Postinjury magnesium sulfate treatment is not markedly neuroprotective for striatal medium spiny neurons after perinatal hypoxia/ischemia in the rat

PURPOSE: This experiment examined the influence of acute exercise on anxiety following caffeine-induced elevations in self-rated anxiety. METHODS: Eleven physically active, moderately fit males aged 25.1 +/- 3.8 yr completed four conditions in a within-subject, counterbalanced design involving 60 min of (1) cycling at 60% VO2peak or (2) quiet rest following placebo consumption (800 mg of lactose), as well as (3) cycling at 60% VO2peak and (4) quiet rest following 800 mg of caffeine. State anxiety and blood pressure were assessed 10 min before and 10 and 20 min after the conditions. RESULTS: A main effect for drug (caffeine vs placebo) determined by repeated measures ANOVA, (F(1,8) = 9.77; P = 0.01), indicated that state anxiety was elevated by caffeine. Drug effects were not obtained for blood pressure. Experimental hypotheses were tested by drug-by-condition (exercise vs quiet rest)-by-time (10 and 20 min postcondition) repeated measures ANOVA of change scores from the precondition baseline. A main effect for drug (F(1,8) = 5.81; P = 0.043) indicated that reductions in state anxiety were larger after caffeine ingestion. A condition-by-time effect (F(1,8) = 5.02; P = 0.055) indicated greater reductions in state anxiety 20 min after exercise compared with quiet rest. A condition effect for systolic blood pressure (F(1,10) = 4.56; P = 0.058) and condition-by-time interactions for diastolic (F(1,10) = 8.87; P = 0.014) and mean arterial blood pressures (F(1,10) = 8.46; P = 0.016) indicated reductions after exercise but not after quiet rest following both caffeine and placebo. CONCLUSIONS: We conclude that exercise can reduce anxiety elevated by a high dose of caffeine.     

Clinical implications of penicillin and ceftriaxone resistance among children with pneumococcal bacteremia

BACKGROUND: The influence of non-ionic osmols on thermoregulation is unclear. HYPOTHESIS: Hyperglycemia will attenuate the rise in exercise core temperature. METHODS: Dehydrated by 4-h of water immersion (34.5 degrees C) to the neck, 6 men, (35+/-SD 7 yr) participated in each of three trials where 2.0 g x kg(-1) body wt of oral glucose (33.8% weight per volume) was consumed followed by 80 min supine rest (Glu/Rest), or 70 min supine cycle exercise at 62.8%+/-SE 0.5% (1.97+/-0.02 L x min(-1)) peak O2 uptake, followed by 10 min supine recovery with prior (Glu/Ex) or without glucose (No Glu/Ex) ingestion. Blood samples were taken periodically for measurement of Hb, Hct, Na+, K+, Osm, and glucose; mean skin (Tsk) and rectal (Tre) temperatures, and sweating rate (resistance hygrometry) and skin blood velocity (laser Doppler) were measured intermittently. RESULTS: Mean percent changes in plasma volume (p<0.05) for the exercise trials were not different: -12.3+/-2.2% (No Glu/Ex) and -12.1+/-2.1% (Glu/Ex). Mean (+/-SE) pre-exercise plasma [glucose] for Glu/Ex was higher than that of No Glu/Ex (108.4+/-3.9 vs. 85.6+/-1.6 mg x dL(-1), respectively, p<0.05). Glu/Ex vs. No Glu/Ex data, respectively, at the end of exercise indicated that: Tre was lower by 0.4 degrees C (38.2+/-0.2 vs. 38.6+/-0.1 degrees C, p<0.05), Tsk was lower (32.0+/-0.3 vs. 32.4+/-0.2 degrees C, p<0.05), forearm sweating rate was lower (0.94+/-0.09 vs. 1.05+/-0.07 mg x cm(-2) x min(-1), p<0.05); and head (temporal) skin blood velocity was not different (1.67+/-0.21 vs. 1.51+/-0.24 Hz x 10(3), NS). CONCLUSIONS: Elevation of plasma [glucose] prior to supine submaximal exercise in dehydrated men attenuates the increase of Tre without alteration of heat production, total body sweating, serum electrolytes and osmolality, or exercise-induced hypoglycemia: the mechanism may be enhanced peripheral blood flow that could enhance body heat loss.     

Young and old subjects matched for aerobic capacity have similar noradrenergic responses to exercise

Sympathetic nervous system activity as indicated by circulating norepinephrine has been demonstrated to increase with advancing chronological age both at rest and during submaximal exercise. Much of the earlier work investigating this aging phenomenon used a younger group that had a higher peak oxygen consumption (VO2) than did the older group, which made comparisons difficult. In the present study, young [n = 7, 36 +/- 1.0 (SE) yr] and old subjects (n = 8, 61 +/- 1.2 yr) were matched on peak VO2 and then exercised at approximately the same relative submaximal VO2 (75%) and power output on a cycle ergometer for 21 min. Blood samples were collected at rest and in the 7th, 14th, and last minute of a 21-min exercise bout via an indwelling catheter in an antecubital vein. The norepinephrine responses for the young and old groups, respectively, were as follows: rest, 486 +/- 111 vs. 673 +/- 108; 7 min, 1,258 +/- 255 vs. 1,185 +/- 172; 14 min, 1,639 +/- 316 vs. 1,528 +/- 288; and 21 min, 2,038 +/- 488 vs. 1,936 +/- 453 pg/ml. These responses were not significantly different between the groups at any time period. The epinephrine values for the age groups were not statistically different: rest, 115 +/- 60 vs 88 +/- 51; 7 min, 140 +/- 18 vs. 326 +/- 88; 14 min, 216 +/- 33 vs. 366 +/- 104; and 21 min, 324 +/- 100 vs. 447 +/- 113 pg/ml.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improved walking economy in patients with peripheral arterial occlusive disease

The effect of exercise rehabilitation on the oxygen cost of ambulation in patients with peripheral arterial occlusive disease (PAOD) was evaluated with specific emphasis on the effects of exercise rehabilitation on the slow component of VO2. Because the slow component of VO2 represents an increase in VO2 despite constant-intensity exercise, it can profoundly affect the relative energy cost of exercise in individuals with a low functional capacity. Twenty-six patients with intermittent claudication performed treadmill walking at 2.0 mph/0% grade for 20 min or until maximal claudication pain before and after 4 months of rehabilitation. The slow component of VO2 during the treadmill test was defined as the difference between the end-exercise VO2 and the VO2 observed at minute 3. Ankle/brachial systolic pressure index (ABI) was measured before and immediately following the exercise test. Rehabilitation consisted of 3 d x wk(-1) of treadmill walking for 15-30 min at 60-70% of VO2peak. The slow component of VO2 and end-exercise VO2 at pretraining (0.75 +/- 0.90 and 11.12 +/- 2.10 mL x kg[-1] x min[-1]) were significantly reduced after 4 months of exercise rehabilitation (-0.07 +/- 1.11 and 10.07 +/- 1.80 mL x kg[-1] x min[-1]; P < 0.05). Exercise rehabilitation also significantly (P < 0.05) increased the post-exercise ABI (pre-rehabilitation = 0.36 +/- 0.26, post-rehabilitation = 0.43 +/- 0.25). These data suggest that 4 months of exercise rehabilitation: 1) improves walking economy in PAOD patients because of a decreased slow component of VO2, and 2) increases post-exercise ABI.     

Effect of carbohydrate ingestion on sprint performance following continuous and intermittent exercise

PURPOSE: This investigation was conducted to study the effects on sprint performance of glucose and fructose ingestion during a 15-min rest period half way through 90 min of continuous and intermittent exercise. On three occasions, eight subjects cycled at 76 +/- 2% VO2max for 90 min (continuous trials: CON trials) with a 15-min half-time break. METHODS: On another three occasions, they cycled for 90 min between moderate (65% VO2max) and high (100% VO2max) intensity (intermittent trials: INT trials) with the same half-time. In both trials, 90-min exercise was followed by a 40-s Wingate test to evaluate remaining sprint capacity. During half-time, they consumed either 20% glucose polymer (G), 20% fructose (F) or sweet placebo (P). Ingestion of G maintained plasma glucose levels, carbohydrate oxidation rate and lower value of ratings of perceived exertion (RPE) in both trials and indicated higher sprint performance compared with P (mean power of CON trials: 614.3 +/- 23.3 W vs 574.0 +/- 22.7 W, P < 0.001, INT trials: 629.5 +/- 27.6 W vs 596.3 +/- 25.5 W, P < 0.01). RESULTS: Ingestion of F showed similar effect in CON trials (603.8 +/- 26.1 W vs 574.0 +/- 22.7 W, P < 0.01) but had no positive effect in INT trials. Additionally, mean power of G was higher than F (629.5 +/- 27.6 W vs 598.4 +/- 34.2 W, P < 0.01) in INT trials. CONCLUSIONS: These results indicated that ingestion of G during half-time of 90-min exercise could maintain carbohydrate utilization and improve sprint performance in both CON and INT trials.     

Post-exercise changes in blood pressure, heart rate and rate pressure product at different exercise intensities in normotensive humans

To evaluate the effect of exercise intensity on post-exercise cardiovascular responses, 12 young normotensive subjects performed in a randomized order three cycle ergometer exercise bouts of 45 min at 30, 50 and 80% of VO2peak, and 12 subjects rested for 45 min in a non-exercise control trial. Blood pressure (BP) and heart rate (HR) were measured for 20 min prior to exercise (baseline) and at intervals of 5 to 30 (R5-30), 35 to 60 (R35-60) and 65 to 90 (R65-90) min after exercise. Systolic, mean, and diastolic BP after exercise were significantly lower than baseline, and there was no difference between the three exercise intensities. After exercise at 30% of VO2peak, HR was significantly decreased at R35-60 and R65-90. In contrast, after exercise at 50 and 80% of VO2peak, HR was significantly increased at R5-30 and R35-60, respectively. Exercise at 30% of VO2peak significantly decreased rate pressure (RP) product (RP = HR x systolic BP) during the entire recovery period (baseline = 7930 +/- 314 vs R5-30 = 7150 +/- 326, R35-60 = 6794 +/- 349, and R65-90 = 6628 +/- 311, P < 0.05), while exercise at 50% of VO2peak caused no change, and exercise at 80% of VO2peak produced a significant increase at R5-30 (7468 +/- 267 vs 9818 +/- 366, P < 0.05) and no change at R35-60 or R65-90. Cardiovascular responses were not altered during the control trial. In conclusion, varying exercise intensity from 30 to 80% of VO2peak in young normotensive humans did not influence the magnitude of post-exercise hypotension. However, in contrast to exercise at 50 and 80% of VO2peak, exercise at 30% of VO2peak decreased post-exercise HR and RP.     

Hypogastric arterial aneurysms associated with abdominal aortic aneurysms

The purpose of this study was to compare the physiological responses of professional and elite road cyclists during an incremental cycle ergometer test. Twenty-five elite cyclists (EC; 23+/-1 yr) and 25 professional cyclists (PC; 25+/-2yr) performed a ramp protocol (increases of 25 W x min(-1)) during which the following parameters were measured: oxygen consumption (VO2), pulmonary ventilation (VE), ventilatory equivalents for oxygen and carbon dioxide (VE x VO2(-1) and VE x VCO2(-1), respectively), respiratory exchange ratio (RER), ventilatory thresholds 1 and 2 (VT1 and VT2, respectively), blood lactate, and electromyographic activity (EMG) of the vastus lateralis. Significant differences existed between the two groups mainly at submaximal intensities, since both VT1 and VT2 occurred at a higher exercise intensity (p<0.001) in PC than in EC (VT2: 80.4+/-6.6 vs 87.0+/- 5.9% VO2max in EC and PC, respectively). Lactate levels showed a similar response in both groups at low-to-moderate intensities (< 300 W), and thereafter blood lactate was significantly higher in EC. Finally, the "electromyographic threshold" (EMGT) occurred at a significantly higher intensity (p < 0.05) in PC when compared to EC (64.7+/-14.2 vs 56.0+/-14.9% VO2max, respectively). It was concluded that, in comparison with EC, PC exhibit some remarkable physiological characteristics such as a high VT2, an important reliance on fat metabolism even at high power outputs, and several neuromuscular adaptations.     

Enlarged scale chemical synthesis and range of activity of drosocin, an O-glycosylated antibacterial peptide of Drosophila

OBJECTIVE: Poor cardiorespiratory endurance is a common finding in neuromuscular disease (NMD), and the capacity of such patients to respond to aerobic training is unclear. This study was conducted to determine if a 12-week walking program results in increased aerobic capacity in slowly progressive NMD subjects, whether such a program is safely tolerated, and whether such patients can adhere to a self-monitored, home-based training program. DESIGN: Before-after trial. SETTING: Subjects' homes. PATIENTS: A cohort of 8 slowly progressive NMD subjects (4 men, 4 women) followed in the neuromuscular disease clinic participated (age, 36.6 +/- 8.0 yrs; ht, 170 +/- 11 cm; wt, 74.3 +/- 19.0 kg) (Mean +/- SD). INTERVENTION: Subjects walked 15 to 30 min 3 to 4 days a week at 50% to 60% of their heart rate reserve. MAIN OUTCOME MEASURES: Resting, submaximal, and peak heart rates, systolic and diastolic blood pressures, oxygen uptake, and peak power output. RESULTS: Graded exercise testing to volitional fatigue using a semirecumbent cycle ergometer before and after the training program found significant decreases in submaximal heart rate by 7 +/- 3 beats/min (Mean +/- SEM) (95% CI = -23 to 9) (p = .046) and submaximal systolic blood pressure by 11 +/- 4 mmHg (95% CI = -31 to 9) (p = .019), and nonsignificant increases in peak power output and VO2. CONCLUSIONS: These results suggest that moderate-intensity aerobic exercise training is well tolerated and may provide modest improvement in aerobic capacity in slowly progressive NMD subjects.     

Exercise VO2 estimation using recovery sampling

Various situations present a challenge to determine oxygen uptake (VO2) accurately simply because of the restrictions imposed by the equipment employed. This investigation was undertaken to 1) compare a select number of recovery VO2 measurements with respect to their accuracy in estimating actual exercise VO2 and 2) to determine whether absolute workload or VO2max affect this relationship. Fifteen subjects [8 highly trained (HT), VO2max +/- SD = 70.2 +/- 3.5 ml/kg . min-1 and 7 untrained (UT), VO2max = 49.7 +/- 3.8 ml/kg . min-1] completed a number of 5 min workbouts on a bicycle ergometer at 25-70% VO2max (VO2 = .899--3.879 l . min-1). VO2 and VCO2 (l . min-1) were monitored continuously throughout the exercise and for 5 min of recovery via a breath-by-breath system. The results indicated that 1) exercise VO2 +/- Sy.x can be estimated from several recovery collection periods, the first breath y = .953X + .441 +/- .319, the first two breaths y = 1.046X + .327 +/- .270, the first three breaths y = 1.089X + .260 +/- .241, and the second three breaths y = 1.101X + .387 +/- .234, and 2) VO2max does not affect this relationship (p greater than 0.05) while increasing absolute workload produces a greater exercise VO2 underestimation (p less than 0.05). It was concluded that using this method exercise VO2 can be estimated with reasonable accuracy (Sy.x = .234--.319, r = .92--.94, p less than 0.01).     

Impairment of exercise capacity and peak oxygen consumption in patients with mild left ventricular dysfunction and coronary artery disease

AIMS: Most studies in chronic heart failure have only included patients with marked left ventricular systolic dysfunction (i.e. ejection fraction < or =0.35), and patients with mild left ventricular dysfunction are usually excluded. Further, exercise capacity strongly depends on age, but age-adjustment is usually not applied in these studies. Therefore, this study sought to establish whether (age-adjusted) peak VO2 was impaired in patients with mild left ventricular dysfunction. METHODS: Peak VO2 and ventilatory anaerobic threshold were measured in 56 male patients with mild left ventricular dysfunction (ejection fraction 0.35-0.55; study population) and in 17 male patients with a normal left ventricular function (ejection fraction >0.55; control population). All patients had an old (>4 weeks) myocardial infarction. By using age-adjusted peak VO2 values, a 'decreased' exercise capacity was defined as < or = predicted peak VO2 - 1 x SD (0.81 of predicted peak VO2), and a severely decreased exercise capacity as < or = predicted peak VO2 - 2 x SD (0.62 of predicted peak VO2). RESULTS: Patients in the study population (age 52+/-9 years; ejection fraction 0.46+/-0.06) were mostly asymptomatic (NYHA class I: n=40, 76%), while 16 patients (24%) had mild symptoms, i.e. NYHA class II. All 17 controls (age 57+/-8 years) were asymptomatic. Mean peak VO2 was lower in patients with mild left ventricular dysfunction (23.6+/-5.7 vs 27.1+/-4.6 ml x min(-1) x kg(-1) in controls, P<0.05). In 75% of the study population patients (n=42) age-adjusted peak VO2 was decreased (NYHA I/II: n=29/13) and in 18% of them severely decreased (n=10; NYHA I/II: n=6/4). In contrast, only three patients (18%) in the control population had a decreased and none a severely decreased age-adjusted peak VO2. CONCLUSION: In patients with mild left ventricular dysfunction, who have either no or only mild symptoms of chronic heart failure, a substantial proportion has an impaired exercise capacity. By using age-adjustment, impairment of exercise capacity becomes more evident in younger patients. Patients with mild left ventricular dysfunction are probably under-diagnosed, and this finding has clinical and therapeutic implications.     

First total synthesis of ganglioside GT1a alpha

Controversy still exists concerning the potential ergogenic benefit of caffeine (CAF) for exercise performance. The purpose of this study was to compare the effects of CAF ingestion on endurance performance during exercise on a bicycle ergometer at two different intensities, i.e., approximately 10% below and 10% above the anaerobic threshold (AT). Eight untrained males, non-regular consumers of CAF, participated in this study. AT, defined as the intensity (watts) corresponding to a lactate concentration of 4 mM, was determined during an incremental exercise test from rest to exhaustion on an electrically braked cycle ergometer. On the basis of these measurements, the subjects were asked to cycle until exhaustion at two different intensities, i.e., approximately 10% below and 10% above AT. Each intensity was performed twice in a double-blind randomized order by ingesting either CAF (5 mg/kg) or a placebo (PLA) 60 min prior to the test. Venous blood was analyzed for free fatty acid, glucose, and lactate, before, during, and immediately after exercise. Rating of perceived exertion and time to exhaustion were also measured during each trial. There were no differences in free fatty acids or lactate levels between CAF and PLA during and immediately after exercise for either intensity. Immediately after exercise glucose increased in the CAF trial at both intensities. Rating of perceived exertion was significantly lower (CAF = 14.1 +/- 2.5 vs PLA = 16.6 +/- 2.4) and time to exhaustion was significantly higher (CAF = 46.54 +/- 8.05) min vs PLA = 32.42 +/- 14.81 min) during exercise below AT with CAF. However, there was no effect of CAF treatment on rating of perceived exertion (CAF = 18.0 +/- 2.7 vs PLA = 17.6 +/- 2.3) and time to exhaustion (CAF = 18.45 +/- 7.28 min vs PLA = 19.17 +/- 4.37 min) during exercise above AT. We conclude that in untrained subjects caffeine can improve endurance performance during prolonged exercise performed below AT and that the decrease of perceived exertion can be involved in this process.     

The effects of changing intracellular pH on calcium and potassium currents in smooth muscle cells from the guinea-pig ureter

Effect of weight training exercise and treadmill exercise on postexercise oxygen consumption. Med. Sci. Sports Exerc., Vol. 30, No. 4, pp. 518-522, 1998. To compare the effect of weight training (WT) and treadmill (TM) exercise on postexercise oxygen consumption (VO2), 15 males (mean +/- SD) age = 22.7 +/- 1.6 yr; height = 175.0 +/- 6.2 cm; mass = 82.0 +/- 14.3 kg) performed a 27-min bout of WT and a 27-min bout of TM exercise at matched rates of VO2. WT consisted of performing two circuits of eight exercises at 60% of each subject's one repetition maximum with a work/rest ratio of 45 s/60 s. Approximately 5 d after WT each subject walked or jogged on the TM at a pace that elicited an average VO2 matched with his mean value during WT. VO2 was measured continuously during exercise and the first 30 min into recovery and at 60 and 90 min into recovery. VO2 during WT (1.58 L.min-1) and TM exercise (1.55 L.min-1) were not significantly (P > 0.05) different; thus the two activities were matched for VO2. Total oxygen consumption during the first 30 min of recovery was significantly higher (P < 0.05) as a result of WT (19.0 L) compared with that during TM exercise (12.7 L). However, VO2 values at 60 (0.32 vs 0.29 L.min-1), and 90 min (0.33 vs 0.30 L.min-1) were not significantly different (P > 0.05) between WT and TM exercise, respectively. The results suggest that, during the first 30 min following exercise. WT elicits a greater elevated postexercise VO2 than TM exercise when the two activities are performed at matched VO2 and equal durations. Therefore, total energy expenditure as a consequence of WT will be underestimated if based on exercise VO2 only.     

Cardiovascular and metabolic costs of forward, backward, and lateral motion

PURPOSE: The purpose of this study was to compare the metabolic and cardiovascular responses of movement in forward (FM), backward (BM), and lateral (LM) directions. METHODS: Thirteen athletes with the following characteristics (mean +/- SD) were evaluated: age 21+/-3 yr, height 172.0+/-9.0 cm, weight 62.92+/-9.05 kg, and VO2max 54.13+/-7.42 mL x kg(-1) x min(-1). Subjects were evaluated at 80.45 and 134.08 m x min(-1). A repeated measures ANOVA was used for statistical analysis (P < 0.05). RESULTS: At 80.45 m x min(-1), the following respective VO2 mL x kg(-1) x min(-1) and heart rate (HR) beats x min(-1) responses were: FM = 12.42+/-2.29, 113+/-10; BM = 15.95+/-2.45, 132+/-16; and LM = 22.10+/-4.76, 140+/-15. Both VO2 and HR were significantly different between conditions: LM > BM > FM. At 134.08 m x min(-1), the following respective VO2 and HR responses were: FM = 27.15+/-2.51, 146+/-7; BM = 31.33+/-5.77, 168+/-11; and LM = 32.58+/-5.74, 169+/-10. At 134.08 m x min(-1) neither HR or VO2 were significantly different between LM or BM (LM, BM, > FM). Stride length and stride frequency were also significantly different between conditions. These results indicate the variation in the energy cost of FM, BM, and LM.     

Kinetics of oxygen uptake at the onset of exercise in boys and men

The objective of this study was to compare the O2 uptake (VO2) kinetics at the onset of heavy exercise in boys and men. Nine boys, aged 9-12 yr, and 8 men, aged 19-27 yr, performed a continuous incremental cycling task to determine peak VO2 (VO2 peak). On 2 other days, subjects performed each day four cycling tasks at 80 rpm, each consisting of 2 min of unloaded cycling followed twice by cycling at 50% VO2 peak for 3.5 min, once by cycling at 100% VO2 peak for 2 min, and once by cycling at 130% VO2 peak for 75 s. O2 deficit was not significantly different between boys and men (respectively, 50% VO2 peak task: 6.6 +/- 11.1 vs. 5.5 +/- 7.3 ml . min-1 . kg-1; 100% VO2 peak task: 28.5 +/- 8.1 vs. 31.8 +/- 6.3 ml . min-1 . kg-1; and 130% VO2 peak task: 30.1 +/- 5.7 vs. 35.8 +/- 5.3 ml . min-1 . kg-1). To assess the kinetics, phase I was excluded from analysis. Phase II VO2 kinetics could be described in all cases by a monoexponential function. ANOVA revealed no differences in time constants between boys and men (respectively, 50% VO2 peak task: 22. 8 +/- 5.1 vs. 26.4 +/- 4.1 s; 100% VO2 peak task: 28.0 +/- 6.0 vs. 28.1 +/- 4.4 s; and 130% VO2 peak task: 19.8 +/- 4.1 vs. 20.7 +/- 5. 7 s). In conclusion, O2 deficit and fast-component VO2 on-transients are similar in boys and men, even at high exercise intensities, which is in contrast to the findings of other studies employing simpler methods of analysis. The previous interpretation that children rely less on nonoxidative energy pathways at the onset of heavy exercise is not supported by our findings.     

Exercise-induced anxiolysis: a test of the "time out" hypothesis in high anxious females

PURPOSE: One purpose was to test the hypothesis that anxiety reductions following exercise are caused by a "time out" from daily cares and worries, and the second purpose was to document the magnitude of the change in state anxiety after exercise in high trait anxious females. METHODS: Anxious women (N = 14) completed four randomly ordered conditions: Exercise Only, 20 min of cycling (40% of VO2peak) followed by 20 min of recovery; Study Only, 40 min of studying while sitting on a cycle ergometer; Exercise/Study, 20 min of cycling (40% of VO2peak) while studying followed by 20 min of studying while sitting on the cycle ergometer; and Control, sitting quietly on an ergometer for 40 min. RESULTS: State anxiety was assessed before and after each condition. State anxiety was reduced following the Exercise Only condition (mean raw change score +/- 95% confidence interval (CI) of 4.3 +/- 3.5; t = 2.3, P = 0.04, d = 0.52). The 95% CI did not include zero after adjusting for precondition anxiety scores (adjusted change +/- 95% CI of 3.3 +/- 3.2). CONCLUSIONS: Because the reduction in state anxiety following exercise was blocked in the Exercise/Study condition (t = -0.05, P = 0.97, d = 0.01) and the associated CIs included zero (unadjusted 0.1 +/- 3.4, adjusted 0.8 +/- 3.2), the findings support the hypothesis that anxiety reductions following exercise occur because exercise affords individuals a time out from daily worries.     

Effect of caffeine on metabolism, exercise endurance, and catecholamine responses after withdrawal

In this study the effects of acute caffeine ingestion on exercise performance, hormonal (epinephrine, norepinephrine, insulin), and metabolic (free fatty acids, glycerol, glucose, lactate, expired gases) parameters during short-term withdrawal from dietary caffeine were investigated. Recreational athletes who were habitual caffeine users (n = 6) (maximum oxygen uptake 54.5 +/- 3.3 ml x kg-1 x min-1 and daily caffeine intake 761.3 +/- 11.8 mg/day) were tested under conditions of no withdrawal and 2-day and 4-day withdrawal from dietary caffeine. There were seven trials in total with a minimum of 10 days between trials. On the day of the exercise trial, subjects ingested either dextrose placebo or 6 mg/kg caffeine in capsule form 1 h before cycle ergometry to exhaustion at 80-85% of maximum oxygen uptake. Test substances were assigned in a random, double-blind manner. A final placebo control trial completed the experiment. There was no significant difference in any measured parameters among days of withdrawal after ingestion of placebo. At exhaustion in the 2- and 4-day withdrawal trials, there were significant increases in plasma norepinephrine in response to caffeine ingestion. Caffeine-induced increases in serum free fatty acids occurred after 4 days and only at rest. Subjects responded to caffeine with increases in plasma epinephrine (P < 0.05) at exhaustion and prolonged exercise time in all caffeine trials compared with placebo, regardless of withdrawal from caffeine. It is concluded that increased endurance is unrelated to hormonal or metabolic changes and that it is not related to prior caffeine habituation in recreational athletes.     

Evaluation of right ventricular systolic pressure during incremental exercise by Doppler echocardiography in adults with atrial septal defect

STUDY OBJECTIVES: Pulmonary hypertension is the most important complication in patients with atrial septal defect (ASD), but its role in limiting exercise has not been examined. This study sought to evaluate exercise performance in adults with ASD and determine the contribution of elevated pulmonary artery pressure in limiting exercise capacity. DESIGN: We used Doppler echocardiography during exercise in 10 adults (aged 34 to 70 years) with isolated ASD (New York Heart Association class I, II) and an equal number of matched control subjects. Incremental exercise was performed on an electrically braked upright cycle ergometer. Expired gases and VE were measured breath-by-breath. Two-dimensional and Doppler echocardiographic images were obtained at rest prior to exercise to determine ASD size, stroke volume (SV), shunt ratio (Qp:Qs), right ventricular outflow tract (RVOT) size, and right ventricular systolic pressure at rest (RVSPr). Doppler echocardiography was repeated at peak exercise to measure right ventricular systolic pressure during exercise (RVSPex). RESULTS: Resting echocardiography revealed that RVOT was larger (21+/-4 vs 35+/-8 mm, mean+/-SD; p=0.0009) and RVSPr tended to be higher (17+/-8 vs 31+/-8 mm Hg; p=0.08) in ASD; however, left ventricular SV was not different (64+/-23 vs 58+/-23 mL; p>0.05), compared with control subjects. Despite normal resting left ventricular function, ASD patients had a significant reduction in maximum oxygen uptake (VO2max) (22.9+/-5.4 vs 17.3+/-4.2 mL/kg/min; p=0.005). RVSPex was higher (19+/-8 vs 51+/-10 mm Hg; p=0.001) and the mean RVSP-VO2 slope (1+/-2 vs 18+/-3 mm Hg/L/min; p=0.003) and intercept (17+/-4 vs 27+/-4 mm Hg; p=0.05) were higher in the ASD group. VO2max correlated inversely with both RVSPr (r=-0.69; p=0.007) and RVSPex (r=-0.67; p=0.01). CONCLUSION: These findings suggest that adults with ASD have reduced exercise performance, which may be associated with an abnormal increase in pulmonary artery pressure during exercise.     

Improved oxygen utilization during mild exercise in heart failure

In heart failure with low cardiac output, exercise tolerance is reduced despite modulated regional blood distribution and oxygen extraction. However, low cardiac output does not necessarily lead to reduced exercise tolerance especially during mild exercise. In the present study, in order to understand the mechanisms regulating exercise tolerance in heart failure, we measured oxygen consumption (VO2) and cardiac output (CO) during both mild and intense exercise. Patients with heart failure were divided into 2 groups; group L (n = 8) consists of patients with low anaerobic threshold (AT) < 13 ml/min per kg and group H (n = 7) consisting of patients with AT > 13 ml/min per kg. At rest, VO2 was similar between groups L and H, whereas CO was lower in group L than in group H (3.5 + 0.3 vs 4.8 + 1.4 ml/min, p < 0.01). Increase in VO2 during warm-up exercise was not significant between the 2 groups (7.4 +/- 0.5 (group L) vs 6.2 +/- 0.3 ml/min per kg (group H), ns), but increase in CO was lower in group L than in group H (2.5 +/- 0.6 vs 3.4 +/- 0.4 ml/min, p < 0.01). After warm-up to the AT point, however, the increase in not only VO2 but also CO was markedly reduced in group L than in group H (VO2: 0.5 +/- 0.4 vs 3.7 +/- 0.8 ml/min per kg, p < 0.01, CO: 0.2 +/- 0.3 vs 1.1 +/- 0.3 L/min, p < 0.01). Based on these measurements, we calculated the arteriovenous oxygen difference (c(A-V)O2 difference) during exercise in individual patients using Fick's equation. The c(A-V)O2 difference was markedly increased in severe heart failure during the warm-up stage, but between the end of warm-up and the AT point, it remained at the same level as that of group H. These results suggest the presence of a unique mechanism regulating the c(A-V)O2 difference in severe heart failure patients, activation of which may, at least during mild exercise, contribute to efficient oxygen delivery to the peripheral tissues thus compensating for the jeopardized exercise tolerance in those patients.     

Effect of exercise intensity on glucose and insulin metabolism in obese individuals and obese NIDDM patients

OBJECTIVE: The primary purpose of this study was to evaluate the acute effect of exercise of differing intensity on plasma glucose and insulin responses to an oral glucose challenge. RESEARCH DESIGN AND METHODS: Six obese men and six obese men with NIDDM of similar age, weight, percentage body fat, and VO2peak participated in the study. Each subject underwent two 7-day exercise programs in a counterbalanced order at 2-week intervals. During each 7-day exercise period, the subjects cycled every day at a power output corresponding to 50% VO2peak for 70 min or 70% VO2peak for 50 min. Muscle glycogen utilization was estimated during exercise on day 7 using a [3H]glucose infusion technique in conjunction with indirect calorimetry. During the day before and after each 7-day exercise period, a 3-h oral glucose tolerance test (OGTT) was administered after a 12-h overnight fast. RESULTS: The average caloric expenditure did not differ between exercise at 50 and 70% VO2peak in both obese and obese NIDDM subjects. However, the carbohydrate oxidation was higher (P < 0.05) during exercise at 70 than 50% VO2peak in obese subjects (77 +/- 5 vs. 68 +/- 6 g) and obese NIDDM subjects (70 +/- 4 vs. 58 +/- 6 g). Muscle glycogen utilization was also higher (P < 0.05) during exercise at 70 than 50% VO2peak in obese subjects (59 +/- 9 vs. 30 +/- 7 g) and in obese NIDDM subjects (48 +/- 5 vs. 24 +/- 5 g). In obese subjects, plasma glucose response area during the OGTT did not change after 7 days of exercise at either 50 or 70% VO2peak. Plasma insulin response area during the OGTT also did not change after 7 days of exercise at 50% VO2peak. However, plasma insulin response area was reduced (P < 0.05) after 7 days of exercise at 70% VO2peak (9,644 +/- 1,783 vs 7,538 +/- 1,522 microU.ml-1.180 min-1). In obese NIDDM subjects, both plasma glucose and insulin response areas during the OGTT did not decrease after 7 days of exercise at either 50 or 70% VO2peak. CONCLUSIONS: It is concluded that the exercise-induced improvement in insulin sensitivity is influenced by exercise intensity in obese individuals. The improved insulin sensitivity after 7 days of exercise at 70% VO2peak in obese individuals may be related to greater muscle glycogen utilization during exercise. The lack of improvement in glucose tolerance and insulin sensitivity after 7 days of exercise at either 50 or 70% VO2peak in obese NIDDM patients may be due to the fact that the NIDDM patients selected in the present study were relatively hypoinsulinemic.     

Two-year experience with rate-modulated pacing controlled by mixed venous oxygen saturation

Mixed venous oxy-hemoglobin saturation (MVO2) is a physiological variable with several features that might be desirable as a control parameter for rate adaptive pacing. Despite these desirable characteristics, the long-term reliability of the MVO2 sensor in vivo is uncertain. We, therefore, designed a study to prospectively evaluate the long-term performance of a permanently implanted MVO2 saturation sensor in patients requiring VVIR pacing. Under an FDA approved feasibility study, eight patients were implanted with a VVIR pulse generator and a right ventricular pacing lead incorporating an MVO2 sensor. In order to accurately assess long-term stability of the sensor, patients underwent submaximal treadmill exercise using the Chronotropic Assessment Exercise Protocol (CAEP) at 2 weeks, 6 weeks, and 3, 6, 9, 12, 18, and 24 months following pacemaker implantation. Paired maximal exercise testing using the CAEP was also performed with the pacing system programmed to the VVI and VVIR modes in randomized sequence with measurement of expired gas exchange after 6 weeks and 12 months of follow-up. During maximal treadmill exercise the peak exercise heart rate (132 +/- 9 vs 71.5 +/- 5 beats/min, P < 0.00001) and maximal rate of oxygen consumption (1,704 +/- 633 vs 1382 +/- 407 mL/min, P = 0.01) were significantly greater in the VVIR than in the VVI pacing mode. Similarly, the duration of exercise was greater in the VVIR than the VVI pacing mode (8.9 +/- 3.6 min vs 7.6 +/- 3.7 min, P = 0.04). The resting MVO2 and the MVO2 at peak exercise were similar in the VVI and VVIR pacing modes (P = NS). However, the MVO2 at each comparable treadmill exercise stage was significantly higher in the VVIR mode than in the VVI mode (CAEP stage 1 (P = 0.005), stage 2 (P = 0.04), stage 3 (P = 0.008), and stage 4 (P = 0.04). The correlation between MVO2 and oxygen consumption (VO2) was excellent (r = -0.93). Telemetry of the reflectance of red and infrared light and MVO2 in the right ventricle during identical exercise workloads revealed no significant change over the first 12 months of follow-up (ANOVA, P = NS). The chronotropic response to exercise remained proportional to VO2 in all patients over the first 12 months of follow-up. The time course of change in MVO2 during maximal exercise was significantly faster than for VO2. At the 18- and 24-month follow-up exercise tests, a significant deterioration of the sensor signal with attenuation of chronotropic response was noted for 4 of the 8 subjects with replacement of the pacing system required in one patient because of lack of appropriate rate modulation. Rate modulated VVIR pacing controlled by right ventricular MVO2 provides a chronotropic response that is highly correlated with VO2. This parameter responds rapidly to changes in workload with kinetics that are more rapid than those of VO2. Appropriate rate modulation provides a higher MVO2 at identical workloads than does VVI pacing. Although the MVO2 sensor remains stable and accurate over the first year following implantation, significant deterioration of the signal occurs by 18-24 months in many patients.