RESUMEN
Because individuals with claudication pain secondary to peripheral arterial disease (PAD) are limited in both walking speed and duration, the benefits of walking exercise may be insufficient to yield a cardiovascular training effect. The objectives of this analysis were to determine whether polestriding exercise training, performed by persons with PAD, would improve exercise endurance, elicit a cardiovascular training benefit, and improve quality of life (QoL). Persons (n = 49) whose claudication pain limited their exercise capacity were randomized into a 24-week polestriding training program (n = 25, 65.8 +/- 7.1 years of age) or a nonexercise attention control group (n = 24, 68.0 +/- 8.6 years of age). Those assigned to the polestriding group trained 3 times weekly. Control group subjects came to the laboratory biweekly for ankle blood pressure measurements. A symptom-limited ramp treadmill test, ratings of perceived leg pain, and QoL data (using the Short Form-36) were obtained at baseline and upon completion of training. After 24 weeks of polestriding training, subjects increased their exercise endurance from 10.3 +/- 4.1 minute to 15.1 +/- 4.5 minute. This was significantly greater than control group subjects whose exercise endurance declined (from 11.2 +/- 4.7 to 10.3 +/- 4.7 minute; P < .001). Relationships between systolic blood pressure (P < .001), heart rate (P = .04), rate pressure product (P = .05), oxygen uptake (P = .016), and perceived leg pain (P = .02) and exercise time improved from the baseline symptom-limited treadmill test to the 6-month symptom-limited treadmill test in the polestriding group compared to the control group. The improvement in the physical component summary score of the Short Form-36 was also greater in the polestriding group (P = .031). Polestriding training significantly improved the clinical indicators of cardiovascular fitness and QoL, and decreased symptoms of claudication pain during exertion.
Asunto(s)
Terapia por Ejercicio/métodos , Tolerancia al Ejercicio , Enfermedades Vasculares Periféricas/rehabilitación , Resistencia Física , Caminata , Anciano , Velocidad del Flujo Sanguíneo , Presión Sanguínea , Distribución de Chi-Cuadrado , Prueba de Esfuerzo , Terapia por Ejercicio/normas , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca , Humanos , Masculino , Consumo de Oxígeno , Dimensión del Dolor , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/fisiopatología , Enfermedades Vasculares Periféricas/psicología , Calidad de Vida , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , UltrasonografíaRESUMEN
Hypogonadism, found in about one-third of patients with chronic obstructive pulmonary disease (COPD), has potential for decreasing muscle mass and muscle performance. Compared with eugonadal patients, we hypothesized that hypogonadal patients with COPD have decreased respiratory and skeletal muscle performance. Nineteen hypogonadal and 20 eugonadal men with COPD (FEV(1) 1.14 +/- 0.08 and 1.17 +/- 0.11 L [standard error], respectively) were studied. Diaphragmatic contractility, assessed as transdiaphragmatic twitch pressure generated by phrenic nerve stimulation, was similar in hypogonadal and eugonadal patients: 20.6 +/- 2.2 and 19.8 +/- 2.5 cm H(2)O, respectively. During progressive inspiratory threshold loading, hypogonadal and eugonadal patients had similar respiratory muscle endurance times (302 +/- 29 and 313 +/- 48 seconds, respectively) and airway pressure sustained during the last minute of loading (38.2 +/- 3.0 and 40.5 +/- 4.7 cm H(2)O, respectively) (similar to predicted values in healthy subjects). Hypogonadal and eugonadal patients had equivalent limb muscle strength and endurance. During cycle exercise to exhaustion, exercise performance, gas exchange, and respiratory muscle recruitment (estimated by esophageal and gastric pressure swings during tidal breathing) were similar in both groups. In conclusion, hypogonadism does not decrease respiratory or limb muscle performance and exercise capacity in men with moderate-to-severe COPD who, for the most part, are not underweight.
Asunto(s)
Hipogonadismo/fisiopatología , Músculo Esquelético/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Músculos Respiratorios/fisiopatología , Anciano , Estudios de Casos y Controles , Diafragma/fisiopatología , Estimulación Eléctrica , Prueba de Esfuerzo , Tolerancia al Ejercicio/fisiología , Humanos , Hipogonadismo/complicaciones , Masculino , Contracción Muscular/fisiología , Nervio Frénico/fisiología , Enfermedad Pulmonar Obstructiva Crónica/complicacionesRESUMEN
PURPOSE: The purpose of this study was to determine whether subjects with chronic heart failure, who completed a 12-week rehabilitation program, would have significantly greater quality of life, better aerobic fitness, less difficulty with symptoms of heart failure, greater self-efficacy for exercise, and higher daily activity levels when compared with subjects in a control group. METHODS: Thirty-one males, aged 64 +/- 10 years with left ventricular ejection fraction of 29 +/- 7%, were randomized to a moderate intensity supervised aerobic exercise program (n = 15) or a control group (n = 16). Twenty-seven subjects completed at least 1 follow-up assessment. RESULTS: After 12 weeks there were significant differences in the change scores for perceived physical function (using RAND Corporation's 36-item short form) (P =.025) and peak oxygen uptake (P =.019) between the exercise and control groups with the exercise group experiencing improved physical function and fitness. CONCLUSIONS: Exercise training in adults with heart failure increases exercise tolerance and perceived physical function. Improved heart failure symptoms, self-efficacy for exercise, or increased physical activity may not be associated with enhancement of exercise tolerance.
Asunto(s)
Terapia por Ejercicio , Insuficiencia Cardíaca/rehabilitación , Consumo de Oxígeno/fisiología , Resistencia Física/fisiología , Anciano , Enfermedad Crónica , Prueba de Esfuerzo , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Autoeficacia , Perfil de Impacto de Enfermedad , Encuestas y CuestionariosRESUMEN
PURPOSE: The purpose of this investigation was to evaluate the efficacy of PoleStriding exercise (a form of walking that uses muscles of the upper and lower body in a continuous movement similar to cross-country skiing) and vitamin E (alpha-tocopherol) to improve walking ability and perceived quality of life (QOL) of patients with claudication pain secondary to peripheral arterial disease (PAD). METHODS: Fifty-two subjects were randomized into four groups: PoleStriding with vitamin E (N = 13), PoleStriding with placebo (N= 14), vitamin E without exercise (N= 13), and placebo without exercise (N = 12). The dose of vitamin E was 400 IU daily. Only the PoleStriding with vitamin E and PoleStriding with placebo groups received PoleStriding instruction and training. Assignment to vitamin E or placebo was double blind. Subjects trained three times weekly for 30-45 min (rest time excluded). Individuals in vitamin E and placebo groups came to the laboratory biweekly for ankle blood-pressure measurements. RESULTS: Results of this randomized clinical trial provide strong evidence that PoleStriding significantly (P< 0.001) improved exercise tolerance on the constant work-rate and incremental treadmill tests. Ratings of perceived claudication pain were significantly less after the PoleStriding training program (P= 0.02). In contrast, vitamin E did not have a statistically significant effect on the subjects' ratings of perceived leg pain (P= 0.35) or treadmill walking duration ( P= 0.36). Perceived distance and walking speed (Walking Impairment Questionnaire) and perceived physical function (Rand Short Form-36) improved in the PoleStriding trained group only (P< 0.001, 0.022 and 0.003, respectively). CONCLUSION: PoleStriding effectively improved the exercise tolerance and perceived QOL of patients with PAD. Little additional benefit to exercise capacity was realized from vitamin E supplementation.
Asunto(s)
Terapia por Ejercicio , Pierna/irrigación sanguínea , Pierna/patología , Enfermedades Vasculares Periféricas/fisiopatología , Enfermedades Vasculares Periféricas/terapia , Vitamina E/uso terapéutico , Actividades Cotidianas/psicología , Anciano , Manejo de la Enfermedad , Método Doble Ciego , Prueba de Esfuerzo , Tolerancia al Ejercicio/efectos de los fármacos , Tolerancia al Ejercicio/fisiología , Femenino , Estudios de Seguimiento , Humanos , Illinois , Claudicación Intermitente/fisiopatología , Claudicación Intermitente/terapia , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/efectos de los fármacos , Consumo de Oxígeno/fisiología , Cooperación del Paciente , Resistencia Física/efectos de los fármacos , Resistencia Física/fisiología , Estudios Prospectivos , Calidad de Vida/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Flujo Sanguíneo Regional/efectos de los fármacos , Flujo Sanguíneo Regional/fisiología , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Caminata/fisiologíaRESUMEN
The purpose of this study was to evaluate the efficacy of a unique program of ventilation-feedback training combined with leg-cycle exercise to improve exertional endurance and decrease perceived dyspnea in patients with chronic obstructive pulmonary disease (COPD). Thirty-nine patients (67.5 +/- 8.1 yr of age) with moderate to severe COPD (42.6% of predicted forced expiratory volume in 1 s) were randomized to one of three 6-week experimental interventions: ventilation-feedback with exercise (V(+EX)), exercise only (EX(ONLY)), or ventilation-feedback only (VF(ONLY)). At baseline and at 6 weeks, patients completed a constant work-rate leg-cycle ergometer test at 85 percent of maximal power output. There were increases within the groups in exercise duration: 11.5 min (103%), 8.0 min (66%), and 0.4 min (4%) for the VF(+EX), EX(ONLY) and VF(ONLY) groups, respectively. The VF(ONLY) group experienced no significant within-group changes in selected gas exchange parameters. However, there were significant (p < 0.05) posttraining changes in minute ventilation, tidal volume, breathing frequency (f), and expiratory time (Te) in the VF(+EX) group, and in f and Te in the EX(ONLY) group. After completing the training, VF(+EX) and EX(ONLY) patients reported less breathlessness and perceived exertion (p < 0.05). The VF(ONLY) patients' ratings changed in the hypothesized direction but were not significant. Based on these preliminary data, VF(+EX) and EX(ONLY) were equally effective in improving leg-cycle exercise tolerance in patients with moderate to severe COPD.