Exercise training in heart failure improves quality of life and exercise capacity

AIMS: Benefit from exercise training in heart failure has mainly been shown in men with ischaemic disease. We aimed to examine the effects of exercise training in heart failure patients < or = 75 years old of both sexes and with various aetiology. METHODS AND RESULTS: Fifty-four patients with stable mild-to-moderate heart failure were randomized to exercise or control, and 49 completed the study (49% > or = 65 years; 29% women; 24% non-ischaemic aetiology; training, n = 22; controls, n = 27). The exercise programme consisted of bicycle training at 80% of maximal intensity over a period of 4 months. Improvements vs controls were found regarding maximal exercise capacity (6 +/- 12 vs -4 +/- 12% [mean +/- SD], P < 0.01) and global quality-of-life (2 [1] vs 0 [1] units [median ?inter-quartile range?], P < 0.01), but not regarding maximal oxygen consumption or the dyspnoea-fatigue index. All of these four variables significantly improved in men with ischaemic aetiology compared with controls (n = 11). However, none of these variables improved in women with ischaemic aetiology (n = 5), or in patients with non-ischaemic aetiology (n = 6). The training response was independent of age, left ventricular systolic function, and maximal oxygen consumption. No training-related adverse effects were reported. CONCLUSION: Supervised exercise training was safe and beneficial in heart failure patients < or = 75 years, especially in men with ischaemic aetiology. The effects of exercise training in women and patients with non-ischaemic aetiology should be further examined.     

Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons

It is unclear whether the age-associated reduction in baroreflex sensitivity is modifiable by exercise training. The effects of aerobic exercise training and yoga, a non-aerobic control intervention, on the baroreflex of elderly persons was determined. Baroreflex sensitivity was quantified by the alpha-index, at high frequency (HF; 0.15-0.35 Hz, reflecting parasympathetic activity) and mid-frequency (MF; 0.05-0.15 Hz, reflecting sympathetic activity as well), derived from spectral and cross-spectral analysis of spontaneous fluctuations in heart rate and blood pressure. Twenty-six (10 women) sedentary, healthy, normotensive elderly (mean 68 years, range 62-81 years) subjects were studied. Fourteen (4 women) of the sedentary elderly subjects completed 6 weeks of aerobic training, while the other 12 (6 women) subjects completed 6 weeks of yoga. Heart rate decreased following yoga (69 +/- 8 vs. 61 +/- 7 min-1, P < 0.05) but not aerobic training (66 +/- 8 vs. 63 +/- 9 min-1, P = 0.29). VO2 max increased by 11% following yoga (P < 0.01) and by 24% following aerobic training (P < 0.01). No significant change in alpha MF (6.5 +/- 3.5 vs. 6.2 +/- 3.0 ms mmHg-1, P = 0.69) or alpha HF (8.5 +/- 4.7 vs. 8.9 +/- 3.5 ms mmHg-1, P = 0.65) occurred after aerobic training. Following yoga, alpha HF (8.0 +/- 3.6 vs. 11.5 +/- 5.2 ms mmHg-1, P < 0.01) but not alpha MF (6.5 +/- 3.0 vs. 7.6 +/- 2.8 ms mmHg-1, P = 0.29) increased. Short-duration aerobic training does not modify the alpha-index at alpha MF or alpha HF in healthy normotensive elderly subjects. alpha HF but not alpha MF increased following yoga, suggesting that these parameters are measuring distinct aspects of the baroreflex that are separately modifiable.     

Effects of aerobic exercise training, age, and physical fitness on memory-search performance.

We investigated the effects of exercise training on memory performance. One group of 13 men (M?=?42.92 years of age) participated in supervised aerobic exercise (jogging) three times a week for 12 weeks. A second group of 15 men (M?=?43.67 years of age) performed anaerobic exercise (strength training) for the same period of time. Subjects' reaction time (RT) performance in a memory-search task was assessed both before (Time 1) and after (Time 2) the 12 weeks of exercise training. Results indicated that there was no significant change in memory-search performance over time as a function of exercise training. Analyses of the Time 2 RTs demonstrated that aspects of memory-search performance were related significantly both to subjects' initial (Time 1) level of fitness and to age, but not to the amount of change of fitness associated with aerobic exercise training over this 12-week duration in this age group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of body composition changes to observed improvements in cardiopulmonary parameters after exercise training with cardiac rehabilitation

STUDY OBJECTIVE: To discriminate the effects of body fat reduction on improvements in peak aerobic capacity made following exercise training during cardiac rehabilitation. DESIGN: Observational, prospective study. SETTING: Outpatient cardiovascular health center at regional academic center. PATIENT INTERVENTIONS: Peak oxygen uptake (pkVO2), percent body fat, lean body mass (LBM), and other anthropometric measures were assessed before and after a 3-month program of cardiac rehabilitation and exercise training in 500 consecutive cardiac patients following a major coronary event. Baseline pkVO2 was corrected for LBM (pk/VO2 lean) and compared with posttraining values. RESULTS: Following exercise training, percent body fat decreased 5% from 26.2+/-8.0 to 24.8+/-7.5 (p<0.0001), and LBM increased 1% from 61.3+/-12.5 to 61.7+/-11.8 kg (p=0.02). pk/VO2 increased 16% from 16.0+/-4.1 to 18.5+/-4.8 mL/kg/min (p<0.0001), and pkVO2 lean increased 13% from 21.7+/-5.3 to 24.6+/-6.0 mL/kg/min (p<0.0001). Isolating the effects of reduction in body fat, we discern that these changes contributed to 0.3 of the 2.5 mL/kg/min increase in pkVO2 or 12% of the increase in pkVO2 observed. CONCLUSIONS: Changes in body composition, as a consequence of dietary and exercise modification, contribute to 12% of the "observed" improvement noted in weight-adjusted peak aerobic capacity following cardiac rehabilitation and exercise training. Changes in pkVO2 lean should be used by investigators to assess the singular effects of exercise conditioning alone.     

Depressed mood does not explain neuropsychological deficits in HIV-infected persons.

The relationship of depressed mood to cognitive disturbance in HIV infection was examined in a sample of 139 homosexual men. Ss were grouped according to the classification of the Centers for Disease Control: 39 were in Group IV, 62 were in Group II or Group III, and 38 were HIV-negative. Ss completed the Profile of Mood States and 10 neuropsychological tests. Analysis employing a classification approach indicated that, although symptoms of depression and neuropsychological impairment were more common in Ss who were HIV-positive, particularly those classified as Group IV, there were no systematic relationships between depression and neuropsychological impairment. Depressed mood and cognitive disturbance each seem to have unique associations to HIV illness status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assertion training with handicapped persons.

Investigated the effects of assertion training in 9 handicapped college students and 5 handicapped discharged rehabilitative medicare outpatients. Ss were matched on self-reported assertiveness and were assigned to 1 of 2 groups: (a) treatment Ss who received assertion training, and (b) waiting-list-control Ss who received no treatment for 5 wks and then received assertion training. Behavioral role playing, self-report, and activity budget pre- and posttest measures revealed that assertion-training Ss reported significantly greater gains in assertive behavior and showed greater improvement in performance on 7 criterion measures than did control Ss. 18 criterion measures did not show any differences between treatment and control groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical fitness training and mental health.

Reviews theory and research that have attempted to relate fitness training to improvements on psychological variables among normals as well as selected clinical populations. Theoretical speculations in this area are critiqued, and research designs are evaluated as either experimental or quasi-experimental and therefore interpretable, or preexperimental and therefore largely uninterpretable. The research suggests that physical fitness training leads to improved mood, self-concept, and work behavior; the evidence is less clear as to its effects on cognitive functioning, although it does appear to bolster cognitive performance during and after physical stress. Except for self-concept, personality traits are not affected by improvements in physical fitness. Mentally retarded children demonstrate psychological improvement following physical fitness training, but no conclusion can be reached regarding the effects of physical fitness training with other clinical syndromes. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of physical fitness in the performance of adequate cardiopulmonary resuscitation

Trehalose is a saccharide that possesses no reducing group and so has possible use in parenteral nutrition, especially because it can be stored with amino acids without undergoing the Maillard reaction. To evaluate this possibility, a series of experiments were conducted. The activity of trehalase, an enzyme that metabolizes trehalose to glucose, was measured in rabbit serum and kidney. Conversion of trehalose to glucose and excretion of trehalose in the urine were measured in rabbits administered 10% trehalose intravenously. The effects on nutritional indices as indicators of its use as an energy source were also measured in rabbits infused with 8.23 g.kg-1.d-1 (4. 12 g.kg-1 on d 1) of trehalose for 5 d. Trehalase activity resembled maltase activity, both being high in the renal cortex (2.04 +/- 0.71 and 2.93 +/- 0.26 micromol.g-1.min-1, respectively), weak in the medulla, and undetectable in the serum. Serum glucose and insulin concentrations were increased significantly by trehalose infusion. Significant elevations were observed in serum glucose but not insulin levels by maltose infusion. On the other hand, urinary excretion of trehalose (1.1 +/- 2.1% of dose) was significantly lower than that of maltose (10.1 +/- 4.9% of dose). Similar effects of trehalose and maltose infusions as seen in normal rabbits occurred in rabbits with alloxan diabetes (urinary excretion rate, 3. 8 +/- 3.0% of the infused trehalose dose and 35.6 +/- 9.7% of the infused maltose dose). Nitrogen balance was positive in the trehalose- and glucose-infused normal rabbits with significant difference from the control group infused with saline, suggesting that trehalose was used as an energy source. These results suggest that trehalose has the potential for use as a saccharide source for parenteral nutrition.     

Endurance exercise training improves body composition and plasma insulin responses in 70- to 79-year-old men and women

Forty-two men and women aged 70 to 79 years were studied to assess the effects of 6 months of endurance or resistance training and subsequent cessation of training on glucose tolerance, plasma insulin responses, serum triglyceride and cholesterol levels, and plasma dehydroepiandrosterone (DHEA) levels. The endurance training group (n = 16) exercised at 75% to 85% heart rate reserve for 35 to 45 minutes three times per week; the resistance training group (n = 17) completed one set of eight to 12 repetitions on 10 Nautilus machines three times per week. No significant changes in any variables occurred in a control group (n = 9). Maximal oxygen consumption (VO2max) increased by 20% with endurance training, but did not change with resistance training. Upper- and lower-body strength increased in the resistance training group, but did not change with endurance training. Neither group changed their body weight with training, but the endurance training group elicited a significant reduction in their sum of seven skinfolds and percent body fat. Neither group altered their glucose tolerance with training; however, the endurance training group had lower plasma insulin responses after training compared with the other two groups. Serum lipid and plasma DHEA levels did not change in either the endurance or resistance training groups. Ten days of no exercise following training did not significantly alter body weight or composition, glucose tolerance, plasma insulin responses, or plasma DHEA levels in either the endurance training (n = 10) or resistance training (n = 14) group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis

Kidney ectopeptidases play an important role in the metabolism of different peptides. They activate precursor proteins or inactivate peptides including hormones, cytokines, vasoactive peptides (angiotensin II, endothelin), neuroendocrine hormones, changing local concentration in active peptides. Kidney ectopeptidase regulate cell proliferation, adhesion, matrix synthesis, cell signaling, cell activation, differentiation and cell-cell communication. The role of four major ectopeptidases (aminopeptidase A and N, dipeptidylpeptidase IV, and neutral endopeptidase) is presented.     

Screening for distal sensory peripheral neuropathy in HIV-infected persons in research and clinical settings

OBJECTIVE: To determine the accuracy of a screening examination for distal sensory peripheral neuropathy (DSPN) performed by nonphysician clinicians and to explore the associations between DSPN and clinical features in HIV-infected persons. METHODS: A case-control study of a volunteer sample of 226 HIV-infected individuals was performed. An interview, focusing on risks and symptoms of DSPN, and a screening neurologic examination were performed. RESULTS: Compared with the neurologist's examinations, the clinicians' examination was sensitive (92 to 95%) but not as specific (71 to 84%) for the diagnosis of DSPN. After excluding 27 patients with confounders, 42 of 199 patients (21%) had DSPN. This was associated significantly with neurotoxic nucleoside antiretroviral use and with more advanced HIV disease. Of the 42 patients with DSPN, 30 (71%) had no neuropathy symptoms. CONCLUSIONS: A brief examination performed by trained nonphysician clinicians can be used to screen for DSPN in HIV-infected persons. Asymptomatic DSPN is common in these individuals.     

Ambulatory sports in asthma improves physical fitness and reduces asthma-induced hospital stay

BACKGROUND: Prevention of posttransfusion non-A,non-B hepatitis in recipients of blood components improved considerably with the introduction of the second-generation of hepatitis C virus (HCV) antibody tests. In 1993, third-generation HCV antibody assays were introduced in Europe. STUDY DESIGN AND METHODS: The performance of three generations of anti-HCV enzyme-linked immunosorbent assay (ELISA) (ELISA-1, -2, -3) was compared in routine blood donor screening (99,394 donations were tested with ELISA-1, 167,999 donations with ELISA-2, and 262,090 donations with ELISA-3) and in serial samples from nine patients with documented acute posttransfusion HCV infection. RESULTS: Eight (0.01%) repeat donors, previously negative in ELISA-1, were found positive in ELISA-2 and were confirmed as positive in second-generation recombinant immunoblot assay and/or cDNA polymerase chain reaction. In the donor population, no difference in the sensitivity of ELISA-2 and -3 was observed. The specificity of the three generations of ELISAs was comparable (99.8, 99.7, and 99.7%). In seroconversion samples, ELISA-2 and -3 detected HCV antibodies at the same time in seven patients, but in two patients, ELISA-3 found HCV antibodies, respectively, 63 and 77 days earlier than ELISA-2 did. In the seroconversion samples, ELISA-2 and -3 were significantly more sensitive than second- and third-generation recombinant immunoblot assays. CONCLUSION: ELISA-3 did not detect more HCV-infected individuals in a donor population that previously tested negative in ELISA-2, but it did detect HCV antibodies earlier in some patients with acute HCV infection. ELISA-2 and -3 were significantly more sensitive than second- and third-generation recombinant immunoblot assays.     

Modified ultrafiltration improves left ventricular systolic function in infants after cardiopulmonary bypass

OBJECTIVE: Our objective was to test the hypothesis that use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function in children. METHODS: Twenty-one infants undergoing cardiopulmonary bypass were instrumented with ultrasonic dimension transducers, to measure the anteroposterior minor axis diameter, and a left ventricular micromanometer. Patients were randomized to modified ultrafiltration (n = 11, age 226 +/- 355 days, weight 6.7 +/- 3.1 kg) or control (n = 10, age 300 +/- 240 days, weight 7.0 +/- 2.5 kg) (all differences p > 0.05 between groups). Left ventricular systolic function was assessed by means of the slope of the preload-recruitable stroke work index. Myocardial cross-sectional area was measured by echocardiography. Data were acquired immediately after separation from bypass, at steady state, and during transient vena caval occlusion. Data acquisition was repeated after 13 +/- 5 minutes of modified ultrafiltration or after 12 +/- 5 minutes without modified ultrafiltration in the control group. Inotropic drug support was the same at both study points. RESULTS: In the modified ultrafiltration group, the filtrate volume was 363 +/- 262 ml. The hematocrit value increased from 26.0% +/- 2.7% to 36.7% +/- 9.5% (p = 0.018), myocardial cross-sectional area decreased from 3.72 +/- 0.35 cm2 to 3.63 +/- 0.36 cm2 (p = 0.04), end-diastolic length increased from 25.6 +/- 9.0 mm to 28.8 +/- 9.9 mm (p = 0.01), and end-diastolic pressure fell from 5.6 +/- 0.8 mm Hg to 4.2 +/- 0.8 mm Hg (p = 0.005), suggesting an improved diastolic compliance. In the control group, the hematocrit value, myocardial cross-sectional area, end-diastolic length, and pressure did not change (all p > 0.05). Mean ejection pressure increased in the ultrafiltration group (p = 0.001) but did not change in the control group (p = 0.22). The slope of the preload-recruitable stroke work index increased after ultrafiltration from 52.3 +/- 52.0 to 74.2 +/- 66.0 (10[3] erg/cm3) (p = 0.02) but did not change in the control group (p = 0.07). One patient from each group died in the postoperative period. Patients in the ultrafiltration group received less inotropic drug support in the first 24 hours after the operation (156.62 +/- 92.31 microg/kg in 24 hours) than patients in the control group (865.33 +/- 1772.26 microg/kg in 24 hours, p = 0.03). CONCLUSIONS: Use of modified ultrafiltration after cardiopulmonary bypass improves intrinsic left ventricular systolic function, improves diastolic compliance, increases blood pressure, and decreases inotropic drug use in the early postoperative period.     

The role of cardiopulmonary exercise testing in lung and heart-lung transplantation

Cardiopulmonary exercise testing in recipients of lung and heart-lung transplants demonstrates significant restoration of exercise tolerance to individuals severely disabled by their underlying cardiopulmonary disease. Recipients can perform moderate levels of activity compatible with a normal lifestyle. Considerable exercise limitation, however, remains in most recipients as measured by maximum oxygen uptake and work rate, despite substantial improvement and often normalization in resting cardiopulmonary function. The amount of exercise limitation observed in recipients of single-lung, bilateral-lung, and heart-lung transplants is interestingly similar, and the pattern of limitation is somewhat stereotyped. Ventilatory abnormalities are never limiting. Gas exchange abnormalities are sometimes seen (especially in single-lung transplant recipients) but generally are not limiting. Cardiac dysfunction is sometimes seen (particularly in heart-lung transplant recipients) but also does not appear to be limiting. Peripheral factors limiting exercise (which may include abnormalities in the peripheral circulation and peripheral neuromuscular structure and function) are almost universally seen and are probably the primary determinant of exercise limitation in these patients. At present, the relative contributions of various peripheral factors to exercise limitation are unclear. Further study may help elucidate these issues.     

Reduced serum IgG reactivities with bacteria from dental plaque in HIV-infected persons with periodontitis

Serum samples were obtained from 44 HIV-seropositive (HIV+) and 37 HIV-seronegative (HIV-) persons that were grouped according to periodontal status. Serum IgG and IgA reactivities towards Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis. Prevotella intermedia, Prevotella nigrescens and Fusobacterium nucleatum were measured by means of ELISA. HIV+ persons with chronic marginal periodontitis showed significantly lower IgG reactivities to the periodontal pathogens A. actinomycetemcomitans, P. gingivalis, P. intermedia and F. nucleatum as compared with their HIV- counterparts (p < 0.05). Specific serum IgA reactivities were similar in the two periodontitis groups, except for P. nigrescens where the HIV+ group with chronic marginal periodontitis had lower values than their systemically healthy counterparts (p < 0.05). The results indicate that HIV infection affects the humoral serum immune responses against bacteria in dental plaque; the depressed antibody responses may contribute to the increased susceptibility for periodontal infections in HIV-infected patients.     

Physical fitness training: Beneficial for professional psychologists?

A survey was conducted to explore the degree to which practicing psychologists are involved in exercise programs, the patterns of exercise favored, and the degree of effect attributed to exercise on various dimensions of psychotherapy practice. Survey instruments were mailed to 262 psychologists listed in the National Register of Health Service Providers; 196 (74.81%) responded. Most of the respondents (71.43%) reported engaging in regular exercise. Chi-square analyses revealed that patterns of exercise were related to demographic factors. Dimensions of psychotherapy perceived as most positively affected by exercise were the physical stamina, mood, and mental stamina of the therapist. Analyses of variance revealed that demographic and exercise pattern variables were related to perceptions of exercise effect on some of the dimensions of psychotherapy. Most respondents reported that they would recommend regular exercise both to other therapists and to patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes of psychologists in training toward persons with AIDS.

Clinical and counseling graduate students (N?=?266) from 8 different universities read a vignette that described a hypothetical patient as having either AIDS or leukemia. These psychologists in training then completed a scale that measured attitudes toward the hypothetical patient. Results indicated that psychologists in training had some attitudes toward AIDS patients that were less positive than their attitudes toward identically described leukemia patients. However, psychologists in training were more willing to interact with AIDS patients and to accept them as psychotherapy clients than were psychologists studied in earlier research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervised relaxation training: A model for greater accessibility of behavioral interventions.

Developed a method of relaxation training—supervised relaxation training—to address (1) problems of cost and availability, which limit the applicability of such training to relatively few individuals, and (2) the inherent limitations of self-help programs. Although this training method required less professional involvement than other methods, it was not intended as a self-help approach to relaxation. Using 55 volunteers (aged 19–67 yrs), 2 treatment groups and 1 control group were formed: One treatment group consisted of self-selected Ss from the community at large; the other represented Ss from a specific work site in the community. The procedure consisted of the use of a self-study manual in conjunction with professional training. Outcome was determined on the basis of changes in blood pressure, scores on the State-Trait Anxiety Inventory, and emotional indicators on human figure drawings. MANOVA indicated a positive effect for both treatment groups. Potential applications of the program are discussed, with recommendations for the use of this procedure as a model for other skill-developing interventions. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)