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Halvorsen J, Henderson C, Romney W, Hågå M, Barkenæs Eggen T, Nordvik JE, Rosseland I, Moore J. Feasibility and Safety of Early Post-COVID-19 High-Intensity Gait Training: A Pilot Study. J Clin Med 2023; 13:237. [PMID: 38202245 PMCID: PMC10780026 DOI: 10.3390/jcm13010237] [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: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The feasibility and safety of rehabilitation interventions for individuals recovering from COVID-19 after the acute stage is not well understood. This pilot study aims to provide a preliminary investigation of the feasibility and safety of providing high-intensity gait training (HIT) with a targeted cardiovascular intensity of 70-85% of the age-predicted maximum heart rate (HRmax) for individuals undergoing rehabilitation post-COVID-19. METHODS Consecutive patients who were medically cleared for HIT were invited to participate in the study. Participants practiced walking in varied contexts (treadmill, overground, and stairs), aiming to spend as much time as possible within their target cardiovascular intensity zone during scheduled physical therapy (PT) sessions. Training characteristics and adverse events were collected to determine the feasibility and safety of HIT. The severity of adverse events was graded on a 1-5 scale according to the Common Terminology Criteria for Adverse Events. RESULTS The participants (n = 20) took a mean of 2093 (±619) steps per PT session. The average peak heart rate during PT sessions was 81.1% (±9.4) of HRmax, and 30.1% (±21.0) of the session time was spent at heart rates ≥ 70% HRmax. Mild adverse events (grade 1) occurred in <5% of the sessions, and no intervention-requiring or life-threatening adverse events (grade 2-5) occurred. CONCLUSION This pilot study provides preliminary evidence that HIT may be feasible and safe during inpatient rehabilitation for patients post-COVID-19 following medical clearance.
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Affiliation(s)
- Joakim Halvorsen
- Forsterket Rehabilitering Aker, Helseetaten, Oslo kommune, Trondheimsveien 235, 0586 Oslo, Norway; (M.H.); (I.R.)
| | - Christopher Henderson
- Institute for Knowledge Translation, Carmel, IN 46033, USA; (C.H.); (J.M.)
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46254, USA
| | - Wendy Romney
- Department of Physical Therapy and Human Movement Science, Sacred Heart University, Fairfield, CT 06825, USA;
| | - Magnus Hågå
- Forsterket Rehabilitering Aker, Helseetaten, Oslo kommune, Trondheimsveien 235, 0586 Oslo, Norway; (M.H.); (I.R.)
| | | | - Jan Egil Nordvik
- Faculty of Health Sciences, Oslo Metropolitan University, 0166 Oslo, Norway;
| | - Ingvild Rosseland
- Forsterket Rehabilitering Aker, Helseetaten, Oslo kommune, Trondheimsveien 235, 0586 Oslo, Norway; (M.H.); (I.R.)
| | - Jennifer Moore
- Institute for Knowledge Translation, Carmel, IN 46033, USA; (C.H.); (J.M.)
- Regional Kompetansetjeneste for Rehabilitering, Sunnaas HF, Trondheimsveien 235, 0586 Oslo, Norway
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Pasetes LN, Rosendahl-Garcia KM, Goel N. Cardiovascular measures display robust phenotypic stability across long-duration intervals involving repeated sleep deprivation and recovery. Front Neurosci 2023; 17:1201637. [PMID: 37547137 PMCID: PMC10397520 DOI: 10.3389/fnins.2023.1201637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction We determined whether cardiovascular (CV) measures show trait-like responses after repeated total sleep deprivation (TSD), baseline (BL) and recovery (REC) exposures in two long-duration studies (total N = 11 adults). Methods A 5-day experiment was conducted twice at months 2 and 4 in a 4-month study (N = 6 healthy adults; 3 females; mean age ± SD, 34.3 ± 5.7 years; mean BMI ± SD, 22.5 ± 3.2 kg/m2), and three times at months 2, 4, and 8 in an 8-month study (N = 5 healthy adults; 2 females; mean age ± SD, 33.6 ± 5.17 years; mean BMI ± SD, 27.1 ± 4.9 kg/m2). Participants were not shift workers or exposed to TSD in their professions. During each experiment, various seated and standing CV measures were collected via echocardiography [stroke volume (SV), heart rate (HR), cardiac index (CI), left ventricular ejection time (LVET), and systemic vascular resistance index (SVRI)] or blood pressure monitor [systolic blood pressure (SBP)] after (1) two BL 8h time in bed (TIB) nights; (2) an acute TSD night; and (3) two REC 8-10 h TIB nights. Intraclass correlation coefficients (ICCs) assessed CV measure stability during BL, TSD, and REC and for the BL and REC average (BL + REC) across months 2, 4, and 8; Spearman's rho assessed the relative rank of individuals' CV responses across measures. Results Seated BL (0.693-0.944), TSD (0.643-0.962) and REC (0.735-0.960) CV ICCs showed substantial to almost perfect stability and seated BL + REC CV ICCs (0.552-0.965) showed moderate to almost perfect stability across months 2, 4, and 8. Individuals also exhibited significant, consistent responses within seated CV measures during BL, TSD, and REC. Standing CV measures showed similar ICCs for BL, TSD, and REC and similar response consistency. Discussion This is the first demonstration of remarkably robust phenotypic stability of a number of CV measures in healthy adults during repeated TSD, BL and REC exposures across 2, 4, and 8 months, with significant consistency of responses within CV measures. The cardiovascular measures examined in our studies, including SV, HR, CI, LVET, SVRI, and SBP, are useful biomarkers that effectively track physiology consistently across long durations and repeated sleep deprivation and recovery.
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Affiliation(s)
- Lauren N. Pasetes
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | | | - Namni Goel
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Hornby TG, Plawecki A, Lotter JK, Scofield ME, Lucas E, Henderson CE. Gains in Daily Stepping Activity in People With Chronic Stroke After High-Intensity Gait Training in Variable Contexts. Phys Ther 2022; 102:pzac073. [PMID: 35670001 PMCID: PMC9396452 DOI: 10.1093/ptj/pzac073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/03/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Many physical therapist interventions provided to individuals with chronic stroke can lead to gains in gait speed or endurance (eg, 6-Minute Walk Test [6MWT]), although changes in objective measures of participation are not often observed. The goal of this study was to determine the influence of different walking interventions on daily stepping (steps per day) and the contributions of demographic, training, and clinical measures to these changes. METHODS In this secondary analysis of a randomized clinical trial, steps per day at baseline and changes in steps per day following 1 of 3 locomotor interventions were evaluated in individuals who were ambulatory and >6 months after stroke. Data were collected on 58 individuals who received ≤30 sessions of high-intensity training (HIT) in variable contexts (eg, tasks and environments; n = 19), HIT focused on forward walking (n = 19), or low-intensity variable training (n = 20). Primary outcomes were steps per day at baseline, at post-training, and at a 3-month follow-up, and secondary outcomes were gait speed, 6MWT, balance, and balance confidence. Correlation and regression analyses identified demographic and clinical variables associated with steps per day. RESULTS Gains in steps per day were observed across all groups combined, with no between-group differences; post hoc within-group analyses revealed significant gains only following HIT in variable contexts. Both HIT groups showed gains in endurance (6MWT), with increases in balance confidence only following HIT in variable contexts. Changes in steps per day were associated primarily with gains in 6MWT, with additional associations with baseline 6MWT, lower-extremity Fugl-Meyer scores, and changes in balance confidence. CONCLUSION HIT in variable contexts elicited gains in daily stepping, with changes primarily associated with gains in gait endurance. IMPACT Providing HIT in variable contexts appears to improve measures of participation (eg, daily stepping) that may be associated with clinical measures of function. Gains in multiple measures of mobility and participation with HIT in variable contexts may improve the efficiency and value of physical therapy services.
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Affiliation(s)
- T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Abbey Plawecki
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | | | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
| | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
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Fahey M, Brazg G, Henderson CE, Plawecki A, Lucas E, Reisman DS, Schmit BD, Hornby TG. The Value of High Intensity Locomotor Training Applied to Patients With Acute-Onset Neurologic Injury. Arch Phys Med Rehabil 2020; 103:S178-S188. [PMID: 33383032 DOI: 10.1016/j.apmr.2020.09.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/02/2022]
Abstract
Long-standing research in animal models and humans with stroke or incomplete spinal cord injury (iSCI) indicate that specific physical training variables, such as the specificity and amount of practice, may influence neurologic recovery and locomotor function. More recent data highlight the contributions of exercise intensity, as estimated indirectly by cardiovascular exertion, as potentially more important than previously considered. The effects of exercise intensity are well described in neurologically intact individuals, although confusion regarding the definitions of intensity and safety concerns have limited its implementation during physical rehabilitation of patients with neurologic injury. The purpose of this review is to delineate some of the evidence regarding the effects of exercise intensity during locomotor training in patients with stroke and iSCI. We provide specific definitions of exercise intensity used within the literature, describe methods used to ensure appropriate levels of exertion, and discuss potential adverse events and safety concerns during its application. Further details on the effects of locomotor training intensity on clinical outcomes, and on neuromuscular and cardiovascular function will be addressed as available. Existing literature across multiple studies and meta-analyses reveals that exercise training intensity is likely a major factor that can influence locomotor function after neurologic injury. To extend these findings, we describe previous attempts to implement moderate to high intensity interventions during physical rehabilitation of patients with neurologic injury, including the utility of specific strategies to facilitate implementation, and to navigate potential barriers that may arise during implementation efforts.
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Affiliation(s)
- Meghan Fahey
- Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Christopher E Henderson
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN
| | | | - Emily Lucas
- Rehabilitation Hospital of Indiana, Indianapolis, IN
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN; Rehabilitation Hospital of Indiana, Indianapolis, IN.
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Hornby TG, Henderson CE, Plawecki A, Lucas E, Lotter J, Holthus M, Brazg G, Fahey M, Woodward J, Ardestani M, Roth EJ. Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke. Stroke 2019; 50:2492-2499. [PMID: 31434543 DOI: 10.1161/strokeaha.119.026254] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background and Purpose- The amount of task-specific stepping practice provided during rehabilitation poststroke can influence locomotor recovery and reflects one aspect of exercise dose that can affect the efficacy of specific interventions. Emerging data suggest that markedly increasing the intensity and variability of stepping practice may also be critical, although such strategies are discouraged during traditional rehabilitation. The goal of this study was to determine the individual and combined contributions of intensity and variability of stepping practice to improving walking speed and distance in individuals poststroke. Methods- This phase 2, randomized, blinded assessor clinical trial was performed between May 2015 and November 2018. Individuals between 18 and 85 years old with hemiparesis poststroke of >6 months duration were recruited. Of the 152 individuals screened, 97 were randomly assigned to 1 of 3 training groups, with 90 completing >10 sessions. Interventions consisted of either high-intensity stepping (70%-80% heart rate reserve) of variable, difficult stepping tasks (high variable), high-intensity stepping performing only forward walking (high forward), and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (low variable). Participants received up to 30 sessions over 2 months, with testing at baseline, post-training, and a 3-month follow-up. Primary outcomes included walking speeds and timed distance, with secondary measures of dynamic balance, transfers, spatiotemporal kinematics, and metabolic measures. Results- All walking gains were significantly greater following either high-intensity group versus low-variable training (all P<0.001) with significant correlations with stepping amount and rate (r=0.48-60; P<0.01). Additional gains in spatiotemporal symmetry were observed with high-intensity training, and balance confidence increased only following high-variable training in individuals with severe impairments. Conclusions- High-intensity stepping training resulted in greater improvements in walking ability and gait symmetry than low-intensity training in individuals with chronic stroke, with potential greater improvements in balance confidence. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02507466.
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Affiliation(s)
- T George Hornby
- From the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine (T.G.H., C.E.H., M.A.).,Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.).,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (T.G.H., E.J.R.)
| | - Christopher E Henderson
- From the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine (T.G.H., C.E.H., M.A.).,Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Abbey Plawecki
- Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Emily Lucas
- Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Jennifer Lotter
- Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Molly Holthus
- Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Gabrielle Brazg
- Shirley Ryan Ability Lab, Chicago, IL (G.B., M.F., J.W., E.J.R.)
| | - Meghan Fahey
- Shirley Ryan Ability Lab, Chicago, IL (G.B., M.F., J.W., E.J.R.)
| | - Jane Woodward
- Shirley Ryan Ability Lab, Chicago, IL (G.B., M.F., J.W., E.J.R.)
| | - Marzieh Ardestani
- From the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine (T.G.H., C.E.H., M.A.).,Rehabilitation Hospital of Indiana (T.G.H., C.E.H., A.P., E.L., J.L., M.H., M.A.)
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (T.G.H., E.J.R.).,Shirley Ryan Ability Lab, Chicago, IL (G.B., M.F., J.W., E.J.R.)
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Woodward JL, Connolly M, Hennessy PW, Holleran CL, Mahtani GB, Brazg G, Fahey M, Maganti K, Hornby TG. Cardiopulmonary Responses During Clinical and Laboratory Gait Assessments in People With Chronic Stroke. Phys Ther 2019; 99:86-97. [PMID: 30476281 DOI: 10.1093/ptj/pzy128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/16/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is a common clinical assessment used to evaluate locomotor function in patients after stroke. Previous work suggests the 6MWT can estimate peak metabolic capacity (VO2peak) without cardiorespiratory assessments during graded exercise tests (GXTs), which may assist with exercise prescription. However, selected research also indicated increased heart rates (HRs) during 6MWTs beyond levels considered safe without GXTs. OBJECTIVE The goal of this study was to examine cardiorespiratory responses during 6MWTs and GXTs in individuals with chronic stroke and their associations with demographic or clinical characteristics. DESIGN The study used a cross-sectional observational design. METHODS Cardiorespiratory responses were assessed during 6MWTs at self-selected velocity (SSV) and fastest velocity (FV), and during GXTs. Secondary assessments included the lower extremity Fugl-Meyer Assessment, Functional Gait Assessment, gait speeds, and daily stepping activity. Correlation and regression analyses were used to evaluate associations between locomotor performance, cardiorespiratory responses, and clinical and demographic characteristics. RESULTS Average HRs during 6MWT-FV were 72% to 76% of the age-predicted maximum (HRmax), with 20% of participants exceeding 85% predicted HRmax. When normalized to HRs during GXTs, HRs during 6MWT-FV were 86% to 88% of observed HRmax. Primary predictors of increased HRs during 6MWTs were resting HR, body mass index, and daily stepping. Distance during 6MWT-FV was a significant predictor of VO2peak in combination with other variables. Electrocardiographic abnormalities were observed in >80% of participants at rest and 31% demonstrated distinct abnormalities during GXTs, which were not related to 6MWT or GXT performance. LIMITATIONS In addition to sample size, a primary limitation involved the ability to accurately predict or measure HRmax in patients with motor dysfunction after stroke. CONCLUSIONS Cardiac responses were higher than anticipated during 6MWTs and often exceeded recommended HR thresholds. Clinicians should closely monitor cardiorespiratory responses during 6MWTs.
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Affiliation(s)
- Jane L Woodward
- Shirley Ryan AbilityLab, Chicago, Illinois. She is a board-certified neurologic clinical specialist
| | | | - Patrick W Hennessy
- Infiniti Rehab Inc, Portland, Oregon. He is a board-certified neurologic clinical specialist
| | - Carey L Holleran
- Division of Physical Therapy, Washington University of St. Louis, St. Louis, Missouri. He is a board-certified neurologic clinical specialist
| | | | - Gabrielle Brazg
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Meghan Fahey
- Shirley Ryan AbilityLab. She is a board-certified neurologic clinical specialist
| | - Kameswari Maganti
- Department of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - T George Hornby
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46524 (USA)
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Barnes JN, Fu Q. Sex-Specific Ventricular and Vascular Adaptations to Exercise. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:329-346. [PMID: 30051394 DOI: 10.1007/978-3-319-77932-4_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Increasing data suggest that there are sex differences in ventricular and vascular adaptations to aerobic (endurance) exercise, which may be attributed to different physical and physiological features in men and women. Despite that cardiovascular control during acute exercise at the same relative work rate (e.g., the percentage of peak oxygen uptake) appears to be similar between the sexes, women have blunted responses or adaptations to prolonged (e.g., ≥1 year) exercise training compared with men. Currently, there is little evidence to suggest that exercise-induced vascular adaptations are different between men and women. Furthermore, sex differences in skeletal muscle adaptations to exercise, and how this influences cardiovascular function, remain unclear. Identifying potential differences and the mechanisms behind such exercise-induced adaptations is important for the optimization of exercise interventions between men and women across the life span.
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Affiliation(s)
| | - Qi Fu
- Institute for Exercise and Environmental Medicine, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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Costa DC, de Santi GL, Crescêncio JC, Seabra LP, Carvalho EEV, Papa V, Marques F, Gallo L, Schmidt A. Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men. Braz J Med Biol Res 2015; 48:1136-44. [PMID: 26397972 PMCID: PMC4661031 DOI: 10.1590/1414-431x20154692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the agreement between measurements of unloaded oxygen uptake and peak oxygen uptake based on equations proposed by Wasserman and on real measurements directly obtained with the ergospirometry system. We performed an incremental cardiopulmonary exercise test (CPET), which was applied to two groups of sedentary male subjects: one apparently healthy group (HG, n=12) and the other had stable coronary artery disease (n=16). The mean age in the HG was 47±4 years and that in the coronary artery disease group (CG) was 57±8 years. Both groups performed CPET on a cycle ergometer with a ramp-type protocol at an intensity that was calculated according to the Wasserman equation. In the HG, there was no significant difference between measurements predicted by the formula and real measurements obtained in CPET in the unloaded condition. However, at peak effort, a significant difference was observed between oxygen uptake (V˙O2)peak(predicted)and V˙O2peak(real)(nonparametric Wilcoxon test). In the CG, there was a significant difference of 116.26 mL/min between the predicted values by the formula and the real values obtained in the unloaded condition. A significant difference in peak effort was found, where V˙O2peak(real)was 40% lower than V˙O2peak(predicted)(nonparametric Wilcoxon test). There was no agreement between the real and predicted measurements as analyzed by Lin's coefficient or the Bland and Altman model. The Wasserman formula does not appear to be appropriate for prediction of functional capacity of volunteers. Therefore, this formula cannot precisely predict the increase in power in incremental CPET on a cycle ergometer.
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Affiliation(s)
- D. C. Costa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G. L. de Santi
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J. C. Crescêncio
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L. P. Seabra
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E. E. V. Carvalho
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V. Papa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F. Marques
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L. Gallo
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A. Schmidt
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de
Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Souza DR, Gomides RS, Costa LAR, Fernandes JRC, Ortega KC, Mion Jr D, Tinucci T, Forjaz CLDM. Betabloqueio com atenolol não reduz potência aeróbia nem muda limiares ventilatórios em hipertensos sedentários. REV BRAS MED ESPORTE 2013. [DOI: 10.1590/s1517-86922013000500008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: O exercício aeróbio é recomendado para o tratamento da hipertensão. Sua intensidade pode ser prescrita com base na porcentagem da frequência cardíaca máxima (%FCmáx) ou no consumo pico de oxigênio (%VO2pico) em que os limiares ventilatórios (LV) são alcançados. Entretanto, alguns hipertensos que iniciam o treinamento podem estar tomando betabloqueadores, o que pode influenciar esses parâmetros. OBJETIVO: verificar os efeitos do atenolol sobre os LV de hipertensos sedentários. MÉTODOS: Nove voluntários realizaram dois testes ergoespirométricos máximos após quatro semanas de tratamento com atenolol (25 mg administrado por via oral duas vezes por dia) e com placebo, administrados em ordem fixa e de forma cega. Durante os testes, a frequência cardíaca (FC), a pressão arterial (PA) e o VO2 no repouso, limiar anaeróbio (LA), ponto de compensação respiratória (PCR) e pico do esforço foram analisados. RESULTADOS: O VO2 aumentou progressivamente no exercício e seus valores foram semelhantes nos dois tratamentos. A PA sistólica e a FC também aumentaram no exercício, mas seus valores absolutos foram significativamente menores com o atenolol. Porém, o aumento da PA sistólica e da FC no exercício foi semelhante com os dois tratamentos. Assim, o percentual da FCmáx e o percentual do VO2pico em que LA e PCR foram alcançados não diferiram entre o placebo e o atenolol. CONCLUSÃO: O atenolol na dosagem de 50 mg/dia não afetou o percentual do VO2pico e da FCmáx em que os LV são atingidos, o que confirma que a prescrição de intensidade de treinamento com base nessas porcentagens pode ser mantida em hipertensos que recebem betabloqueadores.
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Harms CA, Cooper D, Tanaka H. Exercise Physiology of Normal Development, Sex Differences, and Aging. Compr Physiol 2011; 1:1649-78. [DOI: 10.1002/cphy.c100065] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hawkins MN, Barnes Q, Purkayastha S, Eubank W, Ogoh S, Raven PB. The effects of aerobic fitness and β1-adrenergic receptor blockade on cardiac work during dynamic exercise. J Appl Physiol (1985) 2009; 106:486-93. [DOI: 10.1152/japplphysiol.90795.2008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this investigation was to determine whether cardiovascular adaptations characteristic of long-term endurance exercise compensate more effectively during cardioselective β1-adrenergic receptor blockade-induced reductions in sympathoadrenergic-stimulated contractility. Endurance-trained (ET) athletes ( n = 8) and average-trained (AT; n = 8) subjects performed submaximal cycling exercise at moderate [45% maximum oxygen uptake (V̇o2max)] and heavy (70% V̇o2max) workloads, with and without metoprolol. Cardiac output (Q̇c), heart rate (HR), and systolic blood pressure were recorded at rest and during exercise. Cardiac work was calculated from the triple product of HR, stroke volume, and systolic blood pressure, and myocardial efficiency is represented as cardiac work for a given total body oxygen consumption. Metoprolol reduced Q̇c at 45% V̇o2max ( P = 0.004) and 70% V̇o2max ( P = 0.022) in ET subjects, but did not alter Q̇c in the AT subjects. In ET subjects at 45% V̇o2max, metoprolol-induced reductions in Q̇c were a result of decreases in HR ( P < 0.05) and the absence of a compensatory increase in stroke volume ( P > 0.05). The cardiac work and calculated cardiac efficiency were reduced with metoprolol in ET subjects at both exercise intensities and in the AT subjects during the high-intensity workload ( P < 0.01). The cardiac work and the calculated cardiac efficiency were not affected by metoprolol in the AT subjects during the 45% V̇o2max exercise. Therefore, in AT subjects, β-blockade reduced the amount of pressure generation necessary to produce the same amount of work during moderate-intensity exercise. In patients with heart disease receiving metoprolol, a decrease in the generation of cardiac pressure necessary to perform a given amount of work during mild-to-moderate exercise would prove to be beneficial.
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Mizuno J, Yoshiya I, Yokoyama T, Yamada Y, Arita H, Hanaoka K. Age and sex-related differences in dose-dependent hemodynamic response to landiolol hydrochloride during general anesthesia. Eur J Clin Pharmacol 2007; 63:243-52. [PMID: 17211618 DOI: 10.1007/s00228-006-0249-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 11/30/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Landiolol hydrochloride is a new ultra-short-acting beta(1)-adrenergic receptor blocking agent that is used for patients with tachycardia during general anesthesia. The hemodynamic response to a beta-adrenergic receptor blocking agent is generally dependent on the subject. In the present investigation we investigated the effects of age and sex on the hemodynamic response to different doses of landiolol. METHODS Following a persistence of tachycardia for more than 1 min, landiolol was infused at 0.03125, 0.0625 and 0.125 mg kg(-1) min(-1) for 1 min followed by 0.01, 0.02 and 0.04 mg kg(-1)min(-1) for 10 min in groups L, M and H, respectively. Heart rate (HR), systolic (sBP) and diastolic blood pressure (dBP) were recorded each minute during the procedure. The respective changes were evaluated using logistic analysis with the equation Y(t) = p + (q - p)/[1 + exp {4m/(q - p))(k - t)}], where p, q, m and k indicate the upper asymptote, lower asymptote, maximum slope and time at the maximum slope. RESULTS Parameters q and k for HR in group H were smaller than those in group L, whereas the parameters for sBP and dBP were unchanged among the three groups. Parameter q for HR in group H decreased with age of the patient. There was no significant difference in the landiolol-induced change in HR between males and females. CONCLUSION The hemodynamic response to landiolol is reliably modeled by the logistic function, especially in terms of HR. Landiolol causes a rapid and dose-dependent decrease in HR, whereas landiolol-induced changes in sBP and dBP are independent of dose. The landiolol-induced decrease in HR becomes larger with aging, but shows no sex difference. The logistic model may be useful for studying hemodynamic responses to landiolol based on age and sex differences, and may allow development of an improved monitoring system. IMPLICATION STATEMENT The logistic function reliably represents the hemodynamic responses to landiolol. Landiolol reduces HR rapidly and in a dose-dependent manner whereas landiolol-induced changes in sBP and dBP are independent of dose. A larger decrease in HR is caused by landiolol in elderly patients, but there is no sex difference in the landiolol-induced change in HR.
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Affiliation(s)
- Ju Mizuno
- Departrment of Anesthesiology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Nieminen T, Kähönen M, Kööbi T. Letter by Nieminen et al regarding article, "Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study". Circulation 2006; 114:e536; author reply e540-1. [PMID: 17030695 DOI: 10.1161/circulationaha.106.622225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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