Martin Busse

Estimation of an individual equilibrium between lactate production and catabolism during exercise

During an incremental exercise test after a preceding bout of maximum exercise, blood lactate initially decreases to an individual minimum and then increases again. To determine whether this minimum represents an individual equilibrium between lactate production and catabolism during constant load exercise, the following field tests were performed: in 25 runners and five basketball players (series 1) the speed corresponding to the individual lactate minimum (LM) was measured in test 1 (incremental test after exercise induced lactic acidosis). On two occasions, two constant speed runs over 8 km were performed, one using the LM speed (LMS) (test 2), and another at a running speed of 0.2 m.s-1 above the LMS (test 3). Results of runners/basketball players: blood lactate concentration ([Lac-]B) in test 2 changed from 3.6/4.9 mmol.l-1 to 4.0/4.9 mmol.l-1 during the last 4.8 km, in test 3 from 4.6/4.6 mmol.l-1 to 6.5/6.9 mmol.l-1. These results indicate: 1) the LM speed in test 1 corresponds to a maximum lactate steady state speed during constant load exercise; 2) only a slight speed increase above the LM speed results in continuous marked [Lac-]B increase and earlier exhaustion. Variation of the increment duration in 13 males (series 2) shows no change of the LMS using 800-m and 1200-m increments (4.49 and 4.44 m.s-1) but a marked shift to higher speed using 400-m increments (4.96 m.s-1). Effects of low muscle glycogen stores on the LMS were determined in 10 males (series 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Reduction of insulin-like growth factor-I expression in the skeletal muscle of noncachectic patients with chronic heart failure.

OBJECTIVES We sought to assess the role of insulin-like growth factor-I (IGF-I) in muscle wasting in chronic heart failure (CHF), serum concentrations and local muscular IGF-I expression were determined in patients with severe CHF. BACKGROUND Chronic heart failure is associated with progressive muscle atrophy, leading to cardiac cachexia. Skeletal muscle disuse and inflammatory activation with elevated cytokine levels have been implicated; however, the pathomechanism involved remains largely unknown. METHODS Serum levels of IGF-I were measured by competitive solid phase immunoassay in 47 patients with severe CHF (left ventricular ejection fraction < or =30%) and 15 age-matched healthy subjects (HS). Insulin-like growth factor-I and IGF-I receptor expression were assessed in vastus lateralis biopsies by real-time PCR and Western blot analysis. RESULTS Although serum IGF-I was not significantly different (175 +/- 10 ng/ml in CHF vs. 170 +/- 12 ng/ml in HS, p = NS), local muscle IGF-I mRNA expression was reduced by 52% in CHF (6.7 +/- 0.4 vs. 14.0 +/- 0.9 arbitrary units in HS, p < 0.001). This was accompanied by an increase in IGF-I receptor mRNA expression (86.8 +/- 5.4 in CHF vs. 23.1 +/- 1.8 arbitrary units in HS, p < 0.001). Local IGF-I expression was significantly correlated with muscle cross-sectional area (R = 0.75, p = 0.01). Chronic heart failure patients with a body mass index of < 25 kg/m(2) showed signs of peripheral growth hormone (GH) resistance, as indicated by elevated serum GH, and reduced IGF-I levels. CONCLUSIONS In CHF patients, muscle IGF-I expression is considerably reduced in the presence of normal serum IGF-I levels, possibly contributing to early loss of muscle mass. These findings are consistent with a potential role of IGF-I for skeletal muscle atrophy in CHF.

Functional and morphological skeletal muscle abnormalities correlate with reduced electromyographic activity in chronic heart failure.

Background Exercise intolerance and early muscle fatigue are key symptoms in patients with chronic heart failure (CHF). In advanced stages of the disease, profound metabolic abnormalities have been described finally leading to a catabolic state with progressive loss of muscle bulk. The aim of this study was to investigate morphological, functional and electromyographical parameters of the skeletal muscle in CHF. Methods We included 17 patients with CHF and 12 age-matched healthy controls (left ventricular ejection fraction 25 ± 2 versus 68 ± 1%, body mass index 26.6 ± 0.8 versus 28.0 ± 1.0 kg/m2; P=NS) in this study. Cross-sectional area (CSA) of the thigh was assessed by computed tomography. Under electromyographical control, maximal and submaximal (30%) isometric strength as well as the relative decrease of muscle strength of the quadriceps muscle over a period of 20 s were determined. Results Patients with CHF showed a significant reduction of muscle CSA (134.8 ± 5.3 versus 165.2 ± 7.4 cm2, P=0.002) as compared with healthy controls. The maximal quadriceps muscle strength was found to be significantly reduced in patients with CHF (226.7 ± 22.3 versus 286.9 ± 17.1 N, P<0.05) who also exhibited a higher extent of muscular fatigability (−2.18 ± 0.33 versus − 0.54 ± 0.20 N/s, P<0.01). Electromyographic activity at 30% submaximal contraction showed a lower increase in patients with CHF (66 ± 22 versus 114 ± 36%; P<0.05) indicating impaired muscle fibre recruitment. Furthermore, a significant correlation between muscular fatigability and reduced electromyographic activity was found in CHF (r=0.84; P<0.001). Conclusions Our findings demonstrate an impaired electromyographic activity and muscular function in patients with CHF suggesting a new pathomechanism contributing to functional abnormalities of the skeletal muscle in advanced stages of this disease. Eur J Cardiovasc Prevention Rehab 11:155–161

Increasing physical education in high school students: effects on concentration of circulating endothelial progenitor cells

Aims Levels of endothelial progenitor cells (EPCs), that can be increased by regular exercise, correlate with vascular function. In the context of primary prevention, the impact of regular physical activity on the amount and function of EPC has not yet been investigated in school children. Methods Four sixth grade classes of high school students (n = 92) were randomly assigned to either the intervention group (IG) with daily physical exercise (45 min) at school or to the control group (CG) with conventional physical education (PE) (2h/week). In addition, one sixth grade class at a high school focused on competitive sports (PE) served as a reference group. After 1 school year, exercise capacity and the amount and function of EPCs were evaluated. Results After 1 year, a significantly higher Vo2max was evident in the intervention group. Nevertheless, exercise capacity did not reach the level of children from PE. In addition, exercise intervention was successful in increasing the amount of EPCs but failed to increase the migratory capacity of the cells. Conclusion The result of this study shows, that intensified, supervised school sports leads to an increase in exercise capacity and EPCs in children. Nevertheless, its effect on primary prevention in cardiovascular disease has to be proven in further longitudinal studies. Eur J Cardiovasc Prev Rehabil 15:416-422

Bestimmung des Bereichs intensiver Dauerleistungsfähigkeit bei Patienten mit koronarer Herzkrankheit

Körperliches Training mit hoher Intensität kann bei Patienten mit KHK anhaltend die Funktion des Myokards und das Risikoprofil verbessern. Neben einer hohen Trainingseffektivität haben intensive Belastungen ein kardiales Gefährdungspotential im Sinne einer geringen therapeutischen Breite. Es wird ein Untersuchungsverfahren auf der Basis der Laktat-In- und -Evasionskinetik vorgestellt, das die individuell maximal vertretbare therapeutische Ausdauertrainingsintensität ermittelt. Im Rahmen einer erweiterten Routinediagnostik wurden in zwei Kollektiven jeweils 30 KHK-Patienten untersucht. Zwei aufeinanderfolgende Stufentests mit einer dazwischenliegenden 7 minütigen Pause wurden auf dem Fahrradergometer gefahren. In Stufentest 1 wird durch die Ausbelastung ein „intrinsischer” Laktatbolus gesetzt. In Stufentest 2 findet zunächst bei leichter und mittlerer Belastung ein überwiegender Laktatabbau mit entsprechendem Abfall der Blutlaktatkonzentration statt. Bei zunehmend intensiver Belastung kommt es zu einem Gleichgewicht von Blutlaktat- In- und -evasion, der Laktatsenke, bei weiter ansteigender Intensität dann zu einem Überwiegen der Laktat-Invasion mit entsprechendem Laktatkurvenanstieg. In zwei gleich großen Kollektiven wurden die Patienten in zwei Dauertesten mit der Intensität an der Laktatsenke und mit einer um 10% höheren Intensität über 30 min randomisiert untersucht. In den Dauertests mit der Senkenintensität stellte sich ein Steady-State von Laktat und Herzfrequenz ein. Bei den Dauertests mit einer um 10% höheren Intensität brachen 50% der Patienten den Dauertest wegen Erschöpfung vorzeitig ab. Herzfrequenz und Laktat stiegen bis zum Belastungsabbruch signifikant an als Zeichen dafür, dass hier gerade die Ausdauerleistungsgrenze überschritten wurde. Die Laktatsenke, ermittelt im doppelten Stufentestverfahren, erlaubt eine exakte Festlegung der individuellen Ausdauerdauerleistungsgrenze. Eine nur geringfügig erhöhte Intensität sollte als Trainingsvorgabe für Dauerbelastungen vermieden werden. Intensive physical exercise improves cardiac perfusion, skeletal muscle function and risk factors in patients with coronary artery disease (CAD). Otherwise, overdosed intensity can induce training adaptation as well as cardiac events. Therefore, we tested whether exercise intensity corresponding to an equilibrium between lactate production and elimination from the blood during incremental exercise tests represented the blood lactate [Lac–]B steady-state intensity during constant physical training. Randomized into two groups with 30 CAD patients each (T1: 25 male, 5 female; 59±7 years; T2: 26 male, 4 female; 60±9 years), the patients initially performed two successive incremental exercise tests. In the first test, workload was increased stepwise until exhaustion or symptom limitation (maximal workload: T1 142±48 watts, T2 145±45 watts) with the corresponding [Lac–]B accumulation of up to 6.7±2.6 (T1) or 6.5±2.0 (T2) mmol/l, respectively. After a seven minute active rest the second test began with 25 watts, increased with 5 (maximum workload in first test <100 watts) or 10 watts per minute, respectively. During lower intensities in the second test, [Lac–]B initially decreased to an individual lactate minimum intensity (workload at LMI 83±32 in T1 or 86±29 in T2 watts, respectively; [Lac–]B at LMI 4.6±2.2 and 4.9±1.8 mmol/l, respectively) and then increased again. To check if the individual LMI represented the [Lac–]B steady-state workload in constant workload exercise, the patients performed 30 min constant load tests with the LMI (CT1) or a 30 min constant load test with an intensity 10% above the LMI (CT2), respectively. The workload in CT1 was 83±32 watts with a mean exercise time of 29.0±1.7 min. After 10min of exercise the [Lac–]B steady state was reached at 3.3±1.4 mmol/l with no further increase in the last 20min. The mean workload in CT2 was 95±31 watts with an exercise time of 23.3±8.3 min (p<0.01). [Lac–]B increased from 4.4±1.7 mmol/l after 10 min to 4.7±2.0 mmol/l at the end (p<0.01). Fifty percent of patients stopped CT2 before the 30 minute end. The results indicates that the LMI, estimated during lactic acidosis in two successive incremental tests, represented the individual lactate steady-state intensity also during constant load exercise. Therefore, training regimens for CAD patients could be deduced from LMI.

Functional endurance capacity and exercise training in long-term treatment after heart transplantation

Objective: The aim of this study was to investigate the influence of cardiac denervation on endurance exercise capacity in heart transplant recipients (HTR) in comparison to patients with coronary artery disease (CAD). Methods: We performed two successive incremental tests and a 30-min constant load test (CLT) in 20 HTR (55 ± 7 years old, 4.9 ± 2.2 years after transplantation) and in 13 patients with CAD (58 ± 8 years). Results: Maximal workload in HTR was 106 ± 25 W (163 ± 41 W; p < 0.01). In CLT at anaerobic threshold of 55 ± 6 W (97 ± 34 W; p < 0.01), lactate increased from 0.9 ± 0.2 (1.0 ± 0.2) to 2.9 ± 1.3 (3.3 ± 1.3) after 10 min and to 3.1 ± 1.6 (3.4 ± 1.5; NS) mmol · l–1 after 30 min, confirming that the anaerobic threshold reflects a steady state. The CLT kinetics of heart rate (+6 beats in HTR and in CAD between 10th and 30th min) and lactate are comparable in HTR and CAD, demonstrating that endurance kinetics are not influenced by cardiac denervation.

Phase III rehabilitation after heart transplantation

Longterm treatment after heart transplantation (HTX) improves survival, although the quality of life and exercise tolerance decreased continuously between one and ten years after transplantation. The role of physical exercise and psychological support in longterm treatment after HTX has not been determined. We analyzed the effects of a one year outpatient rehabilitation program in combination with a home based, computer assisted training program on exercise capacity, coronary risk factors and quality of life. 20 heart transplant recipients in an intervention group and 12 patients after HTX in a control group participated in the study (IG (CG); 5.1±2.2 (4.5±2.3) years after HTX; age: 55±7 (54±8) years; body mass index: 28.3±1.0 (28.7±0.9) kg·m–2). Before and after the intervention, maximum and constant load exercise capacity, and self-reported quality of life were evaluated. The 12 month intervention period included 10 days of exercise testing as well as medical and psychological support. Furthermore, the IG group performed a computer-assisted and controlled home ergometer training every second day. After one year with 114±18 exercise training sessions, maximum oxygen consumption increased in the IG from 18.8±4.2 to 20.1±4.2 ml ·min–1 ·kg–1 (p<0.05; CG 19.3± 4.5 to 18.5±2.8 ml·min– 1 ·kg–1; p<0.01 IG vs CG). In the IG, lower back pain, body fat, and blood pressure were all reduced, while the self-reported quality of life, endurance exercise capacity and HDL cholesterol were increased. No significant changes occurred in the control group. When initiated years after heart transplantation, longterm rehabilitation reduced coronary risk factors and significantly improved both the subjects’ quality of life, as well as a near to normal capacity for physical work. Bei gesteigerten Überlebensraten nach Herztransplantation (HTX) ist die subjektive Lebensqualität und Leistungsfähigkeit im Langzeitverlauf reduziert, einhergehend mit erhöhten kardiovaskulären Risikoparametern. Ziel der prospektiven Studie war die Entwicklung und Evaluierung eines Modells zur Phase III Rehabilitation Herztransplantierter im Langzeitverlauf, um in Ergänzung zur etablierten medizinischen Nachsorge Lebensqualität, Gesundheitsverhalten und Risikosituation zu verbessern. Bei 20 Patienten der Interventions- bzw. 12 Patienten der Kontrollgruppe (IG (KG)); 5,1±2,2 (4,5±2,3) Jahre nach HTX; Alter: 55±7 (54±8) Jahre; BMI: 28,3±1,0 (28,7±0,9) kg·m–2) wurde vor und nach der Intervention bzw. Kontrollphase jeweils eine Ergospirometrie durchgeführt, die subjektive Lebensqualität mit dem PLC-Fragebogen sowie die kardialen Risikoparameter untersucht. Intervention: Die IG erhielt an 10 Tagen, verteilt über 12 Monate psychologische und sportmedizinische Beratungen sowie Ergometerausdauertests. Auf der Basis der Testergebnisse wurde für die IG ein fernüberwachtes Heimergometertraining jeden 2. Tag über 30 min individuell gesteuert. Die Kontrollgruppe erhielt das etablierte Nachsorgeprogramm. Nach einem Jahr und 114±18 Heimtrainingseinheiten stieg die Ausdauerleistung in der IG bei unveränderter Herzfrequenz von 46±12 auf 66±16 W (+ 43%, p<0,01). In den Stufentests zeigte die IG Verbesserungen der maximalen Leistung (102±23 auf 114±25 W; p<0,01; KG: 108±30 und 107±23 W) bei gleicher maximaler Herzfrequenz. Body-Mass-Index, Körperfettanteil, Blutdruck, HDL-Cholesterin sowie die subjektive Lebensqualität in physischen Dimensionen waren nach der Jahresmaßnahme nur in der IG signifikant verbessert. 5 Jahre nach HTX führt ein ambulantes Rehabilitationsprogramm zur Verbesserung bzw. Normalisierung der Lebensqualität, der Leistungsfähigkeit und der kardiovaskulären Risikoparameter.

Belastungsdiagnostische Kenngrößen und Katecholamine bei Koronarpatienten

Exercise training for patients with coronary artery disease (CAD) is recommended in a wide range between 40–85% of maximum functional capacity (MFC) or 55–90% of maximum heart rate (HR). During exercise, high levels of catecholamines and metabolic acidosis could induce arrhythmia and ischemia. But catecholamines have never been determined in CAD during constant load exercise in the upper range of recommended intensities. In 11 CAD patients (age 58±8 years, BMI 26.1±4.0kg·m–2, NYHA I n=7, II n=4) we tested the maximum functional capacity (MFC), norepinephrine (NE), epinephrine (E) and blood lactate ([Lac–]B) in a symptom-limited incremental ergometer test. Related to the exercise recommendation, the kinetics of NE, E and [Lac–]B were determined in two 30min constant load tests in randomized order: one was performed at the anaerobic lactate threshold (CTAT), a second was performed 10% above the individual threshold intensity (CT+10%). In the incremental tests maximum workload and VO2 were 141±54 W and 1766±532 ml·min–1, respectively (85±22% of normal; [Lac–]B 5.7±1.9mmol·l–1, HR 138±28b·min–1, NE 11.7±5.1, E 1.6±1.4nmol·l–1). In CTAT the anaerobic threshold (63±7% of MFC) represented the mean range of recommended exercise intensity for CAD (40–85%) and could be validated as steady-state intensity because catecholamines and [Lac–]B concentrations remained constant after the initial increase (workload 88±35W, [Lac–]B 3.3±1.4 mmol·l–1, HR 117± 23b·min–1, NE 8.3±3.5, E 0.8± 0.7nmol·l–1). In all patients CT+10% (71±7% of MFC) led to a continous rise in [Lac–]B, to a NE overload and to earlier exhaustion, although the intenisties were in the recommended training range (workload 100±38W, [Lac–]B 5.8± 1.9mmol·l–1, HR 129± 29b·min–1, NE 13.9±6.9, E 1.5± 1.7nmol·l–1; p<0.01 against CTAT for all except E). Conclusions In the upper range of recommended training intensity for CAD patients, norepinephrine and lactate were higher during endurance exercise than at MFC in incremental tests. Endurance exercise with intensities >70% of MFC could overload the cardiac patient and increase the risk of arryhthmia and ischemia. Therefore, endurance exercise should be performed below 70% of MFC or below 85% of maximum HR, respectively, whereas higher intensities should apply to interval exercise. Ausdauerbelastungen für Patienten mit koronarer Herzkrankheit sind bei 55–90% der maximalen Herzfrequenz oder 40–85% der maximalen Leistung empfohlen. Steuergröße von Metabolismus und Herz-Kreislauf sowie Trigger myokardialer Ischämien und Herzrhythmusstörungen sind u.a. die Plasmakatecholamine. Fragestellung war daher, ob Plasmakatecholamine bei Dauerbelastungen an bzw. oberhalb der anaeroben Schwelle den Bereich des Steady-States markieren bzw. übersteigen, und ob die weitgefassten Belastungsempfehlungen mit Vorgaben korrelieren, die sich aus dem Katecholaminverhalten bei den Dauertests ableiten?    Bei 11 Patienten mit koronarer Herzkrankheit wurde die anaerobe Schwelle im doppelten Ergometerstufentest ermittelt. In zwei Dauertests über 30min mit und 10% oberhalb dieser Schwellenintensität wurde das Katecholamin-, Stoffwechsel- und Atmungsverhalten bestimmt.    Bei einer maximalen Stufentestleistung von 141±54 W bzw. VO2max von 1766±532 ml·min–1 entsprechend 85±22% des Normwertes stiegen Adrenalin und Noradrenalin auf 1,6±1,4 bzw. 11,7±5,1nmol·l–1 an. In den Dauertests über 30min mit der Intensität der anaeroben Schwelle bei 88±35 W stellte sich ein Steady-State von Laktat (3,3±1,4mmol·l–1), Adrenalin (0,8±0,7nmol·l–1) und Noradrenalin (8,3±3,5nmol·l–1) ein. In den überschwelligen Dauertests mit 100±38 Watt stiegen Laktat (5,8±1,9mmol·l–1), Adrenalin (1,5±1,7nmol·l–1) und Noradrenalin (13,9±6,9nmol·l–1) stetig an und führten zum Belastungsabbruch nach 19,2±2,7min (p<0,001). Überschwellige Dauerbelastungen bei 71% der Maximalleistung führten zu 18% höheren Plasmanoradrenalinwerten als am Ende eines symptomlimitierten Belastungs-EKGs. Damit verbunden waren Ermüdungsanstiege metabolischer und kardiopulmonaler Größen und vorzeitige Erschöpfung. Mit der Dauerleistung im maximalen Laktat-Steady-State bei 63% der Maximalleistung korreliert eine Belastung bei 70% der Herzfrequenzreserve bzw. eine Belastung bei 85% der symptomlimitierten Herzfrequenz besser als die methodisch aufwendigeren Verfahren der Ventilations- und fixen Laktatschwellen.

Ambulante Langzeitrehabilitation von Herzpatienten

ZusammenfassungIm Hannover-Modell wurde eine ambulante kardiologische Langzeitrehabilitation mit verhaltensund sportmedizinischen Schwerpunkten konzipiert. Mit einer sechswöchigen Intensiv- und anschließenden elfmonatigen Langzeitphase konnte eine deutliche Verbesserung des Gesundheitszustands der Herzpatienten erzielt werden.An einer Stichprobe von 112 Patienten (94 Männer und 18 Frauen, Alter 55±11 Jahre) mit Zustand nach Myokardinfarkt (52%), koronarer Bypass-Operation (37%), PTCA (23%), Klappenersatz (3%) und mit weiteren Herz-Kreislauf-Erkrankungen (12%) konnten in der laufenden Studie folgende Zwischenergebnisse beobachtet werden:Gesamtcholesterin und LDL-Cholesterin verringerten sich signifikant über sechs Monate, HDL-Cholesterin war nach sechs Monaten signifikant erhöht, wohingegen die Triglyceride unverändert blieben. Die Dauerleistungsfähigkeit pro Herzfrequenz-Blutdrucksys-Produkt erhöhte sich in sechs Monaten um 46%. Die Cholesterinaufnahme pro Tag sank signifikant um 20% ab. Während der Maßnahme reduzierte sich die Anzahl der Raucher von 16 auf elf.Erste Ergebnisse im Hannover-Modell zeigen, daß sich durch eine flexible Langzeitrehabilitation der Gesundheitszustand auch über die Dauer einer Phase-II-Rehabilitation hinaus stetig verbessern läßt. Hierbei scheinen die Interventionsdauer wie auch die Intensität der kardiologischen, sportmedizinischen und verhaltensmedizinischen Therapie von entscheidender Bedeutung zu sein.AbstractIn Germany cardiac rehabilitation contains a comprehensive 3 to 4 week inpatient program. The aim of our study was to perform an outpatient long-term rehabilitation including intense exercise and bahavior therapy.In this setting the health benefits could be increased over the first 6 months. Hundred and twelve patients (94 men and 18 women, age 55±11 years) after myocardial infarction (52%), bypass-surgery (37%), PTCA (23%), and others (15%) were included in the ongoing study. Cholesterol and LDL-cholesterol diminished significantly. HDL-cholesterol was increased significantly after 6 months. The endurance exercise capacity per rate-pressure-product was increased by 46% during the 6 months period. The intake of cholesterol could significantly be diminished from 307±25 to 25±19 mg per day. Five of 16 patients became free from smoking.The first results from the long-term outpatient program show that the time of intervention and also the intensity of the medical, exercise and the behavior therapy are important factors for a successful rehabilitation.In Germany cardiac rehabilitation contains a comprehensive 3 to 4 week inpatient program. The aim of our study was to perform an outpatient long-term rehabilitation including intense exercise and behavior therapy. In this setting the health benefits could be increased over the first 6 months. Hundred and twelve patients (94 men and 18 women, age 55 +/- 11 years) after myocardial infarction (52%), bypass-surgery (37%), PTCA (23%), and others (15%) were included in the ongoing study. Cholesterol and LDL-cholesterol diminished significantly. HDL-cholesterol was increased significantly after 6 months. The endurance exercise capacity per rate-pressure-product was increased by 46% during the 6 months period. The intake of cholesterol could significantly be diminished from 307 +/- 25 to 258 +/- 19 mg per day. Five of 16 patients became free from smoking. The first results from the long-term outpatient program show that the time of intervention and also the intensity of the medical, exercise and the behavior therapy are important factors for a successful rehabilitation.

Internet-based perioperative exercise program in patients with Barrett’s carcinoma scheduled for esophagectomy [iPEP - study] a prospective randomized-controlled trial

BackgroundPatients undergoing surgery for esophageal cancer have a high risk for postoperative deterioration of lung function and pulmonary complications. This is partly due to one-lung ventilation during thoracotomy. This often accounts for prolonged stay on intensive care units, delayed postoperative reconvalescence and reduced quality of life. Socioeconomic disadvantages can result from these problems. Physical preconditioning has become a crucial leverage to optimize fitness and lung function in patients scheduled for esophagectomy, in particular during the time period of neoadjuvant therapy.Methods/Study designWe designed a prospective multicenter randomized-controlled trial. The objective is to evaluate the impact of an internet-based exercise program on postoperative respiratory parameters and pneumonia rates in patients with Barrett’s carcinoma scheduled for esophagectomy. Patients are randomly assigned to either execute internet-based perioperative exercise program (iPEP), including daily endurance, resistance and ventilation training or treatment as usual (TAU). During neoadjuvant therapy and recovery, patients in the intervention group receive an individually designed intensive exercise program based on functional measurements at baseline. Personal feedback of the supervisor with customized training programs is provided in weekly intervals.DiscussionThis study will evaluate if an intensive individually adapted training program via online supervision during neoadjuvant therapy will improve cardiorespiratory fitness and reduce pulmonary complications following esophagectomy for Barrett’s cancer.Trial registrationNCT02478996, registered 26 May 2015.