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PubMed2005

Prognosis of patients with good exercise capacity and mildly abnormal exercise echocardiography results: identification of an at-risk subgroup.

BACKGROUND: Patients with good exercise capacity and mildly abnormal exercise echocardiography results have a favorable overall prognosis. OBJECTIVE: We sought to define subgroups that might be at higher risk. METHODS: We examined outcomes of 868 patients (women, > or = 5 metabolic equivalents; men, > or = 7 metabolic equivalents) with mild rest- or exercise-induced wall-motion abnormalities and evaluated potential predictors of time to cardiac death or nonfatal myocardial infarction (MI). RESULTS: Mean age was 64 +/- 10 years; 477 patients (55%) were men. Mean follow-up was 3.1 +/- 1.5 years; cardiac event rate was 1.2% per person-year. A history of MI was the only significant predictor (risk ratio, 3.9; 95% confidence interval, 1.9-7.8; P = .0001), with 1-, 3-, and 5-year event-free survival of 98.5% +/- 1.1%, 92.6% +/- 2.6%, and 83.3% +/- 5.1%, respectively (event rate, 3.4%). CONCLUSIONS: Patients with a history of MI have a higher annual cardiac event rate and may benefit from reevaluation, whereas no history of MI connotes a favorable prognosis.

Aged↗
PubMed2005

Adults with Ebstein's anomaly--Cardiopulmonary exercise testing and BNP levels exercise capacity and BNP in adults with Ebstein's anomaly.

INTRODUCTION: Ebstein's anomaly is defined as the significant apical displacement of the part of the tricuspid valve causing significant tricuspid regurgitation and reduction of the functional right ventricle. The aim of the study was to evaluate exercise capacity with cardiopulmonary stress testing and to determine plasma BNP levels in adults with Ebstein's anomaly, and to establish their relation with echocardiogaphic grading of the lesion severity. MATERIALS AND METHODS: Study group consisted of 21 patients (16 males, aged 40.3+/-11.5 years). The control group: 19 healthy individuals (13 males, aged mean 39.9+/-9.3 years). On echocardiography the grade of the lesion severity was calculated (EGE) and used to define the following four groups: I < 0.5, II: 0.5-0.9, III: 1.0-1.49, IV > 1.5. The forced vital capacity (FVC), first second forced expiratory volume (FEV1), peak oxygen uptake (peak VO2), and VE/VCO2 slope were assessed with cardiopulmonary stress test and plasma BNP levels measured with radioimmunometric assay. RESULTS: In the studied group VO2 was lower than in control (21.9+/-5.4 vs. 33.6+/-8.3 mL/kg/min [p = 0.00001]), VE/VCO2 slope was higher in Ebstein's group (40.1+/-8.1, p = 0.00001). BNP levels were higher in the Ebstein group then in controls (35.9+/-25.0 vs. 17.2+/-9.9 pg/mL [p = 0.0002]) and did not differ significantly between EGE groups. PeakVO2 of 24.5+/-3.9 in patients from II EGE group were higher than in patients from EGE groups: III (17.2+/-5.2 p = 0.007) and IV (22.9+/-4.7 p = 0.05). CONCLUSIONS: Exercise capacity of adults with Ebstein's anomaly is significantly reduced and plasma BNP levels are higher compared to healthy individuals. Exercise capacity in patients with Ebstein's anomaly becomes gradually lower alongside the EGE severity; however, BNP levels do not correlate significantly with this parameter.

Adult↗
PubMed2004

[Exercise-intolerance and exercise-induced rhabdomyolisis: etiology and diagnosis].

Exercise intolerance, sometimes complicated by rhabdomyolysis is a frequent complaint of patients consulting in neuromuscular centers. It may be the main clinical manifestation of many metabolic myopathies and muscular dystrophies. The first step of diagnosis relies on the performance of in vivo metabolism investigations: forearm or bicycle ergometer exercise tests, phosphorus nuclear magnetic resonance spectroscopy. A few enzymatic defects may be directly assessed on blood samplings, in particular carnitine palmitoyltransferase deficiency; but muscle biopsy is necessary in most cases in order to precise the etiology. When CK levels are elevated at rest, a muscle CT scan should be performed in order to detect muscles fatty replacement suggestive of a muscular dystrophy; this diagnosis will be confirmed with immunohistochemical and western-blot analysis of muscle proteins. We present a description of the main metabolic myopathies manifesting by exercise intolerance with an overview of clinical and laboratory evaluation leading to diagnosis. Differential diagnosis are also discussed.

Biopsy↗
PubMed1998

Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and quality of life in both women and men with chronic heart failure.

BACKGROUND: Data of training effects in chronic heart failure patients are based on findings in men. The purpose of this study was to compare the effects of skeletal muscle endurance training between men and women with chronic heart failure. METHODS AND RESULTS: Twelve consecutive men (mean [+/- SD] age 58 +/- 9 years, left ventricular ejection fraction 29 +/- 9%) and 12 women (60 +/- 10 years, left ventricular ejection fraction 28 +/- 7%) with moderate, chronic heart failure stratified according to age and inclusion criteria were investigated at baseline and after 8 weeks of knee extensor endurance training. The activity of skeletal muscle citrate synthase and resting heart rate were similar in men and women at baseline and with training improved (P < .0001) similarly in both genders. Peak work rate (P < .0001), peak oxygen uptake (P < .001) and muscle strength (P < .05) at baseline were higher in men than in women. Training improved peak work rate (P < .0001) and muscle strength (P < .0001) similarly in both genders, while improvement in peak oxygen uptake was better in women (P < .001). The distance ambulated during 6 minutes was similar in both genders at baseline and increased after training more in men (P < .004). The overall and physical Sickness Impact Profile indicated similarly reduced health-related quality of life in men and women, while worse psychosocial quality of life was observed in men (P < .05). Both genders improved after exercise training in the overall, physical, and psychosocial Sickness Impact Profile (P < .01). CONCLUSIONS: Exercise-based rehabilitation improves skeletal muscle capacity, exercise tolerance, and the health-related quality of life in women as well as in men with moderate, chronic heart failure.

Aged↗
PubMed2006

Can self-reported preference for exercise intensity predict physiologically defined self-selected exercise intensity?

Exercise prescription guidelines emphasize the importance of individual preferences for different intensities, but such preferences have not been studied systematically. This study examined the hypothesis that the preference scale of the Preference for and Tolerance of the Intensity of Exercise Questionnaire would predict self-selected exercise intensity. Twenty-three previously sedentary middle-aged women participated in a treadmill test and a 20-min session at a self-selected intensity. After controlling for age, body mass index, and peak oxygen uptake, the preference scale accounted for significant portions of the variance in the percentage of oxygen uptake associated with the ventilatory threshold at Minute 15 and Minute 20 of the session at self-selected intensity.

Adult↗
PubMedDate not supplied

Exercise intolerance in congestive heart failure: a lesson in exercise physiology.

The current working hypothesis of exercise intolerance in patients with CHF indicates that an initial reduction in cardiac output, secondary to either systolic or diastolic dysfunction, results in a variety of complex and inter-related pathophysiologic alterations in the skeletal muscle, the vasculature, the pulmonary system, and several neurohumoral systems. These numerous compensatory mechanisms, although they work to preserve vital body functions, they ultimately result in exercise intolerance. Thus, the syndrome of CHF provides a unique opportunity to evaluate the role of several fundamental principles of exercise physiology.

Exercise Test↗
PubMed1994

Effects of digitalis, anti-anginal drugs and arterial hypertension on the relationships between exercise ECG and angiocardiographic variables and on the diagnostic accuracy of exercise ECG in patients with coronary heart disease.

We have previously found a statistically significant correlation between some exercise ECG variables and angiocardiographic scores used to evaluate the extent and type of coronary heart disease (CHD). In the present study we examined the effects of digitalis, beta-adrenergic blockers, slow release nitrates, calcium channel blockers, presence of arterial hypertension (AHT), and angiocardiographic changes on the exercise ECG variables. The effects of drugs and AHT were small as compared to the effects of the angiocardiographically detected pathological changes caused by the CHD. Sensitivity and specificity of the exercise ECG ST criteria in identifying patients with an angiocardiographic criterion indicating coronary insufficiency were not much different in the whole group and in the subsets with AHT or medication with digitalis and anti-anginal drugs.

Adrenergic beta-Antagonists↗
PubMed1990

Exercise electrophysiology testing: the effect of exercise on the induction of ventricular arrhythmias by programmed ventricular stimulation.

In order to assess the effect of acute, reversible myocardial ischemia on the outcome of programmed ventricular stimulation (PVS), ventricular stimulation was performed at rest, during exercise, and during recovery in 10 patients with coronary artery disease. Of these ten patients, four were tested while off antiarrhythmic drugs and six were tested on antiarrhythmic drug therapy. Nine of the ten patients developed acute myocardial ischemia during exercise PVS. However, in only two of these ten patients ventricular arrhythmia could be induced by PVS, one during exercise and one during recovery.

Aged↗
PubMed2002

The effects of a pre-exercise feeding with or without fungal carbohydrases (Carbogen) on blood parameters and exercise performance in elite cyclists: a preliminary study.

The effect of fungal carbohydrases (Carbogen[C]) consumed with a meal replacement bar (MBR) on glucose metabolism and exercise performance was determined in 5 male competitive cyclists. After a 12-hour fast, subjects performed two 60-min cycling bouts at 80% VO2max followed by a time-to-exhaustion (TE) ride at 100% VO2max. One hour prior to each cycling bout, subjects ingested a MRB + 160-mg C or 160-mg CaCO3 placebo (PL) in a double-blind, counterbalanced fashion. Blood was drawn for determination of glucose, insulin, and lactate at: fasting, 1 hour post-feeding, minutes 30 and 60 of exercise, and after TE. Two-way ANOVA revealed a significant (p <.05) treatment and time effect for glucose, with C being higher than PL. Interaction effects were observed for insulin and lactate. An increase in TE (min) at 100% VO2max was observed in the C versus PL trial (6.3 3.4 vs. 4.4 2.9, p <.001). A MRB+C may benefit cyclists due to increased BG and improved exercise performance.

Adult↗
PubMed2003

Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the Exercise in Left Ventricular Dysfunction and Chronic Heart Failure (ELVD-CHF) Trial.

BACKGROUND: The effects of exercise training (ET) on left ventricular (LV) remodeling in chronic heart failure are not definitively established, and the safety of ET in these patients is still debated. METHODS AND RESULTS: This multicenter study investigated the long-term effect of moderate ET on LV remodeling, work capacity, and quality of life (QoL) in 90 patients with stable chronic heart failure caused by LV systolic dysfunction, randomized to a 6-month ET program (T, n=45) or a control group (C, n=45). All patients underwent resting echocardiography, a cardiopulmonary exercise test, 6-minute walking test, and QoL assessment at entry and after 6 months. At entry, end-diastolic (EDV) and end-systolic (ESV) volume, ejection fraction, work capacity, peak o2, and walking distance were similar in the 2 groups. After 6 months, LV volumes diminished in T (EDV, from 142+/-26 to 135+/-26 mL/m2, P<0.006; ESV, from 107+/-24 to 97+/-24 mL/m2, P<0.05) but increased in C (EDV, from 147+/-41 to 156+/-42 mL/m2, P<0.01; ESV, from 110+/-34 to 118+/-34 mL/m2, P<0.01). Ejection fraction improved in T (P<0.001) but was unchanged in C (P=NS). Significant improvement in work capacity (P<0.001), peak VO2 (P<0.006), walking distance (P<0.001), and QoL (P<0.01) was observed in T but not in C (P=NS). T showed a trend toward fewer (P=0.05) hospital readmissions for worsening dyspnea in the absence of other adverse cardiac events. CONCLUSIONS: In stable chronic heart failure, long-term moderate ET has no detrimental effect on LV volumes and function; rather, it attenuates abnormal remodeling. Furthermore, ET is safe and effective in improving exercise tolerance and QoL.

Cardiac Volume↗
PubMed2006

Exercise and respiratory training improve exercise capacity and quality of life in patients with severe chronic pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is associated with restricted physical capacity, limited quality of life, and a poor prognosis because of right heart failure. The present study is the first prospective randomized study to evaluate the effects of exercise and respiratory training in patients with severe symptomatic PH. METHODS AND RESULTS: Thirty patients with PH (21 women; mean age, 50+/-13 years; mean pulmonary artery pressure, 50+/-15 mm Hg; mean World Health Organization [WHO] class, 2.9+/-0.5; pulmonary arterial hypertension, n=23; chronic thromboembolic PH, n=7) on stable disease-targeted medication were randomly assigned to a control (n=15) and a primary training (n=15) group. Medication remained unchanged during the study period. Primary end points were the changes from baseline to week 15 in the distance walked in 6 minutes and in scores of the Short Form Health Survey quality-of-life questionnaire. Changes in WHO functional class, Borg scale, and parameters of echocardiography and gas exchange also were assessed. At week 15, patients in the primary and secondary training groups had an improved 6-minute walking distance; the mean difference between the control and the primary training group was 111 m (95% confidence interval, 65 to 139 m; P<0.001). Exercise training was well tolerated and improved scores of quality of life, WHO functional class, peak oxygen consumption, oxygen consumption at the anaerobic threshold, and achieved workload. Systolic pulmonary artery pressure values at rest did not change significantly after 15 weeks of exercise and respiratory training (from 61+/-18 to 54+/-18 mm Hg) within the training group. CONCLUSIONS: This study indicates that respiratory and physical training could be a promising adjunct to medical treatment in severe PH. The effects add to the beneficial results of modern medical treatment.

Adult↗
PubMed2004

Effects of specific exercise instructions on abdominal muscle activity during trunk curl exercises.

STUDY DESIGN: A repeated-measures, counterbalanced design. OBJECTIVES: To test whether subjects could learn and retain the ability to alter the relative activity of abdominal muscle groups when performing trunk curl exercises. BACKGROUND: Although trunk curl exercises are widely prescribed, a disadvantage of trunk curls is that they primarily activate rectus abdominis, while the internal and external oblique abdominis muscles are considered to be more important contributors to lumbar stability. METHODS AND MEASURES: A convenience sample of 25 subjects performed trunk curl exercises in accordance with 3 different sets of instructions: nonspecific instructions (NS), instructions intended to emphasize rectus abdominis activity (RE), and instructions intended to emphasize oblique abdominis activity (OE). Electromyographic (EMG) activity was recorded from the upper and lower rectus and the internal and external oblique abdominis muscles while a physical target was used to insure that the trunk was raised to the same height for all conditions. Normalized root-mean-square EMG amplitude measures were used to test for instruction-dependent changes in the relative EMG activity of the rectus and oblique muscle groups. RESULTS: Following a single, brief, instruction session, subjects performing trunk curls had significantly greater normalized oblique:rectus EMG ratios when following OE instructions (mean [+/- SD] oblique-rectus ratio, 1.45 +/- 0.34) than when following RE (mean [+/- SD] oblique-rectus ratio, 0.76 +/- 0.24) or NS (mean [ISD] oblique-rectus ratio, 0.63 +/- 0.23) instructions. Retesting 1 week later indicated that subjects retained this skill. CONCLUSIONS: With minimal instruction, subjects are able to volitionally alter the relative activity of the oblique and rectus abdominis muscles when performing trunk curls. Incorporating instructions emphasizing oblique abdominis activity into lumbar stabilization programs appears promising and has potential advantages over other approaches to altering abdominal muscle activity during trunk

Abdominal Muscles↗
PubMed2003

[Physical exercise and atherosclerosis: dynamic high intensity exercise as a factor inducing exogenous dyslipidemia].

Effect of dynamic exercise of various intensity (maximal 100% and submaximal -- 80, 70 and 60% of individual maximally tolerated work load) on blood lipids, lipo- and apolipoproteins (apo) was studied in healthy subjects and patients with coronary heart disease. Both in healthy persons and patients high intensity (100 and 80%) exercise was associated with atherogenic changes of lipid transport system: increases of levels of total and low density lipoprotein cholesterol, triglycerides, apolipoprotein B and apo B/apo-A1 ratio. On the contrary, changes after exercise of moderate (60%) intensity (lowering of apo-B containing lipoproteins in healthy subjects and patients and elevation of apo-A1 concentration in healthy subjects) were antiatherogenic.

Adult↗
PubMed1990

[Exercise test in exercise-induced asthma in children: study of delayed response].

In this study we perform the exercise broncho-provocation test according to a protocol and involving 27 children with allergic asthma to study the prevalence and distinctive traits of the late response in exercise-induced asthma (EIA). At the conclusion of the study, 20 patients (74%) were diagnosed of EIA through some of the tests employed (ergometric bicycle, free run). In the cases where both tests were negative, we reproduced in a controlled manner the exercise reported as asthmogenic on the basis of anamnesis; no positivity was observed for the test in any case. Prevalence of late asthmatic response was 40% (8/20); mean beginning time to this response was 4-6 hours, lasting less than 1 hour and with a mean intensity rate of 26.8% (measured as the percentage of PEFR drop according to the preexercise basal value). The results are discussed, comparing them with those of other authors and with the allergen provocation response pattern; in addition the methods used and therapeutic implications in view of the results are dealt with.

Asthma, Exercise-Induced↗
PubMed1983

Duration of exercise in the provocation of exercise-induced asthma.

With running speed held constant, exercise durations of between two and 32 minutes all provoke significant asthma. However, the severity and length of the bronchoconstriction is less following exercise of two minutes duration. Exercise durations ranging from eight to 32 minutes show no difference in either incidence or severity of EIA.

Adolescent↗
PubMed1994

The protective effects of continuous and interval exercise in athletes with exercise-induced asthma.

To determine the effect of two forms of warm-up on postexercise bronchoconstriction in athletes with exercise-induced asthma, 12 moderately trained persons with asthma (age = 26.5 +/- 2.2 yr; height = 169.2 +/- 2.6 cm; weight = 64.3 +/- 2.6kg; VO2max = 52.7 +/- 1.3 ml.kg-1.min-1) were tested under three experimental conditions; continuous warm-up (CW), interval warm-up (IW), and control (C). CW consisted of 15 min of treadmill running at a velocity corresponding to 60% VO2max followed by an exercise challenge test (ET = 6 min at 90% VO2max). IW involved 8 x 30-s runs (1.5 min rest between bouts of exercise), at an intensity equivalent to 100% VO2max, followed by an ET. C consisted of only the ET. FEV1, FVC, and MMEFR were measured prior to the experimental conditions, repeated before the ET, and every 2 min during a 25-min passive recovery period, using a Breon spirometer. Postexercise changes in pulmonary function were recorded as the largest decrese in FEV1, FVC, and MMEFR during the recovery period, and expressed as a percentage of baseline values. Significant differences were detected in %FEV1 (34. 6,16.7,29.7: P = 0.009), %FVC (30.0,10.7,21.0: P = 0.03), and %MMEFR (50.0,30.2,43.4: P = 0.05), in comparing C, CW, and IW, respectively. Scheffe's test detected significance (P < 0.05) between C and CW for all three dependent variables; no statistical significance between C and IW or IW and CW occurred. These data indicate that a continuous warm-up of 15 min at 60% VO2max can significantly decrease postexercise bronchoconstriction in moderately trained athletes.

Adult↗
PubMed1987

Exercise treatment for paroxysmal positional vertigo: comparison of two types of exercises.

The use of exercises can be an excellent method for treating benign paroxysmal positional vertigo (BPPV). We compared the results obtained by a progressive training method, vestibular habituation training (VHT), with a brisk exercise method. While VHT can be applied in all kinds of "provoked" (positional) vertigo of peripheral origin, the brisk method can be used only in typical BPPV, provided the vertigo is unilaterally provoked. A series of patients with such typical "unilateral" cases were treated by the brisk method and were compared with a second series of identical cases treated by the VHT technique. The results after 1 week seemed to be different: with the brisk method 52% of the patients were free of vertigo, while only 32% with VHT were vertigo free. This difference is not statistically significant. However, those cases treated by VHT and still having vertigo after 1 week had a striking reduction in the severity of their vertigo, as estimated by the score-system used. In contrast, the scores were unchanged for those cases not responding to the brisk method. Continuation of treatment of these latter cases using VHT exercises showed that the final result after 6 weeks was equal for both groups.

Exercise Therapy↗