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Assessment of ability to recall physical activity of several years ago.

In this study we assessed the reliability of recall of physical activity. Study participants were members of the Coronary Artery Risk Development in Young Adult Study (CARDIA) cohort who reported physical activity at each CARDIA examination. In this study, we asked 81 participants to recall activity patterns for the year prior to 2 to 3 years ago so that we could compare recalled activity patterns to those reported 2 to 3 years ago (labeled as "distantly recalled") as well as to activity patterns reported at the other CARDIA examinations. We found that distantly recalled physical activity patterns were highly correlated with those reported at the time of the examination where they were obtained (vigorous activity r = 0.84, moderate activity r = 0.64, and total activity r = 0.81). Distantly recalled activity was less highly associated with activity reported currently (vigorous activity r = 0.57, moderate activity r = 0.45, total activity r = 0.59). The activity recalled the best was jogging or running (r = 0.76) and the activity with the poorest recall was racket sports (r = 0.53). Distantly recalled physical activity also was related to resting pulse rate obtained during the time period of the recalled activity (r = -0.21). These findings suggest that people can recall activity patterns of several years ago with high reliability.

Adolescent↗

[Hip and knee replacement and sport].

INTRODUCTION: Knee or hip arthroplasty in the sportsman raise many problems including the possibility or to come back to sports activities, and the implants longevity. Unicompartimental prosthesis of the knee is a relatively preserving surgery whose results in the long run in particular for the sporting subject can be for some authors sometimes disappointing. Total knee arthroplasty remains more invasive but with functional results always compatible with some sports activities. The functional result depends much on the postoperative, plurifactorial flexion. Concerning the hip, the sportsman, more active and younger than the average population suffering from osteoarthritis suffer statically more of osteoarthritis. The contribution of the total hip prostheses without cement, anatomical even custom, and of the new couples of friction seems to allow a better longevity. In addition, the contribution of the mini-invasive techniques and the computer-assisted surgery seem techniques with a promising future. METHODS: We present our experience with the unicompartimental arthroplasty, the postoperative flexion in the total knee prostheses and in the hip arthroplasty for the younger patient and the relations between these interventions and sports. RESULTS: Many authors studied the possibilities of sporting recovery (standard of sport and level of practice). The majority of the activities can be taken again, by excluding the sports of team, of ball and the jogging. The contribution of the mini-invasive techniques seems to allow a faster recovery and the uncemented hip prostheses give good long-term results in the young and active patient.

Adult↗

Positive, site-specific associations between bone mineral status, fitness, and time spent at high-impact activities in 16- to 18-year-old boys.

The incidence of hip and forearm fracture in elderly men in the United Kingdom is a public health issue, but there is limited knowledge on lifestyle factors affecting male bone health. The aim of this cross-sectional study was to evaluate the relationships between whole body and regional bone mineral status and self-reported participation time in no-, low-, moderate-, and high-impact activities and fitness measurements in 16- to 18-year-old boys. One hundred twenty-eight boys underwent absorptiometry (DXA) measurements (Hologic QDR 1000W) of bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the whole body, hip, spine, and forearm. They also completed the EPIC (European Prospective Investigation of Cancer) physical activity questionnaire, which allowed categorization of activities according to impact and aerobic intensity. Fitness and strength were assessed in each subject using estimated VO2 max, grip strength, and back strength. Significant positive relationships were found between BMC, BA, and BMD and the fitness and strength measurements and participation time in high-impact sports at most skeletal sites. The relationships were further examined after adjustment of BMC for height, weight, and bone area, thereby minimizing the influence of body and bone size on these relationships. VO2 max was a significant positive determinant of size-adjusted BMC at the whole body, the ultradistal and one-third radius, and all the hip sites, except the trochanter. Size-adjusted BMC at the forearm sites and trochanter was significantly positively associated with grip strength. Size-adjusted BMC at the whole body and all the hip sites was significantly positively associated with time spent at high-impact activities. Differences in size-adjusted BMC across thirds of time spent at high-impact activities were also examined. Boys in the highest third of high-impact activity had significantly greater size-adjusted whole body BMC and total hip BMC compared to subjects in the lowest third [+3.4 (1.2)% for whole body and +8.5 (2.2)% for hip, both P = 0.001]. Boys in the highest third of high-impact activity spent most activity time jogging, playing tennis, football and rugby, basketball, and exercising with weights. Back strength and lean mass were significantly greater in subjects in the highest third compared to those in the middle (P = 0.02) and lowest third (P = 0.03). No significant differences were found between subjects in each third of high-impact activity for potential confounders including TV viewing, calcium intake, body fat, and height. These findings indicate that participation of male adolescents in a range of high-impact activities for 1 h or more a day is associated with greater bone size and mineral content, especially at the hip.

Adolescent↗

New developments in exposure assessment: the impact on the practice of health risk assessment and epidemiological studies.

The field of exposure assessment has matured significantly over the past 10-15 years. Dozens of studies have measured the concentrations of numerous chemicals in many media to which humans are exposed. Others have catalogued the various exposure pathways and identified typical values which can be used in the exposure calculations for the general population such as amount of water or soil ingested per day or the percent of a chemical than can pass through the skin. In addition, studies of the duration of exposure for many tasks (e.g. showering, jogging, working in the office) have been conducted which allow for more general descriptions of the likely range of exposures. All of this information, as well as the development of new and better models (e.g. air dispersion or groundwater models), allow for better estimates of exposure. In addition to identifying better exposure factors, and better mathematical models for predicting the aerial distribution of chemicals, the conduct of simulation studies and dose-reconstruction studies can offer extraordinary opportunities for filling in data gaps regarding historical exposures which are critical to improving the power of epidemiology studies. The use of probabilistic techniques such as Monte Carlo analysis and Bayesian statistics have revolutionized the practice of exposure assessment and has greatly enhanced the quality of the risk characterization. Lastly, the field of epidemiology is about to undergo a sea change with respect to the exposure component because each year better environmental and exposure models, statistical techniques and new biological monitoring techniques are being introduced. This paper reviews these techniques and discusses where additional research is likely to pay a significant dividend. Exposure assessment techniques are now available which can significantly improve the quality of epidemiology and health risk assessment studies and vastly improve their usefulness. As more quantitative exposure components can now be incorporated into these studies, they can be better used to identify safe levels of exposure using customary risk assessment methodologies. Examples are drawn from both environmental and occupational studies illustrating how these techniques have been used to better understand exposure to specific chemicals. Some thoughts are also presented on what lessons have been learned about conducting exposure assessment for health risk assessments and epidemiological studies.

Bayes Theorem↗

A model-based image-matching technique for three-dimensional reconstruction of human motion from uncalibrated video sequences.

In many situations, e.g. sports injuries, three-dimensional kinematics cannot be obtained with traditional lab methods. However, if methods for reconstructing motion patterns from video sequences were available, our understanding of injury mechanisms could be improved. The aim of this study was to assess the accuracy of a new model-based image-matching technique for human motion reconstruction from one or more uncalibrated video sequences, using traditional motion analysis as a gold standard. A laboratory trial was conducted with one test subject performing jogging and side step cutting, while being filmed with three ordinary video cameras. This provided three single camera matchings, three double camera matchings and one triple camera matching for each of the motions. The test subject wore 33 reflective skin markers and was filmed with a seven-camera, 240 Hz motion analysis system. Root mean square (RMS) hip and knee flexion/extension angle differences were less than 12 degrees for all the matchings. Estimates for ad-/abduction (<15 degrees) and internal/external rotation (<16 degrees) were less precise. RMS velocity differences up to 0.62 m/s were found for the single camera matchings, but for the triple camera matching the RMS differences were less than 0.13 m/s for each direction. In conclusion, a new model-based image-matching technique has been developed, that can be used to estimate temporal joint angle histories, velocities and accelerations from uncalibrated video recordings. The kinematic estimates, in particular for center of mass velocity and acceleration, are clearly better when two or more camera views are available. This method can potentially be used to arrive at more precise descriptions of the mechanisms of sports injuries than what has been possible without elaborate methods for three-dimensional reconstruction from uncalibrated video sequences, e.g. for knee injuries.

Biomechanical Phenomena↗

Electromyography of selected lower-limb muscles fatigued by exercise at the intensity of soccer match-play.

Surface electromyography has been useful in comparing muscular activity among different sports movements and it is a valuable technique for evaluating muscle activation, co-ordination and fatigue. Since these important variables have not been investigated during the full game in soccer, the present study aimed to investigate the activity of major muscles of the lower extremity during a soccer-simulation fatiguing protocol. Ten amateur soccer players (age 21.40+/-3.13 years; height 1.77+/-0.06 m; mass 74.55+/-8.5 kg) were tested. The exercise protocol, performed on a programmable motorised treadmill, consisted of the different intensities observed during soccer match-play (walking, jogging, running, sprinting). Electromyographic activity was recorded from the rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA) and gastrocnemius (GC) muscles before exercise, at half-time and immediately after the 90-min exercise protocol. The EMG data were analysed using custom-written software to compute the root mean square (RMS) value over ten gait cycles. With regard to RF, BF and TA, a significant main effect (P< 0.05) was found for condition (pre-game, half-time and post-game), speed (6, 12, 15 and 21 km h(-1)) (P<0.05) and interaction between condition and speed (P< 0.05). For GC, a significant effect was not found for condition or interaction between condition and speed, but a significant main effect (P< 0.001) was found for speed, with the RMS value increasing continually with increasing speed from 6 to 2 1km h(-1). The results indicated that after a simulation of the exercise intensity of soccer-play the EMG activity in major lower-limb muscles was less than before. This decrease indicated that prolonged intermittent exercise had an effect on muscle activity even when work-rate was sustained.

Adult↗

Characteristics of anterior cruciate ligament injuries in Australian football.

Anterior cruciate ligament (ACL) injuries are the most costly injuries in football at both professional and amateur levels (Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 2001;29:196-200.). In this study video analysis of 34 ACL injuries in Australian football was performed to investigate the causes of these injuries. Factors that may have contributed to the cause of the injury were analysed, rated and reported. The factors analysed were: type of manoeuvre, direction the knee 'gave way', running speed, knee angle, cutting angle and if the player was accelerating or decelerating. The majority of the injuries analysed occurred in non-contact situations (56%). Of these 37% occurred during sidestepping manoeuvres, 32% in landing, 16% land and step, 10% stopping/slowing and 5% crossover cut manoeuvres. Ninety-two percent of the non-contact injuries occurred at extended knee angles of 30 degrees or less, which is also commonly known to place stress on the ACL and reduce the protective role of hamstrings. Over half (54%) of non-contact injuries occurred whilst decelerating. It would be expected that greater speed and angle cut too would increase the frequency of ACL injury. The results could not confirm this with most injuries occurring at running speeds of slow jogging to running and equal number of injuries occurred at cutting to angles of the ranges 15-45 degrees and 45-75 degrees. These results give greater understanding into potential causes or contributors of ACL injury and information to assist in the development of knee injury prevention programs.

Anterior Cruciate Ligament Injuries↗

Epidemiology of athletic knee injuries: A 10-year study.

The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.

Adolescent↗

Weight-bearing, aerobic exercise increases markers of bone formation during short-term weight loss in overweight and obese men and women.

We investigated the impact of weight-bearing, aerobic exercise- and diet-induced weight loss on markers of bone turnover during a larger study of changes in metabolic fitness during short-term weight reduction using a repeated-measures, within-subject experimental design. Subjects (N = 19) underwent 6 weeks of energy restriction (reduced by approximately 3140 kJ/d) and aerobic exercise ( approximately 1675 kJ/d, walking or jogging at 60% maximum oxygen consumption) to induce a 5% reduction in body weight. Bone turnover markers and hormones were measured in serum collected at baseline and after 6 weeks of weight loss. Despite a 5% reduction in body weight at week 6, markers of bone formation, osteocalcin, and bone alkaline phosphatase, were significantly increased, and resorption markers, C-terminal cross-links of type I collagen and soluble receptor activator of nuclear factor kappaB ligand, were unchanged after 6 weeks of energy restriction and exercise. The concentration of leptin was significantly reduced after weight loss, but insulin-like growth factor I (IGF-I) and cortisol levels were unaffected. In conclusion, weight-bearing, aerobic exercise training may favorably affect the balance between bone resorption and formation during weight loss.

Adolescent↗

Activity levels among adolescents with migraine.

Data was analyzed from the nationally representative Canadian Community Health Survey. A total of 17,549 adolescents reported whether they had "migraine headaches" (response rate 99.9%) and in what exercise activities they participated. Those with migraine reported more daily activity than migraine-free peers when corrected for age and sex. They were as likely to play contact sports but were more involved in other noncompetitive activities, such as walking (P<0.001), gardening and yard work (P=0.008), jogging and running (P=0.002), and fishing (P=0.03). Canadian adolescents with migraine are therefore overall more active than their peers without migraine.

Adolescent↗

In vivo human brain biochemistry after aerobic exercise: preliminary report on functional magnetic resonance spectroscopy.

BACKGROUND: Our aim was to disclose whether the positive psychological changes observed after a single bout of aerobic exercise have a biochemical correlate that can be visualized by proton magnetic resonance spectroscopy (MRS) of the human brain. METHODS: Right-handed male volunteers underwent psychological testing and MRS of the frontal lobe of the left hemisphere, both before and after 20 minutes of jogging at about 70% of their maximal aerobic capacity. RESULTS: Although there was a significant decrease on the postexercise anxiety test scores (z = -2.201, P < .05), there was no significant difference between the preexercise and postexercise scores of positive and negative affect. Considering both "amplitude" and "area under the curve" values calculated for the peaks of metabolites N-acetylaspartate (NAA), creatine, and choline, none were found to be significantly changed (P > .05) after the exercise. CONCLUSION: This is, to our knowledge, the first study to report on a functional application of MRS to mood states. Because it offers the ability to directly measure metabolic changes in the brain during neuronal activation, "functional MRS" may be a potential new tool that may be used as an adjunct to functional magnetic resonance imaging.

Adolescent↗

Effects of high-intensity strength training on quality-of-life parameters in cardiac rehabilitation patients.

Cardiac rehabilitation programs have not consistently been shown to improve the psychological well being of their patients. In our study of 38 cardiac patients (29 men and 9 women), a variety of quality-of-life parameters were assessed before and after they completed either 12 weeks of high-intensity strength training or flexibility training added to their outpatient cardiac rehabilitation aerobic exercise program. The strength-trained patients increased their self-efficacy scores for lifting (29% vs 4%, p <0.05), push-ups (65% vs. 17%, p <0.01), climbing (36% vs 0%, p <0.001), and jogging (100% vs -9%, p <0.001), when compared with the flexibility-trained patients. The strength group also had greater improvements in Profile of Mood States dimensions: total mood disturbance (123% vs 18%, p <0.05), depression/dejection (73% vs 15%, p <0.05), and fatigue/inertia (42% vs 3% p <0.05), than did the flexibility group. The Medical Outcome Survey Short Form 36 role emotional health domain scores were significantly improved in the strength group when compared with the flexibility group (64% vs 0%, p <0.05), and the role limitation scores improved in both groups. Increases in strength were associated with enhanced self efficacy and improved mood and well-being scores (n = 34, r = 0.30 to 0.53, p <0.05). High-intensity strength training added to a cardiac rehabilitation program of selected patients leads to improvements in quality-of-life parameters. These data, in conjunction with improvements in strength, strongly support the value of adding high-intensity strength training to cardiac rehabilitation programs.

Coronary Disease↗

Frictional heating of total hip implants. Part 1: measurements in patients.

Hip implants heat up due to friction during long lasting, high loading activities like walking. Thermal damage in the surrounding soft and hard tissues and deteriorated lubrication of synovial fluid could contribute to implant loosening. The goal of this study was to determine the implant temperatures in vivo under varying conditions. Temperatures and contact forces in the joints were measured in seven joints of five patients using instrumented prostheses with alumina ceramic heads and telemetry data transmission. The peak temperature in implants with polyethylene cups rose up to 43.1 degrees C after an hour of walking but varied considerably individually. Even higher temperatures at the joints are probable for patients with higher body weight or while jogging. The peak temperature was lower with a ceramic cup, showing the influence of friction in the joint. During cycling the peak temperatures were lower than during walking, proving the effect of force magnitudes on the produced heat. However, no positive correlation was found between force magnitude and maximum temperature during walking. Other individual parameters than just the joint force influence the implant temperatures. Based on the obtained data and the available literature about thermal damage of biological tissues a detrimental effect of friction induced heat on the stability of hip implants cannot be excluded. Because the potential risk for an individual patient cannot be foreseen, the use and improvement of low friction implant materials is important.

Aged↗

Physical activity levels and coronary heart disease. Analysis of epidemiologic and supporting studies.

Coronary heart disease, the primary health problem in western life, is caused by the interaction of multiple factors. Absolute proof of the contributing role of physical inactivity is not possible owing to the complexity of the CHD problem and the infeasibility of a definitive clinical trial because of logistical and economic constraints. Despite limitations, existing epidemiologic studies strongly suggest, but fall short of proving, the concept that habitual physical exercise offers partial protection against primary or secondary events of CHD and associated mortality. However, experimental data support this hypothesis and provide evidence of possible mechanisms responsible for the protection. The available epidemiologic data also suggest that physical inactivity is probably not as potent an individual risk factor as elevated serum cholesterol levels, hypertension, and cigarette smoking, and that the protective effects of exercise may be overwhelmed by high levels of these major risk factors. On the other hand, there is some evidence that exercise may attenuate other risk factors both directly and through associated weight reduction. Epidemiologic studies also suggest a dose response relationship between physical activity and rates of CHD. About 2000 kcal per week of moderate intensity, dynamic, endurance-type of exercise (such as walking or jogging about 20 miles per week) or at least one hour of intermittent hard physical labor are required to obtain the optimal effect of exercise on coronary heart disease rates. Experimental studies suggest that this amount of exercise should provide sufficient stimulus to favorably alter blood HDL cholesterol levels and perhaps other CHD risk factors, especially if there is an accompanying reduction in weight. Possible mechanisms for the protective effects of exercise against CHD are illustrated in Figure 1. Insistence on final experimental proof prior to prudent medical practice or public health policy on physical inactivity or other coronary risk factors indicates a lack of understanding of the nature of scientific proof and evidence required for health actions.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Endurance exercise training. An effective therapeutic modality for hemodialysis patients.

These results demonstrate that some of the metabolic complications of chronic uremia treated with maintenance hemodialysis are related to the deterioration in physical fitness and strength that accompanies this chronic disease. Exercise training increased the physical work capacity, improved the lipid profile, normalized insulin sensitivity and glucose metabolism, and lowered the dose of antihypertensive medications required by some of the patients. These changes occurred in the absence of significant changes in diet or body weight. Furthermore, during an equivalent period of follow-up there was a significant deterioration in the lipid profiles of sedentary controls. Thus, exercise training has the potential to reduce the prevalence of many of the medical conditions thought to promote atherogenesis in hemodialysis patients. In addition, there was a significant improvement in the degree of anemia of the exercising patients. None of these metabolic and physiological changes could be attributed to factors related to changes in dialysis scheduling or technology, medications, or diets. Exercise training was associated with an improvement in the mood, level of depression, and psychosocial functioning of these patients; the sedentary controls either became more depressed or reduced their participation in pleasant, socially oriented activities. This raises the possibility that exercise training may have the potential to return some dialysis patients to a more normal social lifestyle, perhaps improving their socioeconomic status and reducing their dependency. These are extremely optimistic possibilities that could have far-reaching implications for the hemodialysis population. The dramatic improvements in lipid and glucose metabolism, hematologic function, blood pressure and work capacity in the exercising patients indicates that aerobic physical training is an effective therapeutic modality with a wide spectrum of effects on many pathologic processes previously thought to be a consequence of chronic uremia. Not only were there major biochemical changes as a result of exercise training, but the psychosocial functioning of these dialysis patients improved. Some of the physiologic changes, such as the increase in work capacity, greater strength and energy, and the rise in hematocrit, contributed to the psychological improvements, but in some patients accomplishing the goal itself (for most a 1-mile jog was the ultimate) seemed sufficient. There are a multitude of potential long-term benefits of exercise training programs for hemodialysis patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study.

BACKGROUND: Exercise-induced anaphylaxis (EIA) is a unique physical allergy that is triggered by exertion, the clinical spectrum and modifying factors of which have been previously studied. At the time of initial description, it was postulated that other factors contributed to this disorder. OBJECTIVE: We sought to determine the clinical course and potential modifying factors in EIA. METHODS: In 1993, we conducted a cross-sectional analysis of 671 individuals with exercise-associated symptoms for more than a decade using a validated 75-item questionnaire. Subjects met criteria for EIA if they had anaphylactic symptoms, including hypotension or upper airway obstruction, urticaria, or angioedema with physical exertion but without a passive increase in core body temperature. RESULTS: Of 365 (54%) questionnaire respondents, 279 (87%) met criteria for EIA (199 females and 80 males). At the time of study entry, subjects with EIA (mean age, 37.5 years; range, 13 to 77 years) had an average of 10.6 years of symptoms, which were most frequently triggered by aerobic activities such as jogging or brisk walking (78% and 42%, respectively). On average, subjects reported that the frequency of attacks had decreased (47% of subjects) or stabilized (46% of subjects) since onset. One hundred (41%) subjects reported being completely free of attacks in the past year. Subjects reduced their attacks by avoiding exercise during extremely hot or cold weather (44%), avoiding ingestion of certain foods before exercise (37%), and restricting exercise during their allergy season (36%) or humid weather (33%). The most common pharmacologic agents used to manage symptoms were H1 antagonists (56%) and/or epinephrine (31%). However, 28% used no treatment at all. CONCLUSION: EIA is an episodic condition in which the frequency of attacks tends to stabilize or decrease over time. Improvement appears to result from individual modification of exercise and avoidance of known environmental and ingestible precipitants.

Adolescent↗

Why is the incidence of ischaemic heart disease in Sweden increasing?: study of men born in 1913 and 1923.

The mortality from ischaemic heart disease (IHD) in the USA is falling, and this has been attributed to a changing life-style, with less smoking, more jogging, and less fat consumption, and to improved medical care. Similar changes in life-style are taking place in Sweden, but IHD mortality there is increasing. The rising incidence of IHD was also evident in two cohorts of 50-year-old Swedish men examined 10 years apart. Despite similar levels of traditional IHD risk factors, the incidence of IHD in the second cohort was almost double that in the first. Possible explanations for the increasing IHD mortality are an increasing prevalence of obesity in Swedish men, a longer "incubation" time during which the traditional risk factors have acted in the second cohort, or the appearance of unknown risk factors.

Aged↗

Myocardial ischemia during physical exercise in patients with stable coronary artery disease: predictability and prevention.

AIMS: We assessed whether exercise-induced myocardial ischemia during intensive group exercise sessions can be predicted in patients with coronary artery disease and stable angina pectoris. METHODS AND RESULTS: Twenty-three patients underwent cardiac catheterization, 201-thallium scintigraphy, and exercise testing prior to participation in group training sessions. Heart rates and myocardial ischemia were documented by Holter monitoring. The individual training heart rate was calculated as a percentage of the maximal heart rate achieved during symptom-limited exercise testing. Myocardial ischemia occurred significantly more often during group exercise sessions (15 of 23 patients) than during treadmill testing (4 of 23 patients, P<0.001). Maximal heart rate (145+/-23 vs. 134+/-21 beats/min, P<0.004) and maximal plasma lactate concentrations (6.0+/-2.9 vs. 4.3+/-2.0 mmol/l, P<0.05) were significantly higher than during symptom-limited exercise testing. Ischemic episodes occurred significantly more often during jogging than during competitive ball games or interval training. Myocardial ischemia occurred in patients who exceeded their individual target training heart rates (43 of 44 episodes; P<0.001). Duration of ischemic episodes did not correlate with any marker obtained at the beginning of the study. CONCLUSION: These data demonstrate that routine diagnostic procedures do not sufficiently identify patients at risk for exercise-induced myocardial ischemia. Ischemic events are only effectively prevented by choosing adequate types of exercise and, above all, by the strict adherence to individual target heart rates.

Coronary Angiography↗