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PubMed2003

PoleStriding exercise and vitamin E for management of peripheral vascular disease.

PURPOSE: The purpose of this investigation was to evaluate the efficacy of PoleStriding exercise (a form of walking that uses muscles of the upper and lower body in a continuous movement similar to cross-country skiing) and vitamin E (alpha-tocopherol) to improve walking ability and perceived quality of life (QOL) of patients with claudication pain secondary to peripheral arterial disease (PAD). METHODS: Fifty-two subjects were randomized into four groups: PoleStriding with vitamin E (N = 13), PoleStriding with placebo (N= 14), vitamin E without exercise (N= 13), and placebo without exercise (N = 12). The dose of vitamin E was 400 IU daily. Only the PoleStriding with vitamin E and PoleStriding with placebo groups received PoleStriding instruction and training. Assignment to vitamin E or placebo was double blind. Subjects trained three times weekly for 30-45 min (rest time excluded). Individuals in vitamin E and placebo groups came to the laboratory biweekly for ankle blood-pressure measurements. RESULTS: Results of this randomized clinical trial provide strong evidence that PoleStriding significantly (P< 0.001) improved exercise tolerance on the constant work-rate and incremental treadmill tests. Ratings of perceived claudication pain were significantly less after the PoleStriding training program (P= 0.02). In contrast, vitamin E did not have a statistically significant effect on the subjects' ratings of perceived leg pain (P= 0.35) or treadmill walking duration ( P= 0.36). Perceived distance and walking speed (Walking Impairment Questionnaire) and perceived physical function (Rand Short Form-36) improved in the PoleStriding trained group only (P< 0.001, 0.022 and 0.003, respectively). CONCLUSION: PoleStriding effectively improved the exercise tolerance and perceived QOL of patients with PAD. Little additional benefit to exercise capacity was realized from vitamin E supplementation.

Activities of Daily Living↗

PubMed1991

Exercise capability in heart failure: is cardiac output important after all?

The exercise capability of 39 patients with severe chronic heart failure was assessed in several ways and compared with measurements of cardiac output. The relation between cardiac index and exercise tolerance measured on a treadmill was poor (r = 0.191, p = 0.245). However, exercise tolerance measured with a series of self-paced corridor walk tests showed moderate correlations with cardiac index (r = -0.404, p = 0.015 to r = -0.516, p = 0.001) and customary activity assessed by step counting correlated better with cardiac index (r = 0.537, p less than 0.001). Cardiac output therefore seems to be a factor determining patients' exercise capability when they choose their own walking speed but not when they undergo formal treadmill tests in the laboratory.

Aged↗

PubMed1989

[Work capacity of patients with neurasthenia].

Clinical and experimental examination of 127 patients suffering from neurasthenia, performed during three stages of the disease development (hyperasthenic, irritative weakness, hypoasthenic++), enabled one to identify an appreciable decrease of a number of the parameters of tolerance to isometric exercise. Thus, force decreased 1.3--2-fold, endurance 2.4--3.4-fold, and work fitness 3.8--6.8-fold as compared to normal persons. Isometric exercise tolerance that increases progressively by the hyposthenic disease stage can be instrumental as an objective diagnostic criterion for evaluation of work fitness during carrying out the rehabilitation measures in neurasthenic patients.

Adult↗

PubMed1999

A neural link to explain the "muscle hypothesis" of exercise intolerance in chronic heart failure.

BACKGROUND: In chronic heart failure the cause of exercise limitation is still unclear: ergoreceptors, muscle afferents sensitive to exercise metabolites, are proposed as a neural link between muscular abnormalities and the limited exercise responses in this syndrome. METHODS: In 92 stable patients with heart failure (34 in New York Heart Association class I, 27 in class II, and 31 in class III) and 28 age-matched normal controls, we assessed exercise tolerance (maximal upright bicycle) and ergoreflex activity (2 dynamic hand grips: one control and one followed by 3 minutes of local circulatory occlusion to isolate the ergoreflex component by metabolite trapping). RESULTS: Patients, with respect to the controls, showed reduced exercise tolerance (peak VO2: 20 vs 33 mL/kg/min), increased ergoreflex effects on ventilation (9 vs 4 L/min), systolic pressure (37 vs 13 mm Hg), and leg vascular resistance (45 vs 22 units) (all P <.005); with the progression of the symptoms, a progressive increase in ergoreflex contribution to the ventilatory response to exercise was observed. The indexes of exercise limitation during arm and leg exercise (ie, peak VO 2, V/VCO2 slope) correlated highly with the ergoreflex contribution to ventilatory response during handgrip test ( r </= 0.7, P <.0001) but weakly with left ventricular ejection fraction (r </= 0.5). CONCLUSION: In chronic heart failure, the overactivity of the ergoreflex is related to a degree of functional limitation and appears, through direct ventilatory and cardiovascular responses, to contribute to the abnormal responses to exercise, explaining the "muscle hypothesis."

Aged↗

PubMedDate not supplied

Investigations of exercise adaptation of the cardiovascular system in pilots breathing an oxygen-poor gas mixture. Part I. Analysis of haemodynamic parameters.

The author studied exercise adaptation of the cardiovascular system in pilots breathing a gas mixture containing 12% of oxygen in nitrogen. During hypoxia the following findings were obtained: earlier achieving of the assumed peak value of heart rate, lower value of diastolic arterial blood pressure and peripheral vascular resistance. Hypoxia modified the exercise tolerance decreasing the maximal power and sum of the performed work. Differences in the adaptation response of the cardiovascular system depended on the fitness level of the pilots. Those with a high fitness level performed greater work at stable heart rates and had higher exercise tolerance during hypoxia. The exercise test in hypoxia related to the haemodynamic parameters increases significantly the scope of information about the efficiency of the cardiovascular system.

Adaptation, Physiological↗

PubMedDate not supplied

Effects of exercise training on aerobic capacity and quality of life in individuals with heart failure.

PURPOSE: The purpose of this study was to determine whether subjects with chronic heart failure, who completed a 12-week rehabilitation program, would have significantly greater quality of life, better aerobic fitness, less difficulty with symptoms of heart failure, greater self-efficacy for exercise, and higher daily activity levels when compared with subjects in a control group. METHODS: Thirty-one males, aged 64 +/- 10 years with left ventricular ejection fraction of 29 +/- 7%, were randomized to a moderate intensity supervised aerobic exercise program (n = 15) or a control group (n = 16). Twenty-seven subjects completed at least 1 follow-up assessment. RESULTS: After 12 weeks there were significant differences in the change scores for perceived physical function (using RAND Corporation's 36-item short form) (P =.025) and peak oxygen uptake (P =.019) between the exercise and control groups with the exercise group experiencing improved physical function and fitness. CONCLUSIONS: Exercise training in adults with heart failure increases exercise tolerance and perceived physical function. Improved heart failure symptoms, self-efficacy for exercise, or increased physical activity may not be associated with enhancement of exercise tolerance.

Aged↗

PubMed1999

Physical and psychological improvements after phase II cardiac rehabilitation in patients with myocardial infarction.

We have designed a new 4-week hospitalized phase II cardiac rehabilitation program. The purpose of the present study is to clarify whether the physical and psychological status of patients with myocardial infarction (MI) improves after participation in our program. Twenty-nine patients (27 males, two females) with acute MI who enrolled in the 4-week hospitalized phase II rehabilitation program were assessed. All patients enrolled in this study had received coronary interventions. The rehabilitation consisted of exercise training, education and counseling. We evaluated the physical and psychological status of the patients before and just after the program, and at a 6-month follow up. The physical status was assessed by exercise tolerance measured by the peak oxygen consumption and anaerobic threshold, frequency of exercise, and serum concentrations of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, and low-density lipoprotein-cholesterol. The psychological status was assessed by the Spielberger state-trait anxiety inventory questionnaire (STAI) and the self-rating questionnaire for depression (SRQ-D). Thirty-four patients (27 men, seven women) with MI who did not participate in our rehabilitation program served as a control group. After participation in our rehabilitation program, exercise tolerance and the serum lipid profiles of the patients were improved compared with those before rehabilitation. These parameters had improved significantly 6 months after rehabilitation. The STAI anxiety score was improved significantly and the SRQ-D depression score tended to be improved just after the rehabilitation program. Regular physical activity was continued even 6 months after the completion of the program. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the psychological status in patients with MI. This comprehensive program may contribute to the secondary prevention of MI as well as the recovery of physical and psychological activities.

Adult↗

PubMed1996

Medium-term effects of beta-blockade on left ventricular mechanics: a double-blind, placebo-controlled comparison of nebivolol and atenolol in patients with ischemic left ventricular dysfunction.

The aim of this study was to compare the effects on left ventricular function and exercise tolerance of a selective beta-antagonist (atenolol) with those of another selective beta 1-antagonist with vasodilator properties (nebivolol) in patients with ischemic left ventricular dysfunction but no overt congestive heart failure. Beta blockers are widely used in ischemic heart disease, but their effects on left ventricular mechanics and exercise tolerance are poorly defined in the subgroup of patients with significant systolic dysfunction but without clinical evidence of ischemia or congestive heart failure. Angiographic and symptom-limited exercise data were obtained at baseline and after an 8-10-week double-blind treatment with placebo (n = 10), 50 mg atenolol daily (n = 10), or 2.5 mg (n = 10) or 5 mg (n = 10) nebivolol daily. When compared to placebo, both atenolol and nebivolol reduced resting heart rate and improved left ventricular ejection fraction (from 33.9 to 39.2% with atenolol and from 36.5 to 40.8% with nebivolol, both P < .05) while lowering mean systolic wall stress. Only nebivolol, however, produced a parallel downward shift of the pressure-volume relationship during early diastolic filling and improved the early peak filling rate when compared to placebo (+ 10%, P < .05). When compared to baseline, maximal exercise duration increased by 7 and 13 seconds with placebo and atenolol, respectively (both NS vs baseline), and increased by 44 seconds with nebivolol (P = .0077 vs baseline). Both atenolol and nebivolol decreased maximal exercise heart rate; the reduction was more pronounced with atenolol. Prolonged beta 1-adrenoceptor blockade leads to a significant increase in left ventricular ejection fraction in patients with ischemic left ventricular dysfunction. The dissociation between the changes in resting left ventricular function and the changes in exercise duration suggests that in this clinical setting, the changes in systolic function may have less impact on functional capacity than an improvement in diastolic distensibility during the rapid filling phase.

Adrenergic beta-Antagonists↗

PubMed1999

Efficacy of air and liquid cooling during light and heavy exercise while wearing NBC clothing.

BACKGROUND: Studies, to date, have not revealed the extent to which the heat strain of continuous heavy exercise while wearing NBC protective clothing can be reduced by providing liquid- or air-cooling and whether one system is more effective than the other in aiding heat transfer from the body and the clothing. It was of interest to know to what extent present-day cooling technologies can reduce the heat strain of light and heavy exercise in NBC clothing and to compare these reductions to other strategies that have employed changes in clothing design. HYPOTHESIS: It was hypothesized that there would be no difference between the liquid and air cooling systems and that sufficient cooling power would be delivered to the body to reduce the heat strain of heavy exercise to a level similar to that experienced with light exercise when no cooling was provided. METHODS: Eight males performed 6 randomized exposures for a maximum of 3 h at 40 degrees C and 30% relative humidity that involved either light (L) (walking at 3.5 km x h(-1) or heavy (H) (walking at 4.8 km x h(-1) and a 5% grade) exercise while wearing the NBC protective clothing ensemble with no cooling (N), liquid (L) or air (A) cooling. RESULTS: For L exercise, tolerance time was significantly increased from 100 min with N to the maximum of 3 h with either cooling system. There was no difference between L and A cooling in the extent of the changes in rectal temperature, heart rate and heat flow. For H exercise, tolerance time was significantly increased 150% from 57 min with N to 149 min with L and 140 min with A. These latter values for HL and HA were not different from each other but both were significantly greater than L exercise with N. Rectal temperature increased more quickly during HL compared with HA during the first 60 min of exposure but there were no differences between cooling trials for the remainder of the heat exposure. CONCLUSIONS: It was concluded that sufficient cooling power could be delivered to the body to effectively reduce the heat strain of wearing NBC protective clothing during heavy exercise in a hot environment to a level comparable to or slightly lower than that experienced with light exercise and no cooling.

Air↗

PubMed2000

Home-based rehabilitation for patients with COPD: organization, effects and financial implications.

Rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to be an effective treatment and can be carried out in different settings, i.e. inpatient, outpatient or home-based. This review focuses on home-based rehabilitation and four important issues are discussed. 1) Which patients should received home-based rehabilitation? 2) How should home-based rehabilitation be organized? 3) What are the effects of home-based rehabilitation? 4) What are the financial implications. Home-based rehabilitation is an attractive approach for most patients with COPD. However, there is some evidence that patients who are severely disabled due to dyspnoea do not gain benefit from home-based rehabilitation. This might not be the appropriate setting for this group, and these patients are probably better candidates for an inpatient or outpatient multidisciplinary approach. After initial evaluation of the patient by a pulmonary physician, home-based rehabilitation can be set up in two different ways. Firstly, the patients can receive their instructions at the hospital: a detailed exercise programme can be developed that the patients can perform unsupervised at home with regular follow-up at the outpatient clinic. Second, home rehabilitation can be fully addressed at home with instruction and regular supervision by a local team. At this moment, it is not clear which disciplines, i.e. what kinds of intervention, are needed in a home rehabilitation team. Nevertheless, the key element of home-based rehabilitation is exercise training, which is the same for the other settings. Short-term studies with a maximum duration of 12 weeks showed increased exercise tolerance, decreased dyspnoea and improved quality of life. Conversely, the effects of long-term home-based rehabilitation are not clearly established. The need for long-term supervision is still open to debate: contradictory results have been shown regarding dyspnoea and exercise tolerance. Cost/benefit analysis showed positive trends in reduction in hospitalization rate and reduction of total costs; however, these results came from uncontrolled studies.

Cost-Benefit Analysis↗

PubMed1981

Long-term maintenance therapy with prazosin in congestive heart failure.

We evaluated the effects of long-term maintenance therapy with oral prazosin (6-20 mg, mean 14 +/- 2 mg/d) in 14 patients with congestive heart failure. The patients were followed for 6 +/- 1 months. Eleven of the fourteen patients reported subjective improvement. Two patients required increased diuretics because of gain in body weight. Systolic blood pressure showed a slight but sustained decrease suggesting persistent vasodilator effect. Reductions in echocardiographic left ventricular end-diastolic (6.35 +/- 0.25-5.88 +/- 0.25 cm, p less than 0.05) and end-systolic (5.16 +/- 0.35-4.73 +/- 0.28 cm, p less than 0.05) diameters were observed at 2 months. However, the cardiothoracic ratio on chest x ray was unaltered. Maximum exercise tolerance time increased in eight patients (57%) during prazosin therapy. Improvement in exercise tolerance time was observed in patients with most marked clinical improvement, suggesting presence of cardiac reserve. Two patients died suddenly after reporting subjective improvement. This study shows sustained clinical improvement in most patients with heart failure treated with oral prazosin.

Adult↗

PubMed1983

Long-term tiapamil treatment of patients with angina pectoris.

The effects of a 12-week oral treatment with tiapamil (200 mg t.i.d.) were compared to those of placebo treatment in a group of 20 men with coronary heart disease. There was a slight reduction of anginal symptoms (p less than 0.05) and a tendency to less nitroglycerin consumption (p less than 0.07). There were no statistically significant differences between the treatments in blood pressure, exercise tolerance during repeated exercise tests, ECG conduction intervals, or routine laboratory tests. No adverse side-effects were encountered. It seems that tiapamil may be beneficial in preventing angina pectoris, but a higher oral dose must be used.

Aged↗

PubMed1992

The effects of captopril on training in patients with ischemic heart disease.

We studied a group of 30 patients to determine the effect of captopril on the exercise training response after a period of training in patients with ischemic heart disease but without cardiac failure. The study was a double-blind placebo-controlled comparison of captopril and placebo. The patients studied were 28 men and 2 women, mean age 53.6 +/- 6.9 years. All were 8 to 12 weeks postmyocardial infarction or coronary artery bypass surgery. These patients underwent an organized exercise training program consisting of exercise training sessions 3 times weekly for a period of 8 weeks. On commencement and completion of the program patients were assessed for exercise tolerance using submaximal exercise stress testing. Patients were assessed in the untreated state. Both groups showed a statistically significant training effect with increased exercise duration, decreased heart rate for equal workload, increased energy expenditure, and reduced functional aerobic impairment. There was no statistically significant change in systolic blood pressure, but the captopril group alone showed a significant reduction in diastolic blood pressure (p less than 0.001). The change in heart rate at rest over the 8-week period was not significant in both groups. In summary, this study shows that treatment with captopril does not affect the exercise training response in patients with ischemic heart disease undergoing an organized exercise training program.

Blood Pressure↗

PubMedDate not supplied

Assessing prognosis after acute myocardial infarction in the thrombolytic era.

The use of physiologic testing for prognostication continues to be useful and widely applied in the predischarge evaluation of patients recovering from an uncomplicated acute myocardial infarction in the thrombolytic era. Because patients with abnormal exercise test results are now routinely sent for angiography, there are no randomized trials or experimental confirmation that exercise parameters are still associated with the same prognostic value in the thrombolytic era. Nevertheless, the excellent outcomes in patients treated with thrombolytic therapy and risk stratified with exercise testing provide strong empiric support for the continued use of noninvasive testing of patients without complications after thrombolytic therapy. Reviews of patient cohorts enrolled in trials of thrombolytic therapy show that these patients have a lower incidence of multivessel disease and less evidence of ischemia (ST segment depression or thallium 201 redistribution) compared with prethrombolytic cohorts. For this and other reasons, the sensitivity and specificity of exercise variables for prognosis or detection of multivessel disease are not as strong. The addition of perfusion imaging will enhance the sensitivity for detection of ischemia within or remote from the infarct zone and will provide information regarding viability. Patients who are unable to exercise or those with poor exercise tolerance, an abnormal exercise blood pressure response, inducible ischemia, or nonsustained ventricular tachycardia are candidates for further invasive evaluation and consideration for coronary revascularization. With 201Tl imaging, evidence for increased pulmonary uptake of the tracer is indicative of high risk and a high probability of an adverse outcome with medical therapy. Low-risk patients are those who achieve their target heart rate or work load without inducible angina, ST segment depression, reversible perfusion abnormalities, or increased lung 201Tl uptake. Defect size is reflective of infarct size, and patients with extensive areas of nonreversible hypoperfusion are also at high risk for future events even in the absence of ischemia. Finally, pharmacologic stress imaging with dipyridamole, adenosine, or dobutamine has been found to be safe when employed for stress testing soon after uncomplicated infarction.

Coronary Disease↗

PubMed2000

Diastolic Heart Failure.

The diagnosis of diastolic heart failure (DHF) can be made when a patient has both symptoms and signs on physical exam of congestive heart failure (CHF), and normal left ventricular volume and ejection fraction. Documentation of abnormal diastolic function is confirmatory but not mandatory. Diastolic heart failure is a frequent cause of CHF (prevalence is 35% to 50%) and has a significant effect on mortality (5-year mortality rate is 25% to 35%) and morbidity (1-year readmission rate is 50%). Treatment should be targeted at symptoms, causal clinical disease, and underlying basic mechanisms. Symptom-targeted therapy: decrease pulmonary venous pressure using diuretics and long-acting nitrates, maintain atrial contraction and atrial ventricular synchrony, reduce heart rate using beta-adrenergic blockers and calcium channel blockers; increase exercise tolerance by reducing exercise- induced increases in blood pressure and heart rate using angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers. Disease-targeted therapy: prevent or treat myocardial ischemia, prevent or regress left ventricular hypertrophy. Mechanism-targeted therapy (future directions): modify neurohumoral activation using renin, angiotensin, and aldosterone system antagonists (ACE inhibitors, angiotensin II receptor blockade, aldosterone and renin antagonist); endothelin antagonists; nitric oxide agonists; and atrial natruretic peptide agonists; alter intracellular mechanisms; alter extracellular matrix structures.

Journal Article↗

PubMed1995

Post-hepatitis syndrome revisited.

To examine the role of acute hepatitis A and B infection in the aetiology of chronic fatigue syndrome and psychiatric morbidity we studied 40 patients with acute viral hepatitis A or B consecutively admitted to an infectious diseases unit and studied at least 6 months after recovery. Liver function tests (LFT) had returned to normal in each case. Forty-seven patients with other infectious diseases, of which 12 were presumed viral, admitted immediately after each hepatitis patient during the same period acted as controls. The main outcome measures were scores on a fatigue and muscle pain questionnaire, general health questionnaire (GHQ-12) and supplementary questions. The hepatitis cases scored significantly higher fatigue scores, GHQ-12 scores and muscle pain scores. Length of time since recovery from illness, age and sex were not confounding factors. Hepatitis cases were also less energetic, had greater weight change, had altered alcohol tolerance, had less exercise tolerance and felt less fit than the control group and compared with their premorbid state. Hence fatigue is more common after recovery in patients hospitalized for hepatitis A and B up to 30 months post-infection compared with matched controls hospitalized for other infectious diseases. Hepatitis A and B infection is a risk factor for post-infection fatigue, intermittent fatigue, as well as for psychiatric morbidity.

Adolescent↗

PubMed1976

Antilipolytic therapy in angina pectoris. Reduction of exercise-induced ST segment depression.

A double-blind cross-over study was performed on 12 men sith stable angina pectoris in order to determine the effect of antilipolytic treatment on exercise tolerance and exercise-induced electrocardiographic changes. The men were exercised to the onset of anginal pain using a reproducible and standardized ergometric load. A nicotinic acid analogue was used to reduce plasma free fatty acids and free glycerol before and during exercise testing and to eliminate their post-exercise rise. This was associated with significant reduction of exercise-induced ST segment depression (p less than 0-005), though there was no significant difference in the duration of exercise before the oneset of pain. A change in the prportions of lipid and carbohydrate for oxidation by the ischaemic myocardium, making relatively more glucose available, is a likely explanation.

Aged↗

PubMed2003

Cardiovascular function in acromegaly.

Even with modern treatment, acromegaly is associated with a 2- to 3-fold increase in mortality, mainly from vascular disease, which is probably a result of the long exposure of tissues to excess GH before diagnosis and treatment. There is accumulating evidence that effective treatment to lower serum GH levels to less than 1-2 ng/ml (glucose suppressed or random, respectively) and normalize IGF-I improves long-term outcome and survival. In addition to recognized cardiovascular risk factors of hypertension, type 2 diabetes mellitus, and dyslipidemia, there is accumulating evidence of specific structural and functional changes in the heart in acromegaly. Along with endothelial dysfunction, these changes may contribute to the increased mortality in this disease. There are specific structural changes in the myocardium with increased myocyte size and interstitial fibrosis of both ventricles. Left ventricular hypertrophy is common even in young patients with short duration of disease. Some of these structural changes can be reversed by effective treatment. Functionally, the main consequence of these changes is impaired left ventricular diastolic function, particularly when exercising, such that exercise tolerance is reduced. Diastolic function improves with treatment, but the effect on exercise tolerance is more variable, and more longitudinal data are required to assess the benefits. What scant data there are on rhythm changes suggest an increase in complex ventricular arrhythmias, possibly as a result of the disordered left ventricular architecture. The functional consequences of these changes are unclear, but they may provide a useful early marker for the ventricular remodeling that occurs in the acromegalic heart. Endothelial dysfunction, especially flow-mediated dilatation, is an early marker of atherosclerosis, and limited data imply that this is impaired in active acromegaly and can be improved with treatment. Similarly, early arterial structural changes, such as thickened intima media layer, appear more common in acromegalics, and there are hints that this may diminish with effective treatment, although more studies are required for a definite conclusion on this topic. In conclusion, impaired cardiac and endothelial structure and function in acromegaly are risk factors for vascular mortality and should be regarded as legitimate therapeutic targets in the overall management of this condition.

Acromegaly↗