Beau J. Freund

Acute response to submaximal and maximal exercise consequent to beta-adrenergic blockade: Implications for the prescription of exercise

Forty-seven healthy male subjects, 17 to 34 years old, completed a test to exhaustion on a motor-driven treadmill to determine their maximal oxygen uptake. A second test was administered 2 days later during which the subject walked for 20 to 25 minutes at a steady-state level representing 60% of the maximal oxygen uptake as determined in the first test. The grade was then increased every 2 minutes until the subject reached the state of exhaustion. After the second test, the subjects were randomly assigned, in a double-blind manner, to either placebo, propranolol (160 mg/day), or atenolol (100 mg/day) treatment for 7 days. Exactly 1 week from the time of the second test, and 3 hours after the last medication, the subjects completed the final exercise test using the same treadmill protocol administered in the second test. Heart rate and systolic blood pressure at rest and during submaximal steady-state exercise were significantly reduced by both drugs, whereas diastolic pressure was unaffected. During submaximal steady-state exercise, cardiac output was reduced in both the placebo and atenolol groups, stroke volume was increased in both atenolol and propranolol groups, oxygen uptake was reduced in the atenolol group, pulmonary ventilation was reduced in both propranolol and atenolol groups, and the respiratory exchange ratio remained unchanged. With maximal exercise, treadmill time was significantly reduced with propranolol, pulmonary ventilation and heart rate were reduced significantly with both drugs, but maximal oxygen uptake remained unchanged. Thus, beta blockade does not appear to limit ability to exercise. However, there appears to be a significant advantage to using a cardioselective rather than a nonselective beta-blocking agent.

Effects of cardioselective and nonselective beta-adrenergic blockade on the performance of highly trained runners

Twenty-five highly trained runners with a maximal oxygen uptake (VO2 max) of 64.7 +/- 4.3 ml . kg-1. min-1 were administered clinically equivalent doses of a nonselective (propranolol) and a cardioselective (atenolol) beta-blocking agent as well as a placebo. The subjects performed a horizontal treadmill test on the eighth day and a 10-km track race on the tenth day of each treatment. Beta blockade decreased submaximal heart rate and propranolol caused the largest decrease. Beta blockade caused a decrease in maximal heart rate, VO2 max, maximal ventilation, maximal respiratory exchange ratio and treadmill time. Propranolol caused a greater decrease than atenolol in each of these values. The 10-km race times were significantly slower during beta blockade, and propranolol race times were significantly slower than atenolol race times. It is concluded that the performance of highly trained distance runners is significantly altered by beta-adrenergic blockade and that nonselective agents reduce performance to a greater extent than cardioselective agents.

Cardiorespiratory alterations consequent to endurance exercise training during chronic beta-adrenergic blockade with atenolol and propranolol

A study was undertaken to determine if normal healthy subjects can increase their endurance capacity consequent to endurance training during chronic beta-adrenergic blockade. Forty-seven subjects, 17 to 34 years of age, were randomly assigned to 1 of 3 treatments (placebo, propranolol, 160 mg/day, and atenolol, 100 mg/day) and then completed a 15-week aerobic exercise training program. All groups reduced their submaximal steady-state heart rates consequent to training; submaximal oxygen uptake was slightly reduced; submaximal stroke volume was increased only in the placebo and atenolol groups; submaximal cardiac output was generally lower; and arterial-mixed venous oxygen difference was increased after training in all 3 groups, suggesting decreased muscle blood flow and increased oxidative capacity. Maximal oxygen uptake and maximal treadmill time were increased in all 3 groups after training. However, while still on medication the atenolol group had significantly greater increases in maximal oxygen uptake and maximal treadmill time compared with the propranolol group. Because most patients will remain on medication, these results suggest a distinct advantage for cardioselective blocking agents. It is concluded that beta-adrenergic blockade does not reduce the ability of normal healthy subjects to gain the benefits associated with cardiorespiratory endurance training.

Interaction of test protocol and inclined run training on maximal oxygen uptake.

Twenty-two men, 17 to 27 years of age, volunteered to participate in an inclined terrain running program. Men were randomly assigned to a control (N = 10) or an experimental (N = 12) group. The experimental group ran on inclined terrain 4 times/wk for 35 min a session at an intensity of 65 to 85% of maximal aerobic power for 12 wk. The purpose of this study was to analyze the interaction between a subjects VO2max on an inclined protocol (IP) vs a horizontal protocol (HP) before and after training on incline terrain. VO2max, HRmax, VEmax, Rmax, and maximum treadmill time were evaluated on both treadmill protocols (IP and HP). Prior to training, results indicated no difference in VO2max values between protocols. Following training, VEmax, maximum treadmill time, and VO2max increased 8.7, 9.1, and 8.5%, respectively, on the IP and 5.8, 6.8, and 5.3% on the HP respectively. All increases were statistically significant at the 0.05 level. The post-training VO2max on the IP was significantly greater than the value on the HP. These results support the concept of specificity of training and indicate the importance of careful selection of both the test protocol as well as the test mode.

Interaction of test protocol and horizontal run training on maximal oxygen uptake.

Twenty-seven untrained college-age males (mean age = 23.1 yr) volunteered for this 12-wk training study, which investigated potential interactions between training specificity and treadmill protocol specificity. The study was designed to analyze the interaction between a subjects maximal oxygen uptake (VO2max) on an inclined protocol (IP) vs a horizontal protocol (HP) before and after training exclusively on flat terrain. Experimental subjects (E, N = 17) trained by running on flat terrain for 12 wk, 4 d/wk, 37 min/d at an intensity equal to 65 to 85% of their heart rate reserve while control subjects (C, N = 10) remained sedentary. All subjects underwent a minimum of four maximal treadmill tests (two with an IP and two with a HP) prior to training and two maximal treadmill tests (one IP and one HP) post-training. Multivariate analysis of variance and post-hoc t-tests using a pooled variance-covariance matrix were used to analyze the data. Alterations in E, consequent to training, included significant increases in VO2max [mean IP = 53.6 to 58.4 (+8.9%) and mean HP = 51.7 to 56.2 ml. kg-1 . min-1 (+8.7%)]. C showed a significant pre- to post-training decrease on the HP for VO2max [mean HP = 52.4 to 50.7 ml . kg-1 . min-1 (-3.2%)], but showed no significant change on the IP. There was no significant pre- to post-training interaction between protocols for VO2max. It was concluded that the post-training results do not support the concept of protocol specificity when evaluating VO2max in subjects trained exclusively on flat terrain.

Beta-blockade and response to exercise: Influence of training

In brief: Beta-blockers and exercise training are recommended for treating cardiovascular disease and hypertension, and researchers have tried to determine the interaction of these two treatment modalities. Data from four studies conducted on 93 subjects over the past five years show that beta-blockade exerts a differential effect on the exercise capacity of subjects of different levels of health and fitness: It increases the capacity of angina patients; decreases the capacity of highly trained, fit individuals; and has little or no effect on the capacity of healthy, untrained individuals.

Alterations in plasma lipids consequent to endurance training and beta-blockade

Alterations in plasma lipids consequent to endurance training and beta-blockade. Med. Sci. Sports Exerc., Vol. 21, No. 3, pp. 288-292, 1989. The chronic use of beta adrenergic blockers (BAB) has been associated with reductions in HDL-cholesterol (HDL-C) and increases in triglycerides (TG). This study evaluated the impact of concurrent endurance exercise training and chronic medication with BAB on plasma lipid and lipoprotein profiles in healthy young adult males. Changes in plasma lipids and lipoproteins were investigated while exercise training under the influence of one of two nonselective BAB [sotalol (320 mg.d-1) and propranolol (160 mg.d-1)], one beta 1 selective BAB [atenolol (100 mg.d-1)], or a placebo control. Total cholesterol (TC), HDL-C, LDL-cholesterol (LDL-C), TG, and the ratios of TC/HDL and LDL/HDL were determined before and after endurance training programs of either 14 (N = 27, sotalol) or 15 (N = 47, propranolol/atenolol) wk duration. The subjects exhibited increases in maximal oxygen uptake of 12-20%. Despite increased endurance capacity, the subjects in both BAB and placebo control groups failed to demonstrate the expected increase in HDL-C and decrease in TG. In fact, HDL-C was significantly decreased post-training in the propranolol group. The placebo groups did decrease TC, LDL-C and the TC/HDL and LDL/HDL ratios, improving their CHD risk profile. Similar changes were not observed in the groups on BAB. Thus, with respect to the present population, BAB does appear to interfere with the usual training-induced improvements in the lipid profile. Endurance training may, however, reduce the deterioration in the lipid profile known to occur with BAB.