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PubMed1999

Physical exercise in outpatients with epilepsy.

PURPOSE: To compare the exercise habits in a sample of adult outpatients with epilepsy with those of a general population of the same age and sex and furthermore to study physical exercise as a seizure precipitant and the risk of sustaining seizure-related injuries while exercising. METHODS: Two hundred four adult outpatients with active epilepsy responded to two questionnaires. The first one, addressing exercise habits, was a selected part of a broad self-assessing screening used every second year by a marketing and media research institute to reveal changes in the average Norwegian's lifestyle. The exercise habits of the epilepsy population were compared with those of the average population. The other questionnaire, addressing seizures and injuries related to physical exercise, consisted of eight sections and was developed at the National Center for Epilepsy in Norway. RESULTS: The portion of those never exercising was significantly higher among the patient group compared with the average population. Otherwise, the exercise patterns were very similar in the two populations. However, the patients exercised more often in fitness centers and together with friends, whereas individual activities like skiing and swimming were more often preferred by the average Norwegian. Of the 204 patients, 53 and 63% had never experienced seizures during or immediately after exercise, respectively. About 10% of the patients claimed that they had seizures quite often in connection with exercise. However, only 2% had genuine exercise-induced seizures, here arbitrarily defined as having seizures in >50% of the training sessions. Among those prone to have exercise-related seizures, there was a predominance of patients with symptomatic localization-related epilepsy (i.e., with an underlying structural brain lesion). Most exercise-related seizures occurred during strenuous activity. About 38% of the patients claimed to have personal experience regarding whether regular physical exercise influenced their seizure disorder; of these, 53% claimed there was no influence, 36% claimed there was a positive influence, and 10% reported a negative influence. Thirty-six percent of the patients had experienced injuries in connection with physical exercise, but in only 10% were these injuries associated with seizures. The injuries were mostly mild. CONCLUSIONS: The surveyed sample of epilepsy outpatients was more active than expected, and their exercise pattern closely resembled that of the average Norwegian population. In the majority of the patients, physical exercise had no adverse effects, and a considerable proportion (36%) claimed that regular exercise contributed to better seizure control. However, in approximately 10% of the patients, exercise appeared to be a seizure precipitant, and this applied particularly to those with symptomatic partial epilepsy. The risk of sustaining serious seizure-related injuries exercising seemed modest.

Adolescent↗

PubMed2004

American College of Sports Medicine position stand. Exercise and hypertension.

Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activities prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm HG after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g.postexercise hypotension), with greatest decreases among those with highest baseline BP. The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time. Individuals with controlled HTN and no CVD or renal complications may participated in an exercise program or competitive athletics, but should be evaluated, treated and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e. > or = 60% VO2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise (40-<60% VO2R) such as walking. When pharmacological therapy is indicated in physically active people it should be, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. based upon the current evidence, the following exercise prescription is recommended for those with high BP: Frequency: on most, preferably all, days of the week. Intensity: moderate-intensity (40-<60% VO2R). Time: > or = 30 min of continuous or accumulated physical activity per day. Type: primarily endurance physical activity supplemented by resistance exercise.

Adolescent↗

PubMed1996

[Clinical significance and mechanism of ST-segment changes during the post-exercise recovery period in male patients with coronary artery disease].

The treadmill exercise test (TET) is evaluated by exercise-induced ST-segment depression (delta ST). However, the depression sometimes only appears during the post-exercise period. Depression appearing only during the post-exercise period may be as useful as depression during exercise to predict coronary artery disease, but little is known about factors that may affect ST depression after exercise. The clinical significance and mechanism of post-exercise ST depression were investigated in patients with coronary artery disease. Target heart rate- or symptom-limited TET was performed in 531 male patients with definitive effort angina pectoris or myocardial infarction using the Bruce protocol. Patients were divided into four groups according to delta ST during exercise and 1-2 min after exercise; 1) no TET or post-exercise delta ST (Nn, n = 192), 2) only post-exercise delta ST (Np, n = 36), 3) only TET delta ST (Pn, n = 112), 4) both TET and post-exercise delta ST (Pp, n = 66). Patient profiles, parameters during TET, echocardiographic and coronary angiographic findings and outcome during the year after TET were compared between the Nn and Np or Pn and Pp groups. The percentage of patients treated with beta-blocker was higher in the Np than that in the Nn group (Nn: 45%, Np: 64%, p < 0.05) and systolic blood pressure declined at 1 min after exercise from peak exercise in the Nn, but not in the Np group (Nn: 175 --> 167 mmHg, p < 0.05; Np: 170 --> 170 mmHg, not significant). There was no difference in age, other parameters during TET, echocardiographic and coronary angiographic findings and outcome between the Nn and Np group. The incidence of right coronary artery stenosis and that of patients with multi-vessel disease were higher in the Pp than those in the Pn group (Pn: 41%, 58%, Pp: 65%, 73%, both p < 0.05). The occurrence of chest pain during exercise was higher in the Pp than the Pn group in spite of less delta ST at peak exercise. However, systolic blood pressure declined after exercise in the Pn group, but not in the Pp group (Pn: 164 --> 158 mmHg, p < 0.05; Pp: 166 --> 164 mmHg, not significant). These results confirmed that the clinical significance of post-exercise delta ST in patients without TET delta ST differs from that in patients with TET delta ST and suggests that post-exercise delta ST without delta ST during exercise may be associated with an abnormal response to imbalances in the cardiovascular sympathetic system in the post-exercise period rather than with myocardial ischemia.

Blood Pressure↗

PubMed1999

Effects of hypoxic exercise conditioning on work capacity, lactate, hypoxanthine and hormonal factors in men.

1. Hypoxanthine is a purine degradation product and exercise plasma hypoxanthine can be an index of ATP supply-demand imbalance during exercise. The present study determined the effects of hypoxic exercise conditioning on work capacity, blood lactate, plasma hypoxanthine and various neurohormonal factors. 2. Blood lactate, plasma hypoxanthine and neurohormonal factors (catecholamines, renin-angiotensin system activity and natriuretic peptides) were measured at rest and after maximal cardiopulmonary exercise testing (at sea level) both at pre- and post-hypoxic exercise conditioning in six males (40 +/- 2 years). The training protocol consisted of ergometer exercise twice weekly for 40 min in a hypobaric chamber (61.7-47.2 kPa) for 3 weeks. 3. Pulmonary function and haematological and echocardiographic parameters were not altered after hypoxic exercise conditioning. Work rate at peak exercise (264 +/- 10 vs 321 +/- 31 W; P = 0.10) tended to be increased and peak O2 pulse (15.0 +/- 1.0 vs 18.4 +/- 1.4 mL/beat; P < 0.05) increased after exercise conditioning. The double product during submaximal exercise decreased and systolic blood pressure at peak exercise increased after exercise conditioning. Resting and exercise neurohormonal factors were unchanged, except for reduced resting plasma adrenaline levels. Blood lactate at peak exercise (7.4 +/- 0.7 vs 4.8 +/- 0.5 mmol/L; P < 0.05) became lower and peak plasma hypoxanthine (43.2 +/- 5.7 vs 26.4 +/- 5.0 mumol/L; P < 0.1) tended to be decreased after exercise conditioning. 4. Hypoxic exercise conditioning tended to increase maximal power output with a decrease in exercise blood lactate and a trend towards a decrease in exercise plasma hypoxanthine. These data suggest that exercise conditioning under simulated altitude may improve ATP supply-demand imbalance during exercise with less anaerobiosis, which could contribute to enhanced endurance performance.

Adult↗

PubMed1995

Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics.

BACKGROUND: We previously showed that exercise capacity in patients with hypertrophic cardiomyopathy (HCM) is related to peak exercise cardiac output. Cardiac output augmentation during exercise is normally dependent on heart rate (HR) response and stroke volume (SV) augmentation by increased left ventricular end-diastolic volume and/or increased contractility. We hypothesized that in contrast to normal subjects, peak exercise capacity in patients with HCM is determined by the diastolic filling characteristics of the left ventricle during exercise, which would in turn determine the degree to which SV is augmented, and that HR is a relatively unimportant determinant of peak exercise capacity. METHODS AND RESULTS: Twenty-three patients with HCM underwent invasive hemodynamic evaluation and measurement of maximal oxygen consumption (VO2max) during erect treadmill exercise to assess the relative importance of changes in HR and SV in determining exercise capacity. Hemodynamic responses to erect and supine exercise were compared in 10 of these patients. In a separate group of 46 patients with HCM, the relation between VO2max and exercise diastolic filling indexes was assessed. Peak HR during erect exercise was 92 +/- 8% of predicted maximum. VO2max was 29.0 +/- 6.4 mL.kg-1.min-1 and was related significantly to peak exercise cardiac index and SV index (r = .71, P < .001 and r = .66, P = .001, respectively) but not to peak HR, HR deficit, or resting or peak pulmonary capillary wedge pressure. Peak cardiac output during erect exercise was not related to peak HR (r = .13, P = NS). When erect and supine exercise were compared, peak HR was lower in the supine position (153.3 +/- 19.9 beats per minute supine versus 172.0 +/- 17.6 beats per minute erect, P = .003), but peak exercise cardiac index was similar (7.9 +/- 2.6 L.min-1.m-2 supine versus 7.5 +/- 2.8 L.min-1.m-2 erect). Pulmonary capillary wedge pressure was higher at rest in the supine versus erect position (15.3 +/- 5.2 versus 8.1 +/- 6.1 mm Hg) but was not significantly higher at peak exercise in the supine versus erect position (28.5 +/- 8 versus 22.4 +/- 11.6 mm Hg erect, P = NS). In the separate group of 46 patients with HCM, VO2max was significantly inversely related to time to peak filling at peak exercise (r = -.60, P < .0001) but did not correlate with time to peak filling at rest, resting ejection fraction, peak filling rate, or peak exercise peak filling rate. CONCLUSIONS: SV is the major determinant of peak exercise capacity in the erect position in patients with hypertrophic cardiomyopathy. This in turn is determined by the exercise left ventricular diastolic filling characteristics. HR augmentation does not appear to be a major determinant of peak cardiac output in the erect position.

Adult↗

PubMed2002

Urine microalbumin excretion in relation to exercise-induced electrocardiographic myocardial ischaemia.

BACKGROUND: Microalbuminuria, a marker of endothelial cell dysfunction, is associated with atherosclerosis and is a predictor of coronary heart disease. It has been suggested that patients with coronary heart disease have exaggerated exercise-induced urinary microalbumin excretion but this is controversial. We, therefore, measured urine microalbumin excretion in men before and after an exercise electrocardiogram. MATERIAL/METHODS: Urine microalbumin excretion expressed as the albumin-creatinine ratio (ACR) was measured before and after an exercise electrocardiogram in 10 subjects with exercise-induced myocardial ischaemia and 14 subjects without exercise-induced myocardial ischaemia. RESULTS: In subjects with a positive exercise electrocardiogram, the pre-exercise electrocardiogram ACR 3.3 +/- 5.50; (mean+/-SD) significantly increased (p=0.0371) following exercise (6.30 +/-10.25). In subjects with a negative exercise electrocardiogram, the pre-exercise electrocardiogram ACR (0.73 +/-0.52) also significantly increased (p=0.0295) following exercise (2.04 +/-1.81). Pre-exercise ACR was higher (p=0.0164) in subjects with a positive exercise electrocardiogram (3.3 +/-5.50) than in those subjects with a negative exercise electrocardiogram (0.73 +/-0.52). Incremental and post-exercise ACR were not significantly different in those with normal and abnormal exercise electrocardiograms. CONCLUSIONS: Patients with exercise-induced myocardial ischaemia have pre-exercise urine microalbumin excretion. Exaggerated urine microalbumin excretion in response to exercise is not associated with exercise-induced myocardial ischaemia.

Aged↗

PubMedDate not supplied

Serial assessment of exercise capacity after heart transplantation.

BACKGROUND: Exercise capacity after heart transplantation is abnormal. This reduced exercise performance may in part be due to treatment with high-dose immunosuppressive therapy, deconditioning, graft rejection, or cardiac denervation. METHODS: To investigate whether exercise capacity significantly improves over time as immunosupression is lessened or whether reinnervation occurs, we measured peak exercise oxygen consumption in 60 patients 0.5 to 60 months after transplantation (age: 52 +/- 11 years; left ventricular ejection fraction: 56% +/- 10%) and in 14 healthy subjects (age: 44 +/- 8 years; p = Not significant). Resting hemodynamic measurements, left ventricular ejection fraction, and immunosuppressive therapy were recorded at the time of each of the patients' 116 exercise tests. Exercise test results were stratified into groups according to time after transplantation. RESULTS: Exercise capacity significantly improved after transplantation (pretransplantation peak exercise oxygen consumption: 9.9 +/- 4.3; posttransplantation: 16.6 +/- 4.0 ml/kg/min; p < 0.001). Patient groups after transplantation were without significance differences with regard to age, gender, left ventricular ejection fraction, resting hemodynamic measurements, antihypertensive regimen, and number of rejection episodes. For those patients exercising at 2 months compared with the patients exercising at 12 months, a significant increase was observed in peak exercise oxygen consumption (14.0 +/- 3.8 ml/kg/min at 2 +/- 2 months to 16.2 +/- 3.8 ml/kg/min at 12 +/- 2 months) and maximum heart rate (124 +/- 24 to 137 +/- 24 beats/min). No significant changes were found in peak exercise oxygen consumption or maximum heart rate after the first year after transplantation. Patients' exercise capacities as measured by peak exercise oxygen consumption remained abnormal (N1 peak exercise oxygen consumption: 35 +/- 11 ml/kg/min) despite significant reductions in steroid, azathioprine, and cyclosporine therapy. Peak exercise oxygen consumption was significantly correlated with maximal heart rate (r = 0.42) (p < 0.0001) but not with maximal blood pressure response, change in heart rate, left ventricular ejection fraction, or resting cardiac index (all p = Not significant). CONCLUSIONS: Exercise capacity is markedly improved after heart transplantation although it remains impaired compared with healthy individuals. Patients achieve their maximal exercise capacity by 1 year after transplantation. Subsequently, exercise capacity does not improve despite significant reductions in immunosuppressive agents. The lack of alteration in the heart rate response to exercise over time suggests that no significant functional reinnervation occurs.

Adult↗

PubMed2001

Cortisol and growth hormone responses to exercise at different times of day.

Exercise of appropriate intensity is a potent stimulus for GH and cortisol secretion. Circadian and diurnal rhythms may modulate the GH and cortisol responses to exercise, but nutrition, sleep, prior exercise patterns, and body composition are potentially confounding factors. To determine the influence of the time of day on the GH and cortisol response to acute exercise, we studied 10 moderately trained young men (24.1 +/- 1.1 yr old; maximal oxygen consumption, 47.9 +/- 1.4 mL/kg.min; percent body fat, 13.2 +/- 0.6%). After a supervised night of sleep and a standard meal 12 h before exercise, subjects exercised at a constant velocity (to elicit an initial blood lactate concentration of approximately 2.5 mmol/L) on a treadmill for 30 min on 3 separate occasions, starting at 0700, 1900, and 2400 h. Blood samples were obtained at 5-min intervals for 1 h before and 5 h after the start of exercise; subjects were not allowed to sleep during this period. Subjects were also studied on 3 control days under identical conditions without exercise. There were no significant differences with time of day in the mean blood lactate and submaximal oxygen consumption values during exercise. The differences over time in serum GH and cortisol concentrations between the exercise day and the control day were determined with 95% confidence limits for each time of day. Exercise stimulated a significant increase in serum GH concentrations over control day values for approximately 105--145 min (P < 0.05) with no significant difference in the magnitude of this response by time of day. The increase in serum GH concentrations with exercise was followed by a transient suppression of GH release (for approximately 55--90 min; P < 0.05) after exercise at 0700 and 1900 h, but not at 2400 h. Although the duration of the increase in serum cortisol concentrations after exercise was similar (approximately 150--155 min; P < 0.05) at 0700, 1900, and 2400 h, the magnitude of this increase over control day levels was greatest at 2400 h. This difference was significant for approximately 130 min and approximately 40 min compared to exercise at 1900 and 0700 h, respectively (P < 0.05). The cortisol response to exercise at 0700 h was significantly greater than that at 1900 h for about 55 min (P < 0.05). A rebound suppression of cortisol release for about 50 min (P < 0.05) was observed after exercise at 2400 h, but not 0700 or 1900 h. Both baseline (before exercise) and peak cortisol concentrations were significantly higher at 0700 h than at 1900 or 2400 h (P < 0.01). We conclude that time of day does not alter the GH response to exercise; however, the exercise-induced cortisol response is modulated by time of day.

Adult↗

PubMed2000

[A 5 year follow-up study on the relationship between changes in serum lipids and blood pressure, and changes in exercise habits in subjects 30 years of age].

A 5 year follow-up study was conducted to investigate the relationships between %changes in serum lipids and blood pressure and corresponding changes in exercise habits in the middle-aged. The subjects were 152 males and 169 females who received a health check-up at 30-years-old during the period between 1990-1992 and then at 35-years-old during the period between 1995-1997. The results are as follows: 1. In multiple regression analysis, % delta toriglyceroid (TG) and % delta AI(atherogenic index) ratio were associated significantly with changes in exercise habits in males (P < 0.05) and % delta high density lipoprotein cholesterol (HDLC) was associated with changes in exercise habits in females (P < 0.05). % delta TG and % delta HDLC were affected by changes in exercise habits adjusted for BMI, smoking, and drinking. But changes in TC and blood pressure were not affected by changes in exercise habits. 2. In males, % delta TG was significantly lower in those subjects who started their exercise habit than in the no exercise group and than in those within the ceased exercise group who ceased their exercise during the study period (P < 0.05). % delta AI was significantly lower in the started exercise group than in the no exercise group. Also, the continued exercise group had a significantly (P < 0.05) lower % delta AI as compared to the ceased exercise group. In females, % delta TG was significantly lower in the started exercise group than in the no exercise group (P < 0.05). % delta HDLC was higher significantly in the continued exercise group than in the ceased exercise group (P < 0.05). From the results obtained, it is recommended that the no exercise subjects should have exercise more than once time per week and those with more than 1 time per week maintain their exercise habits.

Adult↗

PubMed2002

Systemic inflammatory response to exhaustive exercise. Cytokine kinetics.

It has been documented that strenuous exercise not only induces pyrogenesis but also elicits mobilization and functional augmentation of neutrophils and monocytes whereas it suppresses cellular immunity leading to increased susceptibility to infections. As mediators of these phenomena, cytokines released into the circulation have been a recent focus of attention. Indeed, there are as many as one hundred original reports concerning exercise and cytokines, and half of them have been published in rapid succession from 2000, resulting in a tremendous accumulation of new knowledge within such a short term. The first aim of this review is to comprehensively summarize previous studies on systemic cytokine kinetics following exercise, with a special focus on reproducibility and quantitative comparison in human studies using specific immunoassays. Although tumor necrosis factor (TNF)-alpha and interleukin (IL)-1 beta have traditionally been understood to be the main inducer cytokines of acute phase reactions, the majority of studies have shown that the circulating concentration of these cytokines is either unchanged following exercise, or exhibits relatively small, delayed increments. Plasma interferon (IFN)-alpha and IFN-gamma do not appear to change following exercise, whereas IL-2 decreases after endurance exercise. The small changes of these proinflammatory and immunomodulatory cytokines could well be mediated by anti-inflammatory cytokines such as IL-1 receptor antagonist (IL-1ra), IL-6 and IL-10 and cytokine inhibitors (cortisol, prostaglandin E2 and soluble receptors against TNF and IL-2), which are known to increase markedly in the circulation following endurance exercise. Moreover, it has been recently demonstrated that endurance exercise induces systemic release of granulocyte colony-stimulating factor (G-CSF), macrophage CSF (M-CSF), IL-8 and monocyte chemotactic protein 1 (MCP-1). Although the majority of available data have been obtained following prolonged exercise, it remains to be elucidated whether short-duration intensive exercise also causes rapid systemic cytokine release. In addition, there have been few studies that have simultaneously compared the extent of each cytokine response to exercise from a wider perspective. The second aim of this study was to examine possible changes of not only plasma but also urine concentrations of a broad spectrum of cytokines (16 kinds) following maximal exercise, including the time course of recovery. Although plasma TNF-alpha could not be detected throughout, it was present in urine 2 h after exercise. Plasma IL-1 beta rose significantly 2 h after exercise, but plasma IL-1 ra increased more rapidly and markedly than IL-1 beta, thus IL-1 bioactivity should be blocked at least in the circulation. Although there was only a trend toward increased plasma IL-6 concentrations after exercise, urine IL-6 rose significantly 1 h after exercise, indicating that IL-6 was released systemically but eliminated rapidly into the urine. Furthermore, it is shown for the first time that plasma and urine IL-4 concentrations were significantly elevated 2 h after exercise. Therefore, it is possible that anti-inflammatory cytokines might be released into the circulation as a regulatory mode of the cytokine network for adaptation against systemic inflammatory stress. Additionally, we have demonstrated that plasma concentrations of G-CSF, granulocytemacrophage CSF (GM-CSF), M-CSF, IL-8 and MCP-1 increased immediately after short-duration exercise and that the urine concentrations of these cytokines were much more pronounced than the changes observed in plasma. In conclusion, cytokines that are considered to induce systemic bioactivity following exercise are not only anti-inflammatory cytokines but also colony-stimulating factors and chemokines, which were secreted in an earlier phase of exercise without the kinetic involvement of traditional proinflammatory cytokines. Although the wider physiological and pathological implications are still not clearly understood, these cytokine kinetics may partly explain suppressed cell-mediated immunity and increased allergic reactions derived from a lower type-1 to type-2 cytokine ratio, along with mobilization and functional augmentation of neutrophils and monocytes. The sources and stimuli of cytokine production are not fully elucidated at present, but several hypotheses based on recent experimental evidence are discussed in this review herein.

Anti-Inflammatory Agents↗

PubMed2005

Pregnant women's beliefs and influences regarding exercise during pregnancy.

OBJECTIVE: To sample women's exercise habits and beliefs regarding exercise during pregnancy and to determine patient awareness and physician communication of ACOG's 2002 guidelines for exercise during pregnancy. METHODS: A 28-item questionnaire was completed by 211 patients at a private obstetric and gynecology (Ob/Gyn) group practice during a 4-week study period. RESULTS: Ninety-five percent of the women believed that participating in prenatal exercise was helpful. There was a significant correlation (P<0.000) between a woman's beliefs regarding the benefits of prenatal exercise and whether or not she chose to exercise during pregnancy. Forty-one percent of women surveyed and 41.6% of women who exercised indicated that their doctor had the most influence on their beliefs regarding exercise. Approximately 92% of the women who discussed exercise with their physicians were encouraged by them to exercise. In addition, women who were encouraged to exercise by their physician were more likely (P=0.005) to exercise than those who were not. Only 9.8% of the 133 women who talked to their physician reported that their physician helped them develop an exercise program. Over 69% of women were advised by their physician to place limitations on their exercise habits according to ACOG's 1985 guidelines rather than the current guidelines. A significant relationship was found between BMI and whether or not women exercised (P=0.001). Despite the previously known correlation between BMI and gestational diabetes, we failed to find a significant relationship between BMI and whether or not their physician encouraged them to exercise (P=0.531). CONCLUSION: A majority of women studied believed that exercise will have a positive impact on their pregnancy, are deciding to exercise during their pregnancy, and indicated that their doctor had the most influence on their beliefs about exercise during pregnancy. Because women's behaviors are influenced by their physician's instructions, physicians should be prepared to counsel their healthy ante-partum patients on the benefits of prenatal exercise and be informed of ACOG's current guidelines.

Adult↗

PubMed1996

[ST segment depression during recovery after treadmill exercise test in stable patients with previous myocardial infarction].

BACKGROUND: The significance of exercise-induced ST segment depression is well known while limited data are available on the clinical/prognostic power of ST depression occurring only during recovery. Aim of the study was to clarify the clinical/prognostic value of "recovery only" ST depression in stable patients late from myocardial infarction (AMI) and to determine whether the addition of recovery data to exercise parameters improves the interpretation of exercise test. METHODS: From a population of 766 consecutive patients (mean age: 57.2 +/- 8.6 yrs.; male: 89%) who underwent a Bruce Treadmill test at least 1 year after a Q wave AMI and whose exercise data were prospectively entered in the database of our Institution, 4 different Groups were identified: 1) 99 patients with a negative exercise test; 2) 53 patients with "exercise only" ST depression; 3) 140 patients with "exercise and recovery" ST depression; 4) 31 patients with "recovery only" ST depression. The main clinical and exercise data and a cardiac follow-up (average mean length: 1530 +/- 600 day) were evaluated by one-way analysis of variance, Bonferroni T-test, chi-square, relative risk (RR) with 95% confidence intervals (CI), Kaplan-Meler method and log-rank. RESULTS: Baseline clinical parameters were similar in the 4 Groups except for older age in Group 3 compared to Group 2 (< 0.05) and higher prevalence of anterior AMI in Group 4 compared to others (= 0.004). Patients with exercise and recovery ST depression or with "recovery only" ST depression had significantly less exercise tolerance than patients with negative exercise test or "exercise only" ST depression [exercise duration (< 0.05, Group 1 vs. 3, vs. 4; Group 2 vs. 3), peak rate pressure product (< 0.05), maximal heart rate (< 0.05; Group 1 vs. 2; vs. 3; vs. 4)]. Exercise-induced ST depression was higher and angina was significantly more frequent in patients with exercise and recovery ST depression as well as an high Mark's risk score (< 0.001). Only patients with exercise and recovery ST depression demonstrated significantly higher risk of overall mortality (RR: 1.35, CI: 1.04-1.74), unstable angina (RR: 1.34, CI: 1.09-1.65) or revascularisation procedures (RR: 1.51, CI: 1.25-1.83). Relative risk of patients with "recovery only" ST depression was similar to that of subjects with "exercise only" ST depression. CONCLUSIONS: In stable patients with old Q wave AMI, "recovery only" ST depression is rate, but does represent a true sign of ischemia. It could be associated with indirect indexes of worse ventricular function. The prognostical power of "recovery only" ST depression is mild, although similar to that of "exercise only" ST depression. Moreover the presence of ST depression not only during exercise but also during the recovery phase identifies patients with more severe prognosis. Therefore the inclusion of findings from the recovery phase in the analysis of the exercise test could increase the predictive power of the test itself.

Aged↗

PubMed1994

Exercise assessment of arthritic and elderly individuals.

Exercise testing is now widely used as both a diagnostic tool in the elderly and as a means of generating the information necessary to provide them with a valid exercise training prescription. An appropriate medical history and physical examination prior to exercise testing will allow for the adequate assessment of an individual's risk of undergoing an exercise test. Appropriate screening of the individual, assessment of risk prior to exercise, and appropriate monitoring during and following the exercise test have contributed to the relative safety of maximal exercise testing, with statistics indicating roughly one death occurs in every 10,000 clinical maximal exercise tests. When designing an exercise test protocol for use in the elderly, their reduced exercise capacities, increased prevalence of CV disease, and the reason for doing the test must be taken into consideration. The Bruce treadmill protocol is the most widely used exercise test in populations of all ages; however, because of its relatively high VO2 demands in the initial minutes of exercise, it may not be the optimal protocol for the elderly. Other alternative protocols including the Naughton and Balke tests may be more appropriate, especially when attempting to generate a valid exercise prescription. However, the modified Balke protocol, with a constant speed of 2 miles/h and starting on the level, is probably the best protocol for exercise testing in the elderly for the purposes of generating an exercise prescription. If individuals are unable to undergo exercise tests on a treadmill, cycle and arm ergometer tests provide alternative test modalities, but these have a number of inherent problems that must be considered prior to exercise testing. The interpretation of an elderly individual's ECG responses during a maximal exercise test is intimately related to their risk of having CV disease prior to the exercise test, though fewer false-positive tests will be evident because of the increased prevalence of CV disease in the elderly.

Aged↗

PubMed2005

Exercise duration and intensity in a weight-loss program.

OBJECTIVE: To examine the effect of duration and frequency of exercise on weight loss and cardiorespiratory fitness in previously sedentary, overweight, women. DESIGN: Randomized, controlled, 4-arm trial of 12-months duration. SETTING: A university-based behavioral weight loss program during the years 2000 and 2001. PARTICIPANTS: Eligibility criteria were: women, 21 to 45 years of age, body mass index (BMI) 27 to 40, reporting exercise <3 days/week for <20 minutes/day during the previous 6 months. Exclusion criteria were: a history of myocardial infarction, taking medication that would alter the heart rate response during exercise or that would affect metabolism or weight loss, being treated for psychologic conditions, pregnant, recently pregnant, or planning pregnancy, having a medical condition that could affect metabolism or body weight (eg, diabetes) or that would limit exercise participation. INTERVENTION: All 201 participants were assigned to a standard behavioral weight loss program, which included regular group meetings and telephone calls, and caloric and dietary fat restrictions. Participants were given meal plans and kept weekly food diaries. The women were assigned to 1 of 4 exercise groups based on energy expenditure of 1000 kcal/wk or 2000 kcal/wk and exercise intensity (moderate versus vigorous). Exercise intensity was prescribed according to percentage of age-predicted maximal heart rate and rating of perceived exertion. Energy expenditure was converted to minutes of exercise per week. The groups were vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration. All 4 groups started the program at moderate intensity and moderate duration (100 min/week of walking) and increased the vigor and duration of exercise to set targets of 200, 300, 200, and 150 min/week, for the groups respectively. Treadmills were provided to the participants, and feedback on their weekly exercise logs was given. MAIN OUTCOME MEASURES: At 6 and 12 months, changes in body weight and BMI were measured. Cardiorespiratory fitness was measured by a graded exercise treadmill test and expressed as percent change in oxygen consumption from baseline. Excluding 5 women who left the study (because of pregnancy or death) the data were analyzed by the intention-to-treat method (completion rate 184/196 = 94%). MAIN RESULTS: Attendance at group sessions and reported dietary intake and exercise adherence suggested that all groups complied similarly with their dietary and exercise prescriptions. Mean weight loss after 1 year was 8.9, 8.2, 6.3, and 7.0 kg, for the vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration groups, respectively, but there was no effect of exercise duration or exercise intensity on changes in body weight or in BMI. Cardiorespiratory fitness increased for all groups; 22%, 14.9%, 13.5%, and 18.9%, for the vigorous intensity/high duration, moderate intensity/high duration, moderate intensity/moderate duration, and vigorous intensity/moderate duration groups, respectively, but the groups did not differ in effect of exercise intensity (P = 0.11) or exercise duration (P = 0.35). When participants were divided by their reported average weekly duration of exercise at months 6 and 12, the group which averaged > or =200 min/week at both time points lost more weight than the groups which averaged <150 min/week of physical activity or whose activity duration was inconsistent (difference among groups, P = 0.01). They also had a greater percent increase in cardiorespiratory fitness than those who averaged <150 min/week of physical activity (P = 0.007) and those whose activity was inconsistent (P = 0.003). CONCLUSION: Sedentary overweight women lost weight and improved cardiorespiratory fitness in a year-long combined dietary and exercise regimen. Duration of exercise (at least 150 min/week of walking) was more important than vigorous versus moderate intensity in achieving these goals.

Comment↗

PubMed2006

Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise.

OBJECTIVES: Our study attempted to validate a Doppler index of diastolic filling (E/E') during exercise with simultaneously measured left ventricular diastolic pressure (LVDP), investigate its association with exercise capacity, and understand which patients to select for testing. BACKGROUND: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity approximates LVDP at rest, but there is limited validation of exercise E/E' with invasive hemodynamic measurement, and its clinical implications are unclear. METHODS: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity was measured at rest and during supine cycle ergometry in 37 patients undergoing left heart catheterization. In addition to correlation between invasive and estimated LVDP, the accuracy of different cutoffs for identification of elevated LVDP (>15 mm Hg) was determined at both rest and exercise. Doppler index of diastolic filling was also measured at rest and immediately after maximal treadmill exercise in 166 patients to investigate the association between exercise E/E' and exercise capacity (<8 metabolic equivalents [METs]). RESULTS: In patients undergoing invasive measurement, nine (24%) had elevation of LVDP only during exercise. There was a good correlation between E/E' and LVDP at rest (r = 0.67) and during exercise (r = 0.59), and the regressions at rest and exercise corresponded closely. Receiver-operator curve analysis indicated that a cutoff value of 13 for exercise E/E' identified patients with an elevated LVDP during exercise. A post-exercise E/E' >13 was highly specific (90%) for reduced exercise capacity, and even after classification of resting E/E', exercise E/E' permitted classification of patients with exercise capacity <8 METs or > or =8 METs. CONCLUSIONS: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity correlates with invasively measured LVDP during exercise. It can be used to reliably identify patients with elevated LVDP during exercise and reduced exercise capacity.

Cardiac Catheterization↗

PubMed1997

Cardiorespiratory response to exercise after modified Fontan operation: determinants of performance.

OBJECTIVES: This study sought to measure the cardiorespiratory responses to exercise and to identify the perioperative determinants of exercise performance in children, adolescents and young adults who underwent the modified Fontan operation. BACKGROUND: Several studies of the cardiorespiratory responses to exercise after the Fontan operation have demonstrated subnormal maximal oxygen uptake and exercise heart rate, but the perioperative variables that ultimately affect exercise responses have not been assessed systematically. METHODS: The study included 59 of the 548 patients who underwent a modified Fontan operation between January 1, 1984 and December 31, 1993 at the Mayo Clinic. Spirometry was performed at rest in all patients before exercise testing. The patients then exercised using a previously calibrated cycle ergometer and a 3-min incremental cycle exercise protocol. Multiple linear regression analysis was used to determine a subset of variables associated with oxygen uptake at peak exercise (VO2max), blood oxygen saturation (O2sat) and heart rate at peak exercise (HRmax). RESULTS: VO2max ranged from 29% to 95% of normal value; O2sat at peak exercise ranged from 77% to 96%; and HRmax ranged from 39.7% to 97.4% of normal value. Multivariate analysis showed that log VO2max/kg2/3 was associated with age at exercise, male gender, body surface area, preoperative confluent pulmonary arteries and rest VO2max/kg2/3. Preoperative left pulmonary artery stenosis, the presence of a classic Glenn anastomosis at exercise and rest O2sat were associated with O2sat at peak exercise. Age, body surface area at exercise, heart rate at rest and diastolic blood pressure were associated with HRmax at exercise. CONCLUSIONS: Subnormal VO2max and HRmax values were demonstrated at peak exercise. Several perioperative variables were associated with VO2max and O2sat at peak exercise. The presence of a classic Glenn anastomosis was associated with decreased O2sat at peak exercise, suggesting intrapulmonary shunting with the classic Glenn anastomosis.

Adolescent↗

PubMed1998

The effect of maximum heart rate on oxygen kinetics and exercise performance at low and high workloads.

The normal heart rate is linearly related to oxygen consumption during exercise. The maximum heart rate of the normal sinus node is approximated by the formula: HRmax = (220-age) with a variance of approximately 15%. However, the nominal upper rate of most permanent pacemakers is 120 beats/min, a value that remains unchanged for many patients. As this nominal setting falls well below the maximum predicted heart rate for most patients, it is possible that the chronotropic response of rate adaptive pacemakers during moderate and maximal exercise workloads may be less than optimal. The purpose of this study was to determine the effect of the upper programmed rate on oxygen kinetics during submaximal exercise workloads and maximum exercise performance during symptom-limited treadmill exercise. Exercise performance with an upper rate programmed to 220-age was compared with an upper rate of 120 beats/min. Eleven patients (5 men and 6 women, mean age 54 +/- 10 years) with complete heart block following catheter ablation of the atrioventricular junction for refractory atrial fibrillation who were implanted with permanent, rate-modulating VVIR pacemakers comprised the study population. The rate adaptive sensors were based on activity in 8 patients, minute ventilation in 2 patients, and mixed venous oxygen saturation in 1 patient. After performing a symptom-limited treadmill exercise test to determine maximum exercise capacity and to optimized programming of the rate adaptive sensor, each subject performed two treadmill exercise tests in random sequence with a rest period of at least 1 hour between tests. During one of the tests the upper rate was programmed to a value calculated by the formula: HRmax = (220-age). During the other exercise test the upper rate was programmed to 120 beats/min. Patients were blinded as to their programmed values and to the hypothesis of the study. A novel treadmill exercise protocol was used that consisted of a 6 minute, constant-workload phase at approximately 50% of maximum workload followed immediately by incremental, symptom-limited exercise using a modified Chronotropic Assessment Exercise Protocol(CAEP) with 1 minute stages until; peak exertion. Breath-by-breath analysis of expired gases was performed with subjective scoring of exertional difficulty at the end of the constant workload phase and during each stage of incremental exercise using the Borg Perceived Exertion Scale. Exercise duration was significantly longer (637 +/- 47 vs 611 +/- 48 seconds, P < 0.005) with the higher programmed upper rate. Oxygen kinetics were also significantly improved with an age predicted upper rate with a lower O2 deficit (258 +/- 88 vs 395 +/- 155 mL, P = 0.002) and higher VO2 rate constant (3.6 +/- 1.0 vs 2.4 +/- 0.7, P < 0.001). The VO2max during peak exertion was higher with an age predicted upper rate than with an upper rate of 120 beats/min (1807 +/- 751 vs 1716 +/- 702 mL/min, P = 0.04). The mean Borg score was lower during the last common treadmill stage during maximum exercise with an age predicted upper rate than with an upper rate of 120 beats/min (15.7 +/- 2.0 vs 16.5 +/- 1.9, P = 0.04). The mean Borg score during submaximal, constant workload exercise was also lower with a higher upper rate (9.0 +/- 2.5 vs 9.6 +/- 2.2, P = 0.10). Programming the upper rate of rate adaptive pacemakers based on the age of the patient improves exercise performance and exertional symptoms during both low and high exercise workloads as compared with a standard nominal value of 120 beats/min.

Adult↗

PubMed2006

Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: a randomized trial.

BACKGROUND: Guidelines recommend high-intensity continuous exercise to reduce peripheral muscle dysfunction in patients with chronic obstructive pulmonary disease but acknowledge that interval exercise might be an equally effective alternative that is better tolerated by patients. OBJECTIVE: To assess whether interval exercise is no less effective than high-intensity continuous exercise and whether it is tolerated better by patients with severe chronic obstructive pulmonary disease. DESIGN: Randomized, noninferiority trial. SETTING: Publicly funded rehabilitation hospital in Switzerland. PATIENTS: 98 patients with severe chronic obstructive pulmonary disease, with or without recent exacerbations. INTERVENTION: 12 to 15 supervised interval or high-intensity continuous exercise sessions (over 3 weeks) followed by exercise at home. MEASUREMENTS: Health-related quality of life determined by using the Chronic Respiratory Questionnaire (CRQ) (scores from 1 [most severe impairment] to 7 [no impairment]) after 5 weeks and number of unintended breaks during supervised exercise. RESULTS: Both groups experienced large improvements in health-related quality of life (increase of CRQ total scores of 1.00 [SD, 0.98] for the interval exercise group and 1.02 [SD, 1.05] for the continuous exercise group). Adjusted between-group differences between the interval exercise group and the continuous exercise group (-0.05 [95% CI, -0.42 to -0.32] for CRQ and 1.1 meters [CI, -25.4 to 27.6 meters] for 6-minute walking distance) were within the a priori defined boundaries of noninferiority (0.5 for CRQ and 45 meters for 6-minute walking distance). Twenty-one (47.9%) patients using interval exercise and 11 (24.0%) patients using continuous exercise were able to adhere to the protocol (difference, 23.9 percentage points [CI, 5.0 to 42.8 percentage points]; P = 0.014). The median number of unintended breaks lasting 1 minute or more was 2 (interquartile range, 0 to 16) for patients in the interval exercise group and 11 (interquartile range, 2 to 26) for patients in the continuous exercise group (P = 0.023). LIMITATIONS: The study focused on initiation of exercise and not on outpatient or home-based maintenance of exercise. CONCLUSIONS: Clinicians and patients can choose either of the 2 exercise plans to initiate physical exercise. International Standard Randomized Controlled Trial number: SRCTN11611768.

Aged↗