Ralph Beneke

Effects of short-term exercise training and activity restriction on functional capacity in patients with severe chronic congestive heart failure

Previous exercise training studies in patients with chronic congestive heart failure (CHF) were performed for periods lasting > 2 months, and effects of activity restriction on exercise induced-benefits were not systematically assessed. With one exception study, patients were not reported to be transplant candidates. In this random-order crossover study, effects of 3 weeks of exercise training and 3 weeks of activity restriction on functional capacity in 18 hospitalized patients with severe CHF [(mean +/- SEM) age 52 +/- 2 years; ejection fraction 21 +/- 1%; half of them on a transplant waiting list] were assessed. The training program consisted of interval exercise with bicycle ergometer (15 minutes) 5 times weekly, interval treadmill walking (10 minutes), and exercises (20 minutes), each 3 times weekly. With training, the onset of ventilatory threshold was delayed (p < 0.001), with increased work rate by 57% (p < 0.001) and oxygen uptake by 23.7% (p < 0.001). On average, there was a 14.6% decrease in slope of ventilation/carbon dioxide production before the onset of ventilatory threshold (p < 0.05), and ventilatory equivalent of carbon dioxide production by 10.3% (p < 0.01). At the highest comparable work rate (56 +/- 5 W) the following variables were decreased: heart rate (7.3%; p < 0.05), lactate (26.6%; p < 0.001), and ratings of perceived leg fatigue and dyspnea (14.5% and 16.5%; p < 0.001 each). At peak exercise, oxygen uptake was increased by 19.7% (p < 0.01) and oxygen pulse by 14.2% (p < 0.01). There was a correlation of baseline peak oxygen uptake and increase of peak oxygen uptake due to training (r = -0.75; p < 0.004). Independently of the random order, data after activity restriction did not differ significantly from data measured at baseline. Patients with stable, severe CHF can achieve significant improvements in aerobic and ventilatory capacity and symptomology by short-term exercise training using interval exercise methods. Impairments due to activity restriction suggest the need for long-term exercise training.

Dependence of the maximal lactate steady state on the motor pattern of exercise

Background—Blood lactate concentration (BLC) can be used to monitor relative exercise intensity. The highest BLC representing an equilibrium between lactate production and elimination is termed maximal lactate steady state (MLSS). MLSS is used to discriminate qualitatively between continuous exercise, which is limited by stored energy, from other types of exercise terminated because of disturbance of cellular homoeostasis. Aim—To investigate the hypothesis that MLSS intraindividually depends on the mode of exercise. Methods—Six junior male rowers (16.5 (1.4) years, 181.7 (3.1) cm, 69.8 (3.3) kg) performed incremental and constant load tests on rowing and cycle ergometers. Measurements included BLC, sampled from the hyperaemic ear flap, heart rate, and oxygen uptake. MLSS was defined as the highest BLC that increased by no more than 1.0 mmol/l during the final 20 minutes of constant workload. Results—In all subjects, MLSS was lower (p≤0.05) during rowing (2.7 (0.6) mmol/l) than during cycling (4.5 (1.0) mmol/l). No differences between rowing and cycling were found with respect to MLSS heart rate (169.2 (9.3) v 172.3 (6.7) beats/min), MLSS workload (178.7 (29.8) v 205.0 (20.7) W), MLSS intensity expressed as a percentage (63.3 (6.6)% v 68.6 (3.8)%) of peak workload (280.8 (15.9) v 299.2 (28.4) W) or percentage (76.4 (3.4)% v 75.1 (3.0)%) of peak oxygen uptake (60.4 (3.4) v 57.2 (8.6) ml/kg/min). Conclusions—In rowing and cycling, the MLSS but not MLSS workload and MLSS intensity intraindividually depends on the motor pattern of exercise. MLSS seems to decrease with increasing mass of the primarily engaged muscle. This indicates that task specific levels of MLSS occur at distinct levels of power output per unit of primarily engaged muscle mass.

Predictors of response to exercise training in severe chronic congestive heart failure.

We prospectively assessed whether baseline central hemodynamics and exercise capacity can predict improvement of VO2 at ventilatory threshold (VT) after exercise training in patients with severe chronic congestive heart failure. Eighteen patients (mean +/- SEM; age 52 +/- 2 years), half of them listed for transplant, underwent 3 weeks of exercise training (interval cycle and treadmill walking; 5 x/week) and 3 weeks of activity restriction in a random-order crossover trial. Baseline data were not significantly different for groups with exercise training first and activity restriction first: cardiac index at rest (2.1 +/- 0.1 L/m2/min), maximum cardiac index (3.1 +/- 0.2 L/m2/min) (Fick), and echocardiographic ejection fraction (21 +/- 1%). The same was true for cardiopulmonary exercise data (cycle ergometry; up 12.5 W/min): VO2 at VT (9.3 +/- 0.4 ml/kg/min), maximum VO2 (12.2 +/- 0.7 ml/kg/min), VT in percentage of predicted maximum VO2 (31 +/- 2%), heart rate at VT (95 +/- 4 beats/min), and decrease of dead space-to-tidal volume ratio from rest to VT (33 +/- 1 --> 29 +/- 1). Improvement of VO2 at VT after training (2.2 +/- 0.4 ml/kg/min; p <0.001) was not related to baseline central hemodynamics (r = <0.10 for each), but was greater in patients with a lower baseline VO2 at VT (r = -0.65; p <0.01), peak VO2 (r = -0.66; p <0.01), VT in percentage of predicted maximum VO2 (r = -0.74; p <0.001), heart rate at VT (r = -0.63; p <0.01), and smaller decrease of dead space-to-tidal volume ratio from rest to VT (r = 0.65; p <0.01). Ejection fraction after exercise training (24 +/- 2%) and activity restriction (23 +/- 2%) did not differ significantly compared with baseline, and patient status (heart failure and cardiac rhythm) remained stable. Three parameters accounted for 84% of the variance of improvement in VO2 at VT: VO2 at VT in percent predicted maximum VO2, decrease of dead space-to-tidal volume ratio, and heart rate at VT. The findings suggest that there was a greater increase in VO2 at VT after exercise training in patients with greater peripheral deconditioning at baseline. The improvement was unrelated to central hemodynamics. Clinically stable patients with severe chronic congestive heart failure, potential heart transplant candidates, and those awaiting transplantation may benefit from involvement in a short-term exercise training program.

Muscle cross-section measurement by magnetic resonance imaging.

SummaryMuscle cross-section areas were measured by magnetic resonance imaging (MRI) in the thigh of a human cadaver,. the results being compared with those obtained by photography of corresponding anatomic macroslices. A close correlation was found between MRI and photographic evaluation, differences between the methods ranging from nil to 9.5%, depending on the scan position and the muscle groups. In vivo MRI measurements were performed on 12 female and 16 male students, the objectivity, the test-retest reliability and the variability of the MRI measurements being studied by fixing the scan position either manually or by coronary scan. The latter method appeared to be more objective and reliable. The coefficients of variation for muscle cross-section areas measured by MRI were in the range of those for the planimetry of given cross-section areas. Allowing for differentiation between several small muscle bundles in a given area, MRI proved to be a suitable method to quantify muscle cross-sections for intra- and interindividual analysis of muscle size.

Walking performance and economy in chronic heart failure patients pre and post exercise training

Abstract The effect of a 3-week exercise programme on performance and economy of walking was analysed in 16 male patients with chronic heart failure [mean age 51.8 (SD 6.9) years, height 174.9 (SD 6.3) cm, body mass 75.3 (SD 11.5) kg, ejection fraction 20.8 (SD 5.0)%]. They were submitted to a cardiopulmonary exercise test on a cycle ergometer and a 6-min walking test on a treadmill before and after the period of exercise training. The training programme consisted of interval cycle (five times a week for 15 min), and treadmill ergometer training (three times a week for 10 min) at approximately 70% cycling peak oxygen uptake (O2peak) and supplementary exercises (three times a week for 20 min). Compared to the pre values cycling O2peak [11.9 (SD 2.9) vs 14.0 (SD 2.3) ml ·  kg–1 · min–1], maximal self paced walking speed [0.68 (SD 0.33) vs 1.16 (SD 0.30) m · s–1], and net walking power [2.16 (SD 0.89) vs 2.73 (SD 0.91) W · kg–1] had increased (P < 0.01) while net energy cost [3.31 (SD 0.66) vs 2.33 (SD 0.38) J · kg–1 ·  m–1] had decreased (P < 0.001) after the training period. Approximately 42% of the increase of walking speed resulted from a higher walking power output, whereas approximately 58% corresponded to a positive effect on walking economy. The improvement in walking economy was a function of an increase in walking velocity itself and a result of a more efficient walking technique. These results would indicate that in patients with marked exercise intolerance, adequate exercise training programmes could contribute to favourable metabolic changes with positive effects on the economy of motion.

Moderate exercise leads to decreased expression of β1 and β2 integrins on leucocytes

Abstract Intravascular adhesion of leucocytes plays a role in the pathogenesis of acute and chronic vascular disease. Regular aerobic exercise seems to protect against vascular disease. Since leucocyte adhesion is mediated by integrins, we tested the hypothesis that surface expression of the integrin adhesive receptors LFA-1 (cd11a/cd18), MAC-1 (cd11b/cd18), gp 150/95 (cd11c/cd18), and VLA-4 (cd29/cd49) is decreased by moderate endurance exercise. Surface expression of integrins was measured by FACS analysis in 19 healthy subjects (16 males, 3 females, 36.6 ± 8.7 years, 177.1 ± 7.5 cm, 70.3 ± 8.1 kg) before and after submaximal exercise (3 h run) using monoclonal antibodies against cd11a, cd11b, cd11c, cd18, cd29 and cd49. In addition, we compared resting integrin expression in this group with a group of sedentary subjects (19 males, 6 females, 29.3 ± 5.3 years). White blood cell count increased from 5300 ml–1 to 9740 ml–1 during exercise (P<0.001). Nevertheless, the expression (indicated by the mean log fluorescence) of cd11a (94 ± 24 vs. 78 ± 14) and cd18 (128 ± 31 vs. 102 ± 21) on lymphocytes and of cd11a (104 ± 25 vs. 85 ± 16), cd11c (497 ± 171 vs. 408 ± 126) cd29 (109 ± 16 vs. 89 ± 16), cd49 (69± 8 vs. 54 ± 11) on monocytes was decreased after exercise (all P<0.05). In contrast, integrin expression on granulocytes was not altered by exercise. Comparison of exercising and sedentary subjects showed a significantly decreased expression of integrins in exercising subjects. Our results demonstrate that moderate exercise leads to decreased expression of integrin receptors on leucocytes. This decreased expression of adhesion molecules may result in decreased adhesion and infiltration of leucocytes into the vessel wall. This phenomenon may play a role in the beneficial effect of moderate exercise in prevention of acute and chronic vascular disease.

Lipid Peroxide-Related Hemodilution During Repetitive Hyperbaric Oxygenation

Tissue oxygen tension can be elevated under controlled conditions by simultaneously increasing the O2 concentration of inspired air and the ambient pressure (Jamieson and Van Den Brank,1963). Increasing tissue oxygen tension by hyperbaric oxygenation (HBO) reduces organ blood flow (Muhvich et al.,1992; Bergo and Tyssebotn,1992) as well as some forms of edema (Nylander et al.,1985; Yamaguchi et al.,1990; Gehrs et al.,1991). An acutely reversible decrease of blood hemoglobin concentration by HBO (Bergo and Tyssebotn, 1992) further suggests hyperoxia affecting body fluid distribution.