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PubMed1980

Effects of oral pentaerythritol tetranitrate in cardiac failure and angina pectoris. Assessment by hemodynamic measurement and exercise capacity.

Oral pentaerythritol tetranitrate produces sustained beneficial hemodynamic effects in patients with cardiac failure of varied etiology. The principle action is a reduction of elevated left ventricular filling pressure. In a small group of angina patients, the oral nitrate in high dosage resulted in considerable increase in angina-limited exercise capacity compared to placebo for four hours following drug administration. No side effects were associated with ingestion of pentaerythritol tetranitrate in these investigations.

Administration, Oral↗

PubMed1992

Prediction by postexercise fluoro-18 deoxyglucose positron emission tomography of improvement in exercise capacity after revascularization.

The extent of ischemic and hibernating myocardium, which may be detected by increased postexercise uptake of fluoro-18 deoxyglucose (FDG) using positron emission tomography, may determine the degree of functional benefit after revascularization. This study examined the influence of the amount of this FDG-avid myocardium on changes in left ventricular function and exercise parameters after revascularization. Echocardiography and exercise testing were performed before and after intervention in 23 patients who had undergone positron emission tomography for the evaluation of myocardial perfusion (using rubidium-82), and postexercise FDG imaging in the fasting state. Follow-up echocardiography (22 +/- 14 weeks after revascularization) was compared with preoperative FDG activity in 7 myocardial regions per patient. Systolic function improved after intervention in 19 of 26 malperfused, dysfunctional FDG-avid regions (73%), and did not improve in 35 of 47 dysfunctional regions without increased FDG uptake (74%). The influence of the amount of FDG-avid tissue on changes in functional state was examined by comparing 9 patients with multiple (greater than or equal to 2) FDG-avid regions with the remainder. Those with multiple FDG-avid regions demonstrated improvement in peak rate-pressure product (20 +/- 4 to 26 +/- 4 x 10(3), p less than 0.02), and percentage of maximal heart rate achieved at peak (84 +/- 10% to 93 +/- 6%, p = 0.04), neither of which changed significantly in the remaining patients. Exercise capacity increased from 5.6 +/- 2.7 to 7.5 +/- 1.7 METS in the group with multiple FDG-avid regions; this increase of 55 +/- 18% exceeded the increase of 13 +/- 10% in the remainder (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2003

Relationships between self-reported health related quality of life and measures of standardized exercise capacity and metabolic efficiency in a middle-aged and aged healthy population.

BACKGROUND: The purpose of this study was to evaluate to what extent self-reported health related quality of life (HRQL), assessed by the Swedish standard version of the Medical Outcome Study Short-Form 36 (SF-36), is related to measured exercise capacity and metabolic efficiency in a cohort of healthy subjects from the Gothenburg area of Sweden. MATERIAL AND METHODS: Individuals were invited to take part in the evaluation where HRQL was compared with the maximal power output expressed in Watts assessed during a standardized treadmill test with incremental work loads. Whole body respiratory gas exchanges (CO2/O2) were simultaneously measured. Estimate of metabolic efficiency was derived from oxygen uptake per Watt produced (ml O2/min/W) near maximal work. RESULTS: The health status profile in the current population largely agreed with normative data from an age- and gender-matched reference group, although some measured scores were slightly better than reference scores. Males and females had a similar relationship between energy cost (ml O2/min) for production of maximal work (W), while the regressions for maximal exercise power and age were significantly different between males and females (p < 0.01). The overall metabolic efficiency was the same in individuals between 40 and 74 years of age (10.4 +/- 0.07 ml O2/min/ Watt). Maximal exercise power was only related to the SF-36 subscale physical functioning (PF), but unrelated to other physical subscales such as role limitations due to physical problems, good general health and vitality. There was also a discrepancy between measured maximal power and PF in many subjects, particularly in males who experienced either intact or severely reduced PF. CONCLUSIONS: Our results demonstrate that simultaneous measurements of self-reported and objective measures of PF should add a more integrated view for evaluation of therapeutic effectiveness, since the overall correlation was poor between objective and subjective scores among individuals.

Aged↗

PubMed1996

Effects of ingested fluids on exercise capacity and on cardiovascular and metabolic responses to prolonged exercise in man.

It is well established that the ingestion of carbohydrate-containing drinks can improve the performance of prolonged exercise. The present study examined the effects of ingestion of water and two dilute glucose-electrolyte drinks on exercise performance and on cardiovascular and metabolic responses to exercise. Twelve subjects exercised to exhaustion on a cycle ergometer at a workload corresponding to 70% of maximum oxygen uptake (VO2,max) on five occasions each separated by 1 week. The first trial served to accustom subjects to experimental conditions. On one trial, no drinks were given and on the others subjects drank 100 ml every 10 min. Drinks consisted of water, an isotonic glucose-electrolyte solution (I: 200 mmol/l glucose; 35 mmol/l NA2; 310 mosmol/kg) and a hypotonic glucose-electrolyte solution (H: 90 mmol/l glucose; 60 mmol/l Na+; 240 mosmol/kg). Treatment order was randomized. Blood and expired air samples were taken and heart rate and rectal temperature measured at intervals during exercise. Median exercise time was greatest for treatment H (110.3 min) followed by treatment I (107.3 min), water (93.1) and no drink (80.7). Endurance times differed significantly overall, and for pairwise comparisons (P < 0.01) between the no-drink trial and both treatments H and I: a difference between water and no drink was seen at the 5% level. At exhaustion, a significant treatment difference was found for the change in plasma volume, with the greatest decrease (6.7%) on the no-drink trial and the smallest decrease (0.5%) on treatment H. Significant treatment effects were also observed for heart rate, rectal temperature and serum osmolality. The results suggest that the ingestion of glucose-electrolyte drinks can improve exercise performance even when the amount of added glucose is small, and that performance may also be enhanced, albeit to a lesser degree, by ingestion of water.

Adult↗

PubMed1995

Delayed improvement in exercise capacity with restoration of sinoatrial node response in patients after combined treatment with surgical repair for organic heart disease and the Maze procedure for atrial fibrillation.

BACKGROUND: Although the Maze procedure successfully restores sinus rhythm in patients with heart disease and atrial fibrillation, it is still uncertain whether an addition of the Maze procedure in cardiac surgery is beneficial for exercise performance of the patients after surgery. METHODS AND RESULTS: The Maze procedure was performed in 25 patients (age, 37 to 70 years) during valve surgery (18 patients) or closure of atrial septal defect (7 patients). A cardiopulmonary exercise test using ramp incremental protocol (15 W/min) was performed before and 1 month, 6 months, and 1 year after surgery. Sinus conversion was obtained in 23 of 25 patients 1 month after surgery. However, sinoatrial (SA) node response to exercise was attenuated by surgery: Mean heart rate (HR) was 83 +/- 13/min at rest, 94 +/- 13/min at 60 W, and 107 +/- 17/min at peak exercise. Peak oxygen uptake (PVO2) was unchanged at this period (before, 17.6 +/- 4.5 mL.min-1.kg-1; 1 month after, 17.5 +/- 4.2 mL.min-1.kg-1). Thereafter, SA node response was restored 6 months after surgery: Mean HR was 84 +/- 13/min at rest, 104 +/- 16/min at 60 W, and 130 +/- 20/min at peak exercise (P < .01 versus 1 month). PVO2 was also improved at this period (20.7 +/- 4.0 mL.min-1.kg-1, P < .01). The increase in PVO2 from 1 month to 6 months after surgery was correlated with the increase in peak HR (y = 0.73x +/- 3.6, r = .79). There were no further changes in heart rate response or PVO2 from 6 months to 1 year after surgery. CONCLUSIONS: Atrial fibrillation was successfully treated by combined treatment with surgical repair for organic heart disease and the Maze procedure. However, SA node response to exercise was attenuated early after surgery. Thus, exercise capacity was improved at the late phase after surgery, which was related to the extent of restoration in SA node response.

Adult↗

PubMed2006

Exercise capacity and 24-h blood pressure in prehypertensive men and women.

BACKGROUND: Prehypertensive individuals are at increased risk for developing hypertension and cardiovascular disease compared to those with normal blood pressure (BP). Physically active, normotensive individuals are also at lower risk for developing hypertension than sedentary individuals. We assessed the relationship between fitness and 24-h ambulatory BP in prehypertensive men and women. METHODS: We assessed exercise capacity and 24-h BP in 407 men (age 51 +/- 11 years) and 243 women (age 54 +/-10 years) with resting systolic BP 120 to 139 mm Hg and diastolic BP of 80 to 89 mm Hg, defined as prehypertension. Fitness categories (low, moderate, and high) were established according to exercise time and age. RESULTS: Multiple regression analysis revealed that fitness status was inversely associated with ambulatory BP in both genders (P < .001). After adjusting for various confounders, individuals in the lowest fitness category had significantly higher 24-h, daytime, and night-time BP than those in the moderate and high fitness categories. For men, differences between low and moderate fitness categories were 6/4 mm Hg, 8/4 mm Hg, and 7/3 mm Hg for 24-h, daytime, and night-time BP, respectively (P < .05). For women, the differences were 8/5 mm Hg, 9/5 mm Hg, and 8/7 mm Hg for 24-h, daytime, and night-time BP, respectively. Similar differences were evident in both genders between low and high fitness category (P < .05). CONCLUSIONS: Moderate physical activity promotes lower BP during a 24-h period in prehypertensive men and women. The risk for developing hypertension is likely to be lowered if moderate intensity physical activity in this vulnerable population is encouraged.

Adult↗

PubMed1993

Cardiovascular benefits of improved exercise capacity.

The evidence suggesting that regular exercise can help to prevent coronary artery disease is overwhelming. While some studies have suggested that exercise will not provide health benefits, our inactive population needs to pay heed to the substantial data presented by the many international health organisations suggesting the opposite. The American Heart Association Medical/Scientific Statement on Exercise emphasised the large role regular aerobic physical activity plays in the prevention of cardiovascular disease. Several human studies have also demonstrated the positive effects of long term exercise on the human heart. For example, it has been shown that a consistent exercise programme can lessen the impact of atherosclerotic plaques through increasing coronary artery diameter. Echocardiography studies on a training group of competitive swimmers have shown that exercise training can induce rapid changes in left ventricular dimensions and mass, which can ultimately lead to an increased stroke volume and increased maximal oxygen consumption. Studies on sedentary individuals have also demonstrated an increase in maximal oxygen uptake with a regular endurance exercise programme. In addition to these health benefits, habitual dynamic exercise can also decrease the likelihood of a cardiac event. Others have demonstrated a 50% lower incidence of coronary events in those individuals maintaining rigorous activity 2 days a week. With the preponderance of evidence revealing the health benefits of habitual exercise, it is striking to learn that more than 50% of the US population exercises for less than 20 minutes, 3 days a week. The widespread nature of this sedentary lifestyle makes inactivity an attributable fraction of the total risk factors associated with cardiac disease. The amount of exercise needed to reduce the risk of coronary artery disease is a minimum aerobic workout of 30 minutes, 4 to 5 times a week, such as a vigorous walk. Comprehensive programmes promoting exercise training should be implemented at a level appropriate to an individual's capacity and need.

Exercise Therapy↗

PubMed2000

Effect of thoracic sympathectomy on arm and leg exercise capacity and on lung function.

BACKGROUND: Thoracic T(2-4) sympathectomy (TS) relieves palmar hyperhidrosis. These same roots innervate the heart and the lung. Thoracoscopic TS minimizes damage to the chest wall so that the effect of sympathectomy itself on these organs can be studied. We attempted to determine whether attenuated sympathetic output affects arm or leg exercise tolerance and lung function in young adults who underwent this operation. METHODS: Seven subjects, aged 17-30 years, had lung function tests (water spirometer, Godart, Holland), and leg and arm maximal exercise (CPX, MedGraphics, USA), before and 3-6 months after TS. RESULTS: After TS, resting and exercise heart rate and blood pressure were reduced. Baseline leg and arm peak O(2) uptake, 2.08 (0.6) and 1.44 (0.5) liters/min, respectively, were not different from the post-TS values, 2.06 (0.7) and 1.54 (0.5) liters/min (nonsignificant). Post-TS lung functions were not significantly reduced. CONCLUSION: Thoracoscopic T(2-4) sympathectomy does not lead to a clinically important fall in lung function and does not compromise arm or leg exercise capacity. Therefore, TS can be done safely in young subjects with palmar hyperhidrosis.

Adolescent↗

PubMed2006

Maintaining exercise capacity and quality of life following pulmonary rehabilitation.

OBJECTIVE: The optimum method for sustaining the benefits gained from pulmonary rehabilitation (PR) has not been determined. In this report the authors describe the 4-year referral and uptake patterns to a hospital-based outpatient PR programme, and the sustained benefits of PR in patients with COPD attending a community-based maintenance exercise programme. METHODS: Entry and exit data were mapped for all patients referred to the PR service over the review period. All eligible patients were offered a community-based maintenance exercise programme upon completion of PR. A total of 21 patients underwent follow-up assessment of functional exercise capacity, quality of life (QOL) and health-care utilization. RESULTS: Over a 4-year period, 467 patients (80% with COPD) were referred to the programme, of whom 230 entered PR. In total, 172 patients completed PR, with attrition (25%) being mostly due to medical problems. Of the 84 patients who elected for the community-based programme, 46 were still attending at follow up and 21 patients with moderate-to-severe COPD (44.9 +/- 12.6 (mean +/- SD) FEV(1)% predicted) were reassessed at 18.4 +/- 11.9 months post PR. Significant improvements (mean change (95% confidence interval)) persisted in 6-min walk distance (41.1 m (15.7-66.5)), distance walked in 20 min (195.1 m (82.3-308)) and in QOL (Chronic Respiratory Disease Questionnaire) (11.0 points (4.4-17.6)) (P < 0.01). The QOL improvements exceeded the minimum clinically important difference. A trend towards a reduction in COPD-related hospital admissions, bed-days and emergency department presentations was observed in the 12 months following PR. Self-reported adherence with the home exercise programme indicated that 67% of patients were exercising at least 3-5 days each week in addition to attending a class. CONCLUSION: For patients with moderate-to-severe COPD, a weekly community-based maintenance exercise class, supervised by a physiotherapist, combined with a home exercise programme is an effective intervention for maintaining improvements following PR.

Aged↗

PubMed2005

Growth hormone-induced reduction of soluble apoptosis mediators is associated with reverse cardiac remodelling and improvement of exercise capacity in patients with idiopathic dilated cardiomyopathy.

OBJECTIVE: Recent experimental and clinical data indicate that abnormal inflammatory and apoptotic processes contribute to the progression of chronic heart failure (CHF). We sought to study the effects of growth hormone (GH) on circulating soluble apoptosis mediators, and to investigate whether these GH-induced anti-apoptotic effects are associated with the reduction of left ventricular (LV) volumes and attenuation of exercise intolerance in idiopathic dilated cardiomyopathy (IDC) patients. METHODS: Plasma tumour necrosis factor-alpha (TNF-alpha), its soluble receptors sTNFRI and sTNFRII, and plasma apoptosis mediators soluble Fas (sFas) and sFas Ligand (sFAsL) were measured (enzyme-linked immunosorbent assay) in 12 IDC patients (NYHA III; LVEF: 24+/-2%) before and after a 3-month subcutaneous administration of GH 4 IU every other day (randomized, crossover design). Peak oxygen uptake (VO2max), as well as LV volume indices, wall thickness, and end-systolic wall stress (ESWS) were also determined at the same period. RESULTS: Treatment with GH produced a significant reduction in plasma TNF-alpha (7.8+/-1.1 versus 5.5+/-0.9 pg/ml, P<0.02), sTNFRI (4.0+/-0.4 versus 3.3+/-0.3 ng/ml, P<0.05), sTNFRII (2.8+/-0.3 versus 2.4+/-0.2 ng/ml, P<0.05), sFas (4.7+/-0.7 versus 3.3+/-0.5 ng/ml, P<0.05) and sFasL (33.5+/-9.7 versus 20.2+/-6.2 pg/ml, P<0.01). A significant reduction in ESWS (841+/-62 versus 634+/-48 g/cm, P<0.01), LV end-systolic volume index (LVESVI, 128+/-12 versus 102+/-12 ml/m, P<0.001) and LV end-diastolic volume index (LVEDVI, 228+/-16 versus 200+/-18 ml/m, P<0.01) as well as a significant increase in VO2max (15.3+/-0.7 versus 17.1+/-0.9 ml/kg per min, P<0.01) were also observed in the patient population after GH administration. Significant correlations were found between the GH-induced decrease of sTNFRII and sFasL and respective reduction of LVESVI. CONCLUSION: Growth hormone administration reduces circulating TNF system and soluble apoptosis mediators in patients with IDC. These GH-induced anti-apoptotic effects may be associated with the improvement in exercise capacity as well as with the reverse of LV remodelling in patients with CHF and IDC.

Apoptosis↗

PubMed2005

Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease.

BACKGROUND: Muscle wasting and decreased muscle oxidative capacity commonly occur in patients with chronic obstructive pulmonary disease (COPD). Polyunsaturated fatty acids (PUFA) have been shown to mediate several inflammatory and metabolic pathways which may be involved in the pathogenesis of muscle impairment in COPD. The aim of this study was to investigate the effect of PUFA modulation on systemic inflammation, reversal of muscle wasting, and functional status in COPD. METHODS: Eighty patients with COPD (57 men) with forced expiratory volume in 1 second (FEV1) 37.3 (13.8)% predicted received 9 g PUFA or placebo daily in a double blind randomised fashion during an 8 week rehabilitation programme. Body composition (bioelectrical impedance), functional capacity (lung function, incremental cycle ergometry test, submaximal cycle test, isokinetic quadriceps strength) and inflammatory markers (C-reactive protein (CRP), interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha) were assessed at baseline and after 8 weeks. RESULTS: Both groups had similar increases in weight, fat-free mass (FFM), and muscle strength. The peak load of the incremental exercise test increased more in the PUFA group than in the placebo group (difference in increase 9.7 W (95% CI 2.5 to 17.0), p = 0.009) even after adjustment for FFM. The duration of the constant work rate test also increased more in patients receiving PUFA (difference in increase 4.3 min (95% CI 0.6 to 7.9), p = 0.023). The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP, IL-6 and TNF-alpha. CONCLUSIONS: This is the first study to show beneficial effects of PUFA on exercise capacity in patients with COPD.

C-Reactive Protein↗

PubMed1992

Effect of flosequinan on exercise capacity and cardiac function in patients with chronic mild heart failure: a double-blind placebo-controlled study.

Although beneficial effects of a new vasodilating agent, flosequinan, have been demonstrated in patients with severe heart failure, its efficacy has not been studied in patients with a less severe form of chronic heart failure. In this study, the effects of 4 weeks' administration of flosequinan, 50 mg daily, and placebo on exercise capacity, cardiac function, and symptoms of heart failure were investigated in 24 patients with chronic mild heart failure (New York Heart Association functional class, mainly class II) in a double-blind clinical trial. When the parameter changes during the treatment period of the flosequinan and placebo groups were compared, no significant difference was found in any of the measurements except for left ventricular fractional shortening determined from M-mode echocardiograms; it was increased by 2.9 +/- 1.3% in the flosequinan group whereas it was decreased by 1.3 +/- 0.9% in the placebo group (P less than 0.05 vs flosequinan treatment). However, when compared to baseline values, flosequinan significantly increased exercise time in the symptom-limited maximal exercise test (704 +/- 103 to 763 +/- 107 s, P less than 0.05) and the oxygen uptake at the anaerobic threshold (13.8 +/- 1.3 to 16.7 +/- 1.4 ml/min kg, P less than 0.05), and improved symptoms assessed with a new heart failure severity classification (a median value of 2.0-1.5, P less than 0.05). These improvements were not observed in the placebo group. Serious adverse effects were not observed in either group. These results suggest that flosequinan is useful for the treatment of chronic mild heart failure as well as severe heart failure.

Adult↗

PubMed2000

Respiratory-related quality of life: relation to pulmonary function, functional exercise capacity, and sputum biophysical properties.

One of the difficulties in assessing mucoactive therapy is selecting clinical outcome variables that reflect the impact of clearing airway secretions on quality of life (QOL). Petty and colleagues developed a questionnaire designed to evaluate the clinical impact of mucoactive therapy in patients with chronic bronchitis (CB). We evaluated this questionnaire in a multicenter study of a mucolytic medication used in patients with CB and hypothesized that spirometry, exercise capacity, and sputum clearability changes would correlate with QOL changes. This was a multicenter trial in 159 patients with stable CB (111 completed the 16-week study). Spirometry, plethysmography, the 6-minute walk test (6MWT), and Petty score as a measure of QOL were assessed at each visit. Sputum was collected at each visit. Cough transportability was measured in a cough machine, and mucociliary transportability was measured on the frog palate. Cohesivity was measured in a filancemeter, interfacial tension by de Noüy ring, and wettability by contact angle analysis. Within the entire data set of 694 evaluations, there was no correlation between pulmonary function and QOL. There was an inverse correlation with distance covered in a 6MWT (R(2) = 0.041, p < 0.0001). Sputum CTR was directly correlated with QOL (R(2) = 0.027, p < 0.0001). Change from baseline (mean of first three visits) was computed and compared the change in the mean of values at the 8- and 12-week visits (n = 108 sets of data pairs). This was analyzed as a percentage of change for continuous measurements, and as QOL is normative, we calculated the absolute change in QOL. There was no relation between QOL and 6MWT changes. There was an inverse relation between change in forced expiratory volume in 1 second and QOL (R(2) = 0.092, p = 0.0021) as well as between forced vital capacity and QOL (R(2) = 0.05, p = 0.024). There was a direct relation between CTR and QOL (R(2) = 0.039, p = 0.048). The relation between QOL and 6-minute walk distance was expected but weak. The consistent relation between CTR and QOL (suggesting that improved CTR of sputum is associated with decreased QOL) is difficult to explain. A change in forced expiratory volume in 1 second and forced vital capacity did correlate with a change in QOL. There is a need for a good QOL tool to evaluate mucus clearance devices or medications. The Petty questionnaire was designed specifically for this task, but the effect on sputum properties by current mucoactive agents may be too small to elicit a significant change in the Petty score.

Analysis of Variance↗

PubMed1990

Review of clinical experience with xamoterol. Effects on exercise capacity and symptoms in heart failure.

The sympathetic nervous system becomes activated in heart failure, and while this is initially beneficial, the consequences of prolonged raised levels of catecholamines can be counterproductive. Xamoterol, a partial agonist that acts on the cardiac beta 1-adrenergic receptor, modifies the response of the heart to variations in sympathetic activity. At rest, it produces modest improvements in cardiac contractility, relaxation, and filling without increase in myocardial oxygen demand. The improvements are maintained during exercise although the attendant tachycardia is attenuated. The beneficial effects of xamoterol on both systolic and diastolic function suggested that it would be effective in patients with mild-to-moderate heart failure, and this was demonstrated in small placebo-controlled studies where effort tolerance and symptoms were improved. A large multicenter study program comprised of four studies demonstrated that patients with mild-to-moderate heart failure randomized to xamoterol (n = 617) 200 mg b.i.d. for 3 months significantly (p less than 0.0001) improved exercise capacity by 37% as compared with the placebo group (n = 300) with an increase of 18%. The xamoterol group also showed significant improvements in symptoms of breathlessness, fatigue, and life values as compared with the placebo group. In one of the multicenter studies in which 433 patients were randomized to xamoterol (n = 220), placebo (n = 109), and a positive control, digoxin 0.125 mg b.i.d. (n = 104), the percentages of improvement in exercise work were 33%, 5%, and 17%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗

PubMed1996

Effect of 30 mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD.

OBJECTIVE: We have shown that the administration of 0.8 mg/kg of morphine (M) to patients with COPD resulted in a 20% increase in the maximum oxygen consumption (Vo2max), but was associated with significant drowsiness and euphoria. The objective of the present study was to ascertain whether lower doses of M alone or in combination with prochlorperazine (PC) or promethazine (P) could elicit significant increases in exercise tolerance. DESIGN: The exercise capacity, psychological status, and reaction times were assessed before and 60 min after the patients received placebo (PLAC), 30 mg M orally, 30 mg M plus 10 mg PC (M-PC), or 30 mg M plus 25 mg P (M-P) in a randomized double-blind crossover study. In a secondary study, nine patients were tested on three separate days before and after receiving PLAC, 25 mg P, or 30 mg M plus 25 mg P. PATIENTS: Seven COPD patients (FEV1=0.99 +/- 0.30 L, Vo2max=990 +/- 315 mL/min) who were ventilatory-limited. SETTING: Veterans Affairs medical center. RESULTS: After the patients ingested M-P, the increase in the Vo2max (129.0 +/- 104 mL/min), the workload (10.0 +/- 6.5 W) and the maximum minute ventilation (4.0 +/- 3.9 L/min) were significantly greater (p<0.05) than after PLAC ingestion (-4.8 +/- 79 mL/min, 1.4 +/- 6.9 W, and -1.6 +/- 2.4 L/min, respectively). Changes after the ingestion of M, P, o r M-PC were intermediate. The M-PC combination adversely affected the patient's reported mental status (Bond visual analog scale) more than the M-P or M regimens. No regimen significantly affected the reaction time. CONCLUSIONS: We conclude that the administration of 30 mg of M plus 25 mg of P significantly improves the exercise tolerance of patients with COPD, without significantly impairing the mental capabilities of the subjects. The utility of this regimen over longer time periods needs to be evaluated.

Administration, Oral↗

PubMed1996

Octreotide treatment increases exercise capacity in patients with acromegaly.

This prospective study was conducted to determine the effect of Octreotide treatment on cardiovascular function in patients with active acromegaly. Ten acromegalic patients who failed to suppress growth hormone (GH) to < 5 mU/l during a 2 h oral glucose tolerance test were treated with 100 micrograms of Octreotide subcutaneously three times daily for 2 months, followed by 200 micrograms three times daily if the mean GH level was > 5 mU/l, for a total of 1 year. All patients had GH and insulin-like growth factor I (IGF-I) estimation, ejection fraction determined by Echocardiogram and multigated image acquisition scan, electrocardiogram (ECG), exercise ECG, 24-h ECG and chest x-ray. At 6 and 12 months, both GH and IGF-I were reduced but ECG, heart size and ejection fraction were unchanged. The patients improved symptomatically and had significant reduction in resting heart rate and increase in weight. Exercise time (mean +/- SD) increased from 637 +/- 137s at baseline to 787 +/- 101s at 1 year (p < 0.01) and work done increased from 9 +/- 3.3 to 11.9 +/- 2.7 metabolic equivalents (p < 0.001). We conclude that the decrease in GH and IGF-I following Octreotide treatment of acromegaly is accompanied by decreased heart rate and increased exercise capacity despite an unchanged ejection fraction.

Acromegaly↗

PubMedDate not supplied

Four-week multidisciplinary cardiac rehabilitation produces similar improvements in exercise capacity and quality of life to a 10-week program.

BACKGROUND: Cardiac rehabilitation (CR) is widely accepted as beneficial for patients with myocardial infarction (MI) and coronary artery bypass graft (CABG). A need exists to evaluate how different formats of delivery can best meet CR service demands. METHODS AND RESULTS: Cardiac patients (n = 60) were randomly assigned to either a standard 10-week (30 sessions) or a 4-week (20 sessions) multifactorial rehabilitation program. Patients underwent exercise testing using the Bruce protocol before, immediately after, and then 6 months after CR. Patients also completed the SF-36 quality of life questionnaire and the Hospital Anxiety and Depression scale at each time point. Compared with pre-CR, exercise time and metabolic equivalents attained were significantly increased, and heart rate significantly decreased both immediately (P<.05) and 6 months after CR (P<.05) in both groups, with no between-group differences. Significant improvements (P<.05) in energy, pain, and general health were reported after CR, and in energy and emotional and social well-being at 6 months after CR. No differences were seen between the groups. CONCLUSIONS: Cardiac rehabilitation after MI and CABG significantly improved exercise capacity and general health and well-being. No significant differences were detected between groups undergoing a 10-week or 4-week course. These preliminary data suggest that shortened courses of CR may be beneficial to cardiac patients and such courses may also facilitate more widespread use of CR.

Aged↗

PubMed1989

Relation of lung function and exercise capacity to mood and attitudes to health.

Results of psychometric tests were obtained on 161 male welders and other tradesmen in heavy industry who had recently been made redundant. Anxiety and depression were scored on the Hospital Anxiety and Depression Scale, and negative attitudes and beliefs regarding breathlessness and related aspects of respiratory health on a semantic differential scale. Scores for attitudes and beliefs about health and personal disability were pooled to give a general attitude score. Personality was rated on a standard scale. Subjects completed a questionnaire on respiratory symptoms and underwent routine spirometry, measurement of carbon monoxide transfer factor for the lung, and a progressive exercise test on a cycle ergometer. Scores for anxiety, depression, and negative mental attitudes were significantly intercorrelated; subjects with disordered personality profiles had above average scores for anxiety and depression. The psychometric scores were associated with clinical grade of breathlessness, lung function, and the physiological response to exercise. The general attitude score could be predicted from the anxiety and depression scores and from lung function expressed relative to age and stature, the combination of mood score and FEV1 explaining 38% of the variance in general attitude score. The general attitude score accounted for more than half the explained variance in the clinical grade of breathlessness and contributed more to the variance in maximal oxygen uptake (R2 = 0.11) than FEV1. It was associated with the level of habitual activity but not with smoking category, wheeze, chronic cough or phlegm. Thus attitude to disability reflected the subject's assessment of his exercise capacity and was closely related to the clinical grade of breathlessness.

Adult↗