ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Exercise intolerance is an integral component of chronic obstructive pulmonary disease (COPD) and coronary heart disease(CHD) and is caused by several mechanisms that ultimately impact overall functional capacity. We assessed various components of exercise function in patients with CHD and COPD during the course of cardiac and pulmonary rehabilitation to evaluate changes unique to each condition.Methods.Work efficiency (WEf, defined as Δwatts/ΔVO2) and peak VO2were measured and compared at baseline and after 3 months (36 sessions) of outpatient cardiac and pulmonary rehabilitation programs in 25 patients (mean age = 66 ± 7 years) with severe COPD (mean FEV1.0= 0.90±0.35 L) and in 25 patients (mean age = 65± 8 years) with CHD.Results.At baseline, patients with COPD had significantly reduced values of WEf (2.04 ± 0.86 versus 3.23± 1.38 watts/mL/kg/min; P = 0.004) and peak VO2(13.2 ± 3.9 versus 17.1 ± 3.9 mL/kg/min; P = 0.005) compared with patients with CHD. After rehabilitation, patients with CHD increased peak VO2by 12% (17.1 ± 3.9 to 19.1 ± 4.9 mL/kg/min; P = 0.01) with no change in WEf (3.23 ± 1.38 to 3.32 ± 1.43 watts/mL/kg/min; P = not significant). In contrast, patients with COPD increased peak VO2by only 5% (13.2 ± 3.9 to 13.9 ± 3.8 mL/kg/min; P = 0.0008), but WEf increased by 36% (2.04 ± 0.86 to 2.78± 0.84 watts/mL/kg/min; P = 0.0002). Subjective measures of functional status improved similarly in both groups.Conclusions.In contrast to patients with CHD, work inefficiency contributes significantly to exercise intolerance in patients with severe COPD. Outpatient rehabilitation programs enhance functional status in patients with CHD and COPD by differing mechanisms, depending on the underlying disease. These data show the disparate effects of out-patient rehabilitation on peak VO2and WEf in cardiac and pulmonary patients.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.The 12-minute walking test is frequently used to measure exercise capacity in patients with severe chronic obstructive pulmonary disease. However, the physiological response to this test has been the subject of limited investigation.Methods.In this study, the metabolic and ventilatory consequences of a self-paced 12-minute treadmill walking test (WT) were measured in 17 patients with severe chronic obstructive pulmonary disease (FEV1: 40 ± 9%) and evaluated using the physiological response to symptom-limited cycle ergometry (CE). During exercise testing, heart rate, transcutaneous oxygen saturation, and lactate concentration were measured, and oxygen consumption, carbon dioxide production, tidal volume, and breathing frequency were recorded breath by breath.Results.After 4 minutes walking, the peak oxygen consumption (V˙O2) was already 99 ± 11% of last-minute walking V˙O2. Walking speed was chosen within 2 minutes and remained stable throughout the test. The WT and CE showed similar (end-) test results for all measurements, except for a higher carbon dioxide production, venous lactate concentration, and respiratory quotient after CE. However, lactate concentration was also significantly increased after WT. Severe and prolonged desaturation was shown during walking in most patients.Conclusions.The physiological stress evoked during the WT is close to the stress developed at an incremental symptom-limited test and the relatively high metabolic and ventilatory stress is sustained from at least 4 to 12 minutes during the WT. This study has shown that anaerobic metabolism not only occurs during incremental cycle ergometry, but also during the WT.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.The study assessed the value of the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR) in determining the psychosocial impact of impairment and disability in patients with chronic irreversible airflow limitation.Methods.Fifty-six consecutive patients admitted to respiratory rehabilitation were studied. Psychosocial adjustment was measured with the PAIS-SR and was judged separately by two health-care workers on the rehabilitation team. Agreement between the PAIS-SR and the health-care workers was determined using the Kappa statistic.Results.Four subjects did not complete the questionnaire. The data from 52 subjects were analyzed. The mean forced expired volume in one second (FEV1) was 1.2 ± 0.4 L. The mean age was 66.4 ± 9.0 years. There was good agreement between the individual assessment of each health-care worker (P < 0.001). There was good agreement between the score on the PAIS-SR and the clinical assessment by each of the health-care workers(P < 0.001). However, there were 10 subjects who identified severe adjustment difficulties that were not recognized by the health-care professionals.Conclusion.Although there was agreement between the PAIS-SR and clinical judgment in assessing the psychosocial impact impairment and disability in chronic airflow limitation, the PAIS-SR may identify individuals with adjustment difficulties not recognized by members of the health-care team. The results support the routine use of objective measures to assess the psychosocial impact of chronic airflow limitation.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.To determine if weight training used during cardiac rehabilitation as soon as 4 weeks after myocardial infarction(MI) is safe, and if weight training combined with aerobic exercise improves aerobic fitness and muscle strength more than aerobic exercise alone.Methods.Twenty-three men within 6 weeks of an acute MI and without exercise-induced ischemia, complex arrhythmias, anterior Q wave MI, or ejection fraction < 40% were randomly assigned to combined weight and cycle training versus cycle training for 10 weeks. The main measures were change in maximal oxygen uptake (VO2max), muscle strength, resting left ventricular (LV) wall segment motion and early diastolic filling by resting and exercise echocardiograms, heart rate, and blood pressure responses.Results.VO2max increased 14% (P < 0.01) and cycle time increased 10% (P < 0.01) in the combined training group. The 8% increases in VO2max (P = 0.15) and cycle time (P = 0.08) in the cycling group were not significant. Arm and leg strength increased (P< 0.01) in each group. However, the change was greater for the combined training group-31% versus 16% (P < 0.03) for leg strength and 20% versus 10% (P < 0.001) for arm strength. There were no changes for either group in resting hemodynamics, body weight and composition, LV wall segment motion, LV fractional shortening, and early diastolic function, and no adverse clinical events or exercise-related complications.Conclusions.Combined training soon after MI improved aerobic and muscle fitness more than cycling alone, and was performed without complication.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Physiological and psychological markers of patients with congestive heart failure (CHF) who will respond to aerobic training are needed as a guide to appropriate therapy.Methods.Seventeen of 21 patients with stable CHF completed a 16-week supervised progressive walking program 5 times per week. Cycle ergometer determinations of peak oxygen intake and peak power output at entry and 16 weeks were supplemented by a 6-minute walk, a disease-specific Quality of Life (QOL) questionnaire, and a standard gamble.Results.Peak oxygen intake increased by 2.6 ± 1.5 mL/(kgmin) over an initial value of 15.6 mL/(kgmin), with parallel gains in peak power and the 6-minute walk. Marked improvements in QOL and standard gamble scores also developed. Initial cardiorespiratory status(heart volume, ejection fraction, oxygen pulse, and peak oxygen intake) was correlated more closely (P = 0.09 to 0.18) with delta peak oxygen intake than with delta peak power or delta walking distance. Physiological gains bore little relationship to initial psychological status. Gains in CHF Questionnaire and Standard Gamble scores were strongly associated with initial scores for these variables (dyspnea, P = .02; mastery, P = .005; standard gamble, P = .001), but could not be predicted from either initial physiological status or gains in physiological condition.Conclusions.Initial cardiorespiratory status provides little indication of which patients with CHF respond well to training. Gains in QOL score are influenced by initial scores, and seem to show a "ceiling" effect.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Background.Plasma Vitamin E status may indicate protection against cholesterol oxidation. The purpose of this study was to determine if the plasma vitamin E status is influenced by exercise training status or a single session of submaximal exercise.Methods.The 41 participants were categorized as sedentary, recreational endurance trained, competitive endurance trained, or cardiac rehabilitation patients. Subjects completed a 3-day dietary record. After a 24-hour diet and exercise control period, including a 12-hour fast, venous blood was collected. Plasma was analyzed for total cholesterol, high-density lipoprotein cholesterol (HDL-C), total lipid, vitamin E, and low-density lipoprotein(LDL) vitamin E concentrations. Each subject then exercised on a treadmill at 60% of measured maximal oxygen consumption for 30 minutes. Postexercise samples were collected 5 minutes after the activity.Results.Multivariate analysis of variance and follow-up Tukey post hoc tests indicated that the cardiac rehabilitation group had lower total fat and monounsaturated fat intake in the diet than the other groups, and the competitive-endurance trained group had higher HDL-C levels. Plasma vitamin E was higher in the cardiac rehabilitation group, but the statistical differences disappeared when expressed per unit of plasma total lipid. The vitamin E content of LDL was not different among the groups. A single exercise session did not alter the plasma lipoprotein or vitamin E status.Conclusions.These results suggest that habitual activity level of healthy individuals or a single session of exercise does not influence the plasma vitamin E or LDL vitamin E concentrations. However, patients in an endurance cardiac rehabilitation program tend to show normal to elevated plasma vitamin E status.

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1998

数据来源: OVID