Effect of pulmonary diffusing capacity on exercise tolerance.
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Cell Respiration↗
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Effects of L-carnitine on exercise tolerance in chronic stable angina: a multicenter, double-blind, randomized, placebo controlled crossover study.
L-carnitine was studied in forty-four men with stable chronic angina in a multicenter, double-blind, randomized, placebo controlled crossover trial. A cycloergometer exercise test was performed after a 10-day wash-out with placebo and at the end of each 4-week treatment period with either L-carnitine (1 g twice daily) or placebo. The mean (+/- SD) exercise work load showed an increase after L-carnitine compared to placebo (102.73 +/- 22.23 and 97.05 +/- 22.77 watts respectively, p = 0.001), as did the watts to onset of angina (95.7 +/- 24.07 and 87.44 +/- 24.67, p = 0.000). On the contrary, the ST segment depression was reduced by L-carnitine compared to placebo both at the maximum work load (1.40 +/- 0.90 and 1.69 +/- 0.82 mm, p = 0.05) and at the maximum work load common to L-carnitine and placebo (1.24 +/- 0.90 and 1.66 +/- 0.79 mm, p = 0.005). 22.7% of the patients became free of angina with L-carnitine and 9.1% with placebo. Resting and exercise blood pressure, heart-rate and double product were unaffected by L-carnitine. 1 patient decided to discontinue the trial because of gastric pyrosis while taking the active drug. The results of this study show that treatment with L-carnitine increases exercise tolerance and reduces ECG indices of ischemia in stable effort-induced angina.
Angina Pectoris↗
[Acute effects of oral acebutolol on exercise tolerance in patients with stable angina pectoris (author's transl)].
Twelve patients affected by stable effort angina were included in a double blind, cross-over study of Acebutolol and Placebo; Acebutolol was orally administered in a dose of 200 mg. Each treatment was preceded by a basal exercise test and, after 120 min a second test was performed to evaluate the efficacy of the drug. Acebutolol produced a significant improvement of angina threshold (p less than 0.005); the amount of exercise necessary to induce 0.1 mV ST segment depression was significantly increased by Acebutolol (p less than 0.005). There was a significant reduction in the heart rate (HR) and in double product (DP) both at rest and at the maximal work performed; no significant change in the systolic blood pressure was observed. At the same level of work Acebutolol produced a significant reduction in the ST segment depression (p less than 0.05). However, when ST segment was evaluated at the same level of HR and DP, no difference was found between the drug and the placebo. It was concluded that Acebutolol induces a significant increase in exercise tolerance.
Acebutolol↗
Effects of clorazepate on breathlessness and exercise tolerance in patients with chronic airflow obstruction.
Five patients with severe chronic lung disease were given placebo or 7.5 mg of clorazepate, a benzodiazepine, at bedtime for two weeks using a double-blind cross-over study design. Exercise tolerance, arterial blood gases, pulmonary function tests, self-rated breathlessness, and self-administered depression and anxiety scores were similar during drug treatment, placebo treatment, and washout periods. Higher doses of clorazepate were not tolerated by three of five patients. Nonanxious patients with chronic lung disease seem not to benefit subjectively or objectively from a low-dose benzodiazepine regimen.
Aged↗
An investigation of nitric oxide metabolites during symptomatic myocardial ischaemia in relation to exercise tolerance test.
BACKGROUND: Nitric oxide (NO) plays a pivotal role in the pathophysiology of coronary heart disease (CHD). Low plasma concentrations of NO metabolites (nitrite and nitrate), the stable oxidation products of NO have been reported in patients with CHD but this is controversial. Plasma nitrite and nitrate concentrations during symptomatic myocardial ischaemia and in response to exercise in subjects with CHD have not been studied. We therefore measured plasma nitrite and nitrate concentrations in subjects before and after an exercise tolerance test (ETT). MATERIAL/METHODS: Plasma nitrite and nitrate concentrations were measured before and after an ETT in 24 subjects with symptomatic exercise-induced myocardial ischaemia (positive ETT) and in 27 subjects without exercise-induced myocardial ischaemia (negative ETT). RESULTS: Plasma nitrate concentrations were higher (p<0.002) before and after the ETT in subjects with a positive ETT (31.51+/-21.80 mol/L and 30.86+/-21.42 mol/L respectively) than in the subjects with a negative ETT (14.75+/-6.71 mol/L and 15.64+/-6.50 mol/L respectively). Plasma nitrite concentrations before and after the ETT were similar in both groups. Within each group, plasma nitrite and nitrate concentrations were not altered by exercise. CONCLUSIONS: Subjects with exercise-induced myocardial ischaemia have higher plasma nitrate concentration than subjects without exercise-induced myocardial ischaemia. This is consistent with either a compensatory or an inflammatory response of the vascular endothelium to endothelial damage. Symptomatic exercise-induced ischaemia is not associated with altered plasma NO metabolite concentrations.
Adult↗
Effects of long-term molsidomine treatment versus isosorbide dinitrate and placebo on exercise tolerance in stable angina.
A single-blind study (n = 59) was performed to assess the effect of long-term (4 week) orally administered molsidomine (2 mg 4 X daily), isosorbide dinitrate (10 mg 4 X daily), and placebo on exercise tolerance performed on the bicycle ergometer by patients with stable angina on effort and with significant coronary artery disease. Isosorbide dinitrate had similar effects to placebo, both failed to modify the pressure-rate product, the sustained work load, and the ST segment depression, but slightly decreased, although not significantly, the incidence of angina. Although not affecting the pressure-rate product and the mean blood pressure, molsidomine decreased significantly the ST segment depression (p less than .05). In conclusion, by markedly reducing preload and because of its long-lasting effect (up to 6 h), the new vasodilator drug molsidomine plays a useful role in the long-term management of stable angina on effort.
Angina Pectoris↗
Effects of magnesium orotate on exercise tolerance in patients with coronary heart disease.
In a pilot study at 14 patients with coronary heart disease (CHD) and left-ventricular dysfunction (left ventricular enddiastolic volume [LVEDV] > or = 100 ml), who actively participated in an ambulatory cardiac sports group, left ventricular endsystolic volume (LVESV), LVEDV and duration of exercise were analyzed by echocardiographic and ergometric tests. An initial workup was followed by a 4 week double blind treatment phase, in which magnesium orotate 3 x 1 g or placebo was given additionally to medication taken prior to the study. At the end of this phase a concluding workup was performed. Magnesium orotate decreased significantly (p = 0.016) LVESV, increased significantly (p = 0.035) EF, decreased in tendency (p = 0.054) LVEDV and increased significantly (p = 0.011) exercise duration. The study gives references to favourable effects of oral magnesium orotate to left ventricular function and exercise tolerance in patients with CHD.
Coronary Disease↗
[Physical exercise tolerance in heart surgery patients during decompensated metabolic acidosis].
Spiroergometric findings obtained before and in different periods (1 month to 8 years) after surgical correction were analyzed in 373 patients with congenital and acquired heart diseases. This allowed the patients to be divided into two groups in terms of their exercise tolerance in decompensated metabolic acidosis. The division should be used to assess the function of the oxygen transport system in cardiac surgical patients who have failed to achieve the "plateau" of oxygen uptake.
Acidosis↗
[The normalizing effect of ECG in exercise tolerance tests under molsidomine in different dosages (author's transl].
In 15 patients with coronary heart disease and typical ST-segment depression during and/or after increasing physical effort in supine cycloergometry the normalizing effect of different dosages of Molsidomine on the electrocardiogram under effort was investigated in 74 exercise tolerance tests. Already after application of 0,5 mg Molsidomine there was observed a significant positive effect in comparison to an identical workload without drug. The normalizing effect was further increased by raising the dosage ot 1 mg or 2 mg respectively. To the administration of 3 mg only 1 out of 10 patients in the trial responded with an additional normalizing effect on the ECG since the rest of the patients showed already normal ECGs on 2 mg. This dose relationship also was observed in the pressure-rate-product. There was a dose-dependent decrease from which we can conclude a relief of the working myocardium. Under effort without drug 13 of 15 patients complained about stenocardia. Under the same effort and under Molsidomine however there were no more of these complaints. Because of these results it is recommended to use 2 mg of Molsidomine as a dosage in daily routine. It is needed 2 or 3 times dialy since in previous investigations there was shown a long-lasting effect over more than 5 hours. 3 out of 15 patients showed side effects which were only weak headache or weak congestion in the head.
Aged↗
[Actions of standardized extracts of Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure].
Standardized extracts of Crataegus leaves and blossoms are said to have positive inotropic, positive dromotropic and negative bathmotropic effects. Clinical trials produce evidence for an improvement of symptoms in patients with congestive heart failure (NYHA II). In this trial the efficacy of a standardized extract of fresh Crataegus berries (Rob 10) on exercise tolerance and quality of life was studied in 88 patients. In a three-month placebo-controlled, randomized, double-blind trial these patients were treated with Rob 10 (3 x 25 drops daily). Total exercise time in bicycle ergometry was defined as primary efficacy variable, while quality of life (Minnesota Questionnaire), Dyspnea-Fatigue Index and the assessment of dyspnea by the patient on a visual analogous scale were chosen as secondary parameters. Investigations were performed after a two week placebo run-in period as well as 6 and 12 weeks after the onset of the study. Treatment with Rob 10 led to a increase of exercise time of 38.9 s vs placebo (95% confidence interval 5.7-72.1 s). Quality of life improved accordingly in favour of Rob 10. In the Minnesota Questionnaire, the total score fell by 31% (30.6 vs 44.1) under Rob 10 vs 18% (34.6 vs 42.4) under placebo. The Dyspnea-Fatigue Index demonstrated an increase of the total score of 12% (9.41 vs 8.37) vs 8% (8.92 vs 8.26) under administration of placebo. According to findings of the assessment of dyspnea by the patient, dyspnea decreased by 11% (50.5 vs 56.6 mm) vs 4% (54.8 vs 57.3 mm) under placebo. The present study proves the efficacy and safety of a standardized extract of fresh Crataegus berries (Rob 10) in patients with congestive heart failure (NYHA II) regarding the parameters evaluated.
Aged↗
[Heart size and left ventricular function in coronary artery disease: I. Heart size, exercise tolerance, cardiac output and filling pressures (author's transl)].
The possible relationship between the cardiac volume, as determined radiologically in the supine position in 119 patients with angiographically proven coronary artery disease, and the results of ergometry and balloon catheterization was investigated. There was no relationship between the heart size on the one side and the maximum exercise tolerance and the maximum cardiac output on the other, except for the fact, that these parameters tended to decrease with increasing heart size. This was especially true in patients with angina. The maximum cardiac output of patients with angina was always below the value of patients without angina but comparable heart size. Reduced cardiac output under exercise (exertional cardiac insufficiency) was present in 50% of patients with enlarged hearts but already in 22% of patients with heart volumes in the lower range of normal. The diastolic pulmonary artery pressure, determined under exercise, was the only parameter with a significant relationship to the heart size: The larger the heart size, the higher the diastolic pulmonary artery pressure. On the other hand: the diastolic pulmonary artery pressure at rest was abnormal with significant frequency only, when the heart was enlarged. Our data suggest, that the hemodynamics are determined by 2 factors: Myocardial scarring secondary to infarction and coronary insufficiency (ischemia). Of these two factors only the former influences cardiac size. Therefore, determination of the heart volume helps evaluating the respective role of these two factors in individual cases.
Adult↗
Exercise tolerance test in lung cancer patients: the relationship between exercise capacity and postthoracotomy hospital mortality.
To evaluate the significance of the blood lactate threshold as a predictor of postthoracotomy hospital mortality resulting from pulmonary complications, a 3-minute incremental exercise test was administered to 33 lung cancer patients who underwent thoracotomy between October, 1981, and May, 1984. The oxygen consumption/body surface area at an arterial lactate level of 20 mg/dl (VO2/BSA at La-20) was adopted as the blood lactate threshold. Age and pulmonary function parameters such as forced expiratory volume in one second (FEV1)/body surface area (BSA), FEV1/forced vital capacity, diffusing capacity for the carbon monoxide/lung volume, and maximum ventilatory volume/BSA revealed significant differences between patients with postthoracotomy pulmonary complications and those without such complications. However, there was no difference in pulmonary function test results between the surviving and deceased patients. In contrast, although VO2/BSA at La-20 did not differ between the patients with and without pulmonary complications, it differed significantly between the surviving and deceased patients. We concluded that postthoracotomy pulmonary complications depended on the severity of preoperatively associated pulmonary function disorders and that the blood lactate threshold expressed by VO2/BSA at La-20 was an important indicator of the risk of hospital mortality.
Aged↗
Effects of a single oral administration of Epanolol on exercise tolerance in patients with stable effort angina pectoris.
A single oral dosage of 100, 200 or 300 mg Epanolol or placebo was administered in a randomized double-blind, cross-over fashion to 12 patients with stable effort angina. Symptom limited bicycle ergometer tests were performed before and 2 and 8 hours after each drug administration. Spontaneous diurnal and day to day differences in exercise tolerance and related analyzed variables were not present; 48 hours after drug intake a carry-over effect of the previous Epanolol administration could not be demonstrated. At each dose level of Epanolol, 2 hours after drug intake, heart rate and rate pressure product at peak exercise fell while exercise duration rose significantly. After 8 hours these effects were less marked. No significant differences between the 3 dose levels were found. In the pooled data of the 3 Epanolol doses, systolic blood pressure at peak exercise and maximal ischemic ST segment depression during exercise were also significantly reduced after 2 hours, while total performed external work rose. The percentage increase in heart rate during exercise after Epanolol administration was similar to the control tests at lower exercise levels but was less marked during the later stages of the test. Heart rate after Epanolol intake was percentage wise more reduced at higher exercise levels. Plasma levels of Epanolol were lower 8 hours after drug administration than after 2 hours. There was no correlation between plasma levels of Epanolol and the observed changes of any of the exercise variables 2 hours after drug intake.
Administration, Oral↗
Angiographic localization of potential culprit coronary arteries in patients with interatrial block following a positive exercise tolerance test.
Interatrial block (IAB), denoted by P waves > or =110 ms, is believed to be associated with underlying ischemia, particularly with that of its principal interatrial conduction pathway, the Bachmann bundle. We investigated if there is an angiographic association of IAB on electrocardiograms at rest in patients who underwent cardiac angiography after a positive exercise tolerance test (ETT) result. Twenty-seven patients with IAB and 42 control patients without IAB on electrocardiograms at rest who had evidence of ischemia on cardiac angiography after ETT were identified. Coronary vessels that were angiographically most significantly stenosed (> or =70% occlusion indicating stenosis) were noted for statistical comparison (a p value <0.05 was considered statistically significant). Among patients with IAB, the right coronary artery was the predominant vessel to be affected, with > or =70% narrowing compared with the left, inclusive of the left main, left circumflex, obtuse marginal, and diagonal coronary arteries (58% vs 23%, p = 0.03). Right coronary artery lesions in patients with IAB were mostly in the proximal and mid portions (54% vs 25% for the entire left coronary artery, p = 0.02). No such difference was noted in control subjects. In conclusion, in patients with IAB at rest who have coronary heart disease, the right coronary artery is predominantly more significantly affected.
Aged↗
Significance of the exercise tolerance test.
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Cardiovascular Diseases↗
The influence of beta-adrenoceptor antagonists with and without partial agonist activity on exercise tolerance and muscle lactate production.
Epanolol is a beta-adrenoceptor antagonist with partial agonist activity, a property which could be useful in reducing the fatigue associated with beta blockers. In a double-blind, randomized, crossover study we have investigated the effects of metoprolol 100 mg b.d., epanolol 100 mg b.d., and epanolol 200 mg b.d. on blood pressure, heart rate, and exercise-induced fatigue in 10 hypertensive men. Fatigue was measured subjectively by the Borg rating scale and objectively by blood lactate concentrations. Resting and exercise heart rates were lower with metoprolol than with either dose of epanolol. Preexercise standing diastolic blood pressure was lowered by metoprolol, but there were no other treatment effects on blood pressure. Exercise-induced fatigue was not altered by any treatment, whether measured subjectively or objectively. These results do not support the hypothesis that partial agonist activity improves exercise tolerance in hypertensive patients treated with beta-adrenoceptor antagonists.
Adolescent↗
Interaction of indomethacin and nitroglycerin on hemodynamics and exercise tolerance in patients with angina pectoris.
The influence of indomethacin therapy on the circulatory and antianginal effects of nitroglycerin were studied in six patients with stable angina pectoris. Indomethacin 50 mg or identical placebo capsules were administered three times a day for 1 week each in a double-blind, random manner. Heart rate, blood pressure, and ST-segment depression were measured at rest and during exercise before and after the administration of 0.6 mg sublingual nitroglycerin during indomethacin and placebo therapy. Nitroglycerin lowered standing systolic blood pressure by 38 mm Hg during placebo therapy (p less than 0.001) and by 36 mm Hg during indomethacin therapy (p less than 0.001). This was accompanied by a reflex increase in heart rate (p less than 0.001) which was of similar magnitude during placebo and indomethacin therapy. The increase in exercise duration to the onset of angina post nitroglycerin was similar during placebo and indomethacin therapy (128 vs 84 s; NS). Similarly, the increase in the total duration of exercise post nitroglycerin was similar during placebo and indomethacin therapy. Reduction in ST-segment depression post nitroglycerin was more pronounced during placebo than indomethacin therapy, but did not achieve statistical significance. The results show that indomethacin did not modify the circulatory effects of nitroglycerin at rest or during exercise and did not attenuate the increase in exercise tolerance produced by sublingual nitroglycerin. Since indomethacin is a potent prostaglandin inhibitor, the findings indirectly suggest that the vasodepressor and antianginal effects of nitroglycerin are in all probability not mediated by prostaglandins.
Aged↗
Effects of chronic oral amiodarone on left ventricular function, ECGs, serum chemistries, and exercise tolerance in healthy dogs.
Amiodarone, a class III antiarrhythmic with beta-adrenergic blocking and antimuscarinic properties, has a wide spectrum of clinical use in humans. This study was conducted to establish the effects of a 25 mg/kg q12h loading dose and a 30 mg/kg q24h maintenance dose of amiodarone, each given PO for 3.5 weeks, on systemic arterial pressure, echocardiographic (ECHO) indices of left ventricular function, ECGs, exercise tolerance, and serum biochemistries in adult, clinically normal dogs. Means were calculated and were compared by analysis of variance with repeated measures. When a significant F statistic was identified, specific means were compared by Bonferroni's post hoc test. Body weight and heart rate (HR) decreased, and PQ, QT, and corrected QT (QTc) increased significantly (P < .05) for the weeks that the dogs received the loading dose, but all parameters returned to values the same as those in the pretest for the weeks when dogs received the maintenance dose. Serum activity of hepatic enzyme activities and cholesterol concentrations increased, and serum concentrations of thyroid hormones (triiodothyronine [T3] and thyroxine [T4]), phosphorous, and total carbon dioxide decreased. The changes in PQ, QT, and QTc are similar to those obtained previously, but the detailed ECG and ECHO observations have not been reported. A dose of 25 mg/kg q12h, but not 30 mg/kg q24h, is an appetite suppressant, and the lower dose produces neither ECG nor ECHO changes of clinical or toxicological significance in normal dogs.
Administration, Oral↗