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PubMed1998

Fibrinolytic activity is not dependent upon exercise mode in post-myocardial infarction patients.

In this study we investigated possible differences in fibrinolytic activity in cardiac patients while they performed treadmill and cycle ergometry. Thirteen post-myocardial infarction patients completed two maximal exercise tests on treadmill and cycle ergometers. Blood was collected before and after each exercise test and was analyzed for the fibrinolytic variables, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) activity, and lactate. Maximal oxygen uptake, heart rate, and ventilation were greater (P < 0.05) on the treadmill than during cycle ergometry, however, blood lactate was similar between modes. t-PA activity significantly increased with exercise (P < 0.05) and there was a trend toward a reduction in PAI-1 activity with exercise, but this did not reach statistical significance. The fibrinolytic responses to maximal exercise did not differ between the two modes of exercise studied. Therefore, exercise intensity, but not the mode of exercise, appeared to be the primary determinant of the fibrinolytic response to acute exercise in these patients.

Bicycling↗
PubMed2005

Functional outcome 5 years after non-operative treatment of type A spinal fractures.

This study was conducted to study the functional outcome after non-operative treatment of type A thoracolumbar spinal fractures without neurological deficit. Functional outcome was determined following the International Classification of Functioning, Disability and Health, measuring restrictions in body function and structure, restrictions in activities, and restrictions in participation/quality of life. All patients were treated non-operatively for a type A thoracolumbar (Th11-L4) spinal fracture at the University Hospital Groningen, The Netherlands. Thirty-three of the eighty-one selected patients agreed to participate in the study (response-rate 41%). Respondents were older than non-respondents (mean 50.5 years vs. 39.2 years), but did not differ from each other concerning injury-related variables. Patients with a neurological deficit were excluded. Treatment consisted either of mobilisation without brace, or of bedrest followed by wearing a brace. Restrictions in body function and structure were measured by physical tests (dynamic lifting test and bicycle ergometry test); restrictions in activities were measured by means of questionnaires, the Roland Morris Disability Questionnaire (RMDQ) and Visual Analogue Scale Spine Score (VAS). Restrictions in participation/quality of life were assessed with the Short Form 36 (SF-36) and by means of return to work status. Thirty-seven per cent of the patients were not able to perform the dynamic lifting test within normal range. In the ergometry test, 40.9% of the patients performed below the lowest normal value, 36.4% of the patients achieved a high VO(2)-max. Mean RMDQ-score was 5.2, the mean VAS-score was 79. No significant differences between patients and healthy subjects were found in SF-36 scores, neither were differences found between braced and unbraced patients in any of the outcome measures. Concerning the return to work status, 10% of the subjects had stopped working and received social security benefits, 24% had arranged changes in their work and 14% had changed their job. We conclude that patients do reasonably well 5 years after non-operative treatment of a thoracolumbar fracture, although outcome is diverse in the different categories and physical functioning seems restricted in a considerable number of patients.

Adult↗
PubMed2005

[Performance testing in mountaineering].

Laboratory ergometry to exhaustion allows cardiopulmonal risk assessment for the prevention of health problems related to mountaineering. Moreover, exercise testing evaluates functional status, so permitting individualized training programs and evaluation of training effects. Additionally, mountaineering-specific performance diagnosis allows individual as well as group-specific determination of exercise performance related to field conditions. Laboratory tests are standardized, easy to perform and cost effective. Treadmill ergometry with constant walking speed and increasing inclination is suggested to be predictive for mountaineering performance. On the other hand, the validity for the specific conditions for mountaineering is questionable. Standardized laboratory exercise tests combined with sport-specific exercise tests provide rough information on the ability to sustain real-situation strain. To compare individual exercise performance, published data tables obtained from field tests may be used. It must, however, be mentioned that high-altitude-adaptation is independent of exercise performance evaluated separately.

Acclimatization↗
PubMed2005

The smoker's paradox and the real risk of smoking.

No satisfactory explanations have been offered for the smoker's paradox, the greater short-term survival of smokers after a myocardial infarction nor for the large variations in the coronary risk rate for smoking ranging between 1 and 5.9. These discrepancies as well as the smoker's paradox may be caused by different baseline characteristics of smokers and nonsmokers, whereas the usually quoted coronary risk of 2 is derived from studies based on the assumption of equal baseline characteristics. As neither this assumption nor the possibility of unequal starting conditions have been tested, we examined the main cardiovascular risk factors in smoking and nonsmoking boys as near as possible to baseline, at the age of fourteen. This age appeared to be best suited, because boys starting to smoke early are most likely to become regular and heavy smokers. Of 336 boys, 39 had smoked 8.3+/-6.0 cigarettes/day for 15.5+/-11.2 months. Compared to nonsmokers, boys who started to smoke early had lower LDL cholesterol and alpha2-antiplasmin, greater handgrip strength, vital capacity and forced expiratory volume, better perfomance on bicycle ergometry and higher testosterone. The differences in total cholesterol, LDL cholesterol, vital capacity, handgrip strength, testosterone and alpha2-antiplasmin persisted after adjustment for age, body mass, and testosterone. In addition, the differences in perfomance on bicycle ergometry and forced expiratory volume persisted after adjustment for age. These favourable baseline characteristics of those starting to smoke early can explain the smoker's paradox. In addition, they suggest that the individual coronary risk in smokers is considerably higher than 2, because the assumption of equal baseline characteristics of smokers and nonsmokers cannot be upheld.

Adolescent↗
PubMed1986

Functional translation of exercise responses from graded exercise testing to exercise training.

This study attempts to develop a quantitative approach to the prescription of absolute exercise intensity during level ground ambulation (min/mile) or cycle ergometry (kpm) from responses observed during GXT. A total of 345 subjects performed GXT and exercise training sessions with either the Bruce treadmill protocol and level ground ambulation (N = 154) or cycle ergometry (N = 191). Responses from 90% of each group were used to generate equations for predicting training pace (or power output) from the time (or power output) during the GXT when target HR was achieved. FAI was also included in the prediction of training pace (or power output). The remaining 10% of subjects in each group were used to cross-validate the prediction equations. The correlation between the time (or power output) during GXT when the training HR was observed and the pace of ambulation (or power output) was 0.70 for treadmill walking and 0.88 for cycle-cycle. Correlations were increased by the addition of FAI to the prediction equation. The results of this investigation suggest that the absolute intensity of exercise for training can be predicted accurately from GXT results.

Cardiac Rehabilitation↗
PubMed1988

More rapid relief of pain with isosorbide dinitrate oral spray than with sublingual tablets in elderly patients with angina pectoris.

To evaluate the possibility of improving clinical practice in the treatment of angina pectoris, the duration of relief of pain with isosorbide dinitrate (ISDN) oral spray and sublingual tablets were compared in elderly patients with chronic stable angina pectoris. Nine patients (mean age 67 years) were studied in a randomized crossover trial. The patients underwent bicycle ergometry, which resulted in typical chest pain associated with electrocardiographic ST-segment depression in all 9. The patients received ISDN oral spray or sublingual tablets immediately on termination of exercise. At least 6 hours later another ergometry test was performed and the patients were crossed over to the other drug. ISDN spray relieved pain in all patients at a mean duration of 61.6 +/- 24.4 seconds after administration, whereas the duration of relief of pain by ISDN sublingual tablets was 112.4 +/- 70 seconds. The difference was highly significant (p less than 0.0005). It is concluded that clinical practice of treatment of angina pectoris in the elderly can be improved by using ISDN oral spray rather than sublingual tablets. The spray is effective at twice the rapidity of the sublingual tablet.

Administration, Oral↗
PubMed1988

Noninvasive assessment of hemodynamic responses to exercise in pulmonary regurgitation after operations to correct pulmonary outflow obstruction.

The influence of pulmonary regurgitation (PR) on exercise capacity is unknown. The hemodynamic responses to exercise in postoperative patients with PR was determined using Doppler-measured regurgitant fraction to indicate PR severity. Maximal heart rate, oxygen consumption and workload capacity were measured during upright cycle ergometry. Cardiac output was measured at rest and during submaximal supine cycle ergometry by pulsed Doppler echocardiography. Oxygen consumption was simultaneously measured and exercise factor was calculated as the change in cardiac output per change in oxygen consumption. Twenty-seven patients were compared with 17 age-, size- and sex-matched control subjects. Patients with PR had larger right ventricles (p less than or equal to 0.001), lower heart rate response (p less than or equal to 0.05), lower maximal oxygen consumption (p less than or equal to 0.005) and lower workloads (p less than or equal to 0.005) when compared with normal control subjects during maximal exercise testing. Exercise factor was the same for both groups. Patients with PR were then separated into mild, moderate and severe groups. Patients with mild PR had a normal response to exercise. However, patients with moderate and severe PR had lower maximal oxygen consumptions and maximal workloads than control subjects. Control, mild and moderate PR groups had similar exercise factors. Patients with severe PR had markedly low cardiac output responses. PR is associated with reduced exercise capability, which is related to the severity of the PR.

Adolescent↗
PubMed1989

Noninvasive and angiographic evaluation of coronary artery disease in patients with peripheral vascular disease.

The accuracy of exercise testing for detection of coronary artery disease in a population with a high incidence of claudication was evaluated in 58 consecutive patients with abdominal aortic aneurysms or lower extremity occlusive disease. Each patient was evaluated by history and physical examination, symptom-limited testing with exercise treadmill, arm ergometry and exercise radionuclide ventriculography. An algorithm was designed that retrospectively examined the results of each test in a stepwise fashion to simulate a clinical decision-making process. The results of the clinical examination, each of the exercise tests and the noninvasive diagnostic algorithm were compared with the results of coronary arteriography. The predictive accuracy of the clinical evaluation was 36%, treadmill stress testing 57%, treadmill stress plus arm ergometry 74%, exercise radionuclide ventriculography 57% and the noninvasive diagnostic algorithm 89%. When discriminant analysis was applied to all of the exercise variables, no individual test improved the accuracy of the noninvasive diagnostic algorithm. When the analysis considered only individual variables without the algorithm, the model correctly classified only 67% of the patients. Thus, accurate noninvasive evaluation of coronary artery disease is possible in patients with severe peripheral vascular disease when care is taken to design exercise protocols that allow adequate stress on the cardiovascular system.

Adult↗
PubMed1989

Effect of atenolol or prazosin on maximal exercise performance in hypertensive joggers.

We evaluated maximal performance during cycle ergometry and treadmill exercise in 14 hypertensive male joggers treated with prazosin or atenolol in an unblinded, placebo-controlled, crossover design. Maximal oxygen uptake was measured during both exercise modalities; cardiac output was measured only during cycle ergometry using the acetylene rebreathing technique. Both drugs reduced resting systolic and diastolic blood pressures. Prazosin reduced total peripheral resistance during submaximal exercise but had little effect on maximal cycle and treadmill performance. Atenolol, in contrast, reduced treadmill duration, maximal oxygen uptake, and heart rate compared with placebo. Atenolol also increased stroke volume and the arterial venous oxygen difference and reduced cardiac output during cycle exercise. Both drugs produced similar reductions in exercise diastolic pressure, but exercise systolic pressure was lower only during atenolol treatment. Prazosin was better tolerated by the subjects and was preferred by 10 of the men. We conclude that both drugs effectively reduced resting blood pressure, but that atenolol decreased exercise cardiac output and may impede exercise performance in physically active hypertensive subjects.

Adult↗
PubMed1987

Metoclopramide decreases baroreflex sensitivity in patients with essential hypertension.

The effect of metoclopramide (10 mg, iv.) or physiological saline on the exercise-induced (standardized bicycle ergometry) increase in blood pressure and heart rate of patients with essential hypertension was investigated in a double blind, randomized, self controlled study. Metoclopramide had no effect on the exercise-induced increase in blood pressure but significantly enhanced the tachycardia due to ergometry after 4-6 min exercise. The mean slope of linear regression lines calculated from the systolic blood pressure and the corresponding heart rate measured before and during (at 1,2,3,4,5 min) exercise after metoclopramide was significantly steeper than after physiological saline (1.1 +/- 0.12 vs 0.79 +/- 0.09; mean +/- SEM), indicating the decrease in baroreflex sensitivity after metoclopramide. On the basis of results the possible role of endogenous dopaminergic mechanisms in suppressing some components of pressor effect of physical exercise can be hypothesized.

Adolescent↗
PubMed1995

Modification of the responses of endothelin-1 to exhaustive physical exercise under simulated high-altitude conditions with acute hypoxia.

To assess whether acute alveolar hypoxia leads to the release of endothelin-1 (ET) in vivo, ET, cortisol (CORT), and lactate (LA) levels were determined in 15 healthy subjects at rest and during exhaustive incremental cycle ergometry on two separate test days. The subjects were to breathe a gas mixture with reduced O2 content ([H] fraction of inspired O2, 0.14) on one day and normal air on the other (N). Modified responses of LA and CORT to exhaustive incremental cycle ergometry on the H day indicated elevated anaerobic tissue metabolism and increased physical stress. With acute alveolar hypoxia, the response of ET to exhaustive physical labor was found to be augmented.

Acute Disease↗
PubMed1992

Amlodipine in patients with stable angina pectoris treated with nitrates and beta-blockers. The influence on exercise tolerance, systolic and diastolic functions of the left ventricle.

The effects of 5 and 10 mg of amlodipine and of placebo were compared in 21 patients with stable angina pectoris and multivessel coronary artery disease. The blind comparison was performed by means of bicycle ergometry and stress echocardiography using esophageal stimulation of the left heart atrium. All patients subsequently received placebo, amlodipine 5 mg and 10 mg for 2 weeks. In bicycle ergometry both doses of amlodipine in comparison with placebo significantly lowered the ST segment depression in lead V5 and prolonged the time to onset of angina. The exercise duration was significantly prolonged only after 10 mg of amlodipine. In stress echocardiography 10 mg of amlodipine significantly improved ejection fraction and reduced wall motion score during stimulation and increased peak velocity of relaxation of left ventricular posterior wall at rest and immediately after stimulation. In the patients with left ventricular end-diastolic pressure < or = 20 mmHg, amlodipine reduced the ratio of peak transmitral flow velocity in atrial contraction to that in early diastole (A/E) at rest and shortened deceleration time at rest and immediately after stimulation. Amlodipine in patients with stable angina pectoris significantly improved the exercise tolerance and the function of the left ventricle in a dose-dependent way. Amlodipine was well tolerated.

Amlodipine↗
PubMed1986

Psychophysiological differentiation of two types of anxiety and its pharmacological modification by minor tranquillizer and beta-receptor-blocker.

To evaluate the influence of beta-blockers and/or minor tranquillizers on autonomic reactions during brief stress, 48 healthy subjects were randomised into 4 groups: A = 4 mg Pindolol, B = 1.5 mg Cloxazolam, C = Placebo, D = 4 mg Pindolol + 1.5 mg Cloxazolam. Subjects underwent four stress situations: Counting, noise, mental arithmetic and ergometry, each lasting 4 min with rest periods of 8 min in between. Electromyogram, finger pulse amplitude, heart rate, pulse wave velocity and electrodermal activity were recorded simultaneously on-line. Analysis of variance showed that the two drugs had significant main effects in different systems: Pindolol reduced heart rate, mainly during mental arithmetic and ergometry, Cloxazolam reduced electrodermal activity, mainly during noise. It can be concluded that different structured situations with a varying amount and type of anxiety induce different autonomic reactions; these reactions can be differentially modified by the drugs applied.

Adult↗
PubMed1995

Observations suggesting a high incidence of exercise-induced severe mitral regurgitation in patients with mild rheumatic mitral valve disease at rest.

OBJECTIVES: The aim of this study was to determine the hemodynamic effects of upright bicycle ergometry in symptomatic patients with mild, mixed mitral stenosis and regurgitation. BACKGROUND: Patients with seemingly mild rheumatic mitral valve disease often complain of exertional dyspnea or fatigue. These symptoms are usually ascribed to flow-dependent increases in the gradient across the stenotic mitral valve. Although catheterization studies in these patients may demonstrate an increase in mitral valve gradient proportional to an increase in cardiac output, this approach does not specifically address the underlying mechanism of any observed increases in mitral gradient or left atrial (i.e., pulmonary capillary wedge) pressure. Exercise echocardiography is uniquely suited to the dynamic assessment of exercise-induced hemodynamic changes. METHODS: Fourteen symptomatic patients with exertional dyspnea and mild mitral stenosis and regurgitation at rest performed symptom-limited upright bicycle ergometry with quantitative two-dimensional, Doppler and color Doppler echocardiographic analysis. RESULTS: Average pulmonary artery systolic pressure in the 13 patients with adequate spectral signals of tricuspid regurgitation increased from 36 +/- 5 mm Hg (mean +/- SD) at rest to 63 +/- 14 mm Hg at peak exercise (p < 0.001). The mean transmitral pressure gradient in all patients increased from 4.5 +/- 1.4 mm Hg at rest to 12.7 +/- 2.7 mm Hg at peak exercise (p < 0.001). Five patients developed severe mitral regurgitation during exercise. CONCLUSIONS: Patients with exertional dyspnea and mild mitral stenosis and regurgitation at rest demonstrate a marked increase in pulmonary artery systolic pressure and mean transmitral pressure gradient during dynamic exercise. In a subset of these patients, marked worsening of mitral regurgitation appears to be the underlying mechanism of this hemodynamic deterioration. Because of the small sample size, this novel observation must be considered preliminary with respect to the true prevalence of exercise-related development of severe mitral regurgitation. If additional studies confirm the importance of this phenomenon, it has important implications for the management of patients with rheumatic mitral valve disease.

Adult↗
PubMed1996

Cardiac structure and exercise blood pressure in urban and rural Canadian men of Icelandic descent.

The objective of the study was to determine the relationship between exercise systolic blood pressure (ESBP), during bicycle ergometry, and echocardiographically determined left ventricular structure in rural and urban Canadian men of Icelandic descent. The study was cross-sectional in design. The settings were urban Winnipeg and the rural Interlake District in the province of Manitoba, Canada. Subjects were adult male volunteers from families of wholly Icelandic descent. The subjects were 30 to 60 years of age and had supine blood pressure < 160/95 mm Hg. Anthropomorphic measurements, echocardiography and sphygmomanometry, at rest and during bicycle ergometry, were performed on all subjects. Prevalence of exaggerated ESBP (> or = 200 mm Hg) and left ventricular hypertrophy (LVH) was not significantly different in the two groups. In all but one individual LVH was classified as eccentric hypertrophy. In both urban and rural subjects with exaggerated ESBP, left ventricular mass index (LVMI) was greater than in those subjects without exaggerated ESBP. The LVMI correlated with ESBP at the highest workloads (> or = 150 W). Multivariate analysis of all subjects showed that cardiac index, ESBP, body mass index, and low exercise heart rate were predictive of LVMI. There was no significant difference in prevalence of ESBP or LVH between urban and rural Manitobans of Icelandic descent. However, LVMI levels were lower, and values for ESBP greater, in the rural group compared with the urban group. Within each of the two groups there was a positive association between ESBP and LVMI; hence, the study supports findings of our previous investigation showing evidence of early target organ effects in normotensive men with an exaggerated ESBP.

Adult↗
PubMed2005

Does exercise have an acute effect on desire to smoke, mood and withdrawal symptoms in abstaining adolescent smokers?

OBJECTIVE: Previous studies have shown that exercise acutely reduces desire to smoke and withdrawal symptoms among adult smokers; however, no study has examined these effects in younger smokers. This study investigated the impact of a short bout of moderate intensity exercise on desire to smoke, withdrawal symptoms and exercise-induced affect in temporarily abstinent adolescent smokers. METHODS: Thirty-seven low-active male and female smokers aged 16-19 years, abstained from smoking overnight and were assigned to either (i) 10 min of moderate intensity cycle ergometry (n=18) or (ii) a placebo control condition that involved very light intensity cycle ergometry (n=19). Measures of desire to smoke, the Mood and Physical Symptoms Scale (MPSS) and Subjective Exercise Experience Scale (SEES) were administered at baseline, 5 min during, 5 min after and 30 min after both conditions. RESULTS AND CONCLUSION: A significant interaction effect for group by time was recorded for psychological distress scores, when the baseline value was covaried. Follow-up tests indicated that the exercise group reported significantly higher PD scores than the placebo control during exercise, but not at any other time point. No other significant effects were found for any other variables. Unlike research involving adult populations, a short bout of moderate intensity exercise did not alter desire to smoke among abstaining adolescent smokers and may negatively impact affective responses during exercise.

Adolescent↗
PubMed2006

Maximal exercise test results in subacute stroke.

OBJECTIVES: To establish the feasibility and reliability of graded maximal exercise testing, suitability of standard indexes of maximum oxygen consumption (Vo(2)max), and evidence of trial-to-trial practice effects in subacute stroke. DESIGN: Descriptive, cross-sectional study. SETTING: Rehabilitation hospital. PARTICIPANTS: Consecutive sample of 35 participants (mean age, 65.7+/-2.6 y; mean days poststroke, 17.6+/-2.2 d). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Graded maximal exercise test using semirecumbent cycle ergometry. A subset (n=20) performed repeated tests to determine test-retest reliability and presence of practice effects. RESULTS: Thirty-one (89%) participants completed the exercise test without symptomatic responses (mean peak level of oxygen consumed [Vo(2)peak], 10.7 mL.kg(-1).min(-1); peak work rate, 39 W). Twelve (34%), 15 (44%), and 3 (9%) participants achieved oxygen consumption per unit time (Vo(2)) plateau, respiratory exchange ratio, and heart rate criteria, respectively. Although test-retest correlations were high (intraclass correlation coefficient range, .67-.87), higher Vo(2)peak (1.0 mL.kg(-1).min(-1), P=.04) and work rate (7.3 W, P=.01) were observed with repeated testing, with no associated increase in reaching standard criteria for Vo(2)max. CONCLUSIONS: This work has important implications for developing guidelines for measuring aerobic capacity early after stroke. Although maximal exercise testing using semirecumbent cycle ergometry is feasible, standard Vo(2)max criteria are not consistently appropriate. At least 1 practice trial is recommended before the actual evaluation is performed.

Adult↗
PubMed2006

Factors affecting exercise capacity in renal transplantation candidates on continuous ambulatory peritoneal dialysis therapy.

It is well known that reduced peak oxygen uptake (peak VO2) is a predictor for mortality in several chronic diseases and during the preoperative period. The aim of this study was to investigate the factors that influence peak VO2 in renal transplant candidates receiving continuous ambulatory peritoneal dialysis (CAPD) therapy. We included 22 chronic renal failure patients (12 men, 10 women; ages 29.64 +/- 8.29 years; CAPD duration, 37.35 +/- 7.15 months) in this study. Pulmonary function tests and symptom-limited cardiopulmonary exercise tests were administered to all patients. Cardiopulmonary exercise tests were performed on a cycle ergometry at the same time of day for all patients. We analyzed the exercise duration, maximum work rate, and peak VO2 level during cycle ergometry. Serum hemoglobin, hematocrit, total cholesterol, triglyceride, blood urea nitrogen, creatinine, albumin, prealbumin, C-reactive protein, sedimentation rate, ferritin, sodium, potassium, parathyroid hormone, calcium, and phosphorus levels were analyzed from samples. Mean values of exercise duration (6.86 +/- 1.56 minutes), peak VO2 (17.20 +/- 4.91 mL/min/kg), and maximum work rate (77.09 +/- 26.09 watts) were lower when we compared them with predicted values for a healthy population. Peak VO2 was well correlated with serum phosphorus levels (4.51 +/- 1.28 mg/dL, r = .592, P = .004). Test duration was correlated with peak VO2 (r = .489, P = .025) and serum phosphorus levels (r = .530, P = .024). There were no significant correlations with other factors. As a component of ATP, phosphorus is at the hub of the energy-related mechanisms operative in muscles of the respiratory and musculoskeletal systems. Therefore, we suggest that low exercise capacity might be related to low serum phosphorus levels, and that optimal control of serum phosphorus therapy would increase exercise capacity, exercise duration, and oxygen consumption resulting in a decrease of postoperative mortality in renal transplantation candidates.

Adult↗