Increased Exercise Tolerance Research Articles

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

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

Physical therapy after total hip arthroplasty

The article deals with the problem of physical therapy after total hip arthroplasty. The urgent issue of early mobilization and activation of patients after total hip arthroplasty by means of physical therapy is raised. The purpose of the article is to evaluate the effectiveness of the proposed complex of means of physical therapy of patients after total hip arthroplasty.
 The study involved 16 patients at the Clinic of Orthopedics, Arthrology and Sports Injury, which were divided into two groups: control and primary, 8 people each.Empirical research methods were the WOMAC Western Ontario and Mc Master Universities osteoarthritis Index and the Leken algal function index. The main group was engaged in the method of N. Kehlet, active mobilization of patients began in the first day after surgery, the control group received traditional physical therapy with verticalization on the second day after surgery. The average hospital stay was 7 days. This is due to the requirements of the surgeons and does not depend on the functionality of the patient. Physical therapy after surgery was aimed at: reducing swelling; prevention of blood clots; pain control; prevention of constipation; improving sleep; improving postural control; increasing exercise tolerance.
 At the present stage, the method of total hip replacement is one of the progressive and widespread types of surgical treatment of coxarthrosis. Today, due to the introduction into clinical practice of high-efficiency technologies of prosthetics, the use of modern joint designs, orthopedic surgeons in most cases manage to achieve effective results and restore lost function.
 The patients of the main group had reached the functional criteria of discharge several days earlier. The study are presented, according to the results of which we believe that the work by the method of N. Kehlet is quite effective and that it should be used in working with middle-aged persons after total hip replacement due to deformable coxarthrosis.

Effects of 100 % oxygen during exercise in patients with interstitial lung disease

PurposeHypoxemia limits exercise in some patients with interstitial lung disease (ILD). High levels of supplemental oxygen during exercise might allow physical training at a higher level and more effective pulmonary rehabilitation (PR). Our goals were to use graded cardiopulmonary exercise testing (CPET) to determine whether hyperoxia (FIO2≈1.0) increased exercise tolerance in patients with mild to moderate ILD. MethodsWe studied 6 patients with ILD, including idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP). The study population included 3 females and 3 males (age 69 ± 5 [SD] years; FVC 61 ± 14 %; absolute DLCO 53 ± 19 %). Subjects underwent 2 ramped (15 W/min) CPET protocols on a cycle ergometer (Jaeger Oxycon Pro™, CareFusion Respiratory Care) breathing either air or oxygen (FIO2≈1.0) from a Douglas bag in random order. ResultsMinute ventilation (VE) increased significantly during CPET breathing air (pre CPET, 18 ± 2 [SEM] L/min; post CPET, 47 ± 6; P = 0.01), but it did not increase significantly breathing oxygen (pre CPET, 15 ± 3 [SEM]; post CPET, 29 ± 9; P = 0.06). Likewise, carbon dioxide production (VCO2) increased significantly during CPET breathing air (pre CPET, 450 ± 93 [SEM] mL/min; post CPET, 1311 ± 200; P = 0.01), but it did not increase significantly breathing oxygen (pre CPET, 369 ± 129; post CPET, 847 ± 832; P = 0.09). Exercise time during CPET did not differ significantly (P = 0.34) in air (5.6 ± 0.9 [SEM] min) or oxygen (7.0 ± 1.8). Increases in heart rate (HR) and Borg dyspnea index (BDI) after CPET were not affected by breathing oxygen. ConclusionExercise-induced increases in VE and VCO2 were prevented by breathing pure oxygen during CPET, demonstrating both decreased ventilatory drive and more efficient exercise at achieved workloads. Hyperoxia could enhance the ability of patients with ILD to train at higher workloads, resulting in more effective rehabilitation.

Ожирение у детей: роль и возможности двигательной активности в комплексном лечении

The article presents an analytical review of scientific research on physical activity of overweight and obese children and adolescents. Obese children have low physical activity levels, decreased exercise tolerance, low adherence to active lifestyles. Worldwide and Russian studies showed that the effectiveness of losing weight and achieving the optimal body weight is higher when various kinds of physical exercises are included in comprehensive obesity treatment programmes. The most significant results for losing weight and increasing exercise tolerance are obtained in patients who are more highly motivated for moderate or high physical activity during 60-minute exercises not less than 3 times a week. Key words: children, adolescents, obesity, physical activity

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.

BackgroundIvabradine is a heart rate-lowering drug that selectively inhibits the funny (If) current of the sinoatrial node. It is currently recommended in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in sinus rhythm and a heart rate of ≥ 70 beats per minute (bpm) at rest. To investigate whether ivabradine has an effect on diastolic dysfunction, exercise tolerance and quality of life (QOL), we conducted a systemic review and meta-analysis of randomized controlled trials (RCTs).MethodsWe searched PubMed, EMBASE and Cochrane Central Register of Clinical Trials for studies on the effect of ivabradine on left ventricular (LV) diastolic dysfunction, exercise tolerance, QOL, readmission for worsening HF and mortality in both patients with HF with preserved ejection fraction (HFpEF) and HFrEF.ResultsThirteen RCTs with 881 patients met the inclusion criteria. According to the pooled analysis, for the HFpEF subgroup, treatment with ivabradine resulted in a decrease in early diastolic mitral inflow to late diastolic flow ratio (E/A) (standardized mean difference (SMD): -0.53; 95% confidence interval (CI): -0.99, -0.07; P < 0.000) and increase in peak oxygen uptake during exercise (VO2) (SMD: 0.05; 95% CI: -0.35, 0.45; P < 0.00; I2 = 95.1%). Similar effect was seen in the HFrEF subgroup with decrease in E/A ratio (SMD: -0.33; 95% CI: -0.59, -0.06; P < 0.000) and early diastolic mitral inflow to annular velocity ratio (E/e’) (SMD: -1.01; 95% CI: -1.49, -0.54; P < 0.012). Ivabradine therapy increased peak VO2 and 6-min walk test (6MWT) in HFrEF patients (SMD: 0.83; 95% CI: 0.35, 1.32; P < 0.00; I2 = 97.5% and SMD: 1.11; 95% CI: 0.82, 1.41; P < 0.000, respectively). There was also significant reduction in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (SMD: -0.68; 95% CI: -0.91, -0.45; P < 0.000). However, there was no significant difference in readmission for worsening HF and all-cause mortality between ivabradine and control (risk ratio (RR): 1.44; 95% CI: 0.73, 2.16; P < 0.148 and RR: 0.76; 95% CI: 0.19, 1.33; P < 0.907, respectively).ConclusionsIvabradine therapy is associated with improved LV diastolic function, increases exercise tolerance and hence QOL, but it has no significant effect on readmission for worsening HF and all-cause mortality.

Impact of pulmonary rehabilitation programs in improving health status in COPD patients

Pulmonary rehabilitation programme (PRP) have a positive impact on multiple outcomes of COPD, such as decreasing symptoms, increasing exercise tolerance and improving general health status. The aim of this study is to evaluate exercise tolerance impairment and to assess the impact of PRP in improving health status in patients diagnosed with COPD. It was conducted a prospective parallel group study in the Pulmonary Rehabilitation Department of the Clinical Hospital "V. Babes”, Timisoara, from 2007 to 2010. The subjects included in the study were patients diagnosed with COPD stages I-IV GOLD, initially evaluated and started a PRP, then re-evaluated after 3 weeks and 6 months. The study group included 168 patients, 158 men, mean age 61.73 years. The initial evaluation revealed higher values of dyspnea scores using mMRC scale in advanced COPD stages (3.69±0.77 in patients with COPD stage IV, vs 0.88±0.5 in patients with COPD stage, p&lt;0.05), decreased Forced expiratory volume in 1 second (FEV1), PImax and PEmax, and 6 minutes walking distance values corresponding with COPD severity stages. Re-evaluation at 3 weeks and 6 months after the pulmonary rehabilitation programme was applied showed significant improved dyspnea scores and exercise tolerance. The results of this study reconfirmed the positive and persistent impact of pulmonary rehabilitation programme on muscle dysfunction, dyspnea, and quality of life in COPD patients, regardless of severity. Key words: COPD, pulmonary rehabilitation programme, 6 minutes walking test, pedometry,

Clinical experience of using double bronchodilation therapy in patients with COPD

Chronic obstructive pulmonary disease is today one of the socially significant diseases, and its treatment remains a major medical problem.Currently, the main goals of treating patients with COPD are: eliminating symptoms and improving the quality of life, preventing exacerbations and reducing future risks, slowing the progression of the disease and reducing mortality.The article presents a clinical case from the practice of a patient with COPD who received tiotropium bromidi as monotherapy. The patient had significant impaired airway patency during spirometry, a decrease in exercise tolerance. The patient was assigned a new representative of combination preparations with a 24-hour action – Anoro Ellipta® (Vilanterol + Umeklidiniy) 22/55 mcg, with a new drug delivery vehicle. After 6 months of therapy with Anoro Ellipt®, the patient has increased exercise tolerance, improved pulmonary function, as well as quality of life.

Cardiovascular magnetic resonance assessment of biventricular changes during vacuum bell correction of pectus excavatum.

Evidence of cardiac dysfunction in patients with pectus excavatum (PE) remains controversial. A growing number of studies report increased exercise tolerance following surgery. Nevertheless, many consider the correction of PE a cosmetic intervention, with post-operative changes ascribed to the concurrent growth of the young patient population. No studies have investigated non-invasively the immediate cardiac changes following relief of the deformity. The aim of this study was to assess cardiac function before and during temporary sternal elevation using the non-invasive vacuum bell (VB) device on young adults with PE. Adult patients scheduled for surgical correction of PE underwent cardiac magnetic resonance imaging (CMRI) before and during the application of the VB. Steady-state free precession sequences were used for the evaluation of biventricular volume and function. Phase contrast sequences measured the aortic and pulmonary flow to calculate stroke index (SI). Scans were analyzed post hoc by the same investigator. A control group of healthy individuals was assessed in the same way. In total, 20 patients with PE (mean age 23±10 years) and 10 healthy individuals (mean age 25±6 years) underwent CMR before and during VB application. Before intervention, baseline cardiac volumes and function were similar between the groups, with patient-values in the low-to-normal range. Following VB application, PE patients revealed a 10% increase in biventricular SI. Furthermore, left ventricular end-diastolic volume index (LV EDVI) improved by 8% and right ventricular ejection fraction (RV EF) increased by 7%. These findings were not mirrored in the healthy individuals. No correlations were found between improved cardiac parameters and the baseline Haller index (HI) of PE patients. Non-invasive, momentary correction of PE is associated with an immediate improvement in SI, RV EF and LV EDVI, not observed in controls. The findings suggest that sternal depression in PE patients affects cardiac function.

Clinical case of retrograde endovascular recanalization of chronic coronary occlusion

Coronary chronic occlusion (CCO) occurs in ~20% of cases when coronary angiography is performed in patients with coronary artery disease. According to large observational studies and registries, it is known that most patients with CCO receive only drug therapy. Only 20-22% of patients with CCO undergo surgical myocardial revascularization. Such a low percentage can be explained by a low success rate and a large number of complications during recanalization of CCO at the development stage of endovascular surgery. The accumulation of experience and the improvement of technical equipment has significantly increased the success rate of endovascular revascularization of CCO and reduced the number of complications. More and more scientific evidence has appeared in favor of the recanalization of CCO. It is known that the myocardium in the area of the occluded artery is in ischemia. The presence of a developed system of collateral circulation allows us to ensure sufficient blood flow in the myocardium only at rest, but with a load of collateral blood supply is not enough. Recanalization of CCO can eliminate myocardial ischemia, improve systolic function of the left ventricular myocardium, increase exercise tolerance and improve the quality of life of patients.

Long-term effects of pulmonary rehabilitation on daily life physical activity of patients with stage IV sarcoidosis: A randomized controlled trial

IntroductionPulmonary rehabilitation (PR) is known to improve exercise tolerance, mood, and quality of life in patients with chronic respiratory diseases. The aim of this work was to determine whether PR provides long-term benefits in increasing daily life physical activity in patients with chronic sarcoidosis. MethodsThis randomized prospective study (registered ClinicalTrials.gov NCT02044939) of 38 patients with stage IV chronic sarcoidosis was performed between 2012 and 2016. Patients were assigned to participate in a 2-month PR program (n=20) or receive counseling (n=18). Assessments were performed at baseline, 2 months (end of the PR program), 6months, and 12months, and included daily life physical activity parameters (measured for 5 consecutive days), exercise tolerance, dyspnea, anxiety, depression, fatigue, and quality of life. The primary outcome was the 12-month change in time spent in activities above an estimated energy expenditure of 2.5metabolic equivalents (METs). Secondary daily life physical activity outcomes included number of steps per day, total daily energy expenditure, and total energy expenditure above 2.5METs. ResultsThe primary outcome did not differ between the two groups; mean between-group differences were −13.2min (95% confidence interval [CI]: −76.3 to 49.8) at 6 months and −18.1min (95% CI: −55.7 to 19.4) at 12months. Although PR had no effect on secondary daily life physical activity outcomes, it did significantly increase exercise tolerance at 6 and 12 months and decrease the dyspnea score at 6 months and the fatigue score at 12months. ConclusionThis trial failed to demonstrate a beneficial effect of PR on daily life physical activity in sarcoidosis patients, suggesting that long-term behavioral programs may be necessary to complement PR.

Therapy of patients with the high risk of arterial hypertension with the use of telmisartan

Aim. The study assesses the effects of therapy based on the use of telmisartan in patients with arterial hypertension and stable angina on the clinical and functional indicators of the cardiovascularvascular system. Material and methods. 52 patients with a combination of arterial hypertension (AH) I and II stages and coronary artery disease II with the mean age 63.5 ± 5.4 years (79% males and 21% of females) were enrolled in the trial. The duration of AH and CAD were 17.5±3.8 and 12.5±3.1 accordingly. All patients took a daily 80 mg dose of telmisartan. The efficacy of treatment was estimated in 3,6 and 12 months. Results. The use of telmisartan in complex treatment of high-risk patients with AH has led to decreasing blood pressure to the target level, increasing exercise tolerance (walking the distance from 315.5 m to 410.2 m in 6 minutes). 12 months of therapy based on telmisartan showed significant decrease in left hy‑ pertrophy ventricle (LV myocardial mass index on average by 10.4%), a decrease in the total duration of depression ST segment from 9.6±2.9 to 2.7±1.5 mm and a decrease in the depth of depression from 1.5±0.3 mm to 0.3±0.09 mm, with a trend towards decrease in the number of episodes of ST-segment depression, as well as the absence of a significant change in heart rate. After 12 months of en‑ dothelium-dependent vasodilation therapy, the condition of 31 (60%) patients improved, and 18 (35%) patients showed the tendency to improvement. The tests with reactive hyperemia conducted after 12 months of treatment revealed decreased linear velocity of blood flow in the brachial artery on average by 17%. Conclusion. The use of telmisartan in complex therapy improves the quality of life according to the EQ-VAS questionnaire by 25 points after 12 months of therapy, contributes to lowering blood pressure in 96% of patients, reduc‑ ing myocardial hypertrophy, endothelial dysfunction and severity of ischemic manifestations (reducing the need for nitroglycerin intake to an average of 0,5 inhalations, as well as a decrease in the ST segment depression of 40% after 12 months of therapy).

PULMONARY HYPERTENSION AS A COMPLICATION OF CARFILZOMIB THERAPY

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Carfilzomib is a second generation proteasome inhibitor approved for use in relapsed or refractory multiple myeloma. Pooled safety data from Phase 2 and Phase 3 clinical trials showed 3.8-6.4% incidence of cardiac failure (monotherapy and combination therapy respectively). Review of the ASPIRE trial reveals that 3.8% had cardiac toxicity vs 1.8% in the control group, but there was no increase in cardiovascular death. A recent systematic review and meta-analysis showed overall 8.6% rate of cardiotoxicity in patients treated with carfilzomib which is significantly greater than other proteasome inhibitors. CASE PRESENTATION: The patient is a 53-year-old male with past medical history of hypertension, gastroesophageal reflux disease, and refractory multiple myeloma which was first diagnosed in May 2017. He presented to clinic for routine visit and was noted to have hypercalcemia and acute kidney injury; he was sent for hospital admission. During the admission interview he reported that he had been feeling rather poorly since initiation of his current chemotherapy regimen with progressive chest tightness and severe dyspnea on exertion along with orthopnea, paroxysmal nocturnal dyspnea and peripheral edema. His pre-treatment echocardiogram had been normal. After admission, he had an echocardiogram which showed normal LVEF, dilated RV with severely reduced systolic function, PASP >55mmHg. A VQ scan was negative. A right heart catheterization showed PA pressure 61/34, wedge 23, pulmonary vascular resistance 480dyn-sec/cm5. DISCUSSION: This patient presented with right heart failure and pulmonary hypertension shortly after starting chemotherapy including carfilzomib. Though cardiac toxicity of carfilzomib is well described, early reports primarily consisted of left heart failure. Basic science literature dating back to 2006 showed that proteasome inhibition could modulate eNOS function; more recent literature suggests that carfilzomib specifically increased resting vasogenic tone in arterial samples. His response to standard treatment for Group I pulmonary hypertension also supports the mechanism being related to endothelial dysfunction. There is no way to prove that carfilzomib was the culprit agent; however, the timeline is highly suggestive and increasing literature confirms significant cardiotoxicity of carfilzomib. CONCLUSIONS: Based on the data above, the patient’s cardiac illness was consistent with mixed presentation of chronic heart failure with preserved ejection fraction with superimposed acute pulmonary hypertension. In addition to diuresis, he was started on tadalafil which was well tolerated. These therapies increased exercise tolerance, resolved volume overload and reduced NT pro BNP levels. Reference #1: Shah, C, et al. (2018). Cardiotoxicity associated with carflizomib: Systematic review and meta analysis . Leukemia and Lymphoma, 10. Reference #2: Wei, Q., & Xia, Y. (2006). Proteasome inhibition down-regulates endothelial nitric-oxide synthase phosphorylation and function. Journal of Biological Chemistry , 281(31), 21652–21659. Reference #3: Perel G, Bliss J, Thomas CM. 2016. Carfilzomib (Kyprolis): A Novel Proteasome Inhibitor for Relapsed And/or Refractory Multiple Myeloma.Pharmacy and Therapeutics 41:303–307. DISCLOSURES: no disclosure on file for MaryEllen Antkowiak; No relevant relationships by Julia Powelson, source=Web Response No relevant relationships by Hibba tul Rehman, source=Web Response

QUALITY OF LIFE IMPROVEMENT IN MIDDLE-AGED PEOPLE WITH TYPE 2 DIABETES BY MEANS OF PHYSICAL THERAPY

Introduction. Diabetes is one of the most common chronic diseases in the world. Recently, this disease has been considered as a social problem, which is getting more and more urgent. The increase in the incidence and mortality of type 2 diabetes observed in recent decades requires active influence on risk factors, development of preventive measures, optimization of treatment regimens, active use of physical therapy. Purpose: To investigate the possibility of quality of life improvement in middle-aged people with type 2 diabetes by means of adjustment of physical activity, namely by implementing a specially designed physical therapy program. Materials and methods: survey (WHOQOL-BREF questionnaire), somatometry (height, weight, circumference), pulsometry, tonometry, dynamometry (handgrip), functional tests (static strength endurance, aerobic endurance), perceived exertion (Borg scale). An adequate physiotherapy program for middle-aged people with type 2 diabetes that is suitable for treatment and rehabilitation process was proposed. The program was implemented in the University Clinic of Sumy State University. Discussion: The theoretical part of the paper emphasizes that the use of comprehensive approach only can help normalize carbohydrate metabolism, increase exercise tolerance, reduce body weight, and improve quality of life. During implementation of the experimental part of the study, we contributed to motivation to increase motor activity, implemented a program of physical therapy for middle-aged people with type 2 diabetes and class I-II obesity, which consisted of strength and aerobic exercises of moderate intensity and relaxation exercises. The empirical part of the work proves the program to be the effective. The analysis of the results indicates positive changes in the functional systems of the organism, namely, decrease in waist circumference, hip circumference, neck circumference, significant change in shoulder arc length, increase in ankle circumference, body mass index, waist circumference to hip circumference ratio, significant increase in static strength endurance of abdominal muscles. These changes have a positive effect on a person's quality of life, self-esteem for physical and especially mental health.

Clinical and Functional Dynamics of Physical Working Capacity and Psychological Adaptation in Patients with Acute Coronary Syndrome at the Stages of Rehabilitation

The objective of the research was to analyze the effectiveness of using suggestive therapy in the patients with acute coronary syndrome by assessing the dynamics of the clinical condition and indicators of anxiety.&#x0D; Materials and Methods. There were examined 135 patients with non-ST-segment elevation myocardial infarction, 60 patients with the use of the conservative treatment and 75 patients who underwent percutaneous coronary intervention. The dynamics of objective indices, adaptation changes and anxiety indices in the groups of patients with traditional treatment and in the groups of patients with suggestive therapy in addition to the traditional rehabilitation measures, were analyzed.&#x0D; Results. Analyzing the dynamics of adaptive indices, it was determined that in the group of patients with non-ST-segment elevation myocardial infarction, who were performed conservative therapy, the dynamics was less significant, which is related to the general desadaptative syndrome. Changes in the group of patients undergoing percutaneous coronary intervention and suggestive therapy, with a decrease of blood pressure, heart rate, and a decrease in the index of functional changes from 3.78±0.15 points before the intervention up to 2.92±0.13 points after suggestive therapy (p&lt;0.01) were more significant. In all groups of patients, high levels of reactive anxiety were observed at the beginning of treatment. As a result of treatment, a decrease in anxiety was noted, but more pronounced changes were seen in the group with the use of suggestive therapy (p&lt;0.05).&#x0D; Conclusions. The use of suggestive therapy methods when treating the patients with acute coronary syndrome is an important intervention, that provides a comprehensive approach considering all the components, enhances the patients’ adaptive abilities in the rehabilitation phase, improves the quality and effectiveness of restorative treatment. The use of suggestive therapy at the rehabilitation stage improves the clinical course, reduces anginal manifestations, stabilizes blood pressure and increases exercise tolerance.

Antifatigue Activity and Exercise Performance of Phenolic-Rich Extracts from Calendula officinalis, Ribes nigrum, and Vaccinium myrtillus.

Calendula officinalis, Ribes nigrum, and Vaccinium myrtillus (CRV) possess a high phenolic compound content with excellent antioxidant activity. Dietary antioxidants can reduce exercise-induced oxidative stress. Consumption of large amounts of phenolic compounds is positively correlated with reduction in exercise-induced muscle damage. Research for natural products to improve exercise capacity, relieve fatigue, and accelerate fatigue alleviation is ongoing. Here, CRV containing a large total phenolic content (13.4 mg/g of CRV) demonstrated antioxidant activity. Ultra-performance liquid chromatography quantification revealed 1.95 ± 0.02 mg of salidroside in 1 g of CRV. In the current study, CRV were administered to mice for five weeks, and the antifatigue effect of CRV was evaluated using the forelimb grip strength test; weight-loaded swimming test; and measurement of fatigue-related biochemical indicators, such as blood lactate, ammonia, glucose, blood urea nitrogen (BUN), and creatine kinase (CK) activity; and muscle and liver glycogen content. The results indicated that in CRV-treated mice, the forelimb grip strength significantly increased; weight-loaded swimming time prolonged; their lactate, ammonia, BUN, and CK activity decreased, and muscle and liver glucose and glycogen content increased compared with the vehicle group. Thus, CRV have antifatigue activity and can increase exercise tolerance.

An Experience of Meldonium Use in Patients with Ventricular Arrhythmias of Ischemic Genesis

Under dynamic observation were 147 patients with IHD and VA (Lown II-IV functional class). The diagnosis of angina pectoris was confirmed by clinical, exercise bicycle ergometry, Holter ECG monitoring, and echocardiography data. Holter ECG monitoring was used for recording VA, heart rate, episodes of ST-segment depression. The levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDLC), high-density lipoprotein cholesterol were determined. All patients were randomly divided into 2 groups. The first group (81 patients) received standard antianginal and antiarrhythmic therapy plus meldonium for 2 months. The second (control) group (66 patients) received standard antianginal and antiarrhythmic therapy only. Statistical analysis of the data was carried out using the statistical package SPSS 13.0. A comparative analysis of the results showed that the use of meldonium in combination with basic therapy significantly improved clinical condition and quality of life indicators, increased exercise tolerance and improved systolic and diastolic dysfunction in patients with IHD and VA. The positive effect of meldonium on LDLC levels was observed. Moreover, the combination of basic antianginal and antiarrhythmic therapy and meldonium in patients with ischemic genesis VA promoted significant reduction of ischemic episodes and decrease of VA, in particular allorhythmia. Results of this study suggest that the use of meldonium in patients with IHD and VA helps to optimize myocardial energy metabolism in conditions of ischemia and reperfusion.

Physical and Edema Therapy Management of Amyloidosis in the Acute Care Setting: A Case Report

Background and Purpose: Currently, there are no formal guidelines describing rehabilitation interventions for those with amyloidosis. This case report explores the application of physical and edema therapy interventions, including external compression, for a patient with a diagnosis of light-chain (AL) amyloidosis and functionally limiting orthostatic hypotension in the acute care setting. Case Description: A 52-year-old man with a diagnosis of immunoglobulin AL amyloidosis presented to the acute care setting with progressed orthostatic hypotension, bilateral lower extremity edema, and episodes of syncope. The patient spent 17 days in the inpatient setting and received physical therapy (PT) and edema therapy through the inpatient lymphedema service. Rehabilitation focused on exercise, compression, and behavioral and educational interventions over the course of 9 PT sessions and 7 edema therapy sessions. Outcomes: Before interventions, the patient was unable to safely ambulate at home due to syncope. He progressed to being able to ambulate 1560 ft with seated rests. The patient demonstrated decreased limb circumferential measurements, improved performance on the 6-Minute Walk Test, improved ability to self-manage orthostatic hypotension and edema, and increased participation in activities of daily living. Discussion: The combination of physical and edema therapy services may have compensated for orthostatic hypotension and improved standing tolerance. The patient's blood urea nitrogen and brain natriuretic peptide levels may have improved because of the application of external compression. Overall, the patient experienced decreased limb size, increased exercise tolerance, decreased syncopal episodes, and improved quality of life without changes in pharmacologic management or adverse events.

O treino de exercício em pessoas com doença respiratória crónica estabilizada : uma Scoping Review

Introdução: A Reabilitação Respiratória (RR) integra a componente não farmacológica das principais guidelines clínicas para o controlo e tratamento das doenças respiratórias crónicas. O Enfermeiro de Reabilitação (ER), integrado numa equipa multidisciplinar, concebe, implementa e monitoriza programas de RR onde se inclui o treino do exercício. Sendo o conhecimento disciplinar de enfermagem um dos pilares da decisão clínica e a garantia da qualidade e segurança dos cuidados de enfermagem torna-se relevante conhecer o impacte destes programas, conduzidos por ER, de forma a melhorar a prática clinica. Objetivo: Conhecer o impacte dos programas de RR, conduzidos por enfermeiros, nas pessoas com doença respiratória crónica. Metodologia: Scoping review com metodologia do Joanna Briggs Institute® com recurso a dois revisores independentes. Resultados: incluímos 10 estudos que revelaram que programas de RR conduzidos por enfermeiros de reabilitação aumentam a tolerância ao exercício, a qualidade de vida, a independência funcional e reduzem a dispneia e a ansiedade. Conclusão: A RR realizada por ER em pessoas com doença respiratória crónica é sobreponível à mais recente evidência. Palavras-chave: Treino de exercício, Enfermagem de Reabilitação, Reabilitação Respiratória, Doença respiratória crónica

Comparison of effectiveness of therapy with lisinopril and fosinopril in patients with diastolic chronic heart failure in the presence of hypertension disease

Aim. Сompare the effectiveness of combination therapy with lisinopril and fosinopril in patients with diastolic chronic heart failure (CHF) in the presence of hypertension disease (HD), considering its impact on the regulatory adaptive status (RAS). Materials and methods. The study take parted 69 patients with CHF II functional class according to the classification of the New York Heart Association in the presence of HD III stage with preserved systolic function of the left ventricle (left ventricular ejection fraction ≥50%), who were randomized into two groups for treatment with lisinopril (13.7±3.7 mg/day, n=34) or fosinopril (14.5±4.1 mg/day, n=35). As part of combination pharmacotherapy, patients were included nebivolol (7.2±2.4 mg/day and 7.0±2.2 mg/day), and acetylsalicylic acid when required (100 mg/day, n=8 and 100 mg/day, n=7), atorvastatin (15.7±4.9 mg/day, n=14 and 16.9±4.6 mg/day, n=16) respectively. Initially and after six months, the following was done: a quantitative evaluation of the RAS (by cardio-respiratory synchronism test), echocardiography, holter monitoring of blood electrocardiograms, all-day monitoring of pressure, treadmill test, determination of the N-terminal precursor of the natriuretic brain peptide level in blood plasma, six-minute walking test, subjective evaluation of quality of life. Results. Both combined pharmacotherapy schemes comparably improved structural and functional state of the heart, neurohumoral activation and optimized blood pressure. However, in this case, the use of fosinopril, in comparison with lisinopril, positively affected on RAS, increased exercise tolerance and improved quality of life more. Conclusion. In patients with diastolic CHF in the presence of HD III stage as part of the combination therapy, the use of fosinopril, in comparison with lisinopril, may be preferable because of a more pronounced positive effect on RAS.

Effect of trimetazidine on cardiac function and exercise tolerance in hypertension patients with diabetic

To determine the effect of trimetazidine on cardiac function and exercise tolerance in primary hypertension patients with type 2 diabetic. In this randomized, double-blind, placebo-controlled prospective study, 60 primary hypertensive patients with diabetic were equally assigned into two groups, patients received trimetazidine (20 mg, 3 times a day) or placebo for 1 year. Echocardiography, cardiopulmonary exercise testing were performed; and the plasma N terminal pro B type natriuretic peptide (NT-ProBNP), hr-CRP, TNF-α, angiotensin Ⅱ and endothelin concentration were determined before and after treatment. In trimetazidine group, the left ventricular mass index, the mitral flow velocity E wave to A wave ratio (E/A), the peak early diastolic velocity (VE) to late diastolic velocity (VA) ratio (VE/VA) and the peak systolic velocity (Vs) were significantly improved, the plasma NT-ProBNP level was significantly decreased, and the exercise time, metabolic equivalent, maximal oxygen uptake and anaerobic threshold were significantly increased (all P<0.05); plasma concentration of hr-CRP, TNF-α, angiotensin Ⅱ and endothelin were significantly reduced after trimetazidine treatment, compared with baseline (all P<0.05) and with placebo (all P<0.05). There were no significant differences in any of above parameters after treatment in placebo group (all P>0.05). No severe adverse reaction was observed in both groups. For patients with both hypertension and diabetes, trimetazidine can improve cardiac function and increase exercise tolerance.