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PubMed1991

Positive and negative exercise test results with and without exercise-induced angina in patients with one healed myocardial infarction: analysis of baseline variables and long-term prognosis.

The prognostic implications of exercise test results with and without exercised-induced angina are not completely understood. In the Program On the Surgical Control Of the Hyperlipidemias (POSCH), 838 subjects with hyperlipidemia who had one healed myocardial infarction were studied and followed for 6 to 13 years (mean 8.6). Of the 417 control subjects, 279 had a treadmill exercise test result that was definitely positive or negative. Angina was also induced by exercise in 30% (45/150) and 8% (10/129) of those with a positive and a negative test result, respectively (p less than 0.0001). The data showed no difference between subjects with a positive or a negative test result with or without angina as regards levels of blood lipids, type of myocardial infarction (Q or non-Q wave), left ventricular function, or prognosis as defined by death, atherosclerotic coronary heart disease death, or myocardial infarction.

Angina Pectoris↗

PubMed2006

Peak systolic blood pressure on a graded maximal exercise test and the blood pressure response to an acute bout of submaximal exercise.

Blood pressure (BP) is immediately reduced after aerobic exercise (postexercise hypotension [PEH]). Whether peak systolic BP on a maximal graded exercise stress test (GEST) relates to PEH is not known. This study examined associations between peak systolic BP on a GEST and PEH. Subjects were 50 men (mean +/- SEM age 43.8 +/- 1.3 years) with elevated BP (145.3 +/- 1.5/85.9 +/-1.1 mm Hg). Men completed a GEST and 3 experiments: nonexercise control and 2 cycle bouts at 40% (LIGHT) and 60% (MODERATE) of maximal oxygen consumption. After the experiments, subjects left the laboratory wearing ambulatory BP monitors. Peak systolic BP on a GEST was categorized into tertiles: low (n = 17, 197.4 +/- 2.0 mm Hg), medium (n = 16, 218.4 +/- 1.4 mm Hg), and high (n = 17, 248.9 +/- 2.8 mm Hg). Repeated-measures analysis of variance tested if BP differed over time and among experimental conditions and peak systolic BP groups. In men with high peak systolic BP, systolic BP was reduced by 7.3 +/- 2.6 mm Hg after LIGHT and by 5.0 +/- 2.2 mm Hg after MODERATE compared with nonexercise control over 10 hours, with the more apparent effects seen after LIGHT (p <0.05). In men with low peak systolic BP, systolic BP was reduced by 6.3 +/- 2.3 mm Hg after MODERATE compared with nonexercise control over 10 hours (p <0.05). In men with medium peak systolic BP, systolic BP was not different after exercise compared with nonexercise control over 10 hours (p >or=0.05). Men with high peak systolic BP had decreased systolic BP to the greatest extent after LIGHT, whereas men with low peak systolic BP reduced systolic BP after MODERATE. In conclusion, the findings of this study suggest that peak systolic BP on a GEST may be used to characterize which men with hypertension will have decreased systolic BP after acute submaximal aerobic exercise.

Adolescent↗

PubMed1998

Exertional dyspnea in heart failure: a symptom unrelated to pulmonary function at rest or during exercise. Duke University Clinical Cardiology Studies (DUCCS) Exercise Group.

BACKGROUND: Exertional dyspnea is a common symptom in patients with heart failure, and the mechanisms responsible for the symptom are unknown. The purpose of this study was to identify factors responsible for the symptom of exertional dyspnea in patients with heart failure. METHODS: Resting pulmonary-function tests and maximal cardiopulmonary exercise tests were performed in 71 patients with New York Heart Association functional class II-IV symptoms (mean ejection fraction 30.6%; mean age, 68 years). RESULTS: The severity of dyspnea at peak exercise, which patients rated as 3 to 10 on a 1 to 10 severity scale, did not correlate with rest or exercise hemodynamic, spirometric, or metabolic variables, including peak oxygen uptake (VO2), minute ventilation (Ve), and respiratory rate, or with derived variables including Ve/VO2, Ve/VCO2, and the dyspnea index (Ve/maximum voluntary ventilation). Additionally, these variables did not differ between patients who reported limitation of exercise by dyspnea and those who were limited by fatigue. CONCLUSIONS: The symptom of exertional dyspnea in patients with heart failure is not determined by abnormalities in ventilatory function or demand.

Aged↗

PubMed1998

Improvement in the mechanical efficiency of walking: an explanation for the "placebo effect" seen during repeated exercise testing of patients with heart failure. Duke University Clinical Cardiology Studies (DUCCS) Exercise Group.

To determine the mechanism responsible for the "placebo effect" seen during serial exercise testing of patients with heart failure, we examined metabolic variables for 81 patients who underwent five baseline exercise tests as part of a multicenter drug trial. The patients were 50 men and 31 women with a mean ejection fraction of 30.1% and a mean age of 69 years. From test 1 to 2, the exercise time increased from 419 +/- 140 to 462 +/- 130 seconds before it reached a plateau over the next three tests. Metabolic measurements at test 1 and test 3 revealed no change in peak oxygen consumption ( 1119 +/- 376 to 1105 +/- 346 ml/min). Maximum heart rate, systolic blood pressure, ventilation, and respiratory exchange ratio also were unchanged. The onset of the anaerobic threshold was delayed from 211 +/- 81 to 238 +/- 93 seconds, but there was no change in oxygen consumption at the anaerobic threshold (810 +/- 222 to 795 +/- 220 ml/min). At a predetermined submaximal level, oxygen consumption, ventilation, and respiratory exchange ratio all decreased to a statistically significant degree. These results indicate that a rapid increase in the mechanical efficiency of walking contributes to the placebo effect among patients with heart failure during serial exercise testing and is independent of changes in conditioning or motivation.

Aged↗

PubMed1998

Importance of exercise capacity in the interpretation of a myocardial ischemic response to exercise testing. Multicenter Study of Myocardial Ischemia Group (MSMI).

Patients who were stable 1 to 6 months after a cardiac event underwent routine exercise testing with thallium scintigraphy. The prognosis of patients with good exercise capacity (Bruce stage 3) was similar whether or not ischemia was demonstrated and similar to patients with reduced exercise capacity and no ischemia, whereas the presence of both ischemia and a reduced exercise tolerance identified patients with a significantly poorer prognosis.

Aged↗

PubMed1995

Exercise effect of modified contralateral stabilization bar during one-legged isokinetic exercise.

We compared the electrical activities recorded from the muscles of the unexercised leg with changing the position of the contralateral stabilization bar to determine whether the degree of muscle contraction was influenced by the position of the bar during one-legged isokinetic exercise using an isokinetic dynamometer. The root mean square (RMS) values recorded from the medial hamstring sites of the unexercised legs showed a significantly higher value when the bar was located behind and on both in front of and behind the unexercised leg during one-legged extension exercise. Results from the isokinetic knee flexion exercise test indicated that a significantly greater RMS value was recorded from the vastus lateralis sites when the bar was located in front of and on both sides of the unexercised leg. During one-legged isokinetic extension-flexion exercise, the mean values of RMS voltage were greater when the bar was positioned in front of and on both sides of the unexercised leg in the vastus lateralis site. At the medial hamstring site, a greater value was noticed when the bar was located behind or on both sides.

Adult↗

PubMed1999

The effect of exercise modality on exercise-induced hypoxemia.

To investigate the effect of exercise mode on arterial oxyhemoglobin saturation (SaO2), 13 healthy, actively training men who displayed exercise-induced hypoxemia (EIH) performed two incremental maximal exercise tests: uphill treadmill running and cycle ergometry. At maximum, treadmill running resulted in a lower SaO2 (88.6+/-2% versus 92.6+/-2.0%) a lower ventilatory equivalent for carbon dioxide (VE/VCO2; 28.8+/-0.6 versus 31.2+/-0.9), and a higher maximal oxygen consumption (VO2, MAX; 4.83+/-0.11 l x min(-1) versus 4.61+/-0.14 l x min(-1) when compared to cycle ergometry. When data were combined from maximal running and cycling. SaO2 was correlated to VE/VCO2 (r = 0.54). However, there was no relationship between the differences in SaO2 and ventilation between exercise modes. This suggests that ventilation is important in the maintenance of SaO2, but that the difference observed in SaO2 between treadmill running and cycle ergometry cannot be explained by differences in ventilation and must be due to differences in diffusion limitation or ventilation-perfusion inequality.

Adult↗

PubMed2001

[Chronic obstructive pulmonary disease: evaluation of exercise tolerance using three different exercise tests].

The clinical usefulness of simple exercise tests in patients with chronic obstructive pulmonary disease (COPD) continues to give rise to debate. Questions remain about whether these tests assess maximum effort or only exercise tolerance (submaximal effort). To determine the levels of stress reached during the six-minute walking (6MW) test and stair climbing (SC) test and their relation to maximum aerobic capacity, 50 patients with COPD (FEV1 49 +/- 19%) were studied. Data collected included spirometric variables and VO2, heart rate (HR), ventilatory response and dyspnea during the progressive effort ergometric cycle (PEEC) test. Two 6MW and SC tests were completed on two separate days, with distance, number of steps, HR and dyspnea recorded. HR was higher during the PEEC test. Among the simple tests, SC caused a faster HR than did the 6MW test. Likewise, a significant linear relation was observed between VO2/kgpeak during the 6MW test (r2 = 0.27; p < 0.05) and the SC test (r2 = 0.33; p < 0.01). We therefore conclude that exercise tolerance in patients with COPD can be evaluated using simple stress tests. The SC test is probably the best simple way to determine maximum functional capacity, whereas the 6MW test can be reserved for measurement of exercise tolerance.

Aged↗

PubMed1984

Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy.

Several diagnostic noninvasive tests to detect coronary and multivessel coronary disease are available for women. However, all are imperfect and it is not yet clear whether one particular test provides substantially more information than others. The aim of this study was to evaluate clinical findings, exercise electrocardiography, exercise thallium myocardial scintigraphy and cardiac fluoroscopy in 92 symptomatic women without previous infarction and determine which tests were most useful in determining the presence of coronary disease and its severity. Univariate analysis revealed two clinical, eight exercise electrocardiographic, seven myocardial scintigraphic and seven fluoroscopic variables predictive of coronary or multivessel disease with 70% or greater stenosis. The multivariate discriminant function analysis selected a reversible thallium defect, coronary calcification and character of chest pain syndrome (p less than 0.05) as the variables most predictive of presence or absence of coronary disease. The ranked order of variables most predictive of multivessel disease were cardiac fluoroscopy score, thallium score and extent of ST segment depression in 14 electrocardiographic leads. Each provided statistically significant information to the model. The estimate of predictive accuracy was 89% for coronary disease and 97% for multivessel coronary disease. The results suggest that cardiac fluoroscopy or thallium scintigraphy provide significantly more diagnostic information than exercise electrocardiography in women over a wide range of clinical patient subsets.

Adult↗

PubMed1997

Evaluation of exercise thallium scintigraphy versus exercise electrocardiography in predicting survival outcomes and morbid cardiac events in patients with single- and double-vessel disease. Findings from the Angioplasty Compared to Medicine (ACME) Study.

OBJECTIVES: We sought to evaluate the prognostic ability of cardiac exercise stress tests in predicting cardiac mortality and morbidity in a low risk group of patients with established coronary artery disease (CAD). BACKGROUND: Although previous studies have demonstrated the superior value of stress nuclear cardiac scintigraphy in the prognosis of patients with CAD, none of these studies have focused on patients with a proven angiographic low risk profile (i.e., single- and double-vessel CAD). METHODS: Three hundred twenty-eight patients with documented single- and double-vessel disease were treated by random assignment to percutaneous transluminal coronary angioplasty or medical therapy in the Angioplasty Compared to Medicine (ACME) trial. Six months after randomization, maximal symptom-limited exercise tests were performed with electrocardiography (n = 300) and thallium scintigraphy (n = 270). Patients were followed up for a minimum of 5 years thereafter. RESULTS: A reversible thallium perfusion deficit documented after 6 months of either therapy was associated with an adverse mortality outcome (18% mortality rate with a reversible thallium perfusion defect and 8% mortality rate with no reversible thallium perfusion deficit, p = 0.02). Moreover, an important mortality gradient was demonstrated in relation to the number of reperfusing defects (0 = 7%, 1 to 2 = 15%, >3 = 20%, p = 0.04). Exercise electrocardiography did not predict this mortality outcome. CONCLUSIONS: A reversible thallium perfusion deficit demonstrated 6 months after medical therapy or coronary angioplasty is a valuable prognostic marker in patients with angiographically documented single- and double-vessel disease and is superior to exercise electrocardiography in this regard.

Aged↗

PubMed2001

Aspirin enhances the induction of type I allergic symptoms when combined with food and exercise in patients with food-dependent exercise-induced anaphylaxis.

We examined the effect of aspirin as a substitute for exercise in inducing urticaria/anaphylaxis in three patients with food-dependent exercise-induced anaphylaxis (FDEIA). Two of the patients had specific IgE antibodies to wheat and the other had antibodies to shrimp. Administration of aspirin before ingestion of food allergens induced urticaria in one patient and urticaria and hypotension in another, while aspirin alone or food alone elicited no response. The third patient developed urticaria only when he took all three items, i.e. aspirin, food and additional exercise, whereas provocation with any one or or two of these did not induce any symptoms. These findings suggest that aspirin upregulates type I allergic responses to food in patients with FDEIA, and further shows that aspirin synergizes with exercise to provoke symptoms of FDEIA. This is the first report of a synergistic effect of aspirin in inducing urticaria/anaphylaxis, which was confirmed using challenge tests in patients with FDEIA.

Adolescent↗

PubMed1992

The effect of exercise training on salivary immunoglobulin A and cortisol responses to maximal exercise.

The salivary immunoglobulin A (s-IgA) and cortisol responses to maximal exercise were examined in 24 adult males (X +/- SD; 22.1 +/- 3.0 yrs) before and after 10 weeks of run training. The subjects performed an incremental treadmill test to exhaustion and were randomly assigned to one of three groups: control (CON; n = 5), low intensity training (LO; n = 8), or high intensity training (HI; n = 11). Following the ten weeks of training, the subjects performed a second maximal treadmill test. Saliva samples were collected before, as well as immediately and 1 hr following each of the maximal treadmill tests and were analyzed for s-IgA and salivary cortisol. Maximal oxygen consumption (VO2max) increased significantly (p < 0.05) in the LO and HI groups but remained unchanged in the CON group. The s-IgA levels decreased significantly (p < 0.05) immediately post-exercise but returned to pre-exercise levels by one hour recovery. In addition, s-IgA and cortisol levels were not significantly (p > 0.05) correlated at any of the sampling times. These findings indicated that the s-IgA response to maximal exercise was unaffected by moderate (70% of VO2 max) to heavy (86% of VO2max) training (designed to develop cardiorespiratory fitness in healthy non-athletic adults) and independent of salivary cortisol.

Adult↗

PubMed1995

Exercise performance as a function of semi-solid and liquid carbohydrate feedings during prolonged exercise.

Aim of this study was to examine the effects of a semi-solid and a liquid carbohydrate feeding on exercise performance. Thirty-two male triathletes performed three exercise trials (3 hours maximal at 75% VO2max) with either a semi-solid feeding (S), an iso-caloric liquid feeding (F) or a liquid placebo (P). Exercise consisted of cycling (bout 1 and 3) and running (bout 2 and 4). Survival analysis revealed that the median maximum test time (MTT) with F, S and P was 180, 126 and 120 min, respectively. Median MTT was longer with F than with S (sign-test; p < 0.05) or P (p < 0.001), with no difference between S and P. Mean power output during supra-maximal tests after bout 2 (W1) and at the end of exercise (Wend) were 371, 365, 362 and 334, 332, 321 W with F, S and P, respectively. Differences between F and P were significant (p < 0.01). Regression analysis identified five variables that were associated with 93% of the variance in MTT. The variance in W1 was explained for 83% by three variables. Wend was explained (90%) by three variables. A significant dietary contribution to MTT and Wend was found, but not to W1. This suggests that the influence of the feedings on performance is different among performance tests.

Adult↗

PubMed1995

Light concentric exercise during recovery from exercise-induced muscle damage.

Eight male volunteers performed two eccentric exercise bouts using the forearm flexors of first one arm, then the other. The two bouts, consisting of 70 maximum voluntary muscle actions, were separated by a period of three weeks. In the experimental condition of the study, five sets of 10 sub-maximal concentric muscle actions were performed on the four days after the eccentric bout. In the control condition of the study, no concentric work was performed. Repeated measures analysis of variance indicated an increase in serum creatine kinase activity (p < 0.01) and decreases in relaxed elbow angle (p < 0.05) and maximum voluntary contraction force (p < 0.01) at three elbow angles (0.87, 1.57 and 2.79 rad) after both eccentric bouts. However, the serum creatine kinase response to eccentric exercise was reduced in the experimental condition (p < 0.05) and recovery of maximum voluntary force production at the most acute joint angle (0.87 rad) was accelerated (p < 0.01). Although muscle soreness increased after both eccentric bouts (p < 0.05; Wilcoxon test), further concentric exercise evoked temporary relief of muscle soreness two days after the bout (p < 0.05; Wilcoxon test). However, light concentric work had no effect on the other parameters monitored. In practical terms, these results suggest that the therapeutic effects of light concentric work on correlates of exercise-induced muscle damage are minimal.

Acceleration↗

PubMed2002

Plasma adenosine concentration increases during exercise: a possible contributing factor in exercise-induced bronchoconstriction in asthma.

We investigated whether the level of plasma adenosine (ADO) changed during exercise and whether this could be related to exercise-induced bronchoconstriction. Baseline levels of ADO did not differ, but exercise resulted in higher ADO in patients with asthma than in healthy subjects (86 +/- 35 vs 59 +/- 16 nmol/L; P <.001). In patients with asthma, the increase in ADO was related to decreases in FEV(1) (r (2) = 0.475; P <.05) and SaO(2) (r (2) = 0.693; P <.05). These data suggest that adenosine might be involved in the development of exercise-induced bronchoconstriction.

Adenosine↗

PubMed2007

Effect of wearing personal protective clothing and self-contained breathing apparatus on heart rate, temperature and oxygen consumption during stepping exercise and live fire training exercises.

Fire fighter breathing apparatus instructors (BAIs) must possess the ability to respond to both the extrinsic stress of a high temperature environment and the intrinsic stress from wearing personal protective equipment (PPE) and self-contained breathing apparatus (SCBA), repeatedly and regularly, whilst training recruits in live fire training exercises (LFTEs). There are few previous investigations on BAIs in hot environments such as LFTEs, since the main research focus has been on regular fire fighters undertaking exercises in temperate or fire conditions at a moderate to high exercise intensity. In this study, the intrinsic cardiovascular stress effects of wearing PPE + SCBA were first investigated using a step test whilst wearing gym kit (control), weighted gym kit (a rucksack weighted to the equivalent of PPE + SCBA) and full PPE + SCBA (weight plus the effects of protective clothing). The extrinsic effects of the very hot environment were investigated in BIAs in LFTEs compared to mock fire training exercises (MFTEs), where the fire was not ignited. There was an increase in heart rate due to the modest workload imposed on the BAIs through carrying out the MFTEs (25.0 (18.7)%) compared to resting. However, when exposed to fire during the LFTEs, heat storage appears to be significant as the heart rate increased by up to 39.8 (+/-20.1)% over that of the mock LFTEs at temperate conditions. Thus, being able to dissipate heat from the PPE is particularly important in reducing the cardiovascular responses for BAIs during LFTEs.

Adult↗

PubMed2006

A comparative study of organized class-based exercise programs versus individual home-based exercise programs for elderly patients following hip surgery.

PURPOSE: To evaluate and compare the effectiveness of supervised and non-supervised exercise programs for improving health and rehabilitation outcomes for elderly persons following hip surgery. METHOD: Prospective, descriptive and quantitative study involving two groups: The class-based program (group A, n = 34: 21 females, 13 males, mean age 79.2 years +/- 5.23) was directed and administered in the outpatient clinic, and a home-based program (group B, n = 29, 17 females, 12 males, mean age 80.3 years +/- 5.74) which administered in the patient's home. Sixty three elderly patients began at a period of 2 weeks post hip surgery for open reduction with internal fixation. The training period took place for 14 consecutive weeks. The main outcome measures include results from physical performance test, functional reach test and short form-36 health survey questionnaire. RESULTS: Fifty five patients completed the exercise program. No significant difference according to gender or Body Mass Index was found between the groups. At the conclusion of 14 weeks of exercise training both groups demonstrated improvement in physical function. However, only 4 of 6 total tasks of a physical performance test were improved in the home-based group compared to improvement in all 6 tasks for the class-based group. The SF-36 scores and the functional reach test indicated that the class-based subjects also presented significant gains in contrast to no significant changes in the home exercise group. CONCLUSIONS: Both groups demonstrated improvement in a number of issues. However, there appears to be more positive health outcomes presented by the participants in the supervised/class-based group when compared to the non-supervised/home-based group. And therefore, patients may select to participate to either a home-based or class-based regime. The clinical relevance is the significant of the necessity for close supervision by a professional therapist. In addition, the results could have some political and economical implications on the healthcare system.

Aged↗

PubMed1990

Exercise intensity does not affect the composition of diet- and exercise-induced body mass loss.

The effect of caloric restriction (1200 kcal/d intake) in combination with high (High) (80-90% of peak VO2) or low (Low) (40-50% of peak VO2) exercise work rates on the composition of lost body mass was determined in 27 obese women (percent fat, 36.7 +/- 4.2%; mean +/- SD). All subjects trained 3 d/wk for 8 wk, with the High (n = 14) and Low (n = 13) groups exercising for 25 and 50 min/d, respectively. After posttesting there were no differences between the groups with respect to pre- to posttest changes (mean of combined groups) in body mass (-7%), fat-free mass (-10%), fat mass (-16%), percent fat (-10%), and sum of five skinfold-thickness measurements (-16%). This study suggests that with regard to conservation of fat-free mass, the selection of an exercise intensity for a diet and exercise regimen may be left to the preference of the clinician and/or dieter.

Adult↗