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Perez DM. Targeting Adrenergic Receptors in Metabolic Therapies for Heart Failure. Int J Mol Sci 2021; 22:5783. [PMID: 34071350 PMCID: PMC8198887 DOI: 10.3390/ijms22115783] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022] Open
Abstract
The heart has a reduced capacity to generate sufficient energy when failing, resulting in an energy-starved condition with diminished functions. Studies have identified numerous changes in metabolic pathways in the failing heart that result in reduced oxidation of both glucose and fatty acid substrates, defects in mitochondrial functions and oxidative phosphorylation, and inefficient substrate utilization for the ATP that is produced. Recent early-phase clinical studies indicate that inhibitors of fatty acid oxidation and antioxidants that target the mitochondria may improve heart function during failure by increasing compensatory glucose oxidation. Adrenergic receptors (α1 and β) are a key sympathetic nervous system regulator that controls cardiac function. β-AR blockers are an established treatment for heart failure and α1A-AR agonists have potential therapeutic benefit. Besides regulating inotropy and chronotropy, α1- and β-adrenergic receptors also regulate metabolic functions in the heart that underlie many cardiac benefits. This review will highlight recent studies that describe how adrenergic receptor-mediated metabolic pathways may be able to restore cardiac energetics to non-failing levels that may offer promising therapeutic strategies.
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Affiliation(s)
- Dianne M Perez
- The Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Kamio N, Suzuki T, Watanabe Y, Suhara Y, Osakabe N. A single oral dose of flavan-3-ols enhances energy expenditure by sympathetic nerve stimulation in mice. Free Radic Biol Med 2016; 91:256-63. [PMID: 26738802 DOI: 10.1016/j.freeradbiomed.2015.12.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/15/2015] [Accepted: 12/24/2015] [Indexed: 02/05/2023]
Abstract
Numerous clinical studies have found that ingestion of chocolate reduces the risk of metabolic syndrome, however, the mechanisms were remain unclear. We have reported that a single dose of a flavan-3-ol fraction derived from cocoa (FL) enhanced energy expenditure (EE) and increased the mRNA expression levels of uncoupling proteins (UCPs) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α), and the protein level of phosphorylated AMP-activated protein kinase (AMPK)α in tissues, along with plasma adrenaline level. In the present study, we examined whether the EE enhancing activity of FL is mediated by adrenergic effect using several adrenalin receptor (AR) blockers. In the first study, mice were butoxamine, as β2AR blocker, with vehicle or 10mg/kg FL orally. We found that pretreatment with butoxamine prevented the increases of EE, the mRNA expression of UCP-3, and phosphorylated AMPKα that were induced in the gastrocnemius muscle of mice by 10mg/kg FL. Secondly, mice were given SR52930, as β3AR blocker. Pretreatment with SR52930 prevented the increases of EE, the mRNA expression of UCP-3, and phosphorylated AMPKα that were induced in the gastrocnemius muscle of mice by 10mg/kg FL. Pretreatment with a combination of both blockers also reduced the increments in mRNA expression levels of UCPs and PGC-1α, however, phosphorylated AMPKα in skeletal muscle was rather increased. These results suggest that the ability of a single oral dose of FL to enhance metabolic activity is mediated by sympathetic nerve system (SNS).
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Affiliation(s)
- Naoya Kamio
- Department of Bio-science and Engineering, Shibaura Institute of Technology, 307 Fukasaku, Munumaku, Saitama 337-8570, Japan
| | - Takuma Suzuki
- Department of Bio-science and Engineering, Shibaura Institute of Technology, 307 Fukasaku, Munumaku, Saitama 337-8570, Japan
| | - Yuto Watanabe
- Department of Bio-science and Engineering, Shibaura Institute of Technology, 307 Fukasaku, Munumaku, Saitama 337-8570, Japan
| | - Yoshitomo Suhara
- Department of Bio-science and Engineering, Shibaura Institute of Technology, 307 Fukasaku, Munumaku, Saitama 337-8570, Japan
| | - Naomi Osakabe
- Department of Bio-science and Engineering, Shibaura Institute of Technology, 307 Fukasaku, Munumaku, Saitama 337-8570, Japan.
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Porro LJ, Al-Mousawi AM, Williams F, Herndon DN, Mlcak RP, Suman OE. Effects of propranolol and exercise training in children with severe burns. J Pediatr 2013; 162:799-803.e1. [PMID: 23084706 PMCID: PMC3556196 DOI: 10.1016/j.jpeds.2012.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/06/2012] [Accepted: 09/07/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate whether propranolol administration blocks the benefits induced by exercise training in severely burned children. STUDY DESIGN Children aged 7-18 years (n = 58) with burns covering ≥30% of the total body surface area were enrolled in this randomized trial during their acute hospital admission. Twenty-seven patients were randomized to receive propranolol, whereas 31 served as untreated controls. Both groups participated in 12 weeks of in-hospital resistance and aerobic exercise training. Muscle strength, lean body mass, and peak oxygen consumption (VO2 peak) were measured before and after exercise training. Paired and unpaired Student t tests were used for within and between group comparisons, and χ(2) tests for nominal data. RESULTS Age, length of hospitalization, and total body surface area burned were similar between groups. In both groups, muscle strength, lean body mass, and VO2 peak were significantly greater after exercise training than at baseline. The percent change in VO2 peak was significantly greater in the propranolol group than in the control group (P < .05). CONCLUSIONS Exercise-induced enhancements in muscle mass, strength, and VO2 peak are not impaired by propranolol. Moreover, propranolol improves the aerobic response to exercise in massively burned children.
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Affiliation(s)
- Laura J. Porro
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
| | - Ahmed M. Al-Mousawi
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
| | - Felicia Williams
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
| | - David N. Herndon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
| | - Ronald P. Mlcak
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
| | - Oscar E. Suman
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
- Shriners Hospitals for Children—Galveston, Galveston, Texas
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Ferretti G, Licker MJ, Anchisi S, Moia C, Susta D, Morel DR. The effects of beta1-adrenergic blockade on cardiovascular oxygen flow in normoxic and hypoxic humans at exercise. Eur J Appl Physiol 2005; 95:250-9. [PMID: 16200423 DOI: 10.1007/s00421-005-1393-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2005] [Indexed: 10/25/2022]
Abstract
At exercise steady state, the lower the arterial oxygen saturation (SaO(2)), the lower the O(2) return (QvO(2)). A linear relationship between these variables was demonstrated. Our conjecture is that this relationship describes a condition of predominant sympathetic activation, from which it is hypothesized that selective beta1-adrenergic blockade (BB) would reduce O(2) delivery (QaO(2)) and QvO(2). To test this hypothesis, we studied the effects of BB on QaO(2) and QvO(2) in exercising humans in normoxia and hypoxia. O(2) consumption VO(2), cardiac output Q, CO(2) rebreathing), heart rate, SaO(2) and haemoglobin concentration were measured on six subjects (age 25.5 +/- 2.4 years, mass 78.1 +/- 9.0 kg) in normoxia and hypoxia (inspired O(2) fraction of 0.11) at rest and steady-state exercises of 50, 100, and 150 W without (C) and with BB with metoprolol. Arterial O(2) concentration (CaO(2)), QaO(2) and QvO(2) were then computed. Heart rate, higher in hypoxia than in normoxia, decreased with BB. At each VO(2), Q was higher in hypoxia than in normoxia. With BB, it decreased during intense exercise in normoxia, at rest, and during light exercise in hypoxia. SaO(2) and CaO(2) were unaffected by BB. The QaO(2) changes under BB were parallel to those in Q.QvO(2) was unaffected by exercise in normoxia. In hypoxia the slope of the relationship between QaO(2) and VO(2) was lower than 1, indicating a reduction of QvO(2) with increasing workload. QvO(2) was a linear function of SaO(2) both in C and in BB. The line for BB was flatter than and below that for C. The resting QvO(2) in normoxia, lower than the corresponding exercise values, lied on the BB line. These results agree with the tested hypothesis. The two observed relationships between QvO(2) and SaO(2) apply to conditions of predominant sympathetic or vagal activation, respectively. Moving from one line to the other implies resetting of the cardiovascular regulation.
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Affiliation(s)
- Guido Ferretti
- Département de Physiologie, Centre Médical Universitaire, Geneva, Switzerland.
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Bussmann JB, Grootscholten EA, Stam HJ. Daily physical activity and heart rate response in people with a unilateral transtibial amputation for vascular disease. Arch Phys Med Rehabil 2004; 85:240-4. [PMID: 14966708 DOI: 10.1016/s0003-9993(03)00485-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the activity level and heart rate response, objectively measured during normal daily life, of persons with a unilateral transtibial amputation for vascular disease. DESIGN Case comparison. SETTING General community, daily life in the Netherlands. PARTICIPANTS Nine subjects with a unilateral transtibial amputation for vascular disease (convenience sample) and 9 control subjects without known impairments (matched for sex, age, social situation, employment). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Duration of dynamic activities, body motility (the intensity of body movement, measured with accelerometry), and heart rate (on 2 consecutive days). RESULTS Persons with an amputation were less active than the comparison subjects (4.3% vs 11.4% of a 48-h period, P=.007). Body motility during walking was lower in the amputee group (.111 g vs.147 g, P=.003). No differences between groups were found in normalized heart rate during walking. In the amputee group, a strong relationship was found between body motility during walking and the percentage of the day that the subject walked (r=.88, P=.002). No relationship was found between the percentage of the day that persons with an amputation were active and data from disability questionnaires. CONCLUSION Persons with a unilateral transtibial amputation for vascular disease were considerably less active than persons without known impairments. Heart rate response during walking of the amputee group did not differ from the response in the comparison group.
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Affiliation(s)
- Johannes B Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Vanhees L, Defoor JG, Schepers D, Lijnen P, Peeters BY, Lacante PH, Fagard RH. Effect of bisoprolol and atenolol on endurance exercise capacity in healthy men. J Hypertens 2000; 18:35-43. [PMID: 10678541 DOI: 10.1097/00004872-200018010-00006] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the effects of a highly beta1-selective adrenoceptor antagonist bisoprolol with those of atenolol and placebo on endurance exercise capacity in young, healthy male volunteers. DESIGN Twelve subjects randomly received oral placebo, atenolol (100 mg/day) or bisoprolol (10 mg/day) for 3 weeks, following a double-blind cross-over design. METHODS At the end of each period, the subjects performed an endurance exercise test on the bicycle ergometer at 70% of maximal aerobic power. Cardiac output was measured by means of an automated CO2-rebreathing method. Venous blood was sampled before, during and after exercise. RESULTS Exercise duration was not significantly different between the two drugs tested. Total exercise duration was significantly reduced by bisoprolol (-19.4 +/- 6.7%, P< 0.01) (mean +/- SEM) and by atenolol (-29.8 +/- 6.6%, P< 0.001), compared with placebo. Atenolol and bisoprolol were equally effective in lowering resting plasma renin activity, heart rate and systolic blood pressure. Resting and exercise stroke volume were significantly increased by both drugs, so that cardiac output was not significantly affected. Both drugs induced significant decreases in plasma-free fatty acid concentrations during recovery and blunted the exercise-induced increase. There were no significant relationships between the reduction of exercise duration and the haemodynamic changes or the degree of impairment of the exercise-induced increase in free fatty acid release resulting from beta-blockade. CONCLUSIONS It is concluded that both drugs affect endurance exercise capacity in young, normotensive men, with a tendency to a smaller reduction during bisoprolol treatment. Haemodynamic variables are unlikely to be involved in the reduction of endurance exercise capacity. The role of the reduced availability of plasma free fatty acids remains unclear.
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Affiliation(s)
- L Vanhees
- Department of Molecular and Cardiovascular Research, Faculty of Medicine, KU Leuven (University of Leuven), Belgium.
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Lamont LS, Romito RA, Finkelhor RS, Kalhan SC. Beta 1-adrenoreceptors regulate resting metabolic rate. Med Sci Sports Exerc 1997; 29:769-74. [PMID: 9219204 DOI: 10.1097/00005768-199706000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This was a randomized, cross-over experiment designed to determine which beta-adrenergic receptors, beta 1, beta 2, or both, regulate metabolic rate in humans. All subjects (3 women, 4 men) were administered a 7-d therapeutic dose of a selective beta 1-antagonist (atenolol 50 mg BID), a combined beta 1, beta 2-antagonist (propranolol 80 mg BID), and a placebo control (BID). Indirect calorimetry was determined before and after 1 h of submaximal exercise. Exercise was performed at 50% of the trial specific VO2peak because maximal exercise was significantly decreased in the presence of the nonselective beta 1, beta 2-antagonist (VO2peak placebo: 44.90 +/- 4.40 mL.kg-1.min-1 vs beta 1, beta 2-antagonism: 39.20 +/- 3.00 mL.kg-1.min-1; P < 0.05). Both the beta 1 and the combined beta 1, beta 2-adrenoreceptor antagonists reduced resting oxygen consumption to a similar extent (0.247 +/- 0.007 L.min-1 placebo, vs 0.218 +/- 0.007 L.min-1 beta 1-antagonism, vs 0.226 +/- 0.007 L.min-1 beta 1, beta 2-antagonism; P < 0.05). However, the 30-min and 60-min excess post-exercise oxygen consumption (mean EPOC) remained unchanged. It is concluded that the beta 1-receptors are regulating the effects of the sympathetic nervous system on resting but not exercise recovery metabolic rate. These metabolic side effects may suggest that changes need to be made in the nutritional requirements of patients using beta-adrenergic antagonists.
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Affiliation(s)
- L S Lamont
- Exercise Science Program, University of Rhode Island, Kingston 02881, USA
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MacGowan GA, Casey M, Stirling R, Brett M, Kinsella A, Horgan JH. Exercise-related potassium and free fatty acid level changes in coronary artery disease. Responses after moderate intensity training. Chest 1993; 103:728-34. [PMID: 8449059 DOI: 10.1378/chest.103.3.728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Exercise produces changes in circulating levels of potassium and free fatty acids which may provoke arrhythmias in patients with coronary artery disease. Twenty patients participating in 6 weeks of training were studied; 9 of these patients took part in 4 more weeks of training and a third exercise test. After 6 weeks, potassium levels were higher at submaximal levels of exercise, free fatty acid levels were reduced at rest, and at 5, 15, and at 30 min post-exercise. Norepinephrine levels were reduced at submaximal work loads after 6 weeks and increased at maximal work loads. The extra 4 weeks had no additive effect on these metabolic changes. Participation by coronary artery disease patients in a short-term, moderate intensity, exercise training program increases potassium levels at submaximal work loads and reduces levels of free fatty acids at rest and after exercise. The arrhythmogenic relevance of these findings deserves further consideration.
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Affiliation(s)
- G A MacGowan
- Department of Cardiology, Beaumont Hospital, Dublin, Ireland
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Jesek JK, Martin NB, Broeder CE, Thomas EL, Wambsgans KC, Hofman Z, Ivy JL, Wilmore JH. Changes in plasma free fatty acids and glycerols during prolonged exercise in trained and hypertensive persons taking propranolol and pindolol. Am J Cardiol 1990; 66:1336-41. [PMID: 2244564 DOI: 10.1016/0002-9149(90)91164-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The extent to which lipolysis is attenuated during prolonged submaximal exercise during beta blockade was determined in 12 normotensive endurance-trained and 12 hypertensive sedentary men using nonselective drugs with and without intrinsic sympathomimetic activity (ISA). Initially, subjects performed a graded treadmill test to determine maximal oxygen uptake (VO2max). This was followed by 2-hour walks at 25 and 45% of the subject's VO2max under each of 3 treatments: pindolol (ISA), propranolol (non-ISA) and placebo. The distribution of medication was randomized and double blinded. Blood samples taken at rest and every 30 minutes during the 2-hour walks were analyzed to determine the concentrations of free fatty acids (FFA) and glycerol. On the basis of the respective changes in FFA, glycerols and the respiratory exchange ratio, beta-adrenergic blockade did not attenuate lipolysis in the untrained hypertensive subjects when compared with the placebo administration. However, beta blockade did demonstrate a tendency to attenuate lipolysis in the trained, normotensive subjects when compared with results after placebo administration. This was particularly evident at 30 minutes of exercise, when both glycerol and FFA concentrations were not increased above resting values under both conditions of beta blockade. No differences between pindolol and propranolol were observed. Therefore, a beta-blocking agent with ISA properties appears to have no clear benefit with respect to lipid metabolism during low and moderate intensity exercise. Furthermore, these data demonstrate that beta blockade does not inhibit exercise-induced lipolysis at low and moderate intensities of exercise as formerly believed, and is unlikely to be the cause of fatigue normally observed during work in patient populations taking beta-blocking medication.
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Affiliation(s)
- J K Jesek
- Department of Kinesiology and Health Education, University of Texas, Austin 78712
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van Baak MA, Koene FM, Verstappen FT. Exercise haemodynamics and maximal exercise capacity during beta-adrenoceptor blockade in normotensive and hypertensive subjects. Br J Clin Pharmacol 1988; 25:169-77. [PMID: 2896013 PMCID: PMC1386471 DOI: 10.1111/j.1365-2125.1988.tb03288.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
1. The effects of atenolol administration on maximal exercise capacity and exercise haemodynamics have been compared in eight normotensive and eight mildly hypertensive subjects, matched for sex, age, body weight, and maximal oxygen uptake, and familiar with maximal exercise testing. 2. Supine and exercise blood pressure, and exercise total peripheral resistance were significantly higher, and exercise cardiac output was significantly lower in the hypertensive than in the normotensive subjects. 3. Administration of atenolol (1 X 100 mg day-1) for 3 days reduced supine and exercise systolic blood pressure, heart rate, and cardiac output, and increased exercise stroke volume. Supine and exercise diastolic blood pressure and exercise total peripheral resistance were unaffected by atenolol. The effects of atenolol did not differ in the normotensive and the hypertensive subjects. 4. Maximal work load, maximal oxygen uptake, and maximal heart rate were reduced to a similar extent in normotensive and hypertensive subjects during atenolol treatment. 5. It is concluded that there is no difference in the effects of short-term atenolol administration on exercise haemodynamics and maximal exercise capacity in normotensive and mildly hypertensive subjects.
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Affiliation(s)
- M A van Baak
- Department of Pharmacology, University of Limburg, Maastricht, The Netherlands
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Vanhees L, Fagard R, Amery A. Effect of calcium channel blockade and beta-adrenoceptor blockade on short graded and single-level endurance exercises in normal men. EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY AND OCCUPATIONAL PHYSIOLOGY 1988; 58:87-91. [PMID: 2904883 DOI: 10.1007/bf00636608] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of verapamil (240 mg) on exercise capacity was studied during a short graded and a single-level endurance exercise test in 12 normal volunteers; it was compared to the effects of atenolol (100 mg x day-1). Intake of verapamil, atenolol and placebo, administered according to a randomized, double-blind cross-over design, was started 3 days before the exercise tests. Compared to placebo, verapamil did not affect peak oxygen uptake in the graded test or exercise duration in the endurance test. Heart rate, systolic blood pressure, rating of perceived exertion and respiratory data at submaximal and peak exercise were unaffected in either test. On the other hand atenolol reduced maximal oxygen uptake by 5% (p less than 0.001) and endurance exercise duration by 17% (p less than 0.05). Besides marked decreases in heart rate and systolic blood pressure during the two types of exercise, atenolol also reduced oxygen uptake at submaximal exercise levels and it increased the rating of perceived exertion (p less than 0.05), the latter only during the endurance exercise test.
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Affiliation(s)
- L Vanhees
- Department of Pathophysiology, University of Leuven, Belgium
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