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PubMed1991

Exercise training programs and cardiorespiratory adaptation.

Prudent, proper, and progressive aerobic exercise can improve the efficiency of the cardiorespiratory system. Several physiologic mechanisms interact to enhance the body's functional capabilities. Central cardiac adaptations such as improved pump efficiency and peripheral adjustments related to efficient energy transfer are the principle manifestations of proper exercise training. Related benefits of physical activity include reduction in risk from life style-related diseases, increased energy reserves for the activities of everyday living, and an improved quality of life. Functional exercise testing when administered properly can be used to establish safe exercise prescriptions, evaluate patients at risk, and determine program efficacy. The method of choice is a maximal exercise stress test with direct determination of oxygen uptake. Results from such evaluations help to accurately and safely determine the appropriate exercise prescriptions and establish a patient's physiologic profile. The exercise prescription should encompass an approach that denotes the proper application of frequency, intensity, duration, and mode of exercise. For the noncompetitive athlete, training programs should begin with a gentle progression of low-level intensity activities that encourages compliance and reduces risk. Short-term reachable goals documenting gradual increases in activity have been shown to be successful in terms of compliance and desired benefits. Although intense exercise training may be an ambitious goal for many persons, moderate levels of habitual physical activity are a more realistic goal. The clinician should realize that habitual physical activity is an integral part of a healthy life style. Lack of fitness has been strongly associated with all-cause morbidity and mortality. Obviously, the health potential of exercise cannot be realized if a society remains inactive. It is estimated that 40% of Americans are completely sedentary and another 40% are active at levels well below a threshold that would produce gains in cardiovascular fitness and health. This situation exists even though the US Public Health Service has prioritized the importance of physical fitness and habitual physical activity in maintaining preventive health measures and population health status.

Adaptation, Physiological↗
PubMedDate not supplied

The role of exercise training in patients with chronic heart failure.

The National Institute for Clinical Excellence (NICE) has recommended that exercise training be offered to patients with chronic heart failure (CHF). This recommendation is supported by research-based evidence from a variety of studies over the past 10 years. Initially, the studies were concerned primarily with the safety and effectiveness of exercise in these high-risk patients, but more recent studies have begun to investigate the most appropriate methods of exercise for this patient population. This article presents a systematic review of the literature relating to exercise training and CHE. It then attempts to identify, in light of the evidence, the most effective programme of exercise, including type, duration and degree of exercise. Finally, it discusses practical application and implementation of the research findings into everyday health care, including issues such as staff development and training, assessment, exercise and prescription for individual patients, and evaluation of the service.

Chronic Disease↗
PubMedDate not supplied

Functional improvements following StairMaster vs. treadmill exercise training for patients with intermittent claudication.

BACKGROUND: Although there have been many studies showing that exercise training is beneficial for patients with peripheral vascular occlusive disease (PVOD), there is little research comparing various modes of training. Previous studies showed that exercise tests performed on a StairMaster (StairMaster Sports/Medical Products, Kirkland, WA) produce responses similar to those elicited by treadmill tests. The purpose of this study was to compare these modes of exercise in a training program for patients with PVOD. METHODS: Of the 23 eligible individuals who began the exercise program, 11 did not complete the regimen due to various complications. Thus, 12 patients were randomly assigned to train for 12 weeks on either a StairMaster (n = 6) or a treadmill (n = 6). Patients underwent progressive and single-stage exercise tests on both exercise modalities before and after training. RESULTS: Mean exercise time before the onset of claudication pain for all tests rose significantly after training (P <.01), but greater improvements were seen on the specific training apparatus (i.e., treadmill training resulted in improvement in treadmill exercise performance with less improvement noted when tested on the StairMaster, and vice versa). Exercise time to maximal pain increased for the training apparatus only (P <.01). There were no changes in foot transcutaneous oxygen tension or the ankle-brachial blood pressure index. CONCLUSIONS: Both StairMaster and treadmill training improve the exercise capacity of PVOD patients. The training effect is most apparent for the specific training apparatus, but there is some cross-over improvement to the other exercise modality. Thus, StairMaster training is appropriate and can be part of the exercise prescription for treatment of these patients.

Aged↗
PubMedDate not supplied

Effects of ubidecarenone in an exercise training program for patients with chronic obstructive pulmonary diseases.

A study was undertaken to determine the usefulness of ubidecarenone in pulmonary rehabilitation in exercise training programs in the management of chronic obstructive pulmonary disease (COPD). The subjects were 20 patients with COPD who had been participating in an exercise training program for at least four weeks. The patients were randomly assigned either to receive 50 mg of oral ubidecarenone daily or to enter a control group during the program. Oxygen consumption, expired volume, and heart rate were measured during exercise tests before and after training. Maximum oxygen consumption increased 13% in the ubidecarenone-treated patients and 7% in the controls, and maximum expired volume increased 10% in each group. The increases were significant in the ubidecarenone group but not in the controls. Heart rate increased 2% in both groups. It is concluded that ubidecarenone deserves further evaluation in exercise training programs for patients with COPD.

Coenzymes↗
PubMed2004

Optimising exercise training in peripheral arterial disease.

Peripheral arterial disease (PAD) is an obstructive condition where the flow of blood through peripheral arteries is impeded. During periods of increased oxygen demand (e.g. during exercise), peripheral limb ischaemia occurs, resulting in the sensation of muscle pain termed 'claudication'. As a result of claudication, subjects' ability to exercise is greatly reduced affecting their quality of life. Although many treatment options for patients with PAD exist, exercise training is an effective and low-cost means of improving functional ability and quality of life. Currently, there are limited specific recommendations to assist the exercise prescription and programming of these individuals. This review summarises data from 28 exercise training studies conducted in patients with PAD and formulates recommendations based on their results. Exercise training for patients with PAD should involve three training sessions per week comprising 45 minutes of intermittent treadmill walking in a supervised environment for a time period of 20 weeks or more. Encouragement and direction is given to further research aimed at investigating the effectiveness of training programmes in these patients.

Exercise↗
PubMed2001

Treatment efficacy of intermittent claudication by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients I: one year results of functional and physiological improvements.

OBJECTIVES: to compare the effect of surgery, exercise and simple observation on maximum exercise power in claudicants. DESIGN: prospective, randomised study. METHODS: a total of 264 unselected claudicants were randomised to supervised exercise training, invasive treatment (open surgical or endovascular procedures) or observation. One year treatment outcomes were analysed on an intention to-treat basis. RESULTS: invasively treated patients showed a significant improvement in maximum walking power, stopping distance, post-ischaemic blood flow and big toe pressure at one year. Patients randomised to physical exercise training or to the control group did not improve in any outcome measure. CONCLUSION: invasive treatment increased walking capacity, leg blood pressure and flow. Supervised physical exercise training offered no therapeutic advantage compared to untreated controls.

Adult↗
PubMed2006

[Exercise training in the treatment of coronary artery disease and obesity].

Endothelial dysfunction has been identified as a major predictor of future cardiovascular events and precedes the development of coronary artery disease (CAD). Regular physical exercise training--as part of a multifactorial intervention--corrects endothelial dysfunction, improves symptoms in patients with CAD, augments myocardial perfusion, and reduces mortality of these patients. This review discusses potential mechanisms, which might be responsible for the exercise training-mediated reduction of mortality in secondary prevention. The activation of stem cells, which are known to regenerate damaged endothelium and promote the development of new vessels by vasculogenesis, the regression of atherosclerosis, the formation of collaterals, and the partial correction of endothelial dysfunction as a consequence of molecular adaptations will be evaluated in this context. However, the positive effects of exercise training in primary and secondary prevention of cardiovascular diseases are not restricted to the correction of endothelial dysfunction. Regular physical activity, either alone or as part of a multifactorial intervention consisting of diet and exercise training, is known to promote effective weight loss. Especially in patients with metabolic syndrome, weight reduction beneficially effects blood glucose control. It increases the levels of vasculoprotective high-density lipoprotein and augments the physical exercise capacity of these individuals. Additionally, regular physical activity attenuates the diet-induced loss in fat-free body mass by 50%, improves body composition and counteracts the reduction in basal energy expenditure, which is another big advantage compared to diet alone in the treatment of obesity. Moreover, physical exercise training is essential to maintain a body weight that has been achieved by caloric restriction. It is important to look for exercise interventions that can easily be integrated in daily life and are not associated with an increased risk of trauma, even in severely obese individuals. Most importantly, patients should enjoy the proposed kind of physical exercise.

Clinical Trials as Topic↗
PubMed2003

Reduction in obesity and coronary risk factors after high caloric exercise training in overweight coronary patients.

BACKGROUND: The majority of patients with coronary heart disease (CHD) are overweight. However, little weight loss occurs with participation in a standard cardiac rehabilitation (CR) program. METHODS: Fifteen overweight patients (average body mass index of 31.0 kg/m2) with CHD completed a 4-month exercise training program in a CR program. The exercise program consisted primarily of walking long duration (60-90 minutes per session) 5 to 7 days per week at a relatively low intensity of 50% to 60% of peak VO2. Measures of body composition by dual-energy x-ray absorptiometry, body fat distribution by computed tomography, plasma lipid-lipoprotein, glucose and insulin concentrations, and peak VO2 were obtained before and after the exercise intervention. Patients maintained an isocaloric diet throughout the study. RESULTS: Patients had reductions in total body weight (-4.6 kg), fat mass (-3.6 kg), percent body fat (-2.9%), and waist circumference (-5.6 cm) (all P <.001) while maintaining fat-free mass. Subcutaneous adipose tissue was reduced by 12% (P <.001) and visceral adipose tissue was lowered by 14% (P <.001). There were favorable changes in the lipid-metabolic profile with reductions in triglyceride levels (-23.7%), total cholesterol/HDL-C ratio (-14.3%), and fasting insulin levels (-22.3%) (all P <.05). Peak VO2 increased by 21.2% (P <.001). CONCLUSIONS: The present pilot study results suggest that a high caloric training exercise training program in the CR setting may be effective in promoting weight loss and improving coronary risk factors in overweight coronary patients. Although additional research with randomized control patients is needed, this alternative to traditional CR may be considered to maximize weight loss as part of a secondary prevention program.

Aged↗
PubMed1996

Simple clinical data are useful in predicting effect of exercise training after myocardial infarction.

OBJECTIVES: The aim of the present study was to determine whether simple clinical variables can predict the effect of intensive exercise training in an unselected population early after myocardial infarction. METHODS: Starting 5 weeks after the qualifying myocardial infarction, 105 patients, 68 years old or younger, completed a 4 week period of intensive exercise training. The training effect was defined as an absolute increase in cumulative work at bicycle ergometry. Using univariate and multivariate analysis, 28 variables were tested against the training effect. RESULTS: The mean exercise capacity increased from 46.7 +/- 22.7 kJ to 69.5 +/- 31.1 kJ (P = 0.0001). Multivariate analysis identified five independent predictors of the training effect. Myocardial infarct size was associated with a better training effect (P = 0.0018), as was male gender (P = 0.0042) and ability to exercise to exhaustion at the baseline exercise test (P = 0.0124). Older age (P = 0.0017) and treatment with beta-adrenergic blocking agents (P = 0.0241) were associated with a lower effect from training. These five variables explained 33% of the variations in effect from training. Patients suffering in-hospital cardiac complications or congestive heart failure achieved a training effect at least as great as patients without cardiac complications. CONCLUSIONS: Five simple clinical variables, including infarct size, can assist in the selection of patients for exercise training after myocardial infarction.

Aged↗
PubMed1991

Mitogenic response of T-lymphocytes to exercise training and stress.

The impact of exercise training and stress on the immune response was examined by measuring the mitogenic response of spleen lymphocytes to the T-cell mitogen concanavalin A (Con-A). Male Sprague-Dawley rats were divided into four groups: sedentary controls (n = 11), handled controls (n = 12), treadmill runners (n = 10), and voluntary runners (n = 11) housed in running wheels. The treadmill group ran at 22 m/min (0.8 mph) for 45 min, 5 days/wk for 8 wk. After the training period, spleen lymphocytes isolated from each rat were incubated with Con-A for 54 h, pulsed with radiolabeled thymidine for 18 h, and counted for tritium activity. Counts per minute per group (means +/- SE) were as follows: sedentary, 6,839 +/- 1,461; handled, 8,959 +/- 1,576; voluntary runners, 13,126 +/- 2,069; and treadmill runners, 18,950 +/- 5,975. One-way analysis of variance and Tukey's highly significant difference test found the counts per minute of the treadmill runners to be significantly different from the counts per minute of the sedentary animals. These results indicate that the responsiveness of spleen lymphocytes to Con-A increases as the level of stress and exercise increases.

Animals↗
PubMed1989

Interactions of iron deficiency and exercise training in male Sprague-Dawley rats: ferrokinetics and hematology.

Ferrokinetic and hematologic studies were performed using adult male Sprague-Dawley rats to determine if 12 wk of exercise training alters the delivery of iron to the red blood cell (RBC) mass, the severity of the anemia or the maximal exercise performance of moderately iron-deficient animals. Forty rats were assigned to either iron-deficient (ID) or control (CN) diets, and further subdivided into sedentary (SD) and exercised (EX) groups. Exercised groups were trained on a treadmill, at a 15% grade, 65% VO2max, for 90 min/d, 4 d/wk. After 12 wk of exercise training and dietary iron deficiency, the final body weight of IDEX rats was 90.5% that of IDSD rats. Fractional plasma iron clearance in IDEX rats was 86% of that in IDSD rats (3.32 vs. 2.85%/min). Exercise training failed to increase absolute VO2max (ml/min) or change hemoglobin concentration in iron-deficient rats. Resting oxygen consumption in IDEX rats was 116% that in IDSD rats (42.8 vs. 32.5 ml.kg-1.min-1, P less than 0.05). We conclude that exercise training and iron deficiency interact to alter iron physiology in exercised, iron-deficient animals. This interaction affects the kinetic behavior of plasma iron, growth and basal oxygen consumption.

Animals↗
PubMed1978

Alterations in ventricular mass and performance induced by exercise training in man evaluated by echocardiography.

Few data are available regarding the effects of exercise training upon cardiac structure and performance in man. We evaluated the echograms of 24 normals before (PRE) and after (POST) 11 weeks of endurance exercise training. Conditioning consisted of a walk-jog-run protocol at 70% maximal heart rate for one hour four days per week. Training reduced heart rate and increased maximal duration and estimated oxygen consumption of treadmill exercise. Compared to PRE, the echogram in the POST training period revealed an increased left ventricular (LV) end-diastolic dimension (EdD), a decreased end-systolic dimension (EsD) and thus an increased stroke volume (EdD3-EsD3) and shortening fraction (EdD-EsD)/EdD). Cardiac output (CO) and peripheral vascular resistance (BP/CO X 80) were identical PRE and POST conditioning. Importantly, an increase in mean fiber shortening velocity was observed POST training as were increases in LV wall thickness, ECG voltage of S in V1 + R in V5, and LV mass. Thus endurance training was accompanied by increases in both LV dimension and mass as well as LV shortening fraction and contraction velocity as observed by echocardiogram.

Adult↗
PubMed1989

Cardiovascular responses of 70- to 79-yr-old men and women to exercise training.

This study determined the effects of endurance or resistance exercise training on maximal O2 consumption (VO2max) and the cardiovascular responses to exercise of 70- to 79-yr-old men and women. Healthy untrained subjects were randomly assigned to a control group (n = 12) or to an endurance (n = 16) or resistance training group (n = 19). Training consisted of three sessions per week for 26 wk. Resistance training consisted of one set of 8-12 repetitions on 10 Nautilus machines. Endurance training consisted of 40 min at 50-70% VO2max and at 75-85% VO2max for the first and last 13 wk of training, respectively. The endurance training group increased its VO2max by 16% during the first 13 wk of training and by a total of 22% after 26 wk of training; this group also increased its maximal O2 pulse, systolic blood pressure, and ventilation, and decreased its heart rate and perceived exertion during submaximal exercise. The resistance training group did not elicit significant changes in VO2max or in other maximal or submaximal cardiovascular responses despite eliciting 9 and 18% increases in lower and upper body strength, respectively. Thus healthy men and women in their 70s can respond to prolonged endurance exercise training with adaptations similar to those of younger individuals. Resistance training in older individuals has no effect on cardiovascular responses to submaximal or maximal treadmill exercise.

Aged↗
PubMed2002

Sympathetic activity and the heterogenous blood pressure response to exercise training in hypertensives.

To test whether changes in sympathetic nervous system (SNS) activity or insulin sensitivity contribute to the heterogeneous blood pressure response to aerobic exercise training, we used compartmental analysis of [3H]norepinephrine kinetics to determine the extravascular norepinephrine release rate (NE2) as an index of systemic SNS activity and determined the insulin sensitivity index (S(I)) by an intravenous glucose tolerance test, before and after 6 mo of aerobic exercise training, in 30 (63 +/- 7 yr) hypertensive subjects. Maximal O2 consumption increased from 18.4 +/- 0.7 to 20.8 +/- 0.7 ml x kg(-1) x min(-1) (P = 0.02). The average mean arterial blood pressure (MABP) did not change (114 +/- 2 vs. 114 +/- 2 mmHg); however, there was a wide range of responses (-19 to +17 mmHg). The average NE2 did not change significantly (2.11 +/- 0.15 vs. 1.99 +/- 0.13 microg x min(-1) x m(-2)), but there was a significant positive linear relationship between the change in NE2 and the change in MABP (r = 0.38, P = 0.04). S(I) increased from 2.81 +/- 0.37 to 3.71 +/- 0.42 microU x 10(-4) x min(-1) x ml(-1) (P = 0.004). The relationship between the change in S(I) and the change in MABP was not statistically significant (r = -0.03, P = 0.89). When the changes in maximal O2 consumption, percent body fat, NE2, and S(I) were considered as predictors of the change in MABP, only NE2 was a significant independent predictor. Thus suppression of SNS activity may play a role in the reduction in MABP and account for a portion of the heterogeneity of the MABP response to aerobic exercise training in older hypertensive subjects.

Aged↗
PubMed2003

[Different effects of exercise training in patients with myocardial infarction with or without diabetes mellitus].

OBJECTIVES: This study investigated whether myocardial infarction patients with diabetes mellitus had lower heart rate reserve to exercise by measuring the increment in heart rate (HR) divided by the increment of norepinephrine (NE) concentration from rest to peak exercise (delta HR/log delta NE). The difference in exercise training effects was also investigated. METHODS: The 148 patients after myocardial infarction were divided into two groups, the DM group (n = 34) and the non-DM group (n = 114). Cardiopulmonary exercise testing was performed in each subject at 1 and 3 months after the onset. Blood samples were taken at rest and immediately after peak exercise, rest brain natriuretic peptide, rest and peak norepinephrine were analyzed. Exercise training was performed from 1 to 3 months after the onset. RESULTS: Resting heart rates were significantly higher in the DM group than in the non-DM group both at 1 and 3 months although peak heart rates were not significantly different. Peak oxygen uptake were lower in the DM group both at 1 and 3 months after onset of myocardial infarction compared to the non-DM group. End-tidal carbon dioxide pressure was lower and the rate of increase of minute ventilation to carbon dioxide output was higher in the DM group. Plasma brain natriuretic peptide was higher in the DM group. delta HR/log delta NE was 19.4 +/- 4.0 in the DM group and 22.2 +/- 5.6 in the non-DM group (p < 0.01), and increased in only the non-DM group. delta HR/log delta NE was more closely correlated with peak oxygen uptake in the DM group than in the non-DM group. CONCLUSIONS: Impaired response to exercise training may be caused, in part, by impaired heart rate reserve to exercise in patients with diabetes mellitus.

Aged↗
PubMed2006

Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation.

BACKGROUND: Cardiac rehabilitation is widely recognized as a medical management procedure that reduces mortality, but the cardiovascular safety of exercise training has not been clearly established. Published data are retrospective or outdated, as patient management has substantially progressed in recent years. The aim of this prospective registry was to determine the current complication rate during exercise performed in the course of cardiac rehabilitation. METHODS: This study was conducted by the Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology. During a 1-year period, 65 cardiac rehabilitation centers reported that serious events had occurred during or 1 hour after an exercise stress test or a training session. Severe cardiovascular events were validated by a scientific committee. RESULTS: A total of 25,420 patients (78% men; mean age, 61.3 years) were included in the study. Initial indications for cardiac rehabilitation were post-cardiac surgery (coronary bypass, 34.3%; valvular surgery, 18.4%); recent percutaneous coronary intervention (21.6%); and other coronary (13.2%) and noncoronary (12.5%) conditions. The study population underwent 42,419 exercise stress tests and 743,471 patient-hours of exercise training. Twenty severe cardiac events were reported: 5 were related to exercise testing and 15 were related to exercise training. The event rate was 1 per 8484 exercise stress tests and 1 per 49,565 patient-hours of exercise training; the cardiac arrest rate was 1.3 per million patient-hours of exercise. Neither fatal complications nor emergency defibrillations were reported. CONCLUSION: The frequency of major cardiovascular complications during supervised exercise training in France is quite low.

Coronary Disease↗
PubMed1998

Fitness and the effect of exercise training on the dietary intake of healthy adolescents.

OBJECTIVE: In healthy, nonobese, adolescent males and females to: (1) Determine the relationship between fitness and energy intake; (2) assess the effect of five-weeks endurance training on energy intake and food choice and (3) compare food record assessments of energy intake with doubly-labeled water (DLW) measurement of total energy expenditure (TEE). DESIGN: (1) Cross sectional analysis of fitness and food intake and (2) Prospective, randomized, controlled interventional study of endurance-type exercise training in 44 females and 44 males (age range, 15-17 y). MEASUREMENTS: Pre and end interventional three day food records were successfully collected from 32 females (15 controls, 17 trained) and 39 males (19 controls, 20 trained). Fitness was assessed from cycle ergometry as peak oxygen uptake normalized both to thigh muscle mass and body weight. Thigh muscle mass was measured by magnetic resonance imaging. TEE using the DLW technique was measured in 12 females (6 controls, 6 trained) and 20 males (10 controls, 10 trained) during weeks 4-5 of the exercise training program (simultaneously with the second assessment of food records). Food record data were analyzed using the Minnesota Nutrition Data System. RESULTS: Fitness was correlated with self reported total caloric intake in males but not females. In females, there was a significant increase in fat intake (19.8+/-9%, P < 0.05) and a significant decrease in carbohydrate intake (-9.8+/-4%) in the trained subjects. No changes were observed in the control subjects. Energy expenditure (2072+/-52 kcal/d) was significantly greater than the estimated energy intake (1520+/-112 kcal/d, P < 0.007) during the intervention in the trained, but not control, subjects. However, there was no weight change in either control or trained subjects. In males, no changes were observed in food choice in either control or trained subjects. Similar to the females, energy expenditure (2425+/-22 kcal/d) was significantly greater than the estimated energy intake (2168+/-117 kcal/d, P < 0.05) during the intervention in the trained, but not control, subjects. No weight changes were observed in either group. CONCLUSIONS: Fitness is associated with increased self-reported energy intake in males but not females, while exercise training led to alterations in food selection (greater fat and reduced carbohydrate) only in females. These observations could reflect specific gender differences, or, alternatively, the generally lower levels of fitness in the females. The apparent negative energy balance without evidence for weight loss in both the trained males and females suggests a systematic under reporting of food intake during exercise programs in adolescents, and indicates the possibility that errors in self reported food intake might be greater during transitions from one level of energy expenditure to another.

Adolescent↗