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PubMed1988

Do data from a previous exercise test influence the prognostic information given by a second routine exercise ECG test? A 13 1/2-year follow-up study in apparently healthy middle aged men.

A positive exercise ECG test in a middle-aged man without confounding disease is a strong indicator of occult coronary heart disease. In the years following a positive test mortality, but CHD events vary considerably compared with subjects having normal exercise tests. If a second exercise test is positive in the same subjects years later, this signifies a disease which is prone to progress in a very severe way in the ensuing years. A first normal test followed by a second pathologic test has an intermediate prognostic significance compared with two normal tests years apart. The clinical course indicates that preventive measures should be taken after observing a positive exercise test, and even more importantly if two positive tests are observed years apart.

Adult↗

PubMed1996

The QRS score: a promising new exercise score for detecting coronary artery disease based on exercise-induced changes of Q-, R- and S-waves: a relationship with myocardial ischaemia.

BACKGROUND: Recently, a new exercise test criterion diagnosing coronary artery disease was proposed, based on a composite of changes in Q-, R- and S-waves: the QRS score. We compared this new criterion with conventional ST-segment depression and other compositions of Q-, R- and S-wave changes in patients and normals and related the QRS score to reversible thallium-201 scintigraphic defects and ST-segment depression as markers for ischaemia. The influence of beta-blockade on the QRS score was also studied. METHODS: The study population consisted of 155 persons with 53 normals (group I) and 102 patients with documented coronary artery disease (group II). Another 20 patients (group III) with proven coronary artery disease and a positive exercise test by ST-segment criteria were studied for the influence of beta-blockade on the QRS score. A symptom-limited exercise protocol according to the modified Bruce protocol was used. For the QRS score, Q-, R- and S-wave amplitudes which could be recovered immediately were subtracted from pretest values: delta Q, delta R, delta S respectively. The score was calculated by the formula: (delta R - delta Q - delta S)AVF + (delta R - delta Q - delta S)V5. RESULTS: Using a cut-off point of > 5 as normal, the QRS score resulted in a sensitivity of 88.2%, a specificity of 84.8% and a predictive accuracy of 87.1%. For ST-segment depression these values were 54.9%, 83% and 64.5% respectively (P < 0.001 compared to the QRS score). Predictive accuracies of changes in Q-, R- and S-waves in leads AVF and V5 separately, combinations of changes and combining the two leads, resulted-with the exception of solitary S-wave changes-in predictive accuracies higher than those of ST-segment depression, but all were lower than the QRS score. We found a significant correlation between the QRS score, the summed ST-segment depression (P < 0.004) and the extent of reversible thallium-201 defects (P < 0.001). Applying Bayes' theorem, the combination of an abnormal QRS score and ST-segment depression resulted in the highest post-test risk for coronary artery disease and a normal QRS score without ST-segment depression in the lowest post-test risk. The QRS score and the maximal ST-segment depression changed significantly under the influence of beta-blockade (P < 0.02 and P < 0.001 respectively). CONCLUSION: Our data suggest that an abnormal QRS score reflects myocardial ischaemia. Furthermore, for the interpretation of the exercise test, the combined analysis of ST-segments and the QRS score is of value for the prediction of the presence or absence of coronary artery disease and its follow-up.

Adrenergic beta-Antagonists↗

PubMed2001

Exercise in chronic pulmonary disease: resistance exercise prescription.

Resistance exercise training has received relatively little attention as a means to reduce the muscle dysfunction and ensuing exercise intolerance seen in chronic pulmonary diseases. To date, only a few studies have examined the characteristics of skeletal muscle function or its responsiveness to strength training in patients with chronic respiratory diseases. It is clear from these studies, however, that peripheral muscle, particularly muscles of ambulation, are weak in patients with lung disease, exhibiting effort-dependent strength scores that are 70--80% of these measures in age-matched healthy subjects. The degree to which this dysfunction is accounted for by deconditioning, disease-related myopathy, or other causes is unclear. It is evident, however, that patients with chronic respiratory diseases can acquire and maintain substantial improvements in skeletal muscle function, physical function, and quality of life through participation in a well-structured program of resistance exercise training. Despite the positive, albeit limited, evidence that skeletal muscle dysfunction may be improved with resistance training, no clear guidelines are available for this purpose. This review discusses the skeletal muscle dysfunction that accompanies chronic respiratory disease and presents strategies for resistance exercise training that may be considered as part of pulmonary rehabilitation. These strategies are derived from the successful outcomes noted in studies using resistance training in patients with COPD as well as on extrapolations from extant guidelines used to develop strength, power, and endurance in healthy individuals.

Exercise Therapy↗

PubMed2000

Special feature for the Olympics: effects of exercise on the immune system: neuropeptides and their interaction with exercise and immune function.

It is known today that the immune system is influenced by various types of psychological and physiological stressors, including physical activity. It is well known that physical activity can influence neuropeptide levels both in the central nervous system as well as in peripheral blood. The reported changes of immune function in response to exercise have been suggested to be partly regulated by the activation of different neuropeptides and the identification of receptors for neuropeptides and steroid hormones on cells of the immune system has created a new dimension in this endocrine-immune interaction. It has also been shown that immune cells are capable of producing neuropeptides, creating a bidirectional link between the nervous and immune systems. The most common neuropeptides mentioned in this context are the endogenous opioids. The activation of endogenous opioid peptides in response to physical exercise is well known in the literature, as well as the immunomodulation mediated by opioid peptides. The role of endogenous opioids in the exercise-induced modulation of immune function is less clear. The present paper will also discuss the role of other neuroendocrine factors, such as substance P, neuropeptide Y and vasoactive intestinal peptide, and pituitary hormones, including growth hormone, prolactin and adrenocorticotrophin, in exercise and their possible effects on immune function.

Animals↗

PubMed2000

Special feature for the Olympics: effects of exercise on the immune system. Overview: exercise immunology.

The review articles in this special feature reflect the current status of knowledge in the field of exercise immunology, with a focus on how exercise affects the human immune system and the health implications for resistance to infections and neoplastic diseases. In an Olympic year, the emphasis of exercise immunology research tends to be on elite athletes and the prevention of infections in the quest for optimum performance. However, research presented in this issue also covers recreational athletes, as well as highlighting the benefits of exercise for our ageing population.

Disease Susceptibility↗

PubMed2000

Special feature for the Olympics: effects of exercise on the immune system: effects of exercise on the immune system in the elderly population.

Immunosenescence is characterized by impaired cellular immune function concomitant with increased inflammatory activity. Immune dysfunction is associated with increased mortality risk in elderly people. An important part of human ageing is characterized by a decline in the ability of individuals to adapt to environmental stress. Exercise has been suggested as a prototype for studying the effects of stress factors on the cellular immune system. Studies of interactions between an acute bout of exercise and immune function may be a useful and an ethically acceptable tool to investigate cell trafficking, immune mobilization/deficiency and the acute phase response during physical stress situations in relation to human ageing. Elderly humans have a preserved ability to recruit T lymphocytes and NK cells in response to an acute bout of exercise. Physical exercise training programs do not result in major restoration of the senescent immune system in humans. However, highly conditioned elderly humans seem to have a relatively better preserved immune system, although it is not possible to conclude if this is linked to training or other lifestyle-related factors.

Adolescent↗

PubMed1987

Pre-exercise food and heart rate during submaximal exercise.

The heart rates of 20 movement studies students were measured during multi-stage cycle ergometer tests. The tests were repeated on five occasions following the ingestion of different pre-exercise meals and the results compared. A glucose solution taken three hours prior to the exercise (G3) resulted in the lowest heart rates at each work rate. The highest heart rates at each work rate were recorded following the ingestion of glucose or protein one hour before the exercise (G1 and P1 respectively). The heart rate values during G3 were on average 10.3 beat.min-1 lower than those used during G1 and P1. Intermediate heart rates were obtained with protein taken three hours prior to the exercise or a complete fast for 12 to 14 hours. The results have implications for those attempting to predict maximum oxygen uptake from submaximal heart rates.

Adult↗

PubMed2002

Repeated exercise paired with "imperceptible" dead space loading does not alter VE of subsequent exercise in humans.

We employed an associative learning paradigm to test the hypothesis that exercise hyperpnea in humans arises from learned responses forged by prior experience. Twelve subjects undertook a "conditioning" and a "nonconditioning" session on separate days, with order of performance counterbalanced among subjects. In both sessions, subjects performed repeated bouts of 6 min of treadmill exercise, each separated by 5 min of rest. The only difference between sessions was that all the second-to-penultimate runs of the conditioning session were performed with added dead space in the breathing circuit. Cardiorespiratory responses during the first and last runs (the "control" and "test" runs) were compared for each session. Steady-state exercise end-tidal PCO(2) was significantly lower (P = 0.003) during test than during control runs for both sessions (dropping by 1.8 +/- 2 and 1.4 +/- 3 Torr during conditioning and nonconditioning sessions, respectively). This and all other test-control run differences tended to be greater during the first session performed regardless of session type. Our data provide no support for the hypothesis implicating associative learning processes in the ventilatory response to exercise in humans.

Adult↗

PubMed2006

Evaluation of exercise capacity with cardiopulmonary exercise testing and type B natriuretic peptide concentrations in adult patients with patent atrial septal defect.

UNLABELLED: Adults with patent atrial septal defect (ASD) usually find their exercise capacity satisfactory, and therefore hesitate to accept proposed surgical treatment of the heart disease. The aim of our study was to evaluate both the exercise capacity, using the cardio-pulmonary stress test, and brain natriuretic peptide (BNP) levels in asymptomatic adults with ASD. Thirty-six patients with patent secundum type ASD (aged mean 44.7 +/- 8.2 years) were studied. The control group consisted of 25 healthy subjects at the mean age of 45.6 +/- 6.1 years. Echocardiography and CPST were performed and BNP levels measured in all subjects. Oxygen uptake (VO2 max) was lower in ASD patients than in controls (22.1 +/- 5.6 vs. 30.0 +/- 6.8 ml/kg/min, p = 0.00001); the VE/VO2 slope was elevated in ASD patients compared with healthy subjects (31.3 +/- 6.6 vs. 26.9 +/- 3.3, p = 0.001), and exceeded 34 in 5 patients. VO2 max showed a negative correlation with the pulmonary to systemic flow ratio Qp:Qs (r = -0.46, p = 0.004), and a positive correlation was found between the VE/VO2 slope and Qp:Qs (r = 0.32, p = 0.05). BNP levels were higher in the ASD group than in the controls (60.6 +/- 49.9 vs. 32.6 +/- 24.5 pg/ml, p = 0.02). BNP correlated positively with RV diameter and Qp:Qs (r = 0.38 and 0.39 respectively, p = 0.03) and negatively with maximum VO2 (r = -0.5, p = 0.004) and VO2% (r = -0.32, p = 0.07). CONCLUSIONS: Although most adult patients with ASD perceive their exercise capacity as satisfactory, objective assessment reveals that in fact it is significantly decreased. BNP levels are increased comparing to healthy individuals. Decreased exercise capacity and increased BNP levels seem to result from right ventricular volume overload.

Adult↗

PubMed1992

Prognostic value of thallium-201 exercise scintigraphy in low-risk patients after Q-wave myocardial infarction: comparison with exercise testing and catheterization.

In a prospective study of 100 consecutive patients discharged after a Q-wave myocardial infarction, the value of reversible ischemia on thallium-201 scintigraphy to assess the risk of cardiac events (death or reinfarction) during 4 years was compared with variables from exercise testing and cardiac catheterization. Patients with markedly impaired left ventricular function [ejection fraction (EF) < or = 0.30] were excluded. During follow-up there were 20 cardiac events (10 cardiac deaths and 10 reinfarctions). Thallium-201 scintigraphy was significantly better than all exercise test variables and better than an EF < 0.40, with good sensitivity and specificity (75 and 51%, respectively). Exercise-induced reversible ischemia on scintigraphy yielded the same information as the presence of multivessel disease. Exercise test variables were of limited value to assess prognosis. Thus, thallium-201 scintigraphy can be used as the only tool to predict future cardiac events in low-risk patients after a Q-wave myocardial infarction.

Adult↗

PubMed1994

Relationship between exercise tolerance, hemodynamics at rest and during exercise and ejection fraction, and their prognostic relevance in asymptomatic postinfarction patients.

In 309 postmyocardial infarction patients (age 40 +/- 7.7 years) without persistent ischemia there is only a weak correlation between ejection fraction (EF) and exercise tolerance (r = 0.45, p < 0.01), and between EF and maximum cardiac output (CO; r = 0.41, p < 0.01) and maximum pulmonary capillary wedge pressure (PCWP; r = -0.32, p < 0.001). The same was true for exercise tolerance and maximum PCWP (r = -0.53, p < 0.001). A big scattering of individual values could be observed. Although we found a high positive correlation between maximum CO and exercise tolerance (r = 0.80, p < 0.001), in individual cases a low CO could be related to high exercise tolerance and vice versa. In the multivariate analysis, only the heart volume/kg body weight and maximum PCWP could be shown to be of independent prognostic importance for survival and/or mortality in the following years (chi 2 = 5.9, p < 0.015 and chi 2 = 7.2, p < 0.007, respectively).

Adult↗

PubMed2006

Warm-up exercise suppresses platelet-eosinophil/neutrophil aggregation and platelet-promoted release of eosinophil/neutrophil oxidant products enhanced by severe exercise in men.

Heterotypic platelet-eosinophil/neutrophil aggregation and subsequent release of eosinophil/neutrophil oxidant products contribute to pathogenesis of conditions such as asthma and inflammatory bowel diseases. This study investigates whether warmup exercise (WUE) affects platelet-eosinophil/neutrophil interaction mediated by high-intensity exercise (HIE). Twenty-three healthy sedentary men performed on three occasions light-intensity exercise (LIE, 40%VO(2 max) for 40 min) and HIE (80%VO(2 max) for 40 min) with and without WUE (40%VO(2 max) for 20 min). Before and immediately after exercise, platelet-eosinophil and platelet-neutrophil aggregation (PEA and PNA), reactive oxygen species production of eosinophils and neutrophils (EROS and NROS) enhanced by platelets, and adhesion molecule expression on platelets, eosinophils, and neutrophils were measured. The results of this study demonstrated that HIE enhanced PEA, PNA, and platelet-induced EROS and NROS, was accompanied by increased expressions of Mac-1 on eosinophils and neutrophils and P-selectin on platelets at 5 dyne/cm(2) of shear stress, 100 microg/ml lipopolysaccharide, and 1 microM N-formylmethionyl- leucyl-phenylalanine treatments, whereas the enhancement of HIE on platelet-eosinophil/neutrophil interaction was suppressed by WUE. Conversely, LIE significantly reduced PEA and PNA, suppressed platelet-induced EROS and NROS, and down-regulated eosinophil/neutrophil Mac-1 and platelet P-selectin expressions under various stimuli and shear flow conditions. Moreover, these effects were more pronounced in platelet interaction with eosinophils than with neutrophils. It is concluded that HIE enhances hetero-aggregation, adhesion molecules expressions, and subsequent oxidative bursts mediated by platelets and eosinophils/neutrophils, this effect diminishes after WUE. However, LIE minimizes the risk of thromboinflammation.

Adult↗

PubMed1997

Attenuation of unfavorable remodeling by exercise training in postinfarction patients with left ventricular dysfunction: results of the Exercise in Left Ventricular Dysfunction (ELVD) trial.

BACKGROUND: Exercise is currently recommended for patients after myocardial infarction; however, the effects of regular exercise on the remodeling process remain to be defined. The aim of this multicenter, randomized study was to investigate whether a long-term physical training program influences left ventricular size and function in postinfarction patients with systolic dysfunction. METHODS AND RESULTS: Consecutive patients with <40% ejection fraction after a first Q-wave myocardial infarction were randomly assigned to a 6-month exercise training program (n=39) or control group (n=38). After 6 months, a significant increase in work capacity was observed only in the training group (from 4.462+/-1.095 to 5.752+/-1.749 kilopond-meters [Kp-m], P<.01), not in the control group (from 4.375+/-1.143 to 4.388+/-1.199 Kp-m), whereas left ventricular volumes had increased in the control group (end-diastolic volume, from 94+/-26 to 99+/-27 mL/m2, P<.01; end-systolic volume, from 62+/-20 to 67+/-23 mL/m2, P<.01) but not in the training group (end-diastolic volume, from 93+/-28 to 92+/-28 mL/m2, P=NS; end-systolic volume, from 61+/-22 to 57+/-23 mL/m2, P=NS). Conversely, ejection fraction had improved in the training group (from 34+/-5% to 38+/-8%, P<.01) but not in the control group (from 34+/-5% to 33+/-7%, P=NS). CONCLUSIONS: In postinfarction patients with systolic dysfunction, long-term exercise training may attenuate the unfavorable remodeling response and even improve ventricular function over time.

Adult↗

PubMed2003

Exercise to exhaustion in the second-wind phase of exercise in a case of McArdle's disease with and without creatine supplementation.

The cardio-pulmonary and biochemical changes observed in a case of McArdle's disease, exercising with increasing work rates to exhaustion in the "second-wind" phase of exercise are reported for the first time. A work rate of 275-325 watts was achieved. Venous blood lactate remained unchanged throughout. The plasma ammonium level reached a plateau of approximately 400 mmol/l at 100 watts. At a work rate of 150-175 watts the ratio of O2 consumption to CO2 production increased, the inverse of an anaerobic threshold. Maximal cardiopulmonary responses were achieved at 200 watts. During the final periods of exercise from 200 to 275/325 watts pulmonary ventilation did not significantly change but there was a decrease in the venous blood H+ concentration, and pO2 and in increase in the pCO2. Creatine supplementation at 25 g/day for five days did not improve exercise performance.

Creatinine↗

PubMedDate not supplied

Exercise: Part I. Physiological response to exercise in diabetes mellitus.

Exercise is a valuable and effective tool for assisting with diabetes management. The benefits of exercise are significant. Metabolic responses to various workloads vary greatly and depend on many factors, including type of diabetes; time, dosage, and type of diabetes medication; time and content of last meal; fitness level; and intensity and duration of activity performed. Exercise-induced hypo- and hyperglycemia can occur in diabetes, and strategies to avoid this should be taught. Weight loss is a common goal in NIDDM, although often difficult to attain. Exercise plays a critical role in weight loss and should be considered part of the treatment plan when fat loss is a goal.

Diabetes Mellitus↗

PubMed1990

Effects of exercise mode on muscle glycogen restorage during repeated days of exercise.

The purpose of this study was to examine differences in muscle glycogen storage during three successive days of running or cycling. In a crossover design, seven male subjects performed two 3-d trials of either running (trial R) or cycling (trial C) for 60 min at 75% VO2max. Biopsy samples were obtained before and after each day's exercise from the gastrocnemius (trial R) or vastus lateralis (trial C) muscle. Diets in the 2 d preceding and during each trial contained 5 g carbohydrate.kg-1.d-1 and 14,475 +/- 402 kJ.d-1. Mean pre-exercise glycogen content (mmol.kg-1 wet wt.) was significantly reduced in both trials on day 3 (103.4 +/- 6.0) when compared to day 1 and day 2 (119.9 +/- 6.8 and 116.4 +/- 5.7, respectively). Day 1 glycogen reduction was significantly greater in trial C (P less than 0.03), and glycogen restorage was greater (P less than 0.02) only in trial C between the 1st and 2nd d. On day 3, spectrophotometric analysis of PAS strains showed that pre-exercise glycogen content in either muscle group was significantly (P less than 0.01) less in Type I as compared to Type II fibers. This difference in fiber glycogen storage did not appear to be attributable to muscle damage as negligible leukocyte infiltration and low blood CK levels were obtained. No difference between modes were observed for CK values throughout the trials. These data suggest that the depressed glycogen storage before the 3rd d of exercise was due to the moderate carbohydrate intake.

Adult↗

PubMed2002

Left atrial function preserves pulmonary circulatory pressure during pacing-tachycardia and contributes to exercise capacity in patients with idiopathic dilated cardiomyopathy in sinus rhythm, whose exercise is limited by dyspnea.

The aim of this study was to determine whether left atrial (LA) function contributes to pulmonary circulatory pressure during pacing-tachycardia and exercise capacity in patients with idiopathic dilated cardiomyopathy (DCM). Thirty-two patients with DCM and in sinus rhythm had limited exercise capacity because of dyspnea. The correlation between peak oxygen consumption (VO2) and the variables of cardiac function by cardiac catheterization and 2-dimensional, Doppler echocardiography, and plasma neurohumoral factor levels was tested, as was the correlation between non-invasive LA functional parameters and pulmonary circulatory pressure during pacing-tachycardia. A significant correlation was observed between VO2 and LA dimension (r = -0.45, p < 0.01), the peak velocities of LA appendage empty flow during atrial systole (r = 0.63, p < 0.0001) and the pulmonary venous forward flow in early ventricular systole (PVS1; r = 0.74, p < 0.0001), as well as plasma brain natriuretic peptide (BNP) concentrations. The predictable equation to VO2 with the multiple regression analysis was: VO2 = -0.01 BNP+0.21 PVS1+15.4 (r = 0.81, p < 0.0001). Furthermore, LA functional variables derived from pulmonary venous flow, especially PVS1, but not plasma BNP concentration, were useful for predicting the degree of the increase in pulmonary circulatory pressure during pacing-tachycardia. Therefore, it is suggested that LA function contributes to exercise capacity through its influence on pulmonary hemodynamic reserve in patients with DCM with sinus rhythm whose exercise is limited by dyspnea.

Adult↗

PubMed1992

Strategies to increase exercise-report correspondence by boys with moderate mental retardation: collateral changes in intention-exercise correspondence.

Correspondence between verbal and nonverbal behavior in an exercise room was taught to 4 13-year-old boys diagnosed with moderate mental retardation. Participants were asked prior to each exercise session which exercise machine(s) they intended to use. No contingencies on stating intentions (promising) were applied. Following the exercise session, participants were asked to say (report) which machine(s) they had used. Following the baseline condition, do-report correspondence training was introduced sequentially across participants. During do-report correspondence training, accurate reporting was reinforced. High rates of both do-report and promise-do correspondence were observed. Data were analyzed via a multiple baseline across subjects design and contingency-space analysis. Results are discussed with regard to observed changes in promise-do correspondence subsequent to observed changes in do-report correspondence.

Adolescent↗