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Desanlis J, Gordon D, French C, Calveyrac C, Cottin F, Gernigon M. Effects of occlusion pressure on hemodynamic responses recorded by near-infrared spectroscopy across two visits. Front Physiol 2024; 15:1441239. [PMID: 39324105 PMCID: PMC11422206 DOI: 10.3389/fphys.2024.1441239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/21/2024] [Indexed: 09/27/2024] Open
Abstract
Ischemic Preconditioning (IPC) has emerged as a promising approach to mitigate the impact of hypoxia on physiological functions. However, the heterogeneity of occlusion pressures for inducing arterial occlusion has led to inconsistent hemodynamic outcomes across studies. This study aims to evaluate the peripheral hemodynamic responses to partial and total blood-flow occlusions on the left arm at rest, using absolute or individualized pressures, on two occasions. Thirty-five young males volunteered to participate in this study. IPC procedure (3 × 7-min) was performed on the left upper arm with cuff pressures at 50 mmHg (G1), 50 mmHg over the systolic blood pressure (SBP + 50 mmHg) (G2) or 250 mmHg (G3). NIRS-derived parameters were assessed for each occlusion and reperfusion phase in the brachioradialis. Results showed a significantly lower magnitude of deoxygenation (TSIAUC) for G1 compared to G2 (-1959.2 ± 1417.4 vs. -10908.1 ± 1607.5, P < 0.001) and G3 -1959.2 ± 1417.4 vs. -11079.3 ± 1828.1, P < 0.001), without differences between G2 and G3. However, G3 showed a significantly faster reoxygenation only for tissue saturation index (TSIslope) compared to G2 (1.3 ± 0.1 vs. 1.0 ± 0.2, P = 0.010), but without differences in the speed of recovery of deoxyhemoglobin [(HHb) slope], or in the magnitude of post-occlusive hyperemia (PORH). Besides TSI reoxygenation speed, G2 and G3 elicit comparable resting hemodynamic responses measured by NIRS. Thus, this study highlights the practicality and effectiveness of using relative occlusion pressures based on systolic blood pressure (SBP) rather than relying on excessively high absolute pressures.
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Affiliation(s)
- Julien Desanlis
- CIAMS, Université Paris-Saclay, Orsay, France
- CIAMS, Université d'Orléans, Orléans, France
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Dan Gordon
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chloe French
- CIAMS, Université Paris-Saclay, Orsay, France
- CIAMS, Université d'Orléans, Orléans, France
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Camille Calveyrac
- CIAMS, Université Paris-Saclay, Orsay, France
- CIAMS, Université d'Orléans, Orléans, France
| | - François Cottin
- CIAMS, Université Paris-Saclay, Orsay, France
- CIAMS, Université d'Orléans, Orléans, France
| | - Marie Gernigon
- CIAMS, Université Paris-Saclay, Orsay, France
- CIAMS, Université d'Orléans, Orléans, France
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Jansson AK, Schumacher TL, Kocanda L, Whatnall M, Fenwick M, Betts D, Bauman A, Kerr J, Duncan MJ, Collins CE, Boyle A, Inder KJ, Plotnikoff RC. A Systematic Review of the Completion of Cardiac Rehabilitation Programs for Adults Aged 18-50 Years. J Cardiopulm Rehabil Prev 2024; 44:E30-E51. [PMID: 39185913 DOI: 10.1097/hcr.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To perform a systematic review of completion rates of cardiac rehabilitation (CR) in adults aged 18 to 50 yr and describe how core components were reported, measured, and tailored to those under 50 yr. REVIEW METHODS Database search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and the Cochrane Library based on keywords, including articles from January 1, 1990. The last search was performed on April 21, 2023. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses protocol, eligible articles contained adults (aged between 18 and 50 yr) who had participated in a CR program. SUMMARY Out of the articles screened (n = 24,517), 33 reports across 31 independent studies were considered eligible (n = 1958 patients aged ≤50 yr). Cardiac rehabilitation completion rates ranged from 64% to 100%; however, only 5 studies presented a completion rate definition. The length of the program ranged from 7 d to 20 wk, with most (65%) ranging between 6 and 12 wk. While the studies included in this systematic review indicated relatively high rates of completing CR, these are likely to overrepresent the true completion rates as few definitions were provided that could be compared to completion rates used in clinical practice. This systematic review also found that all interventions prescribed exercise (eg, aerobic alone or combined with resistance training or yoga) but had very limited inclusion or description of other integral components of CR (eg, initial assessment and smoking cessation) or how they were assessed and individualized to meet the needs of younger attendees.
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Affiliation(s)
- Anna K Jansson
- Author Affiliations: Centre for Active Living and Learning, School of Education, The University of Newcastle, Newcastle, New South Wales, Australia (Drs Jansson and Plotnikoff); Active Living Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia (Dr Jansson, Mr Fenwick, and Drs Duncan and Plotnikoff); Department of Rural Health, The University of Newcastle, Tamworth, New South Wales, Australia (Drs Schumacher and Kocanda); School of Health Science, College of Health and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia (Drs Whatnall and Collins); Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, New South Wales, Australia (Drs Kocanda, Whatnall, and Collins); School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia (Mr Fenwick and Drs Duncan and Boyle); Cancer Council NSW, Sydney, New South Wales, Australia (Mrs Betts); School of Public Health, University of Sydney, Sydney, New South Wales, Australia (Dr Bauman); Hunter New England Health, Newcastle, New South Wales, Australia (Ms Kerr and Dr Inder); and School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia (Dr Inder)
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Whyte E, Thomas S, Marzolini S. Muscle Oxygenation of the Paretic and Nonparetic Legs During and After Arterial Occlusion in Chronic Stroke. J Stroke Cerebrovasc Dis 2021; 31:106265. [PMID: 34954600 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Oxygen delivery and demand are reduced in the paretic leg post-stroke, reflecting decreased vascular function and reduced muscle quantity and quality. However, it is unknown how muscle oxygenation, the balance between muscle oxygen delivery and utilization, is altered in chronic stroke during and after occlusion-induced ischemia. OBJECTIVES The objective was to determine muscle oxygen consumption rate, microvascular responsiveness and reactive hyperemia in the paretic and nonparetic legs during and after arterial occlusion post-stroke. MATERIALS AND METHODS Muscle oxygen saturation was measured with near-infrared spectroscopy on the vastus lateralis of each leg during 3-minute arterial occlusion and recovery (3 min). Muscle oxygen consumption was derived from the desaturation slope during ischemia, microvascular responsiveness was derived from the resaturation slope after ischemia and reactive hyperemia was derived from the area under the curve above baseline after ischemia. RESULTS Eleven subjects (91% male; 32.2±6.1 months post-stroke; age 62.9±13.6 years) with a hemiparetic gait pattern participated. There was no significant between-leg muscle oxygenation difference at rest (paretic: 64.9±16.6%; nonparetic: 70.6±15.6%, p = 0.13). Muscle oxygen consumption in the paretic leg (-0.53±0.24%/s) was significantly reduced compared to the nonparetic leg (-0.70±0.36%/s; p = 0.03). Microvascular responsiveness was significantly reduced in the paretic leg compared to the nonparetic leg (paretic: 4.6±1.8%/s; nonparetic: 5.7±1.6%/s, p = 0.04). Reactive hyperemia was not significantly different between legs (paretic:4384±2341%·s; nonparetic: 3040±2216%·s, p = 0.07). CONCLUSION Muscle oxygen consumption and microvascular responsiveness are impaired in the paretic compared to the nonparetic leg, suggesting both reduced skeletal muscle aerobic function and reduced ability to maximally perfuse muscle tissue.
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Affiliation(s)
- Elizabeth Whyte
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Susan Marzolini
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada.
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Tickle PG, Hendrickse PW, Weightman A, Nazir MH, Degens H, Egginton S. Impaired skeletal muscle fatigue resistance during cardiac hypertrophy is prevented by functional overload- or exercise-induced functional capillarity. J Physiol 2021; 599:3715-3733. [PMID: 34107075 DOI: 10.1113/jp281377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/04/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Capillary rarefaction is hypothesized to contribute to impaired exercise tolerance in cardiovascular disease, but it remains a poorly exploited therapeutic target for improving skeletal muscle performance. Using an abdominal aortic coarctation rat model of compensatory cardiac hypertrophy, we determine the efficacy of aerobic exercise for the prevention of, and mechanical overload for, restoration of hindlimb muscle fatigue resistance and microvascular impairment in the early stages of heart disease. Impaired muscle fatigue resistance was found after development of cardiac hypertrophy, but this impairment was prevented by low-intensity aerobic exercise and recovered after mechanical stretch due to muscle overload. Changes in muscle fatigue resistance were closely related to functional (i.e. perfused) microvascular density, independent of arterial blood flow, emphasizing the critical importance of optimal capillary diffusion for skeletal muscle function. Pro-angiogenic therapies are an important tool for improving skeletal muscle function in the incipient stages of heart disease. ABSTRACT Microvascular rarefaction may contribute to declining skeletal muscle performance in cardiac and vascular diseases. It remains uncertain to what extent microvascular rarefaction occurs in the earliest stages of these conditions, if impaired blood flow is an aggravating factor and whether angiogenesis restores muscle performance. To investigate this, the effects of aerobic exercise (voluntary wheel running) and functional muscle overload on the performance, femoral blood flow (FBF) and microvascular perfusion of the extensor digitorum longus (EDL) were determined in a chronic rat model of compensatory cardiac hypertrophy (CCH, induced by surgically imposed abdominal aortic coarctation). CCH was associated with hypertension (P = 0.001 vs. Control) and increased relative heart mass (P < 0.001). Immediately upon placing the aortic band (i.e. before development of CCH), post-fatigue test FBF was reduced (P < 0.003), coinciding with attenuated fatigue resistance (P = 0.039) indicating an acute arterial perfusion constraint on muscle performance. While FBF was normalized during CCH in chronic groups (P > 0.05) fatigue resistance remained reduced (P = 0.039) and was associated with reduced (P = 0.009) functional capillarity after development of CCH without intervention, indicating a microvascular limitation to muscle performance. Normalization of functional capillarity after aerobic exercise (P = 0.065) and overload (P = 0.329) in CCH coincided with restoration to control levels of muscle fatigue resistance (P > 0.999), although overload-induced EDL hypertrophy (P = 0.027) and wheel-running velocity and duration (both P < 0.05) were attenuated after aortic banding. These data show that reductions in skeletal muscle performance during CCH can be countered by improving functional capillarity, providing a therapeutic target to improve skeletal muscle function in chronic diseases.
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Affiliation(s)
- Peter G Tickle
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Paul W Hendrickse
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Andrew Weightman
- Department of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - M Hakam Nazir
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Hans Degens
- Department of Life Sciences, Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Stuart Egginton
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Goulart CDL, Arêas GPT, Caruso FR, Araújo ASG, de Moura SCG, Catai AM, Beltrame T, Junior LCDC, Dos Santos PB, Roscani MG, Mendes RG, Arena R, Borghi-Silva A. Effect of high-intensity exercise on cerebral, respiratory and peripheral muscle oxygenation of HF and COPD-HF patients. Heart Lung 2020; 50:113-120. [PMID: 32709499 DOI: 10.1016/j.hrtlng.2020.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate cerebral oxygenation (Cox) responses as well as respiratory (Res) and active peripheral muscle (Pm) O2 delivery during high-intensity cycling exercise and contrast responses between patients with coexistent chronic obstructive pulmonary disease (COPD)-heart failure (HF) and HF alone. METHODS Cross-sectional study involving 11 COPD-HF and 11 HF patients. On two different days, patients performed maximal incremental cardiopulmonary exercise testing (CPET) and constant load exercise on a cycle ergometer until the limit of tolerance (Tlim). The high-intensity exercise session was 80% of the peak CPET work rate. Relative blood concentrations of oxyhemoglobin ([O2Hb]), deoxyhemoglobin ([HHb]) of Res, Pm (right vastus lateralis) and Cox (pre-frontal) were measured using near infrared spectroscopy. RESULTS We observed a greater decrease in [O2Hb] at a lower Tlim in COPD-HF when compared to HF (P < 0.05). [HHb] of Res was higher (P < 0.05) and Tlim was lower in COPD-HF vs. HF. Pm and Cox were lower and Tlim was higher in (P < 0.05) HF vs. COPD-HF. In HF, there was a lower ∆[O2Hb] and higher ∆ [HHb] of Pm when contrasted to Cox observed during exercise, as well as a lower ∆ [O2Hb] and higher ∆ [HHb] of Res when contrasted with Cox (P < 0.05). However, COPD-HF patients presented with a higher ∆ [HHb] of Res and Pm when contrasted with Cox (P < 0.05). CONCLUSION The coexistence of COPD in patients with HF produces negative effects on Cox, greater deoxygenation of the respiratory and peripheral muscles and higher exertional dyspnea, which may help to explain an even lower exercise tolerance in this multimorbidity phenotype.
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Affiliation(s)
- Cássia da Luz Goulart
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Guilherme Peixoto Tinoco Arêas
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil; Human Physiology Laboratory, Physiology Department, Federal University of Amazonas, UFAM, v. General Rodrigo Octávio, 6200, Coroado I, CEP: 69080-900, Manaus, AM, Brazil
| | - Flávia Rossi Caruso
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Adriana S Garcia Araújo
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Sílvia Cristina Garcia de Moura
- Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Thomas Beltrame
- Cardiovascular Physical Therapy Laboratory, Physiotherapy Department, Federal University of São Carlos, Rod Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Luiz Carlos de Carvalho Junior
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Polliana Batista Dos Santos
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | | | - Renata Gonçalves Mendes
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Physiotherapy Department, Federal University of Sao Carlos, UFSCar, Rodovia Washington Luis, KM 235, Monjolinho, CEP: 13565-905, Sao Carlos, SP, Brazil.
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Palmer K, Bowles KA, Paton M, Jepson M, Lane R. Chronic Heart Failure and Exercise Rehabilitation: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:2570-2582. [DOI: 10.1016/j.apmr.2018.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/26/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
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Koutsioumpa E, Makris D, Theochari A, Bagka D, Stathakis S, Manoulakas E, Sgantzos M, Zakynthinos E. Effect of Transcutaneous Electrical Neuromuscular Stimulation on Myopathy in Intensive Care Patients. Am J Crit Care 2018; 27:495-503. [PMID: 30385541 DOI: 10.4037/ajcc2018311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Critical illness polyneuropathy or myopathy is a severe disorder that may adversely affect patients in the intensive care unit, resulting in reduced mobilization, decline in muscle mass, and prolonged recovery periods. OBJECTIVE To examine whether the application of trans-cutaneous electrical neuromuscular stimulation (TENMS) reduces the incidence or severity of myopathy related to critical illness in intensive care unit patients. METHODS A total of 80 patients aged 18 years or older with an intensive care unit stay of 96 hours or more and receipt of mechanical ventilation for 96 hours or more were initially enrolled in a prospective, open-label randomized controlled trial in a university hospital. Patients received either conventional physical therapy alone (control group) or conventional physical therapy plus TENMS (TENMS group) for 10 days. Myopathy was assessed histologically (by needle biopsy of the quadriceps muscles) on the 4th and 14th days of the intensive care unit stay. RESULTS Of the 68 patients who completed the study, 27 (40%) had myopathy on the 14th day: 11 patients in the TENMS group (9 mild, 1 moderate, and 1 severe) and 16 patients in the control group (13 mild, 2 moderate, and 1 severe). Patients who progressed from mild to moderate or severe myopathy between the 4th and 14th days had significantly lower body mass index (P = .001) and longer time periods with inadequate nutrition (P = .049) compared with the other patients. Mean (SD) Rankin scale scores at 6 months were 3.2 (1.8) and 3.8 (2.1) in the TENMS and control groups, respectively (P = .09). CONCLUSION TENMS had no significant impact on myopathy in the critically ill patients in this study.
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Affiliation(s)
- Evangelia Koutsioumpa
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Demosthenes Makris
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athina Theochari
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitra Bagka
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stathis Stathakis
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstratios Manoulakas
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
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8
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Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients: An observational study. Eur J Anaesthesiol 2018; 34:688-694. [PMID: 28834795 DOI: 10.1097/eja.0000000000000684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion. OBJECTIVE The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired. DESIGN Prospective, observational study. SETTING Single-centre, tertiary university teaching hospital, Belgium. PATIENTS Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery. INTERVENTION Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy. MAIN OUTCOME MEASURES Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined. RESULTS Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P < 0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min, P < 0.001]. After induction of anaesthesia, recovery times were longer [40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery was lower [114 (12 to 497) vs. 80 (3 to 271)% min, P < 0.001]. CONCLUSION After induction of anaesthesia, oxygen consumption was decreased. The longer recovery times and slower rates of recovery indicate impaired microvascular reactivity after induction of anaesthesia. TRIAL REGISTRATION The research project was registered at ClinicalTrials.gov (NCT02034682).
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Shirshin EA, Gurfinkel YI, Matskeplishvili ST, Sasonko ML, Omelyanenko NP, Yakimov BP, Lademann J, Darvin ME. In vivo optical imaging of the viable epidermis around the nailfold capillaries for the assessment of heart failure severity in humans. JOURNAL OF BIOPHOTONICS 2018; 11:e201800066. [PMID: 29845751 DOI: 10.1002/jbio.201800066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/22/2018] [Indexed: 05/03/2023]
Abstract
Heart failure (HF) is among the socially significant diseases, involving over 2% of the adult population in the developed countries. Diagnostics of the HF severity remains complicated due to the absence of specific symptoms and objective criteria. Here, we present an indicator of the HF severity based on the imaging of tissue parameters around the nailfold capillaries. High resolution nailfold video capillaroscopy was performed to determine the perivascular zone (PZ) size around nailfold capillaries, and 2-photon tomography with fluorescence lifetime imaging was used to investigate PZ composition. We found that the size of PZ around the nailfold capillaries strongly correlates with HF severity. Further investigations using 2-photon tomography demonstrated that PZ corresponds to the border of viable epidermis and it was suggested that the PZ size variations were due to the different amounts of interstitial fluid that potentially further translates in clinically significant oedema. The obtained results allow for the development of a quantitative indicator of oedematous syndrome, which can be used in various applications to monitor the dynamics of interstitial fluid retention. We therefore suggest PZ size measured with nailfold video capillaroscopy as a novel quantitative sensitive non-invasive marker of HF severity.
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Affiliation(s)
- Evgeny A Shirshin
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
- Institute of spectroscopy of the Russian Academy of Sciences, Troitsk, Moscow, Russia
| | - Yury I Gurfinkel
- Research Clinical Center of JSC "Russian Railways", Moscow, Russia
- Lomonosov Moscow State University Clinic, Moscow, Russia
| | | | - Maria L Sasonko
- Research Clinical Center of JSC "Russian Railways", Moscow, Russia
| | | | - Boris P Yakimov
- Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - Juergen Lademann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Berlin, Germany
| | - Maxim E Darvin
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venerology and Allergology, Center of Experimental and Applied Cutaneous Physiology, Berlin, Germany
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Van Iterson EH, Olson TP. Therapeutic Targets for the Multi-system Pathophysiology of Heart Failure: Exercise Training. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:87. [DOI: 10.1007/s11936-017-0585-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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11
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Panagopoulou N, Karatzanos E, Dimopoulos S, Tasoulis A, Tachliabouris I, Vakrou S, Sideris A, Gratziou C, Nanas S. Exercise training improves characteristics of exercise oscillatory ventilation in chronic heart failure. Eur J Prev Cardiol 2017; 24:825-832. [PMID: 28436722 DOI: 10.1177/2047487317695627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Exercise oscillatory ventilation in chronic heart failure has been suggested as a factor related to adverse cardiac events, aggravated prognosis and higher mortality. Exercise training is well known to affect exercise capacity and mechanisms of pathophysiology beneficially in chronic heart failure. Little is known, however, about the exercise training effects on characteristics of exercise oscillatory ventilation in chronic heart failure patients. Design and methods Twenty (out of 38) stable chronic heart failure patients exhibited exercise oscillatory ventilation (age 54 ± 11 years, peak oxygen uptake 15.0 ± 5.0 ml/kg per minute). Patients attended 36 sessions of high intensity interval exercise. All patients underwent cardiopulmonary exercise testing before and after the programme. Assessment of exercise oscillatory ventilation was based on the amplitude of cyclic fluctuations in breathing during rest and exercise. All values are mean ± SD. Results Exercise training reduced ( P < 0.05) the percentage of exercise oscillatory ventilation duration (79.0 ± 13.0 to 50.0 ± 25.0%), while average amplitude (5.2 ± 2.0 to 4.9 ± 1.6 L/minute) and length (44.0 ± 10.9 to 41.0 ± 6.7 seconds) did not change ( P > 0.05). Exercise oscillatory ventilation patients also increased exercise capacity ( P < 0.05). Conclusions A rehabilitation programme based on high intensity interval training improved exercise oscillatory ventilation observed in chronic heart failure patients, as well as cardiopulmonary efficiency and functional capacity.
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Affiliation(s)
- Niki Panagopoulou
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tasoulis
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Ioannis Tachliabouris
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Styliani Vakrou
- 2 Third Cardiology Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Antonios Sideris
- 3 Second Department of Cardiology, "Evaggelismos" General Hospital, Athens, Greece
| | - Christina Gratziou
- 4 Pulmonary and Critical Care University Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1 Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, School of Medicine, National and Kapodistrian University of Athens, Greece
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12
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Tzanis G, Philippou A, Karatzanos E, Dimopoulos S, Kaldara E, Nana E, Pitsolis T, Rontogianni D, Koutsilieris M, Nanas S. Effects of High-Intensity Interval Exercise Training on Skeletal Myopathy of Chronic Heart Failure. J Card Fail 2017; 23:36-46. [PMID: 27327970 DOI: 10.1016/j.cardfail.2016.06.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 06/11/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND It remains controversial which type of exercise elicits optimum adaptations on skeletal myopathy of heart failure (HF). Our aim was to evaluate the effect of high-intensity interval training (HIIT), with or without the addition of strength training, on skeletal muscle of HF patients. METHODS AND RESULTS Thirteen male HF patients (age 51 ± 13 years, body mass index 27 ± 4 kg/m2) participated in either an HIIT (AER) or an HIIT combined with strength training (COM) 3-month program. Biopsy samples were obtained from the vastus lateralis. Analyses were performed on muscle fiber type, cross-section area (CSA), capillary density, and mRNA expression of insulin-like growth factor (IGF) 1 isoforms (ie, IGF-1Ea, IGF-1Eb, IGF-1Ec), type-1 receptor (IGF-1R), and binding protein 3 (IGFBP-3). Increased expression of IGF-1Ea, IGF-1Eb, IGF-1Ec, and IGFBP-3 transcripts was found (1.7 ± 0.8, 1.5 ± 0.8, 2.0 ± 1.32.4 ± 1.4 fold changes, respectively; P < .05). Type I fibers increased by 21% (42 ± 10% to 51 ± 7%; P < .001) and capillary/fiber ratio increased by 24% (1.27 ± 0.22 to 1.57 ± 0.41; P = .005) in both groups as a whole. Fibers' mean CSA increased by 10% in total, but the increase in type I fibers' CSA was greater after AER than COM (15% vs 6%; P < .05). The increased CSA correlated with the increased expression of IGF-1Ea and IGF-1Εb. CONCLUSIONS HIIT reverses skeletal myopathy of HF patients, with the adaptive responses of the IGF-1 bioregulation system possibly contributing to these effects. AER program seemed to be superior to COM to induce muscle hypertrophy.
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Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital," National & Kapodistrian University of Athens, Greece
| | - Anastassios Philippou
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Eleftherios Karatzanos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital," National & Kapodistrian University of Athens, Greece
| | - Stavros Dimopoulos
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital," National & Kapodistrian University of Athens, Greece
| | - Elisavet Kaldara
- 3rd Cardiology Department, "Laiko" Hospital, National and Kapodistrian University of Athens, Greece
| | - Emmeleia Nana
- 3rd Cardiology Department, "Laiko" Hospital, National and Kapodistrian University of Athens, Greece
| | - Theodoros Pitsolis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital," National & Kapodistrian University of Athens, Greece
| | | | - Michael Koutsilieris
- Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital," National & Kapodistrian University of Athens, Greece.
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Novakovic M, Jug B, Lenasi H. Clinical impact of exercise in patients with peripheral arterial disease. Vascular 2016; 25:412-422. [PMID: 28256934 DOI: 10.1177/1708538116678752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Increasing prevalence, high morbidity and mortality, and decreased health-related quality of life are hallmarks of peripheral arterial disease. About one-third of peripheral arterial disease patients have intermittent claudication with deleterious effects on everyday activities, such as walking. Exercise training improves peripheral arterial disease symptoms and is recommended as first line therapy for peripheral arterial disease. This review examines the effects of exercise training beyond improvements in walking distance, namely on vascular function, parameters of inflammation, activated hemostasis and oxidative stress, and quality of life. Exercise training not only increases walking distance and physiologic parameters in patients with peripheral arterial disease, but also improves the cardiovascular risk profile by helping patients achieve better control of hypertension, hyperglycemia, obesity and dyslipidemia, thus further reducing cardiovascular risk and the prevalence of coexistent atherosclerotic diseases. American guidelines suggest supervised exercise training, performed for a minimum of 30-45 min, at least three times per week, for at least 12 weeks. Walking is the most studied exercise modality and its efficacy in improving cardiovascular parameters in patients with peripheral arterial disease has been extensively proven. As studies have shown that supervised exercise training improves walking performance, cardiovascular parameters and quality of life in patients with peripheral arterial disease, it should be encouraged and more often prescribed.
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Affiliation(s)
- Marko Novakovic
- 1 Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Jug
- 1 Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Helena Lenasi
- 3 Faculty of Medicine, Institute of Physiology, University of Ljubljana, Ljubljana, Slovenia
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Rodríguez-Núñez I, Romero F, Saavedra MJ. [Exercise-induced shear stress: Physiological basis and clinical impact]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:244-54. [PMID: 27118039 DOI: 10.1016/j.acmx.2016.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/10/2016] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
The physiological regulation of vascular function is essential for cardiovascular health and depends on adequate control of molecular mechanisms triggered by endothelial cells in response to mechanical and chemical stimuli induced by blood flow. Endothelial dysfunction is one of the major risk factors for cardiovascular disease, where an imbalance between synthesis of vasodilator and vasoconstrictor molecules is one of its main mechanisms. In this context, the shear stress is one of the most important mechanical stimuli to improve vascular function, due to endothelial mechanotransduction, triggered by stimulation of various endothelial mechanosensors, induce signaling pathways culminating in increased bioavailability of vasodilators molecules such as nitric oxide, that finally trigger the angiogenic mechanisms. These mechanisms allow providing the physiological basis for the effects of exercise on vascular health. In this review it is discussed the molecular mechanisms involved in the vascular response induced by shear stress and its impact in reversing vascular injury associated with the most prevalent cardiovascular disease in our population.
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Affiliation(s)
- Iván Rodríguez-Núñez
- Laboratorio de Biología del Ejercicio, Escuela de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile; Carrera de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Concepción, Chile; Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de la Frontera. Laboratorio de Neurociencia y Biología de péptidos CEBIOR-CEGIN BIOREN, Depto. Ciencias Preclínicas, Facultad Medicina, UFRO, Temuco, Chile; Programa de Magíster en Kinesiología Cardiorrespiratoria, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile.
| | - Fernando Romero
- Programa de Doctorado en Ciencias Médicas, Facultad de Medicina, Universidad de la Frontera. Laboratorio de Neurociencia y Biología de péptidos CEBIOR-CEGIN BIOREN, Depto. Ciencias Preclínicas, Facultad Medicina, UFRO, Temuco, Chile
| | - María Javiera Saavedra
- Programa de Magíster en Kinesiología Cardiorrespiratoria, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
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Tzanis G, Manetos C, Dimopoulos S, Vasileiadis I, Malliaras K, Kaldara E, Karatzanos E, Nanas S. Attenuated Microcirculatory Response to Maximal Exercise in Patients With Chronic Heart Failure. J Cardiopulm Rehabil Prev 2016; 36:33-7. [PMID: 26468631 DOI: 10.1097/hcr.0000000000000145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Exercise training programs improve microcirculatory alternations in patients with chronic heart failure (CHF). However less is known about the acute effect of maximum exercise on the skeletal muscle microcirculation. We aimed to assess the effect of acute exercise on peripheral microcirculation of patients with CHF, as assessed by near-infrared spectroscopy with vascular occlusion technique. METHODS Tissue oxygenation was evaluated in 8 stable patients with CHF (7 males; mean age, 60 ± 9 years; body mass index, 26.3 ± 3.8 kg/m) and 8 healthy subjects (matched for age, sex, and body mass index) before and after cardiopulmonary exercise testing. Tissue oxygen saturation (StO2), StO2peak, oxygen consumption rate, and endothelial function (reperfusion rate), before and after maximum exercise, were assessed. RESULTS Patients with CHF had lower StO2 and reperfusion rate compared with healthy subjects (71.4% ± 9.8% vs 81.0% ± 5.4% and 9 ± 1 %/min vs 13.9 ± 5.8%/min, respectively; P < .05) at rest. Oxygen consumption rate increased after exercise in patients with CHF and healthy subjects (from -31.7 ± 8.2 to -43.7 ± 12.7 and from -35.7 ± 6.7 to -42.4 ± 6.4, respectively; P < .05). StO2 decreased significantly after maximal exercise in patients with CHF (from 71.4 ± 9.8 to 65.2 ± 12.7; P < .05), whereas it returned to the preexercise values in healthy subjects (from 81.0 ± 5.4 to 80.3 ± 7.0). There was a significant between-group difference (P < .05). CONCLUSIONS Patients with CHF present microcirculatory alternations. Acute exercise exerts an effect on microcirculation in peripheral, nonexercising muscles, with altered response in patients with CHF compared with healthy subjects.
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Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department (Drs Tzanis, Manetos, Dimopoulos, Vasileiadis, Karatzanos, and Nanas), Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidion Hospital, NKUA, Athens, Greece; and 3rd Cardiology Department (Drs Malliaras and Kaldara), NKUA, Athens, Greece
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Abstract
Type 2 diabetes (T2DM) disproportionately affects the underserved population, and has been identified as the major risk factor for many microvascular diseases. T2DM also affects the vasculature and neural system of the inner ear, often leading to hearing loss, a major risk factor for falls, depression, and other health problems. This article aims to: increase awareness of the association between T2DM and hearing loss; promote screening for hearing loss; discuss available resources and assistive devices for those with hearing loss; and encourage nurses to take an active role in advocating for assessment and treatment of hearing loss in T2DM patients.
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Georgantas A, Dimopoulos S, Tasoulis A, Karatzanos E, Pantsios C, Agapitou V, Ntalianis A, Roditis P, Terrovitis J, Nanas S. Beneficial effects of combined exercise training on early recovery cardiopulmonary exercise testing indices in patients with chronic heart failure. J Cardiopulm Rehabil Prev 2014; 34:378-85. [PMID: 24983706 DOI: 10.1097/hcr.0000000000000068] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Exercise training induces several beneficial effects in patients with chronic heart failure (CHF). This study investigated the effects of high-intensity aerobic interval training (AIT) compared with combined AIT and strength training (COM) on early ventilatory and metabolic recovery pattern after symptom-limited cardiopulmonary exercise testing (CPET) in CHF patients. METHODS Stable CHF patients (N = 42; 54 ± 10 years [mean ± SD], 35 males) participated in an exercise training program for 12 weeks, 3 times per week. Participants were randomly assigned to either AIT (n = 20) or COM group (n = 22). Cardiopulmonary exercise testing was performed before and after completion of the program. Primary measurements included absolute and percentage difference of oxygen uptake, carbon dioxide output, minute ventilation ((Equation is included in full-text article.)E), tidal volume (VT), respiratory rate, and the first-degree slope of oxygen uptake ((Equation is included in full-text article.)O2/t slope) and carbon dioxide output ((Equation is included in full-text article.)CO2/t slope) during the first minute of recovery after maximal exercise. RESULTS The COM group had a greater improvement in the absolute and the percentage difference of (Equation is included in full-text article.)E (P = .03 and P = .04, respectively) and respiratory rate (P = .02 and P = .01, respectively) during the first minute of recovery period after exercise compared with the AIT group alone. No significant changes were noted for VT measurements. A significant increase in (Equation is included in full-text article.)CO2/t slope was observed in COM compared with the AIT group (P = .01). There was a trend for a greater increase in (Equation is included in full-text article.)O2/t slope in the COM group (P = .07). CONCLUSIONS The addition of strength training to AIT induces significant beneficial effects in terms of ventilatory and metabolic recovery kinetics than AIT alone in CHF patients, possibly indicating greater ventilatory efficiency and metabolic improvement.
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Affiliation(s)
- Andreas Georgantas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory (Drs Georgantas, Dimopoulos, Tasoulis, Karatzanos, Agapitou, Roditis, and Nanas) and 3rd Department of Cardiology, National and Kapodistrian University of Athens (Drs Pantsios, Ntalianis, and Terrovitis), Athens, Greece
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18
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Tzanis G, Dimopoulos S, Agapitou V, Nanas S. Exercise intolerance in chronic heart failure: the role of cortisol and the catabolic state. Curr Heart Fail Rep 2014; 11:70-9. [PMID: 24293034 DOI: 10.1007/s11897-013-0177-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic heart failure (CHF) is a complex clinical syndrome leading to exercise intolerance due to muscular fatigue and dyspnea. Hemodynamics fail to explain the reduced exercise capacity, while a significant skeletal muscular pathology seems to constitute the main underlying mechanism for exercise intolerance in CHF patients. There have been proposed several metabolic, neurohormonal and immune system abnormalities leading to an anabolic/catabolic imbalance that plays a central role in the pathogenesis of the wasting process of skeletal muscle myopathy. The impairment of the anabolic axes is associated with the severity of symptoms and the poor outcome in CHF, whereas increased cortisol levels are predictive of exercise intolerance, ventilatory inefficiency and chronotropic incompetence, suggesting a significant contributing mechanism to the limited functional status. Exercise training and device therapy could have beneficial effects in preventing and treating muscle wasting in CHF. However, specific anabolic treatment needs more investigation to prove possible beneficial effects.
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Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evgenidio Hospital", National & Kapodestrian University of Athens, Papadiamantopoulou str., 20, Athens, 11528, Greece
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19
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Is the evaluation of the sublingual density of perfused capillaries in patients with heart failure a useful tool in the emergency ward? Am J Emerg Med 2013; 32:184. [PMID: 24332909 DOI: 10.1016/j.ajem.2013.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/21/2013] [Accepted: 10/29/2013] [Indexed: 11/23/2022] Open
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Rehn TA, Munkvik M, Lunde PK, Sjaastad I, Sejersted OM. Intrinsic skeletal muscle alterations in chronic heart failure patients: a disease-specific myopathy or a result of deconditioning? Heart Fail Rev 2013; 17:421-36. [PMID: 21996779 DOI: 10.1007/s10741-011-9289-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic heart failure (CHF) patients frequently experience impaired exercise tolerance due to skeletal muscle fatigue. Studies suggest that this in part is due to intrinsic alterations in skeletal muscle of CHF patients, often interpreted as a disease-specific myopathy. Knowledge about the mechanisms underlying these skeletal muscle alterations is of importance for the pathophysiological understanding of CHF, therapeutic approach and rehabilitation strategies. We here critically review the evidence for skeletal muscle alterations in CHF, the underlying mechanisms of such alterations and how skeletal muscle responds to training in this patient group. Skeletal muscle characteristics in CHF patients are very similar to what is reported in response to chronic obstructive pulmonary disease (COPD), detraining and deconditioning. Furthermore, skeletal muscle alterations observed in CHF patients are reversible by training, and skeletal muscle of CHF patients seems to be at least as trainable as that of matched controls. We argue that deconditioning is a major contributor to the skeletal muscle dysfunction in CHF patients and that further research is needed to determine whether, and to what extent, the intrinsic skeletal muscle alterations in CHF represent an integral part of the pathophysiology in this disease.
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Affiliation(s)
- T A Rehn
- Institute for Experimental Medical Research, Oslo University Hospital, Ullevaal, Oslo, Norway.
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Koutroumpi M, Dimopoulos S, Psarra K, Kyprianou T, Nanas S. Circulating endothelial and progenitor cells: Evidence from acute and long-term exercise effects. World J Cardiol 2012; 4:312-26. [PMID: 23272272 PMCID: PMC3530787 DOI: 10.4330/wjc.v4.i12.312] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/31/2012] [Accepted: 11/06/2012] [Indexed: 02/06/2023] Open
Abstract
Circulating bone-marrow-derived cells, named endothelial progenitor cells (EPCs), are capable of maintaining, generating, and replacing terminally differentiated cells within their own specific tissue as a consequence of physiological cell turnover or tissue damage due to injury. Endothelium maintenance and restoration of normal endothelial cell function is guaranteed by a complex physiological procedure in which EPCs play a significant role. Decreased number of peripheral blood EPCs has been associated with endothelial dysfunction and high cardiovascular risk. In this review, we initially report current knowledge with regard to the role of EPCs in healthy subjects and the clinical value of EPCs in different disease populations such as arterial hypertension, obstructive sleep-apnea syndrome, obesity, diabetes mellitus, peripheral arterial disease, coronary artery disease, pulmonary hypertension, and heart failure. Recent studies have introduced the novel concept that physical activity, either performed as a single exercise session or performed as part of an exercise training program, results in a significant increase of circulating EPCs. In the second part of this review we provide preliminary evidence from recent studies investigating the effects of acute and long-term exercise in healthy subjects and athletes as well as in disease populations.
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Affiliation(s)
- Matina Koutroumpi
- Matina Koutroumpi, Stavros Dimopoulos, Serafim Nanas, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
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Moalla W, Elloumi M, Chamari K, Dupont G, Maingourd Y, Tabka Z, Ahmaidi S. Training effects on peripheral muscle oxygenation and performance in children with congenital heart diseases. Appl Physiol Nutr Metab 2012; 37:621-30. [DOI: 10.1139/h2012-036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the effect of training on peripheral muscular performance and oxygenation during exercise and recovery in children with congenital heart diseases (CHD). Eighteen patients with CHD aged 12 to 15 years were randomly assigned into either an individualized 12-week aerobic cycling training group (TG) or a control group (CG). Maximal voluntary contraction (MVC) and endurance at 50% MVC (time to exhaustion, Tlim) of the knee extensors were measured before and after training. During the 50% MVC exercise and recovery, near-infrared spectroscopy (NIRS) was used to assess the fall in muscle oxygenation, i.e., deoxygenation ([Formula: see text]) of the vastus lateralis, the mean rate of decrease in muscle oxygenation, the half time of recovery (T1/2R), and the recovery speed to maximal oxygenation (RS). There was no effect of time on any parameter in the CG. After training, significant improvements were observed in TG for MVC (101.6 ± 14.0 vs. 120.2 ± 19.4 N·m, p < 0.01) and Tlim (66.2 ± 22.6 vs. 86.0 ± 23.0 s, p< 0.01). Increased oxygenation (0.20 ± 0.13 vs. 0.15 ± 0.07 a.u., p < 0.01) and faster mean rate of decrease in muscle oxygenation were also shown after training in TG (1.22 ± 0.45 vs. 1.71 ± 0.78%·s–1, p < 0.001). Moreover, a shorter recovery time was observed in TG after training for T1/2R (27.2 ± 6.1 vs. 20.8 ± 4.2 s, p < 0.01) and RS (63.1 ± 18.4 vs. 50.3 ± 11.4 s, p < 0.01). A significant relationship between the change in [Formula: see text] and both MVC (r = 0.95, p < 0.001) and Tlim (r = 0.90, p < 0.001) in TG was observed. We concluded that exercise training improves peripheral muscular function by enhancing strength and endurance performance in children with CHD. This improvement was associated with increased oxygenation of peripheral muscles and faster recovery.
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Affiliation(s)
- Wassim Moalla
- EA 3300 – APS et Conduites Motrices: Adaptations et Réadaptations, Facultés des Sciences du Sport, Université de Picardie, Amiens, France
- Laboratoire de Physiologie et d’Exploration Fonctionnelle, Faculté Ibn Jazzar, Université de Sousse, Tunisie
- UR EM2S: Institut Supérieur de Sport et d’Education Physique Sfax, Sfax, Tunisie
| | - Mohamed Elloumi
- Laboratoire de Physiologie et d’Exploration Fonctionnelle, Faculté Ibn Jazzar, Université de Sousse, Tunisie
| | - Karim Chamari
- Centre National de Médecine et des Sciences du Sport, Laboratoire optimisation de la performance sportive, Tunis
| | - Grégory Dupont
- EA 3608 – Laboratoire d’Études de la Motricité Humaine, Faculté des Sciences du Sport et de l’Education Physique, Université de Lille 2, France
| | - Yves Maingourd
- Service d’Explorations Cardio-pulmonaires Pédiatriques, CHU Nord, Amiens, France
| | - Zouhair Tabka
- Laboratoire de Physiologie et d’Exploration Fonctionnelle, Faculté Ibn Jazzar, Université de Sousse, Tunisie
| | - Said Ahmaidi
- EA 3300 – APS et Conduites Motrices: Adaptations et Réadaptations, Facultés des Sciences du Sport, Université de Picardie, Amiens, France
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Lacroix S, Gayda M, Gremeaux V, Juneau M, Tardif JC, Nigam A. Reproducibility of near-infrared spectroscopy parameters measured during brachial artery occlusion and reactive hyperemia in healthy men. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:077010. [PMID: 22894522 DOI: 10.1117/1.jbo.17.7.077010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Near-infrared spectroscopy (NIRS) is a noninvasive technique evaluating microvascular function. The aim of this study was to assess the reproducibility of NIRS parameters during reactive hyperemia induced by a 5 min brachial artery occlusion. Twenty-four healthy young males (mean 34 ± 8 years old) had two microvascular function evaluations by NIRS over a 7 to 30-day period (mean 16 ± 10 days). Intra-subject and inter-observer reproducibility were evaluated with intraclass correlation coefficient (ICC), coefficient of variation (CV), and standard error of measurement (SEM%) for every parameter. Mean NIRS parameters did not differ between both evaluations. Reproducibility was greatest for muscle oxygen consumption (ICC: 0.84; CV: 6.51%; SEM: 7.11%), time to basal O(2)Hb (ICC: 0.63, CV: 20.04%, SEM 27.22%), time to maximal O(2)Hb (ICC: 0.71; CV: 15.61%; SEM: 19.27%), peak of O(2)Hb (ICC: 0.63, CV: 6.68%, SEM 8.53%), time to maximal tHb (ICC: 0.73, CV: 19,61%, SEM 24.56%) and area under the O(2)Hb and tHb curves (ICC: 0.68, CV: 16.15%, SEM 22.93% and ICC: 0.62, CV: 18.59%, SEM 26.64%, respectively). Moreover, inter-observer reproducibility ranged from excellent to perfect (ICC from 0.85 to 1.00) for every parameter. NIRS parameters during reactive hyperemia are highly reproducible which enables their repeated measurement to study microvascular function in healthy subjects.
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Affiliation(s)
- Sébastien Lacroix
- Montreal Heart Institute Montreal, Cardiovascular Rehabilitation and Prevention Centre (ÉPIC), Quebec, Canada
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Lipcsey M, Woinarski NC, Bellomo R. Near infrared spectroscopy (NIRS) of the thenar eminence in anesthesia and intensive care. Ann Intensive Care 2012; 2:11. [PMID: 22569165 PMCID: PMC3488540 DOI: 10.1186/2110-5820-2-11] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 03/26/2012] [Indexed: 01/20/2023] Open
Abstract
Near infrared spectroscopy of the thenar eminence (NIRSth) is a noninvasive bedside method for assessing tissue oxygenation. The NIRS probe emits light with several wavelengths in the 700- to 850-nm interval and measures the reflected light mainly from a predefined depth. Complex physical models then allow the measurement of the relative concentrations of oxy and deoxyhemoglobin, and thus tissue saturation (StO2), as well as an approximation of the tissue hemoglobin, given as tissue hemoglobin index. Here we review of current knowledge of the application of NIRSth in anesthesia and intensive care. We performed an analytical and descriptive review of the literature using the terms “near-infrared spectroscopy” combined with “anesthesia,” “anesthesiology,” “intensive care,” “critical care,” “sepsis,” “bleeding,” “hemorrhage,” “surgery,” and “trauma” with particular focus on all NIRS studies involving measurement at the thenar eminence. We found that NIRSth has been applied as clinical research tool to perform both static and dynamic assessment of StO2. Specifically, a vascular occlusion test (VOT) with a pressure cuff can be used to provide a dynamic assessment of the tissue oxygenation response to ischemia. StO2 changes during such induced ischemia-reperfusion yield information on oxygen consumption and microvasculatory reactivity. Some evidence suggests that StO2 during VOT can detect fluid responsiveness during surgery. In hypovolemic shock, StO2 can help to predict outcome, but not in septic shock. In contrast, NIRS parameters during VOT increase the diagnostic and prognostic accuracy in both hypovolemic and septic shock. Minimal data are available on static or dynamic StO2 used to guide therapy. Although the available data are promising, further studies are necessary before NIRSth can become part of routine clinical practice.
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Affiliation(s)
- Miklos Lipcsey
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
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Manetos C, Dimopoulos S, Tzanis G, Vakrou S, Tasoulis A, Kapelios C, Agapitou V, Ntalianis A, Terrovitis J, Nanas S. Skeletal muscle microcirculatory abnormalities are associated with exercise intolerance, ventilatory inefficiency, and impaired autonomic control in heart failure. J Heart Lung Transplant 2011; 30:1403-8. [PMID: 21982360 DOI: 10.1016/j.healun.2011.08.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several skeletal muscle abnormalities have been identified in patients with chronic heart failure (CHF), including endothelial dysfunction. We hypothesized that skeletal muscle microcirculation, assessed by near-infrared spectroscopy (NIRS), is impaired in CHF patients and is associated with disease severity. METHODS Eighty-three stable patients with mild-moderate CHF (72 males, mean age 54 ± 14 years, body mass index 26.7 ± 3.4 kg/m(2)) and 8 healthy subjects, matched for age, gender and body mass index, underwent NIRS with the vascular occlusion technique and cardiopulmonary exercise testing (CPET) evaluation on the same day. Tissue oxygen saturation (StO(2), %), defined as the percentage of hemoglobin saturation in the microvasculature compartments, was measured in the thenar muscle by NIRS before, during and after 3-minute occlusion of the brachial artery. Measurements included StO(2), oxygen consumption rate (OCR, %/min) and reperfusion rate (RR, %/min). All subjects underwent a symptom-limited CPET on a cycle ergometer. Measurements included VO(2) at peak exercise (VO(2)peak, ml/kg/min) and anaerobic threshold (VO(2)AT, ml/kg/min), VE/VCO(2) slope, chronotropic reserve (CR, %) and heart rate recovery (HRR(1), bpm). RESULTS CHF patients had significantly lower StO(2) (75 ± 8.2 vs 80.3 ± 6, p < 0.05), lower OCR (32.3 ± 10.4 vs 37.7 ± 5.5, p < 0.05) and lower RR (10 ± 2.8 vs 15.7 ± 6.3, p < 0.05) compared with healthy controls. CHF patients with RR ≥9.5 had a significantly greater VO(2)peak (p < 0.001), VO(2)AT (p < 0.01), CR (p = 0.01) and HRR(1) (p = 0.01), and lower VE/VCO(2) slope (p = 0.001), compared to those with RR <9.5. In a multivariate analysis, RR was identified as an independent predictor of VO(2)peak, VE/VCO(2) slope and HRR(1). CONCLUSIONS Peripheral muscle microcirculation, as assessed by NIRS, is significantly impaired in CHF patients and is associated with disease severity.
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Affiliation(s)
- Christos Manetos
- First Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, NKUA, Athens, Greece
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Hamaoka T, McCully KK, Niwayama M, Chance B. The use of muscle near-infrared spectroscopy in sport, health and medical sciences: recent developments. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2011; 369:4591-604. [PMID: 22006908 DOI: 10.1098/rsta.2011.0298] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Near-infrared spectroscopy (NIRS) has been shown to be one of the tools that can measure oxygenation in muscle and other tissues in vivo. This review paper highlights the progress, specifically in this decade, that has been made for evaluating skeletal muscle oxygenation and oxidative energy metabolism in sport, health and clinical sciences. Development of NIRS technologies has focused on improving quantification of the signal using multiple wavelengths to solve for absorption and scattering coefficients, multiple pathlengths to correct for the influence of superficial skin and fat, and time-resolved and phase-modulated light sources to determine optical pathlengths. In addition, advances in optical imaging with multiple source and detector pairs as well as portability using small wireless detectors have expanded the usefulness of the devices. NIRS measurements have provided information on oxidative metabolism in various athletes during localized exercise and whole-body exercise, as well as training-induced adaptations. Furthermore, NIRS technology has been used in the study of a number of chronic health conditions. Future developments of NIRS technology will include enhancing signal quantification. In addition, advances in NIRS imaging and portability promise to transform how measurements of oxygen utilization are obtained in the future.
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Affiliation(s)
- Takafumi Hamaoka
- Faculty of Sport and Health Science, Ritsumeikan University, 1-1-1 Nojihigashi, Kusatsu, Shiga 525-8577, Japan.
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Abstract
For patients with heart failure (HF), dyspnea and fatigue resulting in diminished exercise tolerance are among the main factors that contribute to decreased social and physical functioning and quality of life. There has long been evidence to suggest that measures of cardiac function, such as ejection fraction and cardiac output, only poorly correlate with a patient's exercise capacity, indicating the involvement of factors other than those impacting central circulation. The lack of a close correlation between central hemodynamics and exercise tolerance has led to investigations into alterations in the periphery, such as abnormalities in vascular endothelial function, hyperactivation of the sympathetic nervous system, and changes in structure and oxidative capacity of skeletal muscle, which are commonly seen in patients with HF. Over the past 2 decades, numerous clinical trials have demonstrated the beneficial impact of exercise training on skeletal muscle energy metabolism, vascular function, and ventilatory capacity, which correlate with improvements in exercise tolerance, hospitalization rates, and quality of life of patients with HF. In accordance with recent guidelines established by the leading cardiology societies in the United States and Europe, physicians are urged to emphasize exercise training for all clinically stable patients with HF using individualized protocols that feature early mobilization after acute exacerbations of the disease and gradual increases in intensity.
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Kayambu G, Boots RJ, Paratz JD. Early rehabilitation in sepsis: a prospective randomised controlled trial investigating functional and physiological outcomes The i-PERFORM Trial (Protocol Article). BMC Anesthesiol 2011; 11:21. [PMID: 22035174 PMCID: PMC3306201 DOI: 10.1186/1471-2253-11-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/31/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patients with sepsis syndromes in comparison to general intensive care patients can have worse outcomes for physical function, quality of life and survival. Early intensive care rehabilitation can improve the outcome in general Intensive Care Unit (ICU) patients, however no investigations have specifically looked at patients with sepsis syndromes. The 'i-PERFORM Trial' will investigate if early targeted rehabilitation is both safe and effective in patients with sepsis syndromes admitted to ICU. METHODS/DESIGN A single-centred blinded randomized controlled trial will be conducted in Brisbane, Australia. Participants (n = 252) will include those ≥ 18 years, mechanically ventilated for ≥ 48 hours and diagnosed with a sepsis syndrome. Participants will be randomised to an intervention arm which will undergo an early targeted rehabilitation program according to the level of arousal, strength and cardiovascular stability and a control group which will receive normal care.The primary outcome measures will be physical function tests on discharge from ICU (The Acute Care Index of Function and The Physical Function ICU Test). Health-related quality of life will be measured using the Short Form-36 and the psychological component will be tested using The Hospital Anxiety and Depression Scale. Secondary measures will include inflammatory biomarkers; Interleukin-6, Interleukin-10 and Tumour Necrosis Factor-α, peripheral blood mitochondrial DNA content and lactate, fat free muscle mass, tissue oxygenation and microcirculatory flow. DISCUSSION The 'i-PERFORM Trial' will determine whether early rehabilitation for patients with sepsis is effective at improving patient outcomes with functional and physiological parameters reflecting long and short-term effects of early exercise and the safety in its application in critical illness. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000808044.
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Affiliation(s)
- Geetha Kayambu
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
| | - Robert J Boots
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
- Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane QLD 4029, Australia
| | - Jennifer D Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
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Anagnostakou V, Chatzimichail K, Dimopoulos S, Karatzanos E, Papazachou O, Tasoulis A, Anastasiou-Nana M, Roussos C, Nanas S. Effects of interval cycle training with or without strength training on vascular reactivity in heart failure patients. J Card Fail 2011; 17:585-91. [PMID: 21703531 DOI: 10.1016/j.cardfail.2011.02.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 02/21/2011] [Accepted: 02/24/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise training confers beneficial effects on vascular reactivity in patients with chronic heart failure (CHF). This randomized study compares the effects of interval cycle training combined with strength training versus interval training alone on vascular reactivity in CHF patients. METHODS Twenty-eight consecutive stable CHF patients (23 males, 53 ± 10 years, 28.4 ± 4.1 kg/m(2), left ventricular ejection fraction of 37 ± 12%) were randomly assigned to 3 times' weekly training sessions for 3 months, consisting of a) 40 minutes of interval cycle training (n = 14), versus b) 20 minutes of similar interval training plus 20 minutes of strength training of the quadriceps, hamstrings, muscles of the shoulder and biceps brachialis (n = 14). The work/recovery ratio of each session was 30/60 seconds. The intensity of interval training was set at 50% of the peak workload achieved at the steep ramp test (consisted of a 25-Watt increase on a cycle ergometer every 10 seconds until exhaustion). All patients underwent maximal, symptom-limited cardiopulmonary exercise testing and ultrasound evaluation of vascular reactivity by flow-mediated vasodilation (FMD) before and after the program. RESULTS A significant improvement in FMD was observed in the combined training group (P = 0.002), in contrast to the interval training alone group (P = NS); the improvement was significantly greater in the combined training than in the interval training alone group (P < .05). Peak oxygen uptake increased significantly and similarly in both groups, in the interval training group (P = .03), and in the combined training group (P = .006). No significant correlation was found between FMD improvement and cardiopulmonary exercise parameters. CONCLUSIONS A combined high-intensity, interval cycle exercise with strength training induces a greater beneficial effect on vascular reactivity rather than interval exercise training alone in CHF patients.
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Affiliation(s)
- Vania Anagnostakou
- 1(st) Critical Care Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, NKUA, Athens, Greece
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Yu B, Fang TH, Lü GH, Xu HQ, Lu JF. Beneficial effect of Cyclovirobuxine D on heart failure rats following myocardial infarction. Fitoterapia 2011; 82:868-77. [PMID: 21575690 DOI: 10.1016/j.fitote.2011.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/16/2011] [Accepted: 04/23/2011] [Indexed: 10/18/2022]
Abstract
The effect of Cyclovirobuxine D, an active ingredient from Buxus microphylla, was investigated in the potential prevention of cardiac dysfunction in rats with congestive heart failure. Heart failure was induced by left coronary artery occlusion and verified using echocardiography. Cyclovirobuxine D was administered for 30 days (0.5, 1.0 and 2.0mg/kg, ig) and mortality, cardiac function, hemodynamics, microcirculation, histology and ultrastructure assessments were observed. Results from the present study suggest that Cyclovirobuxine D is beneficial for heart failure induced by myocardial infarction and supports the potential for Cyclovirobuxine D as a new therapy for heart failure.
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Affiliation(s)
- Bin Yu
- Jiangsu Key Laboratory for Pharmacology and Safety Evaluation of Chinese Materia Medica, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, PR China.
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31
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Abstract
The volume of literature attesting to the clinical benefits of exercise training in patients with stable chronic heart failure (CHF) is substantial. Training can improve symptoms and exercise capacity, as well as reducing morbidity, mortality, and rates of emergency hospitalization. These benefits are apparent in all patients with stable CHF, irrespective of age or sex, or the etiology or severity of heart failure. Training regimens for patients with stable, systolic CHF should form part of a comprehensive heart-failure support effort and are best delivered using supervised in-hospital exercise combined with some training at home or in a group setting in community centers. In this Review, the modes and intensity of exercise training, selection of patients, duration of training effects, and other clinical guidance for using this treatment option are discussed.
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Affiliation(s)
- Andrew J Stewart Coats
- The Norwich Research Park, University of East Anglia, Colney Lane, Norwich, Norfolk NR4 7TJ, UK.
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Tasoulis A, Papazachou O, Dimopoulos S, Gerovasili V, Karatzanos E, Kyprianou T, Drakos S, Anastasiou-Nana M, Roussos C, Nanas S. Effects of interval exercise training on respiratory drive in patients with chronic heart failure. Respir Med 2010; 104:1557-65. [PMID: 20663654 DOI: 10.1016/j.rmed.2010.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 03/11/2010] [Accepted: 03/16/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) suffer from ventilatory abnormalities. This study examined the effects of interval exercise training on the respiratory drive in CHF patients. METHODS Forty-six clinically stable CHF patients (38 males/8 women, mean age = 53 +/- 11 years) participated in an exercise rehabilitation program (ERP) 3 times/week, for 12 weeks by interval training modality with or without the addition of resistance training. All patients underwent symptom-limited cardiopulmonary exercise testing (CPET), and measurements of mouth occlusion pressure at 100 ms (P(0.1)) and maximum inspiratory muscle strength (P(Imax)) before and after ERP. Respiratory drive was estimated by mouth occlusion pressure P(0.1) and P(0.1)/P(Imax) ratio at rest, and the ventilatory pattern by resting mean inspiratory flow (V(T)/T(I)) and by V(T)/T(I) at identical CPET workloads, before and after ERP. We also studied a control non exercising group of 11 patients (8 men and 3 women). RESULTS P(0.1) at rest decreased from 3.04 +/- 1.52 to 2.62 +/- 0.9 cmH(2)O (p = 0.015), P(0.1)/P(Imax) % at rest from 4.56 +/- 3.73 to 3.69 +/- 2.03 (p = 0.006), resting V(T)/T(I) from 0.44 +/- 0.10 to 0.41 +/- 0.10 l/s (p = 0.014), and V(T)/T(I) at identical work rate from 2.13 +/- 0.59 to 1.93 +/- 0.58 l/s (p = 0.001) after ERP. VO(2) at peak exercise increased from 16.3 +/- 4.8 to 18.5 +/- 5.3 ml/kg/min (p < 0.001) in the exercise group. No improvement was noted in the control group. CONCLUSIONS ERP by interval training improves the respiratory drive and ventilatory pattern at rest and during exercise in CHF patients.
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Affiliation(s)
- Athanasios Tasoulis
- Pulmonary & Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, Evgenidio Hospital, National & Kapodistrian University of Athens, Papadiamantopoulou St, Athens, Greece
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