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PubMed2006

[Improved exercise tolerance can be achieved in chronic obstructive pulmonary disease (COPD) by means of non-pharmacological treatment].

A 67-year-old man with severe COPD and a 56-year-old woman with very severe COPD were dyspnoeic during even mild exercise, so that they could no longer take care of themselves properly. The man followed a rehabilitation programme aimed at restoration of his physical condition and self-confidence and optimisation of his nutritional status. The woman was subjected to surgery to reduce her lung volume. Both were subsequently able to live independently. During the past decade, considerable attention has been given to the non-pharmacological treatment of patients with COPD. Together with optimal pharmacotherapy, COPD can be effectively treated by rehabilitation, lung volume reduction surgery and lung transplantation. Clinically relevant improvements can be achieved in both exercise capacity and quality of life. The clinical condition, lung function and radiological findings guide the choice of treatment in each individual.

Activities of Daily Living↗
PubMed1993

Assessment of exercise tolerance in chronic bronchitis and interstitial lung disease.

Cardiopulmonary exercise testing has a definitive place in objective evaluation of the subjective sensation of breathlessness. In the present study 21 patients with COPD, 10 with ILD and 17 normals were subjected to stage 1 exercise testing and correlations were sought between Vo2 and work, FVC, FeV1, Ve, respiratory rate and tidal volume and between VCO2 and work. In COPD and ILD the Vo2 correlated with work, Fev1, Fvc and Ve whereas in normals it correlated with the VE but not with the FeV1 and FVC. In COPD VO2 correlated with TV though this was not the case in ILD. Thus stage 1 exercise testing can be a useful additional method to assess the disability in COPD and ILD although differentiation between these two respiratory diseases on basis of exercise testing alone may not be possible.

Adult↗
PubMed1996

Exercise tolerance in patients with mitral stenosis before and after acute percutaneous mitral valvuloplasty. Role of lung diffusing capacity limitation?

The aim of this study was to specify in patients with tight mitral stenosis whether lung diffusing capacity could play a role in their exercise intolerance. A similar study was recently carried out in patients with moderate chronic heart failure. Ten patients with tight mitral stenosis were studied before and 6 months after successful percutaneous transvenous balloon valvuloplasty and compared to six control subjects. Measurements of diffusing capacity, evaluated by the lung transfer factor (TLCO) and by the transfer coefficient (TLCO/VA), obtained at rest and during early recovery after cardiopulmonary exercise testing were performed. Cardiac output was determined non-invasively, both at rest and during exercise, using the carbon dioxide exponential rebreathing technique. Prior to valvuloplasty, TLCO and TLCO/VA were not different at rest between the two groups. During exercise, patients differed from control subjects, with lower oxygen uptake (P < 0.001) and lower cardiac output at peak exercise (P < 0.001). These values at peak exercise were significantly correlated (P = 0.02; r = 0.75). Moreover, patients differed from control subjects at early recovery after peak exercise with an absence of increase in TLCO (P < 0.05). Six months after valvuloplasty, a decrease of both TLCO (P < 0.01) and TLCO/VA (P < 0.05) was observed at rest. During exercise, comparison of patients demonstrated a significant increase of both peak exercise oxygen uptake (SLVO2, P < 0.01) and cardiac output (P < 0.001). At early recovery after peak exercise there was a significant increase in TLCO (P < 0.05) and TLCO/VA (P < 0.01), such that a delta TLCO and a delta TLCO/VA appeared (P < 0.05) identical to that observed in control subjects. Moreover, delta SLVO2 was significantly correlated in patients with delta Q+ delta TLCO/VA (P = 0.02; r = 0.72). In conclusion, this study suggests a role, at least partial, of lung diffusing capacity in exercise intolerance in patients with tight mitral stenosis and in the improvement of their aerobic exercise capacity demonstrated after successful percutaneous balloon valvuloplasty.

Adult↗
PubMed2000

Ventilatory capacity and exercise tolerance in patients with chronic stable heart failure.

BACKGROUND: Patients with chronic heart failure complain of breathlessness. This is associated with an increase in the ventilatory response to carbon dioxide production (VE/VCO(2) slope), yet a reduction in the maximal ventilation achieved at peak exercise. We analysed ventilatory capacity in heart failure in relation to exercise capacity. METHODS: We analysed data from 74 patients with chronic stable heart failure [age (S.D.) 50.6 (8.8) years; left ventricular ejection fraction 30 (15)%] and 36 controls [48.9 (11.5) years]. Subjects undertook maximal incremental exercise testing with metabolic gas exchange measurements to derive peak oxygen consumption (VO(2)), the VE/VCO(2) slope and ventilation. Spirometry was used to measure FEV(1) and FVC. Maximal voluntary ventilation (MVV) was calculated as FEV(1)x 35. RESULTS: Peak VO(2) was lower in patients [20.9 (7.5) ml min(-1) kg(-1) vs. 34.5 (10.1); P<0.001] and VE/VCO(2) greater [33.4 (10.7) vs. 26.0 (4.7); P<0.001]. Ventilation at peak exercise was lower in patients [63.5 (20.4) l/min vs. 86.9 (29.5); P<0.001], as was MVV [110.1 (37.9) l/min vs. 136.2 (53.1); P<0.001], but ventilation at peak as a proportion of MVV was the same in patients [60.0 (19.0)%] as controls [65.7 (12.4)%)]. There was an inverse relation between peak VO(2) and VE/VCO(2) slope (r=-0. 62; P<0.001). Percentage predicted FEV(1) correlated with ventilation at peak (r=0.62; P<0.001) and inversely with VE/VCO(2) slope (r=-0.32; P<0.001). There was no relation between percentage of MVV achieved and peak VO(2), or VE/VCO(2) slope. CONCLUSIONS: Although ventilation at peak exercise is lower in patients with heart failure than normal subjects, ventilation is the same proportion of maximal voluntary ventilation. These findings suggest that ventilatory capacity does not limit exercise capacity in heart failure.

Adult↗
PubMed1993

The effect of the angiotensin converting enzyme inhibitor, enalapril, on exercise tolerance and abnormalities of limb blood flow and respiratory function in patients with severe heart failure.

Ten patients with severe (NYHAIII) heart failure were compared with 10 age-matched healthy subjects in terms of oxygen uptake and minute ventilation at rest and during exercise and calf and forearm blood flow measured by venous occlusion plethysmography at rest and after a standardized exercise test. Patients performed a symptom-limited treadmill exercise test and were then treated with enalapril for 5 weeks; the various measurements were repeated at weekly intervals. Oxygen consumption (VO2) at rest was similar in the patients and controls. During exercise, patients VO2 tended to be lower at each workload, but this was not affected by enalapril treatment. Minute ventilation was higher at rest and at each exercise stage in the patients than in the control subjects, and this was significantly reduced by enalapril treatment. Compared with the controls (2.94 +/- 0.10 and 2.93 +/- 0.20 ml.100 ml-1.min-1) forearm and calf blood flow measured by venous occlusion plethysmography was reduced at rest in the patients (1.34 +/- 0.18 and 1.24 +/- 0.11 ml.100 ml-1.min-1). but was significantly increased by enalapril treatment (1.73 +/- 0.15 and 1.60 +/- 0.16 ml.100 ml-1.min-1). Submaximal leg exercise to a fixed VO2 showed attenuation of the normal vasoconstriction in the forearm and vasodilatation of the calf; enalapril treatment changed these responses significantly towards normal but a marked abnormality of flow pattern persisted.

Aged↗
PubMed1987

Effects of exercise tolerance, age, and gender on the specificity of radionuclide angiography: sequential ejection fraction analysis during multistage exercise.

We investigated the factors that determine the left ventricular ejection fraction response to exercise in 57 middle-aged, untrained patients with angiographically normal coronary arteries. The ejection fraction was measured by blood pool radionuclide angiography during each stage of exercise. Stepwise regression analysis was applied to 39 variables, and the resulting significant variables were then included in a logistic regression model to determine which of them would predict a normal ejection fraction response. By stepwise regression analysis, the best model (F = 5.6, p = 0.0004) was obtained by combining four variables: achieving 85% of maximal predicted heart rate, peak heart rate, number of exercise stages performed, and resting pulse pressure. Only the latter two variables were significant by logistic regression analysis. The specificity of greater than or equal to 5 ejection fraction unit increase at peak exercise was 42%, 75%, and 100% in patients who exercised one, two, or three stages, respectively. Furthermore, the increase in ejection fraction during each exercise stage was independent of age or gender. Thus the standard criteria of normality during exercise radionuclide angiography have high specificity only when applied to patients with good exercise performance, regardless of age or gender.

Adult↗
PubMed1997

William Heberden revisited: postprandial angina-interval between food and exercise and meal composition are important determinants of time to onset of ischemia and maximal exercise tolerance.

OBJECTIVES: This study aimed to explore the hemodynamic responses to ingestion of meals of different composition in patients with chronic stable angina and to assess the effect of these meals on time to onset of > 1-mm ST segment depression and limiting angina pectoris during exercise. BACKGROUND: To our knowledge, no study has assessed the effect of meal composition and timing of exercise in patients with coronary artery disease. METHODS: Fifteen patients with chronic stable angina visited our laboratory in the fasted state on three occasions. Measurements of cardiac output, heart rate and blood pressure were taken while patients were standing. A modified Bruce exercise test was then carried out, during which time to onset of > 1-mm ST segment depression and limiting chest pain were recorded. Patients then ate a 2.5-MJ high fat or high carbohydrate meal; on the third occasion, no meal was taken. At 30 min and 1 h after eating the meals, rest hemodynamic measurements and exercise tests were repeated. RESULTS: The high fat meal did not affect exercise variables, whereas the high carbohydrate meal resulted in a reduction in time to onset of ST segment depression of 74.4 +/- 22.2 s (mean +/- SEM) during exercise at 30 min (p < 0.01), and at both 30 and 60 min after the high carbohydrate meal, limiting chest pain occurred 50 to 90 s earlier than when patients fasted (p < 0.01). CONCLUSIONS: One hour after a high carbohydrate meal, the onset of angina during exercise occurs earlier than in the fasted state. Despite similar hemodynamic adjustments, a high fat meal does not affect exercise time.

Aged↗
PubMed2005

Safety and exercise tolerance of acute high altitude exposure (3454 m) among patients with coronary artery disease.

OBJECTIVES: To assess the safety and cardiopulmonary adaptation to high altitude exposure among patients with coronary artery disease. METHODS: 22 patients (20 men and 2 women), mean age 57 (SD 7) years, underwent a maximal, symptom limited exercise stress test in Bern, Switzerland (540 m) and after a rapid ascent to the Jungfraujoch (3454 m). The study population comprised 15 patients after ST elevation myocardial infarction and 7 after a non-ST elevation myocardial infarction 12 (SD 4) months after the acute event. All patients were revascularised either by percutaneous coronary angioplasty (n = 15) or by coronary artery bypass surgery (n = 7). Ejection fraction was 60 (SD 8)%. beta blocking agents were withheld for five days before exercise testing. RESULTS: At 3454 m, peak oxygen uptake decreased by 19% (p < 0.001), maximum work capacity by 15% (p < 0.001) and exercise time by 16% (p < 0.001); heart rate, ventilation and lactate were significantly higher at every level of exercise, except at maximum exertion. No ECG signs of myocardial ischaemia or significant arrhythmias were noted. CONCLUSIONS: Although oxygen demand and lactate concentrations are higher during exercise at high altitude, a rapid ascent and submaximal exercise can be considered safe at an altitude of 3454 m for low risk patients six months after revascularisation for an acute coronary event and a normal exercise stress test at low altitude.

Aged↗
PubMed1992

[Enalapril improves hemodynamics and exercise tolerance in pulmonary heart disease caused by obstructive lung disease].

Chronic enalapril therapy was assessed in 11 patients with cor pulmonale due to chronic obstructive pulmonary disease. Enalapril was added to the maintenance dose of diuretics and digitalis and when clinical stabilisation was achieved haemodynamics, spirometry, blood gases and maximal treadmill exercise test accompanied by +pulse oximetry were performed before and after 30 days, 10-20 mg a day, enalapril therapy. Haemodynamic study showed moderate but significant decrease in mean pulmonary artery pressure, from 24 +/- 3 to 21 +/- 5 mmHg (p = 0.05). There were no substantial differences in cardiac output as well as in blood gases and spirometry after enalapril therapy. Slight decrease in oxygen delivery, on an average from 9157 +/- 3808 to 8074 +/- 3574 (p = NS), was accompanied by a concomitant fall in haemoglobin. We noted significant improvement of maximal exercise test results after enalapril therapy. Maximal workload achieved and the time of exercise increased. It was accompanied by subjective improvement as assessed by Borg scale. We observed no adverse effects of enalapril during one month therapy in patients with cor pulmonale and COPD.

Aged↗
PubMed2002

The relationship between genotype and exercise tolerance in children with cystic fibrosis.

The relationship between fitness and genotype in children with cystic fibrosis (CF) and at least one copy of the DeltaF508 mutation was examined. Genotype was classified according to the second CF mutation. Fitness was measured by peak aerobic capacity (using a modified Bruce protocol during treadmill exercise) and anaerobic power (using the Wingate test on a cycle ergometer). The class of cystic fibrosis transmembrane regulator proteins (CFTR) mutation was statistically related with aerobic capacity, peak anaerobic power, body mass index, lung function (forced expiratory volume in one second), and disease severity as measured by the Shwachman score. Patients with mutations causing defective CFTR production (Class I) or processing (Class II) had a significantly lower peak aerobic capacity (28.6 +/- 4.2 ml/kg/min and 31.7 +/- 5.4 ml/kg/min, respectively) than those with a mutation conferring defective regulation of CFTR (Class III) (43.9 +/- 6.4 ml/kg/min). The peak anaerobic power in subjects with mutations inducing decreased CFTR conduction (Class IV) or CFTR mRNA (Class V), were significantly higher (11.4 +/- 1.7 and 11.6 +/- 1.5 watts/kg, respectively) than children with Class I (9.7 +/- 1.4 watts/kg), Class II (9.8 +/- 1.4 watts/kg), or Class III (10.5 +/- 1.8 watts/kg) mutations. There were no statistically significant differences in the lung function of patients with the different mutations. These results indicate a relationship between CF genotype and some measures of fitness, the mechanisms of which remain to be determined.

Adolescent↗
PubMed2005

Effects of L-carnitine on thyroid hormone metabolism and on physical exercise tolerance.

L-carnitine (CARN) is a water-soluble, naturally occurring quaternary amine ubiquitous in biological fluids and animal tissues; in these tissues, CARN plays an important role in energy metabolism. Skeletal muscles store about 95 % of a total of 20 g CARN contained in the adult human body, but high-intensity physical exercise decreases the CARN muscle content. The daily allowance of CARN is mainly satisfied by diet. Keeping in mind important interstudy differences, the general conclusion is that CARN supplementation may enhance athletic performance when coupled to physical exercise itself. Healthy, essentially sedentary persons and untrained individuals do not benefit from supplementation, and certainly not if CARN is administered for a few days. CARN was also shown to modulate thyroid hormone action in peripheral tissues, the most frequent modulation observed being inhibition.

Animals↗
PubMed2001

Anabolic steroids increase exercise tolerance.

The influence of an anabolic androgenic steroid (AAS) on thymidine and amino acid uptake in rat hindlimb skeletal muscles during 14 days after a single exhaustive bout of weight lifting was determined. Adult male rats were divided randomly into Control or Steroid groups. Nandrolone decanoate was administered to the Steroid group 1 wk before the exercise bout. [3H]thymidine and [14C]leucine labeling were used to determine the serial changes in cellular mitotic activity, amino acid uptake, and myosin synthesis. Serum creatine kinase (CK) activity, used as a measure of muscle damage, increased 30 and 60 min after exercise in both groups. The total amount of weight lifted was higher, whereas CK levels were lower in Steroid than in Control rats. [3H]thymidine uptake peaked 2 days after exercise in both groups and was 90% higher in Control than in Steroid rats, reflecting a higher level of muscle damage. [14C]leucine uptake was approximately 80% higher at rest and recovered 33% faster postexercise in Steroid than in Control rats. In a separate group of rats, the in situ isometric mechanical properties of the plantaris muscle were determined. The only significant difference was a higher fatigue resistance in the Steroid compared with the Control group. Combined, these results indicate that AAS treatment 1) ameliorates CK efflux and the uptake of [3H]thymidine and enhances the rate of protein synthesis during recovery after a bout of weight lifting, all being consistent with there being less muscle damage, and 2) enhances in vivo work capacity and the in situ fatigue resistance of a primary plantarflexor muscle.

Anabolic Agents↗
PubMed1994

Improved exercise tolerance by cardiac rehabilitation after myocardial infarction in the elderly: results of a preliminary, controlled study.

Elderly patients are commonly excluded from cardiac rehabilitation after myocardial infarction (MI). The present controlled, non-randomized trial was undertaken as a preliminary study to compare some effects of cardiac rehabilitation between patients younger and older than 65 years without contraindications to physical exercise. Baseline total work capacity (TWC) was assessed by a maximal ergometric stress testing 4 weeks after MI. Patients were then prospectively enrolled into an 8-week ambulatory rehabilitation program (R-group: age < or = 65 N = 16; age > 65 N = 16). Those who refused or who could not participate in the program because of logistic difficulties served as controls (NR-group: age < or = 65 N = 16; age > 65 N = 14). In spite of non-randomized allocation, clinical characteristics did not differ between either treatment groups or age groups. TWC was re-assessed at 8 weeks from baseline evaluation in all patients. The number of completed training sessions in the R-group, and the proportion of sessions which were suspended for physiological or pathological (adverse events during exercise) causes were similar under and over 65 years. TWC increased (p < 0.001) in the R-group, the improvement being similar in the two age cohorts (< or = 65: +55% vs > 65: +65%, NS). A spontaneous enhancement of TWC (+37%, p < 0.001) occurred among younger controls as well. Only older controls did not improve their TWC; moreover, their +16% change was significantly (p < 0.05) less than the +65% increase obtained by the R-group of the same age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗