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PubMed1998

Exercise training in heart failure: inpatient and outpatient considerations.

Exercise training has become increasingly important in the treatment of heart failure patients. It has long been known that the exercise tolerance of a patient with heart failure is related to his or her morbidity and mortality. Recently, it has been proved that exercise training improves cardiorespiratory function, functional status, and psychosocial status of heart failure patients. It is unknown whether these improvements will improve morbidity and mortality but quality of life appears to be enhanced. Subtle improvements in these areas may lead to a more satisfying and productive life for many heart failure patients. However, further investigation of the specific effects of such improvements is needed.

Ambulatory Care↗

PubMed1988

Effects of aerobic exercise training, age, and physical fitness on memory-search performance.

We investigated the effects of exercise training on memory performance. One group of 13 men (M = 42.92 years of age) participated in supervised aerobic exercise (jogging) three times a week for 12 weeks. A second group of 15 men (M = 43.67 years of age) performed anaerobic exercise (strength training) for the same period of time. Subjects' reaction time (RT) performance in a memory-search task was assessed both before (Time 1) and after (Time 2) the 12 weeks of exercise training. Results indicated that there was no significant change in memory-search performance over time as a function of exercise training. Analyses of the Time 2 RTs demonstrated that aspects of memory-search performance were related significantly both to subjects' initial (Time 1) level of fitness and to age, but not to the amount of change in fitness associated with aerobic exercise training over this 12-week duration in this age group.

Adult↗

PubMed2002

Effect of short-term exercise training on insulin sensitivity in obese and lean mares.

Twelve untrained aged mares were used to determine whether 7 days of light exercise improved peripheral tissue insulin sensitivity. Mares were divided into obese-exercised (n = 3), obese-sedentary (n = 3), lean-exercised (n = 3) and lean-sedentary (n = 3) groups. The exercised groups were worked at a trot to a heart rate (HR) of not more than 140 beats/min for 30 min in a round pen. Each group was subjected to 3 euglycaemic hyperinsulinaemic clamps: prior to exercise (P), 24 h following the seventh exercise training session (E) and 9 days postexercise training (PE). Prior to exercise training, the mares in the obese group were confirmed insulin-resistant compared to the mares in the lean group. There was no change in bodyweight or body condition in the obese or lean groups throughout the study. Glucose infusion rate (GIR) was higher (P<0.05) on E compared to P days in the obese-exercised and lean-exercised groups. Insulin sensitivity returned to pre-exercise values by 9 days postexercise in the obese-exercised and lean-exercised groups. The results of this study suggest that improvement in insulin sensitivity occurs in obese mares without a long interval of exercise training and in the absence of a change in bodyweight.

Animals↗

PubMed1993

Lower extremity muscle thickness during 30-day 6 degrees head-down bed rest with isotonic and isokinetic exercise training.

Muscle thickness was measured in 19 bed-rested (BR) men (32-42 year) subjected to isotonic (ITE, cycle ergometer) and isokinetic (IKE, torque ergometer) lower extremity exercise training, and no exercise (NOE) training. Thickness was measured with ultrasonography in anterior thigh--rectus femoris (RF) and vastus intermedius (VI), and combined posterior leg--soleus, flexor hallucis longus, and tibialis posterior (S + FHL + TP)--muscles. Compared with ambulatory control values, thickness of the (S + FHL + TP) decreased by 9%-12% (p < 0.05) in all three test groups. The (RF) thickness was unchanged in the two exercise groups, but decreased by 10% (p < 0.05) in the NOE. The (VI) thickness was unchanged in the ITE group, but decreased by 12%-16% (p < 0.05) in the IKE and NOE groups. Thus, intensive, alternating, isotonic cycle ergometer exercise training is as effective as intensive, intermittent, isokinetic exercise training for maintaining thicknesses of rectus femoris and vastus intermedius anterior thigh muscles, but not posterior leg muscles, during prolonged BR deconditioning.

Adult↗

PubMed2005

Ischemia-reperfusion-induced calpain activation and SERCA2a degradation are attenuated by exercise training and calpain inhibition.

The Ca2+-activated protease calpain has been shown to play a deleterious role in the heart during ischemia-reperfusion (I/R). We tested the hypothesis that exercise training would minimize I/R-induced calpain activation and provide cardioprotection against I/R-induced injury. Hearts from adult male rats were isolated in a working heart preparation, and myocardial injury was induced with 25 min of global ischemia followed by 45 min of reperfusion. In sedentary control rats, I/R significantly increased calpain activity and impaired cardiac performance (cardiac work during reperfusion = 24% of baseline). Compared with sedentary animals, exercise training prevented the I/R-induced rise in calpain activity and improved cardiac work (recovery = 80% of baseline). Similar to exercise, pharmacological inhibition of calpain activity resulted in comparable cardioprotection against I/R injury (recovery = 86% of baseline). The exercise-induced protection against I/R-induced calpain activation was not due to altered myocardial protein levels of calpain or calpastatin. However, exercise training was associated with increased myocardial antioxidant enzyme activity (Mn-SOD, catalase) and a reduction in oxidative stress. Importantly, exercise training also prevented the I/R-induced degradation of sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA)2a. These findings suggest that increases in endogenous antioxidants may diminish the free radical-mediated damage and/or degradation of Ca2+ handling proteins (such as SERCA2a) typically observed after I/R. In conclusion, these results support the concept that calpain activation is an important component of I/R-induced injury and that exercise training provides cardioprotection against I/R injury, at least in part, by attenuating I/R-induced calpain activation.

Animals↗

PubMed1998

Exercise training in the treatment of heart failure: what is achieved and how?

Exercise intolerance is present in most patients with left ventricular dysfunction. Factors affecting the central and peripheral circulation, ventilatory system and skeletal muscles limit the exercise capacity in varying degrees within each patient. Exercise training is now being applied with growing enthusiasm to patients with heart failure. Improvements in the peripheral circulation and skeletal muscle structure and function appear to account for the observed benefit in exercise tolerance after training. Exercise programmes in these patients should be initially conducted with close supervision and tailored to the individual patient.

Exercise↗

PubMed1998

The effect of exercise training intensity on thyroid activity at rest.

The influence of exercise training intensity on thyroid activity at rest was studied in male Wistar rats, weighting 114 g +/- 24 (mean +/- SD) at the beginning of the experiment. Animals were assigned to the following groups: untrained controls and rats trained on a treadmill at the speed of 20 m/min over a 5-week period with different intensities: 2 x 60 min weekly, 4 x 60 min, 6 x 20 min, 6 x 40 min and 6 x 60 min weekly. Thyroid peroxidase (TPO) and hepatic iodothyronine 5'-monodeiodinase (5'DI) activities as well as plasma thyroxine (T4), 3,3'5-triiodothyronine (T3) and 3,3'.5'-triiodothyronine (rT3) concentrations were determined. Training intensity was found to influence parameters under investigation. TPO activity was decreased in groups trained 240 min (4 x 60 min and 6 x 40 min) and 360 min (6 x 60 min) weekly in comparison to control, untrained group. Furthermore, a drop in T4 plasma concentration in all trained groups and a decrease in T3 plasma concentration in groups exercising for 120 min (2 x 60 min and 6 x 20 min) weekly, as compared to control, untrained rats, was found. Hepatic 5'DI activity and rT3 plasma concentration were not affected by training. Thus, exercise training in rats seems to elicit the fall in TPO activity and T4 plasma concentration at rest but without changing hepatic 5'DI activity and rT3 plasma concentrations. A decline in T3 plasma concentration, observed in rats trained with the lowest exercise intensities, cold be regarded as transitional effect in adaptation to chronic exercise.

Animals↗

PubMed1998

The effect of exercise training in cold on shivering and nonshivering thermogenesis in adult and aged C57BL/6J mice.

To understand the mechanisms of improvement of cold-induced heat production in aged mice following exercise training, the relative contributions of shivering and nonshivering thermogenesis to cold-induced metabolic responses were assessed in adult and aged C57BL/6J male mice, which inhabited sedentarily at room temperature, or were subjected either to a regimen of moderate intensity exercise training at 6 degrees C, or to sedentary repeated exposures to the same temperature. The main findings were that (1) aged mice had greater cold-induced nonshivering thermogenesis, but lower shivering than adult mice; (2) exercise training in a cold environment enhanced cold-induced nonshivering thermogenesis in adult mice, but suppressed it in aged animals; (3) exercise training in a cold environment increased shivering thermogenesis in both age groups, but this increase was much greater in aged mice; (4) the increase of cold-induced shivering thermogenesis was mainly responsible for increased cold tolerance in aged mice after exercise training in a cold environment.

Aging↗

PubMed1996

Effects of short-term exercise training and activity restriction on functional capacity in patients with severe chronic congestive heart failure.

Previous exercise training studies in patients with chronic congestive heart failure (CHF) were performed for periods lasting > 2 months, and effects of activity restriction on exercise induced-benefits were not systematically assessed. With one exception study, patients were not reported to be transplant candidates. In this random-order crossover study, effects of 3 weeks of exercise training and 3 weeks of activity restriction on functional capacity in 18 hospitalized patients with severe CHF [(mean +/- SEM) age 52 +/- 2 years; ejection fraction 21 +/- 1%; half of them on a transplant waiting list] were assessed. The training program consisted of interval exercise with bicycle ergometer (15 minutes) 5 times weekly, interval treadmill walking (10 minutes), and exercises (20 minutes), each 3 times weekly. With training, the onset of ventilatory threshold was delayed (p < 0.001), with increased work rate by 57% (p < 0.001) and oxygen uptake by 23.7% (p < 0.001). On average, there was a 14.6% decrease in slope of ventilation/carbon dioxide production before the onset of ventilatory threshold (p < 0.05), and ventilatory equivalent of carbon dioxide production by 10.3% (p < 0.01). At the highest comparable work rate (56 +/- 5 W) the following variables were decreased: heart rate (7.3%; p < 0.05), lactate (26.6%; p < 0.001), and ratings of perceived leg fatigue and dyspnea (14.5% and 16.5%; p < 0.001 each). At peak exercise, oxygen uptake was increased by 19.7% (p < 0.01) and oxygen pulse by 14.2% (p < 0.01). There was a correlation of baseline peak oxygen uptake and increase of peak oxygen uptake due to training (r = -0.75; p < 0.004). Independently of the random order, data after activity restriction did not differ significantly from data measured at baseline. Patients with stable, severe CHF can achieve significant improvements in aerobic and ventilatory capacity and symptomology by short-term exercise training using interval exercise methods. Impairments due to activity restriction suggest the need for long-term exercise training.

Chronic Disease↗

PubMed1997

Exercise training decreases the growth hormone (GH) response to acute constant-load exercise.

To assess the influence of exercise training on the growth hormone (GH) response to acute exercise, six untrained males completed a 20-min, high-intensity, constant-load exercise test prior to and after 3 and 6 wk of training (the absolute power output (PO) during each test remained constant x PO = 182.5 +/- 29.5 W). Training increased (pre- vs post-training) oxygen uptake (VO2) at lactate threshold (1.57 +/- 0.33 L.min-1 vs 1.97 +/- 0.24 L.min-1 P < or = 0.05). VO2 at 2.5 mM blood lactate concentration ([HLa]) (1.83 +/- 0.38 L.min-1 vs 2.33 +/- 0.38 L.min-1, P < or = 0.05), and VO2peak (3.15 +/- 0.54 L.min-1 vs 3.41 +/- 0.47 L.min-1, P < or = 0.05). Power output at the lactate threshold (PO-LT) increased with training from 103 +/- 28 to 132 +/- 23W (P < or = 0.05). Integrated GH concentration (20 min exercise + 45 min recovery) (microgram.L-1 x min) after 3 wk (138 +/- 106) and 6 wk (130 +/- 145) were significantly lower (P < or = 0.05) than pre-training (238 +/- 145). Plasma epinephrine and norepinephrine responses to training were similar to the GH response (EPI-pre-training = 2447 +/- 1110; week 3 = 1046 +/- 144; week 6 = 955 +/- 322 pmol.L-1; P < or = 0.05; NE pre-training = 23.0 +/- 5.2; week 3 = 13.4 +/- 4.8; week 6 = 12.1 +/- 6.8 nmol.L-1; P < or = 0.05). These data indicate that the GH and catecholamine response to a constant-load exercise stimulus are reduced within the first 3 wk of exercise training and support the hypothesis that a critical threshold of exercise intensity must be reached to stimulate GH release.

Adult↗

PubMed1998

Exercise training reduces myocardial lipid peroxidation following short-term ischemia-reperfusion.

PURPOSE: The purpose of these experiments was to test the hypothesis that endurance exercise training will reduce myocardial lipid peroxidation following short-term ischemia and reperfusion (I-R). METHODS: Female Sprague-Dawley rats (4 months old) were randomly assigned to either a sedentary control group (N = 13) or to an exercise training group (N = 13). The exercise trained animals ran 4 d.wk-1 (90 min.d-1) at approximately 75% V02max. Following a 10-wk training program, animals were anesthetized, mechanically ventilated, and the chest was opened by thoracotomy. Coronary occlusion was achieved by a ligature around the left coronary artery; occlusion was maintained for 5 min followed by a 10-min period of reperfusion. RESULTS: Although training did not alter (P > 0.05) myocardial activities of antioxidant enzymes (superoxide dismutase and glutathione peroxidase), training was associated with significant increase (P > 0.05) in heat shock protein (HSP72) in the left ventricle. Compared with controls, trained animals exhibited significantly lower levels (P < 0.05) of myocardial lipid peroxidation following I-R. CONCLUSION: These data support the hypothesis that exercise training provides protection against myocardial lipid peroxidation induced by short-term I-R in vivo.

Animals↗

PubMed2004

Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients.

OBJECTIVE: To determine whether exercise training in combination with metformin improves cardiovascular risk indices and insulin in comparison to metformin alone among HIV-infected patients. METHODS AND DESIGN: We conducted a prospective, randomized, 3-month study of HIV patients on stable antiretroviral therapy with hyperinsulinemia and fat redistribution. Subjects received metformin alone or metformin and exercise training consisting of 1 h of aerobic and resistance training three times a week. Cardiovascular parameters, including blood pressure and endurance during sub-maximal stress testing, body composition, strength, insulin and other biochemical parameters were determined. RESULTS: Thirty-seven patients were randomized and 25 subjects completed the study. Subjects receiving exercise training and metformin demonstrated significant decreases in median waist-to-hip ratio [-0.02 (-0.06, -0.01) (median (interquartile range) versus -0.01 (0.03, 0.02), P = 0.026], resting systolic [-12 (-20, -4) versus 0 (-11, 11), P = 0.012] and diastolic blood pressures [-10 (-14, -8) versus 0 (-7, 8), P = 0.001], increased thigh muscle cross-sectional area [3 (-3, 12) versus -7 (-11, 0), P = 0.015], and improved exercise time [3 (0, 4) versus 0 (-1, 1), P = 0.045] compared with subjects receiving metformin alone. Fasting insulin and insulin area under the curve decreased significantly more in the exercise and metformin group (P < 0.05). Lipids and resting lactate did not change significantly between treatment groups. CONCLUSIONS: These data demonstrate that exercise training in combination with metformin significantly improves cardiovascular and biochemical parameters more than metformin alone in HIV-infected patients with fat redistribution and hyperinsulinemia. Combined treatment was safe, well tolerated and may be a useful strategy to decrease cardiovascular risk in this population.

Adult↗

PubMed2005

Maximum oxygen uptake corrected for skeletal muscle mass accurately predicts functional improvements following exercise training in chronic heart failure.

BACKGROUND: Skeletal muscle mass and peak oxygen uptake are important predictors of functional status and outcome in patients with stable chronic heart failure. AIMS: To assess changes in skeletal muscle mass and peak oxygen uptake following an exercise training program. METHODS: Thirty-six patients with moderate stable chronic heart failure were randomly allocated to either a bicycle ergometer (bike) or functional electrical muscle stimulators (FES) applied to quadriceps and gastrocnemius muscles to be used daily for six weeks. Dual-energy X-ray absorptionometry (DEXA) scanning was performed before and after training along with symptom limited cardiopulmonary exercise test, quadriceps strength and fatigue resistance, and 6-min walk test. RESULTS: Both exercise modalities resulted in improvements in treadmill exercise time, leg strength, 6-min walk test and peak oxygen uptake per kilogram of skeletal muscle. Despite significant improvements in functional capacity, there were no significant changes in body composition for total skeletal muscle mass, leg muscle mass or total body fat content. Skeletal muscle mass was strongly predictive of maximum oxygen uptake at baseline (r=0.61, p<0.001) and after exercise training (r=0.68, p<0.001). CONCLUSIONS: In moderate stable chronic heart failure, exercise training using bicycle ergometer or FES results in favourable qualitative rather than quantitative changes in skeletal muscle. Correction of maximum oxygen uptake for skeletal muscle mass rather than total body mass is a more sensitive measure of changes associated with exercise training.

Absorptiometry, Photon↗

PubMed1999

Drink composition, voluntary drinking, and fluid balance in exercising, trained, heat-acclimatized boys.

This study examined the effects of beverage composition on the voluntary drinking pattern, body fluid balance, and thermoregulation of heat-acclimatized trained boys exercising intermittently in outdoor conditions (wet bulb globe temperature 30.4 +/- 1.0 degreesC). Twelve boys (age 13.4 +/- 0.4 yr) performed two 3-h sessions, each consisting of four 20-min cycling bouts at 60% maximal aerobic power alternating with 25-min rest. One of two beverages was assigned: unflavored water (W) or flavored water plus 6% carbohydrate and 18 mmol/l Na (CNa). Drinking was ad libitum. Total intake was higher (P < 0.05) during CNa (1,943 +/- 190 g) compared with W (1,470 +/- 143 g). Euhydration was maintained with CNa (+0.18% body wt), but a mild dehydration resulted with W (-0.94% body wt; P < 0.05). Sweat loss, much higher than previously published for children of similar age, was similar between conditions (CNa = 1,644.7 +/- 117.5; W = 1,750.2 +/- 152.7 g). The increase in rectal temperature (CNa = 0.86 +/- 0.3; W = 0.76 +/- 0.1 degreesC), heart rate, and all perceptual variables did not differ between conditions. In conclusion, a flavored carbohydrate-electrolyte drink prevents voluntary dehydration in trained heat-acclimatized boys exercising in a tropical climate despite their large sweat losses. Because hydration changes were minor, the thermoregulatory strain observed was similar between conditions.

Acclimatization↗

PubMed1985

Endurance exercise training. An effective therapeutic modality for hemodialysis patients.

These results demonstrate that some of the metabolic complications of chronic uremia treated with maintenance hemodialysis are related to the deterioration in physical fitness and strength that accompanies this chronic disease. Exercise training increased the physical work capacity, improved the lipid profile, normalized insulin sensitivity and glucose metabolism, and lowered the dose of antihypertensive medications required by some of the patients. These changes occurred in the absence of significant changes in diet or body weight. Furthermore, during an equivalent period of follow-up there was a significant deterioration in the lipid profiles of sedentary controls. Thus, exercise training has the potential to reduce the prevalence of many of the medical conditions thought to promote atherogenesis in hemodialysis patients. In addition, there was a significant improvement in the degree of anemia of the exercising patients. None of these metabolic and physiological changes could be attributed to factors related to changes in dialysis scheduling or technology, medications, or diets. Exercise training was associated with an improvement in the mood, level of depression, and psychosocial functioning of these patients; the sedentary controls either became more depressed or reduced their participation in pleasant, socially oriented activities. This raises the possibility that exercise training may have the potential to return some dialysis patients to a more normal social lifestyle, perhaps improving their socioeconomic status and reducing their dependency. These are extremely optimistic possibilities that could have far-reaching implications for the hemodialysis population. The dramatic improvements in lipid and glucose metabolism, hematologic function, blood pressure and work capacity in the exercising patients indicates that aerobic physical training is an effective therapeutic modality with a wide spectrum of effects on many pathologic processes previously thought to be a consequence of chronic uremia. Not only were there major biochemical changes as a result of exercise training, but the psychosocial functioning of these dialysis patients improved. Some of the physiologic changes, such as the increase in work capacity, greater strength and energy, and the rise in hematocrit, contributed to the psychological improvements, but in some patients accomplishing the goal itself (for most a 1-mile jog was the ultimate) seemed sufficient. There are a multitude of potential long-term benefits of exercise training programs for hemodialysis patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2004

Role of exercise training on cardiovascular disease in persons who have type 2 diabetes and hypertension.

Exercise training is an essential component in the medical management of patients who have type 2 diabetes and hypertension. Regular exercise improves the cardiovascular health of individuals who have these conditions through multiple mechanisms (Fig. 1). These mechanisms include improvements in endothelial vasodilator function,left ventricular diastolic function, arterial stiffness.systematic inflammation, and reducing left ventricular mass. Exercise training also reduces total and abdominal fat, which mediate improvements in insulin sensitivity and blood pressure, and possibly, endothelial function. Persons who are in a prediabetic stage or those who have the metabolic syndrome may be able to prevent or delay the progression to overt diabetes by adopting a healthier lifestyle, of which increasing habitual levels of physical activity isa vital component. Most persons who have diabetes and hypertension or are at risk for these conditions should be able to initiate an exercise program safely after appropriate medical screen-ing and the establishment of an individualized exercise prescription. Despite the increasing amount of evidence that shows the benefits of exercise training, this modality of prevention and treatment continues to be underused. Although patients' lack of knowledge of the benefits of exercise or lack of motivation contributes to this underuse, a lack of clear and specific guidelines from health care professionals also is an important factor. Clinicians need to educate patients about the benefits of exercise for managing their type 2 diabetes and assist in formulating specific advice for increasing physical activity. Specific instructions should be given to patients, rather than general advice, such as "you should exercise more often." Many cardiac re-habilitation and clinical exercise programs can accommodate patients who have type 2 diabetes and hypertension. Such programs can establish individualized exercise prescriptions and provide an environment that is conducive for "lifestyle change" that underlies long-term compliance to exercise and risk factor modification.

Cardiovascular Diseases↗

PubMed1997

Exercise training in aging: hemodynamic, metabolic, and oxidative stress evaluations.

The effects of exercise training on hemodynamic and metabolic parameters as well as on responses to oxidative stress in aged individuals are controversial. The aim of the present study was to investigate changes in heart hate, mean arterial pressure, vasoreactivity, and plasma levels of insulin and glucose in male aged Wistar rats submitted to exercise training for 11 weeks (1 h/d; 5 d/wk) in a treadmill. The isolated heart was perfused by H2O2, and oxidative stress was evaluated using thiobarbituric acid reactive substances. Cardiovascular functions were recorded with a data acquisition system (CODAS, 1 kHz). Trained aged rats were bradycardic as compared with sedentary aged rats (298+/-7 versus 336+/-16 bpm) but presented similar mean arterial pressure and vasoreactivity and plasma levels of insulin and of glucose, which were quantified by radioimmunoassay and colorimetric enzymatic test. Plasma levels of insulin and of glucose ratio were increased in trained aged rats (6.9+/-0.7 versus 3.5+/-0.4 in sedentary aged rats), and the response to oxidative stress was decreased (0.4+/-0.1 versus 0.7+/-0.1 nmol/mg protein in sedentary aged rats). These results showed that exercise training produced a lower resting heart rate as well as changes in metabolic and oxidative responses. This suggests a higher myocardium protection of trained than sedentary aged rats.

Aging↗

PubMed2003

Differential effects of exercise training on skeletal muscle SERCA gene expression.

INTRODUCTION: Exercise training induces significant changes in the performance of skeletal muscle. PURPOSE: To determine whether changes in the gene expression of rat hind-limb muscle sarcoplasmic reticulum Ca2+ -ATPase isoforms (SERCA1a and SERCA2a) in response to either moderate- or high-intensity exercise training underlie the functional remodeling. METHODS: SERCA1a and SERCA2a isoform mRNA expression was determined in predominantly fast-twitch, gastrocnemius muscle and predominantly slow-twitch, soleus muscle with northern analysis. SERCA mRNA was normalized by the 18S rRNA measured in the same sample. RESULTS: Significant increases in the gastrocnemius SERCA2a mRNA expression were observed after both moderate- and high-intensity training. No significant change in SERCA1a expression was found under any conditions. CONCLUSION: These results indicate that both moderate and high intensity exercise increase the relative SERCA2a expression in the gastrocnemius.

Animals↗