RESUMEN

OBJECTIVES: Inspiratory muscle training is used in rehabilitation to exercise respiratory muscles in various conditions associated with limited ventilatory reserve. In this review, we investigated inspiratory muscle training in lung transplant candidates and recipients. MATERIALS AND METHODS: We searched 5 primary databases from inception through April 2024. Two key word entries, "lung transplantation" and "inspiratory muscle training," were matched using the Boolean operator AND. No filters were applied for document type, age, sex, publication date, language, and subject. RESULTS AND CONCLUSIONS: The searched databases returned 119 citations. Seven articles that considered 64 patients (47% female) were included in the final analysis, with 1 study involving a pediatric patient. Lung transplant recipients used a threshold trainer at 15% to 60% of maximal inspiratory pressure and mostly exercised twice daily for 10 to 15 minutes per session. Lung transplant candidates exercised at 30% to >50% of maximal inspiratory pressure twice daily, performing 30 to 60 inspirations or for 15 minutes. The highest inspiratory muscle strength was observed in a series of adult lung transplant recipients whose mean value improved by 31.8 ± 14.6 cmH2O versus baseline after treatment. To the same extent, the highest value of maximal inspiratory pressure was detected in a pediatric patient who scored 180 cmH2O after training. Overall, participants obtained improvements in lung function (forced expiratory volume in 1 second, forced vital capacity), functional performance, dyspnea intensity, and exercise tolerance. Inspiratory muscle training is easy to perform and can be done at home without specific supervision (in adults) before or after a lung transplant. Nevertheless, additional rigorous investigations should aim to replicate the positive effects reported in the present review.

Asunto(s)

Ejercicios Respiratorios , Trasplante de Pulmón , Pulmón , Fuerza Muscular , Recuperación de la Función , Músculos Respiratorios , Humanos , Músculos Respiratorios/fisiopatología , Femenino , Resultado del Tratamiento , Masculino , Pulmón/fisiopatología , Adulto , Niño , Persona de Mediana Edad , Adolescente , Adulto Joven , Inhalación , Factores de Tiempo , Tolerancia al Ejercicio , Anciano

RESUMEN

Aortic valve replacement (AVR) leads to reverse cardiac remodeling in patients with aortic stenosis (AS). The aim of this secondary pooled analysis was to assess the degree and determinants of changes in myocardial perfusion post AVR, and its link with exercise capacity, in patients with severe AS. A total of 68 patients underwent same-day echocardiography and cardiac magnetic resonance imaging with adenosine stress pre and 6-12 months post-AVR. Of these, 50 had matched perfusion data available (age 67 ± 8 years, 86% male, aortic valve peak velocity 4.38 ± 0.63 m/s, aortic valve area index 0.45 ± 0.13cm2/m2). A subgroup of 34 patients underwent a symptom-limited cardiopulmonary exercise test (CPET) to assess maximal exercise capacity (peak VO2). Baseline and post-AVR parameters were compared and linear regression was used to determine associations between baseline variables and change in myocardial perfusion and exercise capacity. Following AVR, stress myocardial blood flow (MBF) increased from 1.56 ± 0.52 mL/min/g to 1.80 ± 0.62 mL/min/g (p < 0.001), with a corresponding 15% increase in myocardial perfusion reserve (MPR) (2.04 ± 0.57 to 2.34 ± 0.68; p = 0.004). Increasing severity of AS, presence of late gadolinium enhancement, lower baseline stress MBF and MPR were associated with a greater improvement in MPR post-AVR. On multivariable analysis low baseline MPR was independently associated with increased MPR post-AVR. There was no significant change in peak VO2 post-AVR, but a significant increase in exercise duration. Change in MPR was associated with change in peak VO2 post AVR (r = 0.346, p = 0.045). Those with the most impaired stress MBF and MPR at baseline demonstrate the greatest improvements in these parameters following AVR and the magnitude of change in MPR correlated with improvement in peak VO2, the gold standard measure of aerobic exercise capacity.

Asunto(s)

Estenosis de la Válvula Aórtica , Válvula Aórtica , Prueba de Esfuerzo , Tolerancia al Ejercicio , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Masculino , Anciano , Femenino , Tolerancia al Ejercicio/fisiología , Prueba de Esfuerzo/métodos , Válvula Aórtica/cirugía , Válvula Aórtica/fisiopatología , Válvula Aórtica/diagnóstico por imagen , Persona de Mediana Edad , Circulación Coronaria , Índice de Severidad de la Enfermedad , Ecocardiografía , Imagen por Resonancia Magnética/métodos

RESUMEN

BACKGROUND: Branch pulmonary artery (PA) stenosis is one of the most common indications for percutaneous interventions in patients with transposition of the great arteries (TGA), tetralogy of Fallot (ToF), and truncus arteriosus (TA). However, the effects of percutaneous branch PA interventions on exercise capacity remains largely unknown. In addition, there is no consensus about the optimal timing of the intervention for asymptomatic patients according to international guidelines. This trial aims to identify the effects of percutaneous interventions for branch PA stenosis on exercise capacity in patients with TGA, ToF, and TA. In addition, it aims to assess the effects on RV function and to define early markers for RV adaptation and RV dysfunction to improve timing of these interventions. METHODS: This is a randomized multicenter interventional trial. TGA, ToF, and TA patients ≥ 8 years with a class IIa indication for percutaneous branch PA intervention according to international guidelines are eligible to participate. Patients will be randomized into the intervention group or the control group (conservative management for 6 months). All patients will undergo transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and cardiopulmonary exercise testing at baseline, 6 months, and 2-4 years follow-up. Quality of life (QoL) questionnaires will be obtained at baseline, 2 weeks post intervention or a similar range for the control group, and 6 months follow-up. The primary outcome is exercise capacity expressed as maximum oxygen uptake (peak VO2 as percentage of predicted). A total of 56 patients (intervention group n = 28, control group n = 28) is required to demonstrate a 14% increase in maximum oxygen uptake (peak VO2 as percentage of predicted) in the interventional group compared to the control group (power 80%, overall type 1 error controlled at 5%). Secondary outcomes include various parameters for RV systolic function, RV functionality, RV remodeling, procedural success, complications, lung perfusion, and QoL. DISCUSSION: This trial will investigate the effects of percutaneous branch PA interventions on exercise capacity in patients with TGA, ToF, and TA and will identify early markers for RV adaptation and RV dysfunction to improve timing of the interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05809310. Registered on March 15, 2023.

Asunto(s)

Tolerancia al Ejercicio , Cardiopatías Congénitas , Estudios Multicéntricos como Asunto , Arteria Pulmonar , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Arteria Pulmonar/fisiopatología , Cardiopatías Congénitas/fisiopatología , Cardiopatías Congénitas/cirugía , Resultado del Tratamiento , Países Bajos , Estenosis de Arteria Pulmonar/fisiopatología , Estenosis de Arteria Pulmonar/etiología , Estenosis de Arteria Pulmonar/diagnóstico por imagen , Función Ventricular Derecha , Niño , Factores de Tiempo , Prueba de Esfuerzo , Masculino , Recuperación de la Función , Tetralogía de Fallot/cirugía , Tetralogía de Fallot/fisiopatología , Femenino

RESUMEN

INTRODUCTION: Cirrhosis is the main cause of morbidity and mortality globally, accounting for approximately 1.2 million deaths annually. Impaired aerobic capacity, muscle wasting and reduced muscle strength are significant complications in patients with cirrhosis. Preoperative exercise intervention "prehabilitation" has been recognised as a potential approach to optimise muscle strength, aerobic capacity and body composition as well as quality of life in patients awaiting abdominal surgery. However, there is little evidence on the effects of preoperative exercise on older adults with cirrhosis and awaiting liver transplant. Thus, the primary objective of this systematic review and meta-analysis will be to assess the effects of exercise interventions in improving aerobic capacity, muscle strength and body composition of older adults with cirrhosis and awaiting liver transplant. METHODS AND ANALYSIS: This systematic review and metaanalysis protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review will include all peer-reviewed randomised controlled trials (RCTs), including cluster RCTs, controlled (non-controlled), complex clinical trials (CCTs) or cluster trials, cohort, observational studies published in English from inception until July 2024. The following electronic databases will be searched: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO) and Scopus (Elsevier) and supplemented by a secondary screening of the reference lists of all included articles. Searches will involve studies with both male and female participants aged ≥ 18 years with cirrhosis and awaiting liver transplant. Primary outcomes will include muscle strength, and aerobic capacity. The secondary outcomes include body composition (e.g. body mass index, and thigh circumference). The Cochrane Collaboration Risk of Bias Tool will be used to evaluate quality of the studies and Review Manager (RevMan) V.5.3 (Copenhagen, Denmark: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Effect sizes will be expressed as a standardised mean difference, and their 95% confidence intervals will be calculated and presented as a forest plot. The standard χ2 and I2 tests will be used to test heterogeneity. CONCLUSION: This systematic review and meta-analysis is anticipated to provide meaningful and contemporary evidence on the effects of preoperative exercise in older adults living with cirrhosis and awaiting liver transplant. In addition, the findings will help clinicians with developing safe and effective preoperative exercise regimens for these patients.

Asunto(s)

Composición Corporal , Cirrosis Hepática , Trasplante de Hígado , Metaanálisis como Asunto , Fuerza Muscular , Ejercicio Preoperatorio , Revisiones Sistemáticas como Asunto , Humanos , Fuerza Muscular/fisiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Tolerancia al Ejercicio/fisiología , Calidad de Vida , Terapia por Ejercicio/métodos

RESUMEN

Cardiopulmonary exercise testing (CPET) is a comprehensive and invaluable assessment used to identify the mechanisms that limit exercise capacity. However, its interpretation remains poorly standardised. This scoping review aims to investigate which limitations to exercise are differentiated by the use of incremental CPET in literature and which criteria are used to identify them. We performed a systematic, electronic literature search of PubMed, Embase, Cochrane CENTRAL, Web of Science and Scopus. All types of publications that reported identification criteria for at least one limitation to exercise based on clinical parameters and CPET variables were eligible for inclusion. 86 publications were included, of which 57 were primary literature and 29 were secondary literature. In general, at the level of the cardiovascular system, a distinction was often made between a normal physiological limitation and a pathological one. Within the respiratory system, ventilatory limitation, commonly identified by a low breathing reserve, and gas exchange limitation, mostly identified by a high minute ventilation/carbon dioxide production slope and/or oxygen desaturation, were often described. Multiple terms were used to describe a limitation in the peripheral muscle, but all variables used to identify this limitation lacked specificity. Deconditioning was a frequently mentioned exercise limiting factor, but there was no consensus on how to identify it through CPET. There is large heterogeneity in the terminology, the classification and the identification criteria of limitations to exercise that are distinguished using incremental CPET. Standardising the interpretation of CPET is essential to establish an objective and consistent framework.

Asunto(s)

Prueba de Esfuerzo , Tolerancia al Ejercicio , Valor Predictivo de las Pruebas , Humanos , Consumo de Oxígeno , Pulmón/fisiopatología , Capacidad Cardiovascular , Reproducibilidad de los Resultados

RESUMEN

PURPOSE: Given the difficulty to perform exercise training wearing a mask, we examined differences in functional capacity improvement between masking during the coronavirus disease 2019 (COVID-19) pandemic and non-masking prior to the pandemic for patients undergoing cardiac rehabilitation (CR). METHODS: Records of 660 patients who underwent and completed ≥ 18 sessions of CR in 2018 (n = 318, non-masking) and in 2022 (n = 342, masking) at an academic health system were analyzed. The primary outcome was post-CR change in functional capacity in metabolic equivalents (MET) measured by exercise stress test. Sessions of CR participation and changes in depression, anxiety, and quality of life scores were secondary outcomes. We used multivariable linear regression to adjust for differences in baseline CR outcome measures, demographics, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk, and comorbid conditions. RESULTS: Baseline age (64.6 ± 0.46 yr), sex (28% female), and racial distribution (85% white) were similar between the masking and non-masking groups. Non-masking patients were more likely to be classified in the AACVPR high risk category and had lower anxiety scores at baseline compared to masking patients. After CR, both groups had similar and significant improvements in depression, anxiety, and quality of life scores, but the improvement in functional capacity was lower in the masking group (-0.62 ± 0.12 MET, P < .001) compared to the non-masking group. Results remained significant after multivariable adjustment. CONCLUSIONS: Cardiac rehabilitation patients requiring masking during the COVID-19 pandemic had less improvement in functional capacity than patients who did not wear masks during CR prior to the pandemic. Interventions to mitigate the potential side effects of masking for CR patients may require further exploration.

Asunto(s)

COVID-19 , Rehabilitación Cardiaca , Máscaras , Calidad de Vida , Humanos , COVID-19/epidemiología , Masculino , Femenino , Rehabilitación Cardiaca/métodos , Persona de Mediana Edad , SARS-CoV-2 , Anciano , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio/fisiología , Ansiedad , Prueba de Esfuerzo/métodos , Depresión , Pandemias , Estudios Retrospectivos

RESUMEN

BACKGROUND: Exercise training is fundamental in pulmonary rehabilitation (PR), but patients with chronic obstructive pulmonary disease (COPD) often struggle with exercise intolerance. Respiratory support during exercise in COPD patients may be a beneficial adjunct therapy. In this study, the effect of different respiratory support therapy during pulmonary rehabilitation exercise training in COPD patients was assessed through a network meta-analysis. METHODS: Five databases were searched to obtain randomized controlled trials involving different respiratory support therapies during PR exercise training in COPD patients. The Cochrane Handbook tool was employed to assess the risk bias of included studies. Network meta-analysis was performed using the STATA software. The study protocol was registered at PROSPERO (CRD42023491139). RESULTS: A total of 35 studies involving 1321 patients and 6 different interventions were included. Network meta-analysis showed that noninvasive positive pressure ventilation (NPPV) is superior in improving exercise capacity (6-Minute Walk Test distance, peak work rate, endurance time), dyspnea, and physiological change (peak VO2, tidal volume, minute ventilation and lactate level) in stable COPD patients who were at GOLD stage III or IV during PR exercise training. The final surface under the cumulative ranking curve value indicated that NPPV therapy achieved the best assistive rehabilitation effect. CONCLUSIONS: The obtained results indicate that NPPV is most powerful in assisting exercise in severe COPD patients under stable condition. Researchers should focus more on the safety, feasibility, and personalization of interventions. Furthermore, there is a need for additional high-quality trials to assess the consistency of evidence across various respiratory support approaches. TRIAL REGISTRATION: The study was registered at PROSPERO (CRD42023491139).

Asunto(s)

Terapia por Ejercicio , Metaanálisis en Red , Enfermedad Pulmonar Obstructiva Crónica , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Humanos , Terapia por Ejercicio/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Tolerancia al Ejercicio/fisiología , Terapia Respiratoria/métodos , Respiración con Presión Positiva/métodos

RESUMEN

People with end-stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in-centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in-centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.

Asunto(s)

Prueba de Esfuerzo , Tolerancia al Ejercicio , Fallo Renal Crónico , Diálisis Renal , Humanos , Masculino , Persona de Mediana Edad , Femenino , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Proyectos Piloto , Anciano , Adulto , Prueba de Esfuerzo/métodos , Diálisis Renal/efectos adversos , Tolerancia al Ejercicio/fisiología , Consumo de Oxígeno

RESUMEN

BACKGROUND: Invasive cardiopulmonary exercise testing (iCPET) combines traditional cardiopulmonary exercise testing with invasive hemodynamic measurements to assess exercise intolerance, which can be caused by preload insufficiency (PI), characterized by low ventricular filling pressures and reduced cardiac output during exertion. We hypothesize that plasma catecholamine levels at rest and during exercise correlate with hemodynamic parameters in PI. METHODS: We included adult patients who underwent iCPET for exercise intolerance and had plasma catecholamines measured at rest and peak exercise. RESULTS: Among 84 patients, PI was identified in 57 (67.8 %). Compared to patients without PI, those with PI were younger [median (IQR) 37 (28, 46) vs 47 (39,55) years, p = 0.005] and had lower workload at peak exercise [81 (66, 96) vs 95 (83.5, 110.50) Watts, p = 0.006]. Patients with PI had higher heart rates at rest and peak exercise [87 (78, 97) vs 79 (74, 87) bpm, p = 0.04; and 167 (154, 183) vs 156 (136, 168) bpm, p = 0.01, respectively]. In all patients, epinephrine and norepinephrine at peak exercise directly correlated with peak workload (r:0.41, p < 0.001 and r:0.47, p < 0.001, respectively). Resting epinephrine was higher in patients with PI [136 (60, 210) vs 77 (41, 110) pg/mL, p = 0.02]. There was no significant difference in the change in catecholamines from rest to peak exercise between patients with or without PI. CONCLUSION: PI patients exhibited elevated heart rate and epinephrine at rest, indicating increased sympathetic activity. We did not find strong associations between catecholamines and cardiac filling pressures, suggesting that catecholamine levels are predominantly influenced by peak workload.

Asunto(s)

Catecolaminas , Prueba de Esfuerzo , Tolerancia al Ejercicio , Humanos , Prueba de Esfuerzo/métodos , Persona de Mediana Edad , Masculino , Tolerancia al Ejercicio/fisiología , Femenino , Catecolaminas/sangre , Adulto , Norepinefrina/sangre , Hemodinámica/fisiología , Frecuencia Cardíaca/fisiología , Epinefrina/sangre , Ejercicio Físico/fisiología , Gasto Cardíaco/fisiología

RESUMEN

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is common in type 2 diabetes mellitus (T2D), leading to high morbidity and mortality. Managing HFpEF in diabetic patients is challenging with limited treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) have shown potential cardiovascular benefits. This meta-analysis compares the effects of GLP1-RA and SGLT2 inhibitors on HFpEF in T2D patients. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating GLP1-RA and SGLT2 inhibitors' impact on HFpEF in T2D patients. Databases searched included PubMed, MEDLINE, and Cochrane Library up to July 2024. Primary outcomes were changes in left ventricular ejection fraction (LVEF), myocardial fibrosis (extracellular volume fraction, ECV), and functional capacity (6-minute walk test, 6MWT). Secondary outcomes included HbA1c, body weight, and systolic blood pressure (SBP).  RESULTS: Twelve studies with 3,428 patients (GLP1-RA: 1,654; SGLT2 inhibitors: 1,774) were included. Both GLP1-RA and SGLT2 inhibitors significantly improved LVEF compared to placebo (GLP1-RA: mean difference [MD] 2.8%, 95% confidence interval [CI] 1.5 to 4.1, p < 0.001; SGLT2 inhibitors: MD 3.2%, 95% CI 2.0 to 4.4, p < 0.001). SGLT2 inhibitors significantly reduced myocardial fibrosis (MD -3.5%, 95% CI -4.2 to -2.8, p < 0.001) more than GLP1-RA (MD -2.3%, 95% CI -3.0 to -1.6, p < 0.001). Functional capacity improved significantly with both treatments (GLP1-RA: MD 45 m, 95% CI 30 to 60, p < 0.001; SGLT2 inhibitors: MD 50 m, 95% CI 35 to 65, p < 0.001). Secondary outcomes showed reductions in HbA1c (GLP1-RA: MD -1.1%, 95% CI -1.4 to -0.8, p < 0.001; SGLT2 inhibitors: MD -1.0%, 95% CI -1.3 to -0.7, p < 0.001) and body weight (GLP1-RA: MD -2.5 kg, 95% CI -3.1 to -1.9, p < 0.001; SGLT2 inhibitors: MD -2.0 kg, 95% CI -2.6 to -1.4, p < 0.001). Both treatments significantly lowered SBP (GLP1-RA: MD -5.2 mmHg, 95% CI -6.5 to -3.9, p < 0.001; SGLT2 inhibitors: MD -4.8 mmHg, 95% CI -6.0 to -3.6, p < 0.001). CONCLUSIONS: GLP1-RA and SGLT2 inhibitors significantly benefit HFpEF management in T2D patients. SGLT2 inhibitors reduce myocardial fibrosis more effectively, while both improve LVEF, functional capacity, and metabolic parameters. These therapies should be integral to HFpEF management in diabetic patients. Further research is needed on long-term outcomes and potential combined therapy effects.

Asunto(s)

Diabetes Mellitus Tipo 2 , Receptor del Péptido 1 Similar al Glucagón , Insuficiencia Cardíaca , Incretinas , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Volumen Sistólico , Función Ventricular Izquierda , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Volumen Sistólico/efectos de los fármacos , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Receptor del Péptido 1 Similar al Glucagón/agonistas , Función Ventricular Izquierda/efectos de los fármacos , Resultado del Tratamiento , Incretinas/uso terapéutico , Incretinas/efectos adversos , Masculino , Anciano , Persona de Mediana Edad , Femenino , Recuperación de la Función , Estudios Observacionales como Asunto , Hipoglucemiantes/uso terapéutico , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Tolerancia al Ejercicio/efectos de los fármacos , Factores de Riesgo , Agonistas Receptor de Péptidos Similares al Glucagón

RESUMEN

We studied the effect of N1-(2,3,4-trimethoxybenzyl)-N2-{2-[(2,3,4-trimethoxybenzyl)amino]ethyl}-1,2-ethanediamine (compound ALM-802) on the physical performance of mice after acute fatigue. The animals' performance was assessed on a treadmill. The criterion for assessing exercise tolerance was the length of the distance passed when running on a treadmill until complete fatigue. To assess the actoprotective activity of compound ALM-802, we used a method of stepwise increase in load with an initial running speed of 42 cm/sec and its subsequent increase by 5 cm/sec every 5 min. The maximum speed of movement of the treadmill belt is 77 cm/sec. Animals that received compound ALM-802 (2 mg/kg intraperitoneally), 1 day after acute fatigue, ran a distance to complete fatigue that exceeded that of control mice by 68% (387.9±60.5 and 230.6±29.6 m, respectively, p=0.023). The reference drug trimetazidine (30 mg/kg, intraperitoneally) did not have a significant effect on the distance traveled. Compound ALM-802 helps restore physical performance, i.e. exhibits significant actoprotective activity.

Asunto(s)

Fatiga , Animales , Ratones , Masculino , Fatiga/tratamiento farmacológico , Tolerancia al Ejercicio/efectos de los fármacos , Condicionamiento Físico Animal , Rendimiento Físico Funcional , Diaminas/química , Diaminas/farmacología

RESUMEN

BACKGROUND: After COVID-19 infection, 10-20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence. METHODS: Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both. RESULTS: The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022). CONCLUSIONS: This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it.

Asunto(s)

COVID-19 , Prueba de Esfuerzo , Tolerancia al Ejercicio , Fatiga , Frecuencia Cardíaca , Disautonomías Primarias , Humanos , COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Disautonomías Primarias/fisiopatología , Disautonomías Primarias/diagnóstico , Fatiga/fisiopatología , Fatiga/diagnóstico , Fatiga/etiología , Anciano , Síndrome Post Agudo de COVID-19 , Adulto , Consumo de Oxígeno , Factores de Tiempo , SARS-CoV-2

RESUMEN

Chronic Obstructive Pulmonary Disease (COPD) is a global health concern. Mind-body exercises like Tai Chi and Yoga are suggested as non-pharmacological interventions for COPD management. This meta-analysis evaluates mind-body exercises' impact on lung function and exercise capacity in stable COPD patients, aiming to assess their effectiveness in rehabilitation. A systematic search across various databases identified relevant randomized controlled trials until April 2024. Primary outcomes included lung function tests (FEV1, FVC, FEV1/FVC, FEV1%) and Six-Minute Walk Test (6MWT) results. The Standardized Mean Difference (SMD) measured intervention effects. Fifteen studies with 1047 participants were analyzed. Mind-body exercises significantly improved FEV1 (SMD = 0.87), FEV1/FVC (SMD = 0.19), FEV1% (SMD = 0.43), and 6MWT (SMD = 1.21) compared to standard care. Sensitivity and subgroup analyses confirmed result stability despite some heterogeneity.In conclusion, Mind-body exercises enhance lung function and exercise capacity in stable COPD patients. Integrating them into comprehensive rehabilitation programs is advisable. Further research should explore the specific impacts of different exercise types and intensities.

Asunto(s)

Enfermedad Pulmonar Obstructiva Crónica , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Humanos , Tolerancia al Ejercicio/fisiología , Pulmón/fisiopatología , Terapias Mente-Cuerpo/métodos , Pruebas de Función Respiratoria , Taichi Chuan/métodos , Terapia por Ejercicio/métodos , Yoga

RESUMEN

PURPOSE: The objective of this study was to explore functional improvements by sex for patients with refractory angina pectoris using a 6-min walk test (6MWT) after enhanced external counterpulsation (EECP) therapy. METHODS: All patients who completed EECP from 2015 to 2023 were identified for analysis retrospectively, utilizing the electronic medical record. Patients completed 35 1-hr EECP sessions 5 d/wk over 7 wk. All baseline and post-EECP intervention 6MWT, exertional angina, and dyspnea measurements were assessed on the first and last sessions, respectively. Paired and unpaired t tests and linear and stepwise multivariable regression analyses were performed. RESULTS: The cohort consisted of 116 patients (24 female) with a mean age of 69 ± 13 yr. After EECP, there was a mean improvement of 128 m (72%) in distance walked during the 6MWT ( P < .001) with 126 ± 91 m improvement in males and 134 ± 73 m in females. The improvement in angina and dyspnea scores was 3.5 ± 2.1 and 4.2 ± 2.4, respectively. There were no differences between the sexes for improvements in 6MWT distance, angina, or dyspnea. Univariate associations for change in 6MWT distance included body mass index (BMI; adjusted R2  = .05) and being a nonsmoker (adjusted R2  = .03). The only independent predictor for increasing distance during 6MWT was BMI (adjusted R2  = .1; P = .001). CONCLUSION: Patients who have refractory angina pectoris can improve their functional capacity while simultaneously decreasing exertional angina and dyspnea using EECP. This study highlights the equal efficacy of EECP therapy for females.

Asunto(s)

Angina de Pecho , Contrapulsación , Disnea , Prueba de Paso , Humanos , Femenino , Masculino , Disnea/fisiopatología , Disnea/etiología , Disnea/terapia , Contrapulsación/métodos , Estudios Retrospectivos , Anciano , Angina de Pecho/terapia , Angina de Pecho/fisiopatología , Prueba de Paso/métodos , Factores Sexuales , Persona de Mediana Edad , Resultado del Tratamiento , Tolerancia al Ejercicio/fisiología

RESUMEN

BACKGROUND: The health-related quality of life (HRQOL) and cardiopulmonary exercise testing (CPET) performance of individuals with subclinical and early stage hypertrophic cardiomyopathy (HCM) have not been systematically studied. Improved understanding will inform the natural history of HCM and factors influencing well-being. METHODS: VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric HCM) participants with early stage sarcomeric HCM (primary analysis cohort) and subclinical HCM (sarcomere variant without left ventricular hypertrophy comprising the exploratory cohort) who completed baseline and year 2 HRQOL assessment via the pediatric quality of life inventory and CPET were studied. Metrics correlating with baseline HRQOL and CPET performance were identified. The impact of valsartan treatment on these measures was analyzed in the early stage cohort. RESULTS: Two hundred participants were included: 166 with early stage HCM (mean age, 23±10 years; 40% female; 97% White; and 92% New York Heart Association class I) and 34 subclinical sarcomere variant carriers (mean age, 16±5 years; 50% female; and 100% White). Baseline HRQOL was good in both cohorts, although slightly better in subclinical HCM (composite pediatric quality of life score 84.6±10.6 versus 90.2±9.8; P=0.005). Both cohorts demonstrated mildly reduced functional status (mean percent predicted peak oxygen uptake 73±16 versus 78±12 mL/kg per minute; P=0.18). Percent predicted peak oxygen uptake and peak oxygen pulse correlated with HRQOL. Valsartan improved physical HRQOL in early stage HCM (adjusted mean change in pediatric quality of life score +4.1 versus placebo; P=0.01) but did not significantly impact CPET performance. CONCLUSIONS: Functional capacity can be impaired in young, healthy people with early stage HCM, despite New York Heart Association class I status and good HRQOL. Peak oxygen uptake was similarly decreased in subclinical HCM despite normal left ventricular wall thickness and excellent HRQOL. Valsartan improved physical pediatric quality of life scores but did not significantly impact CPET performance. Further studies are needed for validation and to understand how to improve patient experience. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01912534.

Asunto(s)

Cardiomiopatía Hipertrófica , Prueba de Esfuerzo , Tolerancia al Ejercicio , Calidad de Vida , Valsartán , Humanos , Femenino , Cardiomiopatía Hipertrófica/fisiopatología , Cardiomiopatía Hipertrófica/tratamiento farmacológico , Masculino , Adolescente , Tolerancia al Ejercicio/efectos de los fármacos , Adulto Joven , Adulto , Valsartán/uso terapéutico , Niño , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Resultado del Tratamiento

RESUMEN

INTRODUCTION: Chronic Chagas cardiomyopathy (CCC), the most severe clinical condition of Chagas disease, often leads to a reduction in functional capacity and the appearance of symptoms such as fatigue and dyspnea on exertion. However, its determinant factors remain unclear. We aimed to evaluate the peak oxygen consumption (VO2peak) in patients with CCC and identify its determining factors. METHODS: An observational study with 97 CCC patients was conducted. Patients underwent clinical examination, cardiopulmonary exercise test (CPET), and echocardiography as part of the standard clinical evaluation. Multivariate linear regression was used to identify independent clinical and echocardiographic predictors of VO2peak and percentage of predicted VO2. RESULTS: Mean age of study patients was 55.9 ± 13.4 years, median left ventricle ejection fraction (LVEF) was 40 (26-61.5) % and median VO2peak was 16.1 (12.1-20.8) ml/Kg/min. 36 patients presented preserved LVEF and 61 presented reduced LVEF. There were significant differences in almost all CPET variables (p < 0.05) between these two groups. VO2peak was associated with age, male sex, NYHA functional class, LVEF, left atrium diameter, LV diastolic diameter, E wave, LV mass index, and pulmonary artery systolic pressure (PASP). Age, male sex, LVEF, and E wave remained independently associated with VO2peak in the multivariate analysis (R2 = 0.69), furthermore, only LVEF and E wave were associated with the predicted VO2 percentage (R2 = 0.53). CONCLUSION: In patients with CCC, disease severity, male sex, LV systolic and diastolic function influence the functional capacity.

Asunto(s)

Cardiomiopatía Chagásica , Ecocardiografía , Prueba de Esfuerzo , Tolerancia al Ejercicio , Humanos , Masculino , Femenino , Persona de Mediana Edad , Cardiomiopatía Chagásica/fisiopatología , Cardiomiopatía Chagásica/diagnóstico por imagen , Tolerancia al Ejercicio/fisiología , Prueba de Esfuerzo/métodos , Ecocardiografía/métodos , Adulto , Anciano , Consumo de Oxígeno/fisiología , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología

RESUMEN

INTRODUCTION: Skeletal muscle dysfunction is a significant factor contributing to exercise limitation in patients with chronic obstructive pulmonary disease (COPD). Although exercise training is often recommended to enhance patient outcomes, there continues to be ongoing debate regarding its exact effects. OBJECTIVE: The aim of this study is to evaluate the effectiveness of endurance exercise, strength training and combined exercise on cardiorespiratory fitness (including maximal oxygen uptake, maximal minute ventilation, and the 6-minute walk test), strength of lower limbs (measured by leg press), and quality of life (using the COPD Assessment Test) in patients with COPD. By conducting a systematic review and meta-analysis of randomized controlled trials (RCTs), our objective is to provide tailored training methods and intensity recommendations for patients with COPD in order to improve their quality of life. METHODS: The meta-analysis included 10 randomized controlled trials (RCTs) of exercise rehabilitation programs involving 180 patients with COPD that were retrieved from electronic databases (PubMed, Cochrane Library, and Embase). Two reviewers independently assessed the topical relevance, trial quality, and extracted data for the meta-analysis. RESULTS: Meta-analysis showed that primary outcomes representing exercise endurance were elevated under different exercise interventions compared to pre-test, such as maximal oxygen uptake (VO2max (ml/kg/min)) [SMD = 0.40, 95% CI (0.15, 0.64)] and the 6-min walk test (6MWT) [MD = 33.90, 95% CI (25.25, 42.55)], and primary outcomes representing strength also increased, such as leg press (1RM) [MD = 24.59, 95% CI (16.08, 33.11)], while secondary outcomes such as assessments of life such as the COPD Assessment Test (CAT) recovered [MD = 2.51, 95% CI (2.01, 3.00)], with all differences being statistically significant (p < 0.05). However, Maximum minute ventilation (VEmax (L)) [MD = 0.91, 95%CI (3.61, 5.43)] was not statistically significant (p > 0.05) when compared with the post-test data. The sensitivity test data were stable, and the results were reliable. We subgrouped the data from different types of exercise interventions and found that different types of exercise affected the experimental results. CONCLUSION: Exercise interventions have a positive effect on the treatment of patients with COPD, significantly improving functional capacity, aerobic capacity, and exercise tolerance, but they should be individualized and developed according to the patient's condition to achieve the best therapeutic effect.

Asunto(s)

Terapia por Ejercicio , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Humanos , Terapia por Ejercicio/métodos , Tolerancia al Ejercicio , Pronóstico , Fuerza Muscular , Entrenamiento de Fuerza/métodos , Prueba de Paso , Capacidad Cardiovascular/fisiología , Consumo de Oxígeno , Masculino , Femenino

RESUMEN

BACKGROUND: Exercise intolerance in heart failure arises from multifactorial pathophysiological mechanisms. Hepatokines, liver-synthesized molecules, regulate systemic metabolisms in peripheral tissues. We previously identified the hepatokine fetuin-A as being linked to liver hypoperfusion in heart failure. Here, we investigated the role of fetuin-A in connecting cardiac-hepatic-peripheral interaction. METHODS AND RESULTS: We conducted a prospective study involving 202 consecutive hospitalized patients (mean age, 56.8 years; 76.2% men) with heart failure who underwent cardiopulmonary exercise testing. We measured the serum concentration of fetuin-A by ELISA. Correlation analysis revealed a negative association between fetuin-A levels and the ratio of minimum minute ventilation to carbon dioxide production, its slope, and a tendency toward a positive correlation with peak oxygen uptake. Patients with impaired exercise tolerance exhibited lower fetuin-A levels. During a median follow-up of 1045 days, 18.3% experienced cardiac events, including 4 cardiac deaths and 33 cases of worsening heart failure. Classification and regression tree analysis identified a high-risk subgroup with lower fetuin-A (<24.3 mg/L) and impaired exercise tolerance (peak oxygen uptake<14.2 mL/kg per min). Kaplan-Meier analysis revealed that this subgroup had the highest risk of cardiac events. In a multivariable Cox proportional hazard model, the combination of lower fetuin-A and exercise intolerance was independently associated with increased risks of cardiac events. CONCLUSIONS: Reduced circulating fetuin-A levels were associated with exercise intolerance in heart failure patients. Fetuin-A could emerge as a target implicated in exercise capacity connecting cardiac-hepatic-peripheral interaction and as a valuable biomarker for predicting prognosis when combined with peak oxygen uptake.

Asunto(s)

Biomarcadores , Tolerancia al Ejercicio , Insuficiencia Cardíaca , alfa-2-Glicoproteína-HS , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , alfa-2-Glicoproteína-HS/metabolismo , Biomarcadores/sangre , Ensayo de Inmunoadsorción Enzimática , Prueba de Esfuerzo , Tolerancia al Ejercicio/fisiología , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/diagnóstico , Hígado/metabolismo , Consumo de Oxígeno , Pronóstico , Estudios Prospectivos , Medición de Riesgo/métodos , Factores de Riesgo

RESUMEN

Exercise is well known to exert beneficial changes to the gut microbiota. An emerging area is how the gut microbiota may regulate exercise tolerance. This review will summarize the current evidence on how exercise influences gut microbial communities, with emphasis on how disruptions or depletion of an intact gut microbiota impacts exercise tolerance as well as future directions.

Asunto(s)

Ejercicio Físico , Microbioma Gastrointestinal , Humanos , Microbioma Gastrointestinal/fisiología , Ejercicio Físico/fisiología , Tolerancia al Ejercicio/fisiología , Probióticos

RESUMEN

Objectives: To determine the proportion of people who achieve minimal clinically important differences (MCID) with centre-based or home-based pulmonary rehabilitation and to synthesise data on adverse events.Methods: Cochrane reviews and electronic databases were searched to identify randomised trials comparing centre-based to home-based pulmonary rehabilitation, or either model to usual care, in people with chronic respiratory disease. Primary outcomes were the proportion of participants achieving MCIDs in exercise capacity and disease-specific quality of life. Secondary outcomes were symptoms and adverse events. Cochrane Risk of Bias 1.0 and GRADE were used to assess the risk of bias and certainty of evidence respectively.Results: Forty-nine trials were eligible. Compared to usual care, a higher proportion of pulmonary rehabilitation participants achieved the MCID for exercise capacity (6MWT: 47% vs 20%, p = 0.11), dyspnoea (43% vs 29%, p = 0.0001), fatigue (48% vs 27%, p = 0.0002) and emotional function (37% vs 25%, p = 0.02), with all of these between group differences statistically significant except for exercise capacity. There were no differences between centre-based and home-based pulmonary rehabilitation in the proportion of participants who achieved MCIDs (34%- 58% across studies). Ninety percent of trials reported no adverse events. Certainty of evidence was low-to- moderate with all outcomes except for CRQ-mastery (centre-based vs home-based pulmonary rehabilitation, or pulmonary rehabilitation vs usual care in COPD), ESWT (pulmonary rehabilitation vs usual care in COPD) and 6MWT (pulmonary rehabilitation vs usual care in bronchiectasis) where evidence was very uncertain.Discussion: Clinically meaningful outcomes are achieved by similar proportions of participants in centre-based and home-based pulmonary rehabilitation, with few adverse events. Reporting of trial outcomes according to MCIDs is necessary for informed decision making regarding pulmonary rehabilitation models.

Asunto(s)

Tolerancia al Ejercicio , Servicios de Atención de Salud a Domicilio , Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Enfermedad Crónica , Disnea/rehabilitación , Disnea/etiología , Fatiga/rehabilitación , Fatiga/etiología , Diferencia Mínima Clínicamente Importante , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Ensayos Clínicos Controlados Aleatorios como Asunto , Centros de Rehabilitación