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Results for “Exercise Tolerance”

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At least 1,531 records · Page 85Linked to original sources

PubMed1992

Validation of subjective measures of fatigue after elective operations.

OBJECTIVE: To find out if it was possible to evaluate postoperative fatigue by questionnaire. DESIGN: Open study. SETTING: University hospital. SUBJECTS: 23 patients about to undergo elective general surgical operations. INTERVENTIONS: A questionnaire was filled in before, and 2-46 days after, operation. MAIN OUTCOME MEASURES: Six measures of fatigue were derived from the questionnaire and validated objectively with changes in body weight, exercise tolerance (n = 10), or grip strength (n = 21). RESULTS: The six measures all showed a significant increase after operation. The changes in fatigue correlated well, but there were differences in sensitivity to changes in perceived weakness compared with perceived tiredness. Each measure correlated significantly with either body weight, exercise tolerance or grip strength. CONCLUSION: Questionnaires can provide reliable results in the assessment of postoperative fatigue.

Adult↗

PubMed1988

Xamoterol in patients with dilated cardiomyopathy: an increase in beta-receptors in lymphocytes.

Xamoterol, a partial-beta 1 agonist, was administered orally (100 mg, twice daily) to healthy volunteers (n = 8) and to patients with heart failure (n = 8) for one week. The density (Bmax) and affinity (Kd) of lymphocyte beta-receptors were lower in the patients with heart failure than in the healthy volunteers (Bmax = 931 +/- 214 vs 1466 +/- 373 sites/cell, and Kd = 0.60 +/- 0.11 vs 1.07 +/- 0.14 nM). During treatment with xamoterol, Bmax (7169 +/- 3768 and 7749 +/- 3807 sites/cell) and Kd (6.01 +/- 3.84 and 9.06 +/- 4.66 nM) increased strikingly (p less than 0.01) in both groups. For 12 months, xamoterol (100 mg bd) was given in the same manner to 10 patients with dilated cardiomyopathy. The long-term effects after three and 12 months were assessed. Xamoterol reduced the cardiothoracic ratio from 57 +/- 6% to 55 +/- 5% after three months and 54 +/- 5% after 12 months of treatment (both p less than 0.05), and increased exercise tolerance from 5 +/- 2 min to 7 +/- 2 min and to 7 +/- 2 min (p less than 0.01, p less than 0.05). Echocardiographic fractional shortening increased from 13 +/- 6% to 20 +/- 8% (p less than 0.01) and to 20 +/- 10% (p less than 0.05). Pulmonary wedge pressure during exercise at the same work load decreased from 40 +/- 12 mmHg to 25 +/- 9 mmHg (p less than 0.01) in three months; whereas pulmonary wedge pressures during exercise or at rest in 12 months were unchanged. Exercise heart rate decreased from 118 +/- 9 beats/min to 106 +/- 6 beats/min in three months (p less than 0.01), but was unchanged in 12 months. Bmax and Kd of the beta-receptors increased from 1024 +/- 413 sites/cell and 0.67 +/- 0.27 nM to 1976 +/- 497 sites/cell and 1.60 +/- 0.42 nM (both p less than 0.01), respectively, in three months, and 1584 +/- 650 sites/cell (NS) and 1.21 +/- 0.54 nM (p less than 0.05), respectively, in 12 months. It is concluded that xamoterol improves exercise tolerance, hemodynamics and resolves subjective symptoms for certain patients with dilated cardiomyopathy by its actions as a beta-agonist and beta-antagonist during longterm treatment.

Adaptation, Physiological↗

PubMed1983

Reversibility of the analgesic effect of meptazinol in volunteers.

A double-blind randomized placebo-controlled study was carried out in 8 healthy volunteers to determine whether the analgesic and other actions of meptazinol could be reversed by naloxone or hyoscine. Heart rate, blood pressure, respiratory rate, pupil diameter, forearm ischaemic exercise tolerance and dental pain threshold were measured before and up to 45 minutes after intramuscular meptazinol 100 mg or placebo, when 'reversal' was attempted with intravenous naloxone 2 mg, hyoscine 1.6 mg or placebo. Meptazinol caused mild pupillary constriction which is unlikely to be clinically significant. Forearm ischaemic exercise tolerance failed to show any analgesic effect of meptazinol. Measurement of dental pain threshold strongly suggested reversal of meptazinol analgesia by naloxone but not by hyoscine, but inter-subject variation in analgesic response was great and these results require confirmation in a group pre-selected for consistent response.

Adult↗

PubMed1998

Adding the new calcium antagonist mibefradil to patients receiving long-term beta-blocker therapy results in improved antianginal and antiischemic efficacy.

OBJECTIVE: The objective of this study was to evaluate the efficacy, tolerability, and safety of mibefradil, a new selective T-type calcium channel blocker, in patients with chronic stable angina pectoris receiving concomitant beta-blocker therapy. DESIGN: This was a multicenter, double-blind, placebo-controlled study. METHODS: Ninety-five patients receiving a stable dose of beta-blockers, which was not changed for the purpose of the study, were administered either 50 mg mibefradil once daily for 2 weeks, then 100 mg once daily for 2 weeks, or matching placebo. Efficacy was evaluated by treadmill exercise tolerance testing 24 hours after dose and by diary registration of anginal episodes and nitroglycerin consumption. RESULTS: Two weeks of treatment with 50 mg mibefradil resulted in a significant increase in symptom-limited exercise duration and a significant delay in the onset of persistent 1 mm ST-segment depression (placebo-corrected treatment effect: 23.2 and 51.7 seconds, respectively). Treatment with the 100 mg dose for 2 additional weeks resulted in a larger improvement in treadmill exercise tolerance testing duration and onset of ischemia (placebo-corrected treatment effect: 52.7 and 75.8 seconds, respectively). In addition, a significant decrease in weekly anginal episodes was observed with the 100 mg dose of mibefradil compared with the effect in the placebo group (-53% vs - 12%, p = 0.037). CONCLUSIONS: The combined treatment of mibefradil and beta-blockers was well tolerated, and the overall incidence of adverse events was no different from that with beta-blockers alone. The results indicate that adding mibefradil to chronic beta-blocker treatment is associated with significant improvement in efficacy, which is not achieved at the expense of tolerability.

Adrenergic beta-Antagonists↗

PubMed1978

Cardiovascular impairment and physical working capacity in children with chronic renal failure.

Forty children with chronic renal failure (CRF) on conservative treatment, on hemodialysis, or after renal transplantation and 22 children respresenting a non-uremic control group were subjected to repeated cardiologic examinations by ECG, PCG, chest X-rays and cycle ergometer exercise tests to monitor signs of uremic heart disease and to evaluate physical working capacity (W170). In the CRF group a progressive impairment of W170 was found, starting at an early stage of the disease. Exercise tolerance was inversely related to the degree of CRF. A correlation was also found between W170 and renal anemia. After starting dialysis, W170 failed to increase significantly. Immediately after dialysis an acute drop in W170 occurred. Renal anemia was found to be the main pathogenetic factor of uremic heart disease in children. In some cases hypercirculation following arteriovenous fistulae became equally important as a cause of reduced myocardial performance. Physical rehabilitation, as measured by exercise tolerance tests, was better in transplanted than in dialysed children.

Adolescent↗

PubMed1981

[Comparative pharmacodynamics study of korinfar and isoptin in ischemic heart disease].

The effect of Korinfar (30 and 50 mg) and isoptin (120 and 200 mg) on exercise tolerance was studied in 11 patients with angina pectoris of effort using the double blind crossover method. Both doses of Korinfar and 120 mg of isoptin increased cardiac output by 70--80% and 200 mg of isoptin--by 136%. Korinfar had a pronounced growth hypotensive effect and induced tachycardia, which is an increased dose hindered growth of exercise tolerance. The negative chronotropic effect of isoptin increased its efficacy. As a result of calcium antagonists action a stable threshold double product was established, and its was higher, than the control one.

Adult↗

PubMed1981

Slow release oxprenolol in angina pectoris: study comparing oxprenolol, once daily, with propranolol, four times daily.

Oxprenolol and propranolol are noncardioselective beta adrenoreceptor blocking agents known to be equally effective in the management of patients with angina pectoris. Both are usually prescribed four times daily. Slow release formulation of oxprenolol administered once daily has been shown to maintain therapeutic effects for 24 hours. In a double-blind crossover study in 23 patients with stable angina pectoris, the effects of 160 mg slow release oxprenolol, administered once daily for 1 month, were compared with those of 40 mg of propranolol given four times daily for a similar period. No adverse effects occurred when patients were switched between treatment schedules. The average number of anginal attacks experienced were 11/month during oxprenolol therapy and 8/month during propranolol therapy (difference not significant). The resting values for heart rate were higher 7 1/2 nd 24 hours after oxprenolol than they were 4 and 12 hours after propranolol (p less than 0.01). The treadmill walking time to the onset of angina and to the development of moderate angina 24 hours after oxprenolol was less than that observed 7 1/2 hours after the drug or 4 and 12 hours after propranolol (p less than 0.01). In contrast, the values for walking time to the onset of angina and to the development of moderate angina at 4 and 12 hours after propranolol were similar. This decreased exercise tolerance 24 hours after oxprenolol was associated with a lesser degree of beta adrenoreceptor blockade than that present after propranolol as documented by higher levels of heart rate (p less than 0.05), systolic blood pressure (p less than 0.05) and rate-pressure product (p less than 0.05) during exercise after oxprenolol therapy. It is concluded that in the doses used, slow release oxprenolol administered once daily does not exert as consistent a beneficial effect on exercise tolerance throughout the dosing schedule as does propranolol given four times daily.

Adult↗

PubMed1994

Early and intermediate results of the Fontan procedure at moderately high altitude.

At higher elevations, alveolar hypoxia increases pulmonary vascular resistance and may limit the cardiac output of individuals without a subpulmonary ventricle. Thus, we reviewed the outcome of definitive palliation for tricuspid atresia and other forms of single ventricle in 60 consecutive Fontan patients living at a mean elevation of 1,370 m (range, 910 to 2,130 m). There were four early deaths (6.7%; 70% confidence limits, 4.1% to 10.7%) and six late deaths. Kaplan-Meier actuarial survival (+/- standard error) is 79.6% +/- 8.2% at 5 years. Survival was significantly decreased in patients with a preoperative mean pulmonary arterial pressure greater than or equal to 15 mm Hg unless the Fontan procedure was performed with a residual fenestration. Exercise tolerance was significantly worse at higher elevations in a subgroup of patients who have traveled to altitudes of 1,680 to 3,350 m. We conclude that the early and intermediate results of the Fontan procedure at moderately high altitude are similar to results reported at sea level. However, exercise tolerance may be impaired at higher elevations in many patients.

Adolescent↗

PubMed2002

[Results of stenting and surgical treatment in patients with ischemic heart disease and multivessel coronary artery involvement].

Efficacy of surgical and endovascular (with the use of stents) methods of treatment was assessed in 56 patients with ischemic heart disease and double and triple vessel involvement. Coronary artery bypass grafting (CABG) was carried out in 31, implantation of stents - in 25 patients. Clinical factors used for assessment of efficacy of treatment were development of events (deaths, myocardial infarctions), presence of angina, changes of exercise capacity. In immediate postoperative period there were 2 myocardial infarctions (1 in each group, i.e. 4 and 3.2% after stenting and CABG, respectively) and no deaths. Absence of clinical effect (persistence of angina) more often occurred after stenting (12%) that after CABG (6.5%). Length of hospital stay was shorter after stenting (13-/+8 days) than after CABG (24-/+10 days). Increment of exercise tolerance was higher after stenting than after CABG (62-/+10 and 54-/+8 W, respectively). During 1 year of follow-up 1 myocardial infarction developed (after stenting). In a year after procedure angina recurred in 24 and 12.9% of patients subjected to stenting and CABG, respectively; increments of exercise tolerance were 53-/+8 and 49-/+7 W after stenting and CABG, respectively. These results are indicative of high efficacy of surgical and endovascular (with implantation of stents) treatment of multivessel coronary artery disease.

Adult↗

PubMed2005

Evaluation of the patient with diabetes mellitus and suspected coronary artery disease.

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in patients with diabetes mellitus. In fact, patients with diabetes have the same risk of myocardial infarction as do nondiabetic subjects with a history of infarction. For this reason, diabetes has been designated by the American College of Cardiology (ACC) and the American Heart Association (AHA) as a CAD equivalent. For women, data indicate a substantially elevated risk of cardiovascular disease (CVD) even before a clinical diagnosis of type 2 diabetes has been made. Identifying patients with diabetes who have CAD and who will benefit from medical and/or invasive intervention to prevent cardiovascular events is a challenge in both symptomatic and asymptomatic patients. The decision to evaluate patients with diabetes who are asymptomatic for CAD presents the greatest challenge; investigation will reveal 10% to 15% of these patients to have CAD. Current diagnostic tools include exercise tolerance testing, stress echocardiography, stress myocardial perfusion imaging (MPI), and cardiac catheterization. Few guidelines are available to aid in the choice of testing modalities for a given patient. Although cardiac catheterization is useful, it is generally reserved for patients in whom invasive intervention is suitable. The American Diabetes Association (ADA) recommends exercise tolerance testing alone in symptomatic patients with > or = 2 CAD risk factors or an abnormal resting electrocardiogram (ECG). However, that recommendation is not based on data; it is the consensus of an expert panel. Stress echocardiography is a useful, noninvasive procedure; however, there is limited experience with this technology in the diabetic population. Recently accumulated data support both diagnostic and prognostic roles for stress MPI, particularly with ECG-gated single-photon emission computed tomographic imaging. In symptomatic patients with diabetes, the presence and extent of abnormal stress MPI findings have been found to be highly accurate independent predictors of subsequent cardiac events: 18% to 26% of asymptomatic patients with diabetes have perfusion defects consistent with CAD. However, CVD risk factors are not predictive of abnormal MPI findings even though duration of diabetes and abnormal ECGs are. The results of future studies may be helpful in guiding the selection of asymptomatic patients to undergo myocardial perfusion and function studies. In conclusion, MPI provides clinicians with an important diagnostic tool, because it offers perfusion as well as functional information for diagnosis and risk stratification in patients with diabetes. These capabilities facilitate decision making regarding the appropriateness of medical therapy or surgical intervention in these individuals.

Cardiac Catheterization↗

PubMed2003

[Tumor necrosis factor in blood plasma and morphofunctional parameters of the hart in patients with chronic heart failure complicated by a course of ischemic heart disease. Dynamics under effect of treatment].

AIM: To examine the course of chronic cardiac failure (CCF), morphofunctional parameters of the heart in correlation with activity of cytokine system; to evaluate effectiveness, tolerance and safety of combined CCF treatment including a cardioselective beta-adrenoblocker bisoprolol in patients with CCF FC I-IV having a high plasm level of tumor necrosis factor alpha (TNF-alpha). MATERIAL AND METHODS: The concentration of TNF-alpha in plasm of 40 patients with IHD complicated by CCF of FC I-IV and ejection fraction under 45% was measured at enzyme immunoassay. The treatment included combined therapy with diuretics, cardiac glycosides, peripheral vasodilators, ACE inhibitors, bisoprolol (group I) or no bisoprolol (group II). RESULTS: CCF patients with TNF-alpha had a significantly reduced IMT, more frequent episodes of CCF decompensation, longer CCF history, lower EF and threshold exercise intensity. In group I patients all these parameters improved. CONCLUSION: CCF patients with elevated plasm levels of TNF-alpha showed a severe course of the disease, low IMT, abnormal myocardial contraction and exercise tolerance. The addition of bisoprolol to combined treatment of the above patients improves their clinical condition, morphological parameters of the heart and exercise tolerance.

Aged↗

PubMed2005

Lung volume reduction surgery: a meta-analysis of randomized clinical trials.

BACKGROUND: Observational studies have suggested that lung volume reduction surgery (LVRS) is superior to optimal medical therapy for selected subsets of patients with advanced emphysema. Randomized clinical trials (RCTs) with the exception of the National Emphysema Treatment Trial (NETT), failed to enroll a sufficient number of patients to provide clinicians and patients with convincing outcome data on the usefulness of LVRS. It was postulated that a meta-analysis of these RCTs (3-12 months' follow up) may provide more compelling information on the value of LVRS in patients with emphysema. METHODS: A comprehensive search of the MEDLINE database between January 1994 and January 2004 for RCTs on LVRS was performed. RESULTS: From a total of eight RCTs on record, six studies (306 patients) with 3- to 12-month follow up were deemed suitable for meta-analysis. Key baseline features of these RCT populations included heterogeneous emphysema, comparable inclusion/exclusion criteria and, in retrospect, low walking capacity as measured by the 6-minute walk distance (6MWD). This profile closely resembles NETT's 'predominantly upper lobe--low exercise tolerance emphysema' cohort. The LVRS arm of the meta-analysis population showed better results than the medical cohort in terms of pulmonary function (FEV(1) p < 0.0001, FVC p < 0.0001, residual volume p < 0.0001, total lung capacity p = 0.004), gas exchange (arterial partial pressure of oxygen p < 0.0001) and exercise capacity (6MWD p = 0.0002). Although information on quality-of-life measures was not sufficiently uniform to qualify for meta-analysis, a survey of available data revealed better results in the surgical than in the medical arms of each RCT. Mortality 6-12 months after random assignment to treatment was similar in the two study arms, suggesting that the operative mortality from LVRS was offset, within months, by deaths in the medical arm. CONCLUSIONS: This meta-analysis showed that a selected subset of patients with advanced, heterogeneous emphysema and low exercise tolerance (6MWD) experienced better outcomes from LVRS than from medical therapy.

Aged↗

PubMed2006

[Transition from prostacyclin to bosentan in five patients with severe pulmonary hypertension: the switch is possible].

Prostacyclin improves symptoms, exercise tolerance, and survival in patients with pulmonary arterial hypertension. However, the difficulty of administration (whether intravenous, subcutaneous, or by inhalation) often causes side effects that can reduce the patient's quality of life and which may sometimes be serious. Bosentan, an orally active endothelin receptor antagonist, improves functional class and exercise tolerance in these patients. We describe the successful transition from prostacyclin to bosentan in five patients with severe pulmonary arterial hypertension who suffered serious side effects with prostacyclin treatment.

Adult↗

PubMed1983

[Results of a 2-year prospective study of patients with ischemic heart disease with stable angina pectoris].

Data of dynamic control of 278 coronary patients with stable angina pectoris are presented. Coronarography was performed in all cases to determine changes in the heart coronary arteries which were of varying markedness. The anginal syndrome, ECG at rest, exercise tolerance, incidence of myocardial infarction and mortality rate were assessed after one and two years of dynamic observation. The incidence of nonfatal myocardial infarction was estimated at an average of 6.3% per year, whereas the mortality rate was 3.8%. The prognosis for patients with stenosing coronary atherosclerosis depends on the number of affected coronary arteries, the functional class of angina pectoris and exercise tolerance. Data on the efficiency of long-term pharmacological treatment of patients with stable angina and stenosing coronary atherosclerosis are obtained.

Adult↗

PubMed1979

[Prinzmetal's angina initiated by interruption of exercise. 5 cases with normal coronary radiograms].

Five male patients, aged between 31 and 58 years, presented with anginal chest pain with nausea and sweating after the interruption of exercise. Prinzmetal variant angina was observed during the recovery phase of exercise tolerance testing. Coronary arteriography and selective left ventricular angiography were normal in all cases. Ergonovine, used in one case, induced coronary artery spasm. The angina was eased by Nifedipine in three patients and passed off with time in the other two patients. In one case attack occurred with amiodarone therapy and in another with glyceril trinitrate, after normal exercise tolerance tests. Vagotonia, all the more pronounced when sympathetic tonus is increased, and hyperventilation seem to be the causative factors of what probably results from coronary artery spasm. Nifedipine, a calcium-blocking agent would appear to be the treatment of choice.

Adult↗

PubMed1981

A study of short-term effect of rehabilitative therapy in chronic obstructive pulmonary disease.

51 male patients with mild degree chronic airway obstruction underwent detailed evaluation of pulmonary function tests, blood gas analysis and exercise tolerance test before and after a short-term therapy. The patients were randomly assigned to medical therapy alone or to medical and rehabilitative therapy. 23 patients treated with medical and rehabilitative therapy showed a significant decrease of respiratory rate and PaCO2 and a significant increase of TV, FEV 1.0, FEV 0.75 x 40, PaO2, SaO2 and exercise tolerance after a month of therapy. 28 patients treated with medical therapy alone showed a significant increase of VC and FEV 0.75 x 40. These data suggest that rehabilitative therapy is a valid adjunct to medical therapy in the short-term treatment of chronic airway obstruction.

Blood Gas Analysis↗

PubMed1993

[Vasodilator therapy in cardiac failure].

In recent years, vasodilator drugs are considered a standard therapy for patients with symptomatic heart failure. Isosorbide dinitrate, venodilator, shows a striking fall in cardiac filling pressure. Hydralazine, arterially active vasodilator, decreases afterload and increases cardiac output. The combined use of nitrates and hydralazine shows synergistic effect in increasing cardiac output, lowering cardiac filling pressure and improving exercise tolerance and life expectancy. Prazosin showed no favourable effect on survival in a V-HeFT trial. Although calcium antagonists have been expected to improve hemodynamics in the patients with heart failure, there have been no controlled large trial to prove that the hemodynamic effect is accompanied by any improvement in exercise tolerance or quality of life. At the present, it is considered to be reasonable to use nitrates and hydralazine combined with ACE inhibitors, in patients with chronic heart failure.

Adrenergic beta-Antagonists↗

PubMed1997

Mibefradil in the treatment of chronic stable angina pectoris: comparative studies with other calcium antagonists.

The ability of mibefradil, a new T-channel-selective calcium antagonist, to improve exercise tolerance and silent ischemic parameters in patients with chronic stable angina was compared in 3 separate trials with 2 other commonly used calcium antagonists: diltiazem SR (120 mg/twice daily) and amlodipine (10 mg/day). Compared with amlodipine, mibefradil 100 mg given once daily over a 3-week period resulted in a statistically significantly larger increase from baseline in total exercise tolerance test (ETT) duration (treatment difference of 40.9 sec, p = 0.04), time to onset of angina (treatment difference 61.2 sec, p < 0.001), and time to onset of ischemia (treatment difference of 54.4 sec, p = 0.004). The decrease in weekly anginal episodes was 58% with mibefradil versus 19% with amlodipine, and the reduction in nitroglycerin consumption was 58% with mibefradil versus a 10% increase with amlodipine. The decrease in the number of silent ischemic episodes detected by a 48-hour Holter recording was significantly larger (p = 0.03) with mibefradil 100 mg (88%) compared with amlodipine 10 mg (38%). Similarly, a larger decrease in the duration of silent ischemia was observed with mibefradil (69%) compared with that seen with amlodipine (38%). The preliminary results of a second trial comparing mibefradil with amlodipine were consistent with the first demonstrating that the improvement for all 3 ETT parameters was larger for mibefradil (ETT duration: 55.2 sec; delay in onset angina: 74.2 sec; time to onset of ischemia: 63.6 sec), but in this trial the treatment differences did not reach statistical significance. In the trial comparing mibefradil (100 mg once daily) with diltiazem SR (120 mg twice daily), both compounds had equivalent effects on all ETT parameters tested. Mibefradil produced a 21% increase in exercise duration compared with a 20% increase with diltiazem. Although mibefradil yielded larger increases in the time to onset of angina and the time to onset of 1-mm ST-segment depression (42% and 38%, respectively) than did diltiazem (34% and 25%, respectively), the treatment differences did not reach statistical significance. Both mibefradil and diltiazem SR were associated with at least a 70% reduction from baseline in anginal frequency and nitroglycerin consumption. Mibefradil-treated patients showed greater decreases in heart rate and the rate-pressure product at each stage of the ETT than patients treated with amlodipine or diltiazem SR. All 3 drugs were well tolerated. However, compared with mibefradil, amlodipine and diltiazem SR produced a higher incidence of leg edema. In conclusion, the effectiveness of mibefradil in improving all 3 ETT parameters was greater than that of amlodipine and equivalent to that of diltiazem SR. Moreover, mibefradil provided greater reductions in the heart rate and cardiac workload than did the other 2 drugs.

Adult↗