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At least 541 records · Page 30Linked to original sources

Response to bosentan in children with pulmonary hypertension.

OBJECTIVE: To describe an early experience of treating 40 children with the dual endothelin receptor antagonist bosentan, which is known to be safe and effective in adults with pulmonary hypertension (PH). DESIGN: In this retrospective, observational study the UK Service for Pulmonary Hypertension for children treated 40 children with bosentan, 20 with idiopathic pulmonary arterial hypertension (IPAH) (mean age 8.03 years, range 1.2-17) and 20 with PH associated with other conditions (congenital heart disease, parenchymal lung or connective tissue disease, or HIV). Their mean age was 8.3 years (range 0.6-16 years). PATIENTS: 39 patients were in World Health Organization (WHO) class III and IV, and all had shown recent deterioration. In IPAH the mean pulmonary vascular resistance (PVR) was 21.7 units.m2 (range 5.6-42.8). In secondary PH the mean PVR was 18 units.m2 (range 4.9-49). No child had a positive response to vasodilator testing with nitric oxide. INTERVENTIONS: Bosentan was given as first line treatment to 25. Nine were given intravenous epoprostenol. Children were treated for a mean of 12.7 months (range 2-24 months). MAIN OUTCOME MEASURES: Response to treatment was judged by WHO functional class, six minute walk test, weight, ECG and echocardiographic findings, and need to add additional treatment. RESULTS: Bosentan was well tolerated. In the IPAH group 19 (95%) stabilised with bosentan treatment but 12 (60%) patients needed combined treatment with epoprostenol. In secondary PH, WHO class, six minute walk test, and weight gain improved significantly. CONCLUSION: Bosentan helped stabilise children with IPAH but intravenous epoprostenol was also needed by 60%. Children with secondary PH improved.

Adolescent↗

[Diuretics improve functional capacity in patients with congestive heart failure].

PURPOSE: The 6-9 minute walking test was used in this study to evaluate the impact of these drugs on functional capacity of patients admitted to the Hospital because of Heart Failure (CHF). METHODS: Ten patients (5 males and 5 females) with mean age of 47 years and NYHACHF functional class III or IV underwent a 6-9 minute walking test at admission and on the day of discharge from the Hospital. The following parameters were evaluated both at admission and discharge: body weight, echocardiography-derived LV dimensions and function, plasmatic levels of sodium, potassium, Bun, creatinine, hemoglobin and hematocrit. Treatment consisted of increasing outpatient dose of furosemide (IV and/or PO) plus the association of thiazide if necessary. The previous dose regimen of digitalis, ACE inhibitors or the association nitrate and hydralazine was kept unchanged. RESULTS: Time to compensation of CHF varied from 4 to 30 days (mean 8.7 +/- 7.8 days). LV end diastolic dimension varied from 47 to 81mm. LV EF spanned from 0.26 to 0.74. The 6min walking distance improved from 193.4 +/- 71.5m to 341.8 +/- 67.7m (p < 0.00002) and the 9min walking distance from 268.1 +/- 119.6m to 518.0 +/- 114.8m (p < 0.00005). Hemoglobin, hematocrit, BUN, creatinine and sodium levels were unchanged from admission to discharge, whereas plasma potassium level increased from 4.0 +/- 0.9mEq/l to 4.69 +/- 1.00mEq/l (p = 0.01), and body weight was reduced from 58.9 +/- 6.42kg to 52.9 +/- 5.3lkg (p < 0.0006). CONCLUSION: Compensating CHF with diuretics leads to a significant improvement in physical capacity. This benefit already evident in the in-hospital phase.

Adult↗

Effects of short-term pulmonary rehabilitation on exercise capacity and quality of life in patients with chronic obstructive pulmonary disease.

Although the rehabilitation of patients with chronic obstructive pulmonary disease (COPD) improves both exercise capacity and quality of life, a standard protocol for COPD patients has not been established. To clarify whether physiologic and quality-of-life improvements can be achieved by an inpatient pulmonary rehabilitation program 5 days per week for 3 weeks, 18 patients with COPD were enrolled in a rehabilitation program. The physical exercise training regimen consisted of respiratory muscle stretch gymnastics and cycle ergometer exercise training. Pulmonary function tests, an incremental ergometer exercise test, a 6-min walking test, and a quality of life assessment by the Chronic Respiratory Questionnaire were administered before and after the program. The peak VO2, an indicator of maximal exercise capacity, did not increase, although the 6-min walking distance, an indicator of functional exercise capacity, increased significantly after rehabilitation. There was a significant improvement in the quality of life in terms of dyspnea, fatigue, and emotional state. These findings suggest that even a 3-week program may be beneficial for COPD patients. Increases in functional exercise capacity, even without an increase in maximal exercise capacity, are helpful for reducing dyspnea and improving quality of life parameters in patients with COPD.

Aged↗

Prospective study of 11 Brazilian patients with mucopolysaccharidosis II.

OBJECTIVE: To assess the progression of mucopolysaccharidosis II in 11 Brazilian patients over a 12-month period. METHODS: Eleven Brazilian patients with mucopolysaccharidosis II were prospectively studied at the Division of Medical Genetics of Hospital de Clínicas de Porto Alegre. The initial assessment and the assessment at 12 months included: anamnesis, physical examination, abdominal nuclear magnetic resonance, echocardiogram, 6-minute walk test, audiometry, serum biochemical tests and urinary glycosaminoglycan concentration. RESULTS: The major findings after comparing the assessments were: 1) two patients had growth retardation; 2) two patients showed negative weight change; 3) one patient went from obese to overweight; 4) three patients revealed left ventricle hypertrophy; of these, two increased the number of cardiac valve lesions; 5) there was no statistically significant difference between the mean distances obtained on the 6-minute walk test; 6) there was splenic enlargement; 7) there was an increase in gamma-glutamyltransferase levels; 8) the urinary concentration of glycosaminoglycans remained unchanged. CONCLUSIONS: In general, echocardiographic findings were the only variable with deterioration and possible immediate clinical consequences. Although a 12-month period is too short to detect changes in most variables related to mucopolysaccharidosis II, its progressive nature should be taken into account when evaluating the efficiency of treatment protocols.

Brazil↗

Functionally oriented rehabilitation program for patients with fibromyalgia: preliminary results.

OBJECTIVE: To evaluate function and disability in patients with fibromyalgia before and after participation in a functionally oriented, multidisciplinary, 8-wk treatment program. DESIGN: A total of 23 patients who met American College of Rheumatology criteria for the diagnosis of fibromyalgia were enrolled in the study. Outcome measures included: range of motion, 6-min walk test, a modified Fibromyalgia Impact Questionnaire, a modified SF-36 Physical Functioning Scale, and the Fibromyalgia Health Assessment Questionnaire. Pretreatment and posttreatment scores were analyzed using paired t tests. RESULTS: All subjects completed the program, and there were no reported injuries. Three subjects failed to complete the survey instruments at the conclusion of the study. Intention to treat analysis including these subjects was carried out but did not significantly change results. For the remaining subjects (n = 20), a significant improvement was found on the Physical Functioning Scale (P = 0.01). Trends toward improvement on the Fibromyalgia Impact Questionnaire (P = 0.40) and Fibromyalgia Health Assessment Questionnaire (P = 0.14) were seen but did not achieve statistical significance. Range of motion testing revealed significant improvements in lumbar spine extension (P < 0.001), straight-leg raise (P < 0.001), cervical spine flexion (P < 0.01), cervical spine rotation (P < 0.05), and cervical spine side bending (P < 0.05). Distance traveled during the 6-min walk test increased significantly (P < 0.01), whereas perceived exertion as measured by the Borg scale did not change. There were no injuries or other adverse consequences of the program. CONCLUSIONS: This study utilized multiple functional outcome measures to demonstrate improved function and decreased disability in patients with fibromyalgia. Our patients reported significantly improved physical function after participation in the 8-wk intensive multidisciplinary treatment program. This progressive, functionally based exercise training program was well tolerated by all participants and outlines an effective exercise prescription for patients with fibromyalgia. Fibromyalgia patients in this study responded favorably to a treatment program that focused on function instead of pain.

Cervical Vertebrae↗

Relationship between different indices of exercise capacity and clinical measures in patients with chronic obstructive pulmonary disease.

PURPOSE: The purpose of this study was to make comparisons between different types of exercise tests used in chronic obstructive pulmonary disease (COPD) to better interpret the results and to select the most suitable testing procedure. Therefore, we evaluated the relationship between exercise capacity and other clinical measures and their relative contributions to exercise capacity in patients with COPD. METHOD: We studied 36 patients with stable COPD. All patients underwent baseline pulmonary function testing. Dyspnea during activities of daily living was assessed with the Oxygen Cost Diagram (OCD). The Hospital Anxiety and Depression Scale and the St George's Respiratory Questionnaire were used to assess psychologic status and health-related quality of life, respectively. All patients performed the 6-minute walking test, progressive cycle ergometry, and the cycle endurance test. RESULTS: Each exercise capacity result correlated significantly with pulmonary function, the OCD, and the Activity and Total scores of the St George's Respiratory Questionnaire. Multiple regression analyses revealed that the OCD was an important predictor of exercise capacity, especially for the walking test. Diffusing capacity was also a significant predictor on progressive cycle ergometry. Body mass index was the most significant predictor of the endurance time. CONCLUSION: The 3 different exercise tests had similar characteristics in relation to pulmonary function, dyspnea, and health-related quality of life in patients with COPD. However, some differences were found in the aspects they evaluated.

Aged↗

Test-re-test reliability of walking speed, step length and step width measurement after traumatic brain injury: a pilot study.

PRIMARY OBJECTIVE: Assess the test-re-test reliability of walking speed, step length and step width measurement in people with traumatic brain injury (TBI). RESEARCH DESIGN: Repeated measures (two test occasions). METHODS: Thirteen people with TBI completed four comfortable and four fast-paced walking trials of the 10 m walk test and two trials of the 6-minute walk test (6MWT). Walking speed, step length and step width were measured during the 10 m walk test and walking distance and average speed were measured during the 6MWT. The tests were repeated 1-week later. MAIN RESULTS: Walking speed and distance showed excellent test-re-test reliability, with an intra-class correlation coefficient (ICC) of 0.95-0.96. Reliability was also high for step length and width measurement (ICC 0.91-0.98). CONCLUSIONS: This test-re-test reliability means that walking speed and distance and step length and width can be used by physiotherapists to monitor improvements in walking after TBI.

Adult↗

Early and late effects of coronary artery bypass grafting on cardiac haemodynamics during daily physical activities in patients with coronary artery disease.

This study investigated the early and late effects of coronary artery bypass grafting (CABG) on left ventricular (LV) function during different physical daily activities in patients with multivessel coronary artery disease (CAD). In ten patients with multivessel CAD, cardiac haemodynamics were assessed during a 6-min walk test and during stair climbing 8+/-2 days before (study 1) and 15+/-3 days (study 2) and 120+/-3 days (study 3) after CABG. LV function was monitored by an ambulatory radionuclide system. In study 1, the walk test induced a significant increase in relative end-diastolic volume (EDV) and end-systolic volume (ESV) and no change in LV ejection fraction as compared to rest. In both study 2 and study 3, EDV increased significantly and ESV was unchanged. As a consequence, LV ejection fraction rose from 48%+/-8% to 52%+/-10% and from 48%+/-7% to 51%+/-6%, respectively (both P<0.05). In study 1, stair climbing induced a significant increase in EDV and ESV and as a consequence LV ejection fraction decreased from 46%+/-8% to 42%+/-9% (P<0.05) as compared to rest. In both study 2 and study 3, EDV increased significantly whereas ESV did not change. As a consequence, LV ejection fraction rose from 48%+/-8% to 52%+/-7% and from 48%+/-8% to 51%+/-7%, respectively (both P<0.05). In conclusion, CABG has beneficial effects on cardiac performance during moderate or more intense physical activity in patients with multivessel CAD and these effects are due to improvement in systolic function. Radionuclide monitoring of LV function provides an objective method for quantitative evaluation of cardiac performance after CABG.

Activities of Daily Living↗

Lung volume reduction surgery for emphysema.

OBJECTIVE: To report the results of lung volume reduction surgery (LVRS) for severe emphysema in Australia. SETTING: A tertiary teaching hospital. DESIGN: A prospective study of a consecutive case series. PARTICIPANTS: 20 patients (mean age, 56 years) with severe emphysema--mean forced expiratory volume in one second (FEV1), 0.72 L (28% of predicted) and severe gas trapping (mean residual volume, 286% of predicted). INTERVENTION: Bilateral apical LVRS was performed via a median sternotomy with a linear stapler; bovine pericardial strips were used to reinforce the staple line. RESULTS: There was a 95% survival, and a mean (range) inpatient stay of 17 (8-45) days. No complications occurred in nine patients; a further six patients had only minor complications. Five patients had major complications (sputum retention requiring reintubation, persistent air leak requiring reoperation, duodenal perforation, and epidural haemorrhage); one patient died from multiorgan failure at 28 days. Intercostal drainage was left in situ for a mean of eight days. The results of FEV1, Medical Research Council (MRC) Dyspnoea Score and six-minute walk test improved in more than 90% of patients. FEV1 improved an average of 0.35 L (54% over baseline) (P < 0.001). Mean MRC Dyspnoea Score decreased from 3.4 to 2.1 (P < 0.001). Mean distance for the six-minute walk test increased from 306 to 431 metres (P < 0.001). CONCLUSION: Our experience confirms that LVRS produces worthwhile early outcomes for a subgroup of patients with severe emphysema. The clinical, economic and ethical questions raised by this new therapy will need to be assessed.

Adult↗

Cardiac resynchronisation therapy in chronic atrial fibrillation: impact on left atrial size and reversal to sinus rhythm.

OBJECTIVE: To evaluate the impact of long term cardiac resynchronisation therapy (CRT) on left atrial and left ventricular (LV) reverse remodelling and reversal to sinus rhythm (SR) in patients with heart failure with atrial fibrillation (AF). PATIENTS: 74 consecutive patients (age 68 (8) years; 67 men) with advanced heart failure and AF (20 persistent and 54 permanent) were implanted with a CRT device. MAIN OUTCOME MEASURES: Patients were evaluated clinically (New York Heart Association (NYHA) class, quality of life, six minute walk test) and echocardiographically (LV ejection fraction, LV diameters, and left atrial diameters) before and after six months of CRT. Additionally, restoration of SR was evaluated after six months of CRT. RESULTS: NYHA class, quality of life score, six minute walk test, and LV ejection fraction had improved significantly after six months of CRT. In addition, left atrial and LV end diastolic and end systolic diameters had decreased from 59 (9) to 55 (9) mm, from 72 (10) to 67 (10) mm, and from 61 (11) to 56 (11) mm, respectively (all p < 0.01). During implantation 18 of 20 (90%) patients with persistent AF were cardioverted to SR. At follow up 13 of 18 (72%) patients had returned to AF and none had spontaneously reverted to SR; thus, only 5 of 74 (7%) were in SR. CONCLUSION: Six months of CRT resulted in significant clinical benefit with significant left atrial and LV reverse remodelling. Despite these beneficial effects, 93% of patients had not reverted to SR.

Aged↗

Detectable serum cardiac troponin T as a marker of poor prognosis among patients with chronic precapillary pulmonary hypertension.

BACKGROUND: Right ventricular failure is a leading cause of death in patients with chronic pulmonary hypertension (PH). We checked whether detection of cardiac troponin T (cTnT), a specific marker of myocyte injury, could be useful in prognostic stratification of those patients. METHODS AND RESULTS: Initial evaluation of 56 clinically stable patients (age 41+/-15 years) with pulmonary arterial (51 patients) or inoperable chronic thromboembolic (5 patients) PH (mean pulmonary arterial pressure 60+/-18 mm Hg) included cTnT test, allowing detection of its serum levels > or =0.01 ng/mL [cTnT(+)]. cTnT was detectable in 8 of 56 (14%) patients (mean+/-SD, 0.034+/-0.022; range, 0.010 to 0.077 ng/mL). Despite similar pulmonary hemodynamics, they had higher heart rate (92+/-15 versus 76+/-14 bpm, P=0.004), lower mixed venous oxygen saturation (50+/-10% versus 57+/-9%, P=0.04), and higher serum N-terminal pro-B-type natriuretic peptide (4528+/-3170 versus 2054+/-2168 pg/mL, P=0.03) and walked less during the 6-minute walk test (298+/-132 versus 396+/-101 m, P=0.02). Cumulative survival estimated by Kaplan-Meier curves was significantly worse at 24 months in cTnT(+) compared with cTnT(-) (29% versus 81%, respectively, log-rank test P=0.001). Multivariate analysis revealed cTnT status (hazard ratio, 4.89; 95% CI, 1.18 to 20.29; P=0.03), 6-minute walk test (hazard ratio, 0.93 for each 10 m; P=0.01), and pulmonary vascular resistance (hazard ratio, 1.13; P=0.01) as independent markers of mortality. All 3 cTnT(+) patients who survived the follow-up period converted to cTnT(-) during treatment. CONCLUSIONS: Detectable cTnT is a so-far ignored independent marker of increased mortality risk in patients with chronic precapillary PH, supporting the role of progressive myocyte injury in the vicious circle leading to hemodynamic destabilization.

Adult↗

Value of the time trade off method for measuring utilities in patients with rheumatoid arthritis.

OBJECTIVE: To assess the feasibility, reliability, and validity of the time trade off (TTO) in patients with rheumatoid arthritis (RA). METHODS: The TTO was applied in 194 patients with RA with increasing difficulty in performing activities of daily living. The test-retest reliability was determined in 35 of these patients and was calculated by the intraclass correlation coefficient (ICC). Construct validity was evaluated with the following sets of variables: measures of utility (rating scale), quality of life (RAND 36 item Health Status Survey (RAND-36) and RAQoL), functional status (Health Assessment Questionnaire, grip strength, and walk test), and disease activity (doctor's global assessment, disease activity score, pain, and morning stiffness). RESULTS: Ten patients (5%) did not complete the TTO. The median value of the TTO was 0.77 (range 0.03-1. 0). The test-retest ICC of the TTO was 0.85 (p<0.001). Construct validity testing of the TTO showed poor to moderate correlations (Spearman's r(s) between 0.19 and 0.36, p<0.01) with all outcome measures except for the subscale role limitation (physical problem) of the RAND-36, the walk test, the doctor's global assessment of disease activity, and morning stiffness. Multiple regression analysis showed that only 17% of the variance of the TTO scores could be explained. CONCLUSIONS: The TTO method appeared to be feasible and reliable in patients with RA. The poor to moderate correlations of the TTO with measures of quality of life, functional ability, and disease activity suggest that the TTO considers additional attributes of health status. This may have implications for the application of the TTO in clinical trials in patients with RA.

Activities of Daily Living↗

Preservation of striatal tissue and behavioral function after neural stem cell transplantation in a rat model of Huntington's disease.

Cell replacement has the potential to become a frontline therapy to remedy behavioral impairments in Huntington's disease. To determine the efficacy of stem cell transplantation, behavioral assessment and in vivo monitoring of the lesion environment are paramount. We here demonstrate that neural stem cells from the MHP36 cell line prevented the development of a deficit on the beam walk test while providing partial recovery of learning in the water maze. However, no beneficial effect on rats' impairment in the staircase test was observed. By quantification of the lesion from serial magnetic resonance images, no effect of neural stem cells on lesion volume was observed. Instead, a preservation of striatal volume over time and its correlation with performance on the beam walk test suggested that sparing of behavioral function was associated with a stagnation of ongoing tissue loss rather than a reduction in lesion size. Serial imaging therefore warrants further implementation in clinical trials of neural grafts to monitor in vivo changes in the damaged brain due to transplantation.

Analysis of Variance↗

The relationships of functional capacity, pain, and isometric and isokinetic torque in osteoarthrosis of the knee.

Thirty-nine patients suffering from osteoarthrosis of the knee were repeatedly measured. The relationship was studied for two groups of variables. The first group consisted of subjective assessments of functional capacity and pain and a walking test. The second group consisted of isometric knee extension torque and isokinetic knee flexion and extension torque at 30 degrees/sec, 60 degrees/sec, 120 degrees/sec and 180 degrees/sec. High correlations between each of the static and dynamic torque values were found. Multiple regression analysis showed that isometric and isokinetic torque measures are unsatisfactory predictors of functional capacity, since only 23-35% of the variation of functional capacity, pain and walking test variables was explained by the variation of torque variables. Dynamic torque measurements had very little advantage over static torque tests. It is concluded that outcome measures in studies of osteoarthrosis should be problem-oriented and include direct assessments of functional capacity, pain and walking ability.

Female↗

Reduction of hospital days by biventricular pacing.

The health care costs for heart failure are substantial. Studies indicate that hospital treatment constitutes 65-75% of these. The aim of this study was to assess total and heart failure related hospital days as well as safety and efficacy of biventricular pacing in 16 patients with severe heart failure and delayed intraventricular conduction (QRS duration >150 ms). They were implanted with a biventricular pacemaker and followed by NYHA class, 6-min walk test and quality of life for a mean of 291+/-76 days. Total number of hospital days and the need for hospitalisations were monitored. Thirteen responders improved by at least one functional class. After 6 months of pacing the 6-min walk test improved from 375+/-83 m to 437+/-73 m (P<0.001) and Minnesota Living with Heart Failure quality of life score from 41+/-19 to 24+/-17 (P<0.001) compared to baseline. The need for hospital care decreased significantly after biventricular pacing. The total number of hospital days in all patients was 253 the year before compared to 45 the year after biventricular pacing (P<0.01). For heart failure related hospital days the corresponding figures were 183 and 39 days, respectively (P<0.01). Biventricular pacing improved 13/16 patients with severe heart failure and wide QRS complexes in this open study. The improvement resulted in a reduced need for hospital care.

Cardiac Pacing, Artificial↗

Physical function in sedentary and exercising older veterans as compared to national norms.

We examined the associations between sedentary older veterans, those regularly involved in an outpatient exercise program and physical function. Sedentary and currently exercising older veterans performed a 30 s chair-stand test and 6 min walk test as part of an exercise program. Test results were then compared to national norms. The exercisers' test scores were not significantly different from the national averages. However, their mean 6 min walk score approached being significantly better than the national average (p = 0.095). The sedentary group's scores were significantly lower (p < or = 0.05) than the exercisers' scores and the national averages for both tests. In this cohort, older veterans who maintain a regular program of physical activity function at a level considered average or slightly above average compared to their age-matched peers, while sedentary veterans are significantly below average. Healthcare providers need to stress the importance of regular exercise to their older veteran patients.

Aged↗

Balance training following stroke: effects of task-oriented exercises with and without altered sensory input.

The purpose of this study was to compare the effects of a task-oriented exercise program with and without altered sensory input on postural stability in subjects with stroke. Sixteen hemiparetic subjects, at least 6 months post-stroke, were randomly assigned to the experimental or control group, and participated in an 8-week task-oriented exercise program focusing on balance and mobility exercises. Exercises were performed under normal conditions by the control group, and under conditions of vision and surface manipulation by the experimental group. Pre- and post-test assessments involved the measurement of the center of pressure (COP) displacement during double-legged stance and sit-to-stand under four sensory conditions: (1) eyes open, normal surface; (2) eyes open, soft surface; (3) eyes closed, normal surface; and (4) eyes closed, soft surface, as well as the 10-m walking test. Results showed significant improvements (P<0.05) in COP displacement under sensory conditions (1) and (2) for the experimental group only, and limited changes for the sit-to-stand in both groups after training. Significant improvements (P<0.05) were also found in both groups for the walking test. It is concluded that a task-oriented exercise program, assisted by sensory manipulation, is more effective at improving the standing balance of stroke subjects than a conventional task-oriented program.

Exercise Therapy↗

Effect of training on the response of plasma vascular endothelial growth factor to exercise in patients with peripheral arterial disease.

Expansion of the capillary network, or angiogenesis, occurs following endurance training. This process, which is reliant on the presence of VEGF (vascular endothelial growth factor), is an adaptation to a chronic mismatch between oxygen demand and supply. Patients with IC (intermittent claudication) experience pain during exercise associated with an inadequate oxygen delivery to the muscles. Therefore the aims of the present study were to examine the plasma VEGF response to acute exercise, and to establish whether exercise training alters this response in patients with IC. In Part A, blood was collected from patients with IC (n=18) before and after (+20 and +60 min post-exercise) a maximal walking test to determine the plasma VEGF response to acute exercise. VEGF was present in the plasma of patients (45.11+/-29.96 pg/ml) and was unchanged in response to acute exercise. Part B was a training study to determine whether exercise training altered the VEGF response to acute exercise. Patients were randomly assigned to a treatment group (TMT; n=7) that completed 6 weeks of high-intensity treadmill training, or to a control group (CON; n=6). All patients completed a maximal walking test before and after the intervention, with blood samples drawn as for Part A. Training had no effect on plasma VEGF at rest or in response to acute exercise, despite a significant increase in maximal walking time in the TMT group (915+/-533 to 1206+/-500 s; P=0.009) following the intervention. The absence of a change in plasma VEGF may reflect altered VEGF binding at the endothelium, although this cannot be confirmed by the present data.

Exercise↗