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Effects of lower-body negative pressure on sympathetic nerve responses to static exercise in humans. Microneurographic evidence against cardiac baroreflex modulation of the exercise pressor reflex.

Although previous studies in both animals and humans have suggested that cardiac baroreceptors modulate reflex sympathetic vasoconstriction during exercise, more recent studies in conscious animals have not supported this view. To further test this concept in humans, we measured sympathetic nerve discharge with intraneural microelectrodes while we used static handgrip to activate the exercise pressor reflex and nonhypotensive lower-body negative pressure (LBNP) to selectively unload the cardiac baroreflex. In nine healthy subjects, we measured blood pressure, heart rate, central venous pressure, and muscle sympathetic nerve activity (MSNA) from the peroneal nerve (resting leg) during 2 minutes of static handgrip at 20% and 30% of maximal voluntary contraction (MVC) alone and in combination with LBNP at -5 mm Hg. Handgrip alone (exercise reflex) at 20% and 30% MVC caused graded increases in MSNA. LBNP alone (cardiac reflex) did not alter blood pressure or heart rate but decreased central venous pressure by 2.5 +/- 0.1 mm Hg (mean +/- SEM, p less than 0.05) and increased MSNA by 92 +/- 22% over the control value. Most important, handgrip performed during LBNP (interaction of reflexes) caused increases in MSNA that were comparable with the increases during handgrip alone: +114 +/- 32% versus +175 +/- 89% at 20% MVC and +328 +/- 101% versus +431 +/- 110% at 30% MVC (handgrip plus LBNP vs. handgrip alone, p greater than 0.1). Pressor and heart rate responses to handgrip also were unaffected by LBNP. In five additional experiments, comparable findings were obtained when the LBNP was superimposed on handgrip rather than handgrip being superimposed on LBNP. In conclusion, this study provides direct evidence in humans that nonhypotensive LBNP does not augment muscle sympathetic outflow during static handgrip and challenges the concept of an important interaction between cardiac baroreceptor and exercise pressor reflexes during this form of exercise.

Adult↗

Association of decreased myocardial beta-receptors and chronotropic response to isoproterenol and exercise in pigs following chronic dynamic exercise.

The effects of chronic dynamic exercise on myocardial beta-adrenergic and muscarinic cholinergic receptors and chronotropic sensitivity to isoproterenol were studied in 5 Yucatan miniswine. Right atrial and left ventricular biopsies, heart rate responses to isoproterenol, and maximal exercise treadmill testing were obtained before and after 10-19 weeks of treadmill running. Radioligand studies using 125I-iodocyanopindolol (ICYP) and 3H-quinuclidinyl benzilate (QNB) were used to determine the number of beta-adrenergic and muscarinic cholinergic receptors. Maximal oxygen consumption increased from 52 +/- 5 to 65 +/- 7 ml/kg/min (mean +/- SD; p less than 0.02), maximal workload from 530 +/- 111 to 1,074 +/- 179 KPM/min (p less than 0.01), resting heart rate decreased from 91 +/- 13 to 62 +/- 4 beats/min (p less than 0.01), heart rate at 75% of pretraining maximal workload decreased from 253 +/- 15 to 196 +/- 12 beats/min (p less than 0.01), and maximal exercise heart rate decreased from 273 +/- 6 to 254 +/- 9 beats/min (p less than 0.01). Decreased heart rate responsiveness to adrenergic stimulation was observed following chronic exercise. Maximal isoproterenol-stimulated heart rate decreased from 225 +/- 13 to 185 +/- 28 beats/min (p less than 0.05) and the slope of the isoproterenol dose-response relation decreased from 63 +/- 16 to 40 +/- 16 (p less than 0.05). Radioligand studies revealed a decrease in beta-receptor number in the right atrium following chronic exercise (61 +/- 9 vs. 34 +/- 8 fmol/mg; p less than 0.02), but receptor number in membranes from the left ventricle did not change (60 +/- 9 vs. 62 +/- 4 fmol/mg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

Wearing a cooling jacket during exercise reduces thermal strain and improves endurance exercise performance in a warm environment.

The aim of the present study was to investigate the effect of wearing a cooling jacket on thermoregulatory responses and endurance exercise performance in a warm environment. Nine untrained male subjects cycled for 60 minutes at 60% Vo(2)max (Ex1) and then immediately exercised to exhaustion at 80% Vo(2)max (Ex2) in 32.0 +/- 0.2 degrees C and 70-80% relative humidity. Four separate conditions were set during exercise: no water intake (NW), water intake (W), wearing a cooling jacket (C) and the combination of C and W (C+W). Rectal temperatures (T(re)) before Ex1 were not different between the 4 conditions, whereas at the end of Ex1 T(re) of C+W was significantly lower than the C and W (p < 0.05). Mean skin temperature (T(sk)) was significantly lower in C and C+W than the NW and W during Ex1. Heart rate of C and C+W were significantly lower than the NW and W, and rating of perceived exertion (RPE) in C+W was lower than in the other conditions. Exercise time to exhaustion was significantly longer in C+W than in the other conditions (NW < W, C < C+W; p < 0.05), whereas T(re) at exhaustion was not different. Our results indicate that the combination of wearing a cooling jacket and water intake enhances exercise endurance performance in a warm environment because of a widened temperature margin before the critical limiting temperature is reached and also because of decreased thermoregulatory and cardiovascular strain.

Adult↗

Metabolic effects of exercise. II. Residual metabolic effects of exercise in rats.

This report described the duration of changes in serum lipids, adrenal weight and hepatic G-6-PD activity in rats following the termination of 10 weeks of voluntary activity in a revolving drum. Exercised rats had lower weight gain, larger adrenal glands, lower serum cholesterol, lower serum triglycerides and lower liver glucose-6-phosphate dehydrogenase (G-6-PD) activity than the sedentary controls. The differences between exercise and control rats in adrenal gland weight, body weight and G-6-PD tend to disappear within 3 wk after termination of the exercise. These experiments provide evidence that exercise can affect lipid metabolism and have a beneficial effect on the lowering of serum lipids. It also shows that this effect will persist for up to 3 wk after the exercise is terminated, under the experimental conditions of this study.

Adrenal Glands↗

Carbohydrate metabolism during hard exercise and in the recovery period after exercise.

The glycogenolytic rates during maximum exercise with different durations have been calculated using own studies and reports from the literature. The initial glycogenolytic rates both in animal and in human muscle are close to the Vmax as determined in vitro. Already within the first seconds of electrical stimulation of human muscle the glycogenolytic rate reaches the maximum value and the phosphorylase is transformed to the a form to near 100%. Continued electrical stimulation or dynamic exercise for longer periods than 30 s results in successively decreasing rates of glycogenolysis, and a reversion back of phosphorylase a to b. The mechanism for this reversion is not known. In a study by Hermansen and Vaage from 1977, it was suggested that lactate formed during exercise could be resynthesized to glycogen by gluconeogenesis in muscle during the rest period after exercise. This study was repeated in our laboratory with addition of measurements of oxygen uptake and splanchnic metabolism. The results showed that only 10% of the lactate formed was taken up by the liver and that maximally 40% was oxidized during an 1 h recovery period. About 7% of the formed lactate remained unchanged in the body at the end of the recovery period. This leaves more than 40% of the lactate unaccounted for. Analysis of muscle tissue showed that glycogen content in muscle had decreased by 41 mmol glucosyl units X kg-1 after exercise and that 50% of this carbohydrate was retained in muscle as free glucose, phosphorylated intermediates and lactate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Exercise two-dimensional echocardiography: correlation between exercise induced asynergy and coronary artery lesions].

Exercise two-dimensional (2-D) echocardiography was performed in patients with suspected coronary artery disease, and exercise induced left ventricular asynergy was evaluated qualitatively and was compared with the coronary artery stenosis and electrocardiographic ST changes. Subjects were 12 patients with angina of effort, 8 patients with spontaneous angina, 8 patients with chest pain syndrome with the normal coronary artery, and 7 patients with hypertrophic cardiomyopathy (HCM). Cases with myocardial infarction were excluded from this study. 1) Left ventricular asynergy during exercise was observed in 10 and ST depression in 11 of 12 patients with angina of effort. In patients with spontaneous angina, left ventricular asynergy and ST depression during exercise were observed in 2 of 8 patients without anginal pain, and both patients had coronary artery stenosis of 90% or more. 2) Exercise induced asynergy was also observed in 4 of 7 patients with HCM without coronary artery stenosis. It seemed likely that the markedly hypertrophied myocardium and impairment of left ventricular compliance and relaxation may induce relative myocardial ischemia.

Adult↗

Exercise training and tumour metastasis in mice: influence of time of exercise onset.

The present study was designed to investigate the factor of timing of activity onset in determining the effects of exercise on experimental metastases. After 9 weeks of wheel running activity (W) or remaining sedentary (S), male C3H/He mice received an i.v. injection of CIRAS 1 tumor cells. Mice were then randomized into sedentary and wheel running groups (SS, SW, WS, WW) for a further 3 weeks. Although the average number of lung tumours did not differ by activity condition, the groups exercised prior to tumour injection had a greater incidence in the lowest tertile of tumour distribution relative to sedentary controls (SS = 8/20 vs. WS = 16/19, p < 0.005; SS vs. WW = 14/18, p < 0.05). In a replication trial, a similar outcome was present in the lowest tertile: increased incidence of animals exercised prior to injection (SS = 3/9 vs. WW = 7/9: p < 0.05). These data suggest that exercise training before, but not after, i.v. exposure to tumour reduces the number of lung metastases and that the timing of exercise onset influences the extent of experimental metastasis in this model.

Animals↗

Kinetics of catecholamines and potassium, and heart rate during exercise testing in obese subjects. Heart rate regulation in obesity during exercise.

BACKGROUND: Obesity is characterised by a marked insulin resistance which involves an abnormal regulation of K(+) uptake and metabolism. Less is known about the effect of physical exercise on K(+) kinetics. AIM OF THE STUDY: To assess plasma catecholamines and potassium levels and their relationship with cardiac activity during a physical effort up to exhaustion in young obese subjects. METHODS: Blood samples for epinephrine (E), norepinephrine (NE), potassium (K+) and heart rate (HR) were collected at the end of every step during a progressive cycloergometric test up to exhaustion in twelve obese subjects (6 males, aged 26+/-2, BMI 39.9+/-1) and twelve normal subjects (6 males, aged 28.2+/-2, BMI 22+/-1). In every subject anaerobic threshold (AT) was detected. RESULTS: In obese subjects plasma catecholamines rose faster but had a lower peak in correspondence of maximal work-loads, with respect to controls. Catecholamines had a linear correlation in the obese group and a quadratic one in the control group when plotted vs O(2) consumption. The increase of plasma potassium was less in obesity than in control. CONCLUSIONS: During physical exercise K(+) and catecholamines kinetics differ significantly in obese subjects vs normals and they may justify a less prompt cardiac response at the higher work-loads and a lower work capacity. The present data can be interpreted in the light of the insulin resistance syndrome of obesity, which causes an abnormal regulation of the Na-KATPase and of K(+) channels during physical exercise. The results of the present study may be relevant to nutritionists when suggesting physical exercise to obese subjects.

Adult↗

[Practical advice for exercise-induced asthma in children: experience of the exercise training centre of Necker-Enfants malades hospital].

Now, to care exercise-induced asthma is not only to prescribe drugs. It is a global and interdisciplinary approach: the pulmonary rehabilitation, matching a therapeutic education and a physical training, with the goal of promoting a regular physical activity in the asthmatic child, achieving physiological benefits and improvement of quality of life. Getting from the experience of Necker-Enfants Malades Hospital's Training Centre, a few advises encourage the physical practice of the asthmatic child, and decrease risks of exercise-induced asthma: optimisation of treatments;progressive beginning and end of exercises; use of the diaphragmatic breathing, keeping up with the exercise; use of the ventilatory threshold (or dysponea threshold) as intensity of the aerobic training; practice of different activities promoting play and conviviality in sports and allowing the integration of sports in the daily life of the asthmatic child.

Adolescent↗

Effects of exercise intensity, posture, pressure on the back and ambient temperature on palmar sweating responses due to handgrip exercises in humans.

We have, by using newly developed ratemeters, attempted to examine the effects of exercise intensity, posture, pressure on the skin of the back, and ambient hyperthermic conditions (approximately 30 degrees C) on the 5-s handgrip exercise-mediated responses of active palmar sweating in humans. Thirty-five right-handed male (n=5) and female (n=30) volunteer students (20.2+/-1.3 years old) participated in the present study. Oral explanation of only the isometric handgrip exercise (IHG) caused a rapid and oscillatory response (pre-operational) of active palmar sweating in almost all subjects (10 of 14 subjects). Performing the IHG for 5-s caused a significant increase in active sweating rate (operation-mediated response) in both ipsi- and contra-lateral palmar surfaces of the thumbs of all subjects. The operation-mediated responses of active palmar sweating to the IHG were reproducible, resulting in no habituation. The increase of operation-mediated responses to the IHG was dependent upon exercise intensity (100-25% maximal voluntary contractions). The IHG-mediated ipsi- and contra-lateral responses of active palmar sweating were significantly decreased by changing the body posture from a seated to a supine position or by pressing the skin of the back. Ambient hyperthermic conditions (approximately 30 degrees C) for 60 min also resulted in a significant decrease in the back-pressure-dependent reduction of the operation-mediated responses of active palmar sweating to the IHG. In conclusion, in order to optimize the precision and reproducibility of clinical tests involving palmar sweating responses, it is important that subjects maintain a constant handgrip force and posture and that ambient temperature be kept under normothermic conditions.

Adult↗

Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD.

The 6-min walking (6MWD) and 6-min treadmill distance (6MTD) are often used as measures of exercise performance in patients with COPD. The aim of our study was to assess their relationship to daily activity in the course of an exercise training program. Eighty-eight patients with stable COPD (71m/17f; mean +/- SD age, 60 +/-8 year; FEV1, 43+/-14% pred) were recruited, 66 of whom performed a hospital-based 10-day walking training, whereas 22 were treated as control. On day 16MTD, and on days 8 and 10, 6MTD and 6MWD were determined. In addition, patients used an accelerometer (TriTrac-R3D) to record 24 h-activity, whereby training sessions were excluded. In both groups there was a linear relationship (r > or = 0.84 and P < 0.0001) between 6MTD and 24 h-activity, the slope of which was 2.5-fold greater in the training group (P < 0.01). Similar relationships emerged for 6MWD. There was no association between baseline 6MTD, FEV1 or BMI and any of the other measures. These data suggest that daily activity did not markedly vary with exercise capacity under baseline conditions. Participation in a training program increased activity significantly stronger than predicted from the gain in exercise capacity. This underlines the importance of non-physiological, patient-centered factors associated with training in COPD.

Activities of Daily Living↗

Using the exercise test to create the exercise prescription.

Exercise testing can provide valuable information to aid the primary care physician in developing a safe and effective exercise program for his or her patients. This review presents the most recent recommendations for the components of an exercise program as well as methods to accomplish appropriate prescription writing for the various subsets of individuals from the healthy patient to the patient with chronic disease. In addition, a plea is made for physicians to encourage all patients to engage in at least some kind of regular exercise activity in an attempt to counteract the increasingly sedentary lifestyles found in our culture.

Exercise Test↗

Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing.

BACKGROUND: The objective of the study was to identify the parameter(s) of cardiopulmonary exercise testing (CPET) that can detect exercise-induced myocardial ischaemia (EIMI), and to determine its diagnostic accuracy for identifying patients with coronary artery disease (CAD). METHODS AND RESULTS: We prospectively studied 202 consecutive patients (173 men, 29 women, mean age 55.7+/-10.8 years) with documented CAD. All patients underwent an incremental exercise stress testing (ECG-St) with breath-by-breath gas exchange analysis, followed by a 2-day stress/rest gated SPECT myocardial scintigraphy (GSMS) as the gold standard for ischaemia detection. ROC analysis selected a two-variable model-O(2)pulse flattening duration, calculated from the onset of myocardial ischaemia to peak exercise, and deltaVO(2)/deltawork rate slope-to predict EIMI by CPET. GSMS identified 140 patients with reversible myocardial defects, with a Summed Difference Score (SDS) of 9.7+/-2.8, and excluded EIMI in 62 (SDS 1.3+/-1.6). ECG-St had low sensitivity (46%) and specificity (66%) to diagnose EIMI as compared with CPET (87% and 74%, respectively). CONCLUSIONS: The addition of gas exchange analysis improves the diagnostic accuracy of standard ECG stress testing in identifying EIMI. A two-variable model based on O(2)pulse flattening duration and deltaVO(2)/deltawork rate slope had the highest predictive ability to identify EIMI.

Analysis of Variance↗

Evaluation of pretest and exercise test scores to assess all-cause mortality in unselected patients presenting for exercise testing with symptoms of suspected coronary artery disease.

OBJECTIVES: To determine how well recently developed multivariables scores assess for all-cause mortality in patients with suspected coronary disease presenting for exercise electrocardiography (ExECG). BACKGROUND: Recently revised American College of Cardiology/American Heart Association guidelines for ExECG have suggested that ExECG scores be used to assist in management decisions in patients with suspected coronary artery disease. Recently developed scores accurately stratify patients according to angiographic disease severity. METHODS: To determine how well these scores assess for all-cause mortality, we utilized 4,640 patients without known coronary disease who underwent ExECG to evaluate symptoms of suspected coronary disease between 1995 and 2001. Previously validated pretest and exercise test scores as well as the Duke treadmill score were applied to each patient. All-cause mortality was our end point. RESULTS: Overall mortality was 3.0% with 2.8 +/- 1.6 years of follow-up. All three scores stratified patients into low-, intermediate-, and high-risk groups (p < 0.00001). No differences were seen when patients were evaluated as subgroups according to gender, diabetes, beta-blockers, or inpatient status. Low-risk patients defined by the Duke treadmill score had consistently higher mortality and absolute number of deaths compared with low-risk patients using other scores. In addition, the Duke treadmill score had less incremental stratifying value than the new exercise score. CONCLUSIONS: Simple pretest and exercise scores risk-stratified patients with suspected coronary disease in accordance with published guidelines and better than the Duke treadmill score. These results extend to diabetics, inpatients, women, and patients on beta-blockers.

Adrenergic beta-Antagonists↗

Comparative effects of losartan and enalapril on exercise capacity and clinical status in patients with heart failure. The Losartan Pilot Exercise Study Investigators.

OBJECTIVES: This study was designed to determine 1) whether 12-week oral administration of losartan, an angiotensin II receptor antagonist, in patients with heart failure is well tolerated; and 2) whether functional capacity and clinical status of patients with heart failure in whom treatment with an angiotensin-converting enzyme (ACE) inhibitor is replaced with losartan for 12 weeks will remain similar to that noted in patients in whom treatment with an ACE inhibitor is continued. BACKGROUND: Losartan is a specific, nonpeptide angiotensin II receptor antagonist. Although specific receptor blockade with losartan has certain theoretic advantages over nonspecific ACE inhibition, definitive demonstration of comparable effects in patients with congestive heart failure is lacking. METHODS: A double-blind, multicenter, randomized, parallel, enalapril-controlled study was conducted in 116 patients with congestive heart failure (New York Heart Association functional classes II to IV) and left ventricular ejection fraction < or = 45% previously treated with stable doses of ACE inhibitors and diuretic agents, with or without concurrent digitalis and other vasodilators. After a baseline exercise period, open-label ACE inhibitors were discontinued, and patients were randomly assigned to 12 weeks of therapy with losartan, 25 mg/day (n = 38); losartan, 50 mg/day (n = 40); or enalapril, 20 mg/day (n = 38). Drug efficacy was evaluated by changes in maximal treadmill exercise time (using a modified Naughton protocol), 6-min walk test, left ventricular ejection fraction and dyspnea-fatigue index. Safety was measured by the incidence of clinical and laboratory adverse experiences. RESULTS: The treadmill exercise time and the 6-min walk test did not change significantly after replacement of ACE inhibitor therapy with losartan. Similarly, a significant change was not observed in either the dyspnea-fatigue index or left ventricular ejection fraction at the end of double-blind period relative to baseline. CONCLUSIONS: Losartan was generally well tolerated and comparable to enalapril in terms of exercise tolerance in this short-term (12-week) study of patients with heart failure. The clinical effects of long-term angiotensin II receptor blockade compared with ACE inhibition remain to be studied.

Activities of Daily Living↗

Estimating the total energy demand for supra-maximal exercise using the VO2-power regression from an incremental exercise test.

The VO2-power regression and estimated total energy demand for a 6-minute supra-maximal exercise test was predicted from a continuous incremental exercise test. Sub-maximal VO2-power co-ordinates were established from the last 40 seconds (s) of 150-second exercise stages. The precision of the estimated total energy demand was determined using the 95% confidence interval (95% CI) of the estimated total energy demand. The linearity of the individual VO2-power regression equations was determined using Pearson's correlation coefficient. The mean 95% CI of the estimated total energy demand was 5.9 +/- 2.5 mL O2 Eq x kg(-1) x min(-1), and the mean correlation coefficient was 0.9942 +/- 0.0042. The current study contends that the sub-maximal VO2-power co-ordinates from a continuous incremental exercise test can be used to estimate supra-maximal energy demand without compromising the precision of the accumulated oxygen deficit (AOD) method.

Adult↗

Improvement of exercise tolerance by single lead VDD pacemaker: evaluation using cardiopulmonary exercise test.

We used a cardiopulmonary test to assess the physiological benefit of single lead VDD pacing in ten patients (six men, four women; aged 32-84 years, mean 69 years) with atrioventricular block. Maximal symptom-limited treadmill exercise test using a ramp protocol was performed under VDD and VVIR or VVI pacing (VVI) in random sequence. The pacemaker was then programmed to the VDD mode, and Holter ECG was recorded in nine patients. Compared with findings during the VVI, the VDD mode had a greater chronotropic response (mean maximal heart rate, VDD 106 +/- 17 beats/min vs VVI 79 +/- 19 beats/min, P = 0.03), and was associated with prolongation of exercise duration (VDD 11.2 +/- 2.9 minute vs VVI 10.5 +/- 3.1 minute; P = 0.01), and the onset of anaerobic threshold at a higher oxygen uptake (VDD 12.4 +/- 3.4 mL/min per kilogram vs VVI 10.0 +/- 2.1 mL/min per kilogram; P < 0.01). Atrial sensing was recognized in almost all normal sinus P waves for all cases examined using Holter ECG. Thus, chronotropic response during exercise by VDD pacemaker improved exercise tolerance, indicating that a VDD pacemaker might be useful for patients requiring physical activity.

Adult↗

Improvement in exercise tolerance and symptoms of congestive heart failure during treatment with candesartan cilexetil. Symptom, Tolerability, Response to Exercise Trial of Candesartan Cilexetil in Heart Failure (STRETCH) Investigators.

BACKGROUND: The renin-angiotensin system plays an important part in the pathogenesis of congestive heart failure (CHF). This study evaluated the effect of an angiotensin II type 1 receptor antagonist on exercise tolerance and symptoms of CHF. METHODS AND RESULTS: In this multicenter, double-blind, parallel-group study, 844 patients with CHF were randomized to 12 weeks' treatment with placebo (n=211) or candesartan cilexetil 4 mg (n=208), 8 mg (n=212), or 16 mg (n=213) after a 4-week placebo run-in period. Changes in exercise time, Dyspnea Fatigue Index score, NYHA functional class, and cardiothoracic ratio were determined. Candesartan cilexetil produced a dose-related improvement in exercise time. For the intention-to-treat population, the increase produced by candesartan cilexetil 16 mg was significantly greater than that produced by placebo (47.2 versus 30.8 seconds, P=0.0463). All doses of candesartan cilexetil significantly improved the Dyspnea Fatigue Index score relative to placebo. NYHA class improved more frequently in the candesartan cilexetil groups; the differences relative to placebo were not significant. The decrease in cardiothoracic ratio with candesartan 4 to 16 mg was small but statistically significant compared with placebo (all P<0.05). In all candesartan cilexetil groups, plasma renin activity and angiotensin II levels increased from baseline and aldosterone levels decreased in the 8- and 16-mg treatment groups. Candesartan cilexetil was well tolerated at all doses. CONCLUSIONS: In summary, treatment with candesartan cilexetil demonstrated significant improvements in exercise tolerance, cardiothoracic ratio, and symptoms and signs of CHF and was well tolerated.

Adult↗