Treadmill Exercise Test Research Articles

Heart Rate Response to Exercise and Recovery: INDEPENDENT PROGNOSTIC MEASURES IN PATIENTS WITHOUT KNOWN MAJOR CARDIOVASCULAR DISEASE.

Heart rate response during exercise testing (ET) provides valuable prognostic information. Limited data are available regarding the prognostic interplay of heart rate (HR) measured at rest, exercise and recovery phases of ET, and its ability to predict risk beyond exercise capacity. Retrospective analysis of treadmill ETs was performed by the Bruce protocol in patients aged 35-75 yr without known cardiovascular disease (CVD; n = 13 887; 47% women). Heart rate recovery at 2 min (HRR2; defined abnormal <42 beats) and chronotropic index (CI; defined abnormal <80%, determined as age-predicted HR reserve) were analyzed in association with the risk of developing myocardial infarction, stroke, or death (major adverse cardiovascular event [MACE]) during median follow-up of 6.5 yr. The HRR2 <42 beats and CI <80% were each associated with increased risk of MACE: adjusted hazard ratios with 95% confidence interval 1.47: 1.27-1.72 and 1.66: 1.42-1.93, P < .001, respectively, evident also when analyzed as continuous variables. Strength of association of HRR2 and CI with outcome was attenuated but remained significant with further adjustment for exercise duration and metabolic equivalents. Having both HRR2 and CI abnormal compared with only one measure abnormal was associated with hazard ratios with 95% confidence interval of 1.66: 1.38-2.00 and 1.48: 1.22-1.79 for MACE, before and after adjustment for cardiorespiratory fitness (CRF). The degree of CRF (low vs mid/high) did not modify the prognostic effect of HRR2 and CI (P-for-interaction nonsignificant). Both HRR2 and CI provide independent prognostic information beyond CRF in patients without CVD referred for ET. The predictive ability is more pronounced when both abnormal HR measures coexist.

Cardiorespiratory Fitness in Adults Aged 18 to 34 Years and Long-Term Pericardial Adipose Tissue (from the Coronary Artery Risk Development in Young Adults Study)

Pericardial adipose tissue (PAT), an ectopic adipose depot surrounding the coronary arteries, is a pathogenic risk marker for cardiometabolic disease; however, the association between cardiorespiratory fitness (CRF) and PAT is unclear. Young adults (n=2,614, mean age 25.1 years, 55.8% women, and 43.8% Black at baseline [1985 to 1986]) from the Coronary Artery Risk Development in Young Adults study were included. Maximal CRF was estimated at baseline, examination year 7 (1992 to 1993) and year 20 (2005 to 2006), using a symptom-limited maximal treadmill exercise test (duration in minutes) among those achieving ≥85% of age-predicted maximal heart rate. PAT volume (ml) was quantified at examination year 15 (2000 to 2001) and year 25 (2010 to 2011) using computed tomography. Multivariable linear and linear mixed regressions with covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) from baseline, year 7, and/or year 20 were used. Separate multivariable regression models revealed inverse associations of CRF at baseline, year 7, or year 20 with PAT at year 25 in fully adjusted models (all p <0.001). The linear mixed model showed that a 1-minute increase in treadmill exercise test duration over 20 years was associated with 1.49 ml lower subsequent PAT volume (p <0.001). In conclusion, findings suggest that higher CRF is inversely associated with subsequent PAT volume. Strategies to optimize CRF may be preventive against excessive PAT accumulation with age.

Differences between Treadmill and Cycle Ergometer Cardiopulmonary Exercise Testing Results in Triathletes and Their Association with Body Composition and Body Mass Index.

Cardiopulmonary exercise testing (CPET) is the method of choice to assess aerobic fitness. Previous research was ambiguous as to whether treadmill (TE) and cycle ergometry (CE) results are transferrable or different between testing modalities in triathletes. The aim of this paper was to investigate the differences in HR and VO2 at maximum exertion between TE and CE, at anaerobic threshold (AT) and respiratory compensation point (RCP) and evaluate their association with body fat (BF), fat-free mass (FFM) and body mass index (BMI). In total, 143 adult (n = 18 female), Caucasian triathletes had both Tr and CE CPET performed. The male group was divided into <40 years (n = 80) and >40 years (n = 45). Females were aged between 18 and 46 years. Body composition was measured with bioelectrical impedance before tests. Differences were evaluated using paired t-tests, and associations were evaluated in males using multiple linear regression (MLR). Significant differences were found in VO2 and HR at maximum exertion, at AT and at RCP between CE and TE testing, in both males and females. VO2AT was 38.8 (±4.6) mL/kg/min in TE vs. 32.8 (±5.4) in CE in males and 36.0 (±3.6) vs. 32.1 (±3.8) in females (p < 0.001). HRAT was 149 (±10) bpm in TE vs. 136 (±11) in CE in males and 156 (±7) vs. 146 (±11) in females (p < 0.001). VO2max was 52 (±6) mL/kg/min vs. 49 (±7) in CE in males and 45.3 (±4.9) in Tr vs. 43.9 (±5.2) in females (p < 0.001). HRmax was 183 (±10) bpm in TE vs. 177 (±10) in CE in males and 183 (±9) vs. 179 (±10) in females (p < 0.001). MLR showed that BMI, BF and FFM are significantly associated with differences in HR and VO2 at maximum, AT and RCP in males aged >40. Both tests should be used independently to achieve optimal fitness assessments and further training planning.

An Externally-Applied, Natural-Mineral-Based Novel Nanomaterial IFMC Improves Cardiopulmonary Function under Aerobic Exercise.

Nanotechnology has widespread applications in sports; however, there are very few studies reporting the use of nanotechnology to enhance physical performance. We hypothesize that a natural-mineral-based novel nanomaterial, which was developed from Japanese hot springs, might overcome the limitations. We examined if it could enhance physical performance. We conducted a treadmill exercise test on 18 students of athletic clubs at Fukushima University, Japan, and measured heart rate, oxygen consumption, maximal oxygen consumption, CO production, and respiratory quotient 106 times in total. The results showed that the elevation of heart rate was significantly suppressed in the natural-mineral-based nanomaterial group, while no differences were observed in oxygen consumption, maximal oxygen consumption, CO production, and respiratory quotient between groups. To our knowledge, this result is the first evidence where an improvement of cardiovascular and pulmonary functions was induced by bringing a natural-mineral-based nanomaterial into contact with or close to a living body without pharmacological intervention or physical intervention. This could open new avenue of biomedical industries even in an eco-friendly direction. The precise mechanisms remain a matter for further investigation; however, we may assume that endothelial NO synthase, hemoglobin and endothelium-derived hyperpolarizing factor are deeply involved in the improvement of cardiovascular and pulmonary functions.

Cardiorespiratory Fitness and Mortality in Patients Aged 60 to 90 Years

Chronological age alone does not fully reflect a patient's prognosis. We sought to assess the association of cardiorespiratory fitness (quantified by METs) with all-cause mortality among patients aged 60 to 90 years. This retrospective study included patients who underwent exercise treadmill testing at an integrated healthcare system from 2011 to 2019. Patients were categorized into age groups: 60 to <70 years, 70 to <80 years, and 80 to 90 years; and cardiorespiratory fitness level: low (<5 METs), moderate (5 to 10 METs), and high fitness (>10 METs). Mean follow-up was 3.5 years. A total of 40,520 patients were included (mean age 67.7 ± 4.7 years, 48.6% women). Of whom, 27,021 were 60 to <70 years old (66.7%); 12,638 70 to <80 years old (31.2%); and 1,861 80 to 90 years old (4.6%). There were 3,494 patients categorized as low (8.6%), 21,863 as moderate (54%), and 15,163 as high fitness (37.4%). Low fitness level was independently associated with lower survival (hazard ratio [HR] 1.61, 95% confidence interval [CI] 1.15 to 2.24). Using age 60 to 70 group with high fitness level as reference, the age 80 to 90 group with high fitness level had better survival than their younger counterparts with low fitness level (age 80 to 90 years high fitness level: HR 2.9, 95% CI 1.2 to 7.2; age 60 to 70 years low fitness level: HR 4.3, 95% CI 3.1 to 5.9; age 70 to 80 years low fitness level: HR 6.8, 95% CI 5.2 to 8.9) on adjusted analysis. In conclusion, higher cardiorespiratory fitness is associated with better survival. Patients >80 years old with high fitness level have comparable or even better survival than their younger counterparts with submoderate fitness levels. Chronological age alone should not be the only factor when considering prognosis.

Implementation of supervised exercise therapy in a veteran population with symptomatic claudication.

Real-world implementation of supervised exercise therapy (SET) referral for symptomatic intermittent claudication has been limited by poor provider awareness around reimbursement and low patient adherence owing to factors including limited center availability and long travel distances to sites. In this study, 76 of 77 consecutive male veteran patients with intermittent claudication managed at a single-center vascular specialty clinic were referred to SET prior to revascularization. Pre- and post-SET submaximal exercise treadmill testing was performed for assessment of exercise capacity in metabolic equivalents (METs). In the 48.7% of subjects who completed 36 sessions of SET (n = 37), the average improvement in METs was 60.3%, reflecting improvement from baseline average of 3.4 METs to 5.5 METs after SET. Another 14 patients pursued self-guided exercise therapy and 25 patients declined any participation in exercise therapy. Reasons for declining participation in SET included inadequate transportation, cost of copayment, and interference with full-time work schedules. There was a nonsignificant numeric trend toward improved change in ankle-brachial index in the combined SET and self-guided exercise groups compared to those that declined exercise therapy (0.011 ± 0.124 vs -0.040 ± 0.105, p = 0.156). High acceptance of referral to SET is possible, despite the limitations to implementation. Incorporation of novel pre- and post-SET submaximal exercise treadmill testing allows for assessment of change in exercise capacity and aids in risk stratification and management of intermittent claudication symptoms.

Abstract P5-18-07: Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer

Abstract Background Targeting the activity of the estrogen receptor and/or estrogen synthesis is a standard primary treatment for eligible patients with estrogen receptor-positive breast cancer. Giredestrant is a highly potent, nonsteroidal oral selective estrogen receptor antagonist and degrader that achieves robust estrogen receptor occupancy. In animal models and early phase studies, giredestrant was associated with a dose-dependent reduction in heart rate. Therefore, we leveraged an ongoing nonrandomized, open-label, dose-escalation and -expansion phase Ia/b study (GO39932) to evaluate its cardiac safety. Methods Eligibility criteria for the main study are available at https://clinicaltrials.gov/ct2/show/NCT03332797. Additional relevant cardiac exclusion criteria included current treatment with medications known to decrease heart rate, e.g., beta blockers.100 mg giredestrant was given daily on Days 1-28 of each 28-day cycle (monotherapy for 14 days; patients then continued monotherapy or received combination treatment with 125 mg daily oral palbociclib for the study duration, per investigator decision). The 100 mg giredestrant dose for this arm (rather than the phase III 30 mg dose) was evaluated to increase the likelihood of observing relevant cardiac effects. Electrocardiograms were required on Day 1 of each cycle; 24-hour Holter data were collected and treadmill-exercise testing was completed at screening (prior to starting giredestrant), steady state (Day 8 [+3 days]), and as clinically indicated. Exercise testing evaluated baseline heart rate, exercise duration, maximal heart rate, and heart rate recovery. A standard Bruce protocol was followed. Results Clinical data cutoff was Apr 16, 2021. Twenty patients were enrolled and included in the current analysis; median age was 59 (range, 45-72); three patients (15%) had a history of hypertension at screening. During follow-up, no dysrhythmias were observed that required treatment or a change in study medication, and no patients were noted to have a resting heart rate of &amp;lt;50 beats per minute based on routine heart rate monitoring. Two Grade 1 bradycardia events (&amp;lt;60 beats per minute) were reported; both in patients receiving palbociclib. No other cardiac adverse events (AEs) were reported overall, nor any other serious AEs. Holter monitoring reports were available for 19 patients at screening and 20 on treatment. There were no episodes of second- or third-degree atrioventricular block. At screening, 2/19 patients (11%) had a paroxysmal supraventricular tachycardia event (SVT; ≤30 seconds). During the study, 4/20 patients (20%) had a paroxysmal SVT event and, of these, 1/4 had four episodes of an SVT event lasting &amp;gt;30 seconds and 1/4 also experienced one episode of non-sustained ventricular tachycardia. No patients required any cardiac treatment or dose modification. Twenty patients underwent exercise testing. Exercise time was similar among patients before and after starting giredestrant (mean exercise time 7 min 10 sec before; 7 min 44 sec after). Exercise intensity was similar before and after starting treatment (mean metabolic equivalents expenditure 7.52 [standard deviation 2.81] and 8.68 [2.78], respectively). One patient had an abnormal heart rate recovery on exercise testing at screening and again while on treatment. Conclusions In a thorough cardiac safety analysis, applying routine electrocardiograms, 24-hour Holter monitoring, and exercise testing, no clinically relevant cardiac effects were observed with 100 mg giredestrant (a higher dose than the phase III 30 mg dose). Citation Format: Tomas G Neilan, Rafael Villanueva-Vázquez, Meritxell Bellet, Elena López-Miranda, Laura García-Estévez, Peter Kabos, John Bond, Mary R Gates, Ching-Wei Chang, Valentina Boni. Heart rate changes, cardiac safety, and exercise tolerance from a phase Ia/b study of giredestrant (GDC-9545) ± palbociclib in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-07.

The Edinburgh Claudication Questionnaire has poor diagnostic accuracy in people with intermittent claudication.

The screening and diagnosis of intermittent claudication is a challenging process and often relies on the expertise of specialist vascular clinicians. We sought to investigate the diagnostic performance of the Edinburgh Claudication Questionnaire (ECQ) as a screening tool for referrals of suspected intermittent claudication from primary to secondary care. Prospectively, 100 referrals from primary care with a stated diagnosis or query regarding intermittent claudication were recruited. All participants who completed the ECQ, underwent an anklebrachial pressure index (ABPI) assessment and treadmill exercise testing. Outcomes of the ECQ were compared to clinical diagnoses of intermittent claudication. The ECQ had a sensitivity of 46.8% (95% CI: 27-65%), specificity of 63.2% (95% CI: 43-82%) and accuracy of 53.0% (95% CI: 43-63%). The diagnostic performance was not changed by combining the ECQ with a positive ABPI or post-exercise ABPI outcome for PAD. The ECQ had a poor diagnostic performance in this cohort. Considering the results found here and in other recent studies, the utility of the ECQ as a screening tool and epidemiological survey tool must be questioned. Novel, low-resource diagnostic tools are needed in this population.

Aerobic exercise training improves endothelial function and attenuates blood pressure reactivity during maximal exercise in chronic kidney disease.

Patients with chronic kidney disease (CKD) have exaggerated increases in blood pressure during exercise that are associated with endothelial dysfunction. We hypothesized that aerobic exercise training would improve endothelial function and attenuate blood pressure reactivity during exercise in CKD. Sedentary individuals with CKD stages III-IV underwent 12 wk of aerobic cycling exercise (n = 26) or nonaerobic exercise (n = 22, control). Both interventions were performed 3 days/wk and matched for duration. Endothelial function was measured via peripheral arterial tonometry and quantified as reactive hyperemia index (RHI). Peak oxygen uptake (V̇o2peak) was assessed via maximal treadmill exercise testing with concomitant blood pressure monitoring. All measurements were performed at baseline and after the 12-wk intervention. A linear mixed model was used to compare the rate of increase in blood pressure during the test. RHI improved with exercise (Pre = 1.78 ± 0.10 vs. Post = 2.01 ± 0.13, P = 0.03) with no change following stretching (Pre = 1.73 ± 0.08 vs. Post = 1.67 ± 0.10, P = 0.69). Peak systolic blood pressure during the maximal treadmill exercise test was lower after exercise training (Pre = 186 ± 5 mmHg, Post = 174 ± 4 mmHg, P = 0.003) with no change after stretching (Pre = 190 ± 6 mmHg, Post = 190 ± 4 mmHg, P = 0.12). The rate of increase in systolic blood pressure during the V̇o2peak test tended to decrease after training for both groups (-2 mmHg/stage) with no differences between groups (P = 0.97). There was no change in V̇o2peak after either intervention. In conclusion, aerobic exercise training improves endothelial function and attenuates peak blood pressure reactivity during exercise in CKD.NEW & NOTEWORTHY Patients with chronic kidney disease (CKD) exhibit increased blood pressure reactivity during exercise that is associated with endothelial dysfunction. Twelve weeks of structured, aerobic, exercise training improves endothelial function and attenuates peak blood pressure responses during exercise in CKD stages III-IV.

Referral rates and patient characteristics of the inpatient cardiac rehabilitation program of a philippine tertiary cardiovascular referral center

Abstract Funding Acknowledgements Type of funding sources: None. Introduction International guidelines recommend effective cardiac rehabilitation programs to decrease mortality and morbidity and improve health-related quality of life. However, cardiac rehabilitation remains underutilized with low referral rates. Data on referral rates and factors affecting referral are lacking in our setting. Purpose We evaluated the utilization of inpatient cardiac rehabilitation in our general hospital in terms of referral rates of patients with Class I indications for cardiac rehabilitation, time to referral, treadmill exercise test (TET) participation rate, and characteristics of patients referred and not referred. Methods We conducted this retrospective descriptive cross-sectional study by reviewing the medical records of eligible patients admitted between January 1 to December 31,2018. Patient characteristics, indications for cardiac rehabilitation, referral rates, time to referral, and TET participation rates were determined. Results We included 759 patients with a mean age of 57.5 years; majority were male (59.9%), married (66.8%), hypertensive (58.4%) and diabetic (32%). The overall referral rate is 17.7%. The highest indication-specific referral rates were for CABG(70%), STEMI(32%), PCI(32%), and PAD(32%). The lowest referral rates were seen in patients with NSTEMI(18%) and HF (16%). The mean time to referral was 6 days. The TET participation rate was 1.3%. Conclusion Cardiac rehabilitation remains underutilized despite evidence-based recommendations. Intensified efforts are needed to enroll all patients with Class I indications for inpatient cardiac rehabilitation, increase referral rates, improve the existing program, and optimize the management of our cardiovascular patients.

Clinical Outcomes Of A Diagnostic And Management Protocol For Popliteal Artery Entrapment Syndrome At A Large Referral Center

<h3>OBJECTIVE</h3> Popliteal Artery Entrapment Syndrome (PAES) is a rare clinical entity without a standardized algorithm for diagnosis. Our objective was to evaluate clinical outcomes using a unique diagnosis and management algorithm for PAES. <h3>METHODS</h3> We retrospectively reviewed patients diagnosed with PAES at a single institution between 2013 and 2021. Demographics, physical exam findings, non-invasive imaging results, and angiographic images were assessed to validate a diagnostic and management algorithm (Figure 1). <h3>RESULTS</h3> Thirty extremities in 20 patients were treated for PAES (Table 1). Physical exam revealed a pulse decrement with provocative maneuvers in 90% of treated limbs. Noninvasive studies to include treadmill exercise testing revealed a mean ABI drop of 0.27 and positional duplex demonstrated peak systolic velocity increase by a mean ratio of 1.72 with provocative maneuvers. DiagnosticImage, figure 1 arteriography was performed in all patients and revealed well-developed collaterals in 100% of treated limbs and complete effacement of the popliteal artery with active provocative maneuvers. Surgical exposure occurred via a posterior approach using a longitudinal incision and intraoperative duplex was performed in all cases. Staged bilateral PAES release occurred in 10 patients and type III PAES was diagnosed in 90%. Wound complications occurred in 4 limbs and included seroma and hypertrophic scarring. All patients experienced symptomatic relief with median follow-up of 4 months. <h3>CONCLUSIONS</h3> We report 100% technical and clinical success in patients with PAES diagnosed and managed using our clinical algorithm. Dynamic angiography to confirm the diagnosis and intraoperative duplex to confirm complete surgical release are essential for successful clinical outcome.Image, table 1Image, table 1

A Comparison of the Validity of Three Exercise Tests for Estimating Maximal Oxygen Uptake in Korean Adults Aged 19–64 Years

The purpose of this study was to compare the validity of three submaximal exercise tests (SMETs) and develop practical predictive models for the VO2max in Korean adults. A total of 541 (287 males and 254 females) adults participated in this study. Their ages ranged from 19 to 64. The VO2max was measured using the maximal-graded exercise treadmill test. The SMETs were performed by a treadmill test, the YMCA step test, and the PACER test. Regression analysis was conducted to compare the validity of the VO2max predictive equations using SMETs. The validity of the predictive models was evaluated using explanatory power, standard error of estimate (SEE), and Bland-Altman analysis. The explanatory power between the measured VO2max and the predicted VO2max was 58.0% (&lt;0.001), 59.2% (&lt;0.001), and 71.7% (&lt;0.001), respectively. The SEEs were 4.545, 4.478, and 3.732 (mL/kg/min). The models were significant predictors of VO2max and had acceptable validity in a large sample of Korean adults. Especially, among the predictive models, PACER had the highest acceptable effectiveness. Therefore, the equations developed in this study are recommended to better evaluate the cardiovascular endurance of Korean adults.

Left Vocal Cord Paralysis, Lung Function and Exercise Capacity in Young Adults Born Extremely Preterm With a History of Neonatal Patent Ductus Arteriosus Surgery—A National Cohort Study

Background: Left vocal cord paralysis (LVCP) is a known complication of patent ductus arteriosus (PDA) surgery in extremely preterm (EP) born neonates; however, consequences of LVCP beyond the first year of life are insufficiently described. Both voice problems and breathing difficulties during physical activity could be expected with an impaired laryngeal inlet. More knowledge may improve the follow-up of EP-born subjects who underwent PDA surgery and prevent confusion between LVCP and other diagnoses.Objectives: Examine the prevalence of LVCP in a nationwide cohort of adults born EP with a history of PDA surgery, and compare symptoms, lung function, and exercise capacity between groups with and without LVCP, and vs. controls born EP and at term.Methods: Adults born EP (<28 weeks' gestation or birth weight <1,000 g) in Norway during 1999–2000 who underwent neonatal PDA surgery and controls born EP and at term were invited to complete questionnaires mapping voice-and respiratory symptoms, and to perform spirometry and maximal treadmill exercise testing. In the PDA-surgery group, exercise tests were performed with a laryngoscope positioned to evaluate laryngeal function.Results: Thirty out of 48 (63%) eligible PDA-surgery subjects were examined at mean (standard deviation) age 19.4 (0.8) years, sixteen (53%) had LVCP. LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, not with lung function or peak oxygen consumption (VO2peak). In the PDA-surgery group, forced expiratory volume in 1 second z-score (z-FEV1) was reduced compared to EP-born controls (n = 30) and term-born controls (n = 36); mean (95% confidence interval) z-FEV1 was −1.8 (−2.3, −1.2), −0.7 (−1.1, −0.3) and −0.3 (−0.5, −0.0), respectively. For VO2peak, corresponding figures were 37.5 (34.9, 40.2), 38.1 (35.1, 41.1), and 43.6 (41.0, 46.5) ml/kg/min, respectively.Conclusions: LVCP was common in EP-born young adults who had undergone neonatal PDA surgery. Within the PDA-surgery group, LVCP was associated with self-reported voice symptoms and laryngeal obstruction during exercise, however we did not find an association with lung function or exercise capacity. Overall, the PDA-surgery group had reduced lung function compared to EP-born and term-born controls, whereas exercise capacity was similarly reduced for both the PDA-surgery and EP-born control groups when compared to term-born controls.

The Placebo Effect on Symptoms, Quality of Life, and Functional Outcomes in Patients With Angina Pectoris: A Meta-analysis of Randomized Placebo-Controlled Trials.

The placebo effect is a well described phenomenon in blinded studies evaluating antianginal therapeutics, although its effect on clinical research metrics remains unknown. We conducted a systematic review and meta-analysis to quantify the effect of placebo on end points of symptoms, life quality, and functional outcomes in randomized placebo-controlled trials (RCTs) of symptomatic stable coronary artery disease. We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for double-blind RCTs of antiangina therapeutics. Patients randomized to the placebo arm were the study population. Main outcomes were the changes in exercise performance (exercise treadmill test [ETT] parameters), quality of life (Seattle Angina Questionnaire domains), symptoms (Canadian Cardiovascular Society angina class) and drug usage (nitroglycerin tablets per week) between baseline and after placebo treatment. The primary outcome was ETT total duration time. Data were pooled with a random effect model. Seventy-eight RCTs (83% drug-controlled, 17% procedure-controlled) were included encompassing 4925 patients randomized to placebo. ETT total duration time was significantly improved after placebo treatment compared with baseline (mean, 29.2; 95% confidence interval, 20.6-37.8] seconds) with evidence of high heterogeneity (I2 = 98%) At subgroup analysis, crossover design was associated with a smaller placebo effect on ETT performance than parallel study design (P for interaction = 0.001). A significant placebo effect was observed for all secondary outcomes with overall high heterogeneity. A substantial placebo effect was present in angina RCTs across a variety of functional and life quality metrics. High variability in placebo effect size was present, mostly unexplained by differences in study and patient characteristics.

Association of left ventricular global area strain derived from resting 3D speckle-tracking echocardiography and exercise capacity in individuals undergoing treadmill exercise test.

Background: Left ventricular (LV) global area strain (GAS) is a novel index derived from resting 3D speckle-tracking echocardiography (STE), and its clinical significance has rarely been studied. We examined the association of LV GAS and exercise capacity in a health check-up population.Methods: We recruited 94 symptom-free participants (52.2 ± 11.7 years, 62.8% male) without substantial structural heart disease or coronary heart diseases who were undergoing a routine health examination. All participants underwent resting echocardiography and symptom-limited treadmill exercise test according to the Bruce protocol. Four strain parameters were obtained from the analysis, namely 3D GAS (GAS3d), global longitudinal strain, global circumferential strain, and global radial strain.Results: After multivariate analysis for factors of exercise time, we observed a significant association in LV GAS3d (P < 0.001). We divided participants into preserved and impaired exercise capacity groups according to the cutoff value of 8 metabolic equivalent of tasks. LV GAS3d (OR 1.24, 95% CI 1.10-1.39, P < 0.001) was an independent predictor of impaired exercise capacity and the optimal cut-off value was -19.96% at a sensitivity of 77.8% and at a specificity of 92.1%. LV GAS3d could improve the discriminatory power of exercise capacity in individuals with early mitral filling velocity to average mitral annulus velocity ratio (E/e') ≥ 8.Conclusions: LV GAS3d was significantly associated with exercise time and exhibited incremental predictive value on E/e' for exercise capacity in participants undergoing treadmill exercise test.

Nedocromil sodium and diphenhydramine HCl ameliorate exercise-induced arterial hypoxemia in highly trained athletes.

IntroductionExercise‐induced arterial hypoxemia (EIAH) has been observed in highly trained endurance athletes during near maximal exercise, which may be influenced by a histamine‐mediated inflammatory response at the pulmonary capillary‐alveolar membrane. In order to test this hypothesis, we examined whether the mast cell stabilizer nedocromil sodium (NS) and H1‐receptor antagonist diphenhydramine HCL (DH) would ameliorate EIAH and mitigate the drop in arterial oxyhemoglobin saturation (SaO2) during intensive exercise.MethodsSeven highly trained male cross country runners (age, 21 ± 2 years; V̇O2max, 74.7 ± 3.5 ml·kg−1·min−1) participated in the study. All subjects completed a maximal exercise treadmill test to exhaustion, followed by three 5‐min constant‐load exercise bouts at 70%, 80%, and 90% V̇O2max. Prior to testing, subjects received either placebo (PL), NS, or DH.ResultsCompared to PL, there was a significant treatment effect on SaO2 (p < 0.001) for both NS and DH during both constant‐load exercise and at V̇O2max. Post hoc tests revealed SaO2 values, compared to PL, were significantly higher at V̇O2max and during DH trials and higher with NS at constant‐load intensities except at 70% (p = 0.13).ConclusionThe findings provide further evidence that histamine contributes directly or indirectly to the development of EIAH during intense exercise in highly trained athletes.

Cardiovascular risk stratification: how important is the hypertensive response to exercise?

Cardiovascular risk stratification: how important is the hypertensive response to exercise?

Metabolic Response of Diabetic Patients with Obesity and No Obesity during Bruce Treadmill Test

Background: Physical exercise alters many biochemical parameters of human body. For that reason, it is recommended as a cure for many diseases of modern life like obesity and diabetics. This study investigates the biochemical and hormonal changes in diabetic, hypertensive and obese individuals after Bruce treadmill tests of different durations and intensities. Method: Our sample consisted of 59 individuals, divided into four groups: A: 12 normal body-weight diabetics, B: 11 overweight diabetics, C: 14 normal body-weight non-diabetics and D: 22 overweight non-diabetics. 66.1% of them were men. The comparisons were done between: 1) Diabetics versus non-diabetics; 2) Over-weight versus normal body-weight persons; 3) Over-weight diabetics versus normal weight diabetics; 4) Over-weight non-diabetics versus normal body-weight non-diabetics of 5) Hypertensives versus non-hypertensives. All individuals performed an intense, short duration treadmill exercise test, independently of the presence or not of DM2, hypertension and obesity. Results: The participants with DM2 (obese and non-obese) had decreased levels of glucose, triglycerides and TSH (P < 0.01) and increased levels of HDL-cholesterol, CK, CK-MB, LDH, renin, aldosterone (P < 0.01) after Bruce test. The non-diabetics participants (obese and non-obese) had decreased levels of glucose, urea, triglycerides, CK, CK-MB, LDH (P < 0.01) and decreased levels of hematocrit, HDL-cholesterol (P < 0.01) after Bruce test. All the other alterations have no statistical importance. Conclusion: Our results proved that the physical exercise, even if it has short duration like that of the Bruce test, has beneficial results in persons with DM2, obesity and arterial hypertension, as well as in normal persons.

Propionyl-L-carnitine for intermittent claudication.

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis. Intermittent claudication is a symptomatic form of PAD that is characterized by pain in the lower limbs caused by chronic occlusive arterial disease. This pain develops in a limb during exercise and is relieved with rest. Propionyl-L-carnitine (PLC) is a drug that may alleviate the symptoms of PAD through a metabolic pathway, thereby improving exercise performance. The objective of this review is to determine whether propionyl-L-carnitine is efficacious compared with placebo, other drugs, or other interventions used for treatment of intermittent claudication (e.g. exercise, endovascular intervention, surgery) in increasing pain-free and maximum walking distance for people with stable intermittent claudication, Fontaine stage II. The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and the ClinicalTrials.gov trials register to July 7, 2021. We undertook reference checking and contact with study authors and pharmaceutical companies to identify additional unpublished and ongoing studies. Double-blind randomized controlled trials (RCTs) in people with intermittent claudication (Fontaine stage II) receiving PLC compared with placebo or another intervention. Outcomes included pain-free walking performance (initial claudication distance - ICD) and maximal walking performance (absolute claudication distance - ACD), analyzed by standardized treadmill exercise test, as well as ankle brachial index (ABI), quality of life, progression of disease, and adverse events. Two review authors independently selected trials, extracted data, and evaluated trials for risk of bias. We contacted study authors for additional information. We resolved any disagreements by consensus. We performed fixed-effect model meta-analyses with mean differences (MDs) and 95% confidence intervals (CIs). We graded the certainty of evidence according to GRADE. We included 12 studies in this review with a total number of 1423 randomized participants. A majority of the included studies assessed PLC versus placebo (11 studies, 1395 participants), and one study assessed PLC versus L-carnitine (1 study, 26 participants). We identified no RCTs that assessed PLC versus any other medication, exercise, endovascular intervention, or surgery. Participants received PLC 1 grams to 2 grams orally (9 studies) or intravenously (3 studies) per day or placebo. For the comparison PLC versus placebo, there was a high level of both clinical and statistical heterogeneity due to study size, participants coming from different countries and centres, the combination of participants with and without diabetes, and use of different treadmill protocols. We found a high proportion of drug company-backed studies. The overall certainty of the evidence was moderate. For PLC compared with placebo, improvement in maximal walking performance (ACD) was greater for PLC than for placebo, with a mean difference in absolute improvement of 50.86 meters (95% CI 50.34 to 51.38; 9 studies, 1121 participants), or a 26% relative improvement (95% CI 23% to 28%). Improvement in pain-free walking distance (ICD) was also greater for PLC than for placebo, with a mean difference in absolute improvement of 32.98 meters (95% CI 32.60 to 33.37; 9 studies, 1151 participants), or a 31% relative improvement (95% CI 28% to 34%). Improvement in ABI was greater for PLC than for placebo, with a mean difference in improvement of 0.09 (95% CI 0.08 to 0.09; 4 studies, 369 participants). Quality of life improvement was greater with PLC (MD 0.06, 95% CI 0.05 to 0.07; 1 study, 126 participants). Progression of disease and adverse events including nausea, gastric intolerance, and flu-like symptoms did not differ greatly between PLC and placebo. For the comparison of PLC with L-carnitine, the certainty of evidence was low because this included a single, very small, cross-over study. Mean improvement in ACD was slightly greater for PLC compared to L-carnitine, with a mean difference in absolute improvement of 20.00 meters (95% CI 0.47 to 39.53; 1 study, 14 participants) or a 16% relative improvement (95% CI 0.4% to 31.6%). We found no evidence of a clear difference in the ICD (absolute improvement 4.00 meters, 95% CI -9.86 to 17.86; 1 study, 14 participants); or a 3% relative improvement (95% CI -7.4% to 13.4%). None of the other outcomes of this review were reported in this study. When PLC was compared with placebo, improvement in walking distance was mild to moderate and safety profiles were similar, with moderate overall certainty of evidence. Although In clinical practice, PLC might be considered as an alternative or an adjuvant to standard treatment when such therapies are found to be contraindicated or ineffective, we found no RCT evidence comparing PLC with standard treatment to directly support such use.

Facemasks do not lead to abnormal gas exchange during treadmill exercise testing in children.

No episodes of oxygen desaturation or carbon dioxide retention were observed in this cross-sectional study assessing children with exercise-induced symptoms wearing a surgical facemask during a submaximal treadmill exercise test https://bit.ly/3GuxhvO