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Exercise Tolerance (exercise + tolerance)
Selected AbstractsImprovement in Exercise Tolerance and Symptoms of Congestive Heart Failure During Treatment With Candesartan CilexetilCONGESTIVE HEART FAILURE, Issue 1 2000David Tepper MD Editor No abstract is available for this article. [source] Mini-Maze Suffices as Adjunct to Mitral Valve Surgery in Patients with Preoperative Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2000ANTON E. TUINENBURG M.D. Mini-Maze and Mitral Valve Surgery. Introduction: After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach limits general appliance. We investigated the clinical outcome of a simplified, less extensive Cox maze procedure ("mini-maze") as adjunct to MV surgery. Methods and Results: Thirteen patients with MV disease and preoperative AF were treated with combined surgery (group 1). Nine control patients without previous AF underwent isolated MV surgery (group 2). We retrospectively compared the results to findings in 23 patients with preoperative AF who had undergone isolated MV surgery (group 3). In group 1, mini-maze took an additional 46 minutes of perfusion time. One 75-year-old patient died of postoperative multiple organ failure. Seven patients showed spontaneously converting (within 2 months) postoperative AF. After 1 year, 82% were in sinus rhythm (SR). No sinus node dysfunction was observed. In group 2, all patients were in SR after 1 year. In group 3, only 53% were in SR after 1 year, despite serial cardioversion and antiarrhythmic drug therapy. Exercise tolerance and heart rate were comparable for groups 1 and 2. Left atrial function was present in all but one patient in group 1 and in all patients in group 2 (after MV reconstruction). Conclusion: Adding a relatively simple mini-maze to MV surgery improves arrhythmia outcome in patients with preoperative AF without introducing sinus node dysfunction or persistent absence of left atrial function. The results of this type of combined surgery are encouraging and deserve further attention. [source] Exercise tolerance and daily life in McArdle's diseaseMUSCLE AND NERVE, Issue 5 2005Karen Ollivier MSc Abstract McArdle's disease is a common disorder of muscle metabolism and is due to myophosphorylase deficiency. The major complaint of patients with this disease is effort intolerance. Although the clinical features of affected patients are well known, their daily lifestyle is not well documented. The main objective of this work was to assess their mean daily energy expenditure (DEE) and compare it with control subjects. Thirty patients and 87 control subjects completed a questionnaire. A 3-day self-record of daily physical activities was used to estimate the mean DEE for patients and control subjects. A separate section of the questionnaire was used to assess patients' clinical features and daily lifestyle. The DEE of patients (44.1 ± 6.9 kcal/kg) was not significantly different from control subjects (44.5 ± 5.6 kcal/kg). Half of the patients with McArdle's disease performed a daily physical leisure activity as sport, sometimes at a high level (17%). Despite large individual variation, physical abilities and patients' symptoms were negatively correlated. Physical leisure activity significantly decreased the sensation of muscle pain (P < 0.03). These findings show that patients with McArdle's disease do not have a strictly sedentary lifestyle. Moreover, physical exercise appears to have positive effects on the main clinical features, such as effort intolerance. Thus, regular, moderate physical activity may be beneficial in McArdle's disease. Muscle Nerve, 2005 [source] Left Coronary Artery Arteriovenous Malformation Presenting as a Diastolic Murmur with Exercise Intolerance in a Child with a Suspected Familial Vascular Malformation SyndromeCONGENITAL HEART DISEASE, Issue 3 2007Valerie A. Schroeder MD Abstract Objective., Intracardiac arteriovenous malformations are rare and may be associated with sudden death in adults. This case report describes an intracardiac left coronary arteriovenous malformation in a 7-year-old boy with a suspected familial cutaneous vascular malformation syndrome. The patient presented with a diastolic murmur, exercise intolerance, chest pain, and a left ventricular mass. Methods., The left ventricular mass was initially identified by echocardiography. Subsequently, a computed tomography scan revealed the vascular nature of the lesion. We hypothesized that the lesion represented either an arteriovenous malformation (AVM) or a hemangioma. These lesions are thought to cause coronary steal and myocardial dysfunction. Skin biopsies of the patient's cutaneous lesions revealed capillary hyperplasia, which was not consistent with either hemangioma or AVM. Thus, a surgical biopsy and partial resection of the mass was performed. Results., The surgical pathology of the cardiac mass was consistent with an AVM. Within 6 months following partial resection of the mass, the patient unexpectedly developed a left ventricular pseudoaneurysm at the resection site and required re-operation. Although a portion of the mass remains, both the patient's chest pain and exercise tolerance have improved subjectively. Conclusion., Patients with cutaneous vascular malformations and diastolic murmurs, as well as cardiac symptoms, should undergo echocardiography or alternative imaging modalities to screen for treatable pathological myocardial vascular malformations. [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] Impaired oxygen kinetics in beta-thalassaemia major patientsACTA PHYSIOLOGICA, Issue 3 2009I. Vasileiadis Abstract Aim:, Beta-thalassaemia major (TM) affects oxygen flow and utilization and reduces patients' exercise capacity. The aim of this study was to assess phase I and phase II oxygen kinetics during submaximal exercise test in thalassaemics and make possible considerations about the pathophysiology of the energy-producing mechanisms and their expected exercise limitation. Methods:, Twelve TM patients with no clinical evidence of cardiac or respiratory disease and 10 healthy subjects performed incremental, symptom-limited cardiopulmonary exercise testing (CPET) and submaximal, constant workload CPET. Oxygen uptake (Vo2), carbon dioxide output and ventilation were measured breath-by-breath. Results:, Peak Vo2 was reduced in TM patients (22.3 ± 7.4 vs. 28.8 ± 4.8 mL kg,1 min,1, P < 0.05) as was anaerobic threshold (13.1 ± 2.7 vs. 17.4 ± 2.6 mL kg,1 min,1, P = 0.002). There was no difference in oxygen cost of work at peak exercise (11.7 ± 1.9 vs. 12.6 ± 1.9 mL min,1 W,1 for patients and controls respectively, P = ns). Phase I duration was similar in TM patients and controls (24.6 ± 7.3 vs. 23.3 ± 6.6 s respectively, P = ns) whereas phase II time constant in patients was significantly prolonged (42.8 ± 12.0 vs. 32.0 ± 9.8 s, P < 0.05). Conclusion:, TM patients present prolonged phase II on-transient oxygen kinetics during submaximal, constant workload exercise, compared with healthy controls, possibly suggesting a slower rate of high energy phosphate production and utilization and reduced oxidative capacity of myocytes; the latter could also account for their significantly limited exercise tolerance. [source] The effects of maximal treadmill graded exercise testing on haemorheological, haemodynamic and flow cytometry platelet markers in patients with systolic or diastolic heart failureEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2008I. Chung ABSTRACT Background, Acute exercise has been associated with activation of thrombosis, and this risk may be accentuated in patients with heart failure. Given the relation of platelets to atherothrombosis, we tested the hypothesis that acute exercise would adversely affect platelet indices and platelet activation markers in patients with systolic and diastolic heart failure. Materials and methods, We studied 20 patients with systolic heart failure (17 men, 3 women; mean age 64 ± 10 years, all with ejection fraction (EF) , 40%) and 20 patients with diastolic heart failure (14 men, 6 women; mean age 64 ± 8 years, mean EF = 66%) who were exercised to maximal intensity, who were compared to 13 healthy controls (6 men, 7 women; mean age 60 ± 4 years, mean EF = 73%). We measured platelet indices (platelet volume, mass and component) and platelet activation markers (platelet-bound CD62P%G, CD63%G and CD40L%G using flow cytometry, as well as plasma sCD40L and soluble P-selectin (sP-sel) levels). Results, Baseline Mean Platelet Volume (MPV), sP-sel, CD40L%G and CD63%G levels were significantly higher in patients with systolic and diastolic heart failure, when compared with controls. The mean exercise duration and VO2 peak in patients with systolic and diastolic heart failure were not significantly different, but lower than that seen in healthy controls. Following exercise, mean haematocrit, CD62P%G, and CD63%G significantly increased in all three subject groups (all P < 0·05). The proportional change in CD62P%G and CD63%G were not significantly different between healthy controls and heart failure patients (P > 0·05). Conclusion, Acute maximal graded exercise increases platelet activation markers, with no disproportionate differences between heart failure patients and healthy controls, despite the former group having a lower exercise tolerance and VO2 peak. [source] Ventilatory control in humans: constraints and limitationsEXPERIMENTAL PHYSIOLOGY, Issue 2 2007Susan A. Ward Below the lactate threshold (,L), ventilation responds in close proportion to CO2 output to regulate arterial partial pressure of CO2. While ventilatory control models have traditionally included proportional feedback (central and carotid chemosensory) and feedforward (central and peripheral neurogenic) elements, the mechanisms involved remain unclear. Regardless, putative control schemes have to accommodate the close dynamic ,coupling' between and . Above ,L, is driven down to constrain the fall of arterial pH by a compensatory hyperventilation, probably of carotid body origin. When requirements are high (as in highly fit endurance athletes), can attain limiting proportions. Not only does this impair gas exchange at these work rates, but there may be an associated high metabolic cost for generation of respiratory muscle power, which may be sufficient to divert a fraction of the cardiac output away from the muscles of locomotion to the respiratory muscles, further compromising exercise tolerance. [source] The effect of a pulmonary rehabilitation programme on older patients with chronic pulmonary diseaseJOURNAL OF CLINICAL NURSING, Issue 1 2008Kim Ae Kyung RN Aim., The aim of this study was to answer the question: is there an effect on the respiratory capacity and activity tolerance of older patients with chronic obstructive pulmonary disease who participate in a pulmonary rehabilitation programme? Background., Pulmonary rehabilitation is now an integral part of chronic obstructive pulmonary disease management. Evidence supports the positive effects of breath training and exercising training on quality of life, exercise tolerance and improved physical condition of individual with chronic obstructive pulmonary disease. Limited empirical documentation exists to support the effectiveness of a nurse managed rehabilitation programme for older patients with chronic obstructive pulmonary disease. The study was done to evaluate the effects of pulmonary rehabilitation provided by nurses on the pulmonary function, gas exchange and exercise tolerance in older patients with chronic obstructive pulmonary disease. Design., A one group pre-test,post-test design was used to evaluate the effects of a pulmonary rehabilitation programme. Method., The sample consisted of 20 patients with chronic obstructive pulmonary disease who participated in a pulmonary rehabilitation programme including breathing exercises, upper-limb exercises and inspiratory muscle training. Results., The findings indicated improvement in exercise performance and a decrease in dyspnea after participation in the pulmonary rehabilitation programme. Relevance to clinical practice., The clinical nurse can make a significant impact on the illness trajectory and quality of life for patients with chronic obstructive pulmonary disease. The nurse has a critical role in helping patient with chronic obstructive pulmonary disease learn to cope, adjust and adapt to life with a chronic illness. Active nurse involvement with a patient in a pulmonary rehabilitation programme can assist in the identification of factors that motivate the patient, help in establishing realistic out comes expectations and provide patient teaching opportunities. The nurse can assist the patient to develop skills of self-awareness regarding particular symptoms, self-monitoring and health status change identification. [source] Investigation into the nutritional status, dietary intake and smoking habits of patients with chronic obstructive pulmonary diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2004W. J. Cochrane Abstract Background and aims Weight loss and reduced fat-free mass are prevalent amongst patients with chronic obstructive pulmonary disease (COPD). However, the causes of this weight loss are not clear. The aims of this study are to investigate the factors affecting body weight and dietary intake in a group of outpatients with COPD, and to investigate any differences between adequately nourished and malnourished patients. Methods In 103 stable outpatients, nutritional status was assessed using Body Mass Index (BMI) and upper arm anthropometry. Lung function, smoking status, exercise tolerance, dietary intake, dietary problems and health-related quality of life were assessed. Patients were classed as either adequately nourished or malnourished. Results Twenty-three per cent of subjects were classed as malnourished. The malnourished subjects had lower lung function measurements, suffered more dietary problems and had lower nutritional intake compared with the adequately nourished subjects. They also had poorer fatigue scores. In linear regression analysis, the factors that had the most effect on BMI were a low transfer factor, presence of early satiety, and being a current smoker. Conclusion Important differences were found between adequately nourished and malnourished subjects. These differences move us closer to understanding how best to screen and treat this group of patients. [source] Current treatment strategies for pulmonary arterial hypertensionJOURNAL OF INTERNAL MEDICINE, Issue 3 2005S. H. LEE Abstract., Lee SH, Rubin LJ (University of California, San Diego, La Jolla, CA, USA). Current treatment strategies for pulmonary arterial hypertension (Review). J Intern Med 2005; 258: 199,215. Pulmonary arterial hypertension (PAH) is a disease characterized by an elevation in pulmonary artery pressure that can lead to right ventricular failure and death. Although there is no cure for PAH, newer medical therapies have been shown to improve a variety of clinically relevant end-points including survival, exercise tolerance, functional class, haemodynamics, echocardiographic parameters and quality of life measures. Since the introduction of continuous intravenous prostacyclin, the treatment armamentarium of approved drugs for PAH has expanded to include prostacyclin analogues with differing routes of administration, a dual endothelin receptor antagonist, and a phosphodiesterase-5 inhibitor. Selective endothelin-A receptor antagonists have shown promise in clinical trials and are likely to be added to the list of options. As the number of medications available for PAH continues to increase, treatment decisions regarding first-line therapy, combination treatments, and add-on strategies are becoming more complex. This article reviews the current treatments strategies for PAH and provides guidelines for its management. [source] Promising outcomes of an adolescent chronic fatigue syndrome inpatient programmeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 5 2009Brett Gordon Introduction: Chronic fatigue syndrome (CFS) is a condition of prolonged and disabling fatigue, which is accompanied by characteristic constitutional and neuropsychiatric symptoms. In children and adolescents, this condition occurring at a developmentally vulnerable time adds to the disability affecting self-concept, autonomy, body image, socialisation, sexuality and academic problems. This case series looks at the effects of a graded exercise programme on physical outcomes, fatigue and mental state in an adolescent population. Methods: Data sets from 16 adolescents who completed combined exercise training as part of the 4-week inpatient intensive CFS programme at the Austin Hospital, Melbourne were analysed. All patients completed an exercise assessment and three questionnaires before beginning any training. A paediatrician (LL) confirmed the diagnosis according to the Fukuda criteria in all patients. Exercise was carefully supervised and prescribed daily by an exercise physiologist (BG) according to each individual's ability and response with the basic aim of increasing exercise tolerance and improving muscle strength and endurance. Results: There was an 18% improvement in volitional time to fatigue (P= 0.02) and 17% improvement in peak oxygen uptake (VO2peak) (P= 0.01). Upper body strength and function improved with a remarkable 70% increase in the number of push-ups. Fatigue severity was reported to improve by 13% (P= 0.01) and depression index improved significantly by 42% (P= 0.02). Conclusions: The significance of these improvements cannot be underestimated as an improvement in physical capacity through increased time to fatigue and less severe fatigue allows adolescents to resume school, social and family activities. [source] Use of Auscultation and Doppler Echocardiography in Boxer Puppies to Predict Development of Subaortic or Pulmonary StenosisJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2009S. Jenni Background: Boxers are predisposed to subaortic and pulmonic stenosis (SAS, PS). Screening of puppies may be useful in estimating the risk of their developing a defect that potentially compromises life expectancy or exercise tolerance. Hypothesis: Presence of SAS or PS in adult Boxers can be predicted by auscultation and Doppler echocardiography at 9,10 weeks of age. Animals: Eighty-five Boxer puppies examined at 9,10 weeks of age and at 12 months of age. Methods: Prospective, longitudinal observational study. Auscultation by stethoscope and continuous wave-Doppler echocardiography for peak velocities (Vmax) in the aorta (Ao) and pulmonary artery (PA). Results: Intensity of heart murmurs in puppies correlated with VmaxAo and VmaxPA in adults. VmaxAo and VmaxPA in puppies correlated with VmaxAo and VmaxPA in adults, respectively. From puppy to adult, VmaxAo increased and VmaxPA remained unchanged. The negative predictive value for absent or only a soft (,II/VI) murmur in puppies being associated with VmaxAo and PA , 2.4 m/s as an adult was 90% and ,3.5 m/s 100%. The negative predictive value of a Vmax, 2.4 m/s as a puppy still being ,2.4 m/s as an adult was 94% for Ao and 96% for PA, and of a Vmax, 3.5 m/s, 99% for Ao and 100% for PA. Conclusions and Clinical Importance: Even though VmaxAo increases during growth in Boxer puppies, indicating relative narrowing of the aorta, puppies with VmaxAo , 2.4 m/s do not usually progress to clinically have relevant SAS at 12 months of age. [source] Capillary Hemodynamics and Oxygen Pressures in the Aging MicrocirculationMICROCIRCULATION, Issue 4 2006DAVID C. POOLE ABSTRACT Healthy aging acts to redistribute blood flow (Q,) and thus O2 delivery (Q,O2) among and within the exercising muscles such that Q,O2 to highly oxidative muscle fibers may be compromised. Within the microcirculation of old muscles capillary hemodynamics are altered and the matching of Q,O2 to oxidative requirements (V,O2) is impaired such that at exercise onset the microvascular O2 pressure falls below that seen in their younger counterparts. This is important because the microvascular O2 pressure denotes the sole driving force for blood-myocyte O2 transfer and any compromise may slow V,O2 kinetics and reduce exercise tolerance. This review considers the microcirculatory evidence for a reduced perfusive (Q,O2) and diffusive O2 flux within aged muscle and highlights the pressing need for intravital microscopy studies of the muscle microcirculation during exercise. [source] Impaired oxygen extraction in metabolic myopathies: Detection and quantification by near-infrared spectroscopyMUSCLE AND NERVE, Issue 4 2007Bruno Grassi MD Abstract Patients with mitochondrial myopathies (MM) or myophosphorylase deficiency (McArdle's disease, McA) show impaired capacity for O2 extraction, low maximal aerobic power, and reduced exercise tolerance. Non-invasive tools are needed to quantify the metabolic impairment. Six patients with MM, 6 with McA, 25 with symptoms of metabolic myopathy but negative biopsy (patient-controls, P-CTRL) and 20 controls (CTRL) underwent an incremental cycloergometric test. Pulmonary O2 uptake (V,O2) and vastus lateralis oxygenation indices (by near-infrared spectroscopy, NIRS) were determined. Concentration changes of deoxygenated hemoglobin and myoglobin (,[deoxy(Hb + Mb)]) were considered an index of O2 extraction. ,[deoxy(Hb + Mb)] peak (percent limb ischemia) was lower in MM (25.3 ± 12.0%) and McA (18.7 ± 7.3) than in P-CTRL (62.4 ± 3.9) and CTRL (71.3 ± 3.9) subjects. V,O2 peak and ,[deoxy(Hb + Mb)] peak were linearly related (r2 = 0.83). In these patients, NIRS is a tool to detect and quantify non-invasively the metabolic impairment, which may be useful in the follow-up of patients and in the assessment of therapies and interventions. Muscle Nerve, 2006 [source] AAIR Versus DDDR Pacing in the Bradycardia Tachycardia Syndrome: A Prospective, Randomized, Double-blind, Crossover TrialPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 11 2001BERNHARD SCHWAAB SCHWABB, B., et al.: AAIR Versus DDDR Pacing in the Bradycardia Tachycardia Syndrome: A Prospective, Randomized, Double-blind, Crossover Trial. In 19 patients paced and medicated for bradycardia tachycardia syndrome (BTS), AAIR and DDDR pacing were compared with regard to quality of life (QoL), atrial tachyarrhythmia (AFib), exercise tolerance, and left ventricular (LV) function. Patients had a PQ interval , 240 ms during sinus rhythm, no second or third degree AV block, no bundle branch block, or bifascicular block. In DDDR mode, AV delay was optimized using the aortic time velocity integral. After 3 months, QoL was assessed by questionnaires, patients were investigated by 24-hour Holter, cardiopulmonary exercise testing (CPX) was performed, and LV function was determined by echocardiography. QoL was similar in all dimensions, except dizziness, showing a significantly lower prevalence in AAIR mode. The incidence of AFib was 12 episodes in 2 patients with AAIR versus 22 episodes in 7 patients with DDDR pacing (P = 0.072). In AAIR mode, 164 events of second and third degree AV block were detected in 7 patients (37%) with pauses between 1 and 4 seconds. During CPX, exercise duration and work load were higher in AAIR than in DDDR mode (423 ± 127 vs 402 ± 102 s and 103 ± 31 vs 96 ± 27 Watt, P < 0.05). Oxygen consumption (VO2), was similar in both modes. During echocardiography, only deceleration of early diastolic flow velocity and early diastolic closure rate of the anterior mitral valve leaflet were higher in DDD than in AAI pacing (5.16 ± 1.35 vs 3.56 ± 0.95 m/s2 and 69.2 ± 23 vs 54.1 ± 26 mm/s, P < 0.05). As preferred pacing mode, 11 patients chose DDDR, 8 patients chose AAIR. Hence, AAIR and DDDR pacing seem to be equally effective in BTS patients. In view of a considerable rate of high degree AV block during AAIR pacing, DDDR mode should be preferred for safety reasons. [source] Effects of sildenafil on pulmonary hypertension and exercise tolerance in severe cystic fibrosis-related lung disease,PEDIATRIC PULMONOLOGY, Issue 4 2006Gregory S. Montgomery MD Abstract Cystic fibrosis (CF) patients with advanced lung disease are at risk for developing pulmonary vascular disease and pulmonary hypertension, characterized by progressive exercise intolerance beyond the exercise-limiting effects of airways disease in CF. We report on a patient with severe CF lung disease who experienced clinically significant improvements in exercise tolerance and pulmonary hypertension without changing lung function during sildenafil therapy. Pediatr Pulmonol. © 2006 Wiley-Liss, Inc. [source] Does the addition of non-invasive ventilation during pulmonary rehabilitation in patients with chronic obstructive pulmonary disease augment patient outcome in exercise tolerance?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2010A literature review Abstract Background.,Non-invasive ventilation (NIV) during exercise in patients with chronic obstructive pulmonary disease (COPD) has been shown to increase exercise time and intensity. Feasibly then, NIV during pulmonary rehabilitation will enhance post-rehabilitation training effects. The purpose of this review is to systematically consider and critique the literature concerning the effects of NIV, when used during an exercise programme in COPD patients on exercise tolerance.,Method.,An electronic literature search was completed and the reference lists of the articles that fitted the following inclusion criteria were screened. Studies that used any mode of NIV during an exercise programme with a primary outcome measure focusing on exercise tolerance and were written after the year 2000 to reflect current practice. Studies that were not written in English or had been included in previous literature reviews were excluded. The studies were then critically appraised and assigned a level of evidence based upon Scottish Intercollegiate Guidelines Network.,Results.,Twenty-eight articles were screened, of which six fitted the inclusion criteria. The methodological quality ranged from level 1, to 1+. All but one study by Bianchi et al. (2002) demonstrated a statistically significant improvement in exercise tolerance with the addition of some form of NIV during pulmonary rehabilitation. The benefits may be greater in patients with more severe airway obstruction as determined by Forced Expiration Volume (FEV), (%pred).,Conclusion.,This review would suggest that NIV may allow an increased exercise intensity and duration during pulmonary rehabilitation in patients with moderate to very severe COPD, (according to the American Thoracic Society guidelines), resulting in a greater training effect and a prolonged exercise capacity. Further research looking at long-term follow-up is recommended. Copyright © 2009 John Wiley & Sons, Ltd. [source] BODE score is a useful predictor of hospital admission in rural patients with chronic obstructive pulmonary diseaseRESPIROLOGY, Issue 3 2008Alice MCKELLAR Background and objective: COPD is a chronic illness with frequent episodic exacerbations that require admission to hospital. The aim of this study was to identify risk factors (or predictors) for hospital admission in a sample of rural COPD patients. Methods: COPD patients from the Goulburn and Crookwell areas of New South Wales, Australia, were included in the study. Patients were divided into two groups: those with two or fewer admissions, and those with three or more admissions in the last year. Patient interviews were conducted, and data were collected on demographics, consumption of health resources, COPD severity measures (BODE score) and quality of life. Results: There were 32 patients recruited with a median age of 68 years, and 21 (65.6%) were male. There were no significant differences in risk factors (or predictors) identified between the two groups. A statistical difference was found between the two groups, with patients with three or more hospital admissions having a higher BODE score (P = 0.004), poorer quality-of-life score (P = 0.015) and reduced exercise tolerance (P = 0.001). Conclusions: In this small sample of COPD patients, there were no clear differences in terms of risk factors for COPD admission between the two groups. The BODE score was found to be a useful predictor of disease severity and likelihood of hospital admission. [source] Arteriolar network architecture and vasomotor function with ageing in mouse gluteus maximus muscleTHE JOURNAL OF PHYSIOLOGY, Issue 2 2004Shawn E. Bearden Physical diminishes with ageing, but little is known of how the microvascular supply to skeletal muscle fibres is affected. To test the hypothesis that ageing alters blood flow control, we investigated network architecture and vasomotor responses of arterioles in the gluteus maximus muscle of young (2,3 months), adult (12,14 months) and old (18,20 months) C57BL6 male mice (n= 83) (Young, Adult and Old, respectively). Microvascular casts revealed that the total number, length and surface area of arteriolar segments (diameter, 10,50 ,m) were not significantly different across age-groups. However, for arterioles with diameter of 30 ,m, tortuosity and branch angles increased with age (P < 0.05). In anaesthetized mice, second-order (2A) distributing arterioles had similar resting (17 ± 1 ,m) and maximal (37 ± 1 ,m) diameters and similar responsiveness to cumulative (10,10,10,4m) superfusion of acetylcholine or phenylephrine. With superfusate oxygen level raised from 0 to 21%, 2A arteriolar constriction in Young (11 ± 1 ,m) was greater (P < 0.05) than Adult and Old (5 ± 1 ,m). Observed 1 mm upstream from microiontophoresis of ACh (1 ,A, 1 s), conducted vasodilatation was 10 ± 1 ,m in Young, 17 ± 1 ,m in Adult and 6 ± 1 ,m in Old (P < 0.05). With muscle contractions (2, 4 and 8 Hz; 30 s) arteriolar diameter increased similarly across age-groups (6 ± 1, 11 ± 1 and 18 ± 1 ,m, respectively). Muscle mass and active tension were similar across age-groups yet postcontraction vasodilatation recovered more rapidly in Old versus Adult and Young (P < 0.05). With arteriolar network architecture maintained during ageing, the impairment in conducted vasodilatation and attenuation of postcontraction vasodilatation may compromise exercise tolerance. [source] THE CONUNDRUM OF CLAUDICATIONANZ JOURNAL OF SURGERY, Issue 10 2006Ramon L. Varcoe Stable claudication has traditionally been treated conservatively by many clinicians as operative therapies involve considerable risk for a condition that is often slowly progressive and non-fatal. The relative safety of less invasive endovascular techniques brings potential survival benefits from the increased exercise tolerance that result. We aimed to revisit and clarify the aetiologies of intermittent claudication in a review of the rarer causes that can mimic atherosclerotic occlusive disease. An extensive search of Medline, Embase and the Cochrane databases was carried out to compile published work addressing the aetiology of claudication and specific non-atherosclerotic causes. The reference lists of these manuscripts were also searched for relevant articles. There are several vasculogenic and neurogenic causes for intermittent claudication, many of which are unrelated to atherosclerosis. Recognition of these rarer syndromes is essential when planning endovascular or operative management strategies. Consideration of non-atherosclerotic differential diagnoses is recommended when assessing the patient with intermittent claudication. This is particularly critical in the young patient whose pattern of symptoms and risk factors may not fit precisely with atherosclerosis. [source] | ||||||||||||||||||||||||||||