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PubMed1993

Effects of electrical stimulation and upper body training after spinal cord injury.

The purpose of this study was to measure the cardiorespiratory improvements during the initial weeks of training in individuals with spinal cord injury (SCI). Eight adult volunteers (ages 23-41) with paraplegia (T4-L1, N = 7) and low levels of quadriplegia (C7, N = 1) participated in a 12-wk training program consisting of 6 wk of computerized functional electrical stimulation leg ergometry (CFES LE) followed by 6 wk of combined arm ergometry and CFES LE (hybrid ergometry; HE). Measures of peak oxygen consumption (pV02) and immediate post-exercise blood lactate (La-) were collected during an intermittent CFES LE graded exercise test (3-min stages; 1/8-kp increments) prior to training (0T), following 6 wk of CFES LE training (6T) and following 6 wk of HE training (12T). Voluntary arm ergometry (AE) graded exercise tests were also completed at each of 0T, 6T, and 12T, and an intermittent graded HE test was also given at 6T and 12T. Following the 6 wk of CFES LE, AE pVO2 increased from 1.14 +/- 0.09 l.min-1 to 1.39 +/- 0.172 l.min-1 (P < 0.05), and CFES LE pVO2 increased from 0.51 +/- 0.05 l.min-1 to 0.83 +/- 0.06 l.min-1 (P < 0.05). Following the 6 wk of HE, HE pVO2 increased from 1.31 +/- 0.15 l.min-1 to 1.49 +/- 0.14 l.min-1 (P < 0.05). HE pVO2 was 58%-60% higher than CFES LE pVO2 at the mid- and post-testing periods. HE pVO2 was 14% higher than AE pVO2 at the post-testing period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Training theory and taper: validation in triathlon athletes.

This paper defines a training theory with which to predict the effectiveness of various formats of taper in optimizing physical performance from a standardized period of training and taper. Four different taper profiles: step reduction vs exponential (exp) decay and fast vs slow exp decay tapers, were simulated in a systems model to predict performance p(t) resulting from a standard square-wave quantity of training for 28 days. The relative effectiveness of each of the profiles in producing optimal physical improvement above pre-taper criterion physical test standards (running and cycle ergometry) was determined. Simulation showed that an exp taper was better than a step-reduction taper, and a fast exp decay taper was superior to a slow exp decay taper. The results of the simulation were tested experimentally in field trials to assess the correspondence between simulation and real-training criterion physical tests in triathlon athletes. The results showed that the exp taper (tau = 5 days) group made a significantly greater improvement above a pre-taper standard (P < or = 0.05) than the step-reduction taper group in cycle ergometry, and was better, but not significantly so, in a 5-km run. A fast exp taper group B (tau = 4 days) performed significantly better (P < or = 0.05) in maximal, cycle ergometry above a pre-taper training standard than a slow exp taper group A (tau = 8 days) and was improved more, but not significantly so, than group A in a 5-km criterion run. The mean improvement on both physical tests by exp decay taper groups all increased significantly (P < or = 0.05) above their pre-taper training standard. Maximum oxygen uptake increased significantly in a group of eight remaining athletes during 2 weeks of final taper after three athletes left early for final preparations at the race site.

Adult↗
PubMed1985

Beta-adrenergic regulation of the blood lymphocyte phenotype distribution in normal subjects and splenectomized patients.

The beta-adrenergic effect on the release of immunoregulatory cells from the spleen was investigated by physical stress testing (bicycle ergometry up to submaximal work capacity) in 19 normal subjects (15 males, median 21 years) and in 10 male patients splenectomized for trauma (median 29 years). It was repeated in 6 subjects of each group during beta-blockade with 80 mg oxprenolol. Blood samples for leucocyte analysis were taken before and at the end of the test. Leucocyte subpopulations were analyzed in a cytofluorograph after staining of buffy coat cells by direct (B cells) or indirect immunofluorescence with monoclonal antibodies directed against the phenotypes of T- (Leu-1), T helper- (Leu-3a), T suppressor/cytotoxic (Leu-2a) cells and natural killer (OKM1+ lymphocytes) cells. In the controls all leucocyte subsets increased at ergometry, but B-, Leu-2a- and OKM1-cells increased more than Leu-3a cells. During beta-blockade the leucocyte changes reached only 50% of the value without treatment; the B- and Leu-2a cell mobilization was reduced more than the Leu-3a-, OKM1 cell- and monocyte changes. In splenectomized patients the proportional cellular changes were only half of those found in normal subjects, except for the Leu-3a cells which were not released. Beta-blockade during ergometry had no effect on Leu-3a cells, a similar effect on B- and Leu-2a cells as in normal subjects and a stronger effect on granulocytes, monocytes and OKM1 cells than in controls. In conclusion, the B- and Leu-2a cell mobilization from the spleen (50%) was beta-adrenoceptor dependent, while the one from other lymphoid organs was beta-adrenoceptor independent. The strongly spleen dependent Leu-3a cell changes were not beta-adrenoceptor mediated. Granulocyte-, monocyte- and OKM1 cell changes were only partly spleen dependent. The spleen independent changes however were strongly beta-adrenoceptor dependent.

Adolescent↗
PubMed1994

Pituitary and adrenal hormone responses to pharmacological, physical, and psychological stimulation in habitual smokers and nonsmokers.

Hormone responses to injection of corticotropin-releasing hormone following bicycle ergometry and psychological stress were studied in ten habitual smokers and ten nonsmokers. Compared to injection of saline, significant increases were found in adrenocorticotropin, prolactin, growth hormone, total serum cortisol, and salivary cortisol under all three stimulations except for salivary cortisol under ergometry. Furthermore, the smokers showed significant elevations of all five hormones investigated following the smoking of two cigarettes of the subject's preferred brand. Comparisons of hormone responses between smokers and nonsmokers revealed a general trend towards stronger responses in nonsmokers. However, due to the small number of subjects investigated and considerable variation in the individual hormone responses these differences reached statistical significance only for growth hormone responses following ergometry and salivary cortisol responses after psychological stress. In addition, the circadian rhythm of salivary cortisol was measured on two occasions between 9 a.m. and 9 p.m. in the subject's natural environment. The typical circadian pattern of decreasing cortisol levels was observed, with no significant differences between smokers and nonsmokers. We conclude that chronic nicotine consumption may lead to lower responses of multiple hormones not only to nicotine but to a variety of stimuli, and that these alterations do not necessarily affect unstimulated circadian profiles of free cortisol.

Adrenocorticotropic Hormone↗
PubMed1986

The entrainment of ventilation frequency to exercise rhythm.

To investigate whether ventilation frequency could be entrained to a sub-harmonic of the exercise rhythm, 19 experimentally naive male volunteers were tested during steady state bicycle ergometry and arm cranking under conditions of constant applied workload. Each exercise was performed at two separate ventilatory loads, one within the linear range and the other in the curvilinear range of ventilatory response to exercise. A preferred exercise rhythm was initially adopted (4 min.) followed by forced incremented and decremented rhythm changes each lasting 3 min during a 12 min exercise period. Ventilation, pedal pulse train and heart rate were sampled at 17 Hz on a PDP 11/23 computer. Ratios of limb frequency to dominant respiratory frequency were determined following Fourier analysis of these signals. Data that lay within +/- 0.05 of an integer and half-integer ratio were accepted as indices of entrainment, provided that the observed entrained scores were statistically significant. Ventilation frequency showed a clear, but intermittent tendency to entrain with limb frequency. This tendency was greater during bicycle ergometry, possibly as a consequence of task familiarisation, although both exercise entrainments were independent of workload. No difference between preferred versus varied exercise rhythm was evident, but more entrainment (p less than 0.01) was observed during a decremental change in exercise rhythm. These responses do not appear to support an appreciable role for limb-based afferents in the control of entrainment. The results of this study provide evidence that exercise rhythm has some regulatory role in the control of breathing during moderate rhythmical laboratory-based exercise ergometry.

Adult↗
PubMed1983

The effect of physical activity on the intraocular pressure of glaucomatous patients.

Chronic simple glaucoma patients who performed physical activity had headache and nausea, symptoms that simulated a sudden rise in intraocular pressure. Twelve patients, who were diagnosed as suffering from simple open angle glaucoma, performed multiple bicycle ergometry. The intraocular pressure was measured during the ergometry and was compared to intraocular pressure measurements at rest. A statistically significant decrease was found in intraocular pressure during the ergometry performance. It was concluded that there is no ocular restriction for simple open angle glaucoma patients in performing physical activity.

Adult↗
PubMed1992

The effect of training on endurance and the cardiovascular responses of individuals with paraplegia during dynamic exercise induced by functional electrical stimulation.

Endurance for dynamic exercise, cardiac output, blood pressure, heart rate, ventilation, and oxygen consumption was measured in eight individuals with paraplegia at the end of 4-min bouts of exercise on a friction braked cycle ergometer. Movement of the subjects' legs was induced by electrically stimulating the quadriceps, gluteus maximus and hamstring muscles with a computer-controlled biphasic square--wave current at a frequency of 30 Hz. The friction braked cycle ergometer was pedalled at work rates which varied between 0 and 40 W. Measurements were repeated after 3 and 6 months to assess the affect of training. After 3 months of training it was found that endurance increased from 8 min at a work rate of 0 W to 30 min at a work rate of 40 W. Compared to the cardiovascular responses in non-paralyzed subjects, computerized cycle ergometry was found to be associated with higher relative stresses for a given level of absolute work. Mean blood pressure, for example, increased by over 30% during maximal work in individuals with paralysis compared to the typical response obtained for able-bodied subjects. Analysis of the data showed that instead of the 20-30% metabolic efficiency commonly reported for cycle ergometry, the calculated metabolic efficiency during computer-controlled cycle ergometry was only 3.6%.

Adult↗
PubMed1989

Anaerobic threshold, muscle volume and hypoxia.

Ventilatory threshold, apparent mechanical efficiency, oxygen debt repayment, heart rate and perceptions of exertion at the ventilatory threshold have been examined in 8 men and 8 women during the performance of four types of exercise (2-leg, 1-leg, arm plus shoulder, and arm ergometry) under normoxic and hypoxic (12% oxygen) conditions. The ventilatory threshold (percentage of task-specific VO2peak at which a disproportionate increase of ventilation begins) was not significantly affected by the sex of the subject, by hypoxia, or by the volume of active muscle involved in the activity, but showed poor reproducibility in small muscle tasks. The apparent mechanical efficiency in 2-leg ergometry was increased from 25.7 to 28.1% under hypoxic conditions, presumably reflecting an increased contribution of anaerobic effort to sub-maximal work. However, oxygen debt repayment following exhausting exercise was much smaller for arm than for leg ergometry. The heart rate corresponding to the ventilatory threshold decreased as the volume of active muscle was reduced. General and respiratory perceptions of effort were rather light for self regulation of an exercise prescription to the ventilatory threshold, and particularly with tasks involving the arm muscles, prescription may best be regulated by the intensity of local muscular sensations.

Adult↗
PubMed2005

[Leisure-time sport activities and cardiac outpatient therapy in coronary patients].

BACKGROUND: Exercise intensity in coronary patients is controlled by heart rate measurements. Very few investigations have compared the maximum heart rate in cardiac outpatient groups, in leisure-time sport activities, and especially in swimming. PATIENTS AND METHODS: Within different exercise conditions 21 coronary patients, nine in well-compensated cardiac condition joining a training group and twelve joining the exercise group with lower intensity, without signs of heart failure, engaged in an incremental bicycle ergometry. A six-lead ECG was derived at the same time with a 24-h ECG. The performance tolerance was measured by the pulse limit derived in 20 patients; one patient failed to show signs of subjective or objective ischemia. During a 24-h ECG monitoring, the patients took part in a 1-h standardized cardiac outpatient program, a standardized swimming program 4 x 25 m, and a typical self-selected leisure-time activity. RESULTS: The patients showed a peak work capacity of 2.2 W/kg and a symptom-free work capacity of 1.3 W/kg. The derived upper heart rate limit was passed during swimming by 19, during leisure-time activity by 16, and during cardiac outpatient program by two patients. The maximum of the mean overriding the limit occurred in leisure-time activity. Signs of ischemia occurred during ergometry in 15, during swimming training in ten patients, during leisure-time activity in eight, and during cardiac outpatient therapy in one. Arrhythmia < Lown IVa was documented on the ergometer in 15, during leisure-time sport activity in 15, during cardiac outpatient therapy in 17, and during swimming in eight patients. Arrhythmia Lown IVa occurred in one patient each during ergometry, leisure sports, and during the night. CONCLUSION: Coronary patients are in danger to exercise beyond the pulse limit during swimming and other leisure-time sports and not during cardiac outpatient therapy. The upper heart rate limit should be observed during swimming and other endurance leisure-time activities, and is of little importance during cardiac outpatient therapy.

Ambulatory Care↗
PubMed1998

Rectal and esophageal temperatures during upper- and lower-body exercise.

This study investigated the question: is core temperature measurement influenced by whether exercise involves predominantly upper- or lower-body musculature? Healthy men were allocated to three groups: treadmill ergometry (T) n = 4, cycle ergometry (C) n = 6 and arm crank ergometry (AC) n = 5. Subjects underwent an incremental exercise test to exhaustion on an exercise-specific ergometer to determine maximum/peak oxygen consumption (VO2max). One week later subjects exercised for 36 min on the same ergometer at approximately 65% VO2max while temperatures at the rectum (T(re)) and esophagus (T(es)) were simultaneously measured. The VO2max (1 x min(-1)) for groups T [4.76 (0.50)] and C [4.35 (0.30)] was significantly higher than that for the AC group [2.61 (0.24)]. At rest, T(re) was significantly higher than T(es) in all groups (P < 0.05). At the end of submaximal exercise in the C group, T(re) [38.32 (0.11) degrees C] was significantly higher than T(es) [38.02 (0.12) degrees C, P < 0.05]. No significant differences between T(re) and T(es) at the end of exercise were noted for AC and T groups. The temperature difference (T(diff)) between T(re) and T(es) was dissimilar at rest in the three groups; however, by the end of exercise T(diff) was approximately 0.2 degrees C for each of the groups, suggesting that at the end of steady-state exercise T(re) can validly be used to estimate core temperature.

Arm↗
PubMed2006

Effects of beta-alanine supplementation on the onset of neuromuscular fatigue and ventilatory threshold in women.

This study examined the effects of 28 days of beta-alanine supplementation on the physical working capacity at fatigue threshold (PWCFT), ventilatory threshold (VT), maximal oxygen consumption (VO2-MAX), and time-to-exhaustion (TTE) in women. Twenty-two women (age+/-SD 27.4+/-6.1 yrs) participated and were randomly assigned to either the beta-alanine (CarnoSyn) or Placebo (PL) group. Before (pre) and after (post) the supplementation period, participants performed a continuous, incremental cycle ergometry test to exhaustion to determine the PWCFT, VT, VO2-MAX, and TTE. There was a 13.9, 12.6 and 2.5% increase (p<0.05) in VT, PWCFT, and TTE, respectively, for the beta-alanine group, with no changes in the PL (p>0.05). There were no changes for VO2-MAX (p>0.05) in either group. Results of this study indicate that beta-alanine supplementation delays the onset of neuromuscular fatigue (PWCFT) and the ventilatory threshold (VT) at submaximal workloads, and increase in TTE during maximal cycle ergometry performance. However, beta-alanine supplementation did not affect maximal aerobic power (VO2-MAX). In conclusion, beta-alanine supplementation appears to improve submaximal cycle ergometry performance and TTE in young women, perhaps as a result of an increased buffering capacity due to elevated muscle carnosine concentrations.

Adult↗
PubMed1998

Oxygen desaturations during exercise and sleep in fit tetraplegic patients.

OBJECTIVE: Tetraplegic patients are particularly at risk for respiratory deficiencies during sleep. In a previous study, it was found that several patients exhibited significant oxygen desaturations during arm ergometry tests. Therefore, the issue of whether patients who desaturate during exercise would be especially at risk for having nocturnal respiratory problems was raised. DESIGN: Respiratory recordings in connection with arm ergometry tests and during sleep. SETTING: Arm ergometry tests were performed in a hospital laboratory, and sleep recordings were performed in the patients' homes. PATIENTS: Nine C5-C6 tetraplegic patients, aged 22 to 42 years with body mass index of 15.2 to 24.2 kg/m2. MAIN OUTCOME MEASURES: Oximetry during exercise and sleep and sleep recordings. RESULTS: During exercise, six patients desaturated 6% to 20%. Only one patient had signs of a significant nocturnal respiratory problem with an average of eight desaturations per hour of sleep and an obstructive respiration movement pattern. Two additional patients (with normal oximetry during exercise) showed occasional desaturation below 89% during rapid eye movement sleep. CONCLUSION: In this study, the majority of tetraplegic patients desaturated during submaximal arm exercise but not during sleep. The reason could be that the patients in this study were all lean and physically active, which is at variance with previously published sleep studies.

Adult↗
PubMed1999

The effect of exercise modality on exercise-induced hypoxemia.

To investigate the effect of exercise mode on arterial oxyhemoglobin saturation (SaO2), 13 healthy, actively training men who displayed exercise-induced hypoxemia (EIH) performed two incremental maximal exercise tests: uphill treadmill running and cycle ergometry. At maximum, treadmill running resulted in a lower SaO2 (88.6+/-2% versus 92.6+/-2.0%) a lower ventilatory equivalent for carbon dioxide (VE/VCO2; 28.8+/-0.6 versus 31.2+/-0.9), and a higher maximal oxygen consumption (VO2, MAX; 4.83+/-0.11 l x min(-1) versus 4.61+/-0.14 l x min(-1) when compared to cycle ergometry. When data were combined from maximal running and cycling. SaO2 was correlated to VE/VCO2 (r = 0.54). However, there was no relationship between the differences in SaO2 and ventilation between exercise modes. This suggests that ventilation is important in the maintenance of SaO2, but that the difference observed in SaO2 between treadmill running and cycle ergometry cannot be explained by differences in ventilation and must be due to differences in diffusion limitation or ventilation-perfusion inequality.

Adult↗
PubMed2000

Acute physiological effects of exhaustive whole-body vibration exercise in man.

Vibration exercise (VE) is a new neuromuscular training method which is applied in athletes as well as in prevention and therapy of osteoporosis. The present study explored the physiological mechanisms of fatigue by VE in 37 young healthy subjects. Exercise and cardiovascular data were compared to progressive bicycle ergometry until exhaustion. VE was performed in two sessions, with a 26 Hz vibration on a ground plate, in combination with squatting plus additional load (40% of body weight). After VE, subjectively perceived exertion on Borg's scale was 18, and thus as high as after bicycle ergometry. Heart rate after VE increased to 128 min-1, blood pressure to 132/52 mmHg, and lactate to 3.5 mM. Oxygen uptake in VE was 48.8% of VO2max in bicycle ergometry. After VE, voluntary force in knee extension was reduced by 9.2%, jump height by 9.1%, and the decrease of EMG median frequency during maximal voluntary contraction was attenuated. The reproducibility in the two VE sessions was quite good: for heart rate, oxygen uptake and reduction in jump height, correlation coefficients of values from session 1 and from session 2 were between 0.67 and 0.7. Thus, VE can be well controlled in terms of these parameters. Surprisingly, an itching erythema was found in about half of the individuals, and an increase in cutaneous blood flow. It follows that exhaustive whole-body VE elicits a mild cardiovascular exertion, and that neural as well as muscular mechanisms of fatigue may play a role.

Adult↗
PubMed1998

Regional mean systolic myocardial velocity estimation by real-time color Doppler myocardial imaging: a new technique for quantifying regional systolic function.

A new color Doppler myocardial imaging (CDMI) system with high spatial and temporal resolution and novel postprocessing modalities has been developed that could allow quantifiable stress echocardiography. The purpose of this study was to determine whether regional myocardial systolic velocities could be accurately and reproducibly measured both at rest and during bicycle ergometry by using CDMI. Thirty normal subjects were examined with CDMI at rest, and peak mean systolic myocardial velocities (MSV) were measured for 34 predetermined left ventricular myocardial segments. Interobserver variability and intraobserver variability were established for all segments. Submaximal bicycle ergometry was performed in 20 normal subjects by using standardized weight-related increases in workload. MSV were measured at each step of exercise for 16 left ventricular stress echo segments. At rest, a base-apex gradient in regional MSV was recorded with highest longitudinal shortening velocities at the base. A similar pattern was noted for circumferential shortening MSV. Measurements were predictable and highly reproducible with low interobserver and intraobserver variability for 26 of 34 segments. Reproducibility was poor for basal anteroseptal segments in all views and mid anterior, anteroseptal, and septal segments in the short-axis views. During exercise, mid and basal segments of all walls showed a significant increase of MSV between each workload step and for apical segments between alternate steps. The resting base-apex velocity gradient observed at rest remained in all walls throughout ergometry. Thus a CDMI system with improved spatial and temporal resolution and postprocessing analysis modalities provided reproducible and accurate quantification of segmental left ventricular circumferential and longitudinal contraction both at rest and during exercise.

Adult↗
PubMed1992

Catecholamine excretion and heart rate as factors of psychophysical stress in table tennis.

Table tennis, like tennis, squash and badminton, is a racket sport. All these sports have in common a rapid succession of mostly short-term maximal or submaximal efforts and short recovery phases. The goal of this paper is to investigate the psychophysical stress in table tennis by means of the stress hormones epinephrine and norepinephrine. The catecholamines were determined from urine samples. 16 Austrian top-level table tennis players were examined. There were 8 female and 8 male players in this group. The catecholamine excretion at rest (R), training (TR), practice competition (PC), competition (C) and treadmill ergometry (TE) are indicated in ng/min of collecting time. When the group is divided according to sex, we find marked differences in the catecholamine release. While the epinephrine excretion during and after training and practice competition is basically the same, it is lower during and after treadmill ergometry and higher after competition. The same result was found with respect to norepinephrine excretion. The ratio between norepinephrine and epinephrine was 4:1 at rest and during and after treadmill ergometry, 6:1 during and after training, 5:1 during and after the practice competition and 2:1 during and after the competition. The investigation showed that a table tennis competition puts high stress on the player. The mental component should therefore receive much more importance in order to keep the stress low.

Adolescent↗
PubMed1995

[Reproducible (latent) obstruction of the left ventricular outflow tract].

BACKGROUND AND OBJECTIVE: Left ventricular outflow tract obstruction (LVOTO) with flow acceleration in late systole (Vmax > or = 2.0 m/s and acceleration/ejection time [AT/ET] > or = 0.5) is often present in a latent form in left ventricular hypertrophy; it can be unmasked by administration of glyceryl trinitrate or with the Valsalva manoeuvre (preload reduction). It was investigated prospectively whether latent LVOTO also occurs on ergometric exercise. PATIENTS AND METHODS: 61 patients (19 female, 42 male, mean age 55.5 +/- 12.9 years) with left ventricular hypertrophy at rest were examined by Doppler echocardiography at rest, under provocation with glyceryl trinitrate and the Valsalva manoeuvre, and during bicycle ergometry. Manifest LVOTO was already present before the test in 3 patients. RESULTS: In 24 patients LVOTO occurred during the provocation (Vmax rose from 1.38 +/- 0.25 to 2.93 +/- 0.53 m/s; AT/ET rose from 0.47 +/- 0.16 to 0.68 +/- 0.09). In 19 of these 24 patients LVOTO also occurred during the ergometry. In four additional patients changes were marginal (AT/ET > or = 0.5; Vmax = 1.8 and 1.9 m/s, respectively). There was a highly significant correlation between provocation and ergometry with regard to Vmax, as well as AT/ET (with r = 0.84 and 0.76, respectively). CONCLUSIONS: These findings show that provokable LVOT gradients are likely to occur during exercise to a similar degree as those on preload reduction. Thus, course of disease could possibly be influenced by early treatment in patients with left ventricular hypertrophy.

Adult↗
PubMed1984

[Effect of bisoprolol in coronary heart disease. Effect on cardiovascular parameters and ischemic ST depression: studies on the duration of the effect].

A beta-adrenoceptor antagonist, bisoprolol, was given by mouth, 5 and 10 mg doses per 24 hours, in a double-blind randomized cross-over trial to 12 patients with stable coronary-heart disease. Ischaemia criteria proved not reproducible in control ergometry tests on two patients, leaving ten patients for further evaluation. On two days, one week apart, bicycle ergometry was undertaken until the occurrence of ST segment depression of at least 0.3 mV, often associated with angina. Four, eight and 24 hours after the drug had been taken, the ergometry was repeated to the same maximal Watt level and duration of exercise. Heart rate and pressure-rate product at rest, as well as the same parameters including ST segment depressions immediately at the end of exercise, significantly fell after bisoprolol during the entire trial period independently of the dose. There was no sign of reduced effectiveness 24 hours after drug intake. The results indicate that treatment of stable angina with bisoprolol can be achieved with a single daily dose.

Adrenergic beta-Antagonists↗