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PubMed1989

Efficacy of exercise for end-stage renal disease patients immediately following high-efficiency hemodialysis: a pilot study.

Nine patients receiving maintenance high-efficiency hemodialysis were studied before and after a 12-week conditioning program to determine the efficacy of exercise immediately following hemodialysis. Each patient performed a combination of bicycle ergometry on the Schwinn Air-Dyne ergometer (SAE) and treadmill walking three times a week for a total exercise time of 15-35 min per session. A low-level Bruce treadmill test and an exercise test on the SAE were administered before and after training. Hematological, serum electrolyte, and serum lipid profiles were also determined before and after training. Following training, there were improvements in exercise capacities for both treadmill walking and ergometry on the SAE. Although a significant increase in serum apolipoprotein A1 was seen following exercise, no significant changes were observed for total cholesterol, low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol or apolipoprotein B. Additionally, no significant changes were seen in hematological parameters and serum electrolyte profiles following the exercise program. The 9 patients demonstrated an average compliance record of 74%. This study demonstrated that patients on high-efficiency hemodialysis can safely engage in an exercise program immediately following dialysis at intensities and frequencies that can improve their physical work capacities.

Aged↗
PubMed1986

Pulmonary gas exchange and central hemodynamics at rest and during exercise in patients with chronic obstructive pulmonary disease.

Right-heart catheterization and ergometry with arterial and mixed venous blood gas analysis were performed in 27 patients with a wide range of chronic obstructive pulmonary diseases. The purpose of the examination was to evaluate the risk in patients for lung surgery or to detect additional heart diseases. Patients who developed exertional hypoxia (group 1) were compared with others who did not (group 2). In all patients the steady-state maximal workload was determined by ventilatory dysfunction. Both groups had normal values for mixed venous pO2 and normal increase of the circulatory parameters during exercise. The patients with exertional hypoxia differed from the others in that they showed no decrease of venous admixture and alveolar-arterial oxygen gradient. In addition, these patients had increasing pCO2 values at rest compared with exercise, indicating alveolar hypoventilation and ventilation-perfusion mismatching. Because of the good correlation of the absolute values of FEV1 (forced expiratory volume in 1 s) with pulmonary artery pressures, parameters of gas exchange and working capacity, this lung function parameter seems to have a central role in predicting the functional state of patients with chronic obstructive disease. Ergometry and blood gas analysis should be performed in addition because these values cannot be predicted with the calculated postoperative FEV1.

Aged↗
PubMed1987

[Acute effect of prostigmin on lung function and breathing of patients with myasthenia gravis at rest and following ergometric exercise].

The acute effects of a single intravenous Prostigmin injection (0.5 mg) on lung function and gas exchange during rest and bicycle ergometry were measured in 26 patients with myasthenia gravis. The mean age of the patients was 44.6 +/- 17.6 years and the mean duration of myasthenia gravis 5.4 +/- 6.3 years. Lung function parameters obtained from 15 patients showed a normal total lung capacity with an increase in functional residual capacity and residual volume, while vital capacity was diminished. While the application of Prostigmin showed no acute effects on these lung volumes, there was a significant increase in airway resistance, even into the pathologic range. Data obtained during spiro-ergometry concerning gas exchange, circulation and muscle metabolism correspond to those expected from healthy individuals; application of Prostigmin did only influence the heart rate, which can be explained by parasympathomimetic activity. We conclude that dyspnoea in patients with myasthenia gravis need not necessarily be a symptom of the illness itself but can also be caused by therapy; in the latter case bronchodilatators are required.

Adult↗
PubMed2005

Ouabain-like compound changes rapidly on physical exercise in humans and dogs: effects of beta-blockade and angiotensin-converting enzyme inhibition.

Ouabain, an inhibitor of the sodium pump, has been identified as a constituent of bovine adrenal glands. We were interested whether the release of this cardiotonic steroid is stimulated by physical exercise. Hence, athletes and healthy dogs were subjected to ergometry. Ouabain-like compound (OLC) was measured in venous blood by enzyme-linked immunosorbent assay as well as by (86)Rb+ uptake inhibition (as ouabain equivalents). OLC increased in venous blood of athletes after 15 minutes of ergometry from 2.5+/-0.5 to 86.0+/-27.2 nmol/L (n=51; P<0.001), as did the concentration of a circulating inhibitor of the sodium pump from 7.3+/-1.7 to 129.8+/-51 nmol/L (ouabain equivalents, P<0.05). Half-maximal increase in heart rate and systolic blood pressure occurred at 5.1+/-1.2 nmol/L and at 30+/-1 nmol/L OLC, respectively. On rest, OLC decreased in humans and dogs with a half-life of 3 to 5 minutes. In beagles exposed to moderate exercise on a treadmill for 13 minutes, levels of OLC increased 46-fold (from 3.7+/-0.8 to 166.9+/-91.8 nmol/L; n=6; P<0.005). This effect was suppressed when the dogs had been treated for 3 weeks with the beta1-adrenergic receptor blocker atenolol or the angiotensin-converting enzyme inhibitor benazepril. We conclude that OLC changes rapidly during exercise and is under the control of norepinephrine and angiotensin II.

Adrenergic beta-Antagonists↗
PubMed2003

Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) may stop cycling due to leg effort rather than breathlessness. However, cycling is not relevant to many patients, although walking may be more familiar. A total of 84 patients with COPD were asked to name the predominant symptom limiting incremental shuttle walking, endurance shuttle walking, incremental cycle ergometry, and endurance cycle ergometry, performed to exhaustion on four separate days. Furthermore, quadriceps fatigability was evaluated in 12 patients by measuring unpotentiated and potentiated twitch quadriceps tensions before and 30 minutes after incremental walking and cycling. Breathlessness alone was a more commonly cited limiting symptom after incremental walking compared with incremental cycling (81 vs. 34%; p < 0.001) and after endurance walking compared with endurance cycling (75 vs. 29%; p < 0.001). In addition, there was no significant change in mean pre- and postwalking twitch quadriceps tensions. However, cycling produced a significant reduction (unpotentiated 7.42 +/- 2.22 vs. 6.48 +/- 2.09 kg [p < 0.001]; potentiated 10.19 +/- 3.99 vs. 8.45 +/- 3.18 kg [p < 0.001]). Pre- to postexercise changes were significantly greater during cycling compared with walking (unpotentiated p = 0.01; potentiated p = 0.003). Leg effort is an infrequent symptom after walking in COPD, and low frequency fatigue of the quadriceps is an infrequent feature of incremental walking.

Aged↗
PubMed1995

Transcutaneous oxygen tension and Doppler ankle pressure during upper and lower body exercise in patients with peripheral arterial occlusive disease.

The effects of upper and lower body exercise on blood supply to the lower extremities were investigated in patients with peripheral arterial occlusive disease (PAOD) by measurements of transcutaneous oxygen tension (tcPO2) and Doppler ankle pressure (DAP). Twenty patients with PAOD (PAOD group) and 10 subjects without PAOD (control group) performed treadmill test (TT), recumbent cycle ergometry (CE), and rowing ergometry (RE) with a fixed seat. The tcPO2 was registered on the calf and DAP was measured at the end of each step of CE and RE. The walking distance in TT of the control group was not limited (> 1000 m), whereas that of the PAOD group was 161 m in median. In the control group there was no significant difference of performance between CE (125 +/- 33 W) and RE (111 +/- 24 W), whereas in the PAOD group, performance was lower in CE (72 +/- 31 W) than in RE (102 +/- 28 W) (P < 0.01). DAP of controls increased during both CE (136 to 165 mmHg) and RE (170 to 213 mmHg), whereas the DAP of the PAOD group decreased during CE (from 85 to 44 mmHg) and remained relatively constant during RE (113 to 101 mmHg). In controls, tcPO2 did not distinctly change during TT (70 to 66 mmHg) and increased during CE (58 to 73 mmHg) and RE (69 to 82 mmHg), whereas in the PAOD group, tcPO2 decreased during TT (66 to 33 mmHg) and CE (50 to 22 mmHg) and remained almost unchanged in RE (64 to 60 mmHg). A hyperbolic relationship was found between tcPO2 and DAP. In conclusion, during upper body exercise, blood supply to the lower extremities in patients with PAOD was not affected, whereas lower body exercise led to exhaustion of the functional reserve of blood supply. Because of a hyperbolic relationship between tcPO2 and DAP, tcPO2 remained relatively constant if blood supply was sufficient, but in disturbed blood supply a small change of DAP was accompanied by a great change of tcPO2. Therefore, in critical ischemia the change of tcPO2 was more sensitive than that of DAP.

Adult↗
PubMedDate not supplied

An acute double-blind placebo-controlled study of transdermal glyceryl trinitrate with 12 months' follow-up in patients with stable angina pectoris.

In an acute double-blind placebo-controlled randomized crossover study, 1 day of treatment with a glyceryl trinitrate transdermal patch releasing 10 mg glyceryl trinitrate daily was compared with placebo in 40 men with stable angina pectoris. Subsequently, the patients participated in an uncontrolled efficacy and tolerability study during which the transdermal patch was applied to the front of the chest for 22-23 hours daily for 12 months. In the acute study, one patch of glyceryl trinitrate or matching placebo was applied at 8.00 a.m. for 24 h; 48 h later the other treatment was applied. Bicycle ergometry was performed 24 and 16 h before the beginning of the treatment, and 8 and 24 h after each dose. Ergometry was repeated after 1, 3, 6 and 12 months' treatment with one patch daily of glyceryl trinitrate during the long-term open follow-up study. In the acute study, a significant reduction of ST-segment depression was observed with treatment compared with placebo. This reduction persisted throughout the 12 months of the open study. During this period also, the mean number of anginal attacks was reduced from 5.3 to 3.6 during week 1 of treatment, and this reduction was maintained throughout the 12 months of the study. No patient needed to be withdrawn because of systemic side-effects or local intolerance to the patch.

Administration, Cutaneous↗
PubMed1989

Effects of low- and moderate-intensity training in spinal cord-injured persons.

This study examined the applicability of exercise prescription guidelines established for the able-bodied to spinal cord-injured (SCI) persons. Two SCI groups performed wheelchair ergometry (WCE) 20 min three times per week for 8 wk. Low-intensity (LI, N = 6) and moderate-intensity (MI, N = 5) groups trained at 50-60% and 70-80% maximal heart rate reserve (HRR), respectively. The subjects completed an incremental discontinuous maximal WCE test to exhaustion pre- and post-training. A submaximal WCE test consisting of 4-min exercise stages at power outputs of 5, 10, and 15 W was also performed pre- and post-training. Blood samples were collected before and after training and analyzed for total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C). The TC/HDL-C ratio was calculated. Both groups exhibited no significant changes (P greater than 0.10) in VO2max, HRmax, POmax, lactate (La)max, and VO2 at 4 mmol [La]. No pre- to post-training differences were recorded in the LI group for submaximal VO2, HR, VE, La, and ratings of perceived exertion (RPE). The MI group had significantly lower (P less than or equal to 0.10) post-training submaximal HR, La, and RPE and no changes in VO2 or VE. Blood lipid levels remained unaltered in the LI group, while the MI group exhibited significant increases in HDL-C and decreases in TG, LDL-C, and the TC/HDL-C ratio. The maximal test data revealed that 8 wk of LI and MI wheelchair ergometry training did not improve VO2max in SCI persons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

The curvature constant parameter of the power-duration curve for varied-power exercise.

INTRODUCTION: The tolerable duration (t) for high-intensity cycle ergometry bears a hyperbolic relationship to the power output (P) with an asymptote termed the critical power (CP), and a curvature constant (W') that is numerically equivalent to an amount of work that can be performed above CP. The physiological nature of W' has received little consideration compared with CP, e.g., whether the total amount of work above CP remains constant when the power actually changes during the high-intensity task. PURPOSE: The purpose of this study was to compare W' derived from the standard estimation method, consisting of several different constant-P tests, and the total amount of work above CP during an exhausting exercise bout using a variable-P protocol. METHODS: Eleven healthy male subjects (age: 21-40 yr) volunteered to participate in this study. Each initially performed four-to-six high-intensity square-wave exercise bouts for estimation of CP [mean (SD); 213.3 (22.4) W] and W' [12.68 (3.08) kJ]. The subjects subsequently performed two variable-P tests to the limit of tolerance. During the first part, P was 117% or 134% of CP for a duration that expended approximately half of W'. The work rate was then abruptly increased to 134% (UP protocol) or decreased to 117% (DOWN protocol) of CP for the second part. RESULTS: There were no significant differences between W' [12.68 (3.08) kJ] and the total amount of work above CP during the UP [12.14 (4.18) kJ] and DOWN [12.72 (4.05) kJ] protocols (P > 0.05). CONCLUSION: We conclude that the work equivalent of W' is not affected by power variations during exhausting cycle ergometry, at least in the P range of 100-134% of CP.

Adult↗
PubMed2004

Regular exercise as an effective approach in antihypertensive therapy.

PURPOSE: Exercise has been well documented to exert a beneficial effect on cardiovascular health. The effective control of arterial pressure (BP) is essential from the standpoint of cardiovascular prevention. So far, no study has determined the long-term effect of regular training as a monotherapy on both BP at rest and during exercise. METHODS: Therefore, 10 subjects with hypertension (aged 43 +/- 3 yr) were studied in order to define BP response to long-term aerobic training. BP measurements were obtained at rest and during ergometry (50-100 W). Patients were instructed to exercise weekly (2 x 60 min aerobic exercise). RESULTS: BP during exercise (100 W) did fall already after 6 months of regular training from 184 +/- 10/107 +/- 6 to 170 +/- 10/100 +/- 7, and this was associated with a 14% decrease in the rate-pressure product (at 100 W). After 18 months of training, there were further reductions in BP, at rest from 139 +/- 9/96 +/- 6 to 133 +/- 14/91 +/- 7 (P < 0.05) and during ergometry (100 W) from 184 +/- 10/107 +/- 6 to 172 +/- 8/96 +/- 6 mm Hg (P < 0.001). During a 3-yr follow-up, BP continued to decrease significantly to 130 +/- 13/87 +/- 7 mm Hg at rest and 167 +/- 9/92 +/- 6 mm Hg during exercise. No significant changes in body weight were documented during the training period. CONCLUSION: The data demonstrate that long-term aerobic exercise is associated with a decrease in BP at rest and during exercise, which is comparable to that of drug therapies. This antihypertensive effect of regular training can be maintained as long as 3 yr.

Adult↗
PubMed2004

Evaluation of the SenseWear Pro Armband to assess energy expenditure during exercise.

PURPOSE: To assess the accuracy of the SenseWear Pro Armband for estimating energy expenditure during exercise. METHODS: : Forty subjects (age = 23.2 +/- 3.8 yr; body mass index = 23.8 +/- 3.1 kg x m) performed four exercises (walking, cycling, stepping, arm ergometry) with each exercise lasting 20-30 min and workload increasing at 10-min intervals. Subjects wore the SenseWear Pro Armband on the right arm, and energy expenditure was estimated using proprietary equations developed by the manufacturer. Estimated energy expenditure from the SenseWear Pro Armband was compared with energy expenditure determined from indirect open-circuit calorimetry, which served as the criterion measure. RESULTS: : When a generalized proprietary algorithm was applied to the data, the SenseWear Pro Armband significantly underestimated total energy expenditure by 14.9 +/- 17.5 kcal (6.9 +/- 8.5%) during walking exercise, 32.4 +/- 18.8 kcal (28.9 +/- 13.5%) during cycle ergometry, 28.2 +/- 20.3 kcal (17.7 +/- 11.8%) during stepping exercise, and overestimated total energy expenditure by 21.7 +/- 8.7 kcal (29.3 +/- 13.8%) during arm ergometer exercise (P < or = 0.001). At the request of the investigators, exercise-specific algorithms were developed by the manufacturer and applied to the data that resulted in nonsignificant differences in total energy expenditure between indirect calorimetry and the SenseWear Pro Armband of 4.6 +/- 18.1 kcal (2.8 +/- 9.4%), 0.3 +/- 11.3 kcal (0.9 +/- 10.7%), 2.5 +/- 18.3 kcal (0.9 +/- 11.9%), and 3.2 +/- 8.1 kcal (3.8 +/- 9.9%) for the walk, cycle ergometer, step, and arm ergometer exercises, respectively. CONCLUSIONS: It appears that it is necessary to apply exercise-specific algorithms to the SenseWear Pro Armband to enhance the accuracy of estimating energy expenditure during periods of exercise. When exercise-specific algorithms are used, the SenseWear Pro Armband provides an accurate estimate of energy expenditure when compared to indirect calorimetry during exercise periods examined in this study.

Adolescent↗
PubMed2004

Validation of a new method for estimating VO2max based on VO2 reserve.

PURPOSE: The American College of Sports Medicine's (ACSM) preferred method for estimating maximal oxygen consumption (VO2max) has been shown to overestimate VO2max, possibly due to the short length of the cycle ergometry stages. This study validates a new method that uses a final 6-min stage and that estimates VO2max from the relationship between heart rate reserve (HRR) and VO2 reserve. METHODS: A cycle ergometry protocol was designed to elicit 65-75% HRR in the fifth and sixth minutes of the final stage. Maximal workload was estimated by dividing the workload of the final stage by %HRR. VO2max was then estimated using the ACSM metabolic equation for cycling. After the 6-min stage was completed, an incremental test to maximal effort was used to measure actual VO2max. Forty-nine subjects completed a pilot study using one protocol to reach the 6-min stage, and 50 additional subjects completed a modified protocol. RESULTS: The pilot study obtained a valid estimate of VO2max (r = 0.91, SEE = 3.4 mL x min(-1) x kg-1) with no over- or underestimation (mean estimated VO2max = 35.3 mL x min(-1) x kg(-1), mean measured VO2max = 36.1 mL x min(-1) x kg(-1)), but the average %HRR achieved in the 6-min stage was 78%, with several subjects attaining heart rates considered too high for submaximal fitness testing. The second study also obtained a valid estimate of VO2max (r = 0.89, SEE = 4.0 mL x min(-1) x kg(-1)) with no over- or underestimation (mean estimated VO2max = 36.7 mL x min(-1) x kg(-1), mean measured VO2max = 36.9 mL x min(-1) x kg(-1), and the average %HRR achieved in the 6-min stage was 64%. CONCLUSIONS: A new method for estimating VO2max from submaximal cycling based on VO2 reserve has been found to be valid and more accurate than previous methods.

Exercise Test↗
PubMed1995

Dyspnea in dystonia. A functional evaluation.

BACKGROUND: Dystonia consists of action-triggered sustained focal muscle contractions, worsened by effort, and resulting in voice changes, abnormal posturing, and dyspnea. The cause of dyspnea, previously unexplained, is the basis of this report. METHODS: Since the maximal efforts required to perform pulmonary function testing (PFT) could worsen the muscular contractions in dystonic patients, we used several tests to identify possible causes of dyspnea. These included spirometry with flow volume loops (FVL), tidal volume breathing, maximum voluntary ventilation (MVV), and inspiratory and expiratory muscle pressures (PImax, PEmax), sitting and supine. We used cycle ergometry with arterial blood gas (ABG) values to detect cardiac/pulmonary limitations and respiratory inductive plethysmography (RIP) to assess chest wall/abdominal movements for synchrony. Dynamic videofluoroscopy (VF) assessed and recorded the action-triggered muscle activity of the upper airways and the diaphragm during quiet breathing, speech, swallowing, and maximal respiratory maneuvers similar to the efforts required during PFT. RESULTS: Twenty-six dystonic patients, 12 women and 14 men, ages 14 to 70 years (mean age, 52.3 years) were evaluated. Their neurologic classification included 22 primary (idiopathic) and 4 secondary (2 postneuroleptic use, 2 posstraumatic). Four patients originally classified as having focal dystonia had dyspnea and were found to have diaphragmatic and/or upper airway dysfunction too. The PFTs showed abnormal FVL and/or tidal volume breathing patterns, with intermittent interruptions of air flow during inspiration or expiration in 20 of 24 patients. The VF was abnormal in 24 of 26 patients: 19 patients had combined upper airway (UA) and diaphragmatic dysfunction (DD); 1 patient had UA dysfunction alone, and 4 patients had DD alone. Except for poor effort and/or dystonic movements, cycle ergometry was normal in 18 of 21 patients. The ABG values and/or pulse oximetry were normal in 19 of 22 patients. CONCLUSION: Dyspnea in dystonia appears to be due to excessive and/or dysynchronized contractions of the upper airways and/or diaphragm, with usually normal gas exchange. These spasmodic and irregular muscular contractions during speech and daily activities are associated with the sensation of excessive effort to overcome the spasms. Excessive spasms can be triggered during PFT and are best detected on FVL patterns coupled with dynamic VF.

Adolescent↗
PubMed1996

High-intensity physical training in adults with asthma. A 10-week rehabilitation program.

Twenty-six adults (23 to 58 years) with mild to moderate asthma underwent a 10-week supervised rehabilitation program, with emphasis on physical training. In the first 2 weeks, they exercised daily in an indoor swimming pool (33 degrees C) and received education about asthma, medication, and principles of physical training. In the following 8 weeks, they exercised in the pool twice a week. Every training session lasted 45 min. The training sessions were made as suitable as possible for the individual subjects, in order to minimize "drop outs" from the program. The aim of the study was to evaluate the efficacy of the rehabilitation program and to determine if inactive asthmatic adults can exercise at high intensity. The rehabilitation program was preceded by a 6-min submaximal cycle ergometry test, a 12-min walking test, spirometry, and a methacholine provocation test. The subjects also responded to a five-item questionnaire related to anxiety about exercise, breathlessness, and asthma symptoms using a visual analogue scale. All subjects were able to perform physical training at a very high intensity, to 80 to 90% of their predicted maximal heart rate. No asthmatic attacks occurred in connection with the training sessions. Twenty-two of the 26 subjects completed the rehabilitation program, felt confident with physical training, and planned to continue regular physical training after the 10-week program. Improvements in cardiovascular conditioning, measured as a decreased heart rate at the same load on the cycle ergometer (average of 12 beats/min), and as a longer distance at the 12-min walking test (average of 111 m), were observed during the program. FEV1 increased significantly from 2.2 to 2.5 L. Forced expiratory flow at 25% of vital capacity also increased slightly but significantly. Methacholine provocation dose causing a fall in FEV1 by 20% was unchanged. Seventeen subjects had a peak expiratory flow reduction of more than 15% after the preprogram ergometry test and were classified as having exercise-induced asthma (EIA). Only three of these subjects had EIA after 10 weeks. The asthmatic subjects were less afraid of experiencing breathlessness during exercise and less anxious about exercising at a high intensity after 10 weeks (p < 0.05). The asthma symptoms abated significantly during the rehabilitation program and the subjects needed less acute asthma care after the rehabilitation program. The results indicate that asthmatic persons benefit from a rehabilitation period, including physical training. Rehabilitation programs are therefore of value as a supplement to conventional pharmacologic treatment of asthma. This rehabilitation program can be adapted for use in clinical practice.

Adult↗
PubMed2003

Adaptation of pulmonary oxygen consumption slow component following 6 weeks of exercise training above and below the lactate threshold in untrained men.

STUDY OBJECTIVES: To examine the effects of 6 weeks of exercise training above or below the lactate threshold (LT) on the slow component (SC) of pulmonary oxygen consumption (.VO(2)). DESIGN: Randomized controlled trial. SETTING: University human performance laboratory. PARTICIPANTS: Apparently healthy, untrained men (n = 18). INTERVENTIONS: Subjects were randomized to one of three groups: high-intensity exercise training (HI) [above the LT], moderate-intensity exercise training (MOD) [below the LT], or no exercise training (CON). Exercise groups performed cycle ergometry 4 d/wk for 6 weeks. Total work throughout training was constant between groups. MEASUREMENTS AND RESULTS: Maximal cycle ergometry was performed at baseline and after training to assess power output at the LT (WLT), .VO(2) at the LT (.VO(2)LT), and peak .VO(2) (.VO(2)PK). High-intensity, constant-load cycling was performed at baseline and weeks 1, 2, 4, and 6 to assess SC adaptations. WLT, .VO(2)LT, and .VO(2)PK increased after 6 weeks in both exercise groups compared to the CON group (p < 0.05), although there were no differences between the training groups. SC of .VO(2) decreased 44% in the HI group following 1 week of exercise training vs MOD (20%, p < 0.05) and CON (12%, p < 0.01) groups. The SC attenuation was more prominent at all time points in the HI group compared to the MOD group. Total SC attenuation over the 6-week training period did not differ between the HI (71%) and MOD (57%) groups. CONCLUSIONS: Training at HI or MOD produced similar improvements in the LT, .VO(2), and power output at peak exertion when total work output was held constant. Attenuation of the SC with training above and below the LT were similar, although above-LT training promoted faster SC adaptations.

Adult↗
PubMed2004

Effects of whole-body exercise training on body composition and functional capacity in normal-weight patients with COPD.

BACKGROUND: Skeletal muscle wasting is related to muscle dysfunction, exercise intolerance, and increased mortality risk in patients with COPD. STUDY OBJECTIVES: The aims of this study were to investigate the effects of whole-body exercise training on body composition in normal-weight patients with COPD, and to study the relationship between changes in body composition and functional capacity. SETTING AND PARTICIPANTS: Fifty patients with COPD (FEV(1), 39% of predicted [SD, 16]) admitted to the pulmonary rehabilitation center at Hornerheide, and 36 healthy age-matched control subjects (for baseline comparison) were included. INTERVENTIONS: Patients participated in a standardized inpatient exercise training program consisting of daily submaximal cycle ergometry, treadmill walking, weight training, and gymnastics during 8 weeks. MEASUREMENTS: Fat-free mass (FFM) was measured by bioelectrical impedance analysis. None of the patients met the criteria for nutritional supplementation (body mass index </= 21, or FFM index </= 15 kg/m(2) in women and </= 16 kg/m(2) in men). Exercise capacity was measured using incremental cycle ergometry. Isokinetic quadriceps strength was measured with a Biodex dynamometer (Biodex Medical Corporation; Shirley, NY). RESULTS: At baseline, patients were characterized by a significantly lower FFM than the control subjects. Age and FFM were independent predictors of skeletal muscle function and exercise capacity in patients. After rehabilitation, weight (72.4 +/- 9.8 to 73.0 +/- 9.4 kg, p < 0.05) significantly increased, as a result of increased FFM (52.4 +/- 7.3 to 53.4 +/- 7.7 kg, p < 0.05), while fat mass (20.0 +/- 6.1 to 19.6 +/- 5.7 kg) tended to decrease. Peak work rate (63 +/- 29 to 84 +/- 42 W, p < 0.001), maximal oxygen consumption (O(2)max) [1,028 +/- 307 to 1,229 +/- 421 mL/min, p < 0.001], and isokinetic quadriceps strength (82.5 +/- 36.4 to 90.3 +/- 34.9 Newton-meters, p < 0.05) all improved. Changes in FFM were proportionally smaller than functional improvements, and were related to changes in O(2)max (r = 0.361, p < 0.05), but not to other changes in functional capacity. CONCLUSIONS: Intensive exercise training per se is able to induce an anabolic response in normal-weight patients with COPD classified into Global Initiative for Chronic Obstructive Lung Disease stages III-IV. Improvements in exercise performance and muscle function are proportionally larger than increases in FFM.

Aged↗
PubMed2004

Reproducibility of cardiopulmonary exercise measurements in patients with pulmonary arterial hypertension.

BACKGROUND AND OBJECTIVES: As part of a recent study, cardiopulmonary exercise tests (CPETs) were used to evaluate and follow up patients with pulmonary arterial hypertension (PAH). These patients were more impaired than those in other published series evaluating CPET reproducibility. We used these patient tests to assess patient performance variability and evaluate reading variability. To achieve this end, six independent evaluators graded key CPET measurements in patients with PAH who underwent duplicate CPETs within 3 days of each other. SETTING AND PATIENTS: Over a 15-month period at two tertiary-care teaching hospitals, 42 patients with PAH underwent repeated, paired CPETs using cycle ergometry. INTERVENTIONS AND MEASUREMENTS: Each patient underwent one to six pairs of cycle ergometry tests to maximal tolerance. Each pair of tests was separated by 3 months, with each test in the pair separated by 1 to 3 days. Specific guidelines were given to the independent evaluators for the key measurements assessed from each CPET study: peak O(2) uptake (Vo(2)), peak heart rate, peak O(2) pulse, anaerobic threshold (AT), and end-tidal Po(2), end-tidal Pco(2), and the ventilatory equivalent for CO(2) at the AT (Ve/Vco(2)@AT). RESULTS: There were no fatalities or complications occurring among the 242 tests performed on 42 patients. The mean peak Vo(2) was 722 mL/min or 41% of predicted; 34 patients were Weber class C or D. Using the specific guidelines to measure the variability of measurements made by the six independent evaluators, the coefficients of variation were < 2.2% for peak Vo(2), peak heart rate, peak O(2) pulse, end-tidal values at the AT, and Ve/Vco(2)@AT, while for the AT, it was 8.5%. There were no significant differences in these measurements between the first and second tests of any pair or between the earlier and later sets of pairs. CONCLUSIONS: Using specific guidelines, key CPET measurements can be safely, reliably, and reproducibly assessed even in patients with severe exercise intolerance.

Adolescent↗
PubMed2005

Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD.

STUDY OBJECTIVES: We have previously shown that tiotropium at 18 mug reduces lung hyperinflation and dyspnea during exercise and improves exercise tolerance in patients with COPD. The present study was designed to gain further insight into the duration of improvements. DESIGN, PATIENTS, AND INTERVENTIONS: A randomized, double-blind, placebo-controlled, parallel-group study was conducted in 261 COPD patients (mean age, 62.5 +/- 7.4 years [+/- SD]; 189 men and 72 women; mean FEV1, 1.2 +/- 0.4 L [43 +/- 12.7% predicted]). On day 0 (first dose), day 21, and day 42 of treatment, pulmonary function tests were performed before and 1 h 20 min after dosing, followed by a constant work rate cycle ergometry test (75% maximum work capacity) to symptom limitation at 2.25 h after dosing. On day 42, an additional constant work rate cycle ergometry test was performed at 8 h after dosing. RESULTS: Adjusted mean (+/- SE) endurance time (ET) on day 42 was 803 +/- 40 s (tiotropium), vs 568 +/- 42 s (placebo) at 2.25 h after dosing (primary end point; treatment difference, 236 +/- 58 s; p = 0.0001) and 665 +/- 40 s (tiotropium) vs 494 +/- 42 s (placebo) at 8 h after dosing (treatment difference, 171 +/- 58 s; p = 0.0035). Adjusted mean dyspnea intensity at isotime on day 42 was 4.60 +/- 0.16 Borg units (tiotropium), vs 5.65 +/- 0.16 Borg units (placebo) at 2.25 h after dosing (p < 0.001), and 5.54 +/- 0.17 Borg units (tiotropium) vs 6.51 +/- 0.18 Borg units (placebo) at 8 h after dosing (p < 0.001). Adjusted mean pre-exercise inspiratory capacity (IC) on day 42 was 2.41 +/- 0.03 L (tiotropium) vs 2.19 +/- 0.03 L (placebo) at 2.25 h after dosing (p < 0.001), and 2.31 +/- 0.03 L (tiotropium) vs 2.16 +/- 0.03 L (placebo) at 8 h after dosing (p < 0.001). The significant increase in IC with tiotropium compared with placebo was maintained throughout exercise. CONCLUSIONS: The present study confirms that tiotropium reduces lung hyperinflation at rest and during exercise, reduces exertional dyspnea, and improves symptom-limited exercise tolerance in COPD patients. Furthermore, this study shows that this improvement is present at 2.25 h and at 8 h after dosing after 6 weeks of treatment.

Aged↗