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Interval versus continuous exercise training after coronary bypass surgery: a comparison of training-induced acute reactions with respect to the effectiveness of the exercise methods.

In order to improve endurance by exercise on a bicycle ergometer, both the interval method (I) (exertion and recovery phases alternate each minute) and the continuous method (constant exertion) can be employed. We examined the effects of both methods on the following parameters: heart rate, blood pressure, rate-pressure product, glucose, lactate, and catecholamine levels, and physical performance. Two groups of nine male patients were trained daily on a bicycle ergometer for 3.5 weeks. These patients had undergone coronary bypass surgery 24 and/or 26 days before the training started. The training heart rate was set at 86% of the individual maximum heart rate. In the last week of training, the exercise intensity in both patient groups, following either I or C regimen, was 20:121 W and 83 W respectively. The exercise training lasted 20 minutes with the following findings: (1) there were no significant differences in blood pressure, rate-pressure product, rates of glucose and catecholamines, and (2) there was a significantly higher rate of lactate in the second ten minutes of the I training. Before and after the training period, the patients were subjected to a multistage bicycle ergometer exercise test (sitting). The following results obtained after the training favor the I method: (1) patients' physical performance increased (+0.63 vs. +0.26 W/kg; p less than 0.001); (2) heart rate was lower at rest (-9 vs. -4 beats/min; p less than 0.04) and at 75 W (-12 vs. -2 beats/min; p less than 0.02); (3) rate-pressure product was lower at rest (-1675 vs. -291; p less than 0.04) and at 75 W (-2810 vs. -735; p less than 0.05); (4) rate of lactate was lower at 75 W (-0.83 vs. -0.33 mmol/l; p less than 0.04); (5) catecholamines were not lowered by I or C training, and no differences between the two groups could be observed. Exercise training according to the I method involves both the aerobic and anaerobic capacity of the organism, whereas exercise training according to the C method involves only oxidative capacity. After coronary bypass surgery, the I method is better suited to increase physical performance and is more effective in economizing the cardiac function.

Adult↗

Blood pressure and heart rate during rest-exercise and exercise-rest transitions.

The transients of mean arterial blood pressure (BPa) and heart rate (fc) during rest-exercise and exercise-rest transitions have been studied in six healthy sport students. After 5 min of rest in an upright position on a cycle ergometer they exercised for 15 min and remained seated for a further 5 min. The subjects exercised at four different constant intensities (40 W, 80 W, 120 W, 160 W) in random order separated by at least 24 h. The BPa was determined by a noninvasive and continuous method. During the first minute of exercise, three phases of response could be distinguished, with the first two showing no clear relationship to intensity. Phase 1 consisted of simultaneous increases in both fc and BP during the first 6 s. In phase 2, BPa decreased while fc continued to increase. During phase 3, BPa and fc approximated constant values or a linear increase. Both parameters showed no comparable intensity-independent reactions during the off-transients. In conclusion, during the first 15 s of rest-exercise transitions there seems to be a fast and uniform cardiovascular drive which overrode other influences on fc.

Adult↗

Short- and long-term effects of a single bout of exercise on heart rate variability: comparison between constant and interval training exercises.

Heart rate variability (HRV) was assessed during the short- (within 1 h) and long- (within 48 h) term recovery following a single bout of either constant (CST) or interval training (SWEET) exercise performed at the same total physical work [9.4 (0.3) kJ kg(-1)]. R-R intervals, systolic (SAP) and diastolic (DAP) arterial pressures were recorded in supine and upright positions before and 1, 24 and 48 h after the termination of the exercises in ten male subjects [mean (SEM), age 24.6 (0.6) years, height 177.2 (1.1) cm and body mass 68.5 (0.9) kg]. The parameters were also recorded in the supine position during the first 20 min following the end of the exercise. Spectral analysis parameters of HRV [total (TP), low- (LF), and high- (HF) frequency power, and LF/TP, HF/TP and LF/HF ratios] were determined over 5 min during each phase. Except for higher HF values in both supine and upright positions during the first hour following CST compared with SWEET, cardiovascular and HRV analysis responses were of the same magnitude after their termination. R-R intervals, TP, and HF/TP were significantly decreased while LF/TP and LF/HF were significantly increased during the early recovery, when compared with control values. This could be a response to the significant decrease in SAP and DAP at this time. Twenty-four and 48 h after the end of the exercise, HRV parameters were at the same levels as before exercises in the supine posture, but a persistent tachycardia continued to be observed in the upright posture, together with reduced TP values, showing that cardiovascular functions were still disturbed. The short-term HRV recovery seemed dependent on the type of exercise, contrary to the long-term recovery.

Adult↗

Acute BDNF and cortisol response to low intensity exercise and following ramp incremental exercise to exhaustion in humans.

The effect of short-term aerobic exercise and a following ramp incremental cycle ergometry to exhaustion on the acute response of the serum concentrations of brain derived neurotrophic factor (BDNF) and cortisol (COR) was examined in 8 healthy male athletes. Venous and capillary blood samples were drawn at rest, immediately after a 10 min warm-up period with aerobic exercise and after a ramp test to exhaustion, as well as 3, 6, 10 and 15 min post exercise. Capillary blood lactate (LA) concentration and blood gases as well as serum BDNF and COR concentrations did not change during the warm-up period. LA was increased (p<0.05) at the end of the ramp test and during recovery period while bicarbonate concentration, carbon dioxide pressure, pH and base excess were decreased (p<0.05) during this period. Serum BDNF was increased at the point of exhaustion (p<0.05) while no significant differences were found between values at rest and those during recovery period. At 10 and 15 min post incremental exercise, COR concentrations were increased (p<0.05) compared to rest. The present study is the first to demonstrate in humans that in contrast to short duration aerobic exercise immediately after a following short duration high-intensity exercise to exhaustion, there is a transient augmentation of serum BDNF concentration. Short-term response of serum BDNF and COR concentrations differs as BDNF returns to baseline level faster than COR.

Adult↗

Glucose and insulin responses following 16 months of exercise training in overweight adults: the Midwest Exercise Trial.

The current study examined the insulin and glucose response during an oral glucose tolerance test (OGTT) in overweight young adults prior to and following exercise training in the Midwest Exercise Trial (MET). Subjects (N = 66) were randomly assigned to non-exercise control (CON; 16 females, 13 males) or exercise (EX; 22 females, 15 males) groups. EX performed supervised and verified exercise on 3 to 5 days per week in 20- to 45-minute sessions at 60% to 75% of heart rate reserve. OGTTs and assessments for body mass, body composition, and maximal oxygen consumption (Vo(2) max) were performed at baseline, and after 9 and 16 months of training. Blood was collected during a 75-g OGTT and analyzed for glucose and insulin concentrations with the total area under the glucose and insulin curves used in the analysis. The EX males had significant decreases from baseline to 9 months in body mass (94.8 +/- 12.5 to 89.2 +/- 9.8 kg) and percent fat (28.3 +/- 4.8 to 24.2 +/- 3.9) with no further changes at 16 months. CON females had significant increases in body mass (78.2 +/- 6.4 to 81.1 +/- 8.1 kg) and percent fat (36.6 +/- 4.2 to 37.8 +/- 4.7) from baseline to 16 months. Vo(2) max increased significantly from baseline to 9 months in the EX males (3.67 +/- 0.62 to 4.36 +/- 0.55 L/min) and EX females (2.53 +/- 0.32 to 2.99 +/- 0.42 L/min). For glucose area under the curve, there were no significant differences between EX or CON across the 16 months of the study. For insulin area under the curve, there was a significant decrease for male EX from baseline to 9 months (12,535 +/- 6,114 to 8,390 +/- 4,231 microU/L/180 min). We conclude that regular exercise in healthy, previously sedentary overweight adult males leads to improvements in Vo(2) max and weight loss and a reduction in the insulin concentration required to dispose of a set glucose load. In females, improvement in Vo(2) max without weight loss does not lead to improvement in insulin sensitivity.

Adolescent↗

The reduction in postprandial lipemia after exercise is independent of the relative contributions of fat and carbohydrate to energy metabolism during exercise.

A single session of exercise several hours before a high-fat meal reduces postprandial lipemia. The purpose of the present study was to test the hypothesis that this effect is independent of substrate metabolism during exercise. Twelve men aged 21 to 36 years underwent three oral fat tolerance tests with intervals of at least 1 week. On one occasion, only activities of daily living were allowed the preceding day (control). On the other two occasions, subjects ran on a treadmill for 90 minutes on the afternoon preceding the fat tolerance test; 90 minutes before running, they ingested either acipimox, an inhibitor of lipolysis in adipose tissue, or placebo. Acipimox abolished the increase in the nonesterified fatty acid (NEFA) concentration observed during the run after placebo and reduced lipid oxidation (placebo, 37 +/- 7 g; acipimox, 21 +/- 3 g; P < .05, mean +/- SEM), but had no effect on gross energy expenditure (placebo, 4.86 +/- 0.20 MJ; acipimox, 4.83 +/- 0.18 MJ). Before each of the three fat tolerance tests, subjects reported to the laboratory after an overnight fast. Blood samples were obtained in the fasted state and for 6 hours after consumption of a high-fat meal (per kilogram of body mass: 1.2 g fat, 1.2 g carbohydrate, and 61 kJ energy). Plasma concentrations of NEFA were higher postprandially with acipimox, compared with control and placebo (P < .05), as were glucose concentrations measured over the first 4 hours. The insulin response to the meal was lower in placebo compared with control and acipimox (P < .05). Despite these counterregulatory responses, postprandial lipemia was reduced to the same degree (compared with control, P < .05) by exercise preceded by acipimox and by exercise preceded by placebo (area under the plasma triacylglycerol concentration v time curve: control, 8.77 +/- 1.17 mmol/L x 6 h; placebo, 6.95 +/- 0.97 mmol/L x 6 h; acipimox, 6.81 +/- 0.81 mmol/L x 6 h). These findings suggest that some factor other than the nature of the metabolic substrate used during exercise determines the attenuating effect of prior exercise on postprandial lipemia.

Adult↗

Intensive home-based exercise training in cardiac rehabilitation increases exercise capacity and heart rate variability.

BACKGROUND: Reduced heart rate variability (HRV) is a risk factor for cardiac death. Animal studies have shown increased HRV and reduced mortality after physical training. We evaluated the change in exercise capacity and HRV in cardiac rehabilitation patients, randomised to routine or home-based intensive training. The design was prospective, stratified randomisation with pre-specified subgroup analysis. METHODS: Maximal bicycle exercise test and 24-h Holter were performed 1 (baseline), 4 and 12 months after myocardial infarction (MI) or coronary artery by-pass surgery (CABG). Patients were randomised to physical training either two (N) or six (I) times per week for 3 months Sixty-two patients (43 MI and 19 CABG patients) were evaluated. RESULTS: Exercise capacity increased significantly more after 3 months of training in group I (mean (S.E.)); 29.0 (3.4) vs. 7.2 (2.6) watts, P<0.001). One year later the difference in exercise capacity remained (26.5 (3.3) vs. 11.8 (3.8) watts, P<0.001). Global HRV measurements SDNN and SDANN increased significantly more in group I after training (17.1 (5.6) vs. 1.7 (3.7) and 16.2 (4.9) vs. 2.8 (3.1) ms, P<0.05) and 1 year later the differences were still significant. Subgroup analysis showed more pronounced HRV response in CABG than MI patients. CONCLUSION: Intensive exercise training in cardiac rehabilitation increases exercise capacity and global HRV, which could be of prognostic significance.

Coronary Artery Bypass↗

Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity.

BACKGROUND: In patients with congestive heart failure (CHF) there is a shift from aerobic type I muscle fibres to less aerobic type II fibres. Exercise training has been shown to have beneficial effects on exercise performance, peripheral pathology and the neurohumoral profile in stable patients with CHF. This study evaluated the effect of a 3 month exercise training program on skeletal muscle characteristics and the correlation of these to cytokines and exercise capacity in CHF patients. METHODS: Skeletal muscle biopsies for enzyme-histochemical analysis were performed in 15 CHF patients in New York Heart Association classes II-III, with a mean ejection fraction of 33+/-5% before and after a 12 week training period. The patients were trained for 30 min, five times a week at 80% of the peak heart rate achieved at baseline ergometer cycle test. Fifteen healthy men were used as controls. Plasma samples were examined by enzyme immunoassays for levels of pro-inflammatory cytokines. RESULTS: (a) At baseline we found muscle atrophy in five of the patients. The percent area of type I fibres (40.7+/-12.0 vs. 56.4+/-11.0%, P<0.05) and the thickness of type IIA (56.10+/-7.8 vs. 71.6+/-11.9 microm, P<0.001) and B-fibres (49.0+/-8.9 vs. 63.9+/-10.6 microm, P<0.001) were reduced, whereas the percent area of type IIA fibres (52.1+/-13.3 vs. 36.4+/-9.9%, P<0.05) was increased in heart failure patients compared to healthy controls. There was a modest correlation between fibre thickness and the level of interleukin 6 (r=-0.657, P=0.008). (b) After exercise training there was a reduction in muscle area examined by light-microscopy, measured as a percentage of field (-2.7, P=0.003) with an concomitant increase in interstitium. This reduction correlated to the increase in the 6-min walk test (r=-0.558, P=0.031). The thickness of type IIB fibres increased (+5.6 microm, P=0.068) and the area of type I fibres decreased (-6.1%, P=0.062). CONCLUSIONS: Patients with CHF have a relatively increased area of type IIA fibres and a relatively decreased area of type I fibres compared to healthy individuals. The thickness of type IIA and type IIB fibres is decreased compared to normal individuals. A modest negative correlation between the level of interleukin 6 and fibre thickness at baseline, suggests that inflammatory cytokines may be involved in the pathogenesis of the CHF related myopathy. A significant correlation between the reduction of muscle area, with increased interstitum, and the increase in the 6-min walk test may indicate that the improvement is due to increased capillary density permitting better flow reserve to exercising muscles.

Aged↗

Effects of exercise position on the ventilatory responses to exercise in chronic heart failure.

OBJECTIVE: Patients with heart failure frequently complain of orthopnoea. The objective was to assess the ventilatory response of patients with chronic heart failure during erect and supine exercise. DESIGN: Maximal incremental exercise testing with metabolic gas exchange measurements in erect and supine positions conducted in random order. SETTING: Tertiary referral centre for cardiology. PATIENTS: Nine patients with heart failure (aged 61.9+/-6.1 years) and 10 age matched controls (63.8+/-4.6). OUTCOME MEASURES: Metabolic gas exchange measurements. The slope of the relation between ventilation and carbon dioxide production. Ratings of perceived breathlessness during exercise. RESULTS: Oxygen consumption (VO2) and ventilation were higher during erect exercise at each stage in each group. Peak VO2 was [mean (SD)] 17.12 ml/kg/min (4.07) erect vs 12.92 (3.61) supine in the patients (P<0.01) and 22.62 (5.03) erect-supine vs 19.16 (3.78) erect (P<0.01) in the controls. Ratings of perceived exertion were higher in the patients at each stage, but unaffected by posture. There was no difference in the slope of the relation between ventilation and carbon dioxide production between erect and supine exercise 36.39 (6.12) erect vs 38.42 (8.89) supine for patients; 30.05 (4.52) vs 28.80 (3.96) for controls. CONCLUSIONS: In this group of patients during exercise, there was no change in the perception of breathlessness, nor the ventilatory response to carbon dioxide production with change in posture, although peak ventilation was greater in the erect position. The sensation of breathlessness may be related to the appropriateness of the ventilatory response to exertion rather than to the absolute ventilation.

Chronic Disease↗

Long term modulation of the leg exercise ventilatory response is not elicited by hypercapnic arm exercise.

The aim of the present investigation was to test the hypothesis that long-term modulation (LTM) of the exercise ventilatory response, evidenced as an augmentation in minute ventilation (V(I)) and tidal volume (VT) during the early phase of exercise, is only evident when the muscle groups recruited are the same during testing and during hypercapnic exercise conditioning. Measurements of cardiorespiratory variables were made at rest and during leg cycling (fH=107+/-5) exercise in eight male subjects, 1 week before and 1 h after conditioning. Conditioning involved either: (a) ten trials of arm cranking exercise (V(I)=29.0+/-4.4), or (b) ten trials of arm cranking exercise paired with external respiratory dead space (1400 ml; V(I)=57.3+/-6.5). Neither arm conditioning paradigm evoked any of the modulatory responses described in previous studies. We, therefore, conclude that the general upregulation of the spinal respiratory motoneuron pool excitability after conditioning (the "final common pathway" hypothesis), may be inadequate to fully explain the underlying mechanisms of LTM of ventilation in humans.

Analysis of Variance↗

Effects of montelukast on physical performance and exercise economy in adult asthmatics with exercise-induced bronchoconstriction.

Leukotriene antagonists are effective in the treatment of exercise-induced bronchoconstriction. Montelukast is a specific cysteinyl-leukotriene receptor1 antagonist without known effects on the pulmonary vessels, which in theory should be advantageous with respect to gas exchange. In addition to lung function, we investigated the effects of montelukast on parameters of gas exchange and physical performance in 16 asthmatics with exercise-induced bronchoconstriction in a double-blind cross-over placebo-controlled study. Subjects were tested at an ambient temperature of -15 degrees C with a tread mill exercise protocol consisting of consecutive workloads of 80% V'O(2max) (6 min), rest (4 min), 60% V'O(2max) (6 min) and step increments of exercise until exhaustion. Montelukast reduced the maximum post-exercise fall in FEV1 (P < 0.01), improved the running time to exhaustion in 11 of 16 test subjects (one unchanged) (P = 0.03), and reduced the Borg score at exhaustion (P = 0.03) and the breathing frequency after 3 min at 60% V'O(2max) (P = 0.03). V'(O2), V'CO(2), minute ventilation, ventilatory equivalents, respiratory exchange ratio, heart rate and oxygen pulse were not significantly different after montelukast and placebo. We conclude that montelukast has a beneficial effect on physical performance in most adults with exercise-induced asthma without any observed effect on gas-exchange parameters.

Acetates↗

Impaired exercise capacity and exercise training in maintenance hemodialysis patients.

Patients with advanced chronic renal failure, including those undergoing maintenance hemodialysis (MHD), commonly suffer from sarcopenia and reduced physical exercise capacity. The causes of these disorders include anemia, cardiovascular and pulmonary diseases, other comorbid conditions, altered skeletal muscle metabolism, myopathic changes that are associated with chronic renal failure per se, malnutrition, and physical deconditioning. Exercise training has been shown to increase exercise capacity and, in some studies, to increase muscle mass. In our experience, cardiopulmonary fitness training of sedentary MHD patients for an average of 8.6 weeks using a stationary ergometer increased endurance capacity, physical performance, and physical strength in the lower extremities, and in particular, quadriceps strength, power, and fatigability. This surprising finding of increased lower-extremity strength with cardiovascular fitness training may reflect the possibility that the MHD patients were so deconditioned that the small amount of resistance encountered with pedaling a stationary ergometer increased their physical strength. By the end of the endurance exercise training program, the MHD patients also showed changes in the right vastus lateralis muscle for the mRNA levels of a number of proteins involved with skeletal muscle protein synthesis and hypertrophy. The mRNA levels changed in a direction that would be expected to promote protein accrual and hypertrophy of skeletal muscle. These findings indicate that in sedentary MHD patients endurance exercise training for a few weeks can result in improved exercise capacity and a pattern of transcriptional factors that may promote an increase in skeletal muscle mass.

Anemia↗

Relationship between post-exercise plasma CK elevation and muscle mass involved in the exercise.

The purpose of this study was to investigate whether a larger post-exercise increase in plasma creatine kinase (CK) activity would be produced when a larger amount of muscle is damaged by eccentric exercise. Twenty-two non-weight trained females were placed into two groups; Group A (n = 12) and Group B (n = 10). Both groups performed 24 maximal eccentric actions of the forearm flexors on each bout. The right and left arm were exercised on the same day for Group A (24 eccentric actions per arm, a total of 48 actions). In contrast, Group B performed 24 actions with either the right or the left arm on the first bout and performed 24 eccentric actions with the opposite arm on the second bout 3-5 weeks later. Blood samples were taken before and for 5 days after each exercise and plasma CK activity was determined. Forearm flexion isometric force (ISO), range of motion evaluated by relaxed elbow joint angle (RANG) and flexed elbow joint angle (FANG), and perceived muscle soreness (SOR) were also examined to indirectly assess muscle damage. All of the muscle damage indicators changed significantly over time (p < 0.01) for both groups, but changes were not significantly different between arms or between groups. Because it seemed that both arms were equally "damaged" for each group, it was expected that Group A (two arms were exercised on the same day) should show an approximate two-fold increase in plasma CK compared to Group B when one arm was exercised on each bout.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Exercise therapy in women who have had breast cancer: design of the Sheffield women's exercise and well-being project.

Recovering from cancer treatment can be a difficult experience, both physically and psychologically. This paper describes a randomized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer. To facilitate behaviour change, exercise counselling is also included as an integral component in the exercise therapy intervention. Participants are randomized to one of three groups: exercise therapy, body conditioning (placebo control) or a normal care control group. The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks. Outcome measures include quality of life, physical self-perceptions, depression, satisfaction with life, exercise behaviour, aerobic capacity and percentage body fat. All outcomes are assessed at baseline, 4 weeks during the intervention and at the end of the 8-week intervention. Follow-up assessments of outcomes take place at 3 and 6 months post-intervention. As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life, it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment.

Adolescent↗

Exercise-induced QRS changes in healthy men and women: a multivariate analysis on their relation to background data and exercise performance.

Changes in the QRS segment during exercise have repeatedly been suggested to provide diagnostic information with respect to ischaemic heart disease, but the subject is controversial. In order to study the possibly confounding effects of gender, age, resting ECG and exercise performance, 50 healthy subjects were investigated with computerized vectorcardiography during a maximal ergometer exercise test. The overall change in the QRS complex decreased significantly with age and female gender (P < 0.001). However, these responses were better explained by baseline QRS size, change in heart rate and systolic blood pressure (adjusted r2 > 0.70, vs adjusted r2 > 0.41). Effects of age were seen in the Y-lead, and gender effects in the X- and Z-leads (P < 0.0001). In multivariate analyses, X- and Y-lead alterations correlated negatively to change in heart rate and resting QRS size (X-lead; adjusted r2 > 0.50, Y-lead; r2 > 0.44). Z-lead alterations correlated negatively with female gender and resting Z-lead QRS size (adjusted r2 > 0.31). ST changes correlated with QRS changes in the X- and Y-leads (P < 0.05). QRS changes immediately after exercise correlated with alterations during exercise (P < 0.004), maximal load (P < 0.01) and time to hypotension post-exercise (X- and Z-lead; P < 0.02). In conclusion, QRS changes appear to be related to baseline QRS size, change in heart rate and ST change, factors which may have important confounding effects. Consideration of these factors may help in resolving the controversy surrounding QRS changes.

Adult↗

Effects of amiodarone on erect and supine exercise haemodynamics and exercise capacity in patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a primary heart muscle disease associated with a high incidence of sudden death. Amiodarone is of benefit in those patients with a high risk profile for sudden death. Amiodarone has also been reported to improve symptoms dramatically in some patients with HCM but to cause functional deterioration in others. In the acute phase of oral amiodarone therapy there are few discernable changes in cardiovascular haemodynamics and the mechanisms of any beneficial effects on symptoms remain unclear. To determine the effect of amiodarone on exercise responses we measured haemodynamic indices in 10 patients during maximal supine- and symptom-limited erect treadmill exercise before and 6 weeks after amiodarone therapy. Following amiodarone therapy there was a significant reduction in resting and peak heart rate during erect exercise (76 +/- 13 vs 97 +/- 19 b.min-1; P = 0.001 and 114 +/- 26 vs 146 +/- 21 b.min-1; P = 0.001 respectively). Despite increases in peak pulmonary and systemic artery pressures with amiodarone therapy there was no difference in the peak left ventricular filling pressure or maximum cardiac output achieved. Similarly, during supine exercise the resting and peak heart rates were less following the 6 weeks amiodarone therapy. Comparison of supine and erect exercise haemodynamic indices demonstrated higher peak LV filling and higher peak systolic and pulmonary artery pressures during supine than during erect exercise (29 +/- 10 vs 25 +/- 12; P less than 0.04; 151 +/- 42 vs 126 +/- 48; P = 0.01 and 66 +/- 27 vs 62 +/- 21; P = 0.08 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Oxygen-assisted exercise training in adult cystic fibrosis patients with pulmonary limitation to exercise.

Exercise training has been considered suitable only in cystic fibrosis (CF) patients with mild to moderate pulmonary dysfunction without progressive hypoxaemia during exercise. We trained 16 CF patients, all with advanced lung disease (mean standardized forced expiratory volume in 1 s (FEV1), 30% pred.), with a ventilatory limitation to exercise and a progressive hypoxaemia and hypercapnia at low maximal exercise capacity, Wmax (mean Wmax, 50% pred). Exercise training was performed on a cycle ergometer twice a day for 20 min at approximately 75% of the maximal predicted heart rate for at least 3 weeks. Supplemental oxygen was administered to reach a haemoglobin oxygen saturation of 90% during training. Patients considered malnourished because of a Quetelet Index of less than 20 kg m-2 received hyperalimentation orally or by duodenal tube (total 3500-4000 kcal day-1). Evaluation directly after the training period showed a statistically significant improvement in Wmax, maximal oxygen consumption, maximal minute ventilation, pulse, PaCO2 at rest, FEV1 and body weight. None of the pretraining variables was able to predict the outcome of the training programme in the individual patient. We detected no adverse effects of the programme. This study shows that oxygen-assisted exercise training in combination with correction of the nutritional status is safe and beneficial in CF patients with severe lung disease.

Adult↗

Exercise-induced asthma screening of elite athletes: field versus laboratory exercise challenge.

PURPOSE: The purpose of this study was to compare a laboratory based exercise challenge (LBC) to a field based exercise challenge (FBC) for pulmonary function test (PFT) exercise-induced asthma (EIA) screening of elite athletes. METHODS: Twenty-three elite cold weather athletes (14 men, 9 women) PFT positive for EIA (FBC screened) served as subjects. Twenty-three gender and sport matched controls (nonasthmatics) were randomly selected to establish PFT reference values for normal elite athletes. Before FBC, athletes completed a medical history questionnaire for EIA symptoms. FBC evaluations consisted of baseline spirometry, actual or simulated competition, and 5, 10, and 15 min postexercise spirometry. PFT positive athletes were evaluated in the laboratory using an exercise challenge simulating race intensity (ambient conditions: 21 degrees C, 60% relative humidity). PFT procedures were identical to FBC. RESULTS: 91% of PFT positive and 48% of PFT normal athletes reported at least one symptom of EIA, with postrace cough most frequent. Baseline spirometry was the same for PFT positives and normal controls. Lower limit reference range (MN - 2 SD) of FEV1 for controls suggests that postexercise decrements of greater than approximately -7% indicate abnormal airway response in this population. Exercise time duration did not effect bronchial reactivity; 78% of FBC PFT positives were PFT normal post-LBC. CONCLUSION: Self-reported symptoms by elite athletes are not reliable in identifying EIA. Reference range criterion for FEV1 decrement in the elite athlete postexercise contrasts current recommended guidelines. Moreover, a large number of false negatives may occur in this population if EIA screening is performed with inadequate exercise and environmental stress.

Adolescent↗