Effects of beta-adrenoceptor blockade on exercise performance and respiratory response in healthy, physically untrained humans

Effects of arotinolol on exercise capacity and humoral factors during exercise in normal subjects

A placebo-controlled, double-blind crossover study was undertaken in 10 normal subjects to examine the effects of arotinolol (10 mg bid), a nonselective beta blocker with alpha-blocking activity, on exercise capacity and hormone levels during exercise after a 2-week treatment period. Maximal oxygen uptake (VO2 max) and blood lactic acid concentration (LA) were measured during progressive exercise testing. An exercise intensity equivalent to 4 mmol/l of LA was used for the constant workload exercise test. Humoral factors were measured after 20 minutes of constant workload exercise. The administration of arotinolol significantly decreased systolic blood pressure and heart rate at rest and during exercise, but diastolic blood pressure did not change. No significant difference was found between arotinolol and placebo with regard to VO2 max and maximal workload. Plasma renin activity (PRA), aldosterone (PAC), and norepinephrine (NE) levels at rest and during exercise did not differ between the two treatments. In contrast, plasma epinephrine (EN) levels at rest and during exercise were significantly greater with arotinolol. Atrial natriuretic peptide (ANP) at rest did not differ between the two treatments. However, exercise caused a significant increase in ANP after arotinolol treatment. These findings suggest that arotinolol decreases blood pressure and heart rate without affecting exercise capacity.

Effect of beta-adrenergic blockade on exercise performance in patients with chronic atrial fibrillation

Beta-adrenergic blocking agents are commonly used in combination with digitalis to control excessive heart rate during exercise in patients with chronic atrial fibrillation. However, little is known about the effect of beta-adrenergic blockade on exercise capacity in these patients. Accordingly, a randomized, double-blind, cross-over placebo-controlled study was performed to assess the efficacy of celiprolol, a new cardioselective beta-blocker with partial intrinsic sympathomimetic activity, on exercise performance in nine men with chronic atrial fibrillation. All but one patient was receiving maintenance digitalis during the study. Heart rate, blood pressure and gas exchange variables were measured at rest and during treadmill exercise testing while the patients were receiving maintenance celiprolol or placebo. Significant reductions in heart rate and systolic blood pressure compared with control values were observed at submaximal exercise, at the gas exchange anaerobic threshold and at maximal exertion while the patients were taking celiprolol. However, oxygen uptake at the gas exchange anaerobic threshold during celiprolol therapy was 12.3 versus 14.0 ml oxygen/kg per min during placebo administration (a 12% difference, p less than 0.01). Similarly, oxygen uptake at maximal exertion during celiprolol therapy was 17.6 versus 21.0 ml/kg per min during placebo administration (a 16% difference, p less than 0.01). Treadmill time was also reduced during the celiprolol phase compared with placebo (11.3 versus 10.3 minutes; a 19% difference, p less than 0.01). These results indicate that in patients with atrial fibrillation the major beneficial effects of beta-adrenergic blockade--reduced submaximal and maximal exercise heart rate and blood pressure--must be weighed against the decrease in exercise capacity.

The effects of beta-adrenoceptor blockade on breathing during progressive exercise in normal man

1 We have studied the effects of single oral doses of 80 mg propranolol and 100 mg atenolol on breathing during progressive exercise in nine healthy men in a double-blind, placebo-controlled experiment. As judged by their effects on exercise heart rate significant levels of beta-adrenoceptor blockade were achieved. 2 At the two lower levels of work rate (50 watts and 100 watts) minute ventilation on atenolol was lower than on placebo while at the highest level of work (200 watts) minute ventilation was higher on atenolol than on placebo. The regression of VE atenolol on VE placebo was 1.28 which is significantly different from unity (P less than 0.001). The results with propranolol were more scattered and failed to reach the 5% level of significance. 3 Effects on the pattern of breathing are small but when minute ventilation is matched with placebo, atenolol results in larger tidal volumes and prolonged inspiratory and expiratory time. 4 These observations are discussed in relation to other work in the literature.

Contractile properties of the human triceps surae following prolonged exercise and beta-blockade

Sixteen healthy males volunteered to perform both an incremental maximal and prolonged submaximal treadmill test with beta-blockade (2 X 80 mg oral propranolol per day) or matched placebo in a blind crossover design. Prior to and following the prolonged exercise, electrical stimulation of the triceps surae was performed to examine contractile properties. During the maximal test, the heart rate (HR) was reduced at all times by beta-blockade. The time to exhaustion in this test was significantly reduced by beta-blockade (P less than 0.03), while the maximal oxygen uptake (VO2 max) was not significantly lower (P = 0.06). In response to prolonged treadmill walking at 60% of VO2 max, the HR was reduced but VO2, respiratory quotient and ventilation were not affected by beta-blockade relative to placebo. Plasma concentrations of free fatty acids increased during exercise in the placebo but not beta-blocked treatment (P less than 0.0001). Plasma noradrenalin and adrenalin increased with exercise; the increase in adrenalin with beta-blockade was greater than that with placebo (P less than 0.0001). The RPE obtained at intervals during the prolonged exercise were greater for beta-blockades than placebo. Eight of 16 subjects were unable to complete full 90 min with beta-blockade; but all 16 completed the test with placebo. The electrically evoked twitches in the triceps surae muscle group after exercise did not differ in peak torque or one-half relaxation time compared to pre-exercise. The time to peak twitch torque was significantly shorter after exercise. No differences in twitch were observed due to beta-blockade. The tetanic responses at 10, 20, 50 and 100 Hz were not affected by either exercise or the beta-blockade. In conclusion, an increased subjective estimate of fatigue (RPE) was observed during prolonged exercise with beta-blockade. This subjective fatigue did not relate to altered peripheral muscle force production during electrical stimulation. The results suggest either a central rather than peripheral origin of fatigue, or fatigue in a muscle group not examined by stimulation of the triceps surae.