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High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease.

BACKGROUND: Increased aerobic exercise capacity appears to reduce both all-cause mortality and cardiovascular disease mortality. Physical exercise to improve peak oxygen uptake (VO2peak) is thus strongly recommended, however evidence regarding the most efficient training intensity for patients with coronary artery disease (CAD) is still lacking. The purpose of this randomized study was therefore to assess the effects of high intensity aerobic interval exercise compared to moderate intensity exercise, representing the same total training load, for increasing VO2peak in stable CAD-patients. METHODS: Twenty-one stable CAD-patients were randomized to supervised treadmill walking at either high intensity (80-90% of VO2peak) or moderate intensity (50-60% of VO2peak) three times a week for 10 weeks. RESULTS: After training VO2peak increased by 17.9% (P=0.012) in the high intensity group and 7.9% (P=0.038) in the moderate intensity group. The training-induced adaptation was significantly higher in the high intensity group (P=0.011). CONCLUSIONS: High intensity aerobic interval exercise is superior to moderate exercise for increasing VO2peak in stable CAD-patients. As VO2peak seems to reflect a continuum between health and cardiovascular disease and death, the present data may be useful in designing effective training programmes for improved health in the future.

Coronary Artery Disease↗

Oxatomide and exercise-induced asthma in children: the value of serial exercise tests.

Two groups of eight asthmatic children carried out serial treadmill exercise tests at 2-hourly intervals, after double-blind premedication with oxatomide (2 mg/kg by mouth), sodium cromoglycate powder (20 mg by inhalation) or matched placebo preparations. The drugs were studied in one group up to 6 hr and in the other group (omitting sodium cromoglycate) from 4 to 10 hr after administration. Peak expiratory flow rate was measured before and after exercise to give an index of exercise-induced asthma. Oxatomide had a slight but significant bronchodilator effect. After a lag period of up to 4 hours, oxatomide exerted a significant protective effect against exercise-induced asthma which lasted until at least 8 hr. At 10 hr after ingestion, the effect had gone. A mean maximum diminution of exercise-induced asthma of 49% was found, in comparison with placebo. Oral oxatomide after a lag period, exerts a significant protective effect against exercise-induced asthma. The relevance of these observations for the clinical management of asthma remains to be determined.

Asthma↗

Increased insulin-stimulated glucose uptake by exercised human muscles one day after prolonged physical exercise.

We evaluated whether the increased peripheral insulin sensitivity often reported after physical exercise is generalized or limited to the active musculature. Substrate exchange in leg (previously active) and forearm (previously inactive) were measured by catheterization technique basally and during a hyperinsulinaemic euglycaemic clamp (2 mU insulin kg-1 BW min-1) in nine healthy men before and 1 day after 3-h exercise (50% VO2max). One day after exercise basal glucose uptake was unchanged in the leg, while it was decreased in the forearm (-61%, P less than 0.01) compared with the pre-exercise condition. Glucose uptake during hyperinsulinaemia was increased in the leg (+31%, P less than 0.05), but not in the forearm. Basal lactate release by the leg was increased by the exercise, while lactate release by the forearm was decreased, significantly only during the clamp. These results indicate that local and not systemic factors are responsible for the changes in insulin sensitivity observed in the recovery from physical exercise.

Adult↗

Special feature for the Olympics: effects of exercise on the immune system: modification of immune responses to exercise by carbohydrate, glutamine and anti-oxidant supplements.

Immunosuppression in athletes involved in heavy training is undoubtedly multifactorial in origin. Training and competitive surroundings may increase the athlete's exposure to pathogens and provide optimal conditions for pathogen transmission. Heavy prolonged exertion is associated with numerous hormonal and biochemical changes, many of which potentially have detrimental effects on immune function. Furthermore, improper nutrition can compound the negative influence of heavy exertion on immunocompetence. An athlete exercising in a carbohydrate-depleted state experiences larger increases in circulating stress hormones and a greater perturbation of several immune function indices. The poor nutritional status of some athletes may predispose them to immunosuppression. For example, dietary deficiencies of protein and specific micronutrients have long been associated with immune dysfunction. Although it is impossible to counter the effects of all of the factors that contribute to exercise-induced immunosuppression, it has been shown to be possible to minimize the effects of many factors. Athletes can help themselves by eating a well-balanced diet that includes adequate protein and carbohydrate, sufficient to meet their energy requirements. This will ensure a more than adequate intake of trace elements without the need for special supplements. Consuming carbohydrate (but not glutamine or other amino acids) during exercise attenuates rises in stress hormones, such as cortisol, and appears to limit the degree of exercise-induced immunosuppression, at least for non-fatiguing bouts of exercise. Evidence that high doses of anti-oxidant vitamins can prevent exercise-induced immunosuppression is also lacking.

Antioxidants↗

Special feature for the Olympics: effects of exercise on the immune system: exercise effects on mucosal immunity.

The present review examines the effects of exercise on mucosal immunity in recreational and elite athletes and the role of mucosal immunity in respiratory illness. Habitual exercise at an intense level can cause suppression of mucosal immune parameters, while moderate exercise may have positive effects. Saliva is the most commonly used secretion for measurement of secretory antibodies in the assessment of mucosal immune status. Salivary IgA and IgM concentrations decline immediately after a bout of intense exercise, but usually recover within 24 h. Training at an intense level over many years can result in a chronic suppression of salivary immunoglobulin levels. The degree of immune suppression and the recovery rates after exercise are associated with the intensity of exercise and the duration or volume of the training. Low levels of salivary IgM and IgA, particularly the IgA1 subclass, are associated with an increased risk of respiratory illness in athletes. Monitoring mucosal immune parameters during critical periods of training provides an assessment of the upper respiratory tract illness risk status of an individual athlete. The mechanisms underlying the mucosal immune suppression are unknown.

Exercise↗

The effects of exercise and diet manipulation on the capacity to perform prolonged exercise in the heat and in the cold in trained humans.

1. This study examined the effects of exercise and diet manipulation intended to alter initial muscle glycogen levels on the capacity to perform prolonged exercise at two ambient temperatures. 2. Six well-trained cyclists participated in randomized order in two diet and exercise regimens each lasting 8 days and comprising four cycle tests to exhaustion at 70 % of maximum oxygen uptake. On days 1 and 5, subjects exercised to exhaustion to deplete muscle glycogen. Three days after each depletion trial a diet providing 10 % (low carbohydrate (CHO)) or 80 % (high CHO) of energy as CHO was consumed, and each diet was followed by a performance trial at the same ambient temperature, either 10 or 30 C (days 4 and 8). This schedule was repeated after a week, but performance trials were carried out at the other ambient temperature. 3. In the cold, cycling time increased (median (range)) from 89.2 min (78.0-129.5 min) on the low CHO trial to 158.2 min (116.9-165.6 min) on the high CHO trial (P < 0.01). In the heat, cycling time increased from 44.0 min (31.8-51.4 min) on the low CHO trial to 53.2 min (50.2-82.2 min) on the high CHO trial (P = 0.02). Total CHO oxidized during exercise in the cold after the low CHO diet was higher than in the heat after either diet suggesting that exercise in the heat was terminated before all available CHO stores had been emptied.

Acclimatization↗

The beneficial effects of group-based exercises on fall risk profile and physical activity persist 1 year postintervention in older women with low bone mass: follow-up after withdrawal of exercise.

OBJECTIVES: To determine whether exercise-induced reductions in fall risk are maintained in older women 1 year after the cessation of three types of interventions--resistance training, agility training, and general stretching. DESIGN: One-year observational study. SETTING: Community. PARTICIPANTS: Ninety-eight women aged 75 to 85 with low bone mass. MEASUREMENTS: Primary outcome measure was fall risk, measured using the Physiological Profile Assessment tool. Secondary outcome measures were current physical activity level, assessed using the Physical Activity Scale for the Elderly, and formal exercise participation, assessed using an interview. RESULTS: At the end of the follow-up, the fall risk of former participants of all three exercise programs was maintained (i.e., still reduced) from trial completion. Mean fall risk value at the end of follow-up was 43.3% lower than mean baseline value in former participants of the resistance-training group, 40.1% lower in the agility-training group, and 37.4% lower in the general stretching group. Physical activity levels were also maintained from trial completion. Specifically, there was a 3.8% increase in physical activity from baseline for the resistance-training group, a 29.2% increase for the agility-training group, and a 37.7% increase for the general stretching group. CONCLUSION: After three types of group-based exercise programs, benefits are sustained for at least 12 months without further formal exercise intervention. Thus, these 6-month exercise interventions appeared to act as a catalyst for increasing physical activity with resultant reductions in fall risk profile that were maintained for at least 18 months in older women with low bone mass.

Accidental Falls↗

Effects of exhaustive stretch-shortening cycle exercise on muscle blood flow during exercise.

AIM: The influence of exhaustive stretch-shortening cycle exercise (SSC) on skeletal muscle blood flow (BF) during exercise is currently unknown. METHODS: Quadriceps femoris (QF) BF was measured in eight healthy men using positron emission tomography before and 3 days after exhaustive SSC exercise. The SSC protocol consisted of maximal and submaximal drop jumps with one leg. Needle biopsies of the vastus lateralis muscles were taken immediately and 2 days after SSC for muscle endothelial nitric oxide synthase (eNOS) and interleukin-1-beta (IL-1beta) mRNA level determinations. RESULTS: All subjects reported subjective muscle soreness after SSC (P < 0.001), which was well in line with a decrease in maximal isometric contraction force (MVC) and increase in serum creatine kinase activity (CK) (P = 0.018). After SSC muscle BF was 25% higher in entire QF (P = 0.043) and in its deep and superficial muscle regions, whereas oxygen uptake remained unchanged (P = 0.893). Muscle biopsies revealed increased IL-1beta (30 min: 152 +/- 75%, P = 0.012 and 2 days: 108 +/- 203%, P = 0.036) but decreased or unchanged eNOS (30 min; -21 +/- 57%, P = 0.050 and 2 days: +101 +/- 204%, P = 0.779) mRNA levels after SSC. CONCLUSION: It was concluded that fatiguing SSC exercise induces increased muscle BF during exercise, which is likely to be associated with pro-inflammatory processes in the exercised muscle.

Adult↗

Pulmonary artery, aortic and oesophageal pressure changes during high intensity treadmill exercise in the horse: a possible relation to exercise-induced pulmonary haemorrhage.

This study investigated changes in packed cell volume (PCV), pulmonary artery and aortic pressures, and the interaction between oesophageal pressure and pulmonary artery and aortic pressures during strenuous exercise in the horse. It was hypothesised that oesophageal pressure changes summate with pulmonary artery and aortic pressures during exercise and contribute to exercise-induced pulmonary haemorrhage (EIPH). Acute treadmill exercise (10 m/sec, 3 degrees incline) produced increases in heart rate (HR) from 50 to 202 beats/min; mean pulmonary artery pressure (PAP) from 28 to 80 mmHg; mean aortic pressure (AP) from 108 to 157 mmHg; and PCV from 0.35 to 0.52 litres/litre. EIPH was observed in three of seven horses after treadmill exercise, but no differences in the above variables were observed between the two groups of horses. Electronic subtraction of the oesophageal pressure signal from PAP and AP signals indicated peak transmural pressures of approximately 150 mmHg pulmonary and 175 mmHg aortic pressure. The elevated PAP associated with exercise appeared related more to increased HR and less to PCV (blood viscosity) or AP (bronchial). Both pulmonary artery and aortic peak transmural vascular pressures were substantially influenced by oesophageal pressure changes; peak and mean pulmonary artery and aortic pressures were significantly higher than resting pressures, and may conceivably contribute to EIPH.

Animals↗

Carotid baroreflex control of leg vasculature in exercising and non-exercising skeletal muscle in humans.

Carotid baroreflex (CBR) function was examined in five men and three women (25 +/- 1 years) using the variable-pressure neck collar technique at rest and during dynamic, one-legged knee extension exercise at 7 W and 25 W. The CBR exhibited control of leg vascular conductance (LVC) at rest and during exercise in both an exercising leg (EL) and a non-exercising leg (NEL) across a wide range of pressures from +40 Torr neck pressure (NP) to -80 Torr neck suction (NS). Specifically, increases in LVC (% change) in response to NS were no different across -20 to -80 Torr in either EL or NEL compared to rest, P > 0.05. However, CBR-mediated decreases in percentage LVC in response to NP were attenuated in EL at both 7 W (16 +/- 1%) and 25 W (12 +/- 1%) compared to rest (40 +/- 3%; P < 0.05) as well as compared to responses in the NEL (36 +/- 6% at 7 W and 36 +/- 7% at 25 W; P < 0.05). This decrease in vascular responsiveness in EL was associated with a reduction in the gain of the percentage muscle sympathetic nerve activity (%MSNA)-%LVC relationship compared to rest (P < 0.05). Collectively, these data indicate that, despite a clear attenuation of the vascular response to MSNA in the exercising leg, CBR-mediated changes in mean arterial pressure were no different between rest and exercise.

Adult↗

Effect of split exercise sessions on excess post-exercise oxygen consumption.

In this study the excess post-exercise oxygen consumption (EPOC), and related metabolic measures, following a 50 minute run compared to two 25 minute runs all at 70 per cent of peak VO2 in six women were investigated. Open-circuit spirometry procedures were used and appropriate control conditions were maintained for all trials. Following exercise, VO2 returned to baseline within 30 minutes for all three exercise trials. Magnitude of EPOC was also similar after all runs. However, the combined magnitude (expressed in kcals) of the two 25 minute runs was significantly greater than the continuous 50 minute run (13.88 vs 6.39). Heart rate remained elevated above baseline, and respiratory exchange ratio was lower than baseline 30 minutes after exercise. It is concluded that split exercise sessions can significantly increase post-exercise caloric expenditure. However, the overall magnitude of the increase is small.

Adult↗

Submaximal exercise testing early after myocardial infarction. Prognostic importance of exercise induced ST segment elevation.

Seventy four patients (66 men, eight women; mean age 54.3 years) underwent submaximal exercise testing 7-23 days (mean 10.7) after acute myocardial infarction. Follow up was a mean period of 11.3 months. When compared with patients with no exercise induced abnormality, ST segment elevation, ST shift (depression or elevation or both), ST depression, inability to complete five metabolic equivalents, and inadequate blood pressure response to exercise were predictive of subsequent cardiac events (cardiac death, left ventricular failure, recurrent myocardial infarction, angina). When the presence or absence of specific variables was assessed, only ST elevation and ST shift predicted subsequent cardiac events. The presence of exercise induced ST elevation was the only exercise test variable which predicted cardiac death. ST segment elevation was, therefore, the exercise induced abnormality which best predicted the risk of future complications.

Adrenergic beta-Antagonists↗

Adaptations in skeletal muscle exercise metabolism to a sustained session of heavy intermittent exercise.

The purpose of this study was to investigate the hypothesis that a single, extended session of heavy exercise would be effective in inducing adaptations in energy metabolism during exercise in the absence of increases in oxidative potential. Ten healthy males [maximal aerobic power (VO(2 peak)) = 43.4 +/- 2.2 (SE) ml x kg(-1) x min(-1)] participated in a 16-h training session involving cycling for 6 min each hour at approximately 90% of maximal oxygen consumption. Measurements of metabolic changes were made on tissue extracted from the vastus lateralis during a two-stage standardized submaximal cycle protocol before (Pre) and 36-48 h after (Post) the training session. At Pre, creatine phosphate (PCr) declined (P < 0.05) by 32% from 0 to 3 min and then remained stable until 20 min of exercise at 60% VO(2 peak) before declining (P < 0.05) by a further 35% during 20 min of exercise at 75% VO(2 peak). Muscle lactate (mmol/kg dry wt) progressively increased (P < 0.05) from 4.59 +/- 0.64 at 0 min to 17.8 +/- 2.7 and 30.9 +/- 5.3 at 3 and 40 min, respectively, whereas muscle glycogen (mmol glucosyl units/kg dry wt) declined (P < 0.05) from a rest value of 360 +/- 24 to 276 +/- 31 and 178 +/- 36 at similar time points. During exercise after the training session, PCr and glycogen were not as depressed (P < 0.05), and increases in muscle lactate were blunted (P < 0.05). All of these changes occurred in the absence of increases in oxidative potential as measured by the maximal activities of citrate synthase and malate dehydrogenase. These findings are consistent with other studies, namely, that muscle metabolic adaptations to regular exercise are an early adaptive event that occurs before increases in oxidative potential.

Adaptation, Physiological↗

Effects of plasma epinephrine on fat metabolism during exercise: interactions with exercise intensity.

This study determined the effects of elevated plasma epinephrine on fat metabolism during exercise. On four occasions, seven moderately trained subjects cycled at 25% of peak oxygen consumption (VO(2 peak)) for 60 min. After 15 min of exercise, subjects were intravenously infused with low (0.96 +/- 0.10 nM), moderate (1.92 +/- 0.24 nM), or high (3.44 +/- 0.50 nM) levels (all P < 0.05) of epinephrine to increase plasma epinephrine above control (Con; 0.59 +/- 0.10 nM). During the interval between 35 and 55 min of exercise, lipolysis [i.e., rate of appearance of glycerol] increased above Con (4.9 +/- 0.5 micromol. kg(-1). min(-1)) with low, moderate, and high (6.5 +/- 0.5, 7.1 +/- 0.8, and 10.6 +/- 1.2 micromol. kg(-1). min(-1), respectively; all P < 0.05) levels of epinephrine despite simultaneous increases in plasma insulin. The release of fatty acid into plasma also increased progressively with the graded epinephrine infusions. However, fatty acid oxidation was lower than Con (11.1 +/- 0.8 micromol. kg(-1). min(-1)) during moderate and high levels (8.7 +/- 0.7 and 8.1 +/- 0.9 micromol. kg(-1). min(-1), respectively; P < 0.05). In one additional trial, the same subjects exercised at 45% VO(2 peak) without epinephrine infusion, which produced a plasma epinephrine concentration identical to low levels. However, lipolysis was lower (i.e., 5.5 +/- 0.6 vs. 6.5 +/- 0.5 micromol. kg(-1). min(-1); P < 0.05). In conclusion, elevations in plasma epinephrine concentration during exercise at 25% of VO(2 peak) progressively increase whole body lipolysis but decrease fatty acid oxidation. Last, increasing exercise intensity from 25 to 45% VO(2 peak) attenuates the lipolytic actions of epinephrine.

Adult↗

Effect of acute exercise and exercise training on VEGF splice variants in human skeletal muscle.

The present study investigated the effect of an acute exercise bout on the mRNA response of vascular endothelial growth factor (VEGF) splice variants in untrained and trained human skeletal muscle. Seven habitually active young men performed one-legged knee-extensor exercise training at an intensity corresponding to approximately 70% of the maximal workload in an incremental test five times/week for 4 wk. Biopsies were obtained from the vastus lateralis muscle of the trained and untrained leg 40 h after the last training session. The subjects then performed 3 h of two-legged knee-extensor exercise, and biopsies were obtained from both legs after 0, 2, 6, and 24 h of recovery. Real-time PCR was used to examine the expression of VEGF mRNA containing exon 1 and 2 (all VEGF isoforms), exon 6 or exon 7, and VEGF(165) mRNA. Acute exercise induced an increase (P < 0.05) in total VEGF mRNA levels as well as VEGF(165) and VEGF splice variants containing exon 7 at 0, 2, and 6 h of recovery. The increase in VEGF mRNA was higher in the untrained than in the trained leg (P < 0.05). The results suggest that in human skeletal muscle, acute exercise increases total VEGF mRNA, an increase that appears to be explained mainly by an increase in VEGF(165) mRNA. Furthermore, 4 wk of training attenuated the exercise-induced response in skeletal muscle VEGF(165) mRNA.

Adult↗

Lactate kinetics in resting and exercising forearms during moderate-intensity supine leg exercise.

Arterial blood lactate was elevated by supine leg exercise (20 min at approximately 65% maximal oxygen uptake) in five untrained male subjects, and the contribution to blood lactate removal from passive uptake vs. metabolic disposal was compared in resting and lightly exercising (15% maximal voluntary contraction static handgrip) forearm skeletal muscle. An integrated form of the Fick equation was used to predict venous lactate levels resulting solely from passive equilibration of lactate between incoming arterial blood and the forearm muscles. In the resting forearm, predicted and measured venous lactate levels were closely correlated during the exercise period (r = 0.995, P < 0.001), indicating that lactate removal could be accounted for in terms of passive uptake alone. In the lightly exercising forearm, measured venous lactate levels were higher than both the arterial and predicted venous levels, indicating net lactate production. It was concluded that most of the blood lactate generated by moderate-intensity supine leg exercise is taken up passively and not metabolized by resting skeletal muscle and that the rate of lactate disposal is unlikely to be enhanced in lightly exercising muscle.

Adult↗

Role of ventilatory response to exercise in determining exercise capacity in COPD.

The progression of chronic obstructive pulmonary disease (COPD) is generally associated with decreased exercise capacity. Differences in forced expired volume in 1 s (FEV1) among patients account for only a fraction of the variability in maximal oxygen consumption (VO2max). We hypothesized that variability in ventilatory response to exercise and in inspiratory mechanics and body mass index contributes importantly to variability in VO2max in this disease. We analyzed the files of 53 patients with established diagnosis of COPD who underwent a recent symptom-limited exercise test. We used inspiratory capacity and maximum inspiratory flow as measures of variability in inspiratory mechanics. The minute ventilation (VE) at the subject's VO2max was divided by the predicted in a normal subject at the same VO2 to obtain a ratio (VE,max/VE,pred). The ventilatory response during exercise provided the best correlation with peak VO2 (r = 0.62). FEV1 and inspiratory capacity also correlated with peak oxygen consumption but not as well as the ventilatory response (r = 0.49 and r = 0.46, respectively). Maximum inspiratory flow and body mass index showed only weak positive correlations (r = 0.23, not significant). The stepwise analysis generated the following equation: VO2max (%predicted) = (77.26 x VE,pred/VE,max) + [0.45 x FEV1 (%predicted)] - 23.66; r = 0.76, P < 0.001. We conclude that variability in the ventilatory response during exercise is one of the main determinants of variability in exercise capacity in COPD patients.

Adult↗

Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount.

Despite the importance of randomized, dose-response studies for proper evaluation of effective clinical interventions, there have been no dose-response studies on the effects of exercise amount on abdominal obesity, a major risk factor for metabolic syndrome, diabetes, and cardiovascular disease. One hundred seventy-five sedentary, overweight men and women with mild to moderate dyslipidemia were randomly assigned to participate for 6 mo in a control group or for approximately 8 mo in one of three exercise groups: 1) low amount, moderate intensity, equivalent to walking 12 miles/wk (19.2 km) at 40-55% of peak oxygen consumption; 2) low amount, vigorous intensity, equivalent to jogging 12 miles/wk at 65-80% of peak oxygen consumption; or 3) high amount, vigorous intensity, equivalent to jogging 20 miles/wk (32.0 km). Computed tomography scans were analyzed for abdominal fat. Controls gained visceral fat (8.6 +/- 17.2%; P = 0.001). The equivalent of 11 miles of exercise per week, at either intensity, prevented significant accumulation of visceral fat. The highest amount of exercise resulted in decreased visceral (-6.9 +/- 20.8%; P = 0.038) and subcutaneous (-7.0 +/- 10.8%; P < 0.001) abdominal fat. Significant gains in visceral fat over only 6 mo emphasize the high cost of continued inactivity. A modest exercise program, consistent with recommendations from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM), prevented significant increases in visceral fat. Importantly, a modest increase over the CDC/ACSM exercise recommendations resulted in significant decreases in visceral, subcutaneous, and total abdominal fat without changes in caloric intake.

Abdominal Fat↗