Capacity In Cardiac Patients Research Articles

Effects of two different types of single exercise modes on salivary C-reactive protein concentration, oxidative stress and antioxidant capacity in post-myocardial infarction patients

ABSTRACT Objectives The aim of the study was to determine the effects of two different types of single cardiac rehabilitation (CR) exercise modes on the inflammation status, oxidative stress and total antioxidant capacity (TAC) of saliva. Methods The study involved two groups of CR patients: group A (n = 21) used a cycloergometer, and group B (n = 21) received breathing and balance exercises. C-reactive protein as an inflammatory biomarker, malondialdehyde (MDA) as a measure of the level of oxidative stress and salivary 2.2-diphenyl-1-picryl-hydrazyl (DPPH) as an index of TAC were performed twice: before the beginning of the CR exercise (pre-CR) and immediately after (post-CR). Results No significant changes were observed for the inflammatory response of saliva after CR exercise regardless of its type. MDA decreased (pre-CR: 39.7 ± 101.9 vs. post-CR: 16.8 ± 44.3 ng·mL−1; p < 0.01) and DPPH increased (pre-CR: 25.9 ± 16.7 vs. post-CR: 32.6 ± 14.0% reduction; p < 0.05) after CR exercise in the group B, with similar but not statistically significant changes in the group A. Discussion Two popular exercise modes, especially breathing and balance exercises, reduce salivary oxidative stress and enhance the antioxidant potential of saliva in CR patients. The approval of saliva as a non-invasive source of information about inflammation status, oxidative stress and antioxidant capacity in cardiac patients requires further studies.

The utility of the oxygen pulse recovery as a marker of the cardiac output response to exercise in patients with chronic heart failure.

The cardiac output (CO) response to exercise is a useful marker to grade the prognosis and severity of chronic heart failure (CHF). The recovery of the oxygen pulse (OP) is a non-invasive parameter, which is related to exercise capacity in cardiac patients. However, the relation between OP recovery and the central haemodynamic response to exercise remains to be determined. We hypothesized that an impaired OP recovery is associated with a reduced CO response to exercise in CHF patients. Sixty one CHF patients performed cardiopulmonary exercise test with simultaneous measurement of CO. Impaired OP recovery was defined as an overshoot during the first minute of recovery or OP at 1-min recovery as a percentage of peak OP (OPRR ). An OP overshoot was observed in 9% (n=5) of patients. In these patients, peak CO and VO2 were significantly lower (peak CO 7.9±0.8 versus 11.2±4.3 L/min and peak VO2 14.1±4.7 versus 19.6±5.8mlmin-1 kg-1 ). Mean relative recovery of OP was 78±20%. Slow OP recovery (negative OPRR ) was seen in 13% (n=8). Peak CO and VO2 were significantly lower in the negative OPRR group (11±4 versus 8±0.7 L/min and 19.7±5.9 versus 14.6±3.7mlkgmin-1 ). There was a significant relation between OPRR and stroke volume (SV) RR (r=.57), as well as between OPRR and a-v O2 diff RR (rs =.4). An impaired OP recovery is associated with a reduced CO response to exercise and worse functional status. Therefore, the OP recovery can be used to grade the severity of CHF.

A Combined and Intensive Exercise Model Improves Physical Capacity in Cardiac Patients

Objective: We have measured the effect of combined strength and high intensity endurance training on physical capacity and lipid profile in patients with heart and coronary diseases. We wanted to see whether cardiac patients were able to increase training intensity to improve strength without losing endurance capacity. Methods: Thirty heart-operated subjects participated in an intervention period of 10 weeks. The age of the participants was between 52-72 years. The Resistance-Interval group (RE-INT) practiced four times a week with two intensive endurance (spinning) sessions and two strength training sessions. The endurance training consisted of intervals where the heart rate reached>90% of maximum heart rate. Strength training was performed in three series with a load of 8-12 repetition maximum (RM). The subjects in the control group (CON) performed two to three sessions per week according to a national program specialized for coronary patients (called “Ullevaal model”). We had a randomized controlled trial. Results: Maximal leg strength increased in both groups during the intervention, but the increase was higher in the RE-INT group (from 107.9 ± 8.1 kg to 162.0 ± 8.4 kg) compared to the CON group (from 110.8 ± 8.9 to 125.4 ± 9.5 ) (p<0.001). Strength in chest press, the maximal oxygen uptake and the concentration of high densitylipoprotein (HDL) protein increased in both groups during the test period. However, no differences were observed between the RE-INT and CON group. Low density-lipoprotein (LDL), blood pressure and body weight did not change during the intervention period in any of the groups. Conclusion: cardiac patients were able to increase training intensity, strength and maximal oxygen uptake during a period of 10 weeks. We found that combined training has an effective impact on the increase in leg strength. The increase in muscle strength can be vital for the everyday quality of life in cardiac patients.

Effects of High-Intensity Interval Training on Aerobic Capacity in Cardiac Patients: A Systematic Review with Meta-Analysis.

Purpose. The aim of this study was to compare the effects of high-intensity interval training (INTERVAL) and moderate-intensity continuous training (CONTINUOUS) on aerobic capacity in cardiac patients. Methods. A meta-analysis identified by searching the PubMed, Cochrane Library, EMBASE, and Web of Science databases from inception through December 2016 compared the effects of INTERVAL and CONTINUOUS among cardiac patients. Results. Twenty-one studies involving 736 participants with cardiac diseases were included. Compared with CONTINUOUS, INTERVAL was associated with greater improvement in peak VO2 (mean difference 1.76 mL/kg/min, 95% confidence interval 1.06 to 2.46 mL/kg/min, p < 0.001) and VO2 at AT (mean difference 0.90 mL/kg/min, 95% confidence interval 0.0 to 1.72 mL/kg/min, p = 0.03). No significant difference between the INTERVAL and CONTINUOUS groups was observed in terms of peak heart rate, peak minute ventilation, VE/VCO2 slope and respiratory exchange ratio, body mass, systolic or diastolic blood pressure, triglyceride or low- or high-density lipoprotein cholesterol level, flow-mediated dilation, or left ventricular ejection fraction. Conclusions. This study showed that INTERVAL improves aerobic capacity more effectively than does CONTINUOUS in cardiac patients. Further studies with larger samples are needed to confirm our observations.

Higher fine particulate matter and temperature levels impair exercise capacity in cardiac patients

ObjectiveFine particulate matter (PM2.5) air pollution and variations in ambient temperature have been linked to increased cardiovascular morbidity and mortality. However, no large-scale study has assessed their effects on directly...

Both Systolic and Diastolic Functions are Determinants of Exercise Capacity in Cardiac Patients with Very High Levels of Plasma BNP

It is well known that left ventricular (LV) diastolic function is one of the independent determinants of exercise capacity in cardiac patients, but systolic function is not. However, it is unknown whether LV systolic function is unrelated with exercise capacity in patients with advanced systolic and diastolic dysfunction with very high levels of plasma BNP (>500pg/mL).

Exercise behavior and physical activity in patients after open heart surgery

Introduction: Open heart surgery helps piece up cardiac disorder and improve functional capacity in cardiac patients. Patients after open heart surgery usually receive structured in-hospital cardiac rehabilitation which builds up physical ability and educates patients to lead active lifestyle. However, whether they maintain regular exercise behavior and perceive adequate physical activity (PA) level after discharge was still unknown. The purposes of this study were to assess exercise behavior and PA level at 6 months after discharge of open heart surgery and possible related factors.

The training effects of skeletal muscle strength and muscle volume to improve functional capacity in cardiac patients

The training effects of skeletal muscle strength and muscle volume to improve functional capacity in cardiac patients

Rehabilitation in Cardiac Patients

This article discusses the effects of training in cardiac rehabilitation and describes the influence of various training modalities on the evolution of exercise capacity in cardiac patients. Both home- and hospital-based studies are analysed separately. From the collected studies, a very heterogeneous character of the content of the rehabilitation programmes appears. Direct comparison of the effects of the training programmes on exercise capacity remains difficult. Baseline factors for predicting a better training outcome are: low exercise capacity and peripheral oxygen extraction; presence of hibernating myocardium; high myocardial perfusion; low degree of coronary vessel occlusion; working status; and improved feelings of wellbeing. The increased work capacity as a result of rehabilitation is associated with: an increased volume density of skeletal muscle mitochondria; peripheral muscular vasodilatory capacity; cardiac output and a decreased left ventricular end-diastolic pressure; depletion of muscular phosphocreatine levels; and degree of restenosis. Home- and hospital-based interventions induce comparable training effects. More research is needed concerning the training modalities in cardiac rehabilitation. There is an influence of weekly training frequency and programme duration on the training outcome. A higher training frequency and/or duration might induce greater training effects. The evolution of the anaerobic threshold is sensitive to the training intensity and inclusion of strength training, which remains to be established for maximal exercise capacity. However, insufficient information is available on the influence of training session duration on the evolution of exercise capacity.

Comparing and Predicting Functional Capacity in Cardiac Patients

Comparing and Predicting Functional Capacity in Cardiac Patients

Comparing and Predicting Functional Capacity in Cardiac Patients

1479 Clinicians in cardiac rehabilitation (CR) lack preadmission symptom limited graded exercise test (SLGXT) results, as many cardiologists simply “waive” the SLGXT requirement. The clinician is uninformed about the incoming patient's functional capacity. Some CR programs have implemented sub maximal walking tests conducted on admission to establish a safe and effective exercise intensity. PURPOSE: To correlate sub maximal values collected from a 12-minute walking test (SUB) on a treadmill with maximal values collected from SLGXT (Bruce Protocol); and to derive a prediction equation to estimate maximal functional capacity (METSmax) in the absence of a SLGXT in this population. METHODS: 47 CR patients (40 m; 7 f; 64 ± 13 yrs; 182.3 ± 26.6 lbs) met criteria for inclusion in this retrospective study. All subjects completed a SUB in which speed and/or grade was increased progressively until subject indicated they felt they were walking at a RPE 12–13 (6–20 scale). From the SUB, systolic blood pressure (SBPsub, 143.2 ± 22.3 mmHg), body mass index (BMI, 27.6 ± 3.7), heart rate achieved (HRsub, 104.5 ± 17.9), and METs achieved (METSsub, 4.6 ± 2.2) were recorded. From a treadmill SLGXT, max systolic blood pressure (SBPmax, 166.7 ± 19.6), max heart rate (HRmax, 139.3 ± 18.5), and max METs achieved (METSmax, 9.9 ± 3.3) were recorded. Pearson Product Moment Correlation (PPMC) was used to analyze correlations between variables. Linear regression (LR) was used to develop a prediction equation. RESULTS: PPMC for AGE, HRmax, and METSsub (−.037, .337, and .508 respectively, p<.05) were significant. LR using predictors HRsub, AGE, and METSsub was highly significant [F (df 3,43) = 16.814, p<.001] and accounted for the majority of variance (R = .735, R2 = .54, SEE ± 2.3 METs). CONCLUSIONS: Using the predictor values HRsub, AGE, and METSsub obtained from a 12-minute walk test, provides an alternative method of estimating functional capacity in a cardiac population. PREDICTION EQU: MAX METS = 18.359 + (.756 * METSsub) – (.386 * AGE) – (.385 * HRsub)

Short-term physical training improves vasodilatory capacity in cardiac patients.

There have been no previous studies that clearly demonstrate the effects of training on the relation between exercise capacity and vasodilatory capacity in skeletal muscle. This study was performed to clarify the effects of short-term, moderate-intensity physical training on exercise tolerance and vasodilatory capacity in cardiac patients. We studied 21 patients after acute myocardial infarction, coronary artery bypass grafting, or valve replacement. Each patient performed symptom-limited incremental exercise tests before and after a 2-week training program of moderate-intensity exercise. A cycle ergometer was used for both the training and exercise tests. Blood pressure measurement and respiratory gas analysis were continuously performed during the tests. Cardiac output was also measured using a dye-dilution method at rest and every 2 minutes during incremental exercise. Reactive hyperemic calf blood flow was measured at rest. After the training program, the subjects attained a significant decrease in systemic vessel resistance and significant increases in oxygen uptake and cardiac output at peak exercise. Changes in reactive hyperemic calf blood flow were significantly correlated with the changes in cardiac output, systemic vascular resistance, and the kinetics of oxygen uptake during warm-up exercise. By improving the peripheral vasodilatory capacity in these patients, short-term, moderate-intensity physical training was found to improve the cardiovascular adaptation not only at peak exercise, but also during the onset of exercise.

COMPARISON OF RAMP TREADMILL PROTOCOLS IN CARDIAC PATIENTS WITH LIMITED FUNCTIONAL CAPACITY.

1261 Treadmill ramp protocols are becoming increasingly popular and commercially available. The main benefits of ramp protocols are the smaller work increments, optimization of test duration, and patient preference. We employ individualized ramp protocols, where a different slope is computed for each patient based on desired speed, target test time (12min), and target MET level. In contrast, researchers from Ball State University have proposed the use of a Bruce Ramp (BR) protocol where each of the 3-minute stages of a standard Bruce protocol are broken into nine 20-second increments. The purpose of this study was to compare maximal responses and prediction of functional capacity in low fit (<6METS) cardiac patients undergoing both the BR and individualized ramp (IR) protocols. Twelve patients (mean age=63±12, mean MET= 4.6±.8) with limited functional capacity (<6METs) enrolled in the Wake Forest Cardiac Rehabilitation Program, underwent two symptom-limited maximal treadmill tests in random order on a motor driven treadmill with direct measurement of expired gases. Maximal values for oxygen consumption (VO2), heart rate (HR), test duration, speed, grade, rating of perceived exertion (RPE), respiratory exchange ratio (RER), systolic blood pressure (SBP), diastolic blood pressure (DBP) and ventilation (VE) were compared using analysis of variance. Comparisons were also made between measured and estimated MET levels using standard ACSM formulae to estimate MET levels for both treadmill protocols. There were no significant differences in peak values for VO2, HR, RPE, RER, SBP, DBP or VE. However, test duration (min) was significantly lower in the BR (BR=5.5±1.1 vs. IR=9.2±2.1) while both speed (mph) and grade (%) were significantly higher (BR= 2.5±.3 vs. IR 2.1±.2, BR 11.5±1.3 vs. IR 7.8±2.6 respectively). The table below provides a comparison of the mean (±SD) measured and estimated MET values for the two protocols as well as correlations (r), and standard error of the estimates (SEE).TableConclusion: In patients with low functional capacity the ACSM equation significantly overpredicts MET levels from the BR, but does not significantly overpredict with the IR protocol. However, the low correlation and high SEE for both protocols indicates that estimating MET levels with the ACSM equation will result in substantial variability and potential inaccuracy. Therefore, direct measurement of VO2 is recommended for accurate assessment of functional capacity in cardiac patients with low functional capacities.

A specific activity questionnaire to measure the functional capacity off cardiac patients

Exercise testing is often performed in persons with cardiac disease to measure their functional capacity. Physical activity questionnaires assessing functional capacity have been used as a low-cost and convenient alternative to exercise testing, but have not been well validated against measured oxygen consumption in a cardiac population. This study assesses the ability of a simple, 13-item, self-administered activity questionnaire, known as the Specific Activity Questionnaire (SAQ), to measure functional capacity prospectively in a large sample of cardiac patients. Ninety-seven consecutive cardiac out-patients (85 men and 12 women aged 59 ± 10 years [mean ± SD]) completed the SAQ before an elective symptom-limited treadmill test. Subjects returned within 10 days to repeat the treadmill test, following the same protocol, with the additional measurement of peak oxygen consumption, VO 2 (ml · kg −1·min −1), using open circuit spirometry. The SAQ score was significantly related to measured peak VO 2 (r = 0.57, p < 0.001). Stepwise multiple linear regression analysis found that the addition of patient age, height, and body weight to SAQ score improved the measurement of peak VO 2, accounting for 51% of the sample variance (R = 0.71, p < 0.001). Peak VO 2 was obtained from the following regression formula: VO 2 = (2.36)SAQ + (0.35)HEIGHT − (0.19)AGE − (0.16) BODY WEIGHT − 33.89; SEE 5.43. Thus SAQ, a simple 13-item self-administered activity questionnaire, is able to provide a moderately good measure of functional capacity in cardiac patients and may be a useful tool in studies of the cardiac population when formal exercise testing is impractical or uneconomical.

Athletic Participation After Myocardial Revascularization: Possibilities and Benefits

Exercise after open heart operation is not only possible but highly desirable. Training increases the efficiency of exercise and therefore decreases myocardial work for any given level of activity. Even before sternal and incisional healing is complete the patient may become physically active. Almost every patient can improve his or her level of fitness safely by following simple guidelines. Exercise treadmill testing is the basis for assessing exercise capacity in cardiac patients. Upper-body exercise is not adequately emphasized in most exercise programs.

Central Versus Peripheral Adaptations for the Enhancement of Functional Capacity in Cardiac Patients

Central Versus Peripheral Adaptations for the Enhancement of Functional Capacity in Cardiac Patients

Post exercise oxygen uptake kinetics and eiercise capacity in cardiac patients

Post exercise oxygen uptake kinetics and eiercise capacity in cardiac patients

Effects of isosorbide dinitrate on exercise capacity in cardiac patients. Relationship between oxygen uptake responses and hemodynamic effects.

Acute effects of oral isosorbide dinitrate on exercise capacity were evaluated in 14 patients with chronic heart disease measuring the anaerobic threshold and left ventricular function during exercise. A symptom-limited exercise test was performed on a bicycle ergometer with work rates increased by 1W every 6 seconds. Left ventricular function was continuously monitored with a computerized cadmium telluride detector following the intravenous injection of technetium-labeled red blood cells. Thirty minutes after the control exercise test, patients were given isosorbide dinitrate, 5 mg orally. The second exercise test was performed 30 min later. Isosorbide dinitrate improved the anaerobic threshold from 715.4 +/- 172.9 to 774.9 +/- 173.5 ml/min (p less than 0.01) and ejection fraction at peak exercise from 36.7 +/- 11.6 to 39.9 +/- 12.3% (p less than 0.05). However, there was no significant change in maximum work rate or peak oxygen uptake. Those patients for whom isosorbide dinitrate resulted in a 10% or greater improvement in the anaerobic threshold had both higher pre-treatment ejection fractions and greater increases in peak exercise ejection fraction following isosorbide dinitrate. Measurements of the anaerobic threshold and left ventricular function during exercise may be useful in the evaluation of the efficacy of vasodilators in cardiac patients.

Effects of DBcAMP on exercise capacity in patients with and without chronic heart failure

The acute effects of vasodilation on exercise capacity in cardiac patients with (group 1) and without (group 2) congestive heart failure were studied using dibutyryl cyclic AMP (DBcAMP). Exercise was performed on an upright bicycle ergometer using a graded protocol. DBcAMP increased cardiac output and decreased pulmonary capillary wedge pressure and systemic vascular resistance both at rest and during maximal exercise in these two groups. However, before and after DBcAMP neither exercise duration (371 ± 52 seconds vs. 388 ± 44, NS, in group 1, 645 ± 148 vs. 635 ± 143 seconds, NS, in group 2, respectively) nor maximal oxygen consumption (12.8 ± 2.3 ml/kg/min vs. 13.1 ± 1.6, NS, in group 1, 20.3 ± 1.4 vs. 20.1 ± 1.5, NS, in group 2, respectively) was improved. In both groups the arteriovenous oxygen differences were lower at rest and during exercise performed while on DBcAMP than in the control state. In group 2 patients excess vasoconstriction mediated by abnormally increased neurohormonal activities or edema were absent. Failure of the vasodilator to increase exercise capacity is probably due to nonspecific vasodilation and maldistribution of increased cardiac output, and not to tight vasoconstriction or narrowed arteriolar lumen.

Aerobic exercise training reduces resting and exertional blood pressure in cardiac patients.

We evaluated the effects of exercise training (ET) on resting and exertional blood pressure in patients with cardiac disease. ET consisted of 20 to 30 minutes of aerobic activity three times weekly for 12 months. The study group comprised 17 males and three females (mean age 58 years, range 40 to 71 years). Blood pressure was evaluated at rest and during exercise after 6 and 12 months ET. A training effect was documented by an increase in functional capacity from 7.5 METs (1 MET = 3.5 mL oxygen consumption/kg/min) pre-ET to 8.8 and 9.2 METs after 6 and 12 months, respectively. The following significant (P less than 0.05) effects occurred on blood pressure in association with ET: resting systolic pressure pre-ET decreased from 131 to 124 mm Hg at 12 months ET; submaximal (50% pre-ET maximum capacity) systolic and diastolic pressures decreased from 150/84 to 142/80 mm Hg (6 months ET) and 144/80 mm Hg (12 months ET); diastolic pressure at maximal exertion fell from 83 to 77 mm Hg (6 months ET) and 78 mm Hg (12 months ET). Systolic blood pressure at maximal exertion was not increased despite significant increases in peak workload achieved at 6 and 12 months ET. Therefore, ET not only enhances functional capacity in cardiac patients but may be associated with a beneficial cardiac effect through attenuation of both rest and exertional blood pressure.