Comparison of the functional and cardiovascular effects of home-based versus supervised hospital circuit training exercises in male wheelchair users with chronic paraplegia.

OBJECTIVES: The aim of this study was to compare the efficacy of home-based upper extremity circuit training exercises (CTEs) with supervised hospital program in male patients with traumatic complete paraplegia. PATIENTS AND METHODS: Twenty men with paraplegia (mean age: 38±10.1 years; range, 30 to 43 years) between January 2007 and November 2007 were randomized into two groups. The first group had supervised hospital CTE program, whereas the second group had home-based CTE. The effects of the upper extremity CTE by using elastic bands 60 min per day, five days a week, for a total of eight weeks (70% maximal oxygen consumption [VO2max]) were examined. The Cybex was used for the isokinetic testing of the upper extremities. The VO2max and maximum heart rate (HR) were assessed using an arm ergometer. The Craig Handicap Report Technique Short Form (CHART-SF) was used for the evaluation of functional independence and mobility. Serum lipid profiles were measured. RESULTS: The mean injury duration was 7.9±2 years. The peak torque values of the upper extremities, VO2max, maximum HR, CHART-SF physical independence and mobility scores, and serum lipid profile were all improved in both groups (p<0.05). There were no significant differences in terms of the increase in the muscle strength and serum lipid levels between the groups (p>0.05). The improvement in the VO2max, physical independence, and mobility scores were greater in the supervised exercise group. CONCLUSION: Upper extremity strength, cardiovascular endurance, and lipid profile were improved after supervised and home-based CTE in the men with paraplegia. Home-based exercise programs may be good alternatives to the hospital rehabilitation for this patient population.

Oxygen Uptake Efficiency Slope and Prediction of Post-operative Morbidity and Mortality in Patients with Lung Cancer.

OBJECTIVE: Peak oxygen consumption is a very valuable cardiopulmonary functional parameter in pre-operative evaluation of patients with lung cancer. However, it has several critical limitations for operability decision due to failure in achieving maximal level of exercise test for cases. The aim of this study was to reveal the importance of more accurate cardiopulmonary parameters that can be calculated from data of submaximal level test, such as oxygen uptake efficiency slope (OUES) and to determine whether it could be used in the operability decision phase for borderline cases by means of morbidity and mortality. MATERIALS AND METHODS: One hundred and twenty-five patients who were scheduled to undergo lung surgery due to lung cancer were included in the study. Peak oxygen uptake (pVO2), heart rate at the anaerobic threshold, and oxygen consumption volume at anaerobic threshold values were obtained after performing the cardiopulmonary exercise test. The OUES value was calculated from the ratio of the peak VO2 value and logarithmic equivalent of the ventilatory volume (VE). The following equation was used for determining OUES: VO2/log10 VE. RESULTS: The peak VO2 mean value was 21.37 ± 4.20 mL/min/kg in patients. However, OUES mean value was 12.44 ± 2.11. When the metabolic parameters of the patients were compared, a significant correlation was determined between the peak VO2 value and peak VE, OUES, and survival (p < 0.01). CONCLUSION: This study demonstrated that OUES is significantly correlated with peak VO2 and it does not require the performance of maximal exercise and can be used together with peak VO2 in this patient population when there is difficulty in making decision for surgery in patients with lung cancer.

Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease.

OBJECTIVE: The aim of this study was to determine the impact of diabetes and diastolic dysfunction on exercise capacity in asymptomatic, normotensive patients with type 2 diabetes without coronary artery disease. METHODS: A total of 43 type 2 diabetes patients (age: 50 ± 5 years) and 20 healthy controls (age: 48 ± 4 years) were enrolled. Diastolic function was investigated by conventional pulsed-wave (PW) Doppler and tissue Doppler imaging (TDI). Exercise capacity was evaluated with cardiopulmonary exercise testing (CPET). RESULTS: In patients with type 2 diabetes, increase in resting heart rate (HR-rest) (p = 0.013), decrease in maximum heart rate during exercise (HR-max) (p < 0.001) and exercise time (p < 0.001) compared with controls were significant. Patients had significantly increased minute ventilation volume (VE)/maximum carbon dioxide discharge (VCO2) ratio (p < 0.001), decreased maximum oxygen consumption (VO2-max) (p < 0.001), oxygen consumption at anaerobic threshold (VO2-an) (p < 0.001) and maximum carbon dioxide discharge (VCO2) (p < 0.001) compared to controls indicating significantly reduced exercise capacity. HbA1c was inversely correlated with VO2-max (r = -0.456, p < 0.01) independent of the absence or presence of mild diastolic dysfunction. CONCLUSION: Exercise capacity was found to be significantly decreased in normotensive patients with type 2 diabetes without coronary artery disease, and this decrease was independent of diastolic dysfunction.

Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction?

INTRODUCTION: Myocardial infarction (MI) as a life-threatening event, carrying high risk of recurrence and chronic disabling complications, increases the risk of developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or both. The aim of this study was to investigate the relationship between illness perceptions and having ASD, PTSD, or both in patients after MI. METHOD: Seventy-six patients diagnosed with acute MI were enrolled into our prospective study. We evaluated patients during the first week and six months after MI. Patients were assessed by using the Clinician Administered PTSD Scale (CAPS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Brief Illness Perception Questionnaire (BIPQ), and a semi-structured interview for socio-demographic characteristics during both the first and second evaluations. RESULTS: Acute stress disorder (ASD) developed in 9.2% of patients and PTSD developed in 11.9% of patients with MI. Illness perception factors of 'consequences, identity and concern' predicted the occurrence of both ASD and PTSD, whereas 'emotion' predicted only PTSD. CONCLUSION: The factors of illness perceptions predicted the induction of ASD and PTSD in patients who had acute MI.

Muscular kinetics and fatigue evaluation of knee using by isokinetic dynamometer in patients with ankylosing spondylitis.

OBJECTIVE: Ankylosing Spondylitis (AS) is an inflammatory disease that is observed with arthritis, sacroiliitis and disability. The aim of the study was to compare the strength and fatigue of knee extensor/flexor muscle group usage by isokinetic in patients with AS with controls. METHODS: Twenty-six AS diagnosed patients and twenty-six healthy volunteers with similar age, height, body weight and gender were included in this study. In both groups the isokinetic tests are conducted by isokinetic dynamometer for every subject. Knee extension/flexion patterns;peak torque, agonist/antagonist ratio and work fatigue isokinetic parameters were evaluated during the knee 60º/s, 180º/s and 240º/s angular velocities. RESULTS: Knee extension/flexion muscle strength in patient group was significantly lower compared to the control group in all angular velocities (p< 0.05). CONCLUSIONS: The study showed knee muscle weakness and fatigue in patients with AS compared to the control group.

The incognita of the known: the athlete's heart syndrome.

Long-term athletic activity causes morphological and functional changes in the heart characterized as left ventricle cavity dimension changes, wall thickness and mass increase and rhythm conduction changes. This condition is identified as "athlete's heart syndrome". The changes that are seen clinically occur as a result of physiological adaptation to exercise. Cardiovascular adaptation depends on the exercise's type as well as its frequency, duration and intensity. In the athlete's physical examination, various changes can be seen that are mistaken with pathological conditions. In addition, there are changes present due to cardiac hypertrophy, increased vagal tone and repolarization. The knowledge and recognition of the organic and functional changes developing in the athlete's heart is being helpful to differentiate physiological changes from cardiac pathologies that can cause sudden death in athletes.

Improvement of coronary flow velocity reserve with telmisartan in patients with autosomal-dominant polycystic kidney disease.

OBJECTIVES: Endothelial dysfunction (ED) has been reported in patients with autosomal-dominant polycystic kidney disease (ADPKD). Coronary flow velocity reserve (CFVR) is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of this study was to investigate the effect of the angiotensin receptor blocker, telmisartan, on CFVR in patients with ADPKD. METHODS: Thirteen patients with ADPKD and well-preserved renal function and 22 healthy controls were included in the study. CFVR was measured at baseline and after dipyridamole infusion by echocardiography. CFVR was calculated as the ratio of hyperemic to baseline average peak diastolic velocities. After the baseline evaluation of CFVR, patients started telmisartan at a dose of 80 mg/day and were followed for 12 months. CFVR was remeasured after 6 and 12 months of therapy. RESULTS: Patients with ADPKD had significantly lower CFVR compared to healthy subjects. CFVR increased significantly after 6 months and 12 months of telmisartan therapy (P = 0.001) in patients with ADPKD. CONCLUSION: One year of telmisartan therapy significantly improved CFVR in patients with ADPKD. This finding suggests that the stimulation of the renin-angiotensin-aldosterone system contributes to the ED in these patients.

Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia.

The aim of this study is to investigate relation between cardiopulmonary performance and muscular microcirculation in patients with fibromyalgia syndrome (FMS). Twenty-one female sedentary patients who were diagnosed as FMS, and 15 sedentary females were enrolled in to the study. All participants underwent a modified Bruce multistage maximal treadmill protocol with metabolic measurements and Near-Infrared Spectroscopy measurements. Exercise sessions were performed 3 times a week for 8 weeks. The results of the study suggest that cardiopulmonary system in charge of delivering oxygen to whole body and muscular microcirculation may have dysfunction in patients with FMS.

Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer.

It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10s of exercise. The following equation was used to determine OUES: VO(2)/log(10)VE. Peak VO(2) without postoperative complication was 22.8+/-3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1+/-4.2 ml/(kg min) (p=0.001). In addition, although the mean OUES in patients with present complications was 11.1+/-1.2, the mean OUES in the absent group was 13.3+/-2.1 (p<0.001). Although peak VO(2) is useful in evaluating selected patients with bronchogenic carcinoma, OUES is also a beneficial parameter and should be calculated and recorded with peak VO(2), a better predictor of poor surgical outcome than absolute values, and should be integrated into preoperative decision making.

Androgenic anabolic steroids also impair right ventricular function.

Chronic anabolic steroid use suppresses left ventricular functions. However, there is no information regarding the chronic effects of anabolic steroids on right ventricular function which also plays a key role in global cardiac function. The main objective of the present study was to investigate the effects of androgenic anabolic steroids usage among athletes on remodeling the right part of the heart. Androgenic-anabolic steroids-using bodybuilders had smaller diastolic velocities of both ventricles than drug-free bodybuilders and sedentary counterparts. This study shows that androgenic anabolic steroids-using bodybuilders exhibited depressed diastolic functions of both ventricles.

Reduced coronary flow reserve and early diastolic filling abnormalities in patients with nephrotic syndrome.

BACKGROUND: Increased cardiovascular disease risk is very well known in nephrotic syndrome. Coronary flow reserve measurement by trans-thoracic echocardiography reflects coronary microvascular and endothelial function. However, diastolic filling abnormalities by echocardiography may indicate diastolic dysfunction. Our aim was to evaluate endothelial and diastolic functions by trans-thoracic echocardiography in nephrotic syndrome. METHODS: Eighteen patients with nephrotic syndrome (five females, 34 +/- 17 years) and 30 controls (10 females, 35 +/- 10 years) were evaluated in this cross-sectional observational study. Age, weight, lipid profile, glucose, blood urea nitrogen, creatinine, serum albumin, total protein, C-reactive protein, erythrocyte sedimentation rate, blood pressures, 24-hour urine volume, and protein were recorded. Glomerular filtration rate was estimated by Cockcroft-Gault Formula. Doppler flow and other echocardiographic parameters were measured by Vivid 7 echocardiography. RESULTS: Coronary flow reserve was significantly lower in patients than controls (p < 0.001) and was negatively correlated with proteinuria (p < 0. 001), creatinine levels (p = 0.03), total cholesterol (p = 0.02), C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.005). E/A ratio was significantly lower in patients than in controls (p = 0.005). DT was significantly higher in patients than in controls (p = 0.01) and isovolumic relaxation time was similar in both groups. CONCLUSION: Coronary flow reserve and left ventricular diastolic filling are significantly impaired in nephrotic syndrome. Proteinuria, serum creatinine, total cholesterol and inflammation may have all contributory effects on endothelial dysfunction. Early evaluation of patients with nephrotic syndrome should include coronary flow and diastolic function by echocardiography.

Coronary flow velocity reserve and carotid intima media thickness in patients with autosomal dominant polycystic kidney disease: from impaired tubules to impaired carotid and coronary arteries.

BACKGROUND AND OBJECTIVES: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease. Endothelial dysfunction, an early and reversible feature in the pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening, and increased intima-media thickness. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of the study was to investigate the carotid intima-media thickness and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Thirty normotensive patients with autosomal dominant polycystic kidney disease (10 male, 20 female) with well-preserved renal function and 30 healthy subjects (12 male, 18 female) were included in the study. Coronary flow velocity reserve was measured at baseline and after dipyridamole infusion by echocardiography. Coronary flow velocity reserve was calculated as the ratio of hyperemic to baseline diastolic peak velocities. RESULTS: Carotid intima-media thickness was significantly higher in patients than in control subjects (0.80 +/- 0.29 versus 0.54 +/- 0.14 mm, respectively; P < 0.001). Moreover, coronary flow velocity reserve was significantly lower in patients than in control subjects (1.84 +/- 0.39 versus 2.65 +/- 0.68, respectively; P < 0.001). CONCLUSIONS: Normotensive patients with autosomal dominant polycystic kidney disease with well-preserved renal function have significantly increased carotid intima-media thickness and significantly decreased coronary flow velocity reserve compared with healthy subjects. These findings suggest that atherosclerosis starts at an early stage in the course of their disease in patients with autosomal dominant polycystic kidney disease.

The trivest in overreaching syndrome: cardiac fatigue, muscular weakness, and vascular dysfunction.

Although the underlying mechanisms responsible for cardiac dysfunction after prolonged exercise remains to be elucidated, it has reported cardiac deterioration following exhaustive exercise in the absence of underlying cardiovascular diseases, which has been attributed to cardiac fatigue. The objective of this study was to evaluate cardiac functions, exercise capacity, and flow-mediated dilatation in overreaching syndrome. We studied 13 male marathon runners who took part in a marathon. Cardiopulmonary exercise testing, transthoracic echocardiography and endothelium-dependent vasodilatation of the brachial artery were performed at before- and after-race. Peak oxygen consumption, left ventricular tissue Doppler imaging parameters and flow-mediated dilatation were decreased after-race values compared with before-race values. Overreaching syndrome could arise involves a physio-pathological trivest, cardio-vasculo-muscular axis, which include three vicious cycles.

Effects of different intensities of acute exercise on flow-mediated dilatation in patients with coronary heart disease.

It is known that regular exercise training improves endothelial dysfunction in coronary artery disease, but, little is known concerning different intensities of acute exercise on endothelial function. We evaluated anaerobic threshold and peak oxygen uptake level of acute exercise on flow-mediated dilatation in patients with stable coronary artery disease. Endothelium-independent vasoreactivity in patients showed a trend with increase at threshold level exercise; however, it was significantly decreased at peak level exercise. Moderate intensity exercise (nearly anaerobic threshold level) should be recommended a therapeutic and preventative strategy for starting of cardiac rehabilitation program in patients with coronary artery disease.

Acute effects of smoking on coronary flow velocity reserve and ventricular diastolic functions.

Although it is well known that chronic effect of smoking on cardiovascular system, relation between coronary vascular reactivity and ventricular functions after acute smoking has not been well understood. The purpose of this study was to assess the relation between coronary flow velocity reserve and ventricular diastolic functions measured by tissue Doppler imaging after acute smoking. We found that coronary flow velocity and diastolic functions of right ventricle were decreased. Also, there was a correlation between coronary flow velocity reserve and diastolic ratio of the ventricle. Acute smoking may affect diastolic functions of the ventricles, especially right ventricle via changes of coronary flow.