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PubMed1989

Increased exercise tolerance and reduced electrocardiographic ischaemia 3 and 12 hours after oral felodipine in effort angina.

The antianginal properties and the duration of action of two doses of felodipine, a dihydropyridine calcium antagonist with a vascular:myocardial potency ratio approximating 100:1, were investigated in 15 patients suffering from disabling effort angina pectoris with reproducible exercise tolerance. Felodipine (5 mg, 10 mg) and placebo were administered once in the morning on three different days, with a 24 h interval between them, according to a double-blind 3 x 3 latin square design, 5 times replicated. Symptom-limited cycloergometric exercise tests were performed 3 and 12 h after administration. Duration of exercise to ST segment depression of 1 mm and to peak exercise was increased (all P less than 0.01) by both doses of felodipine in comparison with placebo. Twelve hours after administration, the 10-mg dose induced a significant improvement in the exercise time and a smaller ST segment depression (all P less than 0.01) in comparison with the 5-mg dose. The relationship between ST segment depression and the pressure-rate product during exercise was favourably influenced by the 10-mg dose at 3 and 12 h after intake, and by the 5-mg dose only at 3 h after intake. These findings suggest an increase in coronary blood flow induced by felodipine. Apart from mild headache there were no other unwanted effects. In conclusion, felodipine improves exercise tolerance and reduces electrocardiographic ischaemia for up to 12 h after single oral administration in patients with effort angina. Increasing the dose from 5 mg to 10 mg produces a more prolonged effect, with increased exercise tolerance 12 h after intake.

Administration, Oral↗
PubMed2003

Effects of a comprehensive cardiac rehabilitation program on quality of life and exercise tolerance in women: A retrospective analysis.

BACKGROUND: Currently, there are a lack of investigations that have examined the effect of participating in a comprehensive cardiac rehabilitation program on quality of life and physiological measures in women of different ages. The purpose of this investigation was to examine the effect of participating in a comprehensive cardiac rehabilitation program on quality of life, exercise tolerance, blood pressure and lipids in women between 33 and 82 years of age. METHODS: The 126 women participated in a 14-week cardiac rehabilitation program that consisted of 7 weeks of formal supervised exercise training and 7 weeks of unsupervised exercise and lifestyle modification. Physiologic and quality of life outcome measures obtained at the outset and after 14 weeks included: 1) exercise treadmill time; 2) resting and peak systolic and diastolic blood pressure; 3) total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol and Triglycerides; 4) Cardiac Quality of Life Index questionnaire. RESULTS: Significant improvements were found in the following quality of life measures after participating in the cardiac rehabilitation program: physical well being, psychosocial, worry, nutrition and symptoms. No significant differences were seen for any QOL variable between the different age groups. Significant improvements were seen in exercise tolerance (+21%) and high density lipoprotein (+5%). CONCLUSION: Cardiac rehabilitation may play an important role in improving quality of life, exercise tolerance and high density lipoprotein cholesterol levels in younger and older women with underlying cardiovascular disease.

Journal Article↗
PubMed1991

Effects of quinapril on exercise tolerance in patients with mild to moderate heart failure.

The objective of this double-blind, placebo-controlled, randomized multicentre study was to determine whether treatment with the new non-sulfhydryl angiotensin converting enzyme (ACE) inhibitor quinapril, as an addition to maintenance therapy with digitalis and/or diuretics, would improve exercise tolerance and patients' symptomatology over a treatment period of 3 months. Two hundred and twenty-five patients with mild to moderate heart failure were studied in four parallel treatment groups receiving either placebo or quinapril in a dose of 10, 20, or 40 mg day-1. Compared to placebo, quinapril therapy resulted in a significant improvement in exercise time. The improvement in exercise tolerance was dose-related and showed a significant increase at the end of the study in the patients who completed the trial and in an intent-to-treat analysis. Twenty-six patients were on monotherapy with quinapril without concomitant medication. In this subgroup of patients, the increase in exercise time was comparable to the subgroup of patients on diuretic treatment alone. After the 12-week study, 189 patients entered an open-label trial for 12 months, in which the dose of the ACE inhibitor could be adjusted according to clinical response. Despite a reduction in the daily dose of quinapril, the patients reached the same level of exercise capacity as in the 3-month study. No serious side effects were recorded, particularly no symptomatic hypotension or deterioration of renal function. The results of the study show that quinapril has a significant favourable effect on exercise tolerance and symptoms in patients with mild to moderate heart failure.

Administration, Oral↗
PubMed1990

Acute effects of nifedipine versus isosorbide dinitrate on exercise tolerance in patients with isolated coronary artery occlusion and collaterals.

The acute effects of slow-release nifedipine and isosorbide dinitrate on exercise tolerance were compared in nine patients with isolated total coronary artery occlusion showing retrograde filling via collaterals. All patients had a reproducible positive exercise stress test off medication before the study. Each patient was randomized to 10 mg slow-release nifedipine and 5 mg isosorbide dinitrate in a single-blind, cross-over study. The exercise stress test was performed 30 minutes after drug administration. After nifedipine, three patients had a negative exercise stress test, whereas the test was negative after isosorbide dinitrate only in one patient. A significantly higher exercise tolerance was detected at peak exercise after nifedipine than after isosorbide dinitrate, as shown by a longer exercise time (380 +/- 44 vs. 295 +/- 41 seconds, p less than 0.001), a more increased maximum work load (355 +/- 89 vs. 255 +/- 55 W x min, p less than 0.02), and a higher rate-pressure product (30,300 +/- 2,500 vs. 26,100 +/- 2,700, p less than 0.01). In conclusion, these results seem to suggest that nifedipine may have a vasomotor effect on collaterals, since it elevated the threshold of ischemia more than isosorbide dinitrate did in patients with isolated coronary artery occlusion, showing retrograde filling via collaterals.

Angina Pectoris↗
PubMed2005

Interatrial block during exercise tolerance tests as an additional parameter for the diagnosis of ischemic heart disease.

INTRODUCTION: Interatrial block (IAB; P-wave duration, >or=120 milliseconds) is associated with increases of left atrial pressure. We studied the use of IAB during exercise tolerance test (ETT) in diagnosis of ischemic heart disease. METHOD: Exercise tolerance tests were performed in 149 patients (mean age, 50 years; male, 60.4%). P-wave duration was measured at rest, at each stage of exercise using the Bruce protocol, and in recovery. As clinically indicated, 71 patients subsequently underwent nuclear stress test and/or catheterization. The evidence of ischemia (EOI) was considered present according to the more definite test, that is, catheterization over nuclear stress test over ETT. RESULTS: Among patients who did not have IAB at rest (n=115), 63 patients (54.7%) developed IAB during the ETT. The incidence of IAB during the ETT was higher in patients with EOI than patients without EOI (88.9% vs 51.9%, P=.03). When IAB during the ETT and positive ETT were used together to detect EOI, they were more accurate (86.1% vs 81.7%) than the ETT alone. Among patients with IAB at rest (n=34), patients with EOI had a higher incidence of P-wave duration increase of more than 20 milliseconds during the recovery period than patients without EOI (100% vs 21.8%, P=.015). When using P-wave duration increase of more than 20 milliseconds during the recovery period in conjunction with positive ETT, the sensitivity in detecting EOI was higher than using the ETT alone (100% vs 0%), but the specificity was worsened (68.8% vs 84.4%). CONCLUSION: New IAB and worsening of IAB during ETT appeared in patients with ischemic heart disease and may be used as additional parameters for the ETT interpretation.

Adult↗
PubMed2006

Exercise tolerance in children and adolescents with musculoskeletal pain in joint hypermobility and joint hypomobility syndrome.

OBJECTIVES: Musculoskeletal pain is a common complaint in a pediatric health care practice, but exercise tolerance has never been described in detail in these children. Our objectives for this study were to evaluate the maximal exercise capacity, including peak heart rate and oxygen consumption, of children with pain-related musculoskeletal problems, particularly in children with (symptomatic) generalized joint hypermobility and hypomobility, during a bicycle ergometry test to exhaustion; to evaluate muscle strength, bone mineral density, and sports activities in these children and to associate these observations with exercise capacity; and to compare these results with reference values. METHODS: Thirty-two children (mean age: 12.1 years; SD: 3.4 years; range: 6.2-20.1 years; 62% male) with musculoskeletal pain-related syndromes (joint hypermobility syndrome [n = 13] and joint hypomobility syndrome [n = 19]) participated. The reference group consisted of 117 healthy primary school prepubertal children, 167 healthy secondary school adolescents, and 98 young adults (249 girls and 133 boys; mean age total reference group: 14.5 +/- 4.0 years; range: 8-20.8 years). Anthropometry, range of joint motion, muscle strength, bone mineral density (speed of sound and broadband ultrasound attenuation), sports activities, and a maximal exercise test using an electronically braked cycle ergometer were performed, and the patient stopped because of volitional exhaustion. Expired gas analysis and heart rate and transcutaneous oxygen saturation by pulse oximetry measurements also were performed. RESULTS: Children with joint hypomobility syndrome as well as children with joint hypermobility syndrome had a higher mean z score (SD) of weight and BMI compared with the reference group. A significantly decreased absolute peak oxygen consumption and relative peak oxygen consumption in both patient groups was found compared with control subjects. In 14 of 32 children with a z score relative peak oxygen consumption of less than -2, maximal heart rate was significantly decreased compared with 18 children with a z score relative peak oxygen consumption of -2 or more (mean [SD] z score speed of sound: -1.3 [0.8] vs -0.5 [1.0] and mean [SD] heart rate: 175.9 [11.5] vs 187.5 [10.9], respectively). In the total group, a high significant correlation between the z score of relative peak oxygen consumption and the z score of the speed of sound was found as well as with z score of BMI. Sixteen (50%) of 32 participated in sports activities with (mean: 0.9 hours/week; SD: 1.4 hours/week), whereas in the control group, 12% of did not participate in sports activities (mean: 2.8 hours/week; SD: 2.2 hours/week). Children who participated in sports activities had a (borderline) significant increased mean (SD) z score of absolute peak oxygen consumption and mean (SD) z score of broadband ultrasound attenuation compared with children who did not participate in sports activities (-0.3 [1.1] vs -1.2 [1.3] and -0.45 [0.8] vs -0.9 [0.5], respectively). CONCLUSIONS: In children with musculoskeletal pain-related syndromes, particular in children with (symptomatic) generalized joint hypermobility and hypomobility, maximal exercise capacity is significantly decreased compared with age- and gender-matched control subjects. The most probable explanation for the reduced exercise tolerance in our patients is deconditioning.

Adolescent↗
PubMed2002

Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure.

OBJECTIVES: This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF). BACKGROUND: In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear. METHODS: We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization. RESULTS: Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01). CONCLUSIONS: Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.

Aged↗
PubMed1990

Respiratory centre sensitivity and exercise tolerance in healthy Thais.

To determine the range of normal values of respiratory centre sensitivity and exercise tolerance in Thais, 69 healthy subjects, 18 to 72 years of age, participated in a series of tests, i.e. ventilatory drive, ventilatory response, musculo-ventilation transfer and the two-minute walking test with rating of the breathing sensation on a visual analogue scale. Our results showed higher end-tidal Pco2 and tidal volume response to CO2 and less exercise tolerance in the elderly than in the young. Only in young males was the ventilatory response to CO2 higher than in females. No attempt has yet been made to explain the lower ventilatory response in Thais as compared with Americans. Apparently, the defective respiratory apparatus, viz. increased airways resistance and not the blunting of respiratory centre sensitivity, contributes principally to relative hypoventilation and exercise limitation in the elderly. The compensation, with high tidal volume response to CO2, seems ineffective in maintaining normo-ventilation.

Adolescent↗
PubMed2000

[Effect of L-arginine on platelet aggregation, endothelial function adn exercise tolerance in patients with stable angina pectoris].

AIM: Examination of the action of donor NO (L-arginine) on platelet aggregation, endothelial function and exercise tolerance in patients with stable angina of effort (SAE). MATERIAL AND METHODS: 42 patients with SAE (functional class I-II) and 10 healthy volunteers (control group) were assigned to two groups. 22 patients of group 1 were randomized to cross-over. They received cardiket (60 mg/day for 10 days or cardiket (60 mg/day) in combination with L-arginine (15 g/day for 10 days). 20 SAE patients of group 2 and control group received L-arginine (15 g/day for 10 days). In each group blood lipids were examined, and bicycle exercise test (BET) was performed. In addition, platelet aggregation and endothelial function were studied in group 2 and control group before and after the course of L-arginine. RESULTS: Compared to control group, endothelial function significantly improved in group 2 (from 5.0 +/- 2.9 to 7.8 +/- 4.1% vs 7.1 +/- 1.9 to 6.6 +/- 4.8%) (M +/- SD). BET duration increased in all the patients. After ADP addition in concentrations 1.5, 2.0, and 5.0 micromol/l platelet aggregation declined in 17 patients except 3 in whom the aggregation remained unchanged. CONCLUSION: Positive effect of L-arginine on endothelial function, exercise tolerance and platelet aggregation was observed in patients with stable angina of effort (functional class I-II). Therefore, arginine can be recommended as an adjuvant in the treatment of patients with ischemic heart disease.

Angina Pectoris↗
PubMed1990

[Effects of exercise tolerance on electrocardiogram (ECG) with emphasis laid on younger generation].

Effects of Exercise Tolerance on young healthy adults were studied. The results obtained were as follows. The subjects selected were non-smoking 100 volunteers aged 20 to 25 years old, without anamnesis in respiratory and circulatory systems. Exercise was conducted in an amount 3 times (test 1) or 4 times (test 2) of that in a going up and down test stipulated in the Master two step method. The results were subjected to determine changes in heart rate (HR) and ST, QT time, QT ratio and QX/QT immediately after and 5 minutes after tolerance, using ECG taken prior to the tolerance as a control. 1. Changes in each determination 1) Heart rate (HR) (HR before tolerance: 100%) Hardly any change was observed in test 1. But test 2 showed a marked increase in HR, that is 201.8% and 150.1% immediately after and 5 minutes after tolerance respectively. 2) ST change Test 2 showed ST changes of 0.4mm and 0.1mm immediately after and 5 minutes after tolerance respectively. 3) QT time and QT ratio Test 2 showed QT time of 0.29 sec. and 0.34 sec. immediately after and 5 minutes after tolerance respectively. The ratio tended to decrease as exercise tolerance increases, that is 0.92 and 0.98 in test 1 and 0.77 and 0.93 in test 2 immediately after and 5 minutes after tolerance respectively. 4) QX/QT Test 1 showed QX/QT of 0.48 and 0.49 immediately after and 5 minutes after tolerance respectively. Test 2 showed QX/QT of 0.44 and 0.47 immediately after and 5 minutes after tolerance respectively in ST change. 2. Correlation between HR and each determination HR was significantly correlated with ST changing, that is in test 2 r = -0.410 (p less than 0.01) immediately after tolerance (p less than 0.01). HR was significantly correlated with QT ratio, that is in test 1, r = -0.629, r = -0.653 and r = -0.553 control, immediately after and 5 minutes after tolerance respectively, and in test 2 r = -0.712, r = -0.708 and r = -0.785 control, immediately after and 5 minutes after tolerance respectively (p less than 0.01). 3. Correlation between HR-changing and ST-changing rate. Primary formula, that is, ST = -0.379 + 0.0174x (HR) was obtained in r = 0.672 (p less than 0.01), suggesting that ST-changing rate decreases as HR increases.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

Metabolic basis of improved exercise tolerance: muscle phosphorylase deficiency after glucagon administration.

A 26-year-old girl with muscle phosphorylase deficiency had exercise intolerance and experienced an occasional "second wind" phenomenon. Muscle glycogen concentration was about three times the normal level, whereas each glycolytic intermediate below the phosphorylase step was equivalent to only 10% of a normal level. Semi-ischemic forearm exercise tests disclosed no elevation of the venous lactate or pyruvate level, but they showed remarkable increases of serum creatine kinase and ammonia. Glucagon administration markedly augmented exercise tolerance. Forearm exercise after glucagon injection significantly increased venous lactate. Thus, the beneficial effect of glucagon is attributable to blood glucose utilization by muscle.

Adult↗
PubMed1980

Effects of varying concentrations of N2/O2 and He/O2 on exercise tolerance in man.

Hyperoxic gas mixtures improve exercise tolerance in humans. It is not clear whether this improvement is due to 1) a decreased anaerobiosis in the working cell, 2) a decreased cost of breathing resulting from the relative hypoventilation in hyperoxia, 3) the reduction of a possible metabolic depressant-N2, or a combination of these. This study made use of He/O2 breathing mixtures to gather data relative to #2 and #3, primarily. Ten subjects ran to exhaustion on a treadmill breathing one of four mixtures-20 O2/80 N2, 20 O2/80 He, 80 O2/20 N2, 80 O2/20 He. Running time to exhaustion, minute ventilation, respiratory frequency, tidal volume, and heart rate were measured. Performance increased significantly on hyperoxic mixtures (P < .001) and He/O2 mixtures (P < .001). Although the peak ventilatory volumes were higher on He/O2 mixtures, the ventilatory mass moved was significantly less (P < .001) on those mixtures conceivably resulting in a decreased cost of breathing. These data did not reject any of the hypotheses but offered the greatest support for hypothesis #2.

Adult↗
PubMed1996

Improvement in exercise tolerance and spirometric values in stable chronic obstructive pulmonary disease patients after an individualized outpatient rehabilitation programme.

OBJECTIVE: We sought to determine whether patients with stable chronic obstructive pulmonary disease (COPD) whose exercise performance is mainly limited by dyspnoea are able to improve their exercise tolerance after rehabilitation with an individualized programme based on aerobic training at the ventilatory threshold (VT) level. PATIENTS AND EXPERIMENTAL DESIGN: Thirteen stable and moderate to severe COPD patients took part in an outpatient rehabilitation programme lasting 4 months. This individualized programme consisted of exercise training (general training on cycle and upper-limb training by rowing at the heart rate corresponding to VT) together with provision of adequate calorie and protein support. RESULTS: Lung function test after rehabilitation revealed significant increases in FVC (82.9 vs 69.2 % pred) and FEV1 (47.2 vs 39.7 % pred), although FEV1/FVC were unchanged (44.8 vs 46.8%). Incremental exercise test performed on cycle revealed significant increases in time, work rate (82.0 vs 63.2 W), peak VO2 (14.6 vs 10.7 ml.kg-1.min-1), peak VO2 (840 vs 701 ml.min-1), peak VT (1309 vs 980 ml), and O2-pulse (8.3 vs 6.7). However, exercise tests were always symptom-limited by dyspnoea. CONCLUSIONS: We conclude that this individualized outpatient rehabilitation programme is able to improve exercise tolerance in stab le COPD patients affected by dyspnoea during exercise, through an apparent reconditioning of both skeletal and respiratory muscles and improved gas exchange during exercise, thus reducing the ratio of dead space to tidal volume. In consequence, patients whose exercise capacity is so reduced that they cannot develop significant lactic acidosis may reduce the ventilatory cost for exercise through this individualized therapy.

Aged↗
PubMed1981

[Exercise tolerance in angina patients 3 and 24 hours after administration of a new delayed-action preparation of metoprolol].

To assess the duration of improved exercise tolerance by metoprolol given in a new sustained-release formulation, 40 in-patients affected by stable exercise-induced angina pectoris received single-blind placebo in day 1 and thereafter, in double-blind cross-over once daily administration, metoprolol RETARD 100 mg and 200 mg in days 3 and 5. Symptom-limited cycloergometric exercise tests were performed at 3 and 24 hours after placebo and after each of the two doses of metoprolol RETARD. Duration of exercise, maximal workload and total work performed did significantly increase at 3 and 24 hours after metoprolol RETARD 100 mg (P less than 0.01) and 200 mg (P less than 0.01), without any significant difference between the two doses. Peak systolic arterial pressure and heart rate were lowered by metoprolol RETARD 200 mg at 3 (P less than 0.01) and 24 (P less than 0.01) hours, whereas only the peak heart rate at 3 hours was lowered (P less than 0.05) by the 100 mg dose. It is concluded that in patients with stable exercise-induced angina pectoris, metoprolol RETARD 200 mg appears to be able to increase exercise tolerance and to reduce exercise-induced myocardial oxygen consumption throughout 24 hours period. This may justify a once daily dosing schedule of the 200 mg dose, aimed at improving patient compliance.

Adult↗
PubMed1990

Isokinetic muscle strength predicts maximum exercise tolerance in renal patients on chronic hemodialysis.

Patients with end-stage renal disease receiving chronic hemodialysis have impaired exercise tolerance. To distinguish between a central cardiorespiratory and a peripheral skeletal muscular origin for this fatigue, we measured exercise performance and peak oxygen consumption during a maximum exercise test in 10 patients receiving chronic hemodialysis. Skeletal muscle function was measured with an isokinetic cycle ergometer and a Cybex II isokinetic dynamometer. Peak rates of oxygen consumption (17.7 +/- 3.6 [mean +/- SD] mL O2/kg/min), blood lactate concentrations (3.4 +/- 0.9 mmol/L), peak heart rates (168 +/- 12 beats/min), and rates of ventilation (37.3 +/- 14.6 L/min) were low, but respiratory exchange ratios (1.1 +/- 0.1) were compatible with maximal effort. There was a significant correlation between isokinetic muscle strength and VO2 peak, exercise duration, peak ventilation, and peak blood lactate concentrations (P less than 0.05 to less than 0.001), but not between hemoglobin concentration, total blood hemoglobin content, or hematocrit and these variables. Therefore, in renal dialysis patients, isokinetic muscle strength is a better predictor of exercise capacity than are variables determining blood oxygen carrying capacity. This suggests that altered skeletal muscle function explains the impaired exercise tolerance of anemic patients with end-stage renal disease receiving chronic hemodialysis.

Adult↗
PubMed1997

Out-patient rehabilitation improves activities of daily living, quality of life and exercise tolerance in chronic obstructive pulmonary disease.

The purpose of this study was to investigate the effects on activities of daily living, quality of life, and exercise tolerance of a comprehensive out-patient rehabilitation programme for patients with moderate-to-severe chronic obstructive pulmonary disease. In this randomized and controlled trial, the main outcome measures were Activities of Daily Living (ADL) score, York Quality of Life Questionnaire (YQLQ) score, Chronic Respiratory Disease Questionnaire (CRDQ) score, 6 min walking distance (6MWD), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). The rehabilitation programme included physical training, occupational therapy, education, and smoking cessation therapy, and lasted for 12 weeks. The patients were evaluated at entry, halfway through, and at the end of the programme. Follow-up was at 24 weeks. Forty seven patients were recruited, and 16 in each group completed the trial. There were significant differences in the improvements in ADL and CRDQ between the control and the treatment groups at 12 and 24 weeks, and at 24 weeks, respectively. At 6, 12 and 24 weeks, improvements in the 6MWD were 21.6 versus 79.8, 36.1 versus 113.1 and 21.4 versus 96.2 for control and treatment groups, respectively (p<0.004). A correlation matrix showed only ADL and 6MWD to be significantly correlated; the matrix was also used to validate the translated questionnaires. The programme required 124 staff-hours in total. An inexpensive, comprehensive out-patient rehabilitation programme can produce long-term improvement in activities of daily living, quality of life, and exercise tolerance in patients with moderate-to-severe chronic obstructive pulmonary disease.

Activities of Daily Living↗
PubMed1997

Non-invasive measurement of cardiac output and ventricular ejection fractions in chronic cardiac failure: relationship to impaired exercise tolerance.

1. The role of cardiac output limitation in the pathophysiology of exercise in patients with chronic failure remains undefined. During steady-state submaximal exercise, oxygen uptake is similar in patients and control subjects, but it is not known if cardiac output is also similar. We wished to determine if the reduced exercise tolerance of patients with chronic cardiac failure during such exercise is related to reduced cardiac output, or to peripheral factors. 2. Ten male patients with stable chronic failure and ten age-matched male normal controls were studied at rest and during exercise. Each subject performed a familiarization exercise test, a symptom-limited maximal exercise test and two submaximal exercise tests. Cardiac output was measured by a carbon dioxide rebreathing method. We also measured oxygen consumption, ventilation, Borg score of perceived exertion and venous lactate concentration, and ejection fractions. 3. As expected, patients had lower peak oxygen consumption [median (range) 1.18 (0.98-1.76) versus 1.935 (1.53-2.31) l/min; P < 0.001], lower peak venous lactate concentration but a similar overall level of perceived exertion. At the same submaximal workload, patients and control subjects had similar oxygen consumption [0.67 (0.59-0.80) versus 0.62 (0.52-0.82) l/min] and cardiac output [6.92 (5.79-9.76) versus 7.3 (5.99-10.38) l/min] but the patients had a greater perceived level of exertion [Borg score: 4 (1-6) versus 3 (1-5); P < 0.005], higher venous lactate concentration [1.6 (1-3.3) versus 1.14 (0.7-1.7) mmol/l; P < 0.05] and higher heart rate [106 (89-135) versus 87 (69-112) beats/ min; P < 0.005]. 4. During submaximal exercise at a similar absolute workload, patients with cardiac failure have a similar oxygen uptake and cardiac output but greater anaerobiosis and increased fatigue when compared with normal subjects. These findings appear to relate predominantly to changes that occur in the periphery rather than abnormalities of central cardiac function.

Adult↗