COMPARISON OF WEARABLES FOR SELF-MONITORING OF HEART RATE IN CORONARY REHABILITATION PATIENTS.

The leading cause of morbidity and mortality in the world is ischemic heart disease. Physical activity is a major approach in prevention and therapy of cardiac diseases. Self-heart-rate-monitoring in daily life is an important point for health awareness of cardiac patients. Aim of this study was validation of measurement accuracy of seven different devices against ECG-monitoring during cardiac rehabilitation training on a bicycle ergometer. Tested devices were: Garmin Forerunner 35 (Garmin), Mio Fuse (Mio), Fitbit Charge HR (FitbitHR), Fitbit Surge (FitbitS), Withings Pulse™ Ox (Withings), Apple Watch Series 1 (Apple) and Pearl Fitness-Tracker (FBT-50.HR PRO.V4). All devices were tested on 35 participants with six timed measurements during 20 minutes constant load bicycle ergometer workout for each. Simultaneousely, ECG measurements were recorded. Pearson´s correlations were assessed. Apple, Mio, and Garmin showed excellent accuracy with close correlation to ECG for self-monitoring of heart rate (HR) during cycling. FitbitHR, Pearl and FitbitS presented reasonable results. In contrast, Withings showed poor correlation to ECG with significant differences. We found significant differences between the tested devices. Since accuracy is of major importance for cardiac patients, only Apple, Mio and Garmin could be recommended. However, further research within distinct clinical and non-clinical settings is necessary and should take different types of physical activities into account.

[Application and effects of blood flow restriction training]. / Anwendung und Effekte des "blood flow restriction training".

Blood flow restriction (BFR) limits arterial and venous blood flow and leads to blood pooling, which could increase exercise-induced training effects. Strength training at lower intensities (20-30% of maximum strength) in combination with BFR showed similar effects on muscle hypertrophy as training with 70% without BFR. Low-intensity cycling endurance training with BFR improves muscle hypertrophy and endurance performance and activates angiogenesis. After determination of the complete occlusion pressure on the corresponding extremity, it is recommended that BFR training should be performed with 40-80% of the measured occlusion pressure. During strength training of the upper extremities, an occlusion of 60-80% leads to a reduction in the arterial blood flow by 20-50%. Local ischemia and hypoxia, a stronger metabolic stimulus, swelling of the muscle cells and the increased oxidative stress are discussed as causes for the increased training effects due to BFR. In short-term studies, comparable adjustments to parameters of fibrinolytic activity, coagulation and inflammation could be observed for strength training with and without BFR. So far, thromboses after BFR have been described only rarely but need to be further clarified by appropriate studies. The BFR training leads to a stronger activation of the muscular metabolic reflex and thus to a relatively greater increase in exercise blood pressure, so that cardiovascular parameters should be controlled during BFR training. First meta-analyses with small numbers of healthy people and patients indicate the effectiveness of BFR training. Standardization or guidelines for clinical use are still lacking.

Whole-body vibration training as a workplace-based sports activity for employees with chronic low-back pain.

The goal of this randomized and controlled study was to examine whether whole-body vibration (WBV) training is able to reduce back pain and physical disability in seated working office employees with chronic low-back pain in a real-world setting. A total of 41 subjects (68.3% female/mean age 45.5±9.1 years/mean BMI 26.6±5.2) were randomly allocated to an intervention group (INT [n=21]) or a control group (CON [n=20]). The INT participated in WBV training 2.5 times per week for 3 months. The primary outcome was the change in the Roland and Morris disability questionnaire (RMQ) score over the study period. In addition, secondary outcomes included changes in the Oswestry Disability Index (ODI), the Work Ability Index Questionnaire, the quality of life questionnaire SF-36, the Freiburger activity questionnaire, and an isokinetic test of the musculature of the trunk. Compliance with the intervention in the INT reached a mean of 81.1%±31.2% with no long-lasting unwanted side effects. We found significant positive effects of 3 months of WBV training in the INT compared to the CON regarding the RMQ (P=.027), the ODI (P=.002), the SF-36 (P=.013), the Freiburger activity questionnaire (P=.022), the post-interventional sick-leave in the INT (P=.008), and trends regarding a positive effect of the intervention on the muscular capacity of the muscles of the trunk in flexion. WBV training seems to be an effective, safe, and suitable intervention for seated working employees with chronic low-back pain.

The KTx360°-study: a multicenter, multisectoral, multimodal, telemedicine-based follow-up care model to improve care and reduce health-care costs after kidney transplantation in children and adults.

BACKGROUND: Follow-up care after kidney transplantation is performed in transplant centers as well as in local nephrologist's practices in Germany. However, organized integrated care of these different sectors of the German health care system is missing. This organizational deficit as well as non-adherence of kidney recipients and longterm cardiovascular complications are major reasons for an impaired patient and graft survival. METHODS: The KTx360° study is supported by a grant from the Federal Joint Committee of the Federal Republic of Germany. The study will include 448 (39 children) incident patients of all ages with KTx after study start in May 2017 and 963 (83 children) prevalent patients with KTx between 2010 and 2016. The collaboration between transplant centers and nephrologists in private local practices will be supported by internet-based case-files and scheduled virtual visits (patient consultation via video conferencing). At specified points of the care process patients will receive cardiovascular and adherence assessments and respective interventions. Care will be coordinated by an additional case management. The goals of the study will be evaluated by an independent institute using claims data from the statutory health insurances and data collected from patients and their caregivers during study participation. To model longitudinal changes after transplantation and differences in changes and levels of immunosuppresive therapy after transplantation between study participants and historical data as well as data from control patients who do not participate in KTx360°, adjusted regression analyses, such as mixed models with repeated measures, will be used. Relevant confounders will be controlled in all analyses. DISCUSSION: The study aims to prolong patient and graft survival, to reduce avoidable hospitalizations, co-morbidities and health care costs, and to enhance quality of life of patients after kidney transplantation. TRIAL REGISTRATION: ISRCTN29416382 (retrospectively registered on 05.05.2017).

[Development and Implementation of a Comprehensive Health Management System (Fit for Work and Life) for Employees of a University Hospital - A Practice Report]. / Entwicklung und Implementierung eines umfassenden Gesundheitsmanagements (Fit for Work and Life) für Mitarbeiter/innen eines Universitätsklinikums ­ ein Praxisbericht.

Background: Due to the increase of sick leave, prolonging working life and the prediction of shortage of skilled workers in the future, health management systems are continuously gaining importance. Employees in a University Hospital are exposed to particular stress factors, which are also reflected in a higher than average amount of sick leave. Against this background, the project "Fit for Work and Life" (FWL) was developed and implemented by the Hannover Medical School (MHH). Aims: FWL aims to maintain, improve or recover the work ability of employees by offering both preventive and rehabilitative treatments. A second goal is to significantly reduce the days of sick leave. Methods: The project was jointly developed and implemented by five MHH departments and the DRV Braunschweig-Hannover (DRV BS-H) according to previously defined principles. It was scientifically evaluated by the following outcomes: average days of sick leave, work ability (WAI), quality of life (SF-36, WHOQOL), coping strategies (FERUS) and effort-reward imbalance (ERI). Results and Conclusions: So far, this project is unique in its concept. It has been successfully implemented in the organisational structures of the MHH. 376 employees have registered during the first project year. Up to now, 182 participants have completed their individual programmes. The results show that 60.4% of employees have moderate to poor WAI values. The average of the mental summary scale of the SF-36 was 44.9, indicating a high workload.

[What is currently available for sport medicine therapy?] / Was ist gesichert in der sportmedizinischen Therapie?

After 30 years of age physical capacity decreases with increasing age by 5-20% per decade. High physical activity in daily life as well as exercise training of endurance, strength, coordination and mobility can delay the functional and anatomical loss of muscle, bone, cartilage and connective tissue by more than 10 years. In recent years, numerous concepts have scientifically been proven in the exercise therapy of internal diseases; therefore, similar to drug treatment, cellular mechanisms of exercise training adaptation are known in detail. With this knowledge the type, dose and intensity of exercise training can be defined in such a way that the targeted use of physical training can achieve health benefits similar to the effects achieved by drugs. This applies to the cardiovascular system, lungs, cancer, metabolic diseases and the immune system. In exercise training therapy of patients, individual exercise programs should be defined in a way that the contents of endurance, strength, coordination and mobility address all health and personal concerns of the patient. For sustained effects and high motivation, the individual and disease-specific definition of exercise programs as well as regular monitoring are necessary. The prescription for movement as well as the prescriptions for sports rehabilitation and functional training incorporate important assistance in this context.

[Exercise and cellular adaptation of muscle]. / Körperliches Training und zelluläre Anpassung des Muskels.

Resistance training and to a lesser extent endurance training are capable of enhancing protein synthesis in skeletal muscle via various signaling pathways. Additionally, the expression of muscle fiber types responds to different regimes of training stimuli and immobilization as characterized by changes in myosin heavy chain isoforms (I<-->IIA<-->IIX). Eccentric resistance training has been shown to be highly efficient in inducing sarcomeric protein assembly in the longitudinal orientation of muscle cells. However, concentric contractions lead to a hypertrophic response (increased fiber diameter) in muscle which can still be activated in old age. The central signaling pathway to mediate the elevation of protein synthesis in response to training is the mTOR pathway, which is also stimulated by free amino acids. Moreover, adaptation to endurance training is mediated by the calcium-calcineurin-NFATc1 pathway which is strongly activated by the calcium transients involved in the muscle contraction process. High contraction frequency and long duration of training sessions are essential for activation and maintenance of fiber type I expression as well as for induction of transformation of type II into type I fibers. Endurance training sessions should therefore be longer than 30 min and dominated by periods of high frequency contractions. A further factor in the muscular response to training includes the recruitment and integration of satellite cells into muscle fibers. Satellite cells can respond to muscular stretch, activity and injury with increased proliferation and can later be integrated into muscle fibers. Therefore, new myonuclei are available to enhance mRNA synthesis and protein expression in muscle cells. New understanding of the cellular mechanisms of signal transduction in muscle in response to training, bed rest and ageing will help to optimize training and interventions in an ageing population.

Exercise increases serum brain-derived neurotrophic factor in patients with major depressive disorder.

BACKGROUND: Brain derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of major depressive disorder (MDD). Existing data on exercise treatment in people with MDD are inconsistent concerning the effect of exercise on BDNF pointing either to increased or unaltered BDNF concentrations. However, studies in non-depressed persons demonstrated a significant effect on resting peripheral BDNF concentrations in aerobic training interventions. Given the lack of clarity mentioned above, the current study aimed at examining the effect of adjunctive exercise on serum BDNF levels in guideline based treated patients with MDD. METHODS: 42 depressed inpatients were included, and randomized either to a 6 week structured and supervised exercise intervention plus treatment as usual (EXERCISE, n=22), or to treatment as usual (TAU, n=20). BDNF serum concentrations were assessed before and after the intervention in both study groups with established immunoassays. RESULTS: Serum BDNF slightly decreased in the TAU group, whilst there was an increase in BDNF levels in the exercise group. There was a significant time x group effect concerning sBDNF (p=0.030) with repeated ANOVA measures with age and BMI as covariates, suggesting an increase in BDNF concentrations in the EXERCISE group compared to TAU. LIMITATIONS: Though there was no statistic difference in the antidepressant medication between EXERCISE and TAU potential interactions between exercise and medication on the effects of exercise in BDNF cannot be excluded. Gender was not considered as a covariate in ANOVA due to the small number of objects. CONCLUSIONS: Exercise training given as adjunct to standard guideline based treatment appears to have additional effects on BDNF serum concentrations in people with MDD. Our results add further evidence to the beneficial effects of exercise in the treatment of MDD.

Effects of additional exercise training on epicardial, intra-abdominal and subcutaneous adipose tissue in major depressive disorder: A randomized pilot study.

OBJECTIVE: Major depressive disorder (MDD) is associated with increased amounts of intra-abdominal and epicardial adipose tissue, risk factors for the development of cardio-metabolic disorders. Exercise has been shown to reduce intra-abdominal fat in different conditions such as obesity and diabetes mellitus, thereby reducing cardio-metabolic risks. Therefore we examined the effects of exercise on adipose tissue compartments in patients with MDD. METHODS: Of thirty depressed patients included, twenty received supervised exercise training, and ten received no specific training. Volumes of subcutaneous, intra-abdominal and epicardial adipose tissue were measured using magnetic resonance imaging, and factors constituting the metabolic syndrome were determined. RESULTS: Significant effects of the training condition were observed on the amount of epicardial adipose tissue (P=0.017), subcutaneous adipose tissue (P=0.023), weight (P=0.047), body-mass index (P=0.04), high density lipoproteins (P=0.021) and the number of metabolic syndrome factors (P=0.018). The amount of intra-abdominal adipose tissue decreased slightly, although not significantly, in the exercise group. CONCLUSION: Exercise training reduces the amount of visceral, in particular epicardial adipose tissue, in patients with MDD, and ameliorates factors constituting the metabolic syndrome. Given the high prevalence of cardio-metabolic disorders in major depression, exercise training may be recommended as an additional treatment component.

Estimation of an individual equilibrium between lactate production and catabolism during exercise.

During an incremental exercise test after a preceding bout of maximum exercise, blood lactate initially decreases to an individual minimum and then increases again. To determine whether this minimum represents an individual equilibrium between lactate production and catabolism during constant load exercise, the following field tests were performed: in 25 runners and five basketball players (series 1) the speed corresponding to the individual lactate minimum (LM) was measured in test 1 (incremental test after exercise induced lactic acidosis). On two occasions, two constant speed runs over 8 km were performed, one using the LM speed (LMS) (test 2), and another at a running speed of 0.2 m.s-1 above the LMS (test 3). Results of runners/basketball players: blood lactate concentration ([Lac-]B) in test 2 changed from 3.6/4.9 mmol.l-1 to 4.0/4.9 mmol.l-1 during the last 4.8 km, in test 3 from 4.6/4.6 mmol.l-1 to 6.5/6.9 mmol.l-1. These results indicate: 1) the LM speed in test 1 corresponds to a maximum lactate steady state speed during constant load exercise; 2) only a slight speed increase above the LM speed results in continuous marked [Lac-]B increase and earlier exhaustion. Variation of the increment duration in 13 males (series 2) shows no change of the LMS using 800-m and 1200-m increments (4.49 and 4.44 m.s-1) but a marked shift to higher speed using 400-m increments (4.96 m.s-1). Effects of low muscle glycogen stores on the LMS were determined in 10 males (series 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Physical capacity and quality of life in patients with multiple sclerosis.

BACKGROUND: Physical capacity (PC) and quality of life (QoL) are both reduced in multiple sclerosis (MS). OBJECTIVE: Aim of our study was to investigate limitations in PC and QoL in response to the severity of MS. METHODS: The study involved 60 patients (PG) (Expanded Disability Status Scale EDSS 0-3:38, EDSS 3.5-6:22) and 48 healthy controls (CG). Endurance capacity was assessed as peak oxygen uptake (VO2peak) and ventilatory anaerobic threshold (VAT). Maximum force was measured in isokinetic testing. QoL was assessed using the SF-36-questionnaire and HALEMS. RESULTS: Patients with MS showed reduced VO2peak and QoL in comparison with CG. Patients with an EDSS >3 showed reduced VO2peak, and maximum force, however at the VAT there was no significant difference independent of the EDSS. The MS-specific QoL HALEMS and subscales 1, 4, 6, 8 and the physical sum score of the SF-36-questionnaire were evaluated to be better in patients with an EDSS ≤3. CONCLUSIONS: There are limitations within PC in patients with MS in comparison with a healthy CG; within the PG there are notes on a similar aerobic capacity but worsened anaerobic capacity in patients with an EDSS >3. This should be taken into account in future treatment strategies for training therapy.

Decision support for teletraining of COPD patients.

BACKGROUND: Supervised physical training has been shown to promote rehabilitation of patients affected by chronic obstructive pulmonary disease (COPD). Currently, due to limited resources, not all COPD patients can be trained by an expert supervisor. OBJECTIVES: The objective of our research is to construct a decision support system (DSS) which observes and controls physical ergometer training sessions of COPD patients. METHODS: A systematic literature review and expert interviews were carried out to build up the knowledge base for the DSS. RESULTS: Nine production rules were established and standardized by Drools and Arden Syntax. The developed software autonomously controls training sessions on a bicycle ergometer on the basis of vital signs data. Thus it offers a new way for the rehabilitation of COPD patients. CONCLUSION: Evaluation with nine healthy subjects in a laboratory environment has confirmed its correct function, but the effects of its use for COPD patients' rehabilitation and their quality of life have to be investigated in a further study.

Hypothalamic-pituitary-thyroid axis in moderate and intense exercise.

Exercise exerts heterogeneous effects on TSH secretion. Whereas TSH is rapidly stimulated by physical exercise within minutes, and these effects are well supported by careful experiments, the results of studies concerning intermediate and long-term response of TSH release to exercise remain unclear, and the underlying mechanism for both is still open to speculation.

[Exercise recommendation and catecholamines in patients with coronary artery disease]. / Belastungsdiagnostische Kenngrössen und Katecholamine bei Koronarpatienten.

Exercise training for patients with coronary artery disease (CAD) is recommended in a wide range between 40-85% of maximum functional capacity (MFC) or 55-90% of maximum heart rate (HR). During exercise, high levels of catecholamines and metabolic acidosis could induce arrhythmia and ischemia. But catecholamines have never been determined in CAD during constant load exercise in the upper range of recommended intensities. In 11 CAD patients (age 58+/-8 years, BMI 26.1+/-4.0 kg x m(-2), NYHA I n=7, II n=4) we tested the maximum functional capacity (MFC), norepinephrine (NE), epinephrine (E) and blood lactate ([Lac(-)](B)) in a symptom-limited incremental ergometer test. Related to the exercise recommendation, the kinetics of NE, E and [Lac(-)](B) were determined in two 30 min constant load tests in randomized order: one was performed at the anaerobic lactate threshold (CTAT), a second was performed 10% above the individual threshold intensity (CT+10%). In the incremental tests maximum workload and VO(2) were 141+/-54 W and 1766+/-532 ml x min(-1), respectively (85+/-22% of normal; [Lac(-)](B) 5.7+/-1.9 mmol x l(-1), HR 138+/-28 b x min(-1), NE 11.7+/-5.1, E 1.6+/-1.4 nmol x l(-1)). In CTAT the anaerobic threshold (63+/-7% of MFC) represented the mean range of recommended exercise intensity for CAD (40-85%) and could be validated as steady-state intensity because catecholamines and [Lac(-)](B) concentrations remained constant after the initial increase (workload 88+/-35 W, [Lac(-)](B) 3.3+/-1.4 mmol x l(-1), HR 117+/- 23 b x min(-1), NE 8.3+/-3.5, E 0.8+/- 0.7 nmol x l(-1)). In all patients CT+10% (71+/-7% of MFC) led to a continuous rise in [Lac(-)](B), to a NE overload and to earlier exhaustion, although the intensities were in the recommended training range (workload 100+/-38 W, [Lac(-)](B) 5.8+/- 1.9 mmol x l(-1), HR 129+/- 29 b x min(-1), NE 13.9+/-6.9, E 1.5+/- 1.7 nmol x l(-1); p<0.01 against CTAT for all except E). Conclusions In the upper range of recommended training intensity for CAD patients, norepinephrine and lactate were higher during endurance exercise than at MFC in incremental tests. Endurance exercise with intensities >70% of MFC could overload the cardiac patient and increase the risk of arryhthmia and ischemia. Therefore, endurance exercise should be performed below 70% of MFC or below 85% of maximum HR, respectively, whereas higher intensities should apply to interval exercise.

Changes in plasma volume and red cell formation after a marathon competition.

The purpose of this study was to investigate middle-term influences of a marathon race on plasma volume (PV) and red cell production. We performed the following measurements in the blood of 15 male athletes: haemoglobin ([Hb]), haematocrit (Hct), plasma protein concentration ([Prot]), plasma osmolality, sodium concentration ([Na+]), potassium concentration ([K+]), aldosterone concentration ([Aldo]), haptoglobin concentration ([Hpto]), and the reticulocyte count, as well as the calculation of relative changes in PV, 3 days before and on 3-consecutive days after a marathon race. By the 2nd day of recovery PV had increased by 16%. Plasma osmolality and [K+] remained constant, whereas [Na+] had decreased slightly 2 days after the competition and [Aldo] tended to be elevated 1 day after the competition. [Hpto] was low before and 1 day after the competition and increased on the following days. Reticulocyte count was unaffected 1 day after the race, but increased by 106% on the 2nd day and was still elevated after 3 days. The causes for higher post-marathon plasma volumes and reticulocyte counts could be in the complex variations in hormonal regulation, which have not yet been sufficiently investigated.

[Ambulatory long-term rehabilitation of heart patients]. / Ambulante Langzeitrehabilitation von Herzpatienten.

In Germany cardiac rehabilitation contains a comprehensive 3 to 4 week inpatient program. The aim of our study was to perform an outpatient long-term rehabilitation including intense exercise and behavior therapy. In this setting the health benefits could be increased over the first 6 months. Hundred and twelve patients (94 men and 18 women, age 55 +/- 11 years) after myocardial infarction (52%), bypass-surgery (37%), PTCA (23%), and others (15%) were included in the ongoing study. Cholesterol and LDL-cholesterol diminished significantly. HDL-cholesterol was increased significantly after 6 months. The endurance exercise capacity per rate-pressure-product was increased by 46% during the 6 months period. The intake of cholesterol could significantly be diminished from 307 +/- 25 to 258 +/- 19 mg per day. Five of 16 patients became free from smoking. The first results from the long-term outpatient program show that the time of intervention and also the intensity of the medical, exercise and the behavior therapy are important factors for a successful rehabilitation.

[Ambulatory long-term cardiac rehabilitation--one year results]. / Ambulante kardiale Langzeitrehabilitation--1-Jahres-Ergebnisse.

After acute hospital therapy of myocardial infarction or bypass surgery the patient in Germany will be treated using an inpatient rehabilitation programme for 3-4 weeks. One year later only 10% of them are still active in outpatients groups. In our study 61 cardiac patients performed an one-year outpatient rehabilitation (instead of 4 weeks inpatient) programme with intense supervised exercise and behaviour therapy. The money input per patient was the same for the usual care 4 weeks inpatient (6000 DM) as for 1 year outpatient rehabilitation (5800 DM). The exercise capacity per heart rate-blood pressure-product was increased by 43% (p > 0.01) after 12 months. The maximum exercise capacity was reached in the 57th week. Without increased medical treatment, cholesterol and LDL-cholesterol were reduced after 12 months by 3.9% down to 195 +/- 25 mg/dl or by 6.6% down to 122 +/- 21 mg/dl, respectively (n.s.). HDL-cholesterol increased by 2.8% to 48 +/- 8 mg/dl (n.s.). This study shows results similar to outpatient rehabilitation programmes in the United States or in Sweden. The long intervention time and the intensity are main factors for the success of cardiac rehabilitation and patient health. Financial resources should primarily be concentrated on long-term outpatient rehabilitation programmes.

[Determining the extent of intensive physical performance in patients with coronary heart disease]. / Bestimmung des Bereichs intensiver Dauerleistungsfähigkeit bei Patienten mit koronarer Herzkrankheit.

Intensive physical exercise improves cardiac perfusion, skeletal muscle function and risk factors in patients with coronary artery disease (CAD). Otherwise, overdosed intensity can induce training adaptation as well as cardiac events. Therefore, we tested whether exercise intensity corresponding to an equilibrium between lactate production and elimination from the blood during incremental exercise tests represented the blood lactate [Lac-]B steady-state intensity during constant physical training. Randomized into two groups with 30 CAD patients each (T1: 25 male, 5 female; 59 +/- 7 years; T2: 26 male, 4 female; 60 +/- 9 years), the patients initially performed two successive incremental exercise tests. In the first test, workload was increased stepwise until exhaustion or symptom limitation (maximal workload: T1 142 +/- 48 watts, T2 145 +/- 45 watts) with the corresponding [Lac-]B accumulation of up to 6.7 +/- 2.6 (T1) or 6.5 +/- 2.0 (T2) mmol/l, respectively. After a seven minute active rest the second test began with 25 watts, increased with 5 (maximum workload in first test < 100 watts) or 10 watts per minute, respectively. During lower intensities in the second test, [Lac-]B initially decreased to an individual lactate minimum intensity (workload at LMI 83 +/- 32 in T1 or 86 +/- 29 in T2 watts, respectively; [Lac-]B at LMI 4.6 +/- 2.2 and 4.9 +/- 1.8 mmol/l, respectively) and then increased again. To check if the individual LMI represented the [Lac-]B steady-state workload in constant workload exercise, the patients performed 30 min constant load tests with the LMI (CT1) or a 30 min constant load test with an intensity 10% above the LMI (CT2), respectively. The workload in CT1 was 83 +/- 32 watts with a mean exercise time of 29.0 +/- 1.7 min. After 10 min of exercise the [Lac-]B steady state was reached at 3.3 +/- 1.4 mmol/l with no further increase in the last 20 min. The mean workload in CT2 was 95 +/- 31 watts with an exercise time of 23.3 +/- 8.3 min (p < 0.01). [Lac-]B increased from 4.4 +/- 1.7 mmol/l after 10 min to 4.7 +/- 2.0 mmol/l at the end (p < 0.01). Fifty percent of patients stopped CT2 before the 30 minute end. The results indicates that the LMI, estimated during lactic acidosis in two successive incremental tests, represented the individual lactate steady-state intensity also during constant load exercise. Therefore, training regimens for CAD patients could be deduced from LMI.

[Health-related quality of life after heart transplantation]. / Lebensqualität im Langzeitverlauf nach Herztransplantation.

BACKGROUND: Quality of life late after heart transplantation is reported to be comparable with that of the general population. However, peak exercise capacity remained approximately 60% of what was normal between 1 and 10 years after transplantation. The gap between patients' good quality of life and their impaired exercise tolerance is not yet explained. The purpose of our study was to examine the relation between quality of life and exercise- related variables in heart transplant recipients (HTR). Then, the results of these examinations were compared with those of patients having congestive heart failure (CHF), with the use of controls (C), respectively. METHODS: (Mean values+/-SD) 29 HTR 4.4 +/- 2.1 years after transplantation, 29 CHF (NYHA II n = 22, III n = 7) and 29 C (age 54 +/- 9, 61 +/- 10, 56 +/- 10 years, body mass index 28 +/- 3, 29 +/- 5, 28 +/- 4 kg x m(-2), body fat 25 +/- 4, 27 +/- 6, 26 +/- 5%, respectively) performed cardiopulmonary exercise testing and were interviewed with the standardized German "Quality of life profile for chronic diseases" questionnaire. RESULTS: Peak oxygen consumption was impaired in HTR and in CHF compared with C (19.0 +/- 4.5, 18.6 +/- 4.3, and 30.2 +/- 6.6 ml x min x kg(-1), respectively; p < 0.01 vs. C each). HTR and CHF patients' quality of life in the physical scores were both impaired (p < 0.05 or p < 0.01 vs. C, respectively), but HTRs have reported better scores than CHF (p < 0.05). In the psychological role, CHF was impaired against C (p < 0.05), and HTR scores were comparable with C. In social functioning HTR and CHF patients both showed reduced quality of life dimensions. The Pearson correlation analysis showed that quality of life in physical functioning was related to peak oxygen consumption (p < 0.001) and percentage of predicted workload (p < 0.001). Quality of life in the social and psychological domains showed no association to exercise-related values. CONCLUSIONS: In HTR and in CHF, exercise testing variables were dominant predictors among the physical scales in quality of life, but not among social or psychological scales. Therefore, even late after heart transplantation, improving physical capacity should be a therapeutic goal with the intention of further increasing the quality of life.