Marked Improvements In Exercise Capacity Research Articles

Effect of a home-based inspiratory muscle training program on functional capacity in post-discharged patients with long COVID: The InsCOVID trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Sociedad Española de Cardiología. Background Fatigue and exercise intolerance are the most common symptoms in patients with long COVID. Purpose This study aimed to evaluate whether a home-based inspiratory muscle training (IMT) program improves maximal functional capacity in patients long COVID after a previous admission due to SARS-CoV-2 pneumonia. Methods This study was a single-centre, blinded assessor, randomised controlled trial. Twenty-six patients with long COVID and a previous admission due to SARS-CoV-2 pneumonia were randomly assigned to receive either a 12-week program of IMT or usual care alone. The physiotherapist and participants were not blinded. Patients allocated to the IMT arm were instructed to train at home twice daily using a threshold inspiratory muscle trainer and to maintain diaphragmatic breathing during the training session. The usual care arm received no intervention. The primary endpoint was changes in peak oxygen consumption (peakVO2). Secondary endpoints were changes in quality of life (QoL), ventilatory efficiency and chronotropic response during exercise (evaluated by chronotropic index-CIx- formula). We used linear mixed regression analysis for evaluating changes in primary and secondary endpoints. Results The median (interquartile range) age of the sample and time to first visit after discharge were 52 (42-59) years and 405 (301-435) days, respectively. A total of 11 (42.3%) were female. At baseline, the median of peakVO2, ventilatory efficiency and CIx were 17.4 (15.6-21.1) mL/kg/min, 29 (24.5-33.3), and 0.64 (0.54-0.87), respectively. The IMT arm improved their peakVO2 significantly compared to usual care (+Δ 4.46 mL/kg/min, 95% CI 3.10 to 5.81; p<0.001). Similar positive findings were found when evaluating changes for CIx and some QoL dimensions. We did not find significant changes in ventilatory efficiency. Conclusion In long COVID patients with a previous admission due to SARS-CoV-2 pneumonia, IMT was associated with marked improvement in exercise capacity and QoL.

Effect of a home-based inspiratory muscle training programme on functional capacity in postdischarged patients with long COVID: the InsCOVID trial

BackgroundFatigue and exercise intolerance are the most common symptoms in patients with long COVID.AimsThis study aimed to evaluate whether a home-based inspiratory muscle training (IMT) programme improves maximal functional capacity...

Abstract P190: Long-term Intake of Muscadine Grape Extract Markedly Improves Exercise Capacity in Older Female (mRen2)27 Hypertensive Rats

Muscadine grapes ( Vitis rotundifolia ) contain significant levels of polyphenols and their antioxidant capacity may have cardiovascular benefit. We determined the cardiovascular effects of a water soluble muscadine grape extract (MGE) from Piedmont Research & Development Corporation (PRDC, Winston-Salem, NC) that we confirmed has a high content of epicatechin, gallic acid, ellagic acid and procyanidin B2. We hypothesize that this soluble MGE with a potentially high phenolic bioavailability exhibits cardioprotective actions. The effect of long-term MGE intake on blood pressure, cardiac function and exercise tolerance was established in female and male hemizygous (mRen2)27 [mRen2] transgenic rats, an Ang II-AT 1 R-dependent model of hypertension. The mRen2 were administered MGE (8 mg of total phenolics/mL) in the drinking water for 26 weeks (7 female; 7 male); control rats (9 female; 11 male) were given water only. At 40 weeks of age, exercise tolerance was assessed by treadmill (10.2 m x min -1 , 5% inclination). The MGE-treated female mRen2 exhibited a >300% improvement in workload ( W: g X m ) as compared to the untreated group [14551 ± 1313 vs. 4498 ± 481; p<0.01]. MGE intake also extended the time to fatigue (TTF) by 300% in females (4943 ± 443 vs.1615 ± 166 sec; p<0.01). In contrast, chronic intake of MGE had no effect on either exercise workload or TTF in the male mRen2. MGE intake did not alter systolic blood pressure in females (162 ± 3 vs. 166 ± 6 mm Hg, p>0.05) and males (165 ± 5 vs. 160 ± 3 mm Hg) nor alter body weight in either group [females: 334 ± 7 g vs. 339 ± 8 g; males: 613 ± 12 g vs. 590 ± 6 g). Echocardiographic analyses revealed that although the female mRen2 exhibited a higher ejection fraction [73.4±5.1 vs. 42.3±4.5%, n=4-5, p<0.05] and a higher fractional shortening [44.2±4.2 vs. 22.1±2.7%, n=4-5, p<0.05] as compared to males, MGE treatment did not improve these indices in either group. We conclude that the marked improvement in exercise capacity in older adult hypertensive females by chronic MGE intake is not accompanied by augmented cardiac performance, perhaps reflecting the lack of an effect on blood pressure. Thus, it is possible that MGE may directly impact the skeletal muscle to improve exercise in the hypertensive mRen2 females, but not the males.

Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) is remarkably common in elderly people with highly prevalent comorbid conditions. Despite its increasing in prevalence, there is no evidence-based effective therapy for HFpEF. We sought to evaluate whether inspiratory muscle training (IMT) improves exercise capacity, as well as left ventricular diastolic function, biomarker profile and quality of life (QoL) in patients with advanced HFpEF and nonreduced maximal inspiratory pressure (MIP). A total of 26 patients with HFpEF (median (interquartile range) age, peak exercise oxygen uptake (peak VO2) and left ventricular ejection fraction of 73 years (66-76), 10 ml/min/kg (7.6-10.5) and 72% (65-77), respectively) were randomized to receive a 12-week programme of IMT plus standard care vs. standard care alone. The primary endpoint of the study was evaluated by positive changes in cardiopulmonary exercise parameters and distance walked in 6 minutes (6MWT). Secondary endpoints were changes in QoL, echocardiogram parameters of diastolic function, and prognostic biomarkers. The IMT group improved significantly their MIP (p < 0.001), peak VO2 (p < 0.001), exercise oxygen uptake at anaerobic threshold (p = 0.001), ventilatory efficiency (p = 0.007), metabolic equivalents (p < 0,001), 6MWT (p < 0.001), and QoL (p = 0.037) as compared to the control group. No changes on diastolic function parameters or biomarkers levels were observed between both groups. In HFpEF patients with low aerobic capacity and non-reduced MIP, IMT was associated with marked improvement in exercise capacity and QoL.

Effects of High-Intensity Training on Indices of Ventilatory Efficiency in Chronic Heart Failure

Measures of ventilatory inefficiency, such as the slope of the relation between ventilation and carbon dioxide production ((Equation is included in full-text article.)slope) and the oxygen uptake efficiency slope (OUES) have recently been shown to be strong prognostic markers in patients with heart failure. Little is known regarding the effects of exercise training on these indices. Fifty heart failure patients (mean age = 55 ± 6 years, ejection fraction = 33 ± 6%) referred to a residential cardiac rehabilitation program were randomized to a 2-month high-intensity training program (n = 24) or to a control group (n = 26). Before and after the study period, maximal cardiopulmonary exercise testing was performed, and markers of ventilatory inefficiency were determined. Training increased peak oxygen uptake ((Equation is included in full-text article.); 23%), exercise time (29%), and peak workload (28%), whereas no changes were observed in controls (all P < .05 between groups). No differences were observed in the (Equation is included in full-text article.)slope in either group. However, the ventilatory equivalent for oxygen ((Equation is included in full-text article.)ratio) was reduced at matched work rates throughout exercise (P < .01). The OUES increased by 12% in the exercise groups (P = .003) and 4% in controls. At baseline, trained patients had an OUES that was 69% of the age-predicted value and this improved to 78% after training (P = .004). The change in OUES was significantly related to the change in peak (Equation is included in full-text article.)with training (r = 0.63, P = .001). High-intensity training resulted in marked improvements in exercise capacity in patients with heart failure. Training improved the OUES and reduced the (Equation is included in full-text article.)ratio, but the (Equation is included in full-text article.)slope was unchanged. Among measures of ventilatory inefficiency, the OUES may be more sensitive to training than the (Equation is included in full-text article.)slope.

Issue Highlights

HomeCirculationVol. 113, No. 23Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published13 Jun 2006https://doi.org/10.1161/circ.113.23.2675Circulation. 2006;113:2675SINGLE-GENE MUTATIONS AND INCREASED LEFT VENTRICULAR WALL THICKNESS IN THE COMMUNITY: THE FRAMINGHAM HEART STUDY, by Morita et al.Left ventricular hypertrophy (LVH) is associated with stroke, coronary heart disease, heart failure, and cardiovascular and all-cause mortality. LVH results from increases in LV wall thickness (LVWT), LV mass, and LV volume. Unexplained increases in LVWT (LVWT 13mm) contribute to LVH in 3% of the general population over the age of 45. Mutations in sarcomere protein, PRKAG2, LAMP2, α-galactosidase A (GLA), and several mitochondrial genes are associated with rare familial cardiomyopathies; their contribution to LVH in the community is unknown, however. Morita et al identified the prevalence and clinical features of single-gene mutations in adults in the community with increased LVWT in the absence of obvious secondary forms of hypertrophy. Among 1862 Framingham Heart Study participants, 50 had unexplained increased LVWT. Eight subjects (16%) had sarcomere protein gene mutations and one (2%) had a GLA mutation. Therefore, approximately 0.5% of the general population over age 45 has increased unexplained LVWT and a single-gene mutation that probably accounts for their hypertrophy. Increased LVWT in the community is a heterogeneous condition, and additional investigation of the prevalence and clinical features of single-gene mutations in other community-based cohorts will help improve our understanding of the broad spectrum of genetic causes of increased LVWT. See p 2697.AEROBIC CAPACITY IN PATIENTS ENTERING CARDIAC REHABILITATION, by Ades et al.Exercise training is a key component of comprehensive cardiac rehabilitation/secondary prevention programs and generally yields marked improvements in exercise capacity, particularly among those with the lowest initial fitness levels. In this issue of Circulation, Ades et al provide normative values for exercise capacity relative to age, gender, and diagnosis among patients entering cardiac rehabilitation that are derived from 2896 patients. The nomograms provided in this paper will serve to assist the clinician in comparing patient status relative to program peers and established norms, motivating the patient, and setting exercise training goals. Incorporation of this important information into the initial patient assessment should serve to enhance the treatment of patients as they enter cardiac rehabilitation programs. See p 2706.HEMOGLOBIN LEVEL, CHRONIC KIDNEY DISEASE, AND THE RISKS OF DEATH AND HOSPITALIZATION IN ADULTS WITH CHRONIC HEART FAILURE: THE ANEMIA IN CHRONIC HEART FAILURE: OUTCOMES AND RESOURCE UTILIZATION (ANCHOR) STUDY, by Go et al.Although several retrospective studies have suggested a link between anemia and adverse events in patients with heart failure, the roles of renal insufficiency, treatment differences, and comorbidities in leading to this relationship have not been clear. Go et al examined longitudinal outpatient hemoglobin and creatinine levels in 59 722 adults with heart failure in an integrated healthcare system. Decreasing hemoglobin and calculated glomerular filtration rate were both associated with increased mortality, and these associations were independent of whether heart failure was due to systolic or diastolic ventricular dysfunction. These results from a large outpatient population support the thesis that anemia and renal dysfunction are independent predictors of adverse outcomes in patients with heart failure. See p 2713.Visit http://circ.ahajournals.org:Images in Cardiovascular MedicineLarge Renal Artery Aneurysm Treated With Stent Graft. See p e848.Severe Endothelial Dysfunction After Sirolimus-Eluting Stent Implantation. See p e850.A 54-Year-Old Female With Chest Pain, Dyspnea, and Inferior Injury on Electrocardiography. See p e852. Download figureDownload PowerPointBook ReviewMolecular Mechanisms of Cardiac Hypertrophy and Failure. See p e853.CorrespondenceSee p e854. Previous Back to top Next FiguresReferencesRelatedDetails June 13, 2006Vol 113, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.113.23.2675 Originally publishedJune 13, 2006 PDF download Advertisement

Effects of Continuous IV Prostacyclin in a Patient With Pulmonary Veno-occlusive Disease

Pulmonary veno-occlusive disease (PVOD) is a rare but life-threatening disease. Although prostacyclin (PGI(2)) attenuates pulmonary hypertension and improves the prognosis in patients with primary pulmonary hypertension, little information is available regarding the effect of PGI(2) on patients with PVOD. This report describes a patient with severe PVOD who showed marked improvement in exercise capacity and pulmonary hemodynamics with continuous IV PGI(2) treatment. Furthermore, he experienced no clinical events for 12 months and survived for 25 months after the initiation of PGI(2) therapy. These results suggest that continuous IV PGI(2) therapy may serve as a bridge to transplantation in some cases of PVOD.

Endothelin Receptor Antagonism: A New Era in the Treatment of Pulmonary Arterial Hypertension

Abstract The endothelin system has been extensively studied over the last several years. It is clear that endothelin-1 (ET-1) is a key mediator in pulmonary vascular biology and physiology. Abnormal increases in ET-1 production and decreased pulmonary clearance appear to play a major pathogenetic and perpetuating role in the pulmonary hypertensive process, through their vasconstrictive, smooth muscle cell proliferative and profibrotic effects. The degree of overexpression of ET-1 may correlate with the severity of pulmonary hypertension (PH). Advances in understanding the role of ET-1 in pulmonary hypertension have driven the development of endothelin receptor antagonists. One such agent, bosentan (Tracleer), is FDA approved for pulmonary arterial hypertension. Bosentan was approved following two randomized, placebo-controlled, double-blind studies that both showed marked improvement in exercise capacity after treatment with bosentan. The beneficial effects of bosentan appear to be sustained in most patients followed for as long as 22 months. Other uses for endothelin receptor antagonists are being examined, such as in combination with epoprostenol (Flolan) or in pediatric PH patients.

Benefits of cardiac rehabilitation and exercise training in elderly women

In conclusion, these data demonstrate the marked improvements in exercise capacity and obesity indexes and the modest improvements in plasma lipids following cardiac rehabilitation in elderly women. In addition, elderly women reduced adverse behavioral characteristics and improved quality of life parameters following this therapy. We believe that these data further support the idea that elderly women should be routinely referred to and strongly encouraged to pursue formal cardiac rehabilitation programs following major CAD events.

Changes in the Cardiopulmonary Response to Exercise after Cardiac Transplantation in Patients Enrolled in an Early Rehabilitation Program

OBJECTIVE: To evaluate the changes in the cardiopulmonary response to exercise in the first year after cardiac transplantation in patients enrolled in a rehabilitation program in the first three months post-transplantation.METHODS: A graded cycle exercise test with mixed expired gas analysis was performed on patients with end-stage cardiac failure before and serially after cardiac transplantation at one, three and 12 months.RESULTS: Before cardiac transplantation, seven patients were fit enough to be tested. They had a low peak oxygen uptake (VO2 max) and a blunted heart rate and blood pressure response to exercise. They also displayed a restrictive pattern of ventilation during exercise. At three months following transplantation, patients (n=19) had a significantly higher VO2 max(19.9±5.3 versus 9.8±1.4 mL/kg/min, P&lt;0.05), higher peak systolic blood pressure (177±22 versus 94±18 mmHg, P&lt;0.05), greater peak minute ventilation (70±23 versus 34±5 L/min, P&lt;0.05) and lower slope of minute ventilation to carbon dioxide output (35.4±6.2 versus 45.1±6.7, P&lt;0.05) than before transplantation. The VO2 maxmeasured at 12 months post-transplant was similar to the three month value and was on average equal to 59% of the predicted value.CONCLUSIONS: These results indicate that there is a rapid and marked improvement in exercise capacity in patients following cardiac transplantation. These changes are associated with significant respiratory and cardiovascular adaptations. However, despite the marked improvement in exercise capacity, the VO2 maxof cardiac transplant recipients enrolled in an early rehabilitation program did not return to normal at 12 months after surgery.

Effects of Cardiac Rehabilitation and Exercise Training Programs in Patients ≥ 75 Years of Age

Even elderly patients > or = 75 years of age with coronary artery disease have modest improvements in lipid levels and marked improvements in exercise capacity, behavioral characteristics, and quality-of-life parameters after cardiac rehabilitation and exercise training programs. These data support that even very elderly patients with coronary artery disease should be routinely referred to and vigorously encouraged to pursue formal outpatient cardiac rehabilitation and exercise training programs following major coronary events.

Clinical improvement after revision in Fontan patients

Arrhythmias, decreased exercise tolerance, or malabsorption will develop in a significant number of Fontan patients. Fontan revision consisting of creation of lateral atrial tunnel, reconnection of the Glenn shunt when present, or both appears to improve these patients. Over a 34-month period, 9 patients underwent Fontan revision. The mean age was 11 +/- 5 years and the mean interval from Fontan operation to revision was 3 +/- 2 years. The reason for revision included marked impairment in exercise capacity, inability to go to school consistently, and chronic fatigue in 6 patients, 3 of whom also had serious atrial arrhythmias. Five of the 6 patients had a classic Glenn shunt. The mean right atrial pressure was greater than the pressure of the Glenn shunt (20 +/- 1.6 versus 17 +/- 0.8 mm Hg). Three of the 6 patients also showed a significant gradient between the right or left pulmonary artery wedge and ventricular end-diastolic pressure, indicating pulmonary vein obstruction from the bulging atrial septum or partitioning patch (13 +/- 3 versus 6.8 +/- 1 mm Hg). The remaining 3 patients had revision because of malabsorption (1), hepatomegaly and obstructed right pulmonary veins from bulging atrial septum (1), and tricuspid insufficiency (1). Fontan revision was accomplished with creation of a lateral atrial tunnel and Glenn reconnection in 6 patients, Glenn reconnection in 2, and creation of a lateral atrial tunnel in 1. Four patients had additional procedures. One patient died of Pseudomonas pneumonia. Early extubation, chest tube removal, and postoperative hospital discharge were accomplished in 8 patients (mean = 1.4 +/- 1, 2.8 +/- 1, and 8 +/- 3 days, respectively). One patient died 8 months postoperatively of brain damage after ventricular fibrillation from attempted cardioversion for atrial flutter. The remaining patients had marked improvement in exercise capacity with ability to consistently go to school, improvement in duration and tolerance to arrhythmias on less medication, and resolution of malabsorption up to 37 months postoperatively (mean, 20 +/- 12 months). We conclude that creation of lateral atrial tunnel with excision of a bulging atrial septum or atrial partitioning patch that causes pulmonary venous obstruction, reconnection of the Glenn shunt, which allows better distribution of flow based on the pulmonary vascular bed and resistance of each lung, or a combination of these procedures will improve Fontan patients.

Effects of cardiac rehabilitation programs on exercise capacity, coronary risk factors, behavioral characteristics, and qualify of life in a large elderly cohort

Despite the limitations of our study, we believe the current data support the beneficial effects of cardiac rehabilitation and exercise training in the elderly, including modest improvements in lipids, obesity Indexes, behavioral characteristics, and quality-of-life parameters, and marked improvements in exercise capacity. In fact, elderly patients had greater improvements than younger patients in both exercise capacity and mental health after cardiac rehabilitation. These data indicate that elderly patients with CAD should be routinely referred to and vigorously encouraged to pursue formal outpatient cardiac rehabilitation and exercise training programs after major CAD events.

Improvement in Exercise Capacity after Nocturnal Positive Pressure Ventilation and Tracheostomy in a Postpoliomyelitis Patient

Progressive neuromuscular symptoms years after recovery from acute paralytic poliomyelitis have been termed the PPS. We describe a 52-year-old man who contracted poliomyelitis at age 9 years who fully recovered and 33 years later developed progressive dyspnea. Neurologic evaluation revealed bilateral paralysis of the vocal cords, generalized weakness, and accentuated mouth occlusion pressure and ventilatory responses to hypercapnic, hyperoxic breathing. An EMG and muscle biopsy showed changes consistent with acute and chronic denervation. Cardiopulmonary exercise evaluation demonstrated a pulmonary mechanical limit with excessive ventilation relative to CO2 output. Tracheostomy and nocturnal positive pressure ventilation resulted in increased respiratory muscle strength, normalization of ventilatory drive and marked improvement in exercise capacity.