Influence of acute normobaric hypoxia on physiological variables and lactate turn point determination in trained men.

The goal of this study is to evaluate the response of physiological variables to acute normobaric hypoxia compared to normoxia and its influence on the lactate turn point determination according to the three-phase model of energy supply (Phase I: metabolically balanced at muscular level; Phase II: metabolically balanced at systemic level; Phase III: not metabolically balanced) during maximal incremental exercise. Ten physically active (VO2max 3.9 [0.49] l·min(-1)), healthy men (mean age [SD]: 25.3 [4.6] yrs.), participated in the study. All participants performed two maximal cycle ergometric exercise tests under normoxic as well as hypoxic conditions (FiO2 = 14%). Blood lactate concentration, heart rate, gas exchange data, and power output at maximum and the first and the second lactate turn point (LTP1, LTP2), the heart rate turn point (HRTP) and the first and the second ventilatory turn point (VETP1, VETP2) were determined. Since in normobaric hypoxia absolute power output (P) was reduced at all reference points (max: 314 / 274 W; LTP2: 218 / 184 W; LTP1: 110 / 96 W), as well as VO2max (max: 3.90 / 3.23 l·min(-1); LTP2: 2.90 / 2.43 l·min(-1); LTP1: 1.66 / 1.52 l·min(-1)), percentages of Pmax at LTP1, LTP2, HRTP and VETP1, VETP2 were almost identical for hypoxic as well as normoxic conditions. Heart rate was significantly reduced at Pmax in hypoxia (max: 190 / 185 bpm), but no significant differences were found at submaximal control points. Blood lactate concentration was not different at maximum, and all reference points in both conditions. Respiratory exchange ratio (RER) (max: 1.28 / 1.08; LTP2: 1.13 / 0.98) and ventilatory equivalents for O2 (max: 43.4 / 34.0; LTP2: 32.1 / 25.4) and CO2 (max: 34.1 / 31.6; LTP2: 29.1 / 26.1) were significantly higher at some reference points in hypoxia. Significant correlations were found between LTP1 and VETP1 (r = 0.778; p < 0.01), LTP2 and HRTP (r = 0.828; p < 0.01) and VETP2 (r = 0.948; p < 0.01) for power output for both conditions. We conclude that the lactate turn point determination according to the three-phase-model of energy supply is valid in normobaric, normoxic as well as hypoxic conditions. The turn points for La, HR, and VE were reproducible among both conditions, but shifted left to lower workloads. The lactate turn point determination may therefore be used for the prescription of exercise performance in both environments. Key PointsThe lactate turn point concept can be used for performance testing in normoxic and hypoxic conditionsThe better the performance of the athletes the higher is the effect of hypoxiaThe HRTP and LTP2 are strongly correlated that allows a simple performance testing using heart rate measures only.

Cardiovascular Rehabilitation With a WCD-Data From the CR3 Study (Cardiac Rehab Retrospective Review).

PURPOSE: Patients at risk for sudden cardiac death may temporarily need a wearable cardioverter-defibrillator (WCD). Exercise-based cardiac rehabilitation (CR) has a class I recommendation in patients with cardiac disease. The aim of this study was to evaluate the safety and feasibility of undergoing CR with a WCD. METHODS: We performed a retrospective analysis of all patients with a WCD who completed a CR in Austria (2010-2020). RESULTS: Patients (n = 55, 60 ± 11 yr, 16% female) with a median baseline left ventricular ejection fraction (LVEF) of 36 (30, 41)% at the start of CR showed a daily WCD wearing duration of 23.4 (22, 24) hr. There were 2848 (8 [1, 26]/patient) automatic alarms and 340 (3 [1, 7]/patient) manual alarms generated. No shocks were delivered by the WCD during the CR period. One patient had recurrent hemodynamically tolerated ventricular tachycardias that were controlled with antiarrhythmic drugs.No severe WCD-associated adverse events occurred during the CR stay of a median 28 (28, 28) d. The fabric garment and the device setting needed to be adjusted in two patients to diminish inappropriate automatic alarms. Left ventricular ejection fraction after CR increased significantly to 42 (30, 44)% ( P < .001). Wearable cardioverter-defibrillator therapy was stopped due to LVEF restitution in 53% of patients. In 36% of patients an implantable cardioverter-defibrillator was implanted, 6% had LVEF improvement after coronary revascularization, one patient received a heart transplantation (2%), two patients discontinued WCD treatment at their own request (4%). CONCLUSION: Completing CR is feasible and safe for WCD patients and may contribute positively to the restitution of cardiac function.

Complementary treatment of obesity and overweight with salacia reticulata and vitamin d.

BACKGROUND: The Indian plant root Salacia reticulata, which is rich in alpha-glucosidase inhibitors, is used for metabolic disorders in Ayurvedic medicine. Vitamin D3 is also used in the treatment of some metabolic diseases. Our goal was to determine its potential effect for humans with obesity. MATERIAL: In a randomized open-label study, we investigated 40 healthy participants aged 30 - 60 years, physically active, with a body mass index (BMI) of 25 - 45. The participants were randomly allocated into two groups. Body weight, BMI, and body composition were measured. Both groups (A and B) received a guideline for lifestyle and fitness training for 4 weeks. Group B additionally took one capsule containing 200 mg of Salacia reticulata and 1.6 µg (i. e. 64 IU) Vitamin D3 (SRD) 3 times/day with the meals. RESULTS: Significant weight and body-fat reduction within 4 weeks was observed. Group A lost 1.8 kg or 2.1 %, group B lost 5.3 kg or 6.1 % (p = 0.03), therefore BMI reduction was achieved. While Group A lost 1.4 % of body fat, group B reduced it by 4.5 % (p = 0.01). CONCLUSION: These promising results suggest that the combination of Salacia reticulata and Vitamin D3 might be highly valuable and potent to treat overweight and obesity, especially in addition to a modifying lifestyle program. Further research is needed in addition to this study to clarify pathways and effect mechanisms.

Blood lactate concentration at the maximal lactate steady state is not dependent on endurance capacity in healthy recreationally trained individuals.

The aim of the study was to investigate the independent relationship between maximal lactate steady state (MLSS), blood lactate concentration [La] and exercise performance as reported frequently. Sixty-two subjects with a wide range of endurance performance (MLSS power output 199 ± 55 W; range: 100-302 W) were tested on an electronically braked cycle ergometer. One-min incremental exercise tests were conducted to determine maximal variables as well as the respiratory compensation point (RCP) and the second lactate turn point (LTP2). Several continuous exercise tests were performed to determine the MLSS. Subjects were divided into three clusters of exercise performance. Dietary control was employed throughout all testing. No significant correlation was found between MLSS [La] and power output at MLSS. Additionally, the three clusters of subjects with different endurance performance levels based on power output at MLSS showed no significant difference for MLSS [La]. MLSS [La] was not significantly different between men and women (average of 4.80 ± 1.50 vs. 5.22 ± 1.52 mmol l(-1)). MLSS [La] was significantly related to [La] at RCP, LTP2 and at maximal power. The results of this study support previous findings that MLSS [La] is independent of endurance performance. Additionally, MLSS [La] was not influenced by sex. Correlations found between MLSS [La] and [La] at maximal power and at designated anaerobic thresholds indicate only an association of [La] response during incremental and MLSS exercise when utilizing cycle ergometry.

Long-term risk factor management after inpatient cardiac rehabilitation by means of a structured post-care programme.

BACKGROUND: Initiation of a long-term improvement of cardiac risk factors is one of the major aims of a cardiac rehabilitation/secondary prevention programme. METHODS AND PARTICIPANTS: The Health Guide collected data in terms of cardiac risk factors: blood pressure, resting pulse, total cholesterol, LDL cholesterol, body weight, physical activity and number of cigarettes at admission and discharge after a stationary rehabilitation programme and every 3 months. After 12 months the Health Guides were returned. In the prospective study 2664 patients (71.8% men, age: MV = 62.94 years, SD = 9.96; 28% women, MV = 67.59 years, SD = 9.53) with coronary heart disease (CHD) were included. RESULTS: All cardiac risk factors documented by the Health Guide improved during the cardiac rehabilitation programme. After one year, risk factors were significantly lower than at admission, apart from total cholesterol. The individual goal in terms of body weight and LDL cholesterol was partially achieved after the rehabilitation programme and maintained after one year. In the investigation years, 2004-2007, the cholesterol and blood pressure were significantly lower than in the years 2000-2003. CONCLUSION: The use of a Health Guide resulted in an improved long-term effect of a cardiac rehabilitation/secondary prevention programme. It is a simple and cheap intervention and can help in the guidance of the patients.

Cardiac rehabilitation in Austria: long term health-related quality of life outcomes.

BACKGROUND: The goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria. METHODS: Patients (N = 487, 64.7% male, age 60.9 +/- 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D]. RESULTS: All MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients.Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time. CONCLUSION: These findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.

Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing.

Determination of an 'anaerobic threshold' plays an important role in the appreciation of an incremental cardiopulmonary exercise test and describes prominent changes of blood lactate accumulation with increasing workload. Two lactate thresholds are discerned during cardiopulmonary exercise testing and used for physical fitness estimation or training prescription. A multitude of different terms are, however, found in the literature describing the two thresholds. Furthermore, the term 'anaerobic threshold' is synonymously used for both, the 'first' and the 'second' lactate threshold, bearing a great potential of confusion. The aim of this review is therefore to order terms, present threshold concepts, and describe methods for lactate threshold determination using a three-phase model with reference to the historical and physiological background to facilitate the practical application of the term 'anaerobic threshold'.

The effect of exercise on the absorption of inhaled human insulin in healthy volunteers.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Exercise is known to affect absorption of other inhaled substances, but so far there are no reports on the effect of exercise on the absorption of inhaled insulin in humans. WHAT THIS PAPER ADDS: This report is the first to investigate the effect of exercise on the absorption of inhaled insulin. In this study in healthy volunteers we found that exercise early after dosing increased absorption (15-20%) of inhaled insulin over the first 2 h after start of exercise, with an approximately 30% increase in maximal insulin concentration, and unchanged overall absorption. AIMS: To investigate the effect of moderate exercise on the absorption of inhaled insulin. METHODS: A single-centre, randomized, open-label, three-period cross-over trial was carried out in 12 nonsmoking healthy subjects. A dose of 3.5 mg inhaled human insulin was administered via a nebulizer and followed in random order by either 1) no exercise (NOEX), 2) 30 min exercise starting immediately after dosing (EX0), or 3) 30 min exercise starting 30 min after dosing (EX30). The study was carried out as a 10 h euglycaemic glucose clamp (90 mg dl(-1) (5.0 mmol l(-1))). RESULTS: The absorption of insulin over the first 2 h after start of exercise was 16% increased for EX0 (ratio (95%CI) 1.16 (1.04, 1.30), P = 0.01) and 20% increased for EX30 (1.20 (1.05, 1.36), P < 0.01), both compared with NOEX; the overall insulin absorption during 6 h and 10 h after dosing was not influenced by exercise. The maximum insulin concentration (C(max)) increased by 32% for EX0 and 35% for EX30 (both P < 0.01) compared with NOEX, while the time to C(max) was 31 min faster for EX0 (P < 0.01), but not significantly different after EX30, compared with NOEX. CONCLUSIONS: A significant and clinically relevant increase of insulin absorption over the first 2 h after the beginning of exercise was observed. Until data from studies using the specific insulin inhalers exists, patients using inhaled insulin should be made aware of a potential increased absorption and higher concentration of insulin in connection with exercise.

Menstrual cycle: no effect on exercise cardiorespiratory variables or blood lactate concentration.

PURPOSE: Numerous investigations have reported changes in metabolic and cardiorespiratory responses associated with the menstrual cycle. We examined whether variables commonly used in exercise testing are influenced by menstrual cycle phases. METHODS: Nineteen eumenorrheic women performed two incremental tests to voluntary exhaustion on a cycle ergometer during two different phases of the menstrual cycle: the follicular phase (FP) and the luteal phase (LP). Our study variables were power output, VO2, HR, VE, RER, ventilatory equivalents of oxygen (VE/VO2) and carbon dioxide (VE/VCO2), and blood lactate concentration (LA) and were measured at rest, at exhaustion, and at different thresholds of aerobic and anaerobic metabolism. The threshold determination consisted of a three-phase model with two lactate turnpoints (LTP1, LTP2) and a three-phase model with two respiratory thresholds: the anaerobic threshold (AT) and the respiratory compensation point (RCP). RESULTS: When comparing power output, VO2, LA, HR, and RER, we found no significant differences between FP and LP at rest, at maximal load, at any selected threshold, or any stage of the incremental tests. We observed higher values for VE/VO2, VE/VCO2, and VE at rest, at exhaustion, and at our AT in LP. CONCLUSION: We did not find performance changes associated with menstrual cycle. Our data do not support findings that the menstrual cycle influences lactate "thresholds" and ventilatory "thresholds." In agreement with other studies, we observed a higher ventilatory drive in the LP compared with the FP of the menstrual cycle.

Clinical applications of cardiovascular magnetic resonance.

The clinical role of magnetic resonance in diseases of the heart and great vessels is rapidly evolving. Cardiovascular magnetic resonance (CMR) has become an established non-invasive imaging modality for the assessment of various cardiac disorders, such as congenital heart disease, cardiac masses, cardiomyopathies, aortic and pericardial diseases. Moreover, due to its accuracy and reproducibility, CMR is currently considered the gold standard for quantification of ventricular volumes, function, and mass. Thus, this technique is ideally suited to assess the efficacy of therapeutic interventions on ventricular hypertrophy and remodelling, which may allow a reduction in sample size to show clinically relevant effects. Comprehensive functional assessment is possible by CMR due to its capability to measure flow velocity and flow volume, which is a basic requirement to quantify lesion severity in valvular heart disease. Within the past years, major technical advances have considerably improved acquisition speed and image quality making CMR a useful tool for the evaluation of patients with ischaemic heart disease. Although the clinical robustness of coronary magnetic resonance angiography still needs improvement, CMR currently provides valuable information to detect reversible ischemia, myocardial infarction, and residual viability. In this review we will present in detail the well-established indications of CMR accompanied by an outlook on new applications that are likely to enter the clinical arena in the near future.

Influence of permanent right ventricular pacing on cardiorespiratory exercise parameters in chronic heart failure patients with implanted cardioverter defibrillators.

STUDY OBJECTIVES: Patients with chronic heart failure and implanted cardioverter-defibrillators (ICDs) may have a higher incidence of new-onset or worsening heart failure requiring hospitalization with dual-chamber ICDs compared with single-chamber ICDs. DESIGN AND SETTING: The purpose of this study was to show the impact of permanent right ventricular (RV) pacing on exercise capacity and related cardiorespiratory parameters in patients with chronic heart failure and ICDs. PATIENTS AND INTERVENTIONS: Seventeen patients with chronic heart failure and a dual-chamber ICD performed cardiopulmonary exercise testing (CPX) on 3 different days. After CPX 1, patients were randomized either to back-up pacing or permanent RV pacing. After 3 months, CPX 2 was performed and patients changed groups (crossover design); CPX 3 was performed after 3 additional months. MEASUREMENTS AND RESULTS: Maximal values for workload (108 +/- 46 W vs 117 +/- 48 W, p < 0.01), oxygen uptake (Vo(2)) [21.0 +/- 5.3 mL/min/kg vs 22.5 +/- 6.4 mL/min/kg, p < 0.05], oxygen pulse (13 +/- 3.7 mL vs 14 +/- 4.0 mL, p < 0.05), and metabolic equivalent (6.0 +/- 1.5 vs 6.4 +/- 1.8, p < 0.05) were significantly lower with permanent RV pacing compared to back-up pacing. Workload, Vo(2), and oxygen pulse were significantly reduced at the ventilatory anaerobic threshold, while workload and Vo(2) were significantly lower at the respiratory compensation point. No differences were found for maximal heart rate, minute ventilation Ve, and respiratory exchange ratio. The Ve/carbon dioxide production slope was significantly steeper with permanent RV pacing compared to back-up pacing. CONCLUSIONS: Permanent RV pacing significantly reduced maximal and submaximal measures of exercise. For patients with chronic heart failure and sufficient atrioventricular conduction, every effort should be made to minimize permanent right ventricular pacing.

Hemodynamic observations in two pulmonary hypertensive patients changing treatment from inhaled iloprost to the oral endothelin-antagonist bosentan.

Two female patients with pulmonary arterial hypertension and a permanently implanted hemodynamic monitor changed treatment from inhaled iloprost to oral bosentan. The hemodynamic changes were seen very early after the first dose of bosentan and there was no need to re-establish inhaled iloprost.

Beta1-adrenoceptor mediated origin of the heart rate performance curve deflection.

PURPOSE: The deflection of the HR performance curve (HRPC) has been described as an objective marker of submaximal exercise performance. HR response to incremental cycle ergometer exercise is shown to be neither linear nor uniform and a physiological explanation of the deflection phenomenon is lacking. We hypothesized that differences in the beta1-adrenoceptor site are the source of these differences. The aim of the study was to investigate the influence of the highly selective beta1-adrenoceptor (beta1-AR) antagonist bisoprolol (Bi) on the HRPC in young healthy male subjects with different HR response patterns. METHODS: Sixteen subjects were treated in randomized order with Bi or a placebo (Pl) in two separate trials. HR response during incremental cycle ergometer exercise was compared between the two trials. Blood lactate concentration (La) and ventilatory variables were measured throughout both tests. RESULTS: Bi changed the direction of the HRPC more in subjects with a regular, s-shaped response pattern under placebo than those with a nonregular or linear pattern. The influence of Bi on the HR at the second lactate turn point was significantly related (R = 0.78; P < 0.001) to the pattern of the HRPC in Pl conditions. CONCLUSION: We suggest that differences between the subjects with regular s-shaped versus nonregular HRPC may be due to differences at the beta1-AR site. The origin of the HRPC deflection is mediated in part by the beta1-AR sensitivity.

Continuous haemodynamic monitoring during exercise in patients with pulmonary hypertension.

BACKGROUND: Right heart haemodynamic parameters can be recorded continuously with the help of an implanted haemodynamic monitor. Aim of the study was to assess the haemodynamic response with and without inhalation of iloprost during cardiopulmonary exercise testing (CPET) in patients with pulmonary hypertension. MATERIALS AND METHODS: Five female patients with documented pulmonary hypertension (mean +/- S.D. age 47 +/- 16 years, 4 arterial, 1 venous) previously implanted with a haemodynamic monitor underwent an incremental exercise test on 2 separate days. The tests were performed before and immediately after inhalation of a single dose of iloprost (17 microg). Parameters recorded by the device were right ventricular (RV)-afterload (RV systolic pressure, RVSP), RV-preload (RV diastolic pressure, RVDP), estimated pulmonary artery diastolic pressure (ePAD), heart rate (HR) and maximum positive rate of RV pressure development (RVdP/dt) (reflecting the dynamic and inotropic state of the RV). RESULTS: After inhalation of iloprost, RV systolic pressure was always reduced at rest. It was followed by an increase with higher workloads without any difference at VO(2peak). The time course of RV systolic pressure was not linear with a flattening at higher workload during the test. This behaviour was found irrespective of iloprost treatment. The remaining determinants of RV performance showed no relevant differences and a linear behaviour during the exercise test. CONCLUSIONS: Inhalation of aerosolised iloprost resulted in a reduction in right ventricular pressure at rest but not at maximal workload. The implantable haemodynamic monitor (IHM) may be useful for the evaluation of RV haemodynamics during exercise and in assessing treatment efficacy.

Tako-tsubo cardiomyopathy and post-traumatic stress disorder after a skiing accident: a case report.

BACKGROUND: Symptoms of a post-traumatic stress disorder can follow Tako-tsubo cardiomyopathy. This vignette describes such a linkage and exemplifies the risk that these symptoms may remain undetected. CASE PRESENTATION: After a skiing accident that had evoked existential fear of suffocation, a post-menopausal woman was diagnosed with Tako-tsubo syndrome and myocardial contusion. Symptoms of post-traumatic stress disorder appeared 2 weeks after remission of the cardiomyopathy. Two months later, a psychological assessment was conducted during cardiac rehabilitation. A post-traumatic stress disorder was diagnosed and successfully treated by narrative exposure. CONCLUSION: This case report suggests that these patients should be informed during the initial hospital stay that post-traumatic stress symptoms could appear. It also suggests including a screening for post-traumatic stress disorder in the follow-up of these patients.

Austrian survey of treating heart failure--AUSTRIA.

BACKGROUND: Treatment of chronic heart failure is based on the results of large clinical trials, which form the basis of treatment guidelines, such as those from the European Society of Cardiology (ESC). The aim of this study was to record treatment-modalities and the implementation of guidelines of chronic heart failure in clinical practice in Austria. METHODS: Overall 96 general physicians, specialists for internal medicine in private practice or in hospital outpatient departments participated in the survey. Physicians were asked to prospectively document 30 consecutive patients with chronic heart failure. RESULTS: 1880 patients were documented. The majority of patients were treated by general physicians (57%). Coronary artery disease was the most frequent aetiology for heart failure (47%). The most frequently used drugs were blockers of the renin-angiotensin-system (RAS-blocker including ACE-inhibitors and angiotensin-receptor-blockers, 78%), diuretics (76%) and beta-blockers (49%). Other drugs like digitalis and spironolactone were used infrequently. Average doses of ACE-inhibitors were approximately 90% of those recommended by the ESC, average doses of beta-blockers were approximately 50% of those recommended. Treatment among the three classes of physicians differed with respect to RAS-blockers and beta-blockers, which were used infrequently by general practitioners. Both groups of drugs were given more frequently to younger patients (<70 years) while digitalis was given more often to elderly patients. CONCLUSIONS: Results from this survey suggest that Austrian physicians treating patients with heart failure use the appropriate drugs in dosages that are suggested by recently published guidelines (ACE-inhibitors and beta-blockers). However, dosages of spironolactone clearly differed from current recommendations.

Effect of high-volume and -intensity endurance training in heart transplant recipients.

BACKGROUND: A recommended component of heart transplant recipients (HTR) is endurance-oriented exercise therapy. However, the trainability of HTR after transplantation is vague. We examined the effect of high-volume and -intensity exercise training on exercise performance in HTR, compared with HTR undergoing regular rehabilitation training, and sedentary healthy subjects (SHS). METHODS: We studied four groups of individuals; of those, three groups were HTR. Subjects were a regularly trained HTR group of denervated (HTR-D; N = 15), reinnervated (HTR-R; N = 26) hearts, a high-volume and -intensity endurance-training group (training time 7-20 h.wk(-1); HTR-ET; N = 12), and a group of sedentary healthy subjects (SHS; N = 21). All participants performed cardiopulmonary exercise testing. RESULTS: The HTR-ET achieved a significantly higher performance (255 +/- 47 W, VO(2max) of 45.2 +/- 6.9 mL.kg(-1).min(-1)) in contrast to all other groups (HTR-D: 119 +/- 17 W, VO(2max) of 17.4 +/- 4.5 mL.kg(-1).min(-1); HTR-R: 119 +/- 17 W, VO(2max) of 16.9 +/- 3.7 mL.kg(-1).min(-1); SHS: 184 +/- 19 W, VO(2max) of 35.0 +/- 6.9 mL.kg(-1).min(-1)). The HR at maximal power output in the HTR-ET was 169 +/- 17 bpm and similar to SHS (164 +/- 17 bpm), but significantly higher than HTR-D (125 +/- 16) and HTR-R (142 +/- 10). Maximal lactate concentration (LAmax) of HTR-ET was 9.9 +/- 2.2 mmol.L(-1), comparable to SHS (9.2 +/- 2.1 mmol.L(-1)), and significantly higher than HTR-D (5.5 +/- 1.5 mmol.L(-1)) and HTR-R (5.1 +/- 1.0 mmol.L(-1)). CONCLUSIONS: Data suggest that HTR can perform high-volume and -intensity exercise training, reaching exercise performance comparable to or even exceeding values of sedentary or moderately trained healthy subjects.

Long-term effects of outpatient cardiac rehabilitation in Austria: a nationwide registry.

AIM: Our Working Group on Out-Patient Cardiac Rehabilitation (AGAKAR) has previously published guidelines, which were endorsed by the Austrian Society of Cardiology. It was the aim of this study to assess the short-term (phase II) and long-term (phase III) effects of these guidelines by use of a nationwide registry. METHODS: All Austrian out-patient rehabilitation facilities entered data into a database of all consecutive patients who completed phase II (4-6 weeks) and/or III (6-12 months) rehabilitation between 1.1.2009-30.11.2011. RESULTS: Data of 1432 phase II and 1390 phase III patients were assessed. Despite the wide spectrum of cardiac diseases patients' exercise capacity improved during phase II by 20 (-193 to 240) watts; 91.0% reached a systolic blood pressure <140 mmHg; 68.1% an LDL <100 mg/dl; 69.8% triglycerides <150 mg/dl, and 66.2% of male patients had a waist circumference <102 cm. During phase III improvement in cardiovascular risk factors, quality of life, anxiety, and depression were further improved in an increasing number of patients. CONCLUSIONS: Our data demonstrate beneficial short- and long-term effects of the Austrian model of out-patient cardiac rehabilitation and provide support for comprehensive long-term rehabilitation programs. Furthermore, our model might be helpful for those who are at the verge of initiating or modifying their programs. It is also hoped that these data will motivate colleagues to refer their patients to out-patient cardiac rehabilitation facilities and that our results may stimulate insurance companies to grant further and comprehensive contracts to provide access for all suitable patients.

Myocardial dimensions and hemodynamics during 24-h ultraendurance ergometry.

PURPOSE: This study aimed to evaluate cardiorespiratory and hemodynamic responses during 24 h of continuous cycle ergometry in ultraendurance athletes. METHODS: Eight males (mean ± SD; age = 39 ± 8 yr, height = 179 ± 7 cm, body weight [Wt] = 77.1 ± 6.0 kg) were monitored during 24 h at a constant workload,∼25% below the first lactate turn point at 162 ± 23 W. Measurements included Wt, HR, oxygen consumption (V˙O2), cardiac output (Q), and stroke volume (SV) determined by a noninvasive rebreathing technique (Innocor; Innovision, Odense, Denmark). Myocardial dimensions were evaluated using a two-dimensional echocardiogram. [M-mode measurement]-left atrial (LAD), ventricular end-diastolic (LVEDD), and end-systolic diameters (LVESD) were obtained over the left parasternal area. Venous blood samples were analyzed for hematocrit (Hct%), albumin (g·L(-1)), aldosterone (pg·mL(-1)), CK, CK-MB (U·L(-1)), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (pg·mL(-1)). RESULTS: HR (bpm) significantly increased (P < 0.01) from 1 h (132 ± 11) to 6 h (143 ± 10) and significantly decreased (P < 0.001) from 6 to 24 h (116 ± 10). V˙O2 and (Q were unchanged during the 24 h. Wt (76.6 ± 5.6 vs 78.7 ± 5.4), SV (117 ± 13 vs 148 ± 19), LVEDD (4.9 ± 0.3 vs 5.6 ± 0.2), and LAD (3.6 ± 0.5 vs 4.3 ± 0.7) significantly increased between 6 and 24 h (P < 0.001). No significant changes were observed for LVESD. Hct (45.1 ± 1.3 vs 41.3 ± 1.2) significantly decreased (P < 0.05) and CK (181 ± 60/877 ± 515), aldosterone (48 ± 17 vs 661 ± 172), and NT-proBNP (23 ± 13 vs 583 ± 449) significantly increased (P < 0.05). The increase in SV (ΔSV) was significantly related to changes in Wt (ΔWt), and HR (ΔHR) and ΔWt were significantly related to ΔLAD and ΔLVEDD. CONCLUSION: Our findings suggest that the decrease in HR during 24 h of ultraendurance exercise was due to hypervolemia and the associated ventricular loading, increasing left ventricular diastolic dimensions because of increased SV and LVEDD, resulting in an increase in NT-proBNP.

[Resistance training for patients with cardiovascular diseases]. / Bedeutung des Krafttrainings zur Prävention und Rehabilitation internistischer Erkrankungen : Konsensuspapier der AG Kardiologische Rehabilitation und Sekundärprävention der Österreichischen kardiologischen Gesellschaft.

Physical training is part of the recommendations for prevention and rehabilitation of cardiovascular and metabolic diseases. The main focus was on endurance training for a long time. However, a positive effect of strength training has also been found for patients with with a wide spectrum of diseases. Beside the improvement of muscle strength similar positive effects as with endurance training have been documented. Moreover, improvements of quality of life and mobility have been found, mainly for older patients. Resistance training is safe and can be recommended to a wide range of patients including those with reduced left ventricular function.