Exercise Intensity In Patients Research Articles

The Association Between Physical Activity/Heart Rate Variability Data Obtained Using a Wearable Device and Timed Motor Functional Tests in Patients with Duchenne Muscular Dystrophy: A Pilot Study.

Duchenne muscular dystrophy (DMD) is a devastating X-linked muscle disease. Clinical evaluation of DMD uses patient-intensive motor function tests, and the recent development of wearable devices allows the collection of a variety of biometric information, including physical activity. In this study, we examined differences in physical activity and heart rate variability (HRV) between patients with DMD and healthy subjects using a wearable device, and investigated any association between these parameters and motor function in patients with DMD. Participants were 7 patients with DMD and 8 healthy males, whose physical activity and HRV were provided by a wearable device. These data were used to investigate the relationship between both physical activity and HRV parameters and timed motor functional tests [Time to stand from supine, 10-meter walking time (10MWT), North Star Ambulatory Assessment (NSAA), and 6-minute walking test (6MWT)] in patients with DMD. Results of 24-hours physical activity, fat burning, total number of steps and active distance, average step rate, average exercise intensity during walking, exercise, degree of forward lean during walking, maximum heart rate, normalized low frequency power (LF norm), and maximum exercise intensity in patients with DMD were lower than those in control subjects. Physical activity and HRV parameters did not correlate with the time to stand from supine. The 10MWT positively correlated with average heart rate, while NSAA negatively correlated with average heart rate, total frequency power (TF), and very low frequency power (VLF) during arousal. The 6MWT negatively correlated with ratio LF/high frequency power (HF). Physical activity and HRV indices that differ from those of normal children and that correlate with motor function assessment may serve as digital biomarkers.

PREDICTED MAX HEART RATE SHOULD NOT BE USED FOR PATIENTS IN CARDIAC REHABILITATION

https://youtu.be/o3sLspfpDqs BACKGROUND A maximal exercise test is often not available for patients in cardiac rehabilitation (CR) and many programs determine a target heart rate (THR) using equations to estimate maximum heart rate (HRmax). The purpose of this study was to describe the % of patients in which a THR based on an estimated HRmax would result in a heart rate (HR) that is consistent with guidelines (i.e., 50%–80% HR reserve) in patients with heart disease (HD) on beta-blockade therapy. METHODS This was a secondary analysis of the iATTEND study; a randomized trial of facility-based only CR vs. hybrid CR. Subjects included in the present analysis had a history of myocardial infarction, coronary revascularization procedure, or heart failure; beta-blockade therapy; and sinus rhythm. Exclusion criteria were heart transplant, atrial fibrillation, implanted pacemaker, and exercise-induced ischemia. Measured HR reserve (maximum - rest) was determined from a symptom-limited maximal exercise test with gas exchange performed on a treadmill. Estimated HRmax was determined using (a) 220 age and (b) a published equation based on patients with HD with beta-blockade (HD BB; 164-0.72xage). % measured HR reserve associated with 60% and 85% estimated HRmax using each equation was compared to guideline recommended intensity of 50%–80% measured HR reserve. Paired sample t-tests were used to compare measured HRmax to the 2 estimates of HRmax. RESULTS Among 166 subjects (68% male; age= 59±11 yr [mean±SD]) measured HRmax was 133±21 min 1. Compared to measured, estimated HRmax using 220-age was significantly higher (161±11 min- 1; p<.001) and estimated HRmax using HD-BB was significantly lower (121±8 min-1; p<.001). At 60% of 220-age, 19% of subjects would have been provided a THR that was consistent with guidelines; 72% would have been too low. At 60% of HD-BB, 1% of subjects would have been provided a THR that was consistent with guidelines; 99% would have been too low. At 85% of 220-age, 16% of subjects would have been provided a THR that was consistent with guidelines; 84% would have been too high. At 85% of HD-BB, 36% of subjects would have been provided a THR that was consistent with guidelines; 15% would have been too high. CONCLUSION THR based on % estimated HRmax from 220-age and HD-BB do not provide an exercise training HR target that is consistent with guideline recommendations, thus should not be used to prescribe an exercise intensity in patients with HD on BB therapy.

Real intensity of physical activity capacity of patients with chronic disease: a cross-sectional study

The aim of this study was to evaluate the real intensity level of exercise in a sample of patients with chronic disease from obesity, rheumatology, hematology and other departments involved in a hospital-based program of adapted physical activity (APA). For this cross-sectional study, we studied seventy-five patients with chronic disease and no beta-blocker treatment. They systematically performed a cardiopulmonary exercise test before participating in a supervised APA practice using a telemetry wireless system to monitor heart rate (HR) during the first session. Based upon the results of the functional evaluation of exercise performance, we studied two groups of patients: (1) No limitation in exercise performance (maximal oxygen uptake greater than or equal to 80% of the theoretical reference) and (2) limited exercise performance (maximal oxygen uptake less than 80% of the theoretical value). Fifty-two patients (69.3%) were women, mean age was 42.6 (± 13.8), and mean BMI was 36.7 (± 10.6). Most patients had been referred for obesity (57.3%). We found 39 patients with normal exercise capacities and 36 patients with limited exercise performance. There were no significant differences in demographic and clinical characteristics between the two groups. For all populations, the mean and median real intensity levels of exercise in a sample of patients were moderate (55–70% HR max) and were the same for both groups. During the most intensive 15-min bout of the APA session, the HR for patients in both groups was greater than 70% of the actual maximum HR. This study observed a moderate level of APA exercise intensity in patients suffering from various chronic diseases. We found no significant difference in intensity level of exercise between patients’ capacities, i.e., with and without limitation of their maximal performance.

The Borg scale is a sustainable method for prescribing and monitoring self-administered aerobic endurance exercise in patients with chronic kidney disease

Aim To examine adherence, performance, and safety of self-administered aerobic endurance exercise when exercise intensity was prescribed and self-monitored with the Borg RPE scale in patients with chronic kidney disease (CKD), and the relationship between performed exercise and change in walking distance. Materials and Methods 97 men and 50 women (age 66 ± 14 years, measured GFR 22 ± 8 mL/min/1.73m2) were prescribed 60 min aerobic endurance exercise/week at RPE 13–15. The 6-minute walk test was measured at 0, 4, 8 and 12 months of exercise. Results 100 patients completed the study, 80% reported exercise intensity at 12 months, 74% performed exercise within the prescribed RPE. Median RPE was 13 (13–15). Median duration was 56 (33–109) minutes/week. Patients with a short walking distance at baseline performed significantly less minutes of exercise/week (p = 0.039). There was no correlation between weekly duration and change in walking distance. No exercise-related incidents were recorded. Walking distance improved significantly by 30 ± 56 metres (p < 0.001). Conclusions The Borg RPE scale is useful, acceptable, simple and safe for prescribing and monitoring intensity of self-administered aerobic endurance exercise in patients with CKD. A RPE of 13–15 improved walking distance in well-functioning and deconditioned patients, within a wide range of weekly duration of exercise.

Effect of different intensity exercises intervention on cardiovascular functions and quality of life on patients with chronic heart failure: A protocol for systematic review and meta-analysis.

Background:Exercise training can improve exercise capacity, quality of life, and reduce hospitalization time in chronic heart failure (CHF) patients. Various training protocols have been studied in CHF, but there is no consensus on the optimal exercise intensity for the rehabilitation of cardiac patients. Therefore, systematic evaluation of the effects of different exercise intensities on the efficacy of cardiac function and quality of life in patients with CHF was done.Methods:Computer searches of PubMed, Web of Science, The Cochrane Library, Embase, SinoMed, the China National Knowledge Infrastructure, Wanfang, and VIP databases were conducted to collect randomized controlled trials of different exercise intensities applied to patients with CHF. Study selection and data extraction will be performed simultaneously by two independent reviewers, using the PEDro scale for quality assessment of the included literature. Publication bias will be assessed by funnel plot, and Begg and Egger tests. The I2 statistic and the chi-square (χ2) test will be used to assess heterogeneity. In addition, subgroup analyses will be performed for different left ventricular ejection fraction populations and different intervention cycles. All meta-analyses will be performed using Revman5.3 software.Results:The present study is a systematic review and meta-analysis program with no results. Data analysis will be completed after the program has been completed.Conclusion:This meta-analysis may provide more reliable, evidence-based evidence for the choice of exercise intensity in patients with CHF.Registration number:CRD42021276529

Efficacy and Safety of Different Aerobic Exercise Intensities in Patients With Heart Failure With Reduced Ejection Fraction: Design of a Multicenter Randomized Controlled Trial (HF-EI Trial).

Background: Heart failure (HF) is one of the major causes of mortality worldwide, representing the terminal stage of several cardiovascular diseases. Exercise-based rehabilitation is a beneficial therapy for patients with chronic heart failure (CHF). However, there is a lack of specific guidance on clinical decision-making regarding optimal exercise intensity. It is necessary to optimize the clinical recommendations for HF exercises. We will evaluate the efficacy and safety of different aerobic exercise intensities in patients with heart failure with reduced ejection fraction (HFrEF): the HF-EI trial. This trial aims to assess the appropriate exercise intensity for patients with HFrEF.Methods: After a baseline assessment to determine the safety of exercise, 180 patients will be randomly assigned to supervised high-intensity exercise training (ET) group, supervised moderate intensity training (MIT) group, and control group at a ratio of 1:1:1. Patients randomly receiving high intensity training (HIT) undergo supervised ET (3 times/week, 30 min) for aerobic endurance at 70% peak oxygen consumption (peak VO2) intensity for 12 weeks. The MIT patients will perform supervised aerobic ET (3 times/week, 35–42 min) at the anaerobic threshold (AT) intensity for 12 weeks. The control group will continue to maintain their daily activities and will not receive ET. During the baseline and follow-up period, physical examination, laboratory tests, cardiology diagnostic tests, cardiopulmonary exercise tests (CPET), 6-min walk distance (6MWD), scale scores, exercise steps, medications, and clinical events will be monitored. Throughout the research, sport bracelets and patient diaries will be used to monitor and record overall physical activity, training courses, and compliance.Discussion: The HF-EI trial will evaluate the effects of different aerobic exercise intensities on peak VO2, quality of life (QoL), and clinical events among patients with HFrEF. The findings of this trial will provide a basis for formulating exercise prescriptions for patients with HFrEF.Clinical Trial Registration:http://www.chictr.org.cn/, identifier: ChiCTR2000036381.

Exercise Intensity in Patients with Cardiovascular Diseases: Systematic Review with Meta-Analysis.

Exercise-induced improvements in the VO2peak of cardiac rehabilitation participants are well documented. However, optimal exercise intensity remains doubtful. This study aimed to identify the optimal exercise intensity and program length to improve VO2peak in patients with cardiovascular diseases (CVDs) following cardiac rehabilitation. Randomized controlled trials (RCTs) included a control group and at least one exercise group. RCTs assessed cardiorespiratory fitness (CRF) changes resulting from exercise interventions and reported exercise intensity, risk ratio, and confidence intervals (CIs). The primary outcome was CRF (VO2peak or VO2 at anaerobic threshold). Two hundred and twenty-one studies were found from the initial search (CENTRAL, MEDLINE, CINAHL and SPORTDiscus). Following inclusion criteria, 16 RCTs were considered. Meta-regression analyses revealed that VO2peak significantly increased in all intensity categories. Moderate-intensity interventions were associated with a moderate increase in relative VO2peak (SMD = 0.71 mL-kg−1-min−1; 95% CI = [0.27–1.15]; p = 0.001) with moderate heterogeneity (I2 = 45%). Moderate-to-vigorous-intensity and vigorous-intensity interventions were associated with a large increase in relative VO2peak (SMD = 1.84 mL-kg−1-min−1; 95% CI = [1.18–2.50], p < 0.001 and SMD = 1.80 mL-kg−1-min−1; 95% CI = [0.82–2.78] p = 0.001, respectively), and were also highly heterogeneous with I2 values of 91% and 95% (p < 0.001), respectively. Moderate-to-vigorous and vigorous-intensity interventions, conducted for 6–12 weeks, were more effective at improving CVD patients’ CRF.

What is the gut feeling telling us about physical activity in colorectal carcinogenesis?

In the last decades, more efforts are focused on the prevention and treatment of malignant diseases, given the increase in all cancers incidence A lifestyle change, including healthy eating habits and regular physical activity, has significantly impacted colorectal cancer prevention. The effect of dose-dependent physical activity on mortality and recurrence rates of colorectal carcinoma has been unequivocally demonstrated in observational studies. However, clear recommendations are not available on the frequency, duration, and intensity of exercise in patients with colorectal cancer due to the lack of evidence in randomized clinical trials. Regarding pathophysiological mechanisms, the most plausible explanation appears to be the influence of physical activity on reducing chronic inflammation and insulin resistance with a consequent positive effect on insulin growth factor 1 signaling pathways.

Evaluation of Aerobic Exercise Intensity in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus.

(1) Background: Physical activity is recommended in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to reduce hyperglycemia and cardiovascular risk. Effective aerobic exercise intensity, however, is not well defined. (2) Methods: 60 consecutive patients performed cardiopulmonary exercise testing (CPX) of 30 min duration targeting a respiratory exchange ratio (RER) between 0.85 and 0.95, being strictly aerobic. Plasma glucose (PG) was measured before and after CPX as well as one and two h after exercise. Maximum exercise intensity was evaluated using a standard bicycle exercise test. (3) Results: 50 patients completed the protocol (62 ± 10 years, BMI (body mass index) 30.5 ± 4.9 kg/m2, HbA1c (glycated haemoglobin) 6.9 ± 0.8%, left ventricular ejection fraction 55 ± 8%). Aerobic exercise capacity averaged at 32 ± 21 Watt (range 4–76 Watt) representing 29.8% of the maximum exercise intensity reached. PG before and after CPX was 9.3 ± 2.2 and 7.6 ± 1.7 mmol/L, respectively (p < 0.0001). PG was further decreased significantly at one and two h after exercise to 7.5 ± 1.6 mmol/L and 6.0 ± 1.0 mmol/L, respectively (p < 0.0001 for both as compared to PG before CPX). (4) Conclusions: Aerobic exercise capacity is very low in patients with CAD and T2DM. Exercise at aerobic intensity allowed for significant reduction of plasma glucose. Individual and effective aerobic exercise prescription is possible by CPX.

Validity of the Talk Test as a Method to Estimate Ventilatory Threshold and Guide Exercise Intensity in Cardiac Patients.

To determine the relationship between the Talk Test (TT) and ventilatory threshold (VT) in patients with cardiac disease and to compare the TT with exercise intensity guidelines. Twenty cardiac patients, aged 65 ± 8.5 yr, performed 2 exercise tests with identical ramp protocols on a cycle ergometer on the same day. One test was a submaximal effort to assess exercise intensity using the TT. The other was a cardiopulmonary exercise test using breath-by-breath gas analysis to identify VT and cardiorespiratory fitness. Oxygen uptake and workload at the last positive stage (TTpos) was significantly lower than at VT. and workload at the equivocal stage (TTeq) and the first negative stage (TTneg) were not significantly different from VT, but limits of agreement (LoA) were wide. There was no significant difference in heart rate (HR) at TTpos and TTeq compared with VT, but HR at Tneg was significantly higher. The correlations between the TT and VT ranged from 0.37 to 0.60. Intensity at the different TT stages ranged from 58-77% of . All TT stages were within intensity guidelines of 40-80% of . Although no significant differences were found in and workload for TTeq and TTneg when compared with VT, LoA demonstrated wide ranges, suggesting poor individual correspondence. The different stages of the TT can be used as a practical method to guide exercise intensity in patients with cardiac disease.

The effects of aerobic exercise on working memory in methamphetamine-dependent patients: Evidence from combined fNIRS and ERP

ObjectiveTo explore the effect of aerobic exercise on working memory according to exercise intensity in patients with methamphetamine (MA) dependence. DesignTwelve-week randomized controlled trial. MethodForty-five MA-dependent patients were divided randomly into three groups participating in 12-week moderate- and high-intensity aerobic exercise interventions and no intervention (control), respectively. Working memory performance was assessed using a 2-back task, and a combined functional near-infrared spectral imaging–event-related potential measure was used to identify spatial and temporal components of the neurofunctional underpinnings of this performance. ResultsHigh-intensity exercise significantly enhanced the discernment aspect of working memory. It also decreased N1 and P2 amplitudes, and increased neural activity in the left dorsolateral prefrontal cortex. ConclusionsThe findings of this study suggest that high-intensity aerobic exercise can enhance working memory and neural activity in MA-dependent patients, and thus that it may serve as an effective therapeutic tool for these patients.

Progression of aerobic exercise intensity in a cardiac rehabilitation program

Introduction and ObjectivesTo describe the progression of aerobic exercise intensity in patients on a cardiac rehabilitation (CR) program. MethodsWe conducted a retrospective analysis of a random sample of patients referred for CR after acute coronary syndrome between 2008 and 2016. The weekly peak exercise intensity achieved during aerobic exercise was estimated by treadmill speed and grade at peak effort and the corresponding perception of effort was assessed using the Borg scale. Initial exercise intensity was prescribed as 60-80% of reserve heart rate plus resting heart rate, and was modified according to perceived exertion. Peak heart rate/intensity and perceived exertion index were used as variables to characterize the response to the intensity achieved. Variables were compared at different time points: T1 (1st week), T2 (4th week) and T3 (8th week). ResultsOf the total of 868, 238 patients were randomly selected. At peak heart rate during the session, exercise intensity (in metabolic equivalents) was: T1: 7.2±2.0, T2: 9.0±2.2, and T3: 9.4±2.2 (p<0.01). The peak heart rate/intensity index was T1: 16.8±5.4, T2: 13.4±3.6 and T3: 13.1±3.8 (p<0.01) and the perceived exertion index was T1: 1.8±0.6; T2: 1.4±0.5; T3: 1.4±0.5 (p<0.01). ConclusionsIncreasing exercise intensity during CR, associated with lower perception of effort and lower heart rate necessary to achieve such intensity, leads to significant improvement in functional capacity.

Effect of exercise intensity on renal blood flow in patients with chronic kidney disease stage 2.

Acute exercise reduces renal blood flow (RBF). However, the effect of exercise intensity on RBF in patients with chronic kidney disease (CKD) stage 2 is not known. We investigated the association between RBF and exercise intensity in patients with CKD stage 2 using pulsed Doppler ultrasonography. Eight men with CKD stage 2 (cystatin C-based estimate of glomerular filtration rate: 60-89ml/min/1.73m2) participated in this study. Using a bicycle ergometer, participants undertook a maximal graded exercise test (MGET) (experiment 1) and a multi-stage exercise test (experiment 2) to determine their lactate threshold (LT). Participants undertook a multi-stage exercise test for 4-min each. Workloads of 60%, 80%, 100%, 120%, and 140% of LT were used in experiment 3. RBF was measured by pulsed Doppler ultrasonography at rest, immediately after exercise, and 1h after exercise in experiment 1, and at rest and immediately after each exercise bout in experiment 3. Renal blood flow after the MGET was 52% lower than at rest, and did not recover as well as after the exercise test. Cross-sectional area (CSA) was significantly lower after graded exercise. RBF tended to be lower at 100% of LT and was significantly lower at 120% of LT. CSA was significantly lower at 100% of LT. Renal blood flow does not change during exercise until the LT is reached. These findings may assist in making appropriate exercise recommendations to patients with CKD stage 2.

Clinical Markers of Exercise Intensity as a Surrogate for Blood Lactate Levels Only During Low-Intensity Exercise in Patients With Coronary Artery Disease

Purpose: To determine if clinical markers of exercise intensity, such as heart rate (HR) and rate of perceived exertion (RPE), reflect physiological demands, measured via blood lactate (La) levels, during a graded exercise test (GXT) in cardiac patients. Methods: Thirty-one subjects (19 men and 12 women; age, 58 ± 12 years) were recruited for a GXT. Heart rate, RPE, and La were assessed at rest and after each GXT stage. Pearson correlations were performed between variables (percentage of maximal HR [%HRmax], RPE, La). Bland–Altman analyses were performed to determine agreement between La and %HRmax and RPE. Results: Overall, 113 GXT stages were included in the analysis. It was found that La correlated with RPE (r = 0.72; P &lt; .01) and %HRmax (r = 0.76; P &lt; .01); %HRmax correlated with RPE (r = 0.76; P &lt; .01). However, there was no agreement between La and RPE (72.6% of the sample laid outside 95% CI [−0.25, 0.25 mmol/L]) and between La and %HRmax (85% of the sample laid outside 95% CI [0.54, 1.04 mmol/L]). Conclusions: The significant associations between La, %HRmax, and RPE could be explained by the direct relationship between these variables that occur during the increasing exercise intensity, characteristic of a GTX. However, HR and RPE should not be used as a surrogate to a La-based descriptor of exercise intensity in patients with coronary artery disease exercising at high intensity.

The relationship between cerebral oxygenation detected by near-infrared spectroscopy and exercise intensity in patients with cardiac diseases

Studies using near-infrared spectroscopy (NIRS) have clearly shown an inverted U-shape relationship between cerebral oxygenation and exercise intensity in healthy adults. However, the pattern of cerebral oxygenation in patients during exercise has not been adequately established. The aim of this study was to investigate the correlation between cerebral oxygenation and exercise intensity in patients with cardiac diseases in order to find the optimal exercise intensity while prescribing cardiac rehabilitation. This observational study included 18 patients with coronary artery disease (CAD) ( n = 9), mitral valve regurgitation (MVR) ( n = 4), congestive heart failure (CHF) ( n = 4) and atrial septal defect(ASD) ( n = 1). They performed incremental cardiopulmonary exercise test (CPET) using a cycle ergometer by the ramp 10 W/min. The concentration of oxyhemoglobin (HbO 2 ), total hemoglobin (HbT) and tissue hemoglobin saturation (STO 2 ) were measured by two bands of non-invasive NIRS positioned on bilateral frontal area during the CPET. The exercise intensity related to highest STO 2 of the two hemispheres were determined. The mean ± standard deviation (SD) age of the study cohort was 58.22 ± 10.12 years and was comprised predominantly of men (77.8%). Five patients reached highest STO 2 during warm-up, 3 after anaerobic threshold, 4 after respiratory compensation point, 6 during recovery stage. The 5 patients with downsloping STO 2 were patients with MR ( n = 3), with ASD ( n = 1), and with CHF ( n = 1). Excluding the 5 patients of downsloping pattern, the mean highest STO 2 of right hemisphere was 49.6622 ± 1.8046 (mM) and left hemisphere was 50.5095 ± 1.7310 (mM). The mean percentage to peak oxygen consumption during highest STO 2 of right hemisphere was 76.27 ± 14.02 (%), left hemisphere was 72.14 ± 17.94 (%). The relationship between cerebral oxygenation and exercise intensity in patients with cardiac diseases such as CAD and CHF revealed a trend as inverted U-shape, with the peak STO 2 located at moderate to high exercise intensity.

Functional Electrical Stimulation—A New Therapeutic Approach to Enhance Exercise Intensity in Chronic Obstructive Pulmonary Disease Patients: A Randomized, Controlled Crossover Trial

ObjectiveTo evaluate the effect of quadriceps functional electrical stimulation (FES)-cycling on exertional oxygen uptake (V˙o2) compared with placebo FES-cycling in patients with chronic obstructive pulmonary disease (COPD). DesignA randomized, single-blind, placebo-controlled crossover trial. SettingPulmonary rehabilitation department. ParticipantsConsecutive patients (N=23) with COPD Global Initiative for Chronic Obstructive Lung Disease stage 2, 3, or 4 (mean forced expiratory volume during the first second, 1.4±0.4L [50.3% predicted]) who had recently begun a respiratory rehabilitation program. InterventionTwo consecutive 30-minute sessions were carried out at a constant load with active and placebo FES-cycling. Main Outcome MeasuresThe primary outcome was mean V˙o2 during the 30-minute exercise session. The secondary outcomes were respiratory gas exchange and hemodynamic parameters averaged over the 30-minute endurance session. Lactate values, dyspnea, and perceived muscle fatigue were evaluated at the end of the sessions. ResultsFES-cycling increased the physiological response more than the placebo, with a greater V˙o2 achieved of 36.6mL/min (95% confidence interval [CI], 8.9–64.3mL/min) (P=.01). There was also a greater increase in lactate after FES-cycling (+1.5mmol/L [95% CI, .05–2.9mmol/L]; P=.01). FES-cycling did not change dyspnea or muscle fatigue compared with the placebo condition. ConclusionsFES-cycling effectively increased exercise intensity in patients with COPD. Further studies should evaluate longer-term FES-cycling rehabilitation programs.

Classical music in cardiac prevention and rehabilitation

Objective: The objective of the current service evaluation was to assess whether classical music positively impacts upon exercise intensity in patients undergoing a cardiovascular prevention and rehabilitation programme. Design: A crossover study design was used, in which patients were exposed to both classical music and no music over 2 consecutive weeks, determined through a random order. Setting: This took place in cardiovascular prevention and rehabilitation exercise sessions at two Imperial College NHS Healthcare sites. Patients: The sample consisted of 30 cardiac rehabilitation patients undergoing secondary prevention. Main outcome measures: Comparison of heart rate (average and peak) and Borg Rating of Perceived Exertion (RPE) recorded in each patient under both music and non-music conditions. Results: Average heart rate, Borg RPE, and energy expenditure showed minimal differences between exercise modes. However, peak heart rate increased on average by 7 beats per minute when comparing exercising under classical to no music. Conclusions: The study found that classical music significantly increased an individual's peak heart rate during a cardiac exercise session, thereby increasing physical activity intensity.

Programming exercise intensity in patients on beta-blocker treatment: the importance of choosing an appropriate method

To verify the usefulness of current recommended level of target exercise heart rate (HR) and of different HR-based methods for calculating target HR in patients with and without beta-blocker treatment. We studied 53 patients not treated with beta-blocker and 159 patients on beta-blocker treatment. All patients underwent a maximal exercise test with gas analysis, and first ventilatory threshold (VT1 or aerobic threshold), second ventilatory threshold (VT2 or anaerobic threshold), time of exercise, maximum load, metabolic parameters, HR at rest (HRrest), HRpeak, HR at VT1 (HRVT1) and at VT2 (HRVT2), and 75, 80, and 85% of HRmax (HR75%, HR80%, HR85%) were calculated. Exercise HR was also determined using the Karvonen formula, applying 60, 70, and 80% of the heart rate reserve (HRR) (HRKarv0.6, HRKarv0.7, and HRKarv0.8). This study included 102 patients on a beta-blocker and 39 not treated with negative cronotropic effect drugs. Maximum load, metabolic parameters, HRrest, HRpeak, HRVT1, and HRVT2 were significantly lower in patients on beta-blocker treatment. The proportion of patients with a HR75%, HR80%, HR85%, ​​HRKarv0.6, HRKarv0.7, and HRKarv0.8 <VT1 and >VT2 was very high and depended on whether patients were on beta-blocker treatment. Prescribed exercise intensity should be within VT1 and VT2, so that the efficacy and safety is guaranteed. If determining VT1 and VT2 is not possible, HR-based methods can be used, but with caution. In fact, there will be always a proportion of patients training below VT1 or above VT2. On the other hand, recommendations for patients on a beta-blocker should be different from patients not receiving a beta-blocker. Patients not treated with a beta-blocker should exercise at HRKarv0.7 or at HR85%. In patients on a beta-blocker, we recommend preferentially a target HR of HRKarv0.6 or HR80%.

Point/Counterpoint

Point/Counterpoint

Robustness of the Oxygen Uptake Efficiency Slope to Exercise Intensity in Patients with Coronary Artery Disease

Oxygen uptake efficiency slope (OUES) and ventilatory efficiency (VE/VCO2 slope) are widely used as submaximal measurements of cardiopulmonary exercise testing as the evaluator or prognosticator of cardiac diseases. However, very few studies have compared the effects of submaximal exercise on these measurements. A total of 58 patients with coronary artery disease underwent maximal cardiopulmonary exercise testing on a treadmill. We compared the values obtained from the first 75% (VE/VCO2 slope75 and OUES75) and 90% (VE/VCO2 slope90 and OUES90) of the exercise period with the entire duration (VE/ VCO2 slope100 and OUES100). Although OUES100, OUES90 and OUES75 were virtually identical, submaximal calculations of VE/VCO2 slope underestimated the measurements. The Bland-Altman method revealed that submaximal measurements of OUES agreed very well with maximal OUES (limits of agreement -5.0% to +6.0% for OUES90, and -11.5% to +12.9% for OUES75). However, the submaximal calculations of VE/ VCO2 slope showed rather poor agreement with the maximal calculations (limit of agreement -11.8% to +3.1% for VE/VCO2 slope90, and -20.8% to +5.3%% for VE/VCO2 slope75). These results revealed that both the OUES and the VE/VCO2 slopes are not overly influenced by exercise.