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PubMed1983

Predictors of physical activity one year after myocardial infarction.

A number of factors predicting habitual physical activity, duration of night's rest, return to work and exercise tolerance one year after acute myocardial infarction (AMI) are studied in fifty-five male patients. Except for exercise tolerance three months after AMI, the results of this prospective study suggest that psychologic factors are more important predictors of the four outcome variables than angina pectoris, infarction size and participation in a physical training program. The most important predictor appears to be the patient's subjective opinion of his physical capabilities, measured by the perceived exercise tolerance scale. The expectation of the eventual return to work three months after MI plays also a significant role as a predictor. Both are predictors of the exercise tolerance and return to work one year after AMI. These findings suggest that physical activity--defined as exercise tolerance, habitual physical activity and duration of night's rest--and return to work are closely related.

Attitude to Health↗

PubMed2003

Cardiopulmonary effects of closed repair of pectus excavatum.

BACKGROUND/PURPOSE: Increasing numbers of patients with pectus excavatum defects are presenting for operative repair. Studies that follow-up with patients after open repair have found a decrease in pulmonary function with some improvement in cardiac output and exercise tolerance; however, these effects have not been examined systematically after closed or Nuss repair of pectus excavatum. This study examined the early postoperative effects of closed repair of pectus on pulmonary function, exercise tolerance, and cardiac function. METHODS: Patients were followed up prospectively after initial evaluation for operation. All patients underwent preoperative computed tomography (CT) scan, and pre- and postoperative (3 months) pulmonary function studies, exercise tolerance, and echocardiographic evaluation of cardiac function. RESULTS: Eleven patients underwent evaluation. Preoperative CT index was 4.1 +/- 0.9. Patients reported an improvement in subjective postoperative exercise tolerance (4.1 +/- 0.7; maximal, + 5). Pulmonary function studies (FVC and vital capacity) were significantly reduced at 3 months postsurgery: change in FVC, -0.67 +/- 0.92 L and VC, -0.5 +/- 0.72 L. Similarly, VO2 max was reduced: preoperative, 35.6 +/- 1.5 versus postoperative, 29.1 +/- 11.9 L/kg/min. Cardiac function was significantly improved postoperation (stroke volume preoperative, 61.6 +/- 25 versus 77.5 +/- 23 mL postoperative). All comparisons had a P value less than.05 by Student's paired t test. CONCLUSIONS: These results show that closed repair of pectus excavatum is associated with a subjective improvement in exercise tolerance, which is paralleled by an increase in cardiac function and a decline in pulmonary function. These findings support the use of closed repair of pectus excavatum in patients who complain of subjective shortness of breath; further study is required to delineate the long-term cardiopulmonary implications after closed repair.

Adolescent↗

PubMed2002

Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND: Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation (NMES) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease (COPD). It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD. METHODS: Fifteen patients with advanced COPD (nine men) were randomly assigned to either a home based 6 week quadriceps femoris NMES training programme (group 1, n=9, FEV(1)=38.0 (9.6)% of predicted) or a 6 week control period before receiving NMES (group 2, n=6, FEV(1)=39.5 (13.3)% of predicted). Knee extensor strength and endurance, whole body exercise capacity, and health related quality of life (Chronic Respiratory Disease Questionnaire, CRDQ) were assessed. RESULTS: All patients were able to complete the NMES training programme successfully, even in the presence of exacerbations (n=4). Training was associated with significant improvements in muscle function, maximal and endurance exercise tolerance, and the dyspnoea domain of the CRDQ (p<0.05). Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity (p<0.01). CONCLUSIONS: For severely disabled COPD patients with incapacitating dyspnoea, short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance, whole body exercise tolerance, and breathlessness during activities of daily living.

Aged↗

PubMed1986

Pulmonary atresia with ventricular septal defect: preoperative and postoperative responses to exercise.

Between April 1982 and June 1984, maximal exercise testing was performed 35 times in 34 consecutive patients with pulmonary atresia and ventricular septal defect (14 studies in patients without repair, 11 studies in patients with partial repair [insertion of a right ventricle to pulmonary artery conduit without ventricular septal defect closure] and 10 studies in patients with complete repair [insertion of a conduit with septal defect closure]). Total work performed, maximal power achieved, exercise time and maximal oxygen uptake were significantly greater in patients after partial or complete repair than in patients without repair. Systemic arterial blood oxygen saturations at rest and during exercise were directly related to the degree of repair. Although heart rate at rest in the three study groups was similar to that in a separate group of normal control subjects, patients in all three study groups had a blunted heart rate response to exercise. The ventilatory equivalent for oxygen was increased both at rest and during exercise for patients without conduit repair and those with a right ventricle to pulmonary artery conduit without ventricular septal defect closure but was similar to that of control subjects in the group with conduit insertion and septal defect closure. This study indicates that patients with pulmonary atresia and ventricular septal defect have decreased exercise tolerance both before and after corrective surgery. Exercise tolerance improves significantly after placement of a conduit from the right ventricle to the pulmonary artery with or without ventricular septal defect closure. Although no further improvement in exercise tolerance occurs with closure of the septal defect, ventilatory function and systemic arterial blood oxygen saturation are improved.

Adolescent↗

PubMed1994

Quality of life in surgically palliated complex congenital heart disease.

The outcome of surgical palliation was evaluated in 26 children with complex cyanotic congenital heart disease. Outcome was examined in terms of ongoing symptoms, exercise tolerance, and the ability to participate in normal childhood activities. An activity score was calculated and each child performed graded treadmill exercise testing. Breathlessness (24 (92%) children), respiratory infections (nine (35%) children), and leg cramps (eight 31%) children) were the most common physical disorders. Although formal exercise testing showed a clear reduction in exercise tolerance compared with age and sex matched controls, palliation had allowed 23 (89%) to function with moderate exercise limitation, three (11%) having severely limited activity. Parents underestimated the child's exercise tolerance in 80% of cases. Sixteen (62%) patients attended school full time, eight (31%) attended part time, and two (8%) received only home tuition. Palliative surgery can give children with a single functional ventricle a level of activity which allows them to take part in most childhood activities. Subjective estimates of exercise tolerance are inaccurate in this group of children, and formal exercise testing can contribute useful information to decision making about further surgical intervention.

Adolescent↗

PubMed2000

[Long-term effects of non-supervised home exercise therapy on quality of life in patients with myocardial infarction].

OBJECTIVES: Improvement in exercise tolerance is an important goal in cardiac rehabilitation, but improvement in quality of life (QOL) must also be considered. Therefore, we planned a non-supervised walking exercise program at home for 1 year in patients in the convalescent phase of myocardial infarction to study the exercise tolerance and QOL. METHODS: Thirty-two patients (mean age 60.3 +/- 10 years, 23 men and 9 women) performed our non-supervised home exercise program in which the exercise prescription was based on the rating of perceived exertion. Before discharge, 1 month and 1 year after discharge, exercise tolerance was measured by the cardiopulmonary treadmill exercise test, and QOL was investigated by questionnaire. RESULTS: Anaerobic threshold increased from 15.8 +/- 3.4 ml/kg/min before discharge to 17.5 +/- 3.0 ml/kg/min 1 month after (p < 0.05) and to 18.3 +/- 3.0 ml/min/kg 1 year after (p < 0.05 vs at discharge), and peak oxygen consumption increased from 22.2 +/- 4.3 to 25.2 +/- 5.1 ml/kg/min (p < 0.05) and to 26.4 +/- 5.2 ml/kg/min (p < 0.05 vs at discharge), respectively. QOL score by questionnaire was maintained in 13 patients (improved in 3, same in 10) and decreased in 19 of 32 patients from discharge to 1 month, and the score was maintained in 18 patients (improved in 13, same in 5) and decreased in 14 of 32 patients from 1 month to 1 year after discharge. CONCLUSIONS: In patients with myocardial infarction in the convalescent phase, our non-supervised home exercise program resulted in improvement in exercise tolerance, but QOL score decreased gradually. Therefore, we should not only prescribe an exercise program, but also must give more psychosocial support to the patients. The reasons for the decreased QOL by cardiac rehabilitation must be further investigated.

Anaerobic Threshold↗

PubMed2000

[The effects of enalapril on exercise capacity and right ventricular function in patients with chronic cor pulmonale].

BACKGROUND: Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC. METHODS: Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study. RESULTS: At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10). CONCLUSIONS: Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.

Aged↗

PubMed1994

Effects of training and acclimation on heat tolerance in exercising men wearing protective clothing.

This study examined the effectiveness of endurance training and heat acclimation in reducing the physiological strain imposed by exercising in the heat while wearing protective clothing. Seven young men underwent 8 weeks of physical training [60-80% maximal aerobic power (VO2max) for 30-45 min.day-1, 3-4 days.week-1 at < 25 degrees C] followed by 6 days of heat acclimation (45-55% VO2max for 60 min.day-1 at 40 degrees C, 30% relative humidity). Nine other young men underwent corresponding periods of control observation and heat acclimation. Before and after each treatment, subjects completed a treadmill walk (4.8 km.h-1, 2% grade) in a climatic chamber (40 degrees C, 30% relative humidity), wearing in turn normal combat clothing or clothing protecting against nuclear, biological, and chemical (NBC) agents. Criteria for halting this test were: (1) a rectal temperature (T(re)) of 39.3 degrees C; (2) a heart rate (fc) > or = 95% of the subject's observed maximum, maintained for 3 min; (3) unwillingness of the subject to continue; (4) the elapse of 120 min. The training regimen increased mean VO2max by 16% and mean plasma volume by 8%. When tested in normal combat clothing, the rates of increase in T(re) and fc were slower after training. However, when wearing NBC protective clothing, the only significant change induced by training was a higher mean skin temperature (Tsk) in the early part of the test. Heat acclimation increased the mean plasma volume of untrained subjects by 8%, but their VO2max remained unchanged. When tested in normal combat clothing, acclimation decreased their mean values of T(re), Tsk, fc, and metabolic rate. When wearing NBC protective clothing, the only significant decrease after acclimation was in overall T(re). In trained subjects, heat acclimation induced no further improvement in any physiological variable when wearing normal combat clothing, but reduced overall T(re) and Tsk when wearing NBC protective clothing. Training- or acclimation-induced increases of sweat secretion (an average increment of 0.14-0.23 kg.h-1) were not accompanied by any statistically significant increase in sweat evaporation when wearing NBC protective clothing. Moreover, tolerance times were unchanged in either normal combat (116-120 min) or NBC protective clothing (47-52 min). We conclude that neither endurance training nor heat acclimation do much to improve exercise tolerance when wearing NBC protective clothing in hot environments, because any added sweat secretion decreases blood volume and increases discomfort without augmenting body cooling.

Acclimatization↗

PubMedDate not supplied

[Gas exchange and physical work capacity of natives of different geographical regions].

A study was carried out to investigate exercise tolerance, gas exchange and external respiration of Latin-American students who lived in Moscow for a year. As controls Soviet students residing in and around Moscow were used. The above parameters were measured at a different time of the day in response to a hypercapnic exposure. Exercise tolerance was determined using the test PWC170. External respiration and gas exchange were investigated at rest and during 5 min exercises with a load of 1 and 2 Wt/kg body weight. CO2 sensitivity was determined by means of the rebreathing method. In the evening the Latin-American students showed a trend towards an increase of the cardiorespiratory activity and exercise tolerance. The Soviet students did not display changes in exercise tolerance. The Latin-American students showed an increase in the morning and a decrease in the evening of external respiration reactions. The Soviet students exhibited opposite variations. Direct alveolar measurements demonstrated an increase of pCO2 in the alveolar air in the Latin-American students in the evening and a decrease of the parameter in the Soviet students. It is suggested that cyclic changes in external respiration in response to hypercapnia are associated with exercise tolerance.

Adaptation, Physiological↗

PubMedDate not supplied

The effect of moderate exercise training on oxygen uptake post-aortic/mitral valve surgery.

BACKGROUND: This study determined the response of aortic and/or mitral valve replacement/reconstruction (AVR/MVR) surgery patients to a 3-month exercise rehabilitation program (ERP) of moderate intensity, frequency, and duration that commenced approximately 9 weeks post-operatively. METHODS: Based on geographic proximity and availability of transportation to attend ERP classes, 29 experimental subjects were enrolled in the ERP and 20 control subjects received standard care that did not include the ERP, but did not prohibit activity/exercise. Exercise tolerance was determined from estimated oxygen uptake (VO2) during exercise tolerance testing (GXT) before and after standard care or the ERP. RESULTS: VO2 at the maximum stage of the GXT increased significantly (P < or = 05) for the experimental (4.89 +/- 5.07 mL/kg/min) and control (5.11 +/- 4.48 mL/kg/min) groups. No significant between-group differences were noted in VO2 at the maximum stage of the exercise testing or at the target heart rate (HR). Furthermore, reported exercise levels of subjects in both groups were comparable and sufficient for training effects to occur. CONCLUSION: Alternate strategies to improve exercise tolerance such as home-based rehabilitation programs should be investigated for relatively healthy aortic and/or mitral valve surgical patients.

Aortic Valve Insufficiency↗

PubMed2006

Helium-hyperoxia, exercise, and respiratory mechanics in chronic obstructive pulmonary disease.

RATIONALE: Hyperoxia and normoxic helium independently reduce dynamic hyperinflation and improve the exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). Combining these gases could have an additive effect on dynamic hyperinflation and a greater impact on respiratory mechanics and exercise tolerance. OBJECTIVE: To investigate whether helium-hyperoxia improves the exercise tolerance and respiratory mechanics of patients with COPD. METHODS: Ten males with COPD (FEV(1) = 47 +/- 17%pred [mean +/- SD]) performed randomized constant-load cycling at 60% of maximal work rate breathing air, hyperoxia (40% O(2), 60% N(2)), normoxic helium (21% O(2), 79% He), or helium-hyperoxia (40% O(2), 60% He). MEASUREMENTS: Exercise time, inspiratory capacity (IC), work of breathing, and exertional symptoms were measured with each gas. RESULTS: Compared with air (9.4 +/- 5.2 min), exercise time was increased with hyperoxia (17.8 +/- 5.8 min) and normoxic helium (16.7 +/- 9.1 min) but the improvement with helium-hyperoxia (26.3 +/- 10.6 min) was greater than both these gases (p = 0.019 and p = 0.007, respectively). At an isotime during exercise, all three gases reduced dyspnea and both helium mixtures increased IC and tidal volume. Only helium-hyperoxia significantly reduced the resistive work of breathing (15.8 +/- 4.2 vs. 10.1 +/- 4.1 L . cm H(2)O(-1)) and the work to overcome intrinsic positive end-expiratory pressure (7.7 +/- 1.9 vs. 3.6 +/- 2.1 L . cm H(2)O(-1)). At symptom limitation, tidal volume remained augmented with both helium mixtures, but IC and the work of breathing were unchanged compared with air. CONCLUSION: Combining helium and hyperoxia delays dynamic hyperinflation and improves respiratory mechanics, which translates into added improvements in exercise tolerance for patients with COPD.

Aged↗

PubMed2003

A randomised double blind placebo controlled clinical trial of a standardised extract of fresh Crataegus berries (Crataegisan) in the treatment of patients with congestive heart failure NYHA II.

A placebo controlled, randomised, parallel group, multicentre trial conducted in accordance with the guidelines of Good Clinical Practice (GCP) shows the efficacy and safety of a standardised extract of fresh berries of Crataegus oxyacantha L. and monogyna Jacq. (Crataegisan) in patients with cardiac failure NYHA class II. A total of 143 patients (72 men, 71 women, mean age of 64.8 (8.0 years) were recruited and treated with 3 times 30 drops of the extract (n = 69) or placebo (n = 74) for 8 weeks. The primary variable for the evaluation of efficacy was the change in exercise tolerance determined with bicycle exercise testing, secondary variables included the blood pressure-heart rate product (BHP). Subjective cardiac symptoms at rest and at higher levels of exertion were assessed by the patient on a categorical rating scale. An overall assessment of efficacy at the final visit was provided by the patient and the investigator. In the ITT population there was a significant increase in exercise tolerance in both groups between visit 1 and visit 3. The difference between the treatment groups was 8.3 watts in favour of the standardised extract of fresh Crataegus berries (p = 0.045). The result is confirmed in the PP population (p = 0.047). Changes in BHP at 50 watts and at comparable maximum load were in favour of Crataegus extract but the results are not statistically significant. The subjective assessment of cardiac symptoms at rest and at higher levels of exertion did not change significantly and the patient and investigator overall assessment of efficacy were similar for the two groups. The medication was well tolerated and had a high level of patient acceptability. The significant improvement, due to the fact that dyspnoea and fatigue do not occur until a significantly higher wattage has been reached in the bicycle exercise testing allows the conclusion that the recruited NYHA II patients may expect an improvement in their heart failure condition under long term therapy with the standardised extract of fresh Crataegus berries.

Aged↗

PubMed1991

Treatment of chronic stable angina with carvedilol in comparison with nifedipine s.r.

Carvedilol 25 mg b.d. was compared with nifedipine s.r. 20 mg b.d. for subchronic treatment of patients with chronic stable angina. After washout and placebo run-in, 163 patients were randomly and double-blindly allocated to one of the two treatment groups. Two symptom-limited seated bicycle exercise tests were performed on placebo in order to confirm stable baseline conditions. After 4 weeks of active treatment, a further exercise test was performed in the morning, 12 h after the preceding dose. Diary cards were kept by the patients throughout the trial in order to record angina attacks and glyceryl trinitrate consumption. Carvedilol seemed to be somewhat more effective than nifedipine s.r. for improving exercise tolerance and exercise time to onset of angina and 1 mm ST-segment depression. Although there were highly statistically significant differences vs placebo, the two treatment groups did not differ significantly. No difference between treatment with carvedilol and nifedipine s.r. was found regarding angina symptoms and glyceryl trinitrate consumption during daily life. Adverse events were less frequently reported in the carvedilol group than in the nifedipine group. Generally, however, both agents were well tolerated. Carvedilol therapy for chronic stable angina seems to be both efficacious and safe.

Adult↗

PubMed2003

Respiratory muscle weakness and anorexia nervosa.

BACKGROUND: Nutritional recovery in anorexia nervosa (AN) is associated with improved exercise tolerance. METHOD: We describe the investigation of a male with AN. Despite nutritional recovery, he complained of impaired exercise tolerance. RESULTS: Respiratory muscle weakness was demonstrated as the cause of the impaired exercise tolerance. DISCUSSION: Weakness of the muscles of respiration results from prolonged malnutrition. The diaphragmatic muscle may be slower to recover than other muscles. This can cause impaired exercise tolerance due to shortness of breath on exertion, despite nutritional recovery.

Anorexia Nervosa↗

PubMed1987

Prognostic importance of exercise-induced ST-segment depression in patients with documented coronary artery disease.

Exercise-induced ST-segment depression is a marker of impaired prognosis in patients with suspected or manifest CAD. Whether ST-segment depression remains of prognostic importance, after exercise tolerance and extent of CAD have been considered, is unknown. We analysed the prognostic importance of exercise-induced ST-segment depression (greater than 0.15 mV) in 1250 medically treated patients with angiographically determined CAD (mean follow-up after angiography 4.5 years). Based on exercise tolerance (supine bicycle ergometry) patients were divided into two groups: group A patients (n = 677) with lower exercise tolerance (less than or equal to 75 W) and group B patients (n = 573) with better exercise tolerance (greater than 75 W). Group A patients had a lower 5-year survival rate than group B patients (81.5% versus 94%, P less than 0.00001). In group A, patients with ST-segment depression had a lower 5-year survival rate than patients without ST-segment depression (76% versus 85%, P = 0.01). In group B, patients with and without ST-segment depression had similar 5-year survival rates (90% versus 96%, P = 0.11). Subgroup analysis of groups A and B according to number of diseased vessels and presence or absence of ST-segment depression revealed that exercise-induced ST-segment depression (greater than 0.15 mV) was of additional prognostic importance only in patients with triple vessel disease. 5-year survival rates in group A with triple vessel disease were 71% with and 80% (P = 0.057) without ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2001

Clinical efficacy of crataegus extract WS 1442 in congestive heart failure NYHA class II.

In a randomised, placebo-controlled, double-blind clinical study the clinical efficacy and safety of Crataegus extract WS 1442, standardised to 18.75% oligomeric procyanidines, were investigated in 40 female and male outpatients suffering from congestive heart failure NYHA class II. Following a wash-out period of up to seven days, the patients were randomised to be treated for 12 weeks with either WS 1442 (3 x 1 capsule) or placebo. The primary outcome variable was exercise tolerance determined with bicycle exercise testing; as a secondary outcome variable the difference of the double product was calculated. On average, the exercise tolerance increased by 66.3 W x min (10.8%) in the WS 1442 group while in the placebo group a reduction of 105.3 W x min (16.9%) was measured. This difference between the groups was borderline statistically significant (p = 0.06). During the three month therapy the difference of the double product (heart rate x systolic blood pressure x 10(-2)) decreased by 14.4 mmHg s(-1) (26.8%) in the WS 1442 group and by 1.3 mmHg s(-1) (2.7%) in the placebo group, respectively. Recording of laboratory parameters and adverse events showed that WS 1442 was safe and well tolerated. The data show that Crataegus extract WS 1442 is clinically effective in patients with congestive heart failure corresponding to NYHA class II.

Adult↗

PubMed2004

Effects of sinus rhythm restoration in patients with persistent atrial fibrillation: a clinical, echocardiographic and hormonal study.

UNLABELLED: The hemodynamic consequences of atrial fibrillation (AF) may lead to impairment of the left ventricular function and a reduction in exercise capacity. Studies on mechanical and neurohormonal remodelling in patients with AF are becoming increasingly important. The results could possibly enhance treatment strategies of these patients. The aim of this study was to assess changes in exercise capacity, echocardiographic findings and plasma atrial natriuretic peptide (ANP) concentrations in patients with non-rheumatic persistent AF, before and 30 days after successful cardioversion. METHODS: We attempted cardioversion in 42 consecutive patients, aged 58 +/- 8 years, with persistent non-valvular AF of duration 7.1 +/- 7.1 months. They underwent echocardiography examination and submaximal exercise testing 24 h before and 30 days after cardioversion. Exercise capacity was determined during symptom-limited exercise testing, according to a modified Bruce protocol with peak VO2 analysis. Plasma samples of ANP were obtained at rest: before, the day after, and 30 days after cardioversion therapy, and were prepared by refrigerated centrifugation and stored until radioimmunoassay. The control study group, without AF, comprised of 11 subjects. RESULTS: Cardioversion was successful in 35 patients. However, in six of the 35 patients, AF reappeared within 1 month. There were no statistical differences before cardioversion in exercise tolerance and ejection fraction of left ventricle between the group with successful cardioversion and the group with unsuccessful cardioversion or with recurrence of AF. On the 30th day after cardioversion we recorded a significant increase in exercise tolerance: duration of exercise 13.7 +/- 3.2 versus 9.5 +/- 3.4 min, (P < 0.05); peak oxygen consumption 32.2 +/- 3.6 versus 19.85 +/- 3.5 ml/min per kg, (P < 0.05); and ejection fraction of left ventricle 58.6 +/- 9.4 versus 52.7 +/- 10.2% (P < 0.05); in the sinus rhythm group. There was no significant improvement observed in the AF group. The mean baseline ANP level was 58.5 +/- 15.7 pg/ml in the study group and 34.3 +/- 10.2 pg/ml in the control group (P < 0.01). The successful therapy reduced significantly the pretreatment mean plasma ANP concentration from 58.5 +/- 15.7 to 31.4 +/- 15.0 pg/ml, (P < 0.01); the day after cardioversion, in the group of 35 patients. It remained stable for the next 30 days (36.9 +/- 15.2 pg/ml) in the group of 29 patients who remained in sinus rhythm, and increased to 53.4 +/- 16.4 pg/ml in the group of six patients who had recurrence of AF. Plasma ANP did not change in the group of seven patients with unsuccessful cardioversion. CONCLUSIONS: The restoration of sinus rhythm in patients with persistent AF was associated with a significant improvement in cardiac performance and exercise tolerance 1 month after cardioversion. Such improvement was not observed in the group with unsuccessful cardioversion or with AF recurrence. The plasma ANP concentration in patients with AF was significantly reduced after successful cardioversion and remained stable for a period of 30 days.

Aged↗

PubMed1993

Relative importance of psychologic traits and severity of ischemia in causing angina during treadmill exercise. Canadian Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

OBJECTIVES: This study was conducted to compare the influence of psychologic traits versus ischemia severity on the occurrence of angina during treadmill exercise. BACKGROUND: Some studies suggest that angina is associated with certain psychologic traits, whereas others show an association with more severe ischemia. The relative influence of these two factors and the extent to which they interact are not known. METHODS: Off-drug treadmill exercise testing and a battery of psychologic tests were performed on 122 patients with known coronary artery disease. Psychologic tests measured sensitivity to physical symptoms, denial and deception, type A behavior, anger, hostility, depression, marital adjustment and amount of external stress. Stepwise logistic regression was used to determine the independent association of psychologic traits, ischemic threshold and exercise tolerance with the occurrence of angina. RESULTS: Angina during treadmill exercise was reported by 66 of 122 patients. On univariate testing, angina was positively associated with sensitivity to physical symptoms (p < 0.001), type A behavior (p = 0.021) and depression (p = 0.032) and was negatively associated with exercise tolerance (p < 0.001) and work load threshold for ischemia (p < 0.01). Multivariate analysis revealed independent and additive associations of angina with sensitivity to physical symptoms (p = 0.003), exercise capacity (p = 0.003) and work load threshold for ischemia (p = 0.018). Once these were included in a logistic model, depression and type A behavior were no longer significant. Other psychologic traits showed no association with angina. CONCLUSIONS: Sensitivity to physical symptoms, ischemic threshold and exercise tolerance are independently associated with angina, with sensitivity to physical symptoms having the stronger influence. The physiologic and psychologic mechanisms underlying symptom perception have an influence on angina that is independent of and additive to the severity of underlying ischemia.

Amlodipine↗