Improvements In VO2peak Research Articles

Efficacy of inspiratory muscle training in chronic heart failure patients: A systematic review and meta-analysis

IntroductionInspiratory muscle training (IMT) offers an alternative to exercise training (ExT) in the most severely deconditioned heart failure patients who are unable to exercise. We conducted a meta-analysis to determine magnitude of change in peak VO2, six minute walk distance (6MWD), Quality of Life measured by the Minnesota Living with Heart Failure Questionnaire (MLWHFQ), maximal inspiratory pressure (PI max) and ventilatory equivalent for carbon dioxide (VE/VCO2 slope) with IMT. MethodsA systematic search was conducted of randomized, controlled trials of IMT therapy in CHF patients using Medline (Ovid) (1950–February 2012), Embase.com (1974–February 2012), Cochrane Central Register of Controlled Trials and CINAHL (1981–February 2012). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, inspiratory or respiratory muscle training, exercise training ResultsThe eleven included studies contained data on 287 participants: 148 IMT participants and 139 sham or sedentary control. Compared to control groups, CHF patients undergoing IMT showed a significant improvement in peak VO2 (+1.83ml kg−1 min−1, 95% C.I. 1.33 to 2.32ml kg−1 min−1, p<0.00001); 6MWD (+34.35m, 95% C.I. 22.45 to 46.24m, p<0.00001); MLWHFQ (−12.25, 95% C.I. −17.08 to −7.43, p<0.00001); PImax (+20.01, 95% C.I. 13.96 to 26.06, p<0.00001); and VE/VCO2 slope (−2.28, 95% C.I. −3.25 to −1.30, p<0.00001). ConclusionsIMT improves cardio-respiratory fitness and quality of life to a similar magnitude to conventional exercise training and may provide an initial alternative to the more severely de-conditioned CHF patients who may then transition to conventional ExT.

Chronotropic incompetence predicts impaired response to exercise training in heart failure patients with sinus rhythm

In most patients with chronic heart failure (CHF), endurance training improves exercise capacity. However, some patients do not respond favourably. The purpose of this study was to explore the reasons of non-response and to determine their predictive value. We studied a cohort of 120 consecutive CHF patients with sinus rhythm (mean age 57 ± 12 years, ejection fraction 29.3 ± 9.9%, peak VO₂ 17.3 ± 5.1 ml/min/kg), participating in a 3-month outpatient cardiac rehabilitation programme. Responders were defined as subjects who improved peak VO₂ by more than 5%, work load by more than 10%, or VE/VCO₂ slope by more than 5%. Subjects who did not fulfil at least one of the above criteria were characterized as non-responders. Multivariate regression analyses were performed to identify parameters that were predictive for a response. Receiver operating characteristic (ROC) analyses were performed for predictive parameters to identify thresholds for response or non-response. Multivariate regression analyses revealed heart rate (HR) reserve, HR recovery at 1 min, and peak HR as significant predictors for a positive training response. ROC curves revealed the optimal thresholds separating responders from non-responders at less than 30 bpm for HR reserve, less than 6 bpm for HR recovery and less than 101 bpm for peak HR. The presence of impaired chronotropic competence is a major predictor of poor training response in CHF patients with sinus rhythm.

Functional electrical stimulation for chronic heart failure: A meta-analysis

IntroductionWe conducted a meta-analysis of randomized, controlled trials of combined electrical stimulation versus conventional exercise training or placebo control in heart failure patients. MethodsA systematic search was conducted of Medline (Ovid) (1950–September 2011), Embase.com (1974–September 2011), Cochrane Central Register of Controlled Trials and CINAHL (1981–September 2011). The search strategy included a mix of MeSH and free text terms for the key concepts heart failure, exercise training and functional electrical stimulation (FES). ResultsFES produced inferior improvements in peak VO2 when compared to cycle training: mean difference (MD) −0.32ml.kg−1.min−1 (95% C.I. −0.63 to −0.02ml.kg−1.min−1, p=0.04), however FES elicited superior improvements in peak VO2: MD 2.30ml.kg−1.min−1 (95% C.I. 1.98 to 2.62ml.kg−1.min−1, p<0.00001); and six minute walk distance to sedentary care or sham FES; MD 46.9m (95% C.I. 22.5 to 71.3m, p=0.0002). There was no difference in change in quality of life between cycling and FES, but FES elicited significantly larger improvements in Minnesota Living with Heart Failure score than placebo or sham treatment; MD 1.15 (95% C.I. 0.69 to 1.61, p<0.00001). Moreover, the total FES intervention hours were strongly correlated with change in peak VO2, (r=0.80, p=0.02). ConclusionsPassive or active exercise is beneficial for patients with moderate to severe heart failure, but active cycling, or other aerobic/resistance activity is preferred in patients with heart failure who are able to exercise, and FES is the preferred modality in those unable to actively exercise. The benefits of FES may however, be smaller than those observed in conventional exercise training. Aggregate hours of electrical stimulation therapy were associated with larger improvements in cardio-respiratory fitness.

Effects of Robot-Assisted Gait Training on Cardiopulmonary Fitness in Subacute Stroke Patients

Background. Robot-assisted gait training has the potential to improve cardiopulmonary fitness after stroke, even for patients who are in the early stages of recovery and not independent ambulators. The authors compared the effects of robot-assisted gait training and conventional physical therapy on cardiopulmonary fitness. Methods. A prospective single-blinded, randomized controlled study of 37 patients receiving inpatient rehabilitation was performed within 1 month after stroke onset. The robot-assisted gait training group (n = 20) received 40 minutes of gait training with Lokomat and 60 minutes of conventional physical therapy each day, whereas the control group (n = 17) received 100 minutes of conventional physical therapy daily. Using a semirecumbent cycle ergometer, changes in cardiopulmonary fitness were investigated using incremental exercise testing. Motor and gait functional recovery was measured according to changes in the lower-extremity score of the Fugl-Meyer Assessment Scale (FMA-L), leg score of the Motricity Index (MI-L), and the Functional Ambulation Category (FAC). Results. Compared with the control group, the robot group showed 12.8% improvement in peak VO2 after training (P < .05). Compared with the control group, the robot group also improved in FMA-L score (P < .05). Conclusion. Patients can be trained to increase their VO2 and lower-extremity strength using a robotic device for stepping during inpatient rehabilitation. This training has the potential to improve cardiopulmonary fitness in patients who are not yet independent ambulators, but that may require more than 2 weeks of continued, progressive training.

Entrenamiento interválico en pacientes con cardiopatía isquémica: metodología y análisis de resultados ergoespirométricos

Background Interval training is an exercise modality underused in patients with coronary artery disease even though different authors have shown its physiological benefits. Objective To describe a simple method of interval training and to evaluate its benefits and safety in patients with coronary artery disease. Method Twenty-five patients with stable coronary artery disease underwent high-intensity interval training on a cycle ergometer. To determine the training work rate, we performed a steep ramp test. The training consisted of intervals of 20 seconds at 50% of the maximum load achieved in the steep ramp test, followed by intervals of 40 seconds at 10%. A cycle ergospirometry was performed before and after the programme to compare data. Results After 8 weeks of interval training, there were significant gains in V0 2 peak (19.9±5.3 vs. 23.8±6 mL·kg -1·min −1), maximal work rate (103.5±42.6 vs.124.6±53.4 watts), maximal heart rate (117.6±15.7 vs. 128±16.5 bpm) and heart rate recovery index in the first minute (16.5±9.2 vs. 21.3±7.7 bpm). There were no adverse events. Conclusion In patients with coronary artery disease, high-intensity interval training is an easy, safe exercise modality that produces improvement in VO2 peak and exercise tolerance.

The Effect of Inspiratory and Expiratory Respiratory Muscle Training in Rowers

This study examined inspiratory and expiratory resistive loading combined with strength and endurance training on pulmonary function and rowing performance. Twenty-one male (n = 9) and female (n = 12) rowers were matched on 2000 m simulated rowing race time and gender and randomly assigned to two groups. The experimental group trained respiratory muscles using a device that provided both an inspiratory and expiratory resistance while the control group used a SHAM device. Respiratory muscle training (RMT) or SHAM was performed 6 d/wk concurrent with strength (3 d/wk) and endurance (3 d/wk) training on alternate days for 10 weeks. Respiratory muscle training (RMT) enhanced maximum inspiratory (PImax) and expiratory (PEmax) strength at rest and during recovery from exercise (P < 0.05). Both groups showed improvements in peak VO2, strength, and 2000 m performance time (P < 0.05). It was concluded that RMT is effective for improving respiratory strength but did not facilitate greater improvements to simulated 2000 m rowing performance.

692 The effect of remote ischemic preconditioning in heart failure: A randomized controlled pilot study

Remote ischemic preconditioning (RIPC) induced by transient limb ischemia confers myocardial and multi-organ protection in a variety of ischemic settings. RIPC may also improve skeletal muscle and exercise performance during activities limited by tissue hypoxia. To date, the effect of RIPC in patients with heart failure has not been explored, and may be associated with improved exercise capacity in this population. We performed a randomized double blind crossover trial of RIPC (4 cycles of 5-minutes upper limb ischemia/5 minutes reperfusion) compared to low-pressure sham control in ambulatory heart failure patients undergoing cardiopulmonary exercise testing. Patients with left ventricular systolic dysfunction and NYHA class II-IV heart failure were recruited from a single center, and randomly allocated to either RIPC or sham intervention immediately prior to undergoing symptom-limited stationary bicycle exercise with respiratory gas analysis. Patients then crossed over and completed the alternate intervention prior to repeat testing during a separate visit. The primary outcome measure was peak VO2 for RIPC versus sham; secondary outcomes included exercise duration, workload achieved and VE/VCO2 slope. Twenty patients completed the study protocol with paired testing a median of 18 days (IQ range 16-28 days) apart. Overall, RIPC prior to cardiopulmonary exercise testing was not associated with improvements in peak VO2 in this population (15.6 +/− 4.2 mL/kg/min vs 15.3 +/− 4.6 mL/kg/min; P = 0.33, for sham and RIPC, respectively). With respect to the secondary outcomes, there was no observed benefit of RIPC on exercise duration, workload achieved, anaerobic threshold, or VE/CO2 slope (Table). Post-hoc exploratory analysis did not identify any baseline clinical characteristics associated with an improved exercise performance following the RIPC intervention.Tabled 1 In this pilot study of RIPC in ambulatory heart failure patients with left ventricular systolic dysfunction, RIPC was not associated with improvements in objective measures of exercise capacity. Mechanistic studies and larger trials are needed to definitively rule out a benefit of RIPC in this population.

The Effect of Exercise Training on Endothelial Function in African American and Caucasian Postmenopausal Women

Endothelial dysfunction measured via flow-mediated dilation (FMD) is an early marker of atherogenesis, and is associated with increased cardiovascular disease risk. Aerobic exercise training improves FMD in mostly Caucasian (C) populations, but has not been assessed in African Americans (AA). PURPOSE: To evaluate the effect of aerobic exercise training on FMD in sedentary AA and C postmenopausal women. METHODS: Eight healthy, but sedentary AA (age= 55.8 + 1.7 yr, VO2 peak= 21.0 + 3.9 ml/kg/min) and 16 C (age= 57.2 + 5.9 yr, VO2 peak= 21.8 + 3.7 ml/kg/min) postmenopausal women participated in 12 weeks of aerobic exercise training four times per week (two days below the lactate threshold (RPE=10-12), and two days above the lactate threshold (RPE=15-17) to a designated caloric expenditure per session (250, 300, or 350 kcals). VO2 peak was assessed before and after training with an incremental exercise test on a motor-driven treadmill. Endothelial function was evaluated at pre-intervention and post-intervention via FMD, which was quantified by comparing B-mode ultrasound images of the brachial artery at rest and during reactive hyperemia after 5 minutes of forearm occlusion. RESULTS: Despite a significant improvement in VO2 peak (AA=13.5% vs. C=18.3%), exercise training did not significantly improve FMD in AA (5.77% to 5.68%, p= 0.950) or C subjects (5.68% to 6.64%, p=0.267). However, there was a significant improvement in FMD in subjects who had endothelial dysfunction (2.22% to 6.16%, p=0.007) at baseline, but not in subjects with normal endothelial function (7.76% to 6.67%, p= 0.508). CONCLUSION: In the present study, we observed no significant improvement in FMD in AA or C subjects. However, we found that exercise training improves FMD in subjects with endothelial dysfunction, but does not further increase FMD in postmenopausal women with previously normal or high endothelial function. Supported by NIH grant RR00847 to the GCRC

Serial Changes in Cardiorespiratory Fitness in Newly Diagnosed Cancer Patients

Although it is generally accepted that measures of physical functioning are adversely affected during cancer treatments, whether these decrements in function return to pre-treatment levels is not fully elucidated. PURPOSE: The purpose of this pilot study is to describe changes in cardiorespiratory fitness before, immediately after, and one year after cancer treatment in patients with breast and prostate cancer enrolled in a year long exercise program. METHODS: 17 patients (11 radiation and 6 chemotherapy) participated in this trial at Henry Ford Hospital between 10/08 and 10/10. A maximal exercise test with gas analysis was performed before and after treatment (5.2 + 5 weeks), and one year post treatment. Training was conducted at home or a hospital facility and consisted of aerobic, resistance, and stretching routines, three or more days per week. Repeated measures ANOVA were performed to compare the two treatments across time. RESULTS: Combining both groups there was a significant time (p = 0.004) and interaction effect (p = 0.015) indicating fitness level dropped after treatment and improved back to pre-treatment levels (Figure 1). A sub-analysis revealed only the chemotherapy group demonstrated a significant effect; a 25% improvement in peak VO2 one year following the completion of chemotherapy (p = 0.025). A similar trend was seen for hemoglobin in the chemotherapy group (p = 0.058).FigureCONCLUSION: In a cohort of patients with cancer who enrolled in an exercise intervention, cardiorespiratory fitness improved from the end of treatment to one year, thus preserving peak VO2 from baseline. The chemotherapy group demonstrated the most pronounced drop and subsequent return of peak VO2 one year following treatment.

Effect of Exercise Training on Peak Oxygen Consumption in Patients with Cancer: A Meta-Analysis

We conducted a meta-analysis to determine the effects of supervised exercise training on peak oxygen consumption (VO(2peak)) in adults with cancer. A literature review using Ovid MEDLINE (1950-2010), the Cochrane Central Register of Controlled Trials (1991-2010), AMED (1985-2010), Embase (1988-2010), PubMed (1966-2010), Scopus (1950-2010), and Web of Science (1950-2010) was performed to identify randomized controlled trials examining the effects of supervised exercise training on measurement of VO(2peak) (via gas exchange analysis) in adults with cancer. Studies were selected using predetermined criteria, and two independent reviewers extracted data. Weighted mean differences (WMDs) were calculated using random effect models. Six studies evaluated VO(2peak) involving a total of 571 adult cancer patients (exercise, n = 344; usual care control, n = 227). Pooled data indicated that exercise training was associated with a statistically significant increase in VO(2peak) (WMD, 2.90 ml·kg(-1)·min(-1); 95% confidence interval [CI], 1.16-4.64); however, significant heterogeneity was evident in this estimate (I(2), 87%). Usual care (control) was associated with a significant decline in VO(2peak) from baseline to postintervention (WMD, -1.02 ml·kg(-1)·min(-1); 95% CI, -1.46 to -0.58; I(2), 22%). Sensitivity analyses indicated superior improvements in VO(2peak) for studies conducted for a shorter duration (<4 months) and following the completion of adjuvant therapy (p-values < .001). Exercise training was not associated with a higher incidence of adverse events, although safety was not rigorously monitored or reported. Supervised exercise training is associated with significant improvements in VO(2peak) following a diagnosis of early-stage cancer, with minimal adverse events.

自重を用いた在宅レジスタンストレーニングが慢性期心疾患患者の運動耐容能に及ぼす効果

Purpose: The purpose of this study was to investigate the effect of non-instrumental resistance training on exercise capacity of patients with chronic heart disease. Methods: Nineteen elderly male patients (66.2±5.7 years) participated in the study. All had experienced coronary artery bypass surgery, coronary artery intervention, or aortic valve replacement [left ventricular ejection fraction (EF): 54.0±15.8 %]. Patients were divided into two groups. T group (N=9) performed combined aerobic and non-instrumental resistance training; and C group (N=10) performed only aerobic exercise. Resistance training involved 10 to 15 repetitions (maximum)(RM) of squats, push ups, calf raises and trunk curls. Each exercise included 3 sets of 10 repetitions repeated 3 times a week. Aerobic exercise was prescribed at the intensity of the aerobic threshold (AT) level 3 times a week. There was no significant base line for either T group or C group. Results: After three months of exercise, peak torque, peak VO2, and peak watts were significantly greater in T group, compared to those of C group. However, there was no significant correlation (r = .49) between the improvement of peak VO2 and peak torque. Conclusion: It was concluded that combined aerobic and non-instrumental resistance training is more effective than aerobic exercise alone for exercise capacity of patients with chronic heart disease. Home-based non-instrumental resistance training is usually highly significant from the perspective of the exercise capacity of patients with chronic heart disease.

Effect of Exercise Training on Interleukin-6, Tumour Necrosis Factor Alpha and Functional Capacity in Heart Failure

Background. We pooled data from four studies, to establish whether exercise training programs were able to modulate systemic cytokine levels of tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). A second aim was to establish if differences in ExT regimens are related to degree of change in cytokines and peak VO2. Methods. Data from four centres relating to training protocol, exercise capacity, and cytokine measures (TNF-alpha and IL-6) were pooled for analysis. Results. Data for 106 CHF patients were collated (98 men, age 62 ± 10 yrs, wt 79 ± 14 Kg). Patients were moderately impaired (peak VO2 16.9 ± 4.4 mls/kg/min), with moderate LV systolic dysfunction (EF 30 ± 6.9%), 78% (83) had ischaemic cardiomyopathy. After ExT, peak VO2 increased 1.4 ± 3.4 ml/kg/min (P < .001), serum TNF-alpha decreased 1.9 ± 8.6 pg/ml (P = .02) and IL-6 was not significantly changed (0.5 ± 5.4 pg/ml, P = .32) for the whole group. Baseline and post-training peak VO2 changes were not correlated with change in cytokine levels. Conclusions. Exercise training reduces levels TNF-alpha but not IL-6 in CHF. However, across a heterogenic patient group, change in peak VO2 was not correlated with alterations in cytokine levels. While greater exercise volume (hours) was superior in improving peak VO2, no particular characteristic of ExT regimes appeared superior in effecting change in serum cytokines.

Rationale and design of the Exercise Intensity Trial (EXCITE): A randomized trial comparing the effects of moderate versus moderate to high-intensity aerobic training in women with operable breast cancer

BackgroundThe Exercise Intensity Trial (EXcITe) is a randomized trial to compare the efficacy of supervised moderate-intensity aerobic training to moderate to high-intensity aerobic training, relative to attention control, on aerobic capacity, physiologic mechanisms, patient-reported outcomes, and biomarkers in women with operable breast cancer following the completion of definitive adjuvant therapy.Methods/DesignUsing a single-center, randomized design, 174 postmenopausal women (58 patients/study arm) with histologically confirmed, operable breast cancer presenting to Duke University Medical Center (DUMC) will be enrolled in this trial following completion of primary therapy (including surgery, radiation therapy, and chemotherapy). After baseline assessments, eligible participants will be randomized to one of two supervised aerobic training interventions (moderate-intensity or moderate/high-intensity aerobic training) or an attention-control group (progressive stretching). The aerobic training interventions will include 150 mins.wk-1 of supervised treadmill walking per week at an intensity of 60%-70% (moderate-intensity) or 60% to 100% (moderate to high-intensity) of the individually determined peak oxygen consumption (VO2peak) between 20-45 minutes/session for 16 weeks. The progressive stretching program will be consistent with the exercise interventions in terms of program length (16 weeks), social interaction (participants will receive one-on-one instruction), and duration (20-45 mins/session). The primary study endpoint is VO2peak, as measured by an incremental cardiopulmonary exercise test. Secondary endpoints include physiologic determinants that govern VO2peak, patient-reported outcomes, and biomarkers associated with breast cancer recurrence/mortality. All endpoints will be assessed at baseline and after the intervention (16 weeks).DiscussionEXCITE is designed to investigate the intensity of aerobic training required to induce optimal improvements in VO2peak and other pertinent outcomes in women who have completed definitive adjuvant therapy for operable breast cancer. Overall, this trial will inform and refine exercise guidelines to optimize recovery in breast and other cancer survivors following the completion of primary cytotoxic therapy.Trial RegistrationNCT01186367

The effects of adding torasemide to standard therapy on peak oxygen consumption, natriuretic peptides, and quality of life in patients with compensated left ventricular systolic dysfunction

Diuretics, when used to treat congestion in patients with chronic heart failure, improve symptoms and, perhaps, prognosis but little information is available to guide their use in patients with left ventricular systolic dysfunction (LVSD) who are not congested. Chronic diuretic therapy causes persistent and potentially harmful neuroendocrine activation. Alternatively, in patients in whom neuroendocrine activation is blocked with angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers, diuretics may be beneficial by decreasing preload and afterload and preventing congestion. We aimed to assess the effect of the loop diuretic, torasemide on quality of life, and surrogate markers of prognosis when given to patients with LVSD who were not clinically congested and who were optimally treated with ACE-inhibitors (or angiotensin receptor antagonists) and beta-blockers. Thirty patients with stable LVSD who had no clinically detectable fluid overload were randomized to receive either torasemide 5 mg daily or placebo for 3 months (Phase A), and after a washout phase of 2 months, cross-over was performed for 3 months (Phase B). Diuretic therapy did not cause significant change in peak VO(2), mean N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) levels, or measures of quality of life compared with placebo. Diuretic therapy did however lead to significant fall in systolic and diastolic blood pressures and increase in plasma renin levels compared with placebo. Diuretic therapy with torasemide is not superior to placebo in improving peak VO(2) or reducing NT-proBNP levels in patients with left ventricular dysfunction who are not clinically congested.

061 Metabolic alteration in hypertrophic cardiomyopathy (METAL-HCM Study): randomised double blinded placebo controlled trial of perhexiline therapy in patient with hypertrophic cardiomyopathy

Background Patients with hypertrophic cardiomyopathy (HCM) exhibit myocardial energetic impairment, but a causative role for this energy deficiency in the pathogenesis of HCM remains unproven. We hypothesised that the metabolic modulator, perhexiline would ameliorate myocardial energy deficiency and thereby improve diastolic function and exercise capacity. Methods Forty-six consecutive patients with symptomatic exercise limitation (peak oxygen consumption – peak VO2 Results Perhexiline improved myocardial PCr/ATP ratios (from 1.27±0.02 to 1.73±0.02; p=0.003) and normalised the abnormal prolongation of nTTPF between rest and exercise (δ nTTPF: +0.11±0.008 s vs −0.01±0.005; p=0.03). These changes were accompanied by improvement in peak VO2 (22.2±0.2 to 24.29±0.2 ml/kg/min; p=0.003) and symptoms (NYHA class by 0.8 units p Conclusion In symptomatic HCM, perhexiline, a modulator of substrate metabolism, ameliorates cardiac energetic impairment, corrects diastolic dysfunction and increases exercise capacity. This study supports the hypothesis that energy deficiency contributes to the pathogenesis and provides a rationale for further consideration of metabolic therapies in HCM.

Changes in Functional Performance Measures in Adults Undergoing Chemoradiation for Primary Malignant Glioma: A Feasibility Study

To investigate the feasibility of longitudinal assessment of functional performance measures in newly diagnosed postsurgical malignant glioma patients. Patients with histologically confirmed, clinically stable, postsurgical, and previously untreated high-grade glioma (HGG) or low-grade glioma (LGG) were studied. Using a prospective design, all participants performed a cardiopulmonary exercise test with expired gas analysis to assess cardiorespiratory function (VO(2peak)) immediately following surgical resection (mean, 10 days). Additional functional outcomes were skeletal muscle cross-sectional area (CSA) via magnetic resonance imaging, isokinetic muscle strength (isokinetic dynamometry), and body composition (air displacement plethysmography). Quality of life (QOL) was assessed by the Functional Assessment of Cancer Therapy-Brain scale. All study assessments were repeated at 6 and 24 weeks following surgery. Thirty-five patients (HGG, n = 25; LGG, n = 10) completed baseline assessments. Of these, 20 HGG (80%) and nine LGG (90%) and 15 HGG (60%) and nine LGG (90%) patients completed study assessments at 6 weeks and 24 weeks, respectively. Intention-to-treat analyses indicated several significant time-by-group interactions, with favorable improvements in functional and QOL endpoints from baseline to 24 weeks in the LGG cohort and unfavorable changes in the HGG cohort. Per-protocol analyses including participants assessed at all three study timepoints indicated significant improvements in VO(2peak) and fatigue from baseline to 24 weeks in the HGG cohort; peak workload, body composition, and muscle strength improved from baseline to 6 weeks (all p-values < .05). Longitudinal quantitative functional assessments are safe and feasible among select patients undergoing chemoradiation for primary malignant glioma. Large prospective studies investigating the clinical importance of these measures appear warranted.

Performance Changes With Three Different Training Phases In Masters Level Cyclists

PURPOSE: The purpose of this study was to determine the changes in performance in Masters level cyclists after eighteen weeks of prescribed training. METHODS: Nine competitive male cyclists (43.3 ± 2.2 yrs) completed three 6-week phases of structured training using power meters. The first phase (P1) consisted of 6 weeks of training focused at a power below 80% of onset of blood lactate accumulation (OBLA), the 2nd phase (P2) consisted of training focused at a power between 84-105% of OBLA and the 3rd phase (P3) consisted of training focused at a power between 97-105+% of OBLA. Testing occurred on 4 occasions, at baseline (P0) and after each phase of training. At each test session body composition was measured and subjects completed a peak exercise test on a cycle ergometer. Heart rate, blood lactate, rating of perceived exertion, and oxygen consumption (VO2) were recorded at each 3-minute stage throughout exercise and at 3 and 6 minutes of an active recovery. A 16.1 km time trial (TT) performance test on a road course was performed the same week as each laboratory test. RESULTS: There was a 4% decrease in body weight and a 3% decrease in lean body mass (p<0.05) from P0 to the end of P3. VO2peak increased 11% (52.2 ± 1.9 to 58.2 ± 2.5 ml-1kg-1min-1) and peak power 9% (328.8 ± 16.9 to 358.8 ± 16.0 watts) from P0 to P3. Power at OBLA increased significantly from P0 to P3. TT times improved from P1 to P3 (28.2 ± 1.1 to 26.1± 0.7 min). CONCLUSIONS: The initial 6 weeks of specific power based training resulted in the majority of the improvements in VO2 peak, peak power and TT performance in Masters level cyclists.

217: A High-Intensity Exercise Program Improves Peak VO2 and Reduces Markers of Systemic Inflammation in Cardiac Transplant Recipients: A Randomized Study

217: A High-Intensity Exercise Program Improves Peak VO2 and Reduces Markers of Systemic Inflammation in Cardiac Transplant Recipients: A Randomized Study

The effects of a neuromuscular electrical stimulation training intervention on physiological measures in a spinal cord injured male: a case study

Background: People with spinal cord injury (SCI) are exposed to the development of comorbidities secondary to a decreased ability to exercise and pathological complications. Aerobic exercise has been advocated as a means of preventing the development of these illnesses. Previous research has indicated that functional electrical stimulation (FES) provides an appropriate aerobic stimulus in an SCI population to provide cardiovascular fitness gains. However, FES devices are time consuming for both clients and medical staff in a rehabilitation and home setting with devices often expensive. Our research group have developed a novel neuromuscular electrical stimulation (NMES) system which may provide an alternative to FES and elicit a similar response. Methods: A 40 year old male with a T6 incomplete SCI, undertook 6 weeks of NMES training for one hour, five days per week. Pre and post intervention measures include a treadmill VO2 peak test, a DXA scan and subjective feedback regarding the NMES device and training stimulus. Results: Improvements in VO2 peak, heart rate and exercise tolerance were observed with minor decreases in total body fat mass. The participant reported that the NMES was an acceptable form of cardiovascular training. Conclusion: Our pilot case study has indicated that our NMES system is capable of eliciting an aerobic training effect in people with SCI, which could potentially improve their cardiovascular fitness. Further study with a greater number of participants is warranted in this population using a similar training program.

Diet and Exercise Interventions Reduce Intrahepatic Fat Content and Improve Insulin Sensitivity in Obese Older Adults

Both obesity and aging increase intrahepatic fat (IHF) content, which leads to nonalcoholic fatty liver disease (NAFLD) and metabolic abnormalities such as insulin resistance. We evaluated the effects of diet and diet in conjunction with exercise on IHF content and associated metabolic abnormalities in obese older adults. Eighteen obese (BMI >or=30 kg/m(2)) older (>or=65 years old) adults completed a 6-month clinical trial. Participants were randomized to diet (D group; n = 9) or diet + exercise (D+E group; n = 9). Primary outcome was IHF quantified by magnetic resonance spectroscopy (MRS). Secondary outcomes included insulin sensitivity (assessed by oral glucose tolerance), body composition (assessed by dual-energy X-ray absorptiometry), physical function (VO(2 peak) and strength), glucose, lipids, and blood pressure (BP). Body weight (D: -9 +/- 1%, D+E: -10 +/- 2%, both P < 0.05) and fat mass (D: -13 +/- 3%, D+E -16 +/- 3%, both P < 0.05) decreased in both groups but there was no difference between groups. IHF decreased to a similar extent in both groups (D: -46 +/- 11%, D+E: -45 +/- 8%, both P < 0.05), which was accompanied by comparable improvements in insulin sensitivity (D: 66 +/- 25%, D+E: 68 +/- 28%, both P < 0.05). The relative decreases in IHF correlated directly with relative increases in insulin sensitivity index (ISI) (r = -0.52; P < 0.05). Improvements in VO(2 peak), strength, plasma triglyceride (TG), and low-density lipoprotein-cholesterol concentration, and diastolic BP occurred in the D+E group (all P < 0.05) but not in the D group. Diet with or without exercise results in significant decreases in IHF content accompanied by considerable improvements in insulin sensitivity in obese older adults. The addition of exercise to diet therapy improves physical function and other obesity- and aging-related metabolic abnormalities.