摘要:

PURPOSE:Although physical activity and physical fitness are inversely and causally associated with coronary heart disease (CHD) morbidity and mortality, available equations for estimating CHD risk do not include scores for activity or fitness. Therefore, this study evaluated the association of physical fitness and moderate-intensity physical activity with the 10-year Framingham CHD risk estimate.METHODS:Cross-sectional analyses were performed on data from 137 healthy middle-aged women (53.9±9.9 yr; 28.3±6.0 kg/m2). Health histories, body composition, blood pressure, and blood samples were obtained from a clinical examination. Levels of moderate (3-6 METS) intensity physical activity, expressed as MET-minutes/day of energy expenditure, were derived from multiple 24-hour physical activity records. Physical fitness was quantified as duration of a symptom-limited maximal treadmill exercise test.RESULTS:After adjustment for race, body mass index (BMI), and hormone replacement status, a graded reduction in the Framingham risk score was observed across low (5.8%), moderate (4.0%), and high (3.6%) fitness levels (Pfor trend=0.009). Women in both the moderate and high fitness categories had a lower (P<0.01) risk score compared with their low fit counterparts. Significant differences in risk were not seen among low (3.9%), moderate (4.9%), and high (4.4%) physical activity groups. The lack of association between the risk score by physical activity may have been due to the homogeneity of activity levels among participants. Our findings reinforce existing data that show enhanced levels of fitness are associated with lower risk for CHD.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Low-fat, high-carbohydrate diets have been used successfully to prevent and treat coronary heart disease, although these diets have been shown to cause elevations in fasting plasma triglyceride concentrations. The present study investigated metabolic factors (glucose, insulin, body weight) associated with changes in plasma triglyceride concentrations in patients participating in a comprehensive, multidisciplinary program, which included the use of a very low-fat diet designed to regress atherosclerotic cardiovascular disease.METHODS:Thirty-six patients were entered into the study and placed on a 10% fat diet. Body mass index and fasting plasma insulin, glucose, lipids, and apolipoproteins were assessed at entrance into and after 3 months of participation in the program. Statistical analysis (discriminant function analysis) was used to identify factors that predicted elevations in plasma triglyceride that occurred during therapy.RESULTS:For the entire group, significant reductions in body weight (−2.4%), fasting glucose (−6%), total cholesterol (−8%), and low-density lipoprotein cholesterol (−11%) were observed, while insulin and triglycerides showed no significant changes. Twenty-one of the patients experienced an increase in fasting triglyceride concentration of 10% or greater.CONCLUSIONS:Three variables (baseline body mass index and fasting triglyceride and insulin concentrations) accurately classified 90% of those who would experience a ≥ 10% elevation in triglycerides (P= 0.0002) and 67% of those who experienced no change. The present analysis provides a practical algorithm for clinicians to predict which patients will experience significant elevations in plasma triglyceride concentration when undergoing risk factor reduction that includes the consumption of a very low-fat, high-carbohydrate diet.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:To measure the prevalence rate of significant depressive symptoms and depression and examine their consequences on quality of life in patients with severe oxygen-dependent chronic obstructive pulmonary disease (COPD).METHODS:Between November 1997 and March 1998, the authors conducted a cross-sectional study among the COPD patients registered at the Quebec City area respiratory home care service. Depression and quality of life were assessed using the Geriatric Depression Scale and the Medical Outcome Survey - Short Form 36 (SF-36).RESULTS:109 patients (63 men; mean age: 71) with severe COPD (median FEV1: 34%) were surveyed. Of them, 105 were on long-term oxygen therapy (LTOT), which had been introduced (median) 19 months earlier. Sixty-two patients (57%; 95% CI: 47-66) demonstrated significant depressive symptoms; in addition, 20 patients (18%; CI: 12-27) were severely depressed. Only 6% of those patients who met the criteria for depression were taking an antidepressant drug. We found significant and moderate correlations between the scores obtained from the Geriatric Depression Scale and 7 of the 8 domains of the SF-36.CONCULSION:Significant depressive symptoms and depression are highly prevalent in patients with severe COPD on LTOT. There is strong evidence that depression is under-recognized and under-treated in this group of patients.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:To (1) identify greatest 6-minute walk distance (6MWD) from among several repetitions (best 6MWD) in a wide age range of healthy volunteers to develop reference values for the multiple repetition 6MWD, and (2) investigate the influence of demographics, anthropometrics, and habitual exercise activity on best 6MWD.METHODS:Four 6MWD were performed on the same day in a 20-meter corridor by 41 male and 38 female healthy volunteers ranging in age from 20 to 80 years. The greatest 6MWD by each subject from among four 6MWDs was the primary outcome measure.RESULTS:Eighty-six percent had their best 6MWD after the first walk; an average increase of 43 meters was observed from first to best 6MWD (P< 0.003). Best 6MWD averaged 698 ± 96 meters and was inversely related to age (P< 0.001), directly to height (P< 0.001), and was greater in men than women (P< 0.0002). A regression model accounted for 41% of between-subject variability in best 6MWD (P< 0.00000001). In a subset of older subjects, predicted 6MWD significantly underestimated measured best 6MWD when reference values were used from another study where test familiarization was not provided, but this difference disappeared when values were used from the present and a third study where test familiarization was provided.CONCLUSIONS:The present study is the first to provide predicted 6MWD values performed with multiple repetitions and for subjects in the 20-40-year-old age range. Selection of appropriate predicted 6MWD values for interpretation of performance should be guided by subject age and degree of test familiarization provided.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:Functional limitation, often associated with congestive heart failure (CHF), is most accurately assessed with measurement of peak VO2(VO2peak) during exercise testing. VO2peakstrongly predicts survival in CHF patients and is used to triage patients for cardiac transplantation. However, the traditional mouthpiece/noseclip equipment used for gas exchange analysis is often cumbersome and uncomfortable. Several alternative facemask designs tested previously in healthy cohorts were inferior to the mouthpiece for measuring VO2peak. In this study, a series of facemasks designed specifically for VO2peaktesting (Hans-Rudolph) was employed. Although previously validated in healthy young adults, this apparatus has not been validated in patients with severe CHF.METHODS:The Hans-Rudolph facemasks were compared with the mouthpiece apparatus in 30 patients with severe CHF. Each subject completed a cardiopulmonary exercise test with each device. Twelve subjects were randomized to evaluate a possible training effect. To enhance recruitment, 18 additional subjects were recruited after they had completed a test with the mouthpiece.RESULTS:There was no evidence of a training effect and no differences in gas exchange measurements were found between the two devices. The weight-adjusted VO2peakmeasurements were 17.1 ± 5.3 ml O2/kg/min for the mouthpiece group and 17.3 ± 5.6 ml O2/kg/min for the mask group (P= 0.54).CONCLUSIONS:The facemask was shown to be equivalent to the mouthpiece for measuring VO2peakin CHF patients. Concerns of hypoventilation and decreased VO2peakassociated with previous facemask designs were not substantiated. Since successful exercise testing depends on maximal exertion, providing a choice of equipment may facilitate cooperation without sacrificing accuracy.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:This study examined the effects of performing combined resistance and aerobic training, versus aerobic training alone, in patients with coronary artery disease.METHODS:Thirty-six patients with coronary artery disease were randomized to either an aerobic-only training group (AE) or a combined aerobic and resistance training group (AE+R). Both groups performed 30 minutes of aerobic exercise 3 days/week for 6 months. In addition, AE+R group performed two sets of resistance exercise on seven different Nautilus® machines after completion of aerobic training each day. Twenty patients (AE:n= 10; AE+R:n= 10) completed the training protocol with > 70% attendance.RESULTS:Strength gains for AE+R group were greater than for AE group on six of seven resistance machines (P< 0.05). VO2peakincreased after training for both AE and AE+R (P< 0.01) with no difference in improvement between the groups. Resting and submaximal exercise heart rates and rate-pressure product were lower after training in the AE+R group (P< 0.01), but not in the AE group. AE+R increased lean mass in arm, trunk, and total body regions (P< 0.01), while AE increased lean mass in trunk region only (P< 0.01). Percent body fat was reduced for AE+R after training (P< 0.05) with a between group trend toward reduced body fat (P= 0.09). Lean mass gain significantly correlated with strength increase in five of seven resistance exercises for AE+R.CONCLUSIONS:Resistance training adds to the effects of aerobic training in cardiac rehabilitation patients by improving muscular strength, increasing lean body mass, and reducing body fat.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

PURPOSE:To bring up-to-date information about all the cardiac rehabilitation (CR) units in the UK, including their staffing and the services they offer, and to determine the numbers and diagnoses of the patients they treat.METHODS:Questionnaire survey to establish the continued functioning of the centers, the disciplines of their staff, the number of patients treated, their diagnoses, and the outcomes measured.RESULTS:286 centers were identified. Of the 236 who returned their questionnaires, 171 (72%) gave figures of the numbers and diagnoses of their patients. The median number treated in the different programs was 150, with a total of 32,499 patients. Of those, 63% were recovering from myocardial infarction, 25% from coronary artery bypass graft (CABG), and 4% from percutaneous transluminal cornonary angioplasty (PTCA). Twenty-four percent of patients were female, 87% were between the ages of 40 and 74, and 10% were older than 75. Of the responders, 80 (34%) performed an exercise test both before and after the course. Of the 171 who gave figures, 113 (66%) measured outcomes.CONCLUSIONS:In the UK, between 14% and 23% of infarct patients, between 33% and 56% of CABG patients, and between 6% and 10% of PTCA patients are enrolled into CR programs.

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:2001

数据来源: OVID