Changes In Exercise Tolerance Research Articles

Development of rehabilitation and preventive programs for employees of "dust-hazardous" professions

Introduction. The main tasks of the occupational pathology service are early diagnosis of occupational diseases, prevention of their formation, and in case of development, slowing down the progression. Due to the timely start of rehabilitation measures, it is possible to preserve employees' ability to work, and the employer — the labor potential of qualified personnel.
 In modern enterprises, it is necessary to create programs to provide workers with medical care at the early stages of the formation of diseases, to prevent their progression, the development of complications and the preservation of professional ability to work.
 The study aims are the scientific substantiation of methodological approaches to optimizing rehabilitation and preventive programs for employees of "dust−hazardous" professions.
 Materials and methods. The scientists have examined 254 employees of KAMAZ PJSC: 164 employees of the Foundry and 90 employees of other divisions of the enterprise. The work uses a complex of hygienic, clinical and laboratory, instrumental, statistical research methods.
 Results. The authors have established the features of the a priori and a posteriori risk of the formation of occupational pathology of the respiratory organs in the departments of a large machine-building enterprise. There is specificity of the development of respiratory pathology depending on the exposure characteristics and characteristics of the physico-chemical properties of industrial aerosols in workers of a machine-building enterprise. The researchers have developed and scientifically substantiated a methodological approach to the application of a set of measures aimed at reducing risk and preventing occupational pathology of the respiratory system in employees of a machine-building enterprise, based on a personalized assessment of harmful factors of the production environment, a differentiated approach to correcting modifiable risk factors.
 Conclusions. The authors justified the use of various rehabilitation and preventive programs for interned employees of the enterprise who have a high risk of developing occupational pathology of the respiratory system, developed a differentiated approach to the use of various rehabilitation and preventive programs based on the analysis of the dynamics of clinical and functional indicators reflecting the course of respiratory pathology under the influence of industrial aerosols of various compositions (formation of obstructive-restrictive disorders, changes in exercise tolerance, the dynamics of morbidity with temporary disability).

ARE CHANGE IN METS DURING CARDIAC REHAB RELATED TO CHANGE IN PEAK VO2 AND 6MWD?

BACKGROUND Change in metabolic equivalents of task (METs) during exercise training is often used as a program outcome in cardiac rehabilitation (CR). The purpose of this study is to assess the correlation between the change in estimated exercise training METs during a CR program and the change in six-minute walk distance (6MWD) and change in peak oxygen uptake (VO2). METHODS This is a secondary analysis of data from the iATTEND trial- a randomized controlled trial that compared facility based CR versus hybrid CR. Subjects included in this analysis had a history of myocardial infraction, coronary revascularization, heart failure, or valve surgery and completed ≥12 sessions of CR. METs during exercise training were estimated using ACSM treadmill equations from the average of the second, third and fourth sessions of CR and the final three sessions of CR. 6MWD and peak VO2 was derived from a symptom limited graded exercise treadmill test with gas exchange were collected at baseline before starting CR and within 14 days of completing CR. Pearson correlation coefficient was determined between change in estimated exercise training METs and both change in 6MWD and in peak VO2. RESULTS The final cohort was n=237 (age=59±12 years; 35% women; 57% non-white race). The correlation between change in estimated exercise training METs and 6MWD was r=0.257, r=0.245, and r=0.235 among patients who completed ≥12 sessions of CR, ≥24 sessions of CR, and 36 sessions of CR, respectively. The correlation between change in estimated exercise training METs and peak VO2 was r=0.121, r=0.100, and r=0.136 among patients who completed ≥12 sessions of CR, ≥24 sessions of CR, and 36 sessions of CR, respectively. CONCLUSIONS Although change in estimated exercise training METs during a CR program, change in 6MWD, and change in peak VO2 have each been used to describe change in exercise tolerance for program outcomes, the association between these variables is low (r= <0.3). This finding was independent regardless of the number of sessions completed. Further research is needed to better understand the relationship between the various methods of assessing change in exercise tolerance and program outcomes in CR.

ОЦЕНКА ТОЛЕРАНТНОСТИ К ФИЗИЧЕСКОЙ НАГРУЗКЕ НА СТАЦИОНАРНОМ ЭТАПЕ РЕАБИЛИТАЦИИ У ЛИЦ, ПЕРЕНЕСШИХ ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ

Abstract. Introduction. It is proven that integrated cardiac rehabilitation helps reduce mortality and hospital readmission rates and improves the quality of life of patients with acute coronary syndrome experience. Key aspect of integrated cardiac rehabilitation is aerobic training contributing to higher exercise tolerance. Aim. This research aims at assessing the changes in exercise tolerance in acute coronary syndrome patients at the second stage of medical rehabilitation. Materials and Methods. The research involved 162 patients of the Department of Medical Rehabilitation of Adult Patients with Somatic Diseases, who have experienced acute coronary syndrome. To assess the patients’ exercise tolerance, we used the six-minute walk test under electrocardiography control with the Accordix system (Neurosoft, Russia) upon their admission and immediately before their discharge from the hospital. Along with drug therapy, the personalized medical rehabilitation plans included electrocardiography-controlled aerobic training, laser therapy, psychological intervention, and occupational therapy classes. Rehabilitation efficiency was assessed by six-minute walk test (m) and Functional Independence Measurement (FIM) scale (score). The findings were analyzed statistically using nonparametric criteria. Results and Discussion. There were reduced exercise tolerance and limited daily activities in a significant part of cardiological patients before admission to the hospital. Upon completion of the medical rehabilitation course, the patients’ exercise tolerance increased significantly, resulting in better individual exercise tolerances, longer distances covered within the six-minute walk test, and the larger total amount of daily activities the patients can perform. Conclusions. Electrocardiography-controlled physical training based on the patient’s initial stamina level promotes increasing their exercise tolerance, their tolerance to daily activities, their mobility, independence, and, accordingly, their life quality.

Ventilation and perceived exertion are sensitive to changes in exercise tolerance: arm+leg cycling vs. leg cycling.

Purpose: Growing evidence suggests that respiratory frequency (f R) is a marker of physical effort and a variable sensitive to changes in exercise tolerance. The comparison between arm+leg cycling (Arm+leg) and leg cycling (Leg) has the potential to further test this notion because a greater exercise tolerance is expected in the Arm+leg modality. We systematically compared Arm+leg vs. Leg using different performance tests. Methods: Twelve males underwent six performance tests in separate, randomized visits. Three tests were performed in each of the two exercise modalities, i.e. an incremental test and two time-to-exhaustion (TTE) tests performed at 90% or 75% of the peak power output reached in the Leg incremental test (PPOLeg). Exercise tolerance, perceived exertion, and cardiorespiratory variables were recorded during all the tests. Results: A greater exercise tolerance (p < 0.001) was found for Arm+leg in the incremental test (337 ± 32W vs. 292 ± 28W), in the TTE test at 90% of PPOLeg (638 ± 154s vs. 307 ± 67s), and in the TTE test at 75% of PPOLeg (1,675 ± 525s vs. 880 ± 363s). Unlike O2 and heart rate, both f R and minute ventilation were lower (p < 0.003) at isotime in all the Arm+leg tests vs. Leg tests. Furthermore, a lower perceived exertion was observed in the Arm+leg tests, especially during the TTE tests (p < 0.001). Conclusion: Minute ventilation, f R and perceived exertion are sensitive to the improvements in exercise tolerance observed when comparing Arm+leg vs. Leg, unlike O2 and heart rate.

Plasma adiponectin as a predictor of the effectiveness of coronary heart disease therapy in patients with metabolic syndrome

BACKGROUND: Adiponectin, an adipose tissue protein, plays a crucial role in the development of metabolic syndrome and atherosclerosis. As a potential therapeutic target, this adipokine can be considered in the context of treatment strategies.&#x0D; AIM: The aim of this study was to assess the correlation between changes in plasma adiponectin concentration during coronary heart disease therapy and the effectiveness of the treatment, as well as to examine the relationship between initial adiponectin levels and treatment outcomes in patients with metabolic syndrome.&#x0D; MATERIALS AND METHODS: The study included 31 patients with coronary heart disease and metabolic syndrome (age 59.7 5.9 years, 21 women) which underwent the reexamination after 23 years. Most patients received statins (n = 26), while some received fibrates (n = 4) and hypoglycemic drugs (n = 4). Additionally, the patients were on hypotensive and antithrombotic therapies. The effectiveness of coronary heart disease therapy was assessed by evaluating changes in the functional class of angina pectoris and exercise tolerance measured through cycle ergometry. Plasma samples were collected at the initial and reexamination periods to determine glucose, insulin, adiponectin, leptin, and lipidogram parameters.&#x0D; RESULTS: The study revealed improvements in insulin sensitivity and plasma lipid spectrum, along with reduced levels of plasma leptin and increased adiponectin levels during the course of therapy. In addition, some patients showed enhanced exercise tolerance. Among the biochemical parameters, changes in insulin resistance during therapy correlated with improvements in exercise performance indicators during cycle ergometry (r = 0.320.36, p 0.05). Moreover, multiple regression analysis indicated that the initial adiponectin concentration independently determined changes in inotropic reserve and the amount of work performed ( = 0.44, p = 0.04 and = 0.64, p = 0.008).&#x0D; CONCLUSIONS: The studys findings regarding the association of plasma adiponectin concentration with changes in exercise tolerance during coronary heart disease therapy suggest the potential for developing specific approaches to raise adiponectin levels in the future.

Longitudinal significance of six-minute walk test in patients with nontuberculous mycobacterial pulmonary disease: an observational study

BackgroundThe long-term exercise tolerance changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) are of great interest because of its chronic course. This study aimed to characterize the associations between changes over time in six-minute walking test (6MWT) parameters and clinical parameters in patients with NTM-PD.MethodsOverall, 188 patients with NTM-PD, visiting outpatient clinics at Keio University Hospital from April 2012 to March 2020 were included in the study. Data were collected using the St. George’s Respiratory Questionnaire (SGRQ), pulmonary function test (PFT), blood tests, and the 6MWT at registration and at least once after that. The association of the anchors and clinical indicators with the 6MWT parameters was assessed.ResultsThe median age [interquartile range] of the patients was 67 [63–74] years. The median baseline six-minute walk distance (6MWD) and final Borg scale (FBS) were 413 [361–470] m and 1 [0–2], respectively. In the correlation analysis, ΔSGRQ total/year (yr), Δforced vital capacity (FVC, % predicted)/yr, Δforced expiratory volume in 1 s (FEV1, % predicted)/yr, and Δdiffusing capacity for carbon monoxide (DLCO, % predicted)/yr correlated with both Δ6MWD/yr and ΔFBS/yr in the longitudinal analysis (|Rho| > 0.20). When stratified into three quantiles of changes in each anchor, the 6MWT parameters worsened over time in the bottom 25% group by mixed-effects model. Specifically, Δ6MWD was affected by SGRQ activity, SGRQ impacts, PFT (FVC, FEV1, and DLCO), and C-reactive protein (CRP). ΔFBS was affected by all SGRQ components, total score, and PFT. Anchor scores and variables at baseline that worsened Δ6MWD were higher SGRQ scores, lower FVC (% predicted), lower DLCO (% predicted), higher Krebs von den Lungen-6, old age, and undergoing treatment at registration. Similarly, these clinical parameters and elevated CRP, excluding undergoing treatment at registration, worsened ΔFBS.ConclusionsThe decreased walking distance and exacerbation of dyspnea on exertion over time in patients with NTM-PD may reflect a deterioration of health-related quality of life and pulmonary function. Thus, the change in 6MWT over time can be used as an indicator to accurately assess the patient’s condition and tailor their healthcare environment.

Rationale and Design of the Effect of Ivabradine on Exercise Tolerance in Patients With Chronic Heart Failure (EXCILE-HF) Trial - Protocol for a Multicenter Randomized Controlled Trial.

Background: A high resting heart rate is an independent risk factor for mortality and morbidity in patients with cardiovascular diseases. Ivabradine selectively inhibits the funny current (I f) and decreases heart rate without affecting cardiac conduction, contractility, or blood pressure. The effect of ivabradine on exercise tolerance in patients with heart failure with reduced ejection fraction (HFrEF) on standard drug therapies remains unclear. Methods and Results: This multicenter interventional trial of patients with HFrEF and a resting heart rate ≥75 beats/min in sinus rhythm treated with standard drug therapies will consist of 2 periods: a 12-week open-label, randomized, parallel-group intervention period (standard drug treatment+ivabradine group and standard drug treatment group) to compare changes in exercise tolerance between the 2 groups; and a 12-week open-label ivabradine treatment period for all patients to evaluate the effect of adding ivabradine on exercise tolerance. The primary endpoint will be the change in peak oxygen uptake (V̇O2) during the cardiopulmonary exercise test from Week 0 (baseline) to Week 12. Secondary endpoints will be time-dependent changes in peak V̇O2 from Week 0 to Weeks 12 and 24. Adverse events will also be evaluated. Conclusions: The EXCILE-HF trial will provide meaningful information regarding the effects of ivabradine on exercise tolerance in patients with HFrEF receiving standard drug therapies and suggestions for the initiation of ivabradine treatment.

Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation

The purpose of this study was to test the hypothesis that an individualized exercise training target heart rate (HR) based on a maximal graded exercise test (GXT) is associated with greater improvements in exercise tolerance during cardiac rehabilitation (CR) compared with no GXT. In this retrospective study, we identified patients who completed 9 to 36 visits of CR between 2001 and 2016, with a length of stay ≤18weeks and a visit frequency of 1 to 3days per week. Patients were grouped based on whether their exercise was guided by a target HR determined from a GXT. To assess the relation between GXT and change in exercise training metabolic equivalents of task (METs), we used generalized linear models adjusted for age, gender, race, referral reason, CR visits, CR frequency, METs at start, CR location, and year of participation. Out of 4,455 patients (37% female, 48% White, median age=62years), 53% were prescribed a target HR based on a GXT. Compared with no GXT, a GXT was associated with a significantly greater increase in covariate-adjusted METs during CR and percentage change from start (+0.44 METs [95% confidence interval [CI] 0.38 to 0.51] and +17% [95% CI 14% to 19%], respectively). In a sensitivity analysis limited to patients with 24 to 36 visits at ≥2days per week (n=1,319), a GXT was associated with a significantly greater increase in covariate-adjusted exercise training METs (+0.51 [95% CI 0.36 to 0.66]; +19% [95% CI 13% to 24%]). In conclusion, to maximize the potential increase in exercise capacity during CR, patients should undergo a GXT to determine an individualized exercise training target HR.

Visual Fatigue as a Predictor of Exercise Tolerance in Pediatric Athletes with Concussion

Background:Concussion patients may manifest changes in exercise tolerance (ET). Since the visual system is affected as well, investigating the relationship between ET and vision could prove useful in developing better rehabilitation strategies.Hypothesis/Purpose:To explore trends between ET and visual fatigue in pediatric concussion patients.Methods:A Retrospective chart review of 63 pediatric concussion patients ages 12-21 was collected from 11/05/21 to 6/10/21. Each patient completed a validated symptom-related questionnaire resulting in quantitative clinical profile (CP) score (0-89) and ocular profile subtype (OPS) score (0-3) with higher scores indicating worse symptoms. The OPS score is a weighted score based off of 5 vision focused questions regarding visual symptoms and visual fatigue. Each patient was also evaluated by a physician and classified into an active rehabilitation (AR) step (Step 1-5) based on exertional testing results using heart rate to establish exertional threshold at the visit. Patients were split up into low ET level (n=10) who could not exceed HR<140bpm and high ET level (n=53) who exhibited vigorous to maximal intensities all tolerating HR>140bpm. Near point convergence (NPC) and other objective exam markers were also evaluated at each patient visit. A paired two sample t-test compared the differences in their OPS and objective clinical data.Results:The low ET group averaged an OPS score of 1.84, CP score of 43.20, and a physician measured average NPC of 9.96 cm, while the high ET group averaged an OPS score of 0.68, CP score of 13.87, and a physician measured NPC of 9.06 cm (Table 1). T-test for the OPS and CP score revealed statistically significant differences (p value of 4.04E-05 and 3.49E-06 respectively) while the t-test for NPC had a p-value of 0.491.Conclusion:Visual fatigue as endorsed by the OPS score may be a critical subjective marker in predicting ET in pediatric athletes after concussion. Those tolerating vigorous or maximal exertion generally had significantly lower OPS scores, despite similar NPC findings in this small sample. Further studies are required to confirm this trend and how it may affect exertional rehabilitation strategies.Table 1:Ocular Profile Score (OPS), Near Point Convergence (NPC), Clinical Profile Score (CPS) in low vs high exercise tolerance (ET) patients

The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

BackgroundSupplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline.MethodsWe will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline.DiscussionOne strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events.Systematic review registrationRegistration number, UMIN000039960.

The effects of atorvastatin and rosuvastatin on exercise tolerance in patients with coronary heart disease

ABSTRACT Objectives This study was aimed to analyze the effects of atorvastatin and rosuvastatin and different lipid-lowering intensity treatments on exercise tolerance in patients with coronary heart disease (CHD). Methods A retrospective analysis was conducted in 549 patients with CHD who underwent cardiopulmonary exercise testing (CPET) from February 2014 to August 2018. The CPET results of patients taking different types and doses of statins were compared from baseline to follow-up. Results No significant difference was found in baseline VO2peak between the rosuvastatin group and the atorvastatin group. The VO2peak growth of the rosuvastatin group was significantly greater than that of the atorvastatin group after treatment [1.52 ± 4.03 ml/kg/min vs 0.90 ml/kg/min (−1.60, 3.45), p = 0.018]. Multivariate analysis showed that atorvastatin was a negative independent influencing factor of ΔVO2peak (B = −0.665, SE = 0.321, t = −2.070, p = 0.039, 95% CI: – 1.295~-0.034). There was no significant difference between the median intensity and high-intensity lipid-lowering groups in parameters of CPET. Conclusions The exercise tolerance improvement was more considerable for patients with CHD taking rosuvastatin compared with those taking atorvastatin. The lipid-lowering intensity of statins was not independently associated with changes in exercise tolerance in patients with CHD.

Abstract No. 658 Exercise intolerance caused by chronic iliocaval venous occlusion: non-invasive quantitative assessment

Patients with chronic inferior vena cava (IVC) and bilateral iliac vein postthrombotic occlusion often report subjective decreased exercise tolerance that improves after stent reconstruction. We report preliminary results of the use of quantitative exercise testing to assess change in exercise tolerance occurring after venous reconstruction. The Institutional Review Board approved this retrospective study. Exercise testing before and after intervention was conducted in the Human Performance Laboratory (HPL): resting blood pressure, heart rate, body mass index (BMI), body composition, standard pulmonary function tests, and incremental maximal exercise testing (VO2 max test). Maximal exercise was defined as a plateau in the oxygen uptake, a respiratory exchange ratio (RER) greater than 1.1, or voluntarily termination of exercise. The VO2 max (mL/kg/min), maximum work (W) and total exercise time were analyzed. Percutaneous venous reconstruction was performed using standard techniques and stents. Results were reported as simple averages and percentages. Three male patients with chronic postthrombotic IVC and bilateral iliac venous occlusions were studied. Mean age 63 ± 8 years, mean duration of occlusion 36 ± 12 months. The interval between reconstruction and testing ranged from 2.5 to 11 months. All patients had stents in the infra-renal IVC to bilateral common femoral veins. No exercise instructions were provided to patients after stent reconstruction. Following venous reconstruction, the V02 max increased an average of 38.7%, the total work increased 74.4%, and the total exercise time increased 18.7%. Each individual lost weight, with an average decrease of 7.5%. Subjectively, all patients reported an increased exercise tolerance and decreased shortness of breath with exertion. Subjective impairment in exercise tolerance and improvement after venous reconstruction was quantitated in three patients with chronic postthrombotic occlusion of the IVC and bilateral iliac veins. HPL testing may be a useful additional objective tool in the study of patients with chronic ilio-caval occlusions.

Change in exercise tolerance after inspiratory muscle training—Comparison of upper and lower limb ergometer—

Change in exercise tolerance after inspiratory muscle training—Comparison of upper and lower limb ergometer—

Dance-based versus conventional exercise in pulmonary rehabilitation: A retrospective service evaluation

Background Pulmonary rehabilitation (PR) is well recognised for improving exercise tolerance and health related qual- ity of life (HRQoL) in people with chronic obstructive pulmonary disease (COPD). However, attendance and completion rates for PR remain suboptimal. Dance is an effective alternative approach to exercise in other chronic disease populations. Latin-based dance may also serve to improve engagement in pulmonary rehabilitation. Aim To conduct a service evaluation of a community-based PR programme that includes Latin dance-based exercise, and compare it with outcomes from a com- parable, conventional programme. The aim of the evaluation was to ascertain whether the dance-based programme resulted in improvements in exercise tolerance and HRQoL. Further, to determine any differences in completion rates between the dance-based and conventional programmes. Methods This retrospective service evaluation compared outcomes from people with COPD who were enrolled into the Barts PR service conventional and dance-based PR pro- grammes, between February and May 2019. The programmes were identical, other than the style of aerobic exercise. Within- and between- group differences following PR in exercise tolerance and HRQoL were compared. Completion rates were also compared. Results In total, four participants enrolled into the dance-based group, and five participants to the conventional group. Median change in exercise tolerance following PR was 47.5m in the dance group (incremental shuttle walk test) and 35.0m in the conventional group (six-minute walk test). Median change in the COPD Assessment Test was -2 in the dance group and +1 in the conventional group. Completion rate was 34.5% higher in the dance group. There were no statistically significant differences reported. Conclusion The results of this service evaluation were inconclusive. Further data are required in the form of a larger, adequately powered observational study.

Diagnosis and management of chronic heart failure: NICE guideline update 2018.

Heart failure (HF) is a common problem affecting almost 1 million people in the UK. Prevalence increases with age, rising to 10% in people aged ≥75 years. The diagnosis requires symptoms and evidence of a structural or functional abnormality of the heart. HF is classified according to left ventricular ejection fraction (EF). In HF with reduced ejection fraction (HFrEF) the EF is below 40%, and in HF with preserved ejection fraction (HFpEF) the EF is ≥50% but there is evidence of impaired relaxation and stiffness in the left ventricle. The type of HF is important for determining further management options. Arrhythmias and valvular heart disease are also important causes of HF. The National Institute for Health and Care Excellence (NICE) has updated its chronic heart failure guideline.1 This article highlights areas of particular importance for primary care. Patients with HF may present with one or more of the classical triad of symptoms: breathlessness, ankle swelling, or fatigue. Clinical assessment is important to determine if the patient is stable or requires admission. The history should include symptom onset, change in exercise tolerance, risk factors for cardiovascular disease, and any history of cardiovascular disease. Examination should include pulse, blood pressure, and oxygen saturations along with auscultation of the heart and lungs with assessment of fluid retention. If HF is suspected, a natriuretic peptide (NP) blood test is required to guide referral decisions. NPs are released by the myocardium in response to increased wall …

Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease

Pharmacological interventions for the treatment of depression in chronic obstructive pulmonary disease

Changes in exercise tolerance and quality of life are unrelated in lung cancer survivors who undergo video-assisted thoracic surgery.

[Purpose] The associations between changes in respiratory function, exercise tolerance, and quality of life (QOL) in patients with lung cancer who undergo lobectomy using video-assisted thoracoscopic surgery (VATS) are unclear. This study aimed to investigate the relationships between exercise tolerance and QOL in patients who underwent VATS. [Subjects and Methods] Thirty-six patients with lung cancer were followed for 3 months after VATS. Patients were evaluated before and 1, 4, and 12 weeks after surgery. Respiratory function, grip strength, and knee extension strength, as well as the results of timed up and go, 6-minute walk, and cardiopulmonary exercise tests, were evaluated using the 36-item short-form health survey. Longitudinal changes in physical performance and QOL were analyzed, as was the relationship between the change in physical function and QOL. [Results] The physical and social aspects of QOL significantly decreased at week 4 post-surgery, but recovered to pre-surgical levels by week 12. In contrast, physical (non-respiratory) function recovered to pre-surgical levels by week 4. There was no correlation between the percentages of change in QOL and those related to physical function. [Conclusion] Our preliminary study highlights the fact that early recovery of physical function is possible after VATS, but does not necessarily correlate with early QOL recovery. It is therefore necessary to perform perioperative interventions to promptly restore QOL after surgery.

Resistance training and exercise tolerance during high-intensity exercise: moving beyond just running economy and muscle strength.

Resistance training and exercise tolerance during high-intensity exercise: moving beyond just running economy and muscle strength.

Phosphodiesterase 4 inhibitors for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is associated with cough, sputum production or dyspnoea and a reduction in lung function, quality of life and life expectancy. Apart from smoking cessation, there are no other treatments that slow lung function decline. Roflumilast and cilomilast are oral phosphodiesterase 4 (PDE4) inhibitors proposed to reduce the airway inflammation and bronchoconstriction seen in COPD. This is an update of a Cochrane review first published in 2011 and updated in 2013. To evaluate the efficacy and safety of oral PDE4 inhibitors in the management of stable COPD. We identified randomised controlled trials (RCTs) from the Cochrane Airways Trials Register (date of last search October 2016). We found other trials from web-based clinical trials registers. We included RCTs if they compared oral PDE4 inhibitors with placebo in people with COPD. We allowed co-administration of standard COPD therapy. One review author extracted data and a second review author checked the data. We reported pooled data in Review Manager as mean differences (MD), standardised mean differences (SMD) or odds ratios (OR). We converted the odds ratios into absolute treatment effects in a 'Summary of findings' table. Thirty-four separate RCTs studying roflumilast (20 trials with 17,627 participants) or cilomilast (14 trials with 6457 participants) met the inclusion criteria, with a duration of between six weeks and one year. These included people across international study centres with moderate to very severe COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades II-IV), with a mean age of 64 years.We considered that the methodological quality of the 34 published and unpublished trials was acceptable overall. Treatment with a PDE4 inhibitor was associated with a significant improvement in forced expiratory volume in one second (FEV1) over the trial period compared with placebo (MD 51.53 mL, 95% confidence interval (CI) 43.17 to 59.90, 27 trials with 20,585 participants, moderate-quality evidence due to moderate levels of heterogeneity and risk of reporting bias). There were small improvements in quality of life (St George's Respiratory Questionnaire (SGRQ), MD -1.06 units, 95% CI -1.68 to -0.43, 11 trials with 7645 participants, moderate-quality evidence due to moderate levels of heterogeneity and risk of reporting bias) and COPD-related symptoms, but no significant change in exercise tolerance. Treatment with a PDE4 inhibitor was associated with a reduced likelihood of COPD exacerbation (OR 0.78, 95% CI 0.73 to 0.83; 23 trials with 19,948 participants, high-quality evidence). For every 100 people treated with PDE4 inhibitors, five more remained exacerbation-free during the study period compared with placebo (number needed to treat for an additional beneficial outcome (NNTB) 20, 95% CI 16 to 26). More participants in the treatment groups experienced non-serious adverse events compared with controls, particularly a range of gastrointestinal symptoms such as diarrhoea, nausea, vomiting or dyspepsia. For every 100 people treated with PDE4 inhibitors, seven more suffered from diarrhoea during the study period compared with placebo (number needed to treat for an additional harmful outcome (NNTH) 15, 95% CI 13 to 17). Roflumilast in particular was associated with weight loss during the trial period and an increase in insomnia and depressive mood symptoms. There was no significant effect of treatment on non-fatal serious adverse events (OR 0.99, 95% CI 0.91 to 1.07) or mortality (OR 0.97, 95% CI 0.76 to 1.23), although mortality was a rare event during the trials. Participants treated with PDE4 inhibitors were more likely to withdraw from the trials because of adverse effects; on average 14% in the treatment groups withdrew compared with 8% in the control groups. In people with COPD, PDE4 inhibitors offered benefit over placebo in improving lung function and reducing the likelihood of exacerbations; however, they had little impact on quality of life or symptoms. Gastrointestinal adverse effects and weight loss were common, and safety data submitted to the US Food and Drug Administration (FDA) have raised concerns over psychiatric adverse events with roflumilast. The findings of this review give cautious support to the use of PDE4 inhibitors in COPD. They may be best used as add-on therapy in a subgroup of people with persistent symptoms or exacerbations despite optimal COPD management. This is in accordance with the GOLD 2017 guidelines. Longer-term trials are needed to determine whether or not PDE4 inhibitors modify FEV1 decline, hospitalisation or mortality in COPD.

SERIAL CHANGES IN THE LEVELS OF MATRIX METALLOPROTEINASE-3, -9, THEIR INHIBITORS AND INDICATORS OF MYOCARDIAL REMODELING IN PATIENTS WITH ACQUIRED HEART DISEASE UNDERGOING MITRAL VALVE REPLACEMENT

Background . The matrix metalloproteinase (MMP) system and their tissue inhibitors (TIMPs) act to control myocardial remodeling processes. Aim. To evaluate serum levels of MMP-3, -9, TIMP-1, -2 and their relationships with instrumental parameters of myocardial remodeling after isolated mitral valve replacement. Methods. All patients enrolled into the mitral stenosis group (n = 24) and the mitral insufficiency group (n=24) underwent measurements of serum levels of MMP-3, -9, TIMP-1, -2 by solid-phase enzyme immunoassay before mitral valve replacement and 1 year after it. Results. Initial elevated levels of MMP-9 correlated with the left ventricular ejection fraction and the integrated systolic remodeling index. One year after mitral valve replacement, MMP-9 levels decreased by 18.54% in the mitral insufficiency group and by 17.17% in the mitral stenosis group (p -0.05). The decrease was more pronounced with a significant increase in exercise tolerance. Conclusion. The activation of MMP-9 is closely as-sociated with structural cardiac remodeling and severe changes in exercise tolerance in patients with isolated mitral valve disease.