Four hundred meters walking test in the evaluation of heart failure patients.

UNLABELLED: The best evaluation of the severity and prognosis of heart failure patients is obtained by the maximal exercise stress testing, but for the very large number of HF patients and for evaluation of their daily effort capacity submaximal stress testing, mainly 6 minutes walking test are used. The limit of 6mWT is that during it the patients are not motivated to walk and also, the periphery, so important for heart failure patients, is not equally involved. OBJECTIVE: To compare a new fixed walking test-400m walking test with 6MWT and maximal exercise testing. METHODS: There were investigated 20 patients with dilated cardiomyopathy (DCM). The patients were included in the study after the relief of the congestive syndrome. Each patient was submitted in three consecutive days to a maximal symptom-limited exercise stress test on cycloergometer, a six minutes walking test, a 400 meters walking test. The last one consisted of walking on a corridor 40 meters long, at a speed chosen by the patient himself. The results were expressed in seconds representing the necessary time to cover the established 400 meters of distance. RESULTS: During cycloergometer exercise stress test the calculated mean peak VO2 was 15.2 +/- 1.4 mlO2/kg/min (4.32 METs). The mean distance walked during 6MWT was 350 +/- 34m and the mean time needed to walk 400m (400mWT) was 300 +/- 27 seconds. The correlation between peak VO2 and distance walked during 6MWT was -0.40, a similar but negative value (r = -0.42) being registered between peak VO2 and time registered during 400mWT. Only weak correlation was registered between LVEF and all the three tests. In turn the correlation between distance registered during 6MWT and time registered during 400mWT was excellent: r = -0.60. CONCLUSION: 400mWT is a useful tool for the evaluation of submaximal effort capacity of CHF patients. Its value to evaluate exercise capacity is similar with that of the 6 MWT, but 400mWT can assure a better evaluation of peripheral involvement.

The effect of very short duration acute physical exercise upon adiponectin and leptin in overweight subjects.

BACKGROUND: Adiponectin is decreased and leptin increased in overweight subjects. In turn, exercise has controversial effect upon adiponectin and leptin plasmatic levels. PURPOSE: To study the effect of acute exercise upon plasmatic levels of adiponectin and leptin in normal and overweight subjects. METHOD: We studied 79 subjects, 42 males and 37 females, aged 56 +/- 9 years, divided into two groups. Group I consisted of 19 patients with body mass index (BMI) < 25 kg/(m)2 and group II consisted of 60 overweight subjects (BMI > 25 kg/(m)2). All subjects were submitted to a maximal symptom limited exercise stress testing on cycloergometer, upon classical protocols (mean effort 103 +/- 27 Ws). Venous blood samples were obtained before exercise (sample I) and at 30 minutes after the effort was stopped (sample II); adiponectin and leptin levels were determined, using ELISA method. RESULTS: At rest adiponectin is significantly decreased and leptin increased in overweight subjects. In turn, during exercise the values of the two adipokines were not significantly different from those registered at rest in both groups, even if the adiponectin remained at a low level and leptin decreased at the limit of significance in overweight subjects. Considering men and women, the data are similar for men but, after exercise, overweight women registered a significant reduction of the leptin values. Also at rest adiponectin levels are more increased in overweight women (p = 0.01). This suggests that overweight women can be protected in comparison with men and exercise could add a supplementary benefice. CONCLUSION: Acute exercise has little effect upon adiponectin and leptin levels, but rest adiponectin is increased and leptin significantly decreased during exercise in overweight women and could be beneficial to this category of subjects.

Rehabilitation in diabetic patients.

Physical activity is very important for diabetic patients. In normal subjects physical activity postpones diabetes mellitus and in diabetic patients postpones the cardiovascular complications. In diabetic patients with cardiovascular disease, physical training increases exercise capacity, decreases complications and prolongs survival. Physical activity can be applied in diabetic patients as physical activity counseling or physical training, the second being recommended to be ambulatory and supervised but, sometimes, also home rehabilitation can be useful. Aerobic exercises, but also resistance exercises will be applied for a 30-60 min duration at least 3x/ week, recommended 5x/ week, and optimal every day. Some specific aspects of diabetic patients as hyper or hypoglycemia, autonomic or peripheral neuropathy, retinopathy, have to be considered during physical rehabilitation and sometimes physical training has to be modulated according to them. In conclusion, physical activity and training represent a real chance for every diabetic patient and has to be recommended and applied in all of them.

Drug secondary prevention in postmenopausal women with ischemic heart disease.

UNLABELLED: It is known that, in comparison with men, women with cardiovascular disease are undertreated, including drug treatment. This aspect was less studied with respect to drugs used for secondary prevention. METHODS: In an urban Romanian community there was studied a representative sample of 150 postmenopausal women with cardiovascular disease (62.7% of them with ischemic heart disease-IHD). We considered the secondary prevention by drugs. The results were compared with those registered in a similar sample of 160 men aged >55 years with cardiovascular disease (68.1% of them with IHD). The study was carried out using general practitioner's files. RESULTS: According to the literature, there were considered as preventive drugs: antiplatelet agents, statins, beta blockers and ACEI. Aspirin was used in 56.4% of the women and 72.5% of the men (p<0.05), ACEI in 69.1% and 79.8 % (p>0.05), beta blockers in 69.1% and 74.3 % (p>0.05) and statins in 48.9% and 48.6% (p>0.05). The results show that antiplatelet drugs are underused in ischemic patients, but especially in women. The maximum use of preventive drugs in women was registered after acute myocardial infarction (beta blockers 85.7%, statins 50%, aspirin 60.7%, ACEI 75%). In turn, the myocardial revascularization by CABG and PCI is low in both groups, but much less in women than in men: CABG 1.1% in women, 4.6% in men p>0.05, PCI 5.3% in women and 13.8% in men p<0.05. CONCLUSION: In postmenopausal women with ischemic heart disease the secondary prevention by drugs is similar with that applied in men, except aspirin and ACEI, which are underused.

Physical training--beyond increasing exercise capacity.

Physical training has traditionally represented the main method used in cardiovascular rehabilitation of ischemic patients in the past years. Nowadays, cardiovascular rehabilitation has been extended to other cardiovascular diseases, such as heart failure. Also, cardiovascular rehabilitation included psychological, social and professional measures along with secondary prevention methods such as lifestyle changes. It has also been found that physical training has other additional effects which increased exercise tolerance. Effects on the risk factors regard beneficial effect on body weight, on the serum lipids levels, on psychosocial stress, on high blood pressure and on insulin resistance and diabetes mellitus. Physical exercise has also beneficial effects on the balance between sympathetic--vagal tone, inducing a vagal predominance, has anti-atherogenic and anti-ischemic effects, influencing the endothelial function, the inflammation (anti-inflammatory effect), both arteriogenesis and angiogenesis and thrombosis. Physical training could improve the symptoms of coronary patients by preconditioning, which has a protective effect for the myocardium. We may state that physical exercise has beneficial effects in cardiovascular patients because it increases exercise tolerance with positive consequences on the quality of life and professional reintegration, but also because it has positive effects beyond this. Thus, physical exercise should be practiced through cardiac rehabilitation programs, by all cardiovascular patients.

Action of 6-hydroxydopamine on two parameters of motor learning.

In rats injected in the cerebral ventricle with 250 micrograms of 6-hydroxydopamine a significant blockade of the improvement of swimming performance due to training occurs. The central injection of 6-OHDA leads to a lengthening of the total latency time (LT) of active conditioned reaction in shuttle box and of the LT of netative escape responses during learning, but not of the positive avoidance responses. 6-OHDA injected after the learing schedule (12 days) has no effect on the LT during relearning and extinction. Therefore a partial destruction of central monoaminergic, and especially of dopaminergic, neurons impairs particularly the acquisition but not the retention of the motor program.