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PubMedDate not supplied

[The mass of the myocardium and tolerance for physical exercise in the postinfarct period in hypertension patients].

As many as 56 patients with stage-II hypertensive disease (HD) as per the WHO classification were examined. On day 30 of myocardial infarction (MI) the left ventricular myocardium mass was calculated and six months later exercise tolerance was evaluated using bicycle ergometer. The evaluation done showed that the presence of hypertrophy of the Left ventricle in HD patients by day 30 of MI was a prognostic sign of low exercise tolerance in postinfarction period, which fact permits exercise tolerability to be foreseen, and issues related to the patients' fitness for work to be settled as early as the hospital stage of rehabilitation of MI patients.

Adult↗
PubMed1989

[Comparative evaluation of tolerance to exercise and various features of cardiodynamics in healthy men and women 20-69 years of age].

The analysis of clinical and polycardiographic findings for 568 healthy males and females provided the basis for development of the criteria for standard exercise tolerance and normal range of cardiac cycle phases in relation to 5 ten-year age groups. With age, physical and mental performance was found to be on the decrease, circulatory adaptation and contractile cardiac reserve deteriorated.

Adult↗
PubMed1993

Exercise rehabilitation in chronic heart failure.

In acute heart failure with pulmonary edema, rest is a useful adjunct to pharmacologic treatment because it increases urinary flow and enhances the effectiveness of diuretic drugs. In chronic heart failure, however, there is increasing evidence that avoiding exercise can lead to deconditioning changes in skeletal muscle and in the peripheral circulation that may actually impair exercise tolerance. Exercise training was introduced as part of postinfarction rehabilitation in the 1960s, but it was not tested in patients with heart failure until well into the 1980s. Several reports have now shown considerable improvements in exercise capacity after physical training in patients with stable chronic nonedematous heart failure. Many of the peripheral abnormalities described in chronic heart failure have been shown to be at least partially reversible after physical training. These include abnormalities of skeletal muscle, respiratory gas exchange and autonomic nervous control of the circulation. Controversy still exists as to whether training may have beneficial prognostic effects in chronic heart failure and how soon after myocardial infarction it is safe to commence training. In addition, little information exists as to the most appropriate form of exercise therapy and the proper criteria for patient selection into training programs. Exercise training seems set to become a popular and beneficial adjunct to the management of patients with chronic heart failure. It has been shown to have a beneficial effect on symptoms, exercise performance and a host of pathophysiologic changes characteristic of chronic heart failure. Whether it improves prognosis is not known.

Cardiovascular System↗
PubMed1988

Hypertension, exercise, and beta-adrenergic blockade.

STUDY OBJECTIVE: To determine whether beta-adrenergic blocking agents affect exercise tolerance, exercise conditioning response, and blood pressure response to conditioning in hypertensive patients. DESIGN: Randomized, double-blinded, placebo-controlled trial with a 10-week exercise period. SETTING: Outpatient, monitored exercise program at a community-based, university-sponsored cardiac rehabilitation facility. PATIENTS: Thirty adults with mean resting blood pressure of 145 mm Hg or greater (systolic), 95 mm Hg or greater (diastolic), or a combined systolic and diastolic pressure of 140/90 mm Hg or greater. Mean systolic pressure of 170 mm Hg or more or mean diastolic pressure of 105 mm Hg or more was exclusionary. Mean blood pressure was 145/95 mm Hg; mean age was 46.5 years. INTERVENTION: The beta-1-nonselective blocker was propranolol, 80 mg twice daily. The beta-1-selective blocker was metoprolol, 100 mg twice daily, compared with placebo. All patients did exercise conditioning consisting of 40 sessions of aerobic exercise with heart rate monitoring. MEASUREMENTS AND MAIN RESULTS: Resting systolic blood pressure measured without drug therapy was lowered markedly after exercise conditioning on placebo (146 to 135 mm Hg) and on metoprolol (144 to 133 mm Hg) (P less than 0.05), but not on propranolol (no change). Acutely, propranolol decreased both maximal oxygen consumption (VO2max) and exercise duration compared with metoprolol and placebo. Chronically, VO2max increased 24% (95% CI, 8 to 40) in response to training on placebo and 8% on metoprolol (95% CI, 3 to 14); it did not increase on propranolol (95% CI, -10 to 15). CONCLUSIONS: If an exercise program is to be recommended as an adjunct to pharmacologic beta-blockade for hypertension, blood-pressure-lowering effects are preserved and exercise capacity is less affected with a beta-1-selective agent than with a beta-1-nonselective agent. Antihypertensive medications may be avoided altogether for selected patients who sustain an aerobic exercise program.

Adrenergic beta-Antagonists↗
PubMed1992

[Cardiopulmonary capacity in patients with mucoviscidosis. Comparison of ergospirometry findings with clinical and radiological scores].

AIM OF STUDY: Shwachman-Kulczycki- and Chrispin-Norman-Scores are widely used scoring systems for CF-patients. Maximum bicycle exercise testing was performed in 15 patients (medium age 13.4 years) to investigate whether clinical and radiographic scores or pulmonary function testing could predict cardiorespiratory fitness. METHODS: A progressive exercise test was used to determine maximum working capacity (Wmax). Prior to exercise testing, lung function and blood gases were investigated. Chest radiographs were scored by an independent radiologist (G.B.) applying the Chrispin-Norman-Score. The Shwachman-Kulczycki-Score was determined by two observers (F.F., H.S.). RESULTS: Chrispin-Norman-Score, Schwachman-Kulczycki-Score, results of lung function testing and blood gas values were significantly correlated to each other. However no significant correlation was found to the degree of exercise limitation. CONCLUSION: Clinical, radiographic scores and lung function testing cannot predict exercise tolerance. Exercise testing is mandatory to evaluate cardio-respiratory fitness in CF-patients.

Adolescent↗
PubMedDate not supplied

[Evaluation of captopril levels in chronic congestive heart failure, stages NYHA III and IV].

Thirty eight patients, aged between 25 and 81 years (mean age 56.9 years) with diagnosed chronic congestive heart failure of NYHA III and IV stages have been examined. The following phases of therapy have been distinguished depending on the used drugs: phase 0--digoxin in a daily dose of 0.25 mg and furosemide in a daily dose of 40-150 mg (mean value 72.4 mg) for 14 days; phase A1A2--nifedipine has been added in a daily dose of 40-80 mg (mean value 64.0 mg), lasting also for 14 days; phase B1B2--captopril (Lopirin--Squibb) has been added to the previous drugs in a daily dose of 25-150 mg (mean value 67.4 mg) in three divided portions for 28 days; phase C1C2--captopril has been withdrawn and drugs as in phase A1A2 have been administered for 14 days. Routine laboratory tests, ECG, a 24-hour ECG-records with Holter's technique, exercise ECG, chest X-ray, and 2D and M echocardiography were performed prior to and after 7 days as well as after each phase of the studies. A significant improvement in the left ventricle functioning assessed with Cubet's echo 2D has been observed in phase B1B2 in comparison with phase A1A2. These parameters have been the following: EF 42.61% vs 31.52%; CO 3.2 vs 2.9 L/min; SV 57.15 vs 44.24 mL (p < .001). Moreover, a decrease in heart volume (X-ray) from 1,145.25 mL to 1,088.25 mL, an increase in exercise tolerance (exercise ECG) in 52.6% of the patients, decrease in Lown's class in 11 out of 24 patients have been noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[The anti-anginal effect of diltiazem in patients with stable exercise-induced stenocardia and vasospastic stenocardia compared with the effect of nifedipine].

Paired bicycle ergometric tests were performed in 13 patients with stable exercise-induced angina who took a single dose of diltiazem (120 mg) and nifedipine (30 mg). Four patients with vasospastic angina underwent repeat ergometrine tests along with the both drugs given in the same doses. The two drugs significantly increased exercise tolerance: exercise time was increased by 83% with diltiazem and by 41.9% with nifedipine, its capacity was elevated by 78.9 and 30.2%, respectively, the "double product" at the peak of exercise was raised by 17.0 and 18.7%, respectively). With intravenous injection of ergometrine, diltiazem and nifedipine eliminated or delayed the spastic reaction of coronary arteries in most cases.

Adult↗
PubMed1990

[Clinical effect of China-made amrinone in the treatment of refractory congestive heart failure].

Clinical and hemodynamic studies were carried out in 20 patients suffering from refractory congestive heart failure with invasive technique and non-invasive methods such as tolerance exercise test, 24-hour Holter monitoring, etc. Digitalis was then withdrawn and China-made amrinone (AMR) was administered orally for 15 days. All the indices mentioned above were repeated and each patient served as his own control. The results indicate that AMR can improve hemodynamic parameters as well as exercise tolerance. Holter monitoring revealed no significant increase in arrythmogenic potentiality. The total clinical effective rate was 95%. No severe side effects were found except thrombocytopenia observed in 20% of the patients. It is suggested that China-made AMR is effective in treating refractory congestive heart failure.

Adult↗
PubMedDate not supplied

Evaluation of the cardiovascular system in children with simple obesity. Part I. Clinical, electrocardiographic and functional studies.

In 45 children with simple obesity (overweight 70 +/- 16%) clinical, electrocardiographic and functional assessment of the cardiovascular system was carried out. The results were compared with those in a control group of 20 healthy children without overweight. Raised arterial blood pressure was found in 14 children (31%) in the studied group. In the control group the blood pressure was normal. Resting electrocardiogram was abnormal in 5 obese (11%) and 2 thin (10%) children. Exercise tolerance was similar in both groups, while the values of systolic pressure and double product were higher in obese children. The value of the tolerated exercise was not correlated with the degree of overweight.

Adolescent↗
PubMed1979

Correlation between heat tolerance during exercise and maximum aerobic work capacity.

Observation of the physiological responses during exercise in a hot environment and measurement of maximal work capacity were made on eight young male subjects, ages 20--22. Exercise was performed on a bicycle ergometer at a constant work load of 450 kg . m/min at a cycling rate of 50 rpm for 30 min in a climatic chamber at 30 degree C with 70% relative humidity. The maximum work capacity was measured by bicycle ergometer exercise. Heat tolerance during exercise was assessed by the magnitude of physiological strain expressed by the combination of relative rise in rectal temperature, relative water loss and relative salt loss. Heat load during exercise was calculated using metabolic rates at rest and during exercise, assuming heat loss through the respiratory tract to be 10 percent of metabolic rate. Fairly good correlations were found between the ratio of work done to maximum work capacity and rise in rectal temperature, ratio of body weight loss to body weight and heat tolerance during exercise. Close correlations were found among relative heat load during exercise and rise in rectal temperature, relative body weight loss and heat tolerance. Heat tolerance during exercise in a hot environment correlated well to capacity of heat dissipation and maximum work capacity.

Adult↗
PubMed1979

Effects of physical training and cardiorespiratory physical fitness on exercise-heat tolerance: recent observations.

Most authors agree that physical training in a cool environment improves tolerance to exercise in the heat and the rate of heat acclimatization, but the extent or degree of improvement remains controversial. The best improvement in heat tolerance for men is associated with intensive interval or continuous training at a training intensity greater than 50% of maximal oxygen uptake (Vo2max) for 8-12 weeks; the Vo2max should be increased 15-20%. Far less is known about the appropriate type, intensity and duration of endurance training associated with improved exercise-heat tolerance in women. The major benefits of physical training appear to apply to both short term (less than 2 hrs) or long term (greater than 2 hrs) exercise-heat exposures for men. Generally, individuals with high Vo2max values (previously trained and endurance athletes) are at an advantage in the heat. Utilization of proper physical training appears to produce about 50% of the total adjustment resulting from heat acclimatization, while increased fitness is associated with greater retention of acclimatization in cool environments. Female athletes appear somewhat better able to tolerate exercise in hot environments than nonathletic females while differences between highly trained females and males do not appear as dramatic as once thought.

Acclimatization↗
PubMed1981

Effect of sleep deprivation on tolerance of prolonged exercise.

Acute loss of sleep produces few apparent physiological effects at rest. Nevertheless, many anecdotes suggest that adequate sleep is essential for optimum endurance athletic performance. To investigate this question, heavy exercise performance after 36 h without sleep was compared with that after normal sleep in eight subjects. During prolonged treadmill walking at about 80% of the VO2 max, sleep loss reduced work time to exhaustion by an average of 11% (p = 0.05). This decrease occurred despite doubling monetary incentives for subjects during work after sleeplessness. Subjects appeared to fall into "resistant" and "susceptible" categories: four showed less than a 5% change in performance after sleep loss, while four others showed decrements in exercise tolerance ranging from 15 to 40%. During the walk, sleep loss resulted in significantly greater perceived exertion (p less than 0.05), even though exercise heart rate and metabolic rate (VO2 and VCO2) were unchanged. Minute ventilation was significantly elevated during exercise after sleep loss ( p less than 0.05). Sleep loss failed to alter the continuous slow rises in VE and heart rate that occurred as work was prolonged. These findings suggest that the psychological effects of acute sleep loss may contribute to decreased tolerance of prolonged heavy exercise.

Adult↗
PubMed2000

Effects of trimetazidine on clinical symptoms and tolerance of exercise of patients with syndrome X: a preliminary study.

BACKGROUND: Trimetazidine diminishes angina and improves tolerance of exercise of patients with ischemic heart disease, and has no influence on blood pressure and heart rate. OBJECTIVE: To determine the effect of trimetazidine on angina symptoms and exercise tolerance in patients with syndrome X. METHODS: We investigated the effect of trimetazidine on the clinical symptoms and tolerance of exercise of 34 patients (20 women and 14 men, aged 32-60 years) with syndrome X (angina pectoris, positive result of exercise test, and normal coronary angiogram). The exercise test was performed before initiation of oral administration of trimetazidine therapy (20 mg three times a day) and 1 and 6 months thereafter. RESULTS: We obtained negative results of exercise treadmill tests for four patients (11.76%) after 1 month and five patients (14.71%) after 6 months of trimetazidine treatment. There was also a decrease in the incidence of effort angina after 6 months of treatment (26 patients or 76.47% before treatment versus 13 patients or 38.23% after 6 months of treatment). The drug had no significant influence on the heart rate and blood pressure. The duration for which patients could exercise was significantly prolonged by 1 month (652.9 +/- 206.2 versus 563.4 +/- 190.4 s, P = 0.0047) and 6 months (650.3 +/- 207.8 s, P = 0.0094) of treatment with trimetazidine. CONCLUSION: Treatment with trimetazidine decreases signs of angina during exercise and improves tolerance of exercise of patients with syndrome X.

Adult↗
PubMed1985

Lidoflazine and propranolol combination treatment in chronic stable angina.

The short-term (1 month) and long-term (6 months) safety of combination lidoflazine-propranolol therapy was investigated in an open trial of 15 patients with stable angina of effort. The possible advantages of adding lidoflazine (titrated to 360 mg daily) to patients having a therapeutic response to propranolol (80-400 mg daily) was also evaluated. Effects on non-invasive indexes of left ventricular function (echocardiography, systolic time intervals, radionuclide ventriculography) and exercise tolerance (treadmill exercise testing) were determined. There was no change in mean resting heart rate with the combination therapy, although one patient developed sinus bradycardia at a rate of 44 and had to have his propranolol dose reduced. Electrocardiographic analysis showed significant prolongation of the QTc intervals on lidoflazine-propranolol therapy compared to propranolol alone, with 3 patients having QTc interval prolongation to above .53 seconds, but there was no evidence of increased arrhythmogenesis with the combination therapy compared to propranolol alone. Left ventricular end-diastolic volume index tended to rise with combination therapy. However, lidoflazine-propranolol therapy did not produce any significant effects on resting ejection fraction determined by M-mode echocardiography or by radionuclide ventriculography. Radionuclide ventriculography determined peak exercise ejection fractions were also not significantly changed with combination therapy compared to propranolol alone. There were only small, insignificant improvements in exercise tolerance with the lidoflazine-propranolol combination treatment compared to propranolol alone. It is concluded that lidoflazine-propranolol combination therapy is generally safe but has the potential of causing serious adverse effects in certain patients, i.e. those with sick sinus disease, prolonged QTc intervals, and severe baseline left ventricular dysfunction, and that caution must be exercised in its use. Furthermore, it would appear that combination therapy provides only slight, if any, improvements in exercise tolerance in patients with chronic stable angina having a therapeutic response to oral propranolol.

Adult↗
PubMed2006

Limited utility of interatrial block in predicting ischemia on coronary angiography in patients with suboptimal exercise performance.

INTRODUCTION: Interatrial block (P waves > or = 110 ms) is thought to be associated with underlying myocardial ischemia during exercise but has not been extensively investigated in patients with suboptimal or borderline exercise tolerance tests (< 3 min exercise). We utilized coronary angiography to assess the relationship of both, the resting baseline and exercise induced increase in P-wave duration with coronary artery disease among patients who had undergone such tests. METHODS: We prospectively identified 51 consecutive patients with interatrial block who had coronary artery disease and hypertension but not atrioventricular valvular heart disease, and had undergone coronary angiography to evaluate myocardial ischemia after a suboptimal exercise tolerance test. A control group of 64 consecutive exercise tolerance test patients with similar preliminary characteristics but without interatrial block at rest was used for comparison. Patients from both groups were then appraised for significant obstructive lesions (> 70%) on coronary angiography that were suggestive of myocardial ischemia. RESULTS: Obstructive coronary artery lesions suggestive of myocardial ischemia were more frequent among interatrial block patients but this was not statistically significant (p=0.25). However, change in P-wave duration of > 20 ms occurred more frequently in interatrial block patients in the presence of a positive exercise tolerance test. Among patients without interatrial block at baseline, more patients who developed new interatrial block had significant disease on coronary angiography. CONCLUSION: The utility of using interatrial block toward predicting myocardial ischemia among patients with suboptimal exercise tolerance tests is limited. However, further investigation on the early change in P-wave duration in patients with interatrial block and the development of new interatrial block during exercise could be helpful in optimizing exercise tolerance tests, particularly when borderline or suboptimal.

Aged↗
PubMed1991

[Characteristics of rehabilitation of physical work capacity in patients with prior myocardial infarct depending on baseline tolerance of exercise test].

The restorative features of physical working capacity (PWC) in relation to baseline exercise (E) tolerance were examined in 223 males aged 30-58 years who had sustained large myocardial infarction. The results indicated that there was a positive dynamics of PWC parameters in the patients who had an initial threshold exercise intensity (TEI) of 25-50 W, the greatest increase in these parameters occurring within three months of the disease. The patients who had a TEI of 75 W or more virtually showed unaltered PWC during a 12-month follow-up. This fact is suggestive of earlier restoration of residual PWC in the patients at a TEI of 75 W or greater. An increase in heart rate (HR), double product (DP), cardiac index (CI) in response to higher exercise was much more significant with higher E. At the same time when the patients performed a routine 25-W exercise during 5 min, the rise in HR, DP, and CI was low, whereas the patients having a lower tolerance to routine E, increased HR, DP, and CI.

Adult↗
PubMed1996

Angina in patients with an active lifestyle.

The care of the active angina patient comprises risk stratification, risk factor modification, cardiac rehabilitation and pharmacotherapy. Risk stratification may be undertaken using a symptom limited exercise test, with the possibility of myocardial perfusion imaging to improve sensitivity. Higher risk patients may be evaluated angiographically. Risk factor modification should be tailored to the individual patient and should include weight reduction, cessation of smoking, treatment of hypertension and a controlled increase in levels of exercise for the sedentary patient. Cardiac rehabilitation is comprised of patient education, risk factor management and an individualized exercise prescription, based on a symptom-limited exercise tolerance test. Exercise training is associated with measurable physiological improvements in exercise tolerance. The risk of myocardial infarction due to sudden bouts of heavy exertion is also reduced, by approximately 50-fold, in those who exercise regularly. Pharmacological management should be based on the patient's anginal threshold. Those with a high threshold may be treated symptomatically with nitroglycerin, while beta-blockers may be the most appropriate therapy for those with a lower threshold. Those with a variable threshold may respond better to calcium channel blockers. Long-acting agents are preferred, ideally providing therapeutic coverage in the morning, and throughout the day, until the next daily dose reaches therapeutic levels.

Angina Pectoris↗