Contribution of lung function to exercise capacity in patients with chronic heart failure.
(9/2144)
BACKGROUND: The importance of exercise capacity as an indicator of prognosis in patients with heart disease is well recognized. However, factors contributing to exercise limitation in such patients have not been fully characterized and in particular, the role of lung function in determining exercise capacity has not been extensively investigated. OBJECTIVE: To examine the extent to which pulmonary function and respiratory muscle strength indices predict exercise performance in patients with moderate to severe heart failure. METHODS: Fifty stable heart failure patients underwent a maximal symptom-limited cardiopulmonary exercise test on a treadmill to determine maximum oxygen consumption (VO2max), pulmonary function tests and maximum inspiratory (PImax) and expiratory (PEmax) pressure measurement. RESULTS: In univariate analysis, VO2max correlated with forced vital capacity (r = 0.35, p = 0.01), forced expiratory volume in 1 s (r = 0.45, p = 0.001), FEV1/FVC ratio (r = 0.37, p = 0.009), maximal midexpiratory flow rate (FEF25-75, r = 0. 47, p < 0.001), and PImax (r = 0.46, p = 0.001), but not with total lung capacity, diffusion capacity or PEmax. In stepwise linear regression analysis, FEF25-75 and PImax were shown to be independently related to VO2max, with a combined r and r2 value of 0. 56 and 0.32, respectively. CONCLUSIONS: Lung function indices overall accounted for only approximately 30% of the variance in maximum exercise capacity observed in heart failure patients. The mechanism(s) by which these variables could set exercise limitation in heart failure awaits further investigation. (+info)
The effect of physical training on hormonal status and exertional hormonal response in patients with chronic congestive heart failure.
(10/2144)
BACKGROUND: Physical training improves exercise capacity in patients with chronic heart failure. It decreases plasma noradrenaline at rest, which may be prognostically favourable. The effect on atrial natriuretic peptide, another prognostic factor, and on catabolic and anabolic hormones remains unknown. Furthermore, to our knowledge, the contribution of exertional hormonal responses to the improved exercise capacity has not been evaluated. METHODS: 27 patients with stable chronic heart failure (New York Heart Association class II-III) were randomized to training (n=12) and control (n=15) groups. The training group exercised on a bicycle ergometer for 30 min three times a week for 3 months. The load corresponded to 50-60% of their peak oxygen consumption. For the next 3 months they exercised at home according to personal instructions. The control group did not change its physical activities. The levels of hormones regulating the cardiovascular system and metabolism were determined at rest and after graded maximal exercise and during exercise with constant submaximal workload. RESULTS: Submaximal exercise capacity increased significantly and peak oxygen consumption tended to improve by 12% in the training group. The plasma noradrenaline at rest tended to decrease by 19%. The plasma level of N-terminal pro atrial natriuretic peptide did not change. Serum cortisol, a catabolic hormone, was normal at baseline and remained unchanged. The serum levels of anabolic hormones, growth hormone and insulin, as well as dehydroepiandrosteronesulfate and free testosterone were within a normal range at baseline. They were not altered by training. The dehydroepiandrosteronesulfate/cortisol, and the free testosterone/cortisol ratios, reflecting anabolic/catabolic balance, did not change, either. Training resulted in a higher peak noradrenaline response during graded maximal exercise. The rise in serum cortisol during exercise tended to attenuate. CONCLUSION: Physical training, which improves exercise capacity, does not have an unfavourable effect on anabolic/catabolic balance or neurohumoral activation in patients with congestive heart failure. It decreases plasma noradrenaline at rest. Minor changes in hormonal responses during exercise emerged after physical training which unlikely contribute to the improved exercise capacity. (+info)
Explosive-strength training improves 5-km running time by improving running economy and muscle power.
(11/2144)
To investigate the effects of simultaneous explosive-strength and endurance training on physical performance characteristics, 10 experimental (E) and 8 control (C) endurance athletes trained for 9 wk. The total training volume was kept the same in both groups, but 32% of training in E and 3% in C was replaced by explosive-type strength training. A 5-km time trial (5K), running economy (RE), maximal 20-m speed (V20 m), and 5-jump (5J) tests were measured on a track. Maximal anaerobic (MART) and aerobic treadmill running tests were used to determine maximal velocity in the MART (VMART) and maximal oxygen uptake (VO2 max). The 5K time, RE, and VMART improved (P < 0.05) in E, but no changes were observed in C. V20 m and 5J increased in E (P < 0.01) and decreased in C (P < 0.05). VO2 max increased in C (P < 0.05), but no changes were observed in E. In the pooled data, the changes in the 5K velocity during 9 wk of training correlated (P < 0.05) with the changes in RE [O2 uptake (r = -0.54)] and VMART (r = 0.55). In conclusion, the present simultaneous explosive-strength and endurance training improved the 5K time in well-trained endurance athletes without changes in their VO2 max. This improvement was due to improved neuromuscular characteristics that were transferred into improved VMART and running economy. (+info)
Effects of repetitive handgrip training on endurance, specificity, and cross-education.
(12/2144)
BACKGROUND AND PURPOSE: Exercise programs are more likely to be successful when they are based on research that predicts the outcomes of such training. This study determined the effect of submaximal rhythmic handgrip training on rhythmic handgrip endurance or work (RHW), isometric handgrip endurance time (IHE), and maximal voluntary isometric contraction for the handgrip force (MVIC) (in newtons). SUBJECTS: Twenty-four male subjects (mean age=26.2 years) with right-hand dominance were randomly assigned to a regular training group (n=8), a low-level training group (n=8), or a control group (n=8). METHODS: Rhythmic handgrip work, IHE, and MVIC were determined bilaterally before and after 6 weeks of a rhythmic right handgrip training program using 30% of MVIC. The low-level training group performed daily training with a near-zero load (<0.005% of MVIC). RESULTS: There was a 1,232% increase in RHW and an 8% decrease in IHE after the training program using 30% of MVIC for the right hand. The left hand showed a 43% increase in RHW after training, whereas the low-level training group showed a 35% increase in RHW. No differences were found between the change in the left-hand RHW of the regular training group and the change in the right-hand RHW of the low-level training group, but both measurements were greater than the change in the control group (6.4%). CONCLUSION AND DISCUSSION: Submaximal handgrip endurance training at 30% of MVIC had a minimal effect on submaximal IHE and MVIC of the handgrip, but it had a large effect on RHW of the trained extremity. The regular training group and the low-level training group showed similar increases in cross-education, suggesting that cross-education during endurance training is not intensity-dependent. (+info)
The effects of exercise and diet manipulation on the capacity to perform prolonged exercise in the heat and in the cold in trained humans.
(13/2144)
1. This study examined the effects of exercise and diet manipulation intended to alter initial muscle glycogen levels on the capacity to perform prolonged exercise at two ambient temperatures. 2. Six well-trained cyclists participated in randomized order in two diet and exercise regimens each lasting 8 days and comprising four cycle tests to exhaustion at 70 % of maximum oxygen uptake. On days 1 and 5, subjects exercised to exhaustion to deplete muscle glycogen. Three days after each depletion trial a diet providing 10 % (low carbohydrate (CHO)) or 80 % (high CHO) of energy as CHO was consumed, and each diet was followed by a performance trial at the same ambient temperature, either 10 or 30 C (days 4 and 8). This schedule was repeated after a week, but performance trials were carried out at the other ambient temperature. 3. In the cold, cycling time increased (median (range)) from 89.2 min (78.0-129.5 min) on the low CHO trial to 158.2 min (116.9-165.6 min) on the high CHO trial (P < 0.01). In the heat, cycling time increased from 44.0 min (31.8-51.4 min) on the low CHO trial to 53.2 min (50.2-82.2 min) on the high CHO trial (P = 0.02). Total CHO oxidized during exercise in the cold after the low CHO diet was higher than in the heat after either diet suggesting that exercise in the heat was terminated before all available CHO stores had been emptied. (+info)
Glucose production during strenuous exercise in humans: role of epinephrine.
(14/2144)
The increase in hepatic glucose production (HGP) that occurs during intense exercise is accompanied by a simultaneous increase in epinephrine, which suggests that epinephrine may be important in regulating HGP. To further investigate this, six trained men were studied twice. The first trial [control (Con)] consisted of 20 min of cycling at 40 +/- 1% peak oxygen uptake (VO2 peak) followed by 20 min at 80 +/- 2% VO2 peak. During the second trial [epinephrine (Epi)], subjects exercised for 40 min at 41 +/- 2% VO2 peak. Epinephrine was infused during the latter 20 min of exercise and resulted in plasma levels similar to those measured during intense exercise in Con. Glucose kinetics were measured using a primed, continuous infusion of [3-3H]glucose. HGP was similar at rest (Con, 11.0 +/- 0.5 and Epi, 11.1 +/- 0.5 micromol. kg-1. min-1). In Con, HGP increased (P < 0.05) during exercise to 41.0 +/- 5.2 micromol. kg-1. min-1 at 40 min. In Epi, HGP was similar to Con during the first 20 min of exercise. Epinephrine infusion increased (P < 0.05) HGP to 24.0 +/- 2.5 micromol. kg-1. min-1 at 40 min, although this was less (P < 0.05) than the value in Con. The results suggest that epinephrine can increase HGP during exercise in trained men; however, epinephrine during intense exercise cannot fully account for the rise in HGP. Other glucoregulatory factors must contribute to the increase in HGP during intense exercise. (+info)
Greater erythrocyte deformability in world-class endurance athletes.
(15/2144)
Because athletes during endurance events require rapid uptake of oxygen, the ability of red blood cells (RBC) to move through capillaries may limit performance. Using ektacytometry, we determined whether RBC deformability (RCD) differed between elite road cyclists (n = 9) and sedentary controls (n = 5). Density profiles and standard hematological measurements were also performed. The deformability index (DI) was higher in the cyclists (0.723 +/- 0.027) compared with that in controls (0.619 +/- 0.040, P < 0.001). Cyclists also had a larger percentage of low-density RBCs (P < 0. 001), and mean cell volume (MCV) was also higher (P = 0.013). These findings are indicative of a larger proportion of "young" RBCs in the blood of elite cyclists and provide further evidence that the turnover of RBCs in endurance athletes is higher than in the general population. With a younger more deformable RBC population and providing the destruction does not exceed replacement, performance potential should be enhanced. Furthermore, examination of factors that contribute to increased RBC turnover in athletes may help us understand the mechanisms that cause RBC aging. (+info)
Repetitive hemodilution in chronic obstructive pulmonary disease and pulmonary hypertension: effects on pulmonary hemodynamics, gas exchange, and exercise capacity.
(16/2144)
BACKGROUND: In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. OBJECTIVE: It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. METHODS: Seven patients with stable COPD (forced expiratory volume in 1 s 33 +/- 3 % of predicted, means +/- SE) and pulmonary hypertension were phlebotomized 5-6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40, 000). This resulted in a stepwise reduction of the hematocrit from 53.3 +/- 2.6 to 45.8 +/- 3.1% and a reduction of whole blood viscosity from 9.8 +/- 0.6 to 8.8 +/- 0.7 mPa x s at a shear rate of 2.0 s-1. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. RESULTS: Mean pulmonary artery pressure (PAm) decreased from 30 +/- 3 to 22 +/- 2 mm Hg and arterial oxygen partial pressure (PaO2) increased from 63.2 +/- 2.2 to 71.8 +/- 3.7 mm Hg at rest. During peak exercise, PAm decreased from 59 +/- 7 to 53 +/- 7 mm Hg and PaO2 increased from 54.0 +/- 5.7 to 63.2 +/- 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 +/- 84 to 750 +/- 59 ml x min-1, corresponding to an increase in cardiac index from 4.25 +/- 0.5 to 5.88 +/- 0.76 liters x min-1 x m-2. Pulmonary vascular resistance fell from 345 +/- 53 to 194 +/- 32 dyn x s x cm-5. The patients' peak exercise capacity increased from 9.2 +/- 2. 0 before to 13.5 +/- 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). CONCLUSION: The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension. (+info)