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PubMed2003

The effect of oral sucrose on exercise tolerance in patients with McArdle's disease.

BACKGROUND: Energy metabolism in muscles relies predominantly on the breakdown of glycogen early in exercise. In patients with McArdle's disease, blocked glycogenolysis in muscles results in low exercise tolerance and can lead to muscle injury, particularly in the first minutes of exercise. We hypothesized that ingesting sucrose before exercise would increase the availability of glucose and would therefore improve exercise tolerance in patients with McArdle's disease. METHODS: In a single-blind, randomized, placebo-controlled crossover study, 12 patients with McArdle's disease drank 660 ml of a beverage that had been sweetened with artificial sweeteners (placebo) or with 75 g of sucrose after an overnight fast. Thirty to 40 minutes later, the patients rode a stationary bicycle at a constant workload for 15 minutes while the heart rate, level of perceived exertion, and venous blood glucose levels were monitored. RESULTS: Supplemental sucrose increased the mean plasma glucose level by more than 36 mg per deciliter (2.0 mmol per liter) and resulted in a marked improvement in exercise tolerance in all patients. The mean (+/-SE) heart rate dropped by a maximum of 34+/-3 beats per minute (P<0.001), and the level of perceived exertion fell dramatically when the patients ingested glucose as compared with when they received the placebo. CONCLUSIONS: This study suggests that the ingestion of sucrose before exercise can markedly improve exercise tolerance in patients with McArdle's disease. The treatment takes effect during the time when muscle injury commonly develops in these patients. In addition to increasing the patients' exercise capacity and sense of well-being, the treatment may protect against exercise-induced rhabdomyolysis.

Administration, Oral↗
PubMed1990

[Influence of aging on coronary arterial morphology, exercise tolerance and daily physical activity in the chronic stage of myocardial infarction].

Coronary angiographic (CAG) findings, exercise tolerance and daily physical activity were studied with reference to aging in 314 cases of the chronic myocardial infarction and in 199 cases of angina pectoris. Exercise tolerance was evaluated by a symptom-limited treadmill test and the daily physical activity by the functional classification of the New York Heart Association (NYHA) based on questionnaires filled out by the patients. Although the single to multivessel disease ratio decreased with age, there was no significant trend in diffuse or segmental character of stenosis with age. In addition, more than 80% of patients showed good exercise tolerance of more than stage II in Bruce's protocol. However, there was a general trend towards decrease in exercise tolerance with age. Furthermore approximately 80% of patients showed a good daily activity. However, the NYHA (I + II) to NYHA (III + IV + cardiac death) ratio was lower in patients aged 60 or more compared to those under age 60. Patients aged 60 or more with single vessel disease had lower daily physical activity compared to the under 60 age group, although this did not seem to be related to any physical limitation. Therefore, social and occupational aspects as well as the clinical severity of ischemic heart disease should be considered in the treatment of elderly cases.

Activities of Daily Living↗
PubMed1993

Effect of sotalol on arrhythmias and exercise tolerance in patients with hypertrophic cardiomyopathy.

The effect of sotalol on exercise tolerance and incidence of arrhythmias was studied in 30 patients with hypertrophic cardiomyopathy (HCM). In this short-term, double-blind, cross-over study, exercise time on sotalol (320 mg/day) was significantly longer than on placebo (10.6 +/- 4.0 vs. 9.4 +/- 3.6 min; p < 0.01). Sotalol eliminated supraventricular arrhythmias in 6 of 7 patients (p < 0.03) and suppressed ventricular arrhythmias in 7 of 13 patients in whom they were present on placebo (p < 0.05). Ventricular tachycardia was abolished in 4 of 8 patients, but appeared during sotalol treatment in 1 patient who was free of repetitive arrhythmias on placebo. Twenty-five patients who had better exercise tolerance on sotalol than on placebo and did not experience aggravation of arrhythmia entered a 6-month prospective, open-label treatment with sotalol (160-480 mg/day, mean +/- SD 377 +/- 94). One patient was withdrawn after 1 month because of bronchospasm. Mean exercise time improved from 9.8 +/- 3.6 min on placebo to 12.7 +/- 3.2 min (p < 0.01) after 6 months of treatment with sotalol. During the prospective follow-up, sotalol abolished ventricular tachycardia in all 6 patients after 1 month (p = 0.022), and in 4 of 6 patients (p > 0.2) after 6 months of treatment. It is concluded that sotalol significantly improves exercise tolerance and is effective in suppressing both supraventricular and ventricular arrhythmias in patients with HCM.

Adolescent↗
PubMedDate not supplied

[Exercise tolerance in children with primary bicuspid valve prolapse syndrome].

Exercise tolerance in children with the primary bicuspid valve prolapse syndrome has been evaluated with ergometric test. Additionally, an effect of environmental factors on exercise tolerance has been assessed in children from the urban and rural areas. A good tolerance of submaximal loads has been shown in both groups. However, the obtained results have been significantly more favourable in children from rural areas. The authors have concluded that limitation of exercise in children with bicuspid valve prolapse is not necessary during an intensive growth.

Adolescent↗
PubMed1990

Skeletal muscle limits the exercise tolerance of renal transplant recipients: effects of a graded exercise training program.

Sixteen renal transplant recipients were studied before and after they had participated in a 24-week exercise training program to determine (1) the nature of the factors explaining their impaired exercise tolerance, and (2) their adaptative responses to exercise training. During progressive treadmill exercise to exhaustion prior to training, renal transplant recipients stopped exercising at lower peak rates of oxygen consumption (VO2max) (29.0 +/- 7.8 47.9 +/- 9.1 mL O2.kg-1.min-1; P less than 0.001) and ventilation (55.9 +/- 13.2 v 124.0 +/- 22.2 L.min-1; P less than 0.0001), and at lower peak heart rates (169 +/- 22 v 196 +/- 9 beats.min-1; P less than 0.05) and peak blood lactate concentrations (5.0 +/- 2.1 v 11.5 +/- 4.0 mmol.L-1; P less than 0.001) than did controls. None showed a plateau in oxygen consumption with increasing workload. Exercise time to exhaustion was also significantly shorter in renal transplant recipients (9.5 +/- 1.8 v 16.0 +/- 1.3 min; P less than 0.0001). After training, exercise time to exhaustion (12.0 +/- 2.0 min; P less than 0.001), VO2max (37.5 +/- 4.8 mL O2.kg-1.min-1; P less than 0.05), maximum ventilation rate (68.5 +/- 14.0 L.min-1; P less than 0.05), peak blood lactate concentrations (7.8 +/- 1.8 mmol-L-1; P less than 0.001), and the rate of oxygen consumption at a blood lactate concentration of 2.0 mmol.L-1 (22.5 +/- 2.5 v 16.5 +/- 2.2 mL O2.kg-1.min-1; P less than 0.001) had all increased significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗
PubMed1992

[Long-term follow-up of exercise tolerance after coronary bypass grafting].

Six hundred forty-eight serial graded exercise tests were performed on 400 patients up to 10 years after coronary bypass graftings (CABG). The maximal attained exercise tolerance, over 10 METS, were observed in 60% of patients and the negative response to exercise test in 43% of patients. The positive response in various parameters were observed at the following rates: graft occlusion-30% vs graft patent-46% (p less than 0.01); incomplete revascularization-39% vs complete revascularization-22% (p less than 0.01); and less than or equal to 8 METS 4-45% vs greater than or equal to 10 METS-28% (p less than 0.01), respectively. However, no significant difference was observed among number of vessels diseased, number of graftings, and presence of old myocardial infarction. The maximal attained stage of exercise, over 10 METS, in various parameters were at the following rates: less than or equal to 59 years old-70% vs greater than or equal to 60 years old-44% (p less than 0.01); male-63% vs female-32% (p less than 0.01); and graft patent-63% vs graft occlusion-50% (p less than 0.05), respectively. The serial analysis of exercise test demonstrated that improved exercise tolerance appears to persist for at least 5 years after CABG. However, the patients in complete revascularization had a tendency to increase the rate of positive response. In conclusion, the completeness of revascularization as well as graft patency was the main factor limiting exercise tolerance, and correlates with the extent and the duration of improvement after CABG.

Coronary Artery Bypass↗
PubMed2003

Effect of diet on exercise tolerance in carnitine palmitoyltransferase II deficiency.

It is generally believed that a diet high in carbohydrate improves exercise tolerance in patients with carnitine palmitoyltransferase II (CPT II) deficiency, but it has never been systematically investigated. The authors investigated the effect of a high- vs low-carbohydrate diet on exercise tolerance in four patients with CPT II, who cycled at a constant workload of 50% of VO2max. Exercise tolerance, assessed by exercise duration and perceived exertion, improved on the carbohydrate-rich diet.

Alanine↗
PubMed1995

[Effect of cilazapril on exercise tolerance and neurohumoral factors in patients with asymptomatic chronic heart failure after myocardial infarction].

The effects of cilazapril on exercise tolerance and neurohumoral factors were investigated in old myocardial infarction (OMI) patients with asymptomatic heart failure and reduced left ventricular ejection fraction. Cilazapril (0.5 mg) was administered once daily to OMI patients (n = 20) [NYHA class I, sinus rhythm, ejection fraction by radionuclide scanning < 50% (36.8 +/- 9.1%, mean +/- SD)]. Two weeks later, five patients were excluded from the study because of cough or hypotension, and 15 patients received 1.0 mg cilazapril once daily for the next 6 weeks. Exercise tolerance, neurohumoral factors and ejection fraction were measured in OMI patients before and after administration of cilazapril. Seven age-matched healthy adults served as the controls. OMI patients had latent heart failure because their exercise tolerance values and aldosterone levels were lower and alpha-atrial natriuretic polypeptide levels were higher than those in healthy subjects. In OMI patients, 8 weeks after cilazapril administration, exercise duration increased from 545 +/- 59 to 590 +/- 74 sec (p < 0.05), anaerobic threshold from 17.5 +/- 3.2 to 20.1 +/- 2.8 ml/min/kg (p < 0.05), peak-VO2 from 23.5 +/- 4.7 to 27.1 +/- 4.4 ml/min/kg (p < 0.05), plasma renin activity from 1.34 +/- 1.13 to 5.82 +/- 5.47 ng/ml/hr (p < 0.01) and alpha-atrial natriuretic polypeptide decreased from 100.7 +/- 44.3 to 80.5 +/- 28.0 pg/ml (p < 0.05). In patients with asymptomatic left ventricular dysfunction after myocardial infarction, 8 week's cilazapril administration improved exercise tolerance and neurohumoral conditions.

Aged↗
PubMedDate not supplied

Screening for the detection of coronary artery disease by using the exercise tolerance test in a preventive medicine population.

We designed this study to identify patients with coronary artery disease (CAD), employing the exercise tolerance test, and to develop further criteria for ordering the exercise tolerance test in the preventive medicine population of the Cleveland Clinic Foundation. During 1987-1988 1,930 patients not known to have CAD were referred from the Department of Preventive Medicine for exercise tolerance tests as part of their periodic physical exams. We hypothesized that age was a major risk factor and ordered most (86.4%) tests on this basis: at age 40 and every two years after age 50. Twenty-five cases of CAD (25/1,930 or 1.3%) were found. One of 297 women was found to have CAD (0.3%). Seventeen patients were treated surgically and eight medically. Using age as an indication for testing detected 23 of 25 cases (92%). We compared the group with normal or nondiagnostic exercise tolerance tests and presumed not to have CAD (1,905 patients, median age 48) with the group with CAD (25 patients, median age 59). Age greater than 40, a total cholesterol level over 240 mg/dL, triglyceride level over 250 mg/dL, a total cholesterol to high-density lipoprotein ratio greater than 4.5, and a history of chest pain of any type were all significantly related to the presence of CAD. Testing men older than forty with two or more CAD risk factors, as has been recommended, would have resulted in finding five of the 25 cases (20%). Testing only patients who complained of any type of chest discomfort would have resulted in detecting 14 of the 25 cases (56%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Effects of enalapril on exercise tolerance and longevity in dogs with heart failure produced by iatrogenic mitral regurgitation.

This study was conducted to evaluate the effects of enalapril on exercise capacity and longevity in dogs with left-sided heart failure produced by iatrogenic mitral regurgitation. After surgical creation of mitral regurgitation, 18 dogs were allocated into replicates according to exercise capacities. One dog in each replicate received placebo, and the other received 0.5 mg/kg of enalapril sid for 9 days and bid thereafter. Exercise tolerance was studied after 10, 19, 52 to 53, and 80 to 81 days, respectively. Finally, the percentage of dogs in each group that survived 357 days was compared. The duration of exercise for dogs in the placebo and enalapril groups did not differ at baseline (P > .1) or after 19 days (P > .1). Dogs that received enalapril had significantly reduced (P < .001) exercise tolerance at day 10, and significantly increased (P = .002) exercise tolerance at days 52 to 53 and 80 to 81 when compared with controls. At 357 days, 22% of dogs receiving placebo were alive, compared with 67% of dogs receiving enalapril; however, these differences were not statistically significant (P = .124). This study shows that enalapril increases exercise tolerance in dogs with left-sided heart failure induced by iatrogenic mitral regurgitation.

Animals↗
PubMed1994

Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea. A study comparing the transtracheal catheter and nasal prongs.

HYPOTHESIS: We hypothesized that high flow transtracheal oxygen (HFTTO) will improve exercise tolerance as compared with low flow transtracheal oxygen (LFTTO) and that transtracheal oxygen (TTO) will increase exercise tolerance with less dyspnea as compared with nasal prongs (NP) at equivalent oxygen saturation (SaO2). PATIENT SELECTION: Ten subjects, six male and four female, who were already receiving TTO were recruited for the study. STUDY DESIGN: Each subject underwent a total of four modified progressive treadmill tests in a single-blind randomized fashion on two separate days. Two tests were performed with the patients receiving LFTTO and HFTTO while the other two were performed with low- and high-flow oxygen by NP. The flows were adjusted to provide equivalent oxygen saturations at rest for respective groups. RESULTS: The mean +/- SD exercise distance with HFTTO (1,134 +/- 631 ft) was 2.5 times greater than with LFTTO (446 +/- 328 ft; p < 0.006); and high-flow NP (HFNP [1207 +/- 763 ft]) was 2.38 times greater than with low-flow NP (LFNP[492 +/- 487 ft; p < 0.005]). There was no significant difference in exercise distance and dyspnea scores with HFTTO as compared with HFNP and LFTTO versus LFNP. CONCLUSION: We conclude that the use of high-flow oxygen via both transtracheal catheter and NP significantly increased exercise tolerance in our COPD patients when compared to low-flow oxygen. Transtracheal oxygen did not increase maximum exercise tolerance with less dyspnea as compared with oxygen via NP at equivalent SaO2.

Aged↗
PubMed2002

Increasing exercise tolerance of persons limited by claudication pain using polestriding.

OBJECTIVE: The efficacy of polestriding exercise (walking with modified ski poles with a movement pattern similar to cross-country skiing) to increase exercise tolerance of persons with intermittent claudication pain caused by peripheral arterial disease was tested in this 24-week prospective randomized clinical trial. METHODS: The study was conducted in a Department of Veterans Affairs Hospital with 52 individuals who gave written informed consent and were randomized into either a polestriding exercise (n = 27; age, 65.5 +/- 7.0 years; ankle brachial index, 0.64 +/- 0.25) or nonexercise control (n = 25; age, 68.6 +/- 8.9 years; ankle brachial index, 0.69 +/- 0.14) group (P >.05 for all comparisons). The polestriding exercise program consisted of supervised training three times per week for 4 weeks, two times per week for 8 weeks, one time per week for 4 weeks, biweekly for 4 weeks and unsupervised training for 4 weeks. Starting in week 5, subjects took their poles home with instructions to repeat the most recent supervised training walk at an appropriate and convenient location near their residence. This was referred to as unsupervised but directed exercise. Subjects were provided with a personal log book for documenting unsupervised exercise sessions. With both supervised and unsupervised exercise, subjects were expected to complete a total of four 30-minute to 45-minute polestriding exercise sessions per week. The main outcome measures were exercise duration on symptom-limited incremental treadmill test, Walking Impairment Questionnaire, rating of perceived leg pain at baseline, 4, 8, 12, 16, and 24 weeks, and constant work-rate treadmill exercise tests at baseline and at 4, 12, and 24 weeks. RESULTS: Polestriding significantly (P <.001) improved exercise tolerance on the constant work-rate and incremental treadmill tests. Ratings of perceived claudication pain were significantly less after the polestriding training program. Subject perceived distance and walking speed scores on the Walking Impairment Questionnaire improved in the polestriding trained group only (P <.001 and.022, respectively). CONCLUSION: This randomized clinical trial provides empirical evidence that 24 weeks of polestriding training significantly improves quantitative and qualitative measures of the exercise tolerance of persons limited by intermittent claudication pain.

Aged↗
PubMed1983

The effect of sequential versus multiple single saphenous vein aortocoronary bypass surgery on exercise tolerance.

The effect of aortocoronary bypass surgery on exercise tolerance in 34 patients undergoing sequential saphenous vein bypass grafts (seq. SVBG) was compared with that in 38 patients who had undergone single SVBGs. Postoperative exercise testing was carried out on average 23 months after surgery in the seq. SVBG group and 27 months after surgery in the single SVBG group (range 10-62 months in both groups). At the time of follow-up complete revascularization was demonstrated in 59% of the patients in the seq. SVBG group and in 50% of the patients in the single SVBG group. The improvement in the maximal load (MaxL) at the follow-up was 90.0% (p less than 0.001) in the seq. SVBG and 41.3% (p less than 0.001) in the single SVBG group. The corresponding increase in maximal heart rate (MaxHR) was 12.5% (p less than 0.001) and 10.1% (p less than 0.001) and the maximal ST depression (MaxSTd) diminished by 70.4% (p less than 0.001) and 54.2% (p less than 0.001). There were no statistically significant differences between the groups with respect to changes in MaxL, MaxHR and MaxSTd postoperatively. The changes in MaxL, MaxHR and MaxSTd in the completely and incompletely revascularized subgroups did not differ statistically. The exercise tolerance in this study was at least as good in the seq. SVBG group as in the single SVBG group and fully justifies continuing bypass surgery with sequential vein grafts.

Adult↗
PubMed2005

Recombinant interferon alpha treatment decreases heart rate variability indices and impairs exercise tolerance in patients with chronic hepatitis.

Complications of interferon (IFN) therapy include cardiac arrhythmias, impaired cardiac function and myocardial ischemia. Decreased heart rate variability (HRV) indices, impaired exercise tolerance and decreased left ventricular (LV) function are related to unfavorable outcome of heart disease. To investigate the effect of IFN therapy on HRV, exercise tolerance and cardiac function, 24-h ambulatory electrocardiographic monitoring (AECG), two-dimensional echocardiography, and exercise treadmill testing (ETT) was performed in 9 patients (age 56 +/- 9 years-old) with chronic hepatitis and without underlying heart disease before and after treatment with IFN (recombinant alpha 2b; 10 x 10(6) U/day for 4 weeks). HRV parameters consisted of standard deviation of RR interval (sdNN, ms), SDANN (ms), S.D. index (ms), rMSSD (ms), pNN50 (%) and frequency analysis of heart rate spectrum resulted in low (ms, 0.04-0.15 Hz), high (ms, 0.15-0.40 Hz) and total (ms, 0.01-1.00 Hz) frequency components. Ischemia was not detected by AECG or ETT, and LV function was normal after INF treatment in all patients. However, INF treatment resulted in a decrease in exercise tolerance time (449 +/- 94 s vs. 329 +/- 67 s, P < 0.05) and a decrease in several HRV parameters (S.D. index, 42 +/- 5 ms vs. 37 +/- 9 ms; rMSSD, 22 +/- 5 ms vs. 19 +/- 4 ms; pNN50, 4 +/- 3% vs. 2 +/- 1%; P < 0.05). Further, patients treated with INF tended to have a lower sdNN and total frequency spectra, although this difference did not reach the level of statistical significance. These data suggest that the arrhythmogenic effect of INF may be mediated by decreases in HRV and impairment of exercise tolerance even in patients without overt heart diseases. Further, INF therapy may be contraindicated in patients with predisposing severe cardiac disorders, including arrhythmias, ischemia and decreased LV function.

Adult↗
PubMed1997

The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.

The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment, and a 3 month control period of drug treatment only, for asthmatic patients and patients with chronic obstructive pulmonary disease (COPD). The programme was run by physiotherapists in eight local practices, and included exercise training, patient education, breathing retraining, evacuation of mucus, relaxation techniques, and recreational activities. In a randomized controlled trial with a cross-over design, the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life (QOL). Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests. QOL was evaluated by means of the Chronic Respiratory Disease Questionnaire (CRDQ). After 3 months, the patients who started with rehabilitation showed significant improvements in endurance time (421 s) and cardiac frequency (6 beats.min-1) during cycling, walking distance (39 m), and total CRDQ score (17 points) compared to the control group. These improvements were still significant after 6 months. Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way, with the exception that there was a greater improvement in walking distance for asthmatics. Improvements in exercise tolerance were not significantly correlated with improvements in QOL. Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practices improves exercise tolerance and quality of life.

Adolescent↗
PubMed2004

Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease.

BACKGROUND: Intermittent hypoxia has been suggested to increase exercise tolerance by enhancing stress resistance and improving oxygen delivery. Because the improvement of exercise tolerance reduces mortality in the elderly with and without coronary artery disease intermittent hypoxia might be a valuable preventive and therapeutic tool. However, controlled studies are lacking. METHODS AND RESULTS: Sixteen males (50-70 years, 8 with and 8 without prior myocardial infarction) were randomly assigned in a double-blind fashion to receive 15 sessions of passive intermittent hypoxia (hypoxia group) or normoxia (control group) within 3 weeks. For the hypoxia group each session consisted of three to five hypoxic (14-10% oxygen) periods (3-5 min) with 3-min normoxic intervals. Controls inhaled only normoxic air in the same way. Exercise tests were performed before and after the 3-week breathing program. After 3 weeks of intermittent hypoxia peak oxygen consumption had increased compared to normoxic conditions (+ 6.2% vs.-3%, p < 0.001). This improvement was closely related to the enhanced arterial oxygen content after hypoxia (r = 0.9, p < 0.001). Both higher haemoglobin concentration and less arterial oxygen desaturation during exercise contributed to the increase in arterial oxygen content. During sub-maximal exercise (cycling at 1 W/kg) heart rate, systolic blood pressure, blood lactate concentration, and the rating of perceived exertion were diminished after intermittent hypoxia compared to control conditions (all p < 0.05). Changes in responses to exercise after intermittent hypoxia were similar in subjects with and without prior myocardial infarction. CONCLUSIONS: Three weeks of passive short-term intermittent hypoxic exposures increased aerobic capacity and exercise tolerance in elderly men with and without coronary artery disease.

Aged↗
PubMed1998

Failure of an ACE inhibitor to improve exercise tolerance. A randomized study of trandolapril. Trandolapril study group.

BACKGROUND: There has been conflicting evidence of the effect of angiotensin-converting enzyme (ACE) inhibitors on exercise tolerance. Meta-analysis of published results has suggested that a beneficial effect of ACE inhibitors is demonstrated if a trial design is adequate. SETTING: Multicentre International Trial. METHODS: In a double-blind, randomized, multicentre trial, 292 patients with moderate (New York Heart Association Grades II and III) heart failure were treated with trandolapril or placebo in addition to diuretics, and followed for 16 weeks. Exercise tolerance on a treadmill was assessed at baseline and after 4, 8, 12 and 16 weeks of treatment. Both a modified Bruce and a modified Naughton protocol were used. RESULTS: Exercise tolerance improved in both treatment groups, with no significant benefit from trandolapril treatment. CONCLUSION: Trandolapril does not improve exercise tolerance as measured by treadmill testing.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Effects of cilazapril on exercise tolerance in the chronic phase of acute myocardial infarction.

The present study was conducted to investigate the effects of cilazapril on exercise tolerance and the hormone kinetics of catecholamines, the reninangiotensin-aldosterone system and alpha-atrial natriuretic peptide (ANP) in patients in the chronic phase of acute myocardial infarction (AMI). The subjects consisted of 19 cases of AMI. Cardiopulmonary exercise testing was performed 1 month after the onset of AMI, and patients were randomly assigned to either a group treated with 1 mg/day of cilazapril (9 cases) and or an untreated group (10 cases). After the completion of 2 months of exercise training at the anaerobic threshold (AT), blood samples were taken during a cardiopulmonary exercise test and various hormones were measured. In comparing the parameters of exercise tolerance before and after the completion of exercise training there were no significant differences between the 2 groups with respect to oxygen uptake, oxygen pulse, or exercise time at AT or at peak exercise. With regard to temporal changes in exercise tolerance, oxygen uptake, oxygen pulse and exercise time all tended to increase in both groups. With regard to hormone kinetics, the alpha-ANP concentration at peak exercise was significantly lower, and the noradrenaline secretions also tended to be lower, in the cilazapril-treated group, even though the peak exercise time was similar in both groups. These results may be support the hypothesis that cilazapril mitigates the left ventricular load during exercise therapy in patients in the chronic phase of AMI.

Aldosterone↗