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PubMed1992

Exercise-induced muscle damage: effects of light exercise on damaged muscle.

The effects of performing light eccentric exercise (LB) during the period of recovery from a heavy eccentric exercise bout (HB) were studied. An experimental and a control group, each consisting of nine college age volunteers (seven women, two men) performed two HB--HB1 and HB2--14 days apart, using the elbow flexor and extensor muscles of one arm. The experimental group performed an additional LB on the day following the first HB. HB1 resulted in muscle soreness, muscle weakness, changes in elbow joint flexibility, and large delayed increases in serum creatine kinase (CK) activity. The HB2 produced smaller changes in all parameters, indicating that adaptation to the effects of eccentric exercise had occurred in the muscle. The LB did not alter muscle soreness, strength or elbow flexibility, but did reduce or delay CK activity increase after HB1. The LB had no apparent effect on adaptation to HB2.

Adult↗

PubMed1995

Exercise gated planar myocardial perfusion imaging using technetium-99m sestamibi for the diagnosis of coronary artery disease: an alternative to exercise tomographic imaging.

Single-photon emission tomography (SPET) using technetium-99m labelled myocardial tracers (e.g. 99mTc-sestamibi) has become one of the most popular myocardial imaging methods for the diagnosis of coronary artery disease (CAD). This prospective study was designed to evaluate the diagnostic performance of 99mTc-sestamibi exercise gated planar myocardial imaging by comparison with both visual and quantitative analyses of SPET. The study was conducted in 115 consecutive patients with known or suspected CAD, including 54 patients with a previous myocardial infarction (MI), referred for exercise testing prior to coronary angiography. Multi-gated planar imaging and SPET were performed after bicycle exercise. The end-diastolic (ED) and SPET images were visually scored (SVi). Myocardial uptake was quantitated on SPET slices using maximum count circumferential profiles (SQu) and defect extent was measured by comparison with gender-matched data sets obtained from 27 controls (< 5% likelihood of CAD). CAD was defined as coronary artery stenosis > 50% and/or regional wall motion abnormality. The cut-off criteria for positivity of the three procedures were determined from receiver operating characteristic (ROC) curves derived from the data of patients without previous MI. The area under the ROC curves was similar for ED, SVi and SQu. This was confirmed by the analysis of sensitivity performed using the ROC curve-derived cut-off criteria, in patients with or without previous MI. SVi was more sensitive than ED in identifying the diseased vessel(s) (ED: 41% vs SVi: 80%; P < 0.0005) but ED was more specific in this respect (ED: 79% vs SVi: 61%; P < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Muscle oxygenation kinetics at the onset of exercise do not depend on exercise intensity.

The purpose of this study was to determine whether the onset kinetics of muscle oxygenation in localized working muscle (mOxy) was affected by differences in exercise intensity. Five healthy male subjects exercised for 6 min at 125 W, 150 W, and 175 W, and 1 min at 300 W on a cycle ergometer. mOxy was estimated by near-infrared spectroscopy (NIRS) with a continuous wave photometer. The NIRS probe was positioned on the vastus lateralis muscle of the right leg. The relative change in mOxy was calculated from the relative change of the oxygenated hemoglobin (OxyHb) and deoxygenated hemoglobin (DeoxyHb) concentration from their resting values ([mOxy]=Delta[OxyHb]-Delta[DeoxyHb]). Assuming an exponential time course with time delay, the time constants of the mOxy were 5.7 (SD 2.2) s at 125 W, 5.6 (SD 1.9) s at 150 W, 6.0 (SD 2.2) s at 175 W, and 5.6 (SD 2.1) s at 300 W. The time delays of the mOxy were 6.7 (SD 4.2) s at 125 W, 8.6 (SD 1.6) s at 150 W, 6.4 (SD 3.0) s at 175 W, and 5.4 (SD 2.9) s at 300 W. The mean response times of the mOxy were 12.5 (SD 2.7) s at 125 W, 14.2 (SD 2.4) s at 150 W, 12.4 (SD 4.4) s at 175 W, and 11.0 (SD 3.1) s at 300 W. These results indicate that the kinetics of mOxy were not affected by differences in exercise intensity.

Adaptation, Physiological↗

PubMed2000

The relationship between exercise work intervals and duration of exercise on lower extremity training induced by electrical stimulation in humans with spinal cord injuries.

A group of 90 male paraplegics were studied to determine the optimal training protocol for isokinetic exercise induced by functional electrical stimulation of the quadriceps muscles. The parameters that were varied were the number of training sessions a week, the length of the training sessions each day, and the work-rest intervals in each training session. Training for 3 days a week for 30 min a day with 6 s of exercise and 6 s of rest proved the optimal protocol. Training for 5 days or for 1 day a week was not as effective in training strength or endurance. A combination of 50% work and 50% rest produced a much greater gain in strength and endurance than work:rest ratios of 66%:33% or 25%:75%. When training was conducted for 5 min, 15 min or 30 min each day, the greatest increase was found when the muscles were exercised for 30 min each day. While more variables need to be examined, this study has provided some initial guidelines for isokinetic training of humans using electrical stimulation.

Adult↗

PubMed2006

Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis.

AIM: The aim of this study was to compare proprioceptive function between computerized proprioception facilitation exercise (CPFE) and closed kinetic chain exercise (CKCE) for knee osteoarthritis. DESIGN: Randomized-controlled. SETTING: Kinesiology laboratory. PATIENTS: Eighty-one patients with bilateral knee osteoarthritis were randomly assigned to CPFE, CKCE, and control groups. INTERVENTION: Both exercise groups underwent an 8-week program of three sessions per week. The control group received no training. The CPFE program included a 20-min computer game to be played by the trained foot of the subject. CKCE included 10 sets of 10 repetitions of repeated knee extension and flexion with resistance of 10-25% of body weight. MAIN OUTCOME MEASURES: Absolute reposition error, functional score, walking speed, and knee muscle strength were assessed with an electrogoniometer, the physical function subscale of Western Ontario and McMaster Osteoarthritis Index, a CASIO stopwatch, and a Cybex 6000 dynamometer before and after the 8-week period. RESULTS: The results of this study showed that both CPFE and CKCE were effective in improving joint position sense, functional score, walking speed, and muscle strength. Furthermore, CKCE showed greater effect in increasing knee extensor torque in patients with knee osteoarthritis. CONCLUSION: Clinical effects of CPFE were the same as those of CKCE except for knee extensor torque. The increase in knee extensor torque in CPFE patients was not as great as that seen in CKCE patients.

Aged↗

PubMed1989

Use of technetium-99m isonitrile (RP-30A) in assessing left ventricular perfusion and function at rest and during exercise in coronary artery disease, and comparison with coronary arteriography and exercise thallium-201 SPECT imaging.

This study compared the results of stress and rest single-photon emission computed tomography imaging of myocardial perfusion using technetium-99m isonitrile (RP-30A) with the results of stress and redistribution tomographic thallium imaging and the results of coronary arteriography in 39 patients, 11 without and 28 with coronary artery disease (CAD). Each patient underwent 2 exercise studies at identical workload, heart rate and double product. In a subset of 13 patients, concomitant evaluation of left ventricular (LV) function using first-pass radionuclide angiography with a multi-crystal camera also was performed with bolus injections of isonitrile. Isonitrile had similar sensitivity (82 vs 82%, difference not significant), a slightly--but not significantly--higher specificity (100 vs 82%) and similar predictive accuracy (87 vs 82%) to thallium-201. The tracer uptake was assessed in 20 segments/study. There was concordance between the isonitrile and thallium-201 images in 723 of the 780 segments (93%) (kappa = 0.83 +/- 0.02). In general, the isonitrile images were considered of better quality than the thallium-201 images. All 10 patients with CAD who underwent concomitant first-pass radionuclide angiography had either perfusion abnormalities or an abnormal ejection fraction response to exercise. Thus, technetium-99m isonitrile provides a reliable method of assessment of CAD with a sensitivity, specificity and predictive accuracy comparable to that of exercise thallium-201 imaging. Additional advantages include better image quality and the ability to obtain concomitant assessment of LV function with the use of first-pass radionuclide angiography.

Angiography↗

PubMed1992

Usefulness of exercise-induced ST-segment depression in the inferior leads during exercise testing as a marker for coronary artery disease.

Multiple lead systems are shown to have a higher sensitivity than that of single leads for detecting coronary artery disease (CAD) during exercise testing, but the value of ST-segment depression isolated to the inferior leads is questionable. To ascertain the diagnostic accuracy of inferior limb lead II compared with that of precordial lead V5, a retrospective analysis of 173 men was performed (108 in a training population and 65 in a validation cohort). All patients had a standard exercise test and underwent diagnostic coronary angiography within 15 days of the exercise test (range 1 to 65). Sixty-three patients had greater than or equal to 1 coronary stenoses greater than or equal to 70%, or left main lesion greater than or equal to 50%, whereas 45 patients in the training population did not. Exclusion criteria were female sex, left ventricular hypertrophy, left bundle branch block or resting ST-segment depression on the baseline electrocardiogram, previous myocardial infarction or revascularization procedures, and any significant valvular or congenital heart disease. Lead V5 had a better combination of sensitivity (65%) and specificity (84%) (chi-square = 24.11; p less than 0.001) than that of lead II (sensitivity 71%, specificity 44%) (chi-square = 2.25; p = 0.13) at a single cut point, and this improved specificity was substantial (95% confidence interval for observed difference 22 to 58%). Receiver-operating characteristic curve analysis also revealed that lead V5 (area = 0.759) was markedly superior to lead II (area = 0.582) over multiple cut points (z = 3.032; 2p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1981

Do exercise- and antigen-induced asthma utilize the same pathways? Antigen provocation in patients rendered refractory to exercise-induced asthma.

Twelve asthmatics (ages 8 to 33 yr) with proven exercise-induced asthma (EIA) and allergen-induced asthma (AIA) were investigated in an attempt to elucidate the pathways through which each type of attack develops. All patients were rendered refractory to EIA by repeated exercise at short intervals and were then immediately challenged by inhalation with an allergen known to evoke AIA. After an average of three runs all subjects were rendered refractory to EIA (post-exercise fall in FEV1 of 7 +/- 8% SEM compared with the control postexercise fall of 32 +/- 14%). In this refractory state six patients failed to respond to antigen challenge (6 +/- 4% SEM fall in FEV1 compared with the 30 +/- 3% fall in control study, p less than 0.001), suggesting a common pathway for EIA and AIA, such as the exhaustion of stored chemical mediators. Six other patients developed attacks of AIA while refractory to EIA, which were at least as severe as those in their control study (34 +/- 7% SEM fall in FEV1 compared with 29 +/- 3%). The fact that AIA could develop while EIA was blocked in this group requires an alternate pathway or mechanism for their AIA. The only significant difference between the AIA "blocked" and AIA "nonblocked" groups was a lower baseline level of lung function in all tests in the nonblocked group.

Adolescent↗

PubMed2005

Assessment of patients with low-risk chest pain in the emergency department: Head-to-head comparison of exercise stress echocardiography and exercise myocardial SPECT.

OBJECTIVES: The aim of the study was to compare head-to-head the performance of exercise tolerance test-stress echocardiography (ex-Echo) and exercise stress-perfusion nuclear imaging (exercise-single-photon emission computed tomography [ex-SPECT]) for the diagnosis of coronary artery disease (CAD) in patients evaluated at the chest pain unit with delay from chest pain (CP) onset. BACKGROUND: As an early triage strategy for CAD in emergency medicine, ex-Echo could have the advantage of widespread availability and low costs. METHODS: In the years 2000-2002, 503 consecutive patients (mean age 60 years) with recent (<24 hours) CP and nonischemic electrocardiogram (ECG), in whom CAD remained undiagnosed after first line 6-hour work-up including serum markers of myocardial injury and resting echocardiogram, underwent ex-Echo and ex-SPECT within 24 hours. Patients with (+)ex-Echo or (+)ex-SPECT or (+)ex-ECG or abnormal troponin I were referred to coronary angiography; otherwise, they were discharged and followed up. End points were coronary stenosis > or =50% and cardiovascular events at 6-month follow-up. RESULTS: Ninety-nine patients (20%) had (+)ex-Echo and 121 (24%) (+)ex-SPECT; CAD was diagnosed in 81% and 67%, respectively; positive tests were concordant in 69%. In negative ex-Echo and ex-SPECT, final evidence of CAD emerged in 14 and 13, respectively. Ex-Echo demonstrated higher accuracy than ex-SPECT (93% +/- 1% vs 89% +/- 1%), optimal specificity (95% +/- 5% vs 90% +/- 5%), and positive predictive value (81% +/- 4% vs 67% +/- 4%); moreover, in the case of (-)ex-ECG, observed effective likelihood ratio indicates a (+)synergy between ex-ECG and ex-Echo. CONCLUSIONS: Ex-Echo can be an effective diagnostic strategy in the early triage of CP patients, improving diagnosis in case of (-)ex-ECG and reducing unnecessary angiography number. Its drawback is represented by the 5% of missed diagnosis.

Adult↗

PubMed2006

IGF-I polymorphism is associated with lean mass, exercise economy, and exercise performance among premenopausal women.

BACKGROUND: We undertook this study to investigate the association of a genetic polymorphism of the insulin-like growth factor, IGF-I(189), on body composition, exercise performance and exercise economy, after controlling for the independent effect of race as assessed by African genetic admixture (AFADM). METHODS: A total of 114 premenopausal sedentary women were genotyped for IGF-I189, obtaining measures of fat mass, lean body mass, VO2 during cycling and stairclimbing, time on treadmill and leg strength. A quantitative value for AFADM was derived from genotypic information of approximately 40 ancestry informative markers and used as covariate in statistical models. RESULTS: After adjusting for AFADM, IGF-I189 was negatively associated with lean body mass (p = 0.029) and lean leg mass (p = 0.050). Leg strength was not associated with the presence/absence of IGF-I189 (p = 0.380), but carriers of the allele demonstrated a longer time on the treadmill (p = 0.015) after adjusting for AFADM. There was also a negative relationship between oxygen uptake during cycling and presence of the IGF-I189 independent of AFADM (p = 0.010). CONCLUSIONS: Independent of AFADM, individuals with IGF-I189 are more likely to have low leg lean mass and to perform better in activities requiring exercise economy and endurance performance.

Adult↗

PubMedDate not supplied

CDE and non-CDE dietitians' knowledge of exercise and content of exercise programs for older adults with type 2 diabetes.

OBJECTIVE: To study differences between non-certified diabetes educator registered dietitians (non-CDE-RDs) and certified diabetes educator registered dietitians (CDE-RDs) in the design and content of programs to promote physical activity in older adults with type 2 diabetes. DESIGN: The Exercise Teaching Questionnaire was used to assess knowledge of and promotion of physical activity. SETTING AND PARTICIPANTS: Surveys were sent to CDE-RDs and non-CDE-RDs in Florida, California, and Texas. Ninety-four CDE-RDs and 73 non-CDE-RDs completed the study. MAIN OUTCOME MEASURES: The independent variable was CDE status. The dependent variables were knowledge, design, content, and total exercise scores. ANALYSIS: Two-way ANOVA's tested for Knowledge, Design, and Content scores by RD status and one of the following: years practicing in diabetes education, state, and practice setting. RESULTS: The exercise Knowledge, Design and Content scores were significantly (P < .001) higher in the CDE-RDs compared to those of the non-CDE-RDs. CONCLUSIONS AND IMPLICATIONS: The results of this study indicate that education and experience play a key role in the design and content of programs to promote physical activity in older adults. Therefore, the results raise the question of the role the dietitian and nutrition educator should play in the promotion of physical activity in older adults.

Adult↗

PubMed1999

Synergistic efficacy of enalapril and losartan on exercise performance and oxygen consumption at peak exercise in congestive heart failure.

Oxygen consumption at peak exercise (peak VO2) is a strong independent predictor of the outcome in congestive heart failure (CHF). Renin-angiotensin system inhibition with either ACE or AT1 receptor blockers is effective on peak VO2. We evaluated whether mechanisms are similar for the 2 categories of drugs and whether their combination is able to produce a synergistic effect. Twenty CHF patients were randomized to receive, in a double-blind fashion, placebo + placebo (P+P), enalapril (20 mg/day) + placebo (E+P), losartan (50 mg/day) + placebo (L+P), and enalapril + losartan (E+L) or the same preparations in a reverse order, each for 8 weeks. Two patients did not complete the trial. Pulmonary function, cardiopulmonary exercise test, plasma neurohormones, and quality of life were assessed at the end of each treatment. Compared with P+P, E+P, and L+P similarly (16% and 15%, respectively) and significantly (p <0.01) augmented peak VO2. Enalapril improved lung function (reduced slope of ventilation vs carbon dioxide production and dead space to tidal volume ratio, and increased alveolar membrane conductance and tidal volume). Losartan likely activated the exercising muscle perfusion (raised delta VO2/delta work rate, which is a measure of aerobic work efficiency). In combination, they further increased peak VO2, 10% from E+P (p <0.05) and 11% from L+P (p <0.05). Compared with run-in, E+P and L+P significantly reduced plasma norepinephrine by 70 +/- 14 pg/ml and 100 +/- 16 pg/ml and aldosterone by 1.6 +/- 0.7 ng/dl and 1.6 +/- 0.8 ng/dl. These changes were significantly greater when the drugs were combined (140 +/- 20 pg/ml for norepinephrine, and 5.6 +/- 0.9 ng/dl for aldosterone). Quality-of-life score did not improve significantly at each treatment step. Thus, lorsartan and enalapril similarly increased peak VO2 in CHF patients, but mediators of this effect were, at least in part, different therapeutic targets that may be synergistic when the 2 drugs are combined.

Adult↗

PubMed2002

A comparison of community-based resistance exercise and flexibility exercise for seniors.

Progressive resistance training has positive effects on the health of elderly people, however exercise programs for seniors frequently focus on other forms of exercise. This study is a randomised trial with a blinded assessor comparing a community based progressive resistance training program (n = 20) with a flexibility program (n = 20), both one hour twice weekly for 10 weeks. Outcomes were strength, gait, balance and quality of life. Progressive resistance training had a greater effect than flexibility training on right sided quadriceps strength (mean difference between groups = 7.7%; 95% CI 3.6-11.8%, p < 0.003 MANOVA), left sided quadriceps strength (mean difference = 9.9%; 95% CI 5.6-14.2%, p < 0.003 MANOVA), left sided biceps strength (mean difference = 15.2%; 95% CI 11.7-19.2%, p < 0.003 MANOVA), functional reach (mean difference = 11.7%; 95% CI 7.1-16.3%, p < 0.003 MANOVA) and step test (mean difference = 8.6%; 95% CI 3.8-13.4%, p < 0.003 MANOVA). Neither group had improvements in SF36 quality of life measures. Results suggest progressive resistance training produces greater strength, gait and balance improvements in elderly people than a flexibility exercise program.

Age Factors↗

PubMedDate not supplied

Shoulder-strengthening exercise with an orthosis for multidirectional shoulder instability: quantitative evaluation of rotational shoulder strength before and after the exercise program.

We evaluated the results of shoulder-strengthening exercises with our novel shoulder orthosis to stabilize the scapula in 46 patients with multidirectional shoulder instability. We quantified the changes in muscle strength produced by our rehabilitation program. Our study included 34 female patients and 12 male patients (mean age, 20 years) with 73 affected shoulders. All patients performed the prescribed exercise program for 8 weeks. Their mean total scores on the modified Rowe grading system significantly increased from 51.9 to 74.9 points (P <.001). The mean peak torque of internal and external rotation, measured with an isokinetic dynamometer, significantly increased (P <.05); the mean external/internal peak torque ratios significantly decreased (P <.05) and were normalized upon completion of the rehabilitation program. Because of failure of conservative treatment, 3 patients underwent surgery at a mean follow-up duration of 7 years. We conclude that the prescribed shoulder-strengthening exercise represents a useful treatment option for patients with multidirectional shoulder instability.

Adolescent↗

PubMed1976

[Accuracy of exercise tests in the recognition of coronary-artery stenosis. Comparison between post-exercise ECG and coronary arteriogram (author's transl)].

Post-exercise ECGs and coronary arteriograms were compared in 180 unselected patients. Coronary-artery stenosis had been diagnosed correctly by arteriography in 94% of cases. In 60% this was also possible from the resting ECG (signs of myocardial infarction), while in the remaining 34% only the exercise ECG was positive. Post-exercise ECG changes are thus an important and largely specific means of diagnosing coronary-artery stenosis.

Adult↗

PubMed1996

The physiologic response of exercising in the water and on land with and without the X1000 Walk'N Tone Exercise Belt.

Study of the physiological effects of exercise that decreases lower joint impact is needed. Participants (N = 18) were exposed to either land or water exercise that included or did not include wearing a belt. Physiological variables of caloric expenditure, net oxygen cost, net oxygen pulse, and heart rate were assessed. A 2 x 2 (Environment x Belt) analysis of variance (ANOVA) revealed a significant environment main effect for net oxygen cost and caloric expenditure. Water actually decreased the energy cost of the exercise. A 2 x 2 x 4 (Environment x Belt x Time) ANOVA revealed a significant environment main effect for net oxygen cost and caloric expenditure. Specifically, land heart rates increased over time, whereas water heart rates did not.

Adult↗

PubMed1977

A study of exercise performance and heart rate: the response to exercise of a small group of manual workers before and after retirement.

Measurements of walking pattern, exercise performance, heart rate response to exercise and body composition have been made in 13 male manual workers at retirement and again one and two years later. The exercise consisted of walking, in accordance with standard instructions; heart rate and footfall signals were recorded on magnetic tape during the test using body-borne tape recorders. After the first year highly significant reductions in walking speed were found but no significant changes in walking pattern, heart rate response or body composition. When the measurements made at the end of one year of retirement were compared with those made at the end of two years no significant changes were found.

Aged↗

PubMed2001

Dipyridamole-atropine stress echocardiography versus exercise SPECT scintigraphy for detection of coronary artery disease in hypertensives with positive exercise test.

OBJECTIVES: Many different stress echocardiographic and radionuclide perfusion imaging tests have been proposed for detecting epicardial coronary artery disease (CAD) in hypertensive patients. Their relative diagnostic and prognostic value has not been exactly established. BACKGROUND: A positive exercise electrocardiography test has a low diagnostic specificity in hypertensive patients and warrants for a complementary imaging test to confirm the diagnosis of coronary artery disease. METHODS: Hypertensive patients (n = 53), (29 males, aged 58 +/- 10 years) with normal left ventricular function detected by echocardiography and previous positive exercise test ( > or = 0.15 mV of ST segment depression on 12 lead electrocardiogram) underwent dipyridamole-atropine stress echocardiography (DASE) and thallium-201 stress/ rest myocardial single-photon emission computed tomography (SPECT). All patients had coronary angiography within 15 days and independently of imaging test results. RESULTS: Coronary angiogram showed significant ( > or = 50% qualitatively assessed diameter reduction) epicardial coronary artery disease in 23 (43%) patients. Sensitivity for detection of coronary artery disease was significantly higher for scintigraphy (DASE = 78% versus SPECT = 100%, P < 0.05) while specificity was higher for echo (DASE = 100% versus SPECT = 47%, P < 0.00001). Diagnostic accuracy was also higher for echo (DASE = 91% versus SPECT = 70%, P < 0.01). CONCLUSION: In patients with exercise-nduced ST segment depression, dipyridamole stress echo and SPECT perfusion scintigraphy are both good diagnostic options, with DASE characterized by higher specificity, lower sensitivity, and at least comparable diagnostic accuracy than SPECT.

Adult↗