Increased Exercise Tolerance Research Articles

DETERMINATION OF THE IMPACT OF BISOPROLOL AND СARVEDILOL ON REGULATORY-ADAPTIVE STATUS OF PATIENTS WITH CHRONIC HEART FAILURE AND PRESERVED LEFT VENTRICULAR FRACTION

Objective. To determine the effect of bisoprolol or carvedilol therapy on the regulatory-adaptive status (RAS) of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV) the background of hypertensive disease (HD).Material and methods. The study involved 68 patients with CHF and pEF of the LV, who were randomized into two groups for treatment with bisoprolol (7,3±2,4 mg/day, n=34) and carvedilol (28,4±12,3 mg/day, n=34). As part of the combination therapy, quinapril was prescribed (13,5±2,5 mg/ day, n=34 and 12,6±2,9 mg/day, n=34), and if indicated – atorvastatin (16,3±5,0 mg/day, n=11 and 15,5±5,2 mg/day, n=11) and acetylsalicylic acid in the intestinal soluble shell (93,8±17,7 mg/day, n=8 and 94,4±15,8 mg/day, n=8), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of RAS (by means of a sample of cardiac-respiratory synchronism), treadmill test, six-minute walking test, subjective assessment of quality of life, determination of the level of N-terminal fragment of brain natriuretic peptide, echocardioscopy, daily monitoring of blood pressure.Results. Both regimens of combined drug therapy had comparable cardioprotective, hypotensive and neuromodulating effects, equally increased exercise tolerance. In comparison with bisoprolol, carvedilol differed positive impact on RAS, improved quality of life more.Conclusion. In patients with CHF and pEF LV in combination therapy, the use of carvedilol, in comparison with bisoprolol, may be preferable due to the positive effect on the RAS.

Assessment of the effect of -blockers on the functional state in patients with ventricular arrhythmias: results of a comparative study

Aim.Compare the effects of bisoprolol, nebivolol and sotalol on the functional state of patients with ventricular arrhythmias (VA).
 Material and methods.120 patients with VA against the background of essential hypertension or its combination with coronary heart disease took part in the research, they were randomized into three groups for treatment with bisoprolol, nebivolol and sotalol. As part of combination therapy, patients were administered lisinopril, and if indicated, acetylsalicylic acid, atorvastatin. Initially and after 24 weeks of therapy the following was done: echocardiography, treadmill test, six-minute walk test, subjective assessment of quality of life, all-day monitoring of blood pressure and electrocardiogram.
 Results.With comparable hypotensive and antiarrhythmic effects, therapy with nebivolol increased exercise tolerance to a greater extent, in comparison with bisoprolol and sotalol. Nebivolol and sotalol improved the quality of life, in comparison with bisoprolol.
 Conclusion.In patients with VA against the background of essential hypertension or its combination with coronary heart disease as part of combination therapy the use of nebivolol may be preferable to bisoprolol or sotalol due to a more pronounced positive effect on the functional state.

Non-invasive ventilation with pursed lips breathing mode for patients with COPD and hypercapnic respiratory failure: A retrospective analysis.

Long-term non-invasive ventilation (NIV) is recommended for patients with stable chronic obstructive lung disease (COPD) and chronic hypercapnia. High inspiratory pressure NIV (hiNIV) and a significant reduction of arterial pCO2 have been shown to prolong survival. Often, patients on hiNIV describe severe respiratory distress, known as "deventilation syndrome", after removal of the NIV mask in the morning. Mechanical pursed lips breathing ventilation (PLBV) is a new non-invasive ventilation mode that mimics the pressure-curve of pursed lips breathing during expiration. The clinical impact of switching patients from standard NIV to PLBV has not been studied so far. In this hypothesis generating study, we retrospectively analysed the effects of switching COPD patients (stage GOLD III-IV) from conventional NIV to PLBV. Medical records of all patients who had an established NIV and were switched to PLBV between March 2016 and October 2017 were screened. Patients were included if they complained of shortness of breath on mask removal, used their conventional NIV regularly, and had a documented complete diagnostic workup including lung function testing, blood gas analysis and 6-minute walk test (6MWT) before and after 3-7 days of PLBV. Six male and 10 female patients (median age 65.4 years; IQR 64.0-71.3) with a previous NIV treatment duration of 38 months (median; IQR 20-42) were analysed. After PLVB initiation, the median inspiratory ventilation pressure needed to maintain the capillary pre-switch pCO2 level was reduced from 19.5 mbar (IQR 16.0-26.0) to 13.8 mbar (IQR 12.5-14.9; p<0.001). The median 6MWT distance increased from 200m (IQR 153.8-266.3) to 270m (IQR 211.3-323.8; p<0.001). Median forced vital capacity (FVC) increased from 49.5% to 53.0% of the predicted value (p = 0.04), while changes in FEV1 and residual volume (RV) were non-significant. Based on this small retrospective analysis, we hypothesise that switching patients with COPD GOLD III-IV and chronic hypercapnia from conventional NIV to PLBV may increase exercise tolerance and FVC in the short term.

Possibilities of using Nordic walking training in cardiac rehabilitation

Cardiac rehabilitation means that cardiac rehabilitation should be considered as multidirectional and comprehensive activities, considering human health in a holistic approach. Cardiac rehabilitation should be implemented as soon as possible, immediately after the end of life-threatening conditions in the course of coronary events or the direct effects of invasive treatment.&#x0D; Many scientific studies indicate the effectiveness of Nordic Walking training in cardiac rehabilitation. It has the benefits of increasing exercise tolerance and oxygen uptake, and improves quality of life. Patients willingly choose this type of activity and tolerate it well, moreover, it is a generally available form of activity that can be practiced anytime and anywhere. This training can be recommended to a wide group of patients both as prevention and as a form of rehabilitation.

OPTIONS FOR USING CELLULAR CARDIOMYOPLASTY FOR CORONARY HEART DISEASE

Despite a significant arsenal of medications and methods of surgical correction of myocardial blood supply, treatment of some forms of coronary heart disease remains relevant. The purpose of the work is to analyze the effectiveness of the use of stromal stem cells (SSC) of bone marrow in autologous transendocardial transplantation in some forms of IHD. Material and methods. In the near and long-term results, we analyzed the histories and diseases and conducted a survey of 68 patients. Of the 68 patients, the largest group was men - 53 (77.9%), women were much fewer - 15 (22.1%). Then we formed 4 groups (17 patients each): 1 group - control - patients received standard drug therapy; Group 2 - to patients who received standard therapy, empty myocardial injections were performed using a catheter and the NOGA XP navigation system; Group 3 - auto-CCK was administered intravenously to patients; 4 group - against the background of therapy, transendocardial auto-SSK was administered. Results and its discussion. When analyzing the patient's subjective sensations in group I, after 3 months in group 1, 4 patients (32%) noted improvement, unchanged - 11 (64.7%), worsening - 2 (11.8%) and significant worsening 1 ( 5.9%). In group II, improvement was in 1 patient, which was 5.9%, unchanged - 13 (76.5%), worsening - 2 (11.8%) and significant deterioration - 2 (11.8%). In group III, improvement was observed in 5 patients - 29.4%, significant improvement in 1 (5.9%), deterioration and significant deterioration in 1 patient (5.9% each, respectively). In group IV unchanged - 6 (35.3%) patients, improvement - 7 (41.2%), significant improvement - 4 (32%), worsening - 1 (5.9%). Cell transplantation, regardless of the method of administration, increases the EF and reduces the EDV of the left ventricle, more significantly in the group with a transendocardial route of administration. Conclusion. In accordance with published data, we obtained similar data - transplantation of human bone marrow SSC with autologous administration causes a positive effect in the form of increased EF LV, decreased EDV of the LV, increased exercise tolerance and a significant improvement in patients' well-being. It should be noted that intravenous and intracoronary administration of auto-SSC is much less effective in the studied parameters than transendocardial introduction of cells into the myocardium.

Enhanced dimethylarginine degradation improves coronary flow reserve and exercise tolerance in Duchenne muscular dystrophy carrier mice.

Duchenne muscular dystrophy (DMD) is an X-linked disease caused by null mutations in dystrophin and characterized by muscle degeneration. Cardiomyopathy is common and often prevalent at similar frequency in female DMD carriers irrespective of whether they manifest skeletal muscle disease. Impaired muscle nitric oxide (NO) production in DMD disrupts muscle blood flow regulation and exaggerates postexercise fatigue. We show that circulating levels of endogenous methylated arginines including asymmetric dimethylarginine (ADMA), which act as NO synthase inhibitors, are elevated by acute necrotic muscle damage and in chronically necrotic dystrophin-deficient mice. We therefore hypothesized that excessive ADMA impairs muscle NO production and diminishes exercise tolerance in DMD. We used transgenic expression of dimethylarginine dimethylaminohydrolase 1 (DDAH), which degrades methylated arginines, to investigate their contribution to exercise-induced fatigue in DMD. Although infusion of exogenous ADMA was sufficient to impair exercise performance in wild-type mice, transgenic DDAH expression did not rescue exercise-induced fatigue in dystrophin-deficient male mdx mice. Surprisingly, DDAH transgene expression did attenuate exercise-induced fatigue in dystrophin-heterozygous female mdx carrier mice. Improved exercise tolerance was associated with reduced heart weight and improved cardiac β-adrenergic responsiveness in DDAH-transgenic mdx carriers. We conclude that DDAH overexpression increases exercise tolerance in female DMD carriers, possibly by limiting cardiac pathology and preserving the heart's responses to changes in physiological demand. Methylated arginine metabolism may be a new target to improve exercise tolerance and cardiac function in DMD carriers or act as an adjuvant to promote NO signaling alongside therapies that partially restore dystrophin expression in patients with DMD.NEW & NOTEWORTHY Duchenne muscular dystrophy (DMD) carriers are at risk for cardiomyopathy. The nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) is released from damaged muscle in DMD and impairs exercise performance. Transgenic expression of dimethylarginine dimethylaminohydrolase to degrade ADMA prevents cardiac hypertrophy, improves cardiac function, and improves exercise tolerance in DMD carrier mice. These findings highlight the relevance of ADMA to muscular dystrophy and have important implications for therapies targeting nitric oxide in patients with DMD and DMD carriers.

Effect of the expiratory positive airway pressure on dynamic hyperinflation and exercise capacity in patients with COPD: a meta-analysis

Expiratory positive airway pressure (EPAP) is widely applicable, either as a strategy for pulmonary reexpansion, elimination of pulmonary secretion or to reduce hyperinflation. However, there is no consensus in the literature about the real benefits of EPAP in reducing dynamic hyperinflation (DH) and increasing exercise tolerance in subjects with chronic obstructive pulmonary disease (COPD). To systematically review the effects of EPAP application during the submaximal stress test on DH and exercise capacity in patients with COPD. This meta-analysis was performed from a systematic search in the PubMed, EMBASE, PeDRO, and Cochrane databases, as well as a manual search. Studies that evaluated the effect of positive expiratory pressure on DH, exercise capacity, sensation of dyspnea, respiratory rate, peripheral oxygen saturation, sense of effort in lower limbs, and heart rate were included. GRADE was used to determine the quality of evidence for each outcome. Of the 2,227 localized studies, seven studies were included. The results show that EPAP did not change DH and reduced exercise tolerance in the constant load test. EPAP caused a reduction in respiratory rate after exercise (− 2.33 bpm; 95% CI: − 4.56 to − 0.10) (very low evidence) when using a pressure level of 5 cmH2O. The other outcomes analyzed were not significantly altered by the use of EPAP. Our study demonstrates that the use of EPAP does not prevent the onset of DH and may reduce lower limb exercise capacity in patients with COPD. However, larger and higher-quality studies are needed to clarify the potential benefit of EPAP in this population.

The Role of Ranolazine for the Treatment of Residual Angina beyond the Percutaneous Coronary Revascularization.

Introduction. Despite a successful percutaneous coronary intervention (PCI), several studies reported that the recurrence of angina after revascularization, even complete, is a particularly frequent occurrence in the first year after PCI. Methods. The aim was to evaluate the efficacy of treatment with ranolazine in addition to conventional anti-ischemic therapy in patients who underwent coronary angiography for persistent/recurrent angina after PCI and residual ischemia only due to small branches not suitable for further revascularization. Forty-nine consecutive patients were included in our registry, adding the ranolazine (375 mg b.i.d) to optimal medical therapy (OMT). The Exercise ECG Test (EET) was performed in all patients before to start the therapy (baseline BL) and at 30 days (T1) after enrollment. Results. The average duration of the exercise was increased after the therapy with ranolazine comparing to baseline (RG 9’1” ± 2’ versus BL 8’10” ± 2’, p = 0.01). Seven (14.3%) patients after receiving ranolazine had not crossed the threshold of six minutes (75 watts) compared to 20 (40.8%) of BL (p = 0.0003). Stress angina appeared more frequently at BL than at 30 days (T1 4.1% versus BL 16.3%, p = 0.04) as well as exercise-induced arrhythmias (BL 30.6% versus T1 14.3%, p = 0.05). Conclusions. The addition of ranolazine to standard anti-ischemic therapy showed a significant improvement in EET results after one month of therapy, including reduced exercise angina, increased exercise tolerance, and reduced exercise arrhythmias.

Astaxanthin Formulation Leads To Greater Lipid Oxidation &amp; Increased Exercise Tolerance In Elderly

PURPOSE: Natural anti-oxidant and anti-inflammatory products have been found to increase fat oxidation and endurance in animals and humans when combined with exercise training. Here, we test this approach as a treatment for the reduced lipid oxidation and associated lower endurance in human aging using a formulation combining natural anti-inflammatory and anti-oxidant products (AX: astaxanthin, 12 mg; tocotrienol, 10 mg; and zinc, 6 mg). METHODS: We conducted a randomized, double-blind, placebo-controlled study in the elderly of a daily oral dose (16 weeks) of AX formulation with 12 weeks of exercise training, 3x/week for 40-60 min of increasing intervals of incline walking, targeting 80% HRmax. Cardiovascular endurance and fat oxidation was calculated from respiratory exchange ratio via Balke treadmill test. Tibia anterior (TA) muscle strength and fatigue resistance was measured as force time integral (FTI) in ankle dorsiflexion exercise to fatigue. TA resistance to fatigue was also determined by number of contractions. RESULTS: After 12 weeks of training both groups improved treadmill time, only AX group delayed time reach to anaerobic threshold (218±15s vs. 311±32s). Total fat oxidation improved in both group, but AX improved (Δ 80.4±19.4%) more compare to training alone (Δ 39.2±10.2%). TA fatigue resistance measured by total contractions (Δ184±77) and FTI (Δ102±30 N) improved only in the AX group. CONCLUSION: AX supplementation combined with interval training improved whole body fat use significantly more than training alone. Delayed anaerobic threshold in AX group suggested higher exercise capacity. This increased fatigue resistance of the TA in addition to the greater exercise capacity suggests that this metabolic effect is occurring at the level of the individual muscle. The increased fat oxidation and delayed anaerobic threshold may due to sustained fat use at lower rates of exercise that leads to carbohydrate sparing and ultimately increased carbohydrate availability at more intense exercise levels. The combination of whole body exercise and single muscle fatigue testing removed the training effect (neuromuscular adaptation) that is commonly seen in exercise training. These results indicate that AX supplementation results in greater metabolic adaptation than endurance training alone.

Dietary Inorganic Nitrate Supplementation And Exercise Tolerance In Patients With Reduced Ejection Fraction Heart Failure

Exercise intolerance is the primary cause of morbidity and decreased quality of life in patients with chronic heart failure (HF). The strong prognostic value of exercise capacity in patients with HF warrants identification of interventions which maximize exercise capacity in this population. Although the etiology of HF is complex, reduced nitric oxide (NO) bioavailability is an underlying characteristic that has been shown to moderate physiological processes related to exercise including vascular function, tissue perfusion, mitochondrial function and contractile efficiency. Dietary inorganic nitrate supplementation has been shown to increase NO bioavailability and increase exercise tolerance in several clinical populations, including peripheral arterial disease, pulmonary disease, and HF with preserved ejection fraction. PURPOSE: To determine the effect of dietary inorganic nitrate supplementation on exercise capacity in patients with heart failure with reduced ejection fraction (HFrEF). METHODS: Sixteen patients with HFrEF (15 men, 63 ± 4 y, BMI: 31.8 ± 2.1 kg·m-2) participated in a randomized, double-blind, crossover design study. Participants consumed either a nitrate rich beetroot juice (16mmol nitrate/day), or a nitrate-depleted placebo for five days prior to the first testing visit, with continued dosing until completion of a cardiopulmonary exercise test (CPX). Between treatment differences were analysed via paired- t-test analysis. Statistical significance was set a-priori at p< 0.05. RESULTS: Both plasma nitrate and nitrite increased following nitrate supplementation (933%, p<0.001 and 94%, p< 0.05, respectively). No differences were observed for VO2peak (nitrate 18.5 ± 5.7ml·kg-1·min-1, placebo: 19.3 ± 1.4ml·kg-1·min-1; p=0.13) or time to exhaustion (nitrate: 1165 ± 92sec, placebo: 1207 ± 96sec, p=0.16) following supplementation. Similarly, there were no differences between the two treatments in blood pressures or deoxygenated or oxygenated haemoglobin at rest or at any stage of the exercise testing. CONCLUSION: Inorganic nitrate supplementation did not improve exercise tolerance, blood pressures or tissue perfusion in patients with HFrEF. Supported by Australian Heart Foundation Vanguard Award 101389 to Jason D. Allen

Dietary Nitrate Intake Improves Vascular Function And Walking Capacity In Patients With Peripheral Artery Disease

Peripheral artery disease (PAD) is the manifestation of atherosclerosis in the arteries of the legs, which reduces blood flow to the lower extremities and impairs walking capacity. Dietary nitrate has been used to reduce blood pressure (BP) and increase exercise tolerance in PAD. However, a standard dose, body mass normalized nitrate, for PAD has yet to be determined. PURPOSE: To elucidate the impacts of a body mass-normalized dose of nitrate (0.11 mmol nitrate/kg) in the form of beetroot juice on resting heart rate (RHR), central and peripheral BP, vascular function, and exercise tolerance in patients with PAD. METHODS: In a randomized crossover design, 10 patients with PAD (stage II-III) received either the nitrate supplement or placebo. At each visit, measures of RHR, central and peripheral BP, brachial and popliteal artery endothelial function (flow-mediated dilation, FMD), arterial stiffness (pulse-wave velocity, PWV), augmentation index (AIx)), maximal walking capacity, and time to claudication (COT) were measured before and after nitrate and placebo. RESULTS: There were significant group by time interactions (p<0.05) for systolic BP, endothelial function, and maximal walking distance. Systolic BP was significantly reduced (p<0.05) while popliteal FMD, brachial FMD, and maximal walking time significantly increased (p<0.05). Nitrate intake reduced central systolic BP and increased maximal walking time (p<0.05). There were trends for decreased diastolic BP (p=0.15), central diastolic BP (p=0.06), and central pulse pressure (p=0.17). There were no changes in RHR, deceleration time, max dP/dt, carotid-to-radial PWV, carotid-to-femoral PWV, carotid-to-ankle PWV, AIx, or COT (p>0.05). CONCLUSIONS: These results indicate that a dose of nitrate (~0.11 mmol nitrate/kg) seems to be an effective dose for improving BP, vascular function, and walking capacity in patients with PAD.

The Effects Of Mental Imagery Use On Perceived Exertion And Exercise Tolerance

Physical inactivity is the main public health concern of the 21st century (Blair, 2009). Perceptions of exertion and physiological stress are important contributors to the problem of physical inactivity (Lind, Welch, & Ekkekakis, 2009). PURPOSE: The purpose of this study was to test the effectiveness of two types of mental imagery (associative vs. dissociative) on perceived exertion and physiological stress. METHODS: Forty-five college students (22 males, 23 females) were randomly assigned to dissociative imagery, associative imagery, and control (i.e., no imagery) conditions. Participants completed a progressive cycling task to volitional fatigue. Ratings of perceived exertion (RPE), attention focus and heart rate (HR) were monitored at 1minute intervals. Lactate accumulation (LA) was recorded at RPE=12 and at task completion. RESULTS: Participants using associative imagery reported the highest RPEs (p < .05). These participants also tended to tolerate the task longer as compared to both the dissociative imagery group (ES = .04) and the control group (ES = .14). Participants in the associative imagery condition focused more on internal cues of exertion (p < .01). Participants using either type of imagery seemed to expend increased effort as demonstrated by higher (p =.102) means for lactate accumulation during and at the completion of the task. CONCLUSION: Using associative imagery might cause individuals to focus on internal cues of exertion thus increasing the subjective perception of effort. However, using associative imagery may help increase exercise tolerance compared to dissociative imagery or no imagery. These findings are consistent with previous research and may have important implications for promoting exercise tolerance.

Nitrate Supplementation And Exercise Tolerance In Well-trained Middle And Older-aged Adults

PURPOSE: Nitrate (NO3-), through its conversion to nitrite (NO2-) and nitric oxide, has been shown to increase exercise tolerance in healthy younger adults and older diseased patients. Nitrate’s effect in well-trained middle to older-aged adults has not been studied. Therefore, the purpose of this investigation was to examine the effects of a NO3- rich beverage on submaximal constant work rate exercise time in well-trained middle to older-aged adults. METHODS: Fifteen, 41-64 year-old, well-trained middle to older-aged adults were assigned to receive one of two treatments (NO3- rich beverage then placebo or placebo then NO3- rich beverage), after which an exercise test at 75 percent of the subject’s maximal work rate was completed. RESULTS: The NO3- rich beverage increased plasma NO3- and NO2- levels by 270 μM and 0.81 μM, respectively (p<0.001). Exercise time was not significantly different (p=0.31) between the NO3- rich versus placebo conditions (1130±151 vs 1060±132 sec, respectively). Changes in exercise time between the two conditions ranged from a 55% improvement to a 40% decrease with the NO3- rich beverage. Oxygen consumption and rating of perceived exertion were not significantly different between the two conditions. CONCLUSIONS: In middle to older-aged well-trained adults, NO3- supplementation has non-significant, albeit highly variable, effects on exercise tolerance.

A randomized controlled trial of nitrate supplementation in well-trained middle and older-aged adults.

PurposeNitrate (NO3-), through its conversion to nitrite (NO2-) and nitric oxide, has been shown to increase exercise tolerance in healthy younger adults and older diseased patients. Nitrate’s effect in well-trained middle to older-aged adults has not been studied. Therefore, the purpose of this investigation was to examine the effects of a NO3- rich beverage on submaximal constant work rate exercise time in well-trained middle to older-aged adults.MethodsThis was a randomized controlled cross-over trial with 15 well-trained middle to older-aged adults, 41–64 year-old, who received one of two treatments (NO3- rich beverage then placebo or placebo then NO3- rich beverage), after which an exercise test at 75 percent of the subject’s maximal work rate was completed.ResultsThe NO3- rich beverage increased plasma NO3- and NO2- levels by 260 μM and 0.47 μM, respectively (p<0.001). Exercise time was not significantly different (p = 0.31) between the NO3- rich versus placebo conditions (1130±151 vs 1060±132 sec, respectively). Changes in exercise time between the two conditions ranged from a 55% improvement to a 40% decrease with the NO3- rich beverage. Oxygen consumption and rating of perceived exertion were not significantly different between the two conditions.ConclusionIn middle to older-aged well-trained adults, NO3- supplementation has non-significant, albeit highly variable, effects on exercise tolerance.ClinicalTrials.gov Identifier: NCT03371966

The effects of a respiratory rehabilitation programme on body composition

Abstract Objective Analysis of the respiratory rehabilitation effects on body composition, performed for 10 patients with respiratory pathology. Materials and method In our pilot study were included patients with respiratory disease, for which bioelectrical impedance analysis was performed before and after an outpatient respiratory rehabilitation (RR) programme. The RR programme consisted of 20 sessions of exercise for lower limb (cycling and walking on a treadmill) and upper limb (weights). Results Ten patients followed the rehabilitation programme (five patients with chronic obstructive pulmonary disease, two with bronchiectasis, one with cystic fibrosis, one with lung cancer and one with idiopathic pulmonary fibrosis). Following the rehabilitation, they presented an important decrease in total body fat distribution (average total body fat distribution before RR – 31.38% and after RR – 27.09%, p = 0.000) and also segmental body fat distribution; we found an increase of total muscle mass after RR programme (average total muscle mass distribution before RR – 53.03 kg and after the RR – 56.84 kg, p = 0.000) and segmental muscle mass. The average body weight of the patients measured before and after the rehabilitation programme remained relatively constant in absolute value (81.8 kg and 81.3 kg after RR), probably by decreasing fat mass and increasing muscle mass. The RR programme had also a positive effect on increasing exercise tolerance (with 88.5 m at 6-min walk test) and dyspnoea improvement (decrease of mMRC scale with 1.5 points). Conclusion The RR programme has modified the body composition by increasing muscle mass and decreasing fat mass in the respiratory patients, with positive effects on symptoms and exercise tolerance.

DIFFERENTIAL ATORVASTATIN APPLICATION IN THE TREATMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE LUNG DISEASE WITH ASSOCIATED TYPE 2 DIABETES

Objective. The aim of the research was to study the effectiveness of the differentiated useof atorvastatin in the treatment of patients with chronic obstructive pulmonary disease(COPD) with concomitant type 2 diabetes mellitus (DM).Material and methods. We examined 49 patients with COPD and concomitant type 2diabetes, who were divided into 2 groups. The first group (26 patients) received 40 mgof atorvastatin against a background of basic treatment, the second group (23 patients)received 20 mg of atorvastatin for 6 months. Evaluation of the effectiveness of thetherapy was carried out according to the CAT test, the test with 6-minute walking, theintegral BODE index, according to the results of spirometry and bioimpedansometry. Atthe beginning and at the end of treatment, the parameters of the blood lipid spectrum,carbohydrate metabolism, the functional state of the endothelium, as well as the levelof C-reactive protein (CRP) in the blood serum were determined. Genotyping of thepolymorphic variant C3435T of the MDR1 gene was carried out followed by assessmentof the distribution of genotypes and alleles between groups using the two-sided Pearsonchi-square test (χ2).Results. It was found that when using 40 mg of atorvastatin for six months of treatment inpatients with COPD with concomitant type 2 diabetes, there was an improvement in thelife quality according to the CAT test for the CC and CT genotypes, increased exercisetolerance for the CT genotype and a decrease in the integral BODE index regardless ofgenotype. A decrease in BMI and% fat mass was observed with the TT genotype. However,this therapy led to deterioration in carbohydrate metabolism (a significant increasein fasting glucose and after 2 hours). The level of total cholesterol (cholesterol) andcholesterol low density lipoproteins (LDL) significantly decreased with the TT genotype.With this genotype, the level of nitrates / nitrites increased significantly compared withthe SS and ST genotype. CRP decreased regardless of genotype.The use of atorvastatin at a dose of 20 mg in the treatment of patients with COPD withconcomitant type 2 diabetes mellitus leads to an improvement in the course of COPDwith concomitant type 2 diabetes, especially in the presence of the T allele (decrease inthe number of scores on the CAT test, increased exercise tolerance, decreased integralBODE index), improving the lipid spectrum of the blood and the functional state of theendothelium in the absence of an effect on carbohydrate metabolism (indicators did notsignificantly change at the end of treatment).Conclusion. It has been found that in patients with COPD with concomitant type 2 diabetes, an association of the response to treatment with atorvastatin with the C3435Tpolymorphism of the MDR1 gene was established. The use of atorvastatin at a dose of20 mg improved the course of COPD in the absence of an effect on type 2 diabetes,especially with the TT genotype.

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

BackgroundChronic obstructive pulmonary disease (COPD) is airway inflammation characterized and low daily physical activity. Most pulmonary rehabilitation (PR) programs are often provided to stable patients, but fewer training programs are specific for hospitalized patients with acute exacerbation (AE). Patients with AECOPD experience increased dyspnea sensations and systemic inflammation during exercise training. High-flow nasal therapy (HFNT) reduces the minute volume, lowers the respiratory rate, and decreases the work of breathing. However, it is not clear whether HFNT is efficient during exercise training. In this study, we investigated the effects of HFNT during exercise training in an early PR program among hospitalized patients with severe AECOPD.MethodsWe enrolled COPD patients hospitalized due to AE. They were randomized into two groups according to their status into HFNT PR and non-HFNT PR groups. This study collected basic data, and also assessed a pulmonary function test, 6-min walking test, blood inflammatory biomarkers, and arterial gas analysis at the baseline, and at 4 and 12 weeks of the intervention. Data were analyzed using SPSS statistical software.ResultWe recruited 44 AECOPD patients who completed the 12-week PR program. The HFNT PR program produced significant improvements in exercise tolerance as assessed by the 6-min walking distance (6MWD), reduced dyspnea sensations in the modified Medical Research Council (mMRC), and decreased systemic inflammation as evidenced by the a lower C-reactive protein (CRP) level. A reduction in the length of hospitalization was achieved with PR in the 1-year follow-up in the two groups. The HFNT PR group showed better trends of reduced air trapping in the delta inspiration capacity (IC) and an increased quality of life according to the COPD assessment test (CAT) than did the non-HFNT PR group.ConclusionsHFNT during exercise training in early PR increases exercise tolerance and reduces systemic inflammation in hospitalized patients with severe AECOPD.

Effect of portable non-invasive ventilation on exercise tolerance in COPD: One size does not fit all

In a cross-over RCT, portable NIV (pNIV) reduced dynamic hyperinflation (DH) compared to pursed lip breathing (PLB) during recovery from intermittent exercise in COPD, but not consistently in all subjects. In this post-hoc analysis, DH response was defined as a reduction ≥4.5 % of predicted resting inspiratory capacity with pNIV compared to PLB.At exercise iso-time (where work completed was consistent between pNIV and PLB), 8/24 patients were DH non-responders (DH: 240 ± 40 mL, p = 0.001 greater using pNIV). 16/24 were DH responders (DH: 220 ± 50 mL, p = 0.001 lower using pNIV). Compared to DH responders, DH non-responders exhibited greater resting DH (RV/TLC: 65 ± 4% versus 56 ± 2%; p = 0.028) and did not improve exercise tolerance (pNIV: 30.9 ± 3.4 versus PLB: 29.9 ± 3.3 min; p = 0.603). DH responders increased exercise tolerance (pNIV: 34.9 ± 2.4 versus PLB: 27.1 ± 2.3 min; p = 0.001). Resting RV/TLC% was negatively associated with the magnitude of DH when using pNIV compared to PLB (r=-0.42; p = 0.043).Patients with profound DH were less likely to improve exercise tolerance with pNIV. Further studies using auto-adjusted ventilators are warranted.

P121 Improving self -efficacy and positive change behaviours using an exercise approach in people with chronic pain

Abstract Background Despite compelling evidence of benefit for exercise in inflammatory arthritis and chronic pain, 68% of rheumatoid arthritis (RA) patients in the UK are inactive, predominantly due to fears of uncertainty, pain and discomfort. The Move to Improve exercise class was developed to address these fears through increasing patients’ confidence to exercise and self-efficacy in order to sustain long term positive health behaviours. The programme focuses on a graded and paced exercise class model. Methods We audited results from our Move to Improve class to establish if positive self-efficacy behaviours were fostered using a structured exercise programme. Patients were referred into the programme from outpatient rheumatology services and by self-referral from patients attending our regular fibromyalgia (FMS) education sessions. The class was open to all patients regardless of physical function or disability assuming they could commit to attend the whole programme. Patients attended the physiotherapy department weekly for a total of 6 sessions where they undertook a specifically designed exercise programme that included a warm-up, 12-station exercise circuit (for example static bike, gym ball, treadmill) aiming to improve movement, reduce fatigue and increase exercise tolerance. The programme included ‘taster’ sessions for specific forms of exercise such as Tai Chi, Pilates and Zumba gold. Classes were supervised by physiotherapists who utilised motivational interviewing techniques to encourage engagement. Before commencing the programme patients self-rated their ability to manage symptoms using the Arthritis Self-Efficacy Scale 8 (ASES 8) score which measures 8 domains (0-10 score) including pain, mood, stiffness, function and depression. At the end of the course patients re-rated and changes in ASES8 score were calculated with an increase in score from baseline indicating greater patient reported confidence to manage symptoms. Results Pre and post programme ASES8 results were available for 89 individuals. A variety of underlying medical conditions were represented, most commonly FMS (40%) RA (22%) or both (15%). 88/89 patients reported an improvement in at least 1 domain and overall 85/89 demonstrated an overall improvement in their confidence to manage symptoms. FMS patients reported the greatest overall improvement in their confidence (60% improvement in total ASES8 score from baseline) as compared to RA (34%). Patients with both RA and FMS reported an improvement like those with RA alone (35%). There was an inverse relationship between pre-programme confidence and the likelihood of benefit whereby patients in the lowest scoring quartile demonstrated the greatest benefit from the programme. Increased confidence in managing daily activities, fatigue and functional impairment was reported by 82%, 73% and 74% of patients respectively. Conclusion Patients completing a six-week supervised exercise programme reported significant improvements in their confidence to manage pain and related symptoms. Longer term benefit from the programme will require further study. Disclosures C. Wood None. D. Cains None. S. del Rosa None. J.L. Marks None. L. Clements None.

An Attempt to Accord the Quality of Therapy of Stable Coronary Heart Disease Patients with Current Clinical Guidelines (ALIGN study): Design and the First Results

Aim. To assess the quality of therapy in stable coronary heart disease (CHD) patients, who first sought consultation in the specialized cardiology department of the research center, and try to adjust the therapy in accordance with current clinical guidelines, paying special attention to achieving the target levels of blood pressure, low-density lipoprotein cholesterol (LDL), and glycosylated hemoglobin (in patients with diabetes mellitus), increasing exercise tolerance and improving the quality of life (QL).Material and methods. The ALIGN study is an integral part of the PROFILE outpatient registry. ALIGN study included all patients with verified coronary heart disease who came for consultation to the specialized institution for the first time or for the first time in more than the last 3 years. Patients have been recruited from December 01, 2017 to December 31, 2019. The study consisted of 4 visits: the first-time visit – inclusion in the study (V0), when drug therapy, QL, and adherence were evaluated, and therapy correction was made in accordance with clinical guidelines. In 3 months (V1) the target values of clinical and laboratory parameters were estimated. The third visit (V2) was planned to take place 1 year after the first visit with reevaluation of QL and patients' adherence to treatment, and effectiveness of the therapy. The fourth visit (V3)/telephone contact was planned in 2 years after the first visit to assess life status, get information about complications and therapy.Results. 389 people were included in the PROFILE registry for the specified period of time, 79 had a verified diagnosis of CHD, and 71 patients were included in the ALIGN study: 55 men (aged of 68.7±8.96 years) and 16 women (aged of 67.5±8.08 years). Arterial hypertension was registered in 90.1% of patients, stable angina class I-III – in 62%, 47.9% of patients had a history of acute myocardial infarction (AMI), 52.1% had percutaneous coronary intervention, 15.5% of patients had coronary artery bypass graft, chronic heart failure was detected in 40.8%, diabetes mellitus – in 21.1%, atrial fibrillation – in 15.5% of patients. Lipid-lowering drugs were taken by 53 (74.6%) patients, but only 21 (29.6%) achieved the target values of LDL cholesterol. Angiotensin-converting enzyme inhibitors were taken by 34 patients (47.9%), and angiotensin receptor blockers by 15 (21%) of patients, 47 (66.2%) patients took beta-blockers, antiplatelet agents were taken by 61 people, and anticoagulants by 10 patients. Patients who had a history of AMI had been prescribed BB in 88%, statins – in 90%, and renin-angiotensin-aldosterone system (RAAS) blockers – in 80% of cases.Conclusions. Initial quality of therapy for patients with stable CHD did not fully match the clinical guidelines: a quarter of patients did not receive lipidlowering therapy, and target levels of LDL cholesterol were achieved only in one third of patients. Among patients who had a history of AMI, every fifth patient did not receive RAAS blockers.