fibrillation with tachycardia. The PROVED and RADIANCE trials proved a detrimental effect of the withdrawal of digoxin therapy on exercise capacity, left-ventricular ejection fraction and clinical symptoms. The DIG trial revealed that digoxin comedication in sinus rhythm patients with congestive heart failure was associated with a lower morbidity (as taken from death or hospitalization because of worsening heart failure) and an unchanged overall mortality , being a unique feature among the available inotropic drugs. Comparable studies for digitoxin have not yet been performed but, because of its higher pharmacological stability, it might well be associated with even more advantages in this regard than digoxin. [source] Physical fitness in children with haemophilia and the effect of overweightHAEMOPHILIA, Issue 2 2009D. C. M. DOUMA-VAN RIET Summary., Although children with haemophilia are advised to participate in physical activities, their physical fitness has not been studied in a large group. In addition, children with haemophilia may be at increased risk for becoming overweight as a result of inactivity because of joint bleedings or because of overprotection. This study aimed to assess physical fitness (aerobic capacity), joint status, muscle strength, quality of life (QoL), self-reported motor competence and also prevalence of overweight and its association with physical parameters. Weight and height were measured. Skin folds were measured unilaterally at biceps, triceps, subscapular and supra-iliac sites. Aerobic capacity was determined on a cycle ergometer or with a 6-min walk test (6MWT). Muscle strength and active range of motion of elbows, knees and ankle joints were measured. Self-reported motor competence was measured with the ,Competentie BelevingsSchaal voor Kinderen'. Joint pain was scored on a Visual Analogue Scale. The Haemo-QoL Index was used to measure QoL. In 158 Dutch boys with haemophilia, with a mean age of 12.7 years (SD 2.9), normal aerobic capacity and muscle strength were found. Joint pain was reported by 16% of the participants. The prevalence of overweight (16%) was slightly increased when compared with healthy Dutch boys (13.5%). Being overweight had a negative association with the 6MWT and QoL. Dutch children with haemophilia have normal aerobic exercise capacity and muscle strength. The majority also has normal joint mobility. Prevalence of overweight is slightly increased. [source] The six-minute walk test: a useful metric for the cardiopulmonary patientINTERNAL MEDICINE JOURNAL, Issue 8 2009T. Rasekaba Abstract Measurement of exercise capacity is an integral element in assessment of patients with cardiopulmonary disease. The 6-min walk test (6MWT) provides information regarding functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. A distance less than 350 m is associated with increased mortality in chronic obstructive pulmonary disease, chronic heart failure and pulmonary arterial hypertension. Desaturation during a 6MWT is an important prognostic indicator for patients with interstitial lung disease. The 6MWT is sensitive to commonly used therapies in chronic obstructive pulmonary disease such as pulmonary rehabilitation, oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. However, it appears less reliable to detect changes in clinical status associated with medical therapies for heart failure. A change in walking distance of more than 50 m is clinically significant in most disease states. When interpreting the results of a 6MWT, consideration should be given to choice of predictive values and the methods by which the test was carried out. [source] Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndromeINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008A. Palazzuoli Summary Background:, Although many studies have found a high prevalence of anaemia in patients with congestive heart failure (CHF), few have carefully examined the relationship between the CHF and the prevalence of anaemia and chronic renal insufficiency (CRI). Patients with advanced renal failure, significant anaemia, diffuse atherosclerosis, respiratory disease and more elderly patients have been systematically excluded from the great majority of the randomised clinical trials. Discussion:, Both anaemia and renal insufficiency are very common associated diseases associated with increased mortality, morbidity and rate of hospitalisation in CHF patients. Impaired renal function is associated with adverse outcomes because it represents a marker of coexistent disease and more diffuse atherosclerosis. In patients with CHF, progressive renal dysfunction leads to a decrease in erythropoietin (EPO) levels with reduced erythrocyte production from bone marrow. This may explain the common association between CHF, anaemia and CRI in clinical practice. The normalisation of haemoglobin concentration by EPO in patients with CHF and CRI results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. Conclusion:, In this review, we describe the mechanisms linking anaemic status, CRI and CHF, the prognostic relevance of each disease, treatment implications, and potential benefit of EPO administration. [source] Cardiac rehabilitation programme for coronary heart disease patients: An integrative literature reviewINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Nidal F Eshah RN, PhD(c) Previous Western cardiac rehabilitation (CR) purported to improve patients' quality of life and health-related parameters for cardiovascular diseases (CVD). Nursing's role in CR was minimally identified. The purpose of this integrative literature review was to determine the effectiveness of current CR programmes and to determine if nurses are included in multidisciplinary CR teams. An online search of databases for the National Institutes of Health Library, Medline, CINAHL, Blackwell Synergy and PsychINFO electronic databases, with keywords,cardiac rehabilitation, lifestyle modification, secondary prevention, quality of life, effects of rehabilitation,identified 13 articles published 2001,2006 for inclusion. Cardiac rehabilitation programmes provided significant improvement in participants' quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction (MI) risk factors, although there was limited participation. They also decreased depression and anxiety. Eight studies included Nurses as CR providers, but without clear descriptions of their role. Nurses in developing countries need to participate in CR programmes to improve patients' participation, and to focus on modalities with lower overhead costs, such as home-based CR, and to clearly articulate their unique contributions. [source] Endurance Exercise Training in Older Patients with Heart Failure: Results from a Randomized, Controlled, Single-Blind TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Peter H. Brubaker PhD OBJECTIVES: To test the hypothesis that exercise training (ET) improves exercise capacity and other clinical outcomes in older persons with heart failure with reduced ejection fraction (HfrEF). DESIGN: Randomized, controlled, single-blind trial. SETTING: Outpatient cardiac rehabilitation program. PARTICIPANTS: Fifty-nine patients aged 60 and older with HFrEF recruited from hospital records and referring physicians were randomly assigned to a 16-week supervised ET program (n=30) or an attention-control, nonexercise, usual care control group (n=29). INTERVENTION: Sixteen-week supervised ET program of endurance exercise (walking and stationary cycling) three times per week for 30 to 40 minutes at moderate intensity regulated according to heart rate and perceived exertion. MEASUREMENTS: Individuals blinded to group assignment assessed four domains pivotal to HFrEF pathophysiology: exercise performance, left ventricular (LV) function, neuroendocrine activation, and health-related quality of life (QOL). RESULTS: At follow-up, the ET group had significantly greater exercise time and workload than the control group, but there were no significant differences between the groups for the primary outcomes: peak exercise oxygen consumption (VO2 peak), ventilatory anaerobic threshold (VAT), 6-minute walk distance, QOL, LV volumes, EF, or diastolic filling. Other than serum aldosterone, there were no significant differences after ET in other neuroendocrine measurements. Despite a lack of a group "training" effect, a subset (26%) of individuals increased VO2 peak by 10% or more and improved other clinical variables as well. CONCLUSION: In older patients with HFrEF, ET failed to produce consistent benefits in any of the four pivotal domains of HF that were examined, although the heterogeneous response of older patients with HFrEF to ET requires further investigation to better determine which patients with HFrEF will respond favorably to ET. [source] Exercise Training as a Therapy for Chronic Heart Failure: Can Older People Benefit?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2003Miles D. Witham BM Despite recent advances in pharmacological therapy, chronic heart failure remains a major cause of morbidity and mortality in older people. Studies of exercise training in younger, carefully selected patients with heart failure have shown improvements in symptoms and exercise capacity and in many pathophysiological aspects of heart failure, including skeletal myopathy, ergoreceptor function, heart rate variability, endothelial function, and cytokine expression. Data on mortality and hospitalization are lacking, and effects on everyday activity, depression, and quality of life are unclear. Exercise therapy for patients with heart failure appears to be safe and has the potential to improve function and quality of life in older people with heart failure. To realize these potential benefits, exercise programs that are suitable for older, frail people need to be established and tested in an older, frail, unselected population with comorbidities. [source] Metabolic responses to oral tryptophan supplementation before exercise in horsesJOURNAL OF ANIMAL PHYSIOLOGY AND NUTRITION, Issue 3-6 2005I. Vervuert Summary This study was conducted to evaluate the effects of oral tryptophan (Trp) supplementation on exercise capacity and metabolic responses in horses. Three horses had to perform an exercise test: a 15-min warm-up followed by a 60-min walk (1.7 m/s, W1), a 10-min trot (3.1 m/s, T1), a second 60-min walk (1.7 m/s, W2), a second 10-min trot (3.1 m/s, T2) and a final 30-min walk (1.7 m/s, W3) until the horses were unwilling to continue. The horses exercised on a treadmill at a 6% incline and with a constant draught load of 40 kg (0.44 kN). Two hours before exercise horses were given 50 g Trp (9.8,10.7 g Trp/100 kg BW) by nasogastric tube. A control exercise test was conducted without Trp. During the control test, one horse was able to finish the final 30-min walk (W3), whereas two horses finished W3 after Trp administration. Higher plasma Trp levels after Trp administration did not change significantly during exercise (Trp: start exercise, 524 ± 41 ,mol/l; end exercise 547 ± 20 ,mol/l; control: start exercise, 70 ± 10 ,mol/l; end exercise, 58 ± 21 ,mol/l). After Trp supplementation, blood lactate concentrations were significantly lower after the first and second trotting periods. Free fatty acids in plasma increased during exercise without any treatment-related differences. Although experimental plasma Trp levels were seven times higher than the control levels, Trp supplementation had no effect on exercise performance and metabolic responses to draught load exercise. [source] Radiofrequency Catheter Ablation of Atrial Fibrillation in Athletes Referred for Disabling Symptoms Preventing Usual Training Schedule and Sport CompetitionJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2008FRANCESCO FURLANELLO M.D. Introduction: Atrial fibrillation (AF) may occasionally affect athletes by impairing their ability to compete, and leading to noneligibility at prequalification screening. The impact of catheter ablation (CA) in restoring full competitive activity of athletes affected by AF is not known. The aim of our study was to investigate the effectiveness of CA of idiopathic AF in athletes with palpitations impairing physical performance and compromising eligibility for competitive activities. Methods and Results: Twenty consecutive competitive athletes (all males; 44.4 ± 13.0 years) with disabling palpitations on the basis of idiopathic drug-refractory AF underwent 46 procedures (2.3 ± 0.4 per patient) according to a prospectively designed multiprocedural CA approach that consolidates pulmonary veins (PV) isolation through subsequent steps. Preablation, effort-induced AF could be documented in 13 patients (65%) during stress ECG and significantly reduced maximal effort capacity (176 ± 21 W), as compared with patients with no AF during effort (207 ± 43 W, P < 0.05). At the end of CA protocol, which also included ablation of atrial flutter (AFL) in 7 patients, 18 (90.0%) patients were free of AF and two (10.0%) reported short-lasting (minutes) episodes of palpitations during 36.1 ± 12.7 months follow-up. Compared with preablation, postablation maximal exercise capacity significantly improved (from 183 ± 32 to 218 ± 20 W, P < 0.02). All baseline quality of life (QoL) parameters pertinent to physical activity significantly improved (P < 0.05) at the end of CA protocol. All athletes obtained reeligibility and could effectively reinitiate sport activity. Conclusions: AF, alone or in combination with AFL, may significantly impair maximal effort capacity thereby limiting competitive performance. Multiple PV isolation proved very effective in these patients to restore full competitive activity and allow reeligibility. [source] | ||||||||||||||||||||||||||||||||||