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PubMed1993

Prediction of maximal exercise capacity in obstructive and restrictive pulmonary disease.

We evaluated the predictive value of resting pulmonary function tests (PFTs) in the determination of maximal exercise capacity in patients with obstructive and restrictive ventilatory disease. We performed resting PFTs and an incremental exercise study on a bicycle ergometer in 146 patients with chronic obstructive pulmonary disease (COPD) and 68 patients with restrictive disease. The patients with obstructive disease were further subdivided into mild, moderate, and severe based on the severity of their airway obstruction (mean +/- SD:FEV1, 2.78 +/- 0.77, 2.12 +/- 0.74, and 1.06 +/- 0.47, respectively). Correlation coefficients for PFTs vs VO2max and VEmax in restricted patients was generally low (DL = 0.67 and 0.34, IC = 0.58 and 0.35, FVC = 0.57 and 0.35, TLC = 0.35 and 0.18). In patients with COPD, the maximum voluntary ventilation (MVV) was the single best predictor of VO2 in all groups with correlation coefficients of 0.75, 0.69, and 0.89 in the mild, moderate, and severe subgroups, respectively. Similarly, the MVV was the best predictor of VEmax in all groups with correlation coefficients of 0.59, 0.64, and 0.89 in the three subgroups. The correlation with FEV1 was slightly less for both VO2max (0.69, 0.65, and 0.87) and VEmax (0.52, 0.64, 0.64) in the mild, moderate, and severe subgroups, respectively. Our findings show that PFTs are unreliable in predicting VEmax and VO2max in restricted patients. In patients with obstruction, the MVV is the single best predictor of VO2max and VEmax in all three categories, but was not significantly improved by stepwise multiple regression with additional PFT variables. Higher correlations were obtained in the severe group in whom the correlation with VO2max and VEmax was 0.89. However, the 95 percent confidence interval of the estimate for VO2 and VE was relatively large (+/- 0.16 L/min and +/- 6.6 L/min, respectively). We conclude that although several PFTs correlate significantly with maximum exercise, the large variance precludes their use to accurately predict maximum performance in individual patients with COPD.

Aged↗

PubMed1989

Improved exercise capacity with acute aminophylline administration in patients with syndrome X.

The efficacy of the adenosine receptor blocker aminophylline on exercise capacity in patients with effort ischemia and documented coronary artery disease has been previously documented. In this study the effect of aminophylline on effort electrocardiographic (ECG) alterations and chest pain was tested in eight patients with syndrome X (anginal chest pain on effort, ischemic ECG changes during exercise, positive dipyridamole test, normal epicardial coronary arteries on angiography and absence of coronary spasm after ergonovine). After double-blind, randomized intravenous infusion of aminophylline (6 mg/kg body weight over 15 min) or placebo (20 ml of saline solution over 15 min), the eight patients with syndrome X underwent an upright bicycle exercise stress test on 2 consecutive days. After aminophylline, there was an increase in effort tolerance (aminophylline 7.7 +/- 1.2 min of exercise versus placebo 5.6 +/- 0.9, p less than 0.01) paralleled by an increase of the rate-pressure product (mm Hg x beats/min x 1/100) at 0.1 mV of ST segment depression or at peak exercise (aminophylline 278 +/- 55 versus placebo 230 +/- 24, p less than 0.05). Aminophylline provoked the abolition of ECG signs of ischemia in all eight patients. Thus, at a dosage that should effectively inhibit adenosine receptors, aminophylline infusion exerts a beneficial effect on exercise-induced chest pain and ischemia-like ECG changes in syndrome X. This effect occurs possibly through the prevention of myocardial flow maldistribution elicited by inappropriate adenosine release during effort in the presence of increased coronary resistance at the level of small intramural coronary arteries. This study, however, does not document the ischemic nature of effort-induced pain and ECG alterations in syndrome X.

Adult↗

PubMed2003

Pulmonary function and exercise capacity for ELBW survivors in preadolescence: effect of neonatal chronic lung disease.

OBJECTIVE: To assess pulmonary function and exercise capacity of apparently asymptomatic children who were born extremely preterm. STUDY DESIGN: Pulmonary function and treadmill testing were performed on 50 children 9 to 15 years old who had birth weight <801 g (extremely low birth weight [ELBW]) and without apparent neurodevelopmental or pulmonary disabilities, compared with 25 children born at term with normal birth weight (NBW). Medical history and physical activity levels were assessed by parent questionnaire. Group differences were determined by two-sample t test. Secondary analysis was performed to assess significant influence of neonatal chronic lung disease (CLD) on outcome measures. RESULTS: Twenty percent of ELBW subjects but no subjects with NBW had clinically abnormal pulmonary function (>2 SD from norms, P=.026). All significant pulmonary function differences except peak expiratory flow rate percentages were accounted for by ELBW subjects who had CLD. Oxygen consumption measurements were significantly lower for subjects with ELBW (30.3+/-6.9 and 38.5+/-5.2 mL/kg/min, P=.000), independent of CLD status. CONCLUSION: Pulmonary function abnormalities consistent with obstructive lung disease were more frequently detected in ELBW children who had neonatal CLD. Low oxygen consumption measurements suggest a lower level of fitness for ELBW children compared with children with NBW.

Child↗

PubMed1986

Indoramin in heart failure: possible adverse effects on hemodynamics and exercise capacity.

Indoramin is an alpha 1-adrenergic antagonist vasodilator of potential value in heart failure. We measured hemodynamics and exercise capacity in 12 patients with heart failure, before and after 1 week of indoramin dosing, 75 mg b.i.d. Maximal hemodynamic effects 2 hours after the first dose of indoramin consisted of reduced mean systemic arterial pressure from 96.0 +/- 15.3 to 87.9 +/- 15.3 mm Hg (P less than 0.05) and pulmonary wedge pressure from 23.6 +/- 7.8 to 16.9 +/- 6.6 mm Hg (P less than 0.001). Heart rate, cardiac index, and total systemic resistance did not change acutely after indoramin, but after 1 week mean systemic arterial pressure was still reduced whereas cardiac index fell from 2.69 +/- 0.38 to 2.32 +/- 0.44 L/min/m2 (P less than 0.05) and total systemic resistance rose from 20.4 +/- 2.8 to 21.9 +/- 4.0 U (P less than 0.1). After 1 week maximal exercise oxygen uptake fell from 16.8 +/- 5.6 to 12.5 +/- 3.5 ml/min/kg (P less than 0.02). This limited observation suggests that indoramin is a predominant venodilator acutely in patients with heart failure but that despite this effect it may worsen functional capacity and hemodynamics during continuous dosing in these patients.

Adult↗

PubMed1994

The effect of a comprehensive, intensive inpatient treatment program on lung function and exercise capacity in patients with cystic fibrosis.

BACKGROUND AND PURPOSE: The purpose of this investigation was to measure the effects of a 10- to 14-day comprehensive, intensive hospital treatment program on peak exercise capacity, endurance capacity, respiratory function, weight change, and maximum inspiratory and expiratory mouth pressures in patients with cystic fibrosis with a pulmonary exacerbation. SUBJECTS: Fourteen young adults with cystic fibrosis admitted to a hospital for an exacerbation of their pulmonary disease were studied. METHODS: Subjects performed pulmonary function tests, inspiratory and expiratory mouth pressure tests, and stationary bicycle exercise tests at admission and discharge. Comprehensive therapy provided during the hospital admission consisted of intravenous antibiotics, physical therapy, high-calorie diet, and daily medical review. RESULTS: The patients showed improvements in forced expiratory volume in 1 second (46%-55% of predicted values) and forced vital capacity (62%-68% of predicted values). Maximum inspiratory and expiratory mouth pressures also improved (118%-131% and 78%-92% of predicted values, respectively). There was a mean weight gain of 2 kg. Maximum work capacity on a bicycle ergometer improved from a mean of 45% to 52% of predicted values. The most impressive result was the marked increase in exercise endurance time from a mean of 9.5 minutes on admission to 16.6 minutes at discharge. CONCLUSION AND DISCUSSION: This study indicates that young adults with cystic fibrosis and an exacerbation of their pulmonary disease obtain measurable benefits from a comprehensive, intensive treatment program, particularly improvement in their capacity for endurance exercise.

Adolescent↗

PubMed1991

Effect of mild-to-moderate airflow limitation on exercise capacity.

To determine the effect of mild-to-moderate airflow limitation on exercise tolerance and end-expiratory lung volume (EELV), we studied 9 control subjects with normal pulmonary function [forced expired volume in 1 s (FEV1) 105% pred; % of forced vital capacity expired in 1 s (FEV1/FVC%) 81] and 12 patients with mild-to-moderate airflow limitation (FEV1 72% pred; FEV1/FVC % 58) during progressive cycle ergometry. Maximal exercise capacity was reduced in patients [69% of pred maximal O2 uptake (VO2max)] compared with controls (104% pred VO2max, P less than 0.01); however, maximal expired minute ventilation-to-maximum voluntary ventilation ratio and maximal heart rate were not significantly different between controls and patients. Overall, there was a close relationship between VO2max and FEV1 (r2 = 0.62). Resting EELV was similar between controls and patients [53% of total lung capacity (TLC)], but at maximal exercise the controls decreased EELV to 45% of TLC (P less than 0.01), whereas the patients increased EELV to 58% of TLC (P less than 0.05). Overall, EELV was significantly correlated to both VO2max (r = -0.71, P less than 0.001) and FEV1 (r = -0.68, P less than 0.001). This relationship suggests a ventilatory influence on exercise capacity; however, the increased EELV and associated pleural pressures could influence cardiovascular function during exercise. We suggest that the increase in EELV should be considered a response reflective of the effect of airflow limitation on the ventilatory response to exercise.

Exercise↗

PubMed1979

Postinfarction exercise capacity after lidoflazine treatment or physical training.

44 male postinfarction volunteers were divided into 4 groups and submitted to performance tests. Groups I and II consisted of 24 patients, 12 of whom followed a 2-month physical training program, while the other 12 served as controls. Groups III and IV (10 patients each) were included in a 10-month double-blind crossover study with lidoflazine 240 mg/day vs. placebo. The cardiovascular adaptation of the patients treated for 5 months with lidoflazine had two features in common with that observed after 2 months of physical training, namely an increase in maximal exercise capacity and, during submaximal exercise tests, a decrease in heart rate compensated for by an increase in stroke volume. In contrast to physical training, treatment with lidoflazine did not improve the peripheral oxygen consumption by the muscles.

Blood Pressure↗

PubMed1977

Infarct size and exercise capacity after myocardial infarction.

Estimation of infarct size from serum creatine phosphokinase elevations of 22 acute myocardial infarction (AMI) patients was compared to their functional exercise capacity determined on a bicyle ergometer. Eleven of these patients entered a controlled exercise program for 3-4 mo and were subsequently retested. Aerobic power of the exercise group increased significantly (mean +- SE 1.42 +- 0.5 met) and was also significantly greater than an unpaired control group tested the same number of months after infarct. Patients grouped 2.5-4.5 mo post-AMI demonstrated a correlation between aerobic power and estimated infarct size (r = -0.68, n = 15). This correlation was higher (r = -0.84, n = 11) after 3-4 mo of a controlled exercise program.

Creatine Kinase↗

PubMed1989

Influence of age and stature on exercise capacity during incremental cycle ergometry in men and women.

The present study re-evaluated the accuracy of standards for maximal exercise capacity (Wcap) recently reported from our laboratory by examining the interaction between height and age on Wcap achieved and predicted in 1,071 subjects (732 males and 339 females). They underwent an incremental exercise test on a cycle ergometer using the same incremental protocol and exercise mode as the previous study, and were retrospectively judged to be normal. Although Wcap predicted was either not significantly different (males) or underestimated Wcap by less than 5% (females, p less than 0.05), significant differences were found in subjects at the extremes of the population ranges for height and age. The influences of age 9yr) and height (m) were found to be nonlinear and interactive, as described by the equations: Males: Wcap = 1506*Ht2.70*Age-0.46(r = 0.78) (lower limit 81% pred) Females: Wcap = 969*Ht2.80*Age-0.43(r = 0.77) (lower limit 79% pred) Wcap (kpm/min) predicted by these equations was compared to Wcap achieved by the 100 subjects who took part in the original study; no significant differences were found (paired t test, p less than 0.05). The interactive influences of age and height expressed by the equations are more plausible from a biological point of view than the linear, additive relationships previously described. The equations should be more reliable than previous equations for patients referred for exercise testing.

Aging↗

PubMed1993

Effects of sodium bicarbonate on cardiorespiratory measurements and exercise capacity in thoroughbred horses.

We examined the effects of sodium bicarbonate in 6 Thoroughbred horses during submaximal and maximal treadmill exercise. Cardiorespiratory function was assessed together with the effect on exercise capacity by determining the run time to fatigue at maximal intensities. To discriminate between sodium bicarbonate's alkalinising effects and the fluid shifts that could result from the high osmotic load, we administered an equimolar solution of sodium chloride as a control. The horses were given sodium bicarbonate (1 g/kg bwt) or an equivalent number of moles of sodium chloride by nasogastric tube. Arterial blood samples were collected before exercise and 5 h after treatment, resulting in mean standard bicarbonate values of 39.6 mmol/l in horses treated with sodium bicarbonate compared with 24.2 mmol/l in horses that received saline. The horses were exercised on a treadmill at 40, 60 and 80% of their VO2max for 4, 2 and 2 mins respectively. The horses were walked for 3 mins and accelerated rapidly to a speed approximately equivalent to 110% VO2max and run until fatigued. The horses ran for 170 +/- 20 secs (mean +/- sem) after administration of sodium bicarbonate compared with 128 +/- 13 secs after receiving sodium chloride (P < 0.02). At rest and throughout submaximal and maximal exercise, the bicarbonate-treated horses had significantly lower arterial oxygen tensions and higher arterial carbon dioxide tensions. There were no differences in cardiac output, heart rate, oxygen uptake or carbon dioxide production between the saline and bicarbonate treatments.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1999

Phospholamban deficiency does not compromise exercise capacity.

Deficiency of phospholamban (PLB) results in enhancement of basal murine cardiac function and an attenuated response to beta-adrenergic stimulation. To determine whether the absence of PLB also reduces the reserve capacity of the murine cardiovascular system to respond to stress, we evaluated the heart rate (HR), blood pressure, and metabolic responses of PLB-deficient (PLB-/-) mice to graded treadmill exercise (GTE). PLB-/- mice were hypertensive at rest (125 +/- 19 vs. 109 +/- 16 mmHg, P < 0.05) but had normal tachycardic and hypotensive responses to isoproterenol. The HR response to GTE was normal; however, the hypertension in PLB-/- mice normalized at peak exercise. Their exercise capacities, as measured by duration of exercise and peak oxygen consumption (VO2), were normal. The oxygen pulse (VO2/HR) curve was also normal in PLB-/- mice, suggesting an ability to appropriately increase stroke volume and oxygen extraction during GTE, despite an inability to increase beta-adrenergically stimulated cardiac contractility. Thus deficiency of PLB, although resulting in diminished beta-adrenergic inotropic reserve, does not compromise cardiac performance during exercise.

Adrenergic beta-Agonists↗

PubMed1994

[Effect of intravenous ambroxol hydrochloride on lung function and exercise capacity in patients with severe chronic obstructive pulmonary disease].

The effect of Ambroxol hydrochloride on spirometry, pulmonary gas exchange and exercise capacity in patients with COPD were evaluated. Twenty patients mean age 59 +/- 9 yr presenting with severe airways obstruction were divided by random number to two groups: treated (L) and control (K). L patients received iv infusion of one gram of Ambroxol in 500 ml of 0.9% saline daily, for 5 days. K patients received infusions of 500 ml 0.9% saline at the same intervals. Blood gases, capnography and incremental exercise test on cycloergometer were performed before treatment and after the fifth dose of the drug or placebo. Before treatment spirometry, blood gases, capnometric++ indices and exercise tolerance were similar in both groups. After treatment in patients from L group an increase in VC from 1.78 +/- 0.61 L to 2.04 +/- 0.58 L (p < 0.01), FEV1 from 0.96 +/- 0.43 L to 1.11 +/- 0.49 L (p < 0.01), MEF25 from 1.36 +/- 0.93 L/sec to 1.61 +/- 0.96 L/sec (p < 0.01) was found. End-tidal carbon dioxide in 60 sec hyperventilation test decreased from 3.7% to 2.9% (p < 0.001). There were no differences in exercise tolerance and blood gases after treatment. In the control group all studied variables remained unchanged. We conclude that Ambroxol improves airways patency in patients with severe COPD.

Aged↗

PubMed2004

Restrictive filling pattern is associated with increased humoral activation and impaired exercise capacity in dilated cardiomyopathy.

OBJECTIVES: Although heart failure (HF) is characterized by increased proinflammatory cytokines, natriuretic peptide levels and impaired exercise capacity, the effect of concomitant diastolic dysfunction on those parameters has not been adequately studied. METHODS: We analyzed circulating levels of IL-1, IL-6, TNF-alpha and its soluble receptors, sTNFRI and sTNFRII, Nt-ANP and Nt-BNP natriuretic peptides in 81 patients, aged 56+/-12 years, with non-ischemic dilated cardiomyopathy (NIDC), LVEF 29.7+/-7.75% and functional NYHA class II-III. An echocardiographic study and cardiopulmonary exercise test (CPE) were performed in all patients. RESULTS: Patients were divided into restrictive (24 patients, group I) and non-restrictive (57 patients, group II) groups, according to their transmitral-filling pattern. No differences in LV dimensions or LVEF were found between the two groups. Group I showed increased levels of IL-6 (P=0.006), TNF-alpha (P=0.05), sTNFRII (P=0.02), Nt-ANP (P<0.001) and Nt-BNP (P<0.001) and decreased exercise duration (P<0.001) and PVO(2) (P<0.001) compared to group II. The strongest independent predictors for restrictive filling pattern were Nt-ANP and IL-6 levels, while Nt-BNP levels were the strongest PVO(2) predictor. CONCLUSIONS: Restrictive filling pattern implying greater diastolic dysfunction may contribute to increased cytokine production in the heart failure syndrome, as well as greater increases in natriuretic peptides and decreased exercise tolerance.

Aged↗

PubMed2004

Effect of DNase on exercise capacity in cystic fibrosis.

DNase can reduce viscosity and facilitate expectoration of airway secretions in cystic fibrosis (CF) lung disease. We evaluated its effect on exercise performance in relation to resting pulmonary function. Fifteen sputum-producing CF patients (aged 9-28 years; FEV1 22-83% predicted) performed spirometry, body plethysmography, nitrogen washout, and incremental cardiopulmonary exercise testing before and after 8 weeks of first-time treatment with daily inhaled rhDNase. Most subjects reported increased amounts and fluidity of sputum. The effect on objective parameters was heterogeneous, without statistical significance. Groupwise, FEV1 increased by 6% without correlation to baseline values; individual patients gained up to 40%. Indices of hyperinflation and air trapping were slightly raised. Maximal workload and oxygen uptake (V'O2) increased by up to 20% in a number of patients. The treatment effect on V'O2 was neither related to baseline levels of pulmonary function and exercise capacity nor to the change in FEV1. Ventilatory equivalents for oxygen and carbon dioxide during exercise were slightly but insignificantly lower after DNase treatment; minimal O2 saturation was unaffected. We conclude that improvement of exercise performance with DNase is restricted to a subgroup of CF patients and may not be predicted or identified by spirometry and subject report alone.

Administration, Inhalation↗

PubMed1987

Effects of felodipine on haemodynamics and exercise capacity in patients with angina pectoris.

We studied the effects of adding felodipine to beta-adrenoceptor blockade on haemodynamics and exercise capacity in 14 patients with stable angina pectoris using a placebo controlled double-blind crossover protocol. Felodipine reduced supine and standing systolic pressure by 13% (P less than 0.01) and 14% (P less than 0.01) respectively and increased supine heart rate 7.4% (P less than 0.05). Felodipine at a plasma concentration of 15.5 +/- 3.0 nmol l-1 increased exercise duration by 16% (P less than 0.01) but failed to attenuate the degree of ST segment depression during exercise. The mean daily number of episodes of angina (0.53 +/- 0.16 on placebo vs 0.37 +/- 0.11 on felodipine) and mean daily GTN consumption (0.51 +/- 0.07 on placebo vs 0.36 +/- 0.12 on felodipine) were not significantly reduced (0.1 less than P greater than 0.05). These findings suggest that felodipine may provide useful additional benefits in patients with hypertension or angina pectoris, who are already receiving beta-adrenoceptor blockers.

Adult↗

PubMed1981

[Hemodynamic and exercise capacity in a 72 years old patient under a ventricular and bifocal pacemaker (author's transl)].

The results of haemodynamic, echocardiographic and bicycle exercise investigations in a 72-year-old man with a permanent complete atrioventricular block and heart failure following infarction are presented. Comparative measurements were obtained under the conditions of a ventricular and an av-sequential pacemaker (PM). The ventricular demand pacemaker (VVI) was implanted three years ago and because of further impairment of cardiac performance an av-sequential pacemaker (DDD) was used to restore atrio-ventricular synchronisation. The treatment with bifocal PM improved dramatically cardiac output and exercise capacity. The echocardiographic findings demonstrate the significance of Frank-Starling mechanism in this case due to better filling of the ventricles. As noninvasive methods, echocardiography and bicycle-exercise test allow long-term analysis of cardiac function.

Aged↗

PubMedDate not supplied

Nocturnal mechanical ventilation improves exercise capacity in kyphoscoliotic patients with respiratory impairment.

BACKGROUND: Patients with severe kyphoscoliosis, with or without stable respiratory failure, frequently experience oxyhaemoglobin desaturation during sleep, exercise, or both. Nasal Intermittent Positive Pressure Ventilation (NIPPV) applied during sleep has been demonstrated to be able to control nocturnal desaturations and also improve diurnal respiratory failure, if this is present, in this group of patients. The aim of this study was to evaluate the effect of a seven-day treatment with nocturnal NIPPV on exercise tolerance in a group of 6 patients with severe kyphoscoliosis and significant nocturnal and exercise-induced oxyhaemoglobin desaturation. METHODS: NIPPV was applied each night for a week by means of a volume cycled pressure ventilator set in assisted/controlled mode. In each patient lung function, daytime arterial blood gas analysis, overnight non invasive recording of arterial saturation, and 6-minutes walking test were carried out initially and at the end of the NIPPV course. RESULTS: During nocturnal NIPPV, as compared to baseline, the percent of night time spent below 90% of oxyhaemoglobin saturation significantly fell from 20 +/- 12.8 to 2.3 +/- 1.9 (Student t-test: p = 0.017). The 6-minute walking distance significantly increased from 244.7 +/- 132.2 to 340 +/- 122.3 m (p = 0.0097). Spirometry, daytime arterial blood gas analysis, and exercise-induced oxyhaemoglobin desaturation were unaffected by treatment. CONCLUSION: A one-week course of treatment with nocturnal NIPPV improves exercise capacity in patients with severe kyphoscoliosis.

Adult↗

PubMed1983

Verapamil improves exercise capacity in chronic atrial fibrillation: double-blind crossover study.

Oral verapamil has previously been shown to reduce heart rate at rest and during mild exercise in chronic atrial fibrillation. Its efficacy in improving cardiovascular performance at higher levels of exercise and its safety were investigated in a prospective, randomized, placebo controlled double-blind study preceded by an open label titration phase in 20 digitalized patients with chronic atrial fibrillation. Maximal exercise capacity was improved (from 522 +/- 257 to 806 +/- 348 work units, p less than 0.0005) when tested by a standardized multistage ergometry exercise test. Heart rate was also reduced at rest, at the end of 3 minutes of 300 KPM exercise, and at the point of maximal exercise. Blood pressure and double product were also reduced. Its efficacy and safety may make verapamil the treatment of choice in chronic atrial fibrillation.

Adult↗