Rehabilitation training improves exercise tolerance after percutaneous coronary intervention

The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group（26 cases） and control group（31 cases）.Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls（P 〈 0.05,or 0.01）.However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.

Effects of Kanlijian (坎离煎) on Exercise Tolerance, Quality of Life, and Frequency of Heart Failure Aggravation in Patients with Chronic Heart Failure

Objective： To observe the effects of conventional therapy combined with Kanlijian （ 坎离煎, KLJ） on exercise tolerance, quality of life and frequency of heart failure aggravation in patients with chronic heart failure（CHF）. Methods： Sixty CHF patients differentiated as sufferring from the syndrome of Xin-Shen Yang deficiency were included in the study and randomly assigned at the ratio of 2 ： 1 into the KLJ group （n =39） and the control group（n = 21）. All the patients were treated with conventional therapy of Western medicine, but to those in the KLJ group, KLJ was medicated additionally one dose daily with 24 wks as one therapeutic course. The efficacy on TCM syndrome and changes of scores on TCM syndrome were observed after treatment. The indexes, including 6-minute walking distance （6MWD）, quality of life （QOL, accessed by LHFQ scoring）, NYHA grade, hemodynamic indexes and reducing/withdrawal rate of diuretic and digoxin before and after treatment were recorded and compared. Also the frequency of re-admission due to aggravation of heart failure in one year＇ s time were observed. Results： （ 1 ） The efficacy on TCM syndrome, improvement on scores of TCM syndrome, therapeutic effects on 6MWD, QOL, and NYHA grade in the KLJ group were superior to those in the control group. （2） Hemodynamic indexes after treatment, left ventricular fractional shortening （LVFS） and E peak/A peak （E/A）, between the two groups had no significant difference, while left ventricular ejection fraction （LVEF） was increased significantly in the KLJ group, but with no obvious change in the control group. （3） The reducing/withdrawal rate of diuretic and digoxin in the KLJ group was significantly higher than that in the control group. （4） The 1-year frequency of re-admission significantly decreased in the KLJ group. Conclusion： The adjuvant treatment of KLJ on the basis of Western conventional therapy can significantly improve CHF patients＇ exercise tolerance, quality of life and cardiac function, reduce the dosage of diuretic and digoxin needed, and decrease the re-admission frequency due to aggravation of heart failure.

Chronotropic incompetence is more frequent in obese adolescents and relates to systemic inflammation and exercise intolerance

Background:Adults with obesity may display disturbed cardiac chronotropic responses during cardiopulmonary exercise testing,which relates to poor cardiometabolic health and an increased risk for adverse cardiovascular events.It is unknown whether cardiac chronotropic incompetence(CI)during maximal exercise is already present in obese adolescents and,if so,how that relates to cardiometabolic health.Methods:Sixty-nine obese adolescents(body mass index standard deviation score=2.23±0.32,age=14.1±1.2 years;mean±SD)and 29lean adolescents(body mass index standard deviation score=-0.16±0.84,age=14.0±1.5 years)performed a maximal cardiopulmonary exercise testing from which indicators for peak performance were determined.The resting heart rate and peak heart rate were used to calculate the maximal chronotropic response index.Biochemistry(lipid profile,glycemic control,inflammation,and leptin)was studied in fasted blood samples and during an oral glucose tolerance test within obese adolescents.Regression analyses were applied to examine associations between the presence of CI and blood or exercise capacity parameters,respectively,within obese adolescents.Results:CI was prevalent in 32 out of 69 obese adolescents(46%)and 3 out of 29 lean adolescents(10%).C-reactive protein was significantly higher in obese adolescents with CI compared to obese adolescents without CI(p=0.012).Furthermore,peak oxygen uptake and peak cycling power output were significantly reduced(p<0.05)in obese adolescents with CI vs.obese adolescents without CI.The chronotropic index was independently related to blood total cholesterol(standardized coefficientβ=-0.332;p=0.012)and C-reactive protein concentration(standardized coefficientβ=-0.269;p=0.039).Conclusion:CI is more common in the current cohort of obese adolescents,and is related to systemic inflammation and exercise intolerance.

Effectiveness of Shenshu Guanxin recipe granules(参术冠心方颗粒)for improving exercise tolerance in patients with stable angina pectoris:a randomized,double-blind,placebo-controlled trial

OBJECTIVE:To assess the effectivess of Shenshu Guanxin recipe granules(参术冠心方颗粒,SGR)in improving exercise tolerance and the quality of life in patients with Stable Angina Pectoris(SAP).METHODS:A total of 189 patients were consecutively enrolled between December 2012 and December 2014.The included patients were randomly assigned to SGR and placebo groups.The primary endpoints included mainly the results of treadmill exercise test and Seattle Angina Questionnaire(SAQ)during 12 weeks of treatment.RESULTS:After 12 weeks of treatment,SGR extended the time of exercise-induced ST-segment depression of 0.1 MV,lowered the maximum ST-segment depression,and shortened the duration of ST-segment depression in patients with SAP in southern China.Besides,the study also proved that SGR could improve the quality of life and functional status of patients with SAP.CONCLUSIONS:SGR showed a positive effect on exercise tolerance compared with the placebo besides optimal medical therapy.Also,the study proved that SGR could improve the SAQ score of the patients.

Yangxinshi Tablets Versus Trimetazidine on Exercise Tolerance After Percutaneous Coronary Intervention: Rationale and Design of the Double-blind, Randomized HEARTRIP Trial

Improving exercise tolerance is indisputably beneficial for long-term survival in patients treated with percutaneous coronary intervention(PCI).Although previous studies suggested that Yangxinshi tablets effectively improve exercise tolerance in patients with coronary heart disease,the evidence is limited due to the lack of high-quality randomized trials.The Effects of Yangxinshi Tablets on Exercise Tolerance Compared with Trimetazidine in Patients after PCI(HEARTRIP)trial is a multicenter,double-blind,double-dummy,active drug-controlled,randomized trial designed to test if the effects of Yangxinshi tablets on exercise tolerance are non-inferior to those of trimetazidine in patients undergoing PCI.A total of 668 patients who have undergone PCI for the first time and completed a cardiopulmonary exercise test(CPET)will be enrolled and randomly assigned,in a 1:1 ratio,to receive Yangxinshi tablets(3 tablets,3 times/d)plus trimetazidine-placebo or trimetazidine(20 mg,3 times/d)plus Yangxinshi-placebo for 24 weeks.The primary endpoint is metabolic equivalent of tasks(METs)measured by CPET at 24 weeks after randomization.The secondary endpoints include comprehensive CPET indicators,incidence of major adverse cardiac and cerebrovascular events,and depression(Patient Health Questionnaire-9),anxiety(Generalized Anxiety Disorder-7),and quality of life(Seattle Angina Questionnaire)scores.This study will appraise current clinical evidence on the beneficial effect of Yangxinshi tablets on improving exercise tolerance after PCI and may substantiate their use as an effective pharmacological option for cardiac rehabilitation patients.The HEARTRIP study protocol received approval from the ethics committee of the General Hospital of Northern Theater Command(Shenyang,China).The procedures set out in this protocol are in accordance with the principles of the Declaration of Helsinki and the Good Clinical Practice guidelines.The results will be published following the guidelines of the CONSORT statement in a peer-reviewed scientific journal(Trial registration number:NCT03809273).

Reduced exercise capacity and self-perceived health status in highrisk patients undergoing lung resection

BACKGROUND Lung resection represents the main curative treatment modality of non-small cell lung cancer.Patients with high-risk to develop postoperative pulmonary complications have been classified as“high-risk patients.”Characterizing this population could be important to improve their approach and rehabilitation.AIM To identify the differences between high and low-risk patients in exercise capacity and self-perceived health status after hospitalization.METHODS A longitudinal observational prospective cohort study was carried out.Patients undergoing lung resection were recruited from the“Hospital Virgen de las Nieves”(Granada)and divided into two groups according to the risk profile criteria(age≥70 years,forced expiratory volume in 1 s≤70%predicted,carbon monoxide diffusion capacity≤70%predicted or scheduled pneumonectomy).Outcomes included were exercise capacity(Fatigue Severity Scale,Unsupported Upper-Limb Exercise,handgrip dynamometry,Five Sit-to-stand test,and quadriceps hand-held dynamometry)and patient-reported outcome(Euroqol-5 dimensions 5 Levels Visual Analogue Scale).RESULTS In total,115 participants were included in the study and divided into three groups:high-risk,low-risk and control group.At discharge high-risk patients presented a poorer exercise capacity and a worse self-perceived health status(P<0.05).One month after discharge patients in the high-risk group maintained these differences compared to the other groups.CONCLUSION Our results show a poorer recovery in high-risk patients at discharge and 1 mo after surgery,with lower self-perceived health status and a poorer upper and lower limb exercise capacity.These results are important in the rehabilitation field.

Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure

Background Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure （CHF）. The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity. Methods A total of 74 patients were enrolled in the study, with 37 having congestive heart failure （left ventricular ejection fraction （LVEF） 〈0.45） and the other 37 with coronary heart disease （by coronary angiography） serving as the control group （LVEF 〉0.55）. Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities. Results The study showed that left ventricular end diastolic / systolic diameter （LVEDD/LVESD）, left atrial diameter （LAD） and left ventricular mass index （LVMI） were significantly enlarged in patients with chronic heart failure compared with controls （P 〈0.01）. The VO2AT, Peak VO2, Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls （P 〈0.05）, VENCO2 slope was increased in patients with chronic heart failure （P 〈0.01）. Multivariate linear regression analysis indicated that the patients＇ exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients （P=0.012）, while Load AT correlated positively with LVEDD in control patients （P=0.006）. VENCO2 slope correlated positively with LAD （B=0.477, P 〈0.0001） in chronic heart failure patients, while the VENCO2 slope correlated negatively with LAD in control patients （P=0.009）. Conclusion The study indicates that the size of LVEDD and LAD are important determinants of exercise capacity in patients with CHF, which may be helpful to identify exercise tolerance for routine monitoring of systolic heart failure.

Continuous positive airway pressure acutely increases exercise duration in children with severe therapy-resistant asthma:a randomized crossover trial

Background Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ven-tilation on exercise capacity in individuals with severe therapy-resistant asthma(STRA)are unknown.This study aimed to evaluate the immediate effect of continuous positive airway pressure(CPAP)on exercise tolerance in children with STRA.Methods We performed a controlled,randomized,crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA.Clinical,anthropometric and lung function data were collected.The participants in the intervention group(IG)used CPAP(PEEP 10cmH2O and FiO20.21)for a period of 40 min.Subjects in the control group(CG)used CPAP with mini-mum PEEP at 1 cmH20 also for 40 min.Afterwards,subjects from both groups underwent cardiopulmonary exercise testing(CPET).After a 15-day washout period,on a subsequent visit,subjects participated in the opposite group to the initial one.Results Thirteen subjects with a mean age of 12.30±1.7 years were included.The variables of peak expiratory flow(PEF)and forced expiratory volume in the first second(FEV1)before using CPAP and after performing CPET did not show sig-nificant differences.Regarding CPET results,there was no significant difference(P=0.59)between groups at peak exercise for oxygen consumption—VO2(CG:33.4±6.3 and IG:34.5±5.9,mL kg^(-1)min^(-1)).However,the IG(12.4±2.1)presented a total test time(min)significantly(P=0.01)longer than the CG(11.5±1.3).Conclusion The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.

Effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following cardiac stent implantation

BACKGROUND Coronary stent implantation is usually used to treat unstable angina to alleviate stenosis or occlusion,promoting blood flow restoration and alleviating symptoms such as myocardial ischemia.And postoperative cardiac rehabilitation is essential for enhancing recovery and prognosis.Nevertheless,conventional rehabilitation lacks specificity,particularly for elderly patients with multiple comorbidities and poor compliance,rendering it less effective.AIM To investigate the effects of systematic cardiac rehabilitation training in elderly patients with unstable angina following coronary stenting intervention.METHODS A retrospective enrollment was conducted comprising fifty-four elderly patients with unstable angina pectoris who underwent systematic cardiac rehabilitation training after receiving coronary intervention as the rehabilitation group,while fifty-three elderly patients who received basic nursing and rehabilitation guidance measures after coronary intervention were assigned to the control group.Differences in Seattle Angina Questionnaire scores,survival quality(SF-36)scores,cardiopulmonary exercise function assessment index,echocardiographic cardiac function index,and adverse cardiovascular events were compared between the two groups.RESULTS After intervention,the rehabilitation group observed greater VO2 Max,maximum metabolic equivalent,eft ventricular ejection fraction,left ventricular end-diastolic diameter and smaller left ventricular end-systolic diameter.And the rehabilitation group observed greater scores of physical activity limitation,stable angina pectoris,treatment satisfaction,and SF-36 score.The incidence of adverse cardiovascular events in the two groups,showed no significant difference.CONCLUSION Systematic cardiac rehabilitation following coronary stenting in elderly patients with unstable angina pectoris can enhance cardiac function recovery,consequently enhancing both quality of life and cardiopulmonary exercise tolerance.

Effects of respiratory muscle training on post-stroke rehabilitation:A systematic review and meta-analysis

BACKGROUND Stroke often results in significant respiratory dysfunction in patients.Respiratory muscle training(RMT)has been proposed as a rehabilitative intervention to address these challenges,but its effectiveness compared to routine training remains debated.This systematic review and meta-analysis aim to evaluate the effects of RMT on exercise tolerance,muscle strength,and pulmonary function in post-stroke patients.AIM To systematically assess the efficacy of RMT in improving exercise tolerance,respiratory muscle strength,and pulmonary function in patients recovering from a stroke,and to evaluate whether RMT offers a significant advantage over routine training modalities in enhancing these critical health outcomes in the post-stroke population.METHODS Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a comprehensive search across PubMed,Embase,Web of Science,and the Cochrane Library was conducted on October 19,2023,without temporal restrictions.Studies were selected based on the predefined inclusion and exclusion criteria focusing on various forms of RMT,control groups,and outcome measures[including forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximal voluntary ventilation(MVV),peak expiratory flow(PEF),maximal inspiratory pressure(MIP),maximal expiratory pressure(MEP),and 6-min walking test(6MWT)].Only randomized controlled trials(RCTs)were included.Data extraction and quality assessment were conducted independently by two reviewers using the Cochrane Collaboration's risk of bias tool.Statistical analyses,including those using the fixed-effect and random-effects models,sensitivity analysis,and publication bias assessment,were performed using Review Manager software.RESULTS A total of 15 RCTs were included.Results indicated significant improvements in MIP(12.51 cmH2O increase),MEP(6.24 cmH2O increase),and various pulmonary function parameters(including FEV1,FVC,MVV,and PEF).A substantial increase in 6MWT distance(22.26 meters)was also noted.However,the heterogeneity among studies was variable,and no significant publication bias was detected.CONCLUSION RMT significantly enhances walking ability,respiratory muscle strength(MIP and MEP),and key pulmonary function parameters(FEV1,FVC,MVV,and PEF)in post-stroke patients.These findings support the incorporation of RMT into post-stroke rehabilitative protocols.

Current opinion on the importance of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Multidisciplinary pulmonary rehabilitation （PR） is a .widely accepted non-pharmacological treatment method that tries to improve exercise tolerance and quality of life in chronic obstructive pulmonary disease （COPD） and non-COPD patients, together with reduction in medical services use.1 The aim of PR is to help respiratory patients to reach and keep a maximal functioning and independence level within community^2 The patients severely affected by other pulmonary diseases than COPD are benefiting of intensive PR and the degree of improvement is similar to that obtained in COPD^3

Quantitative evaluation of cardiopulmonary functional reserve in treated patients with pulmonary embolism

Background There is no research,either at home or abroad,focusing on assessing the cardiopulmonary functional reserve and exercise tolerance in patients with pulmonary embolism （PE）,but the benefits of early exercise are well recognized.The goals of this study were to assess cardiopulmonary functional reserve in treated PE patients using the inert gas rebreathing method of the cardiopulmonary exercise test （CPET）,and to compare it with traditional methods.Methods CPET on the bicycle ergometer were performed in 40 patients with age,gender,body mass index,systolic blood pressure,and pulmonary function matched.The first group was the PE group composed of 16 PE patients （5 male,11 female） who were given the standard antithrombotic therapy for two weeks.The second group was composed of 24 normal individuals （10 male,14 female）.Both groups were evaluated by cardiac ultrasound examination,6-minute walking test （6MVVT）,and CPET.Results （1） Right ventricular systolic pressure （RVSP） in the PE group increased significantly compared to the control group,（34.81±8.15） mmHg to （19.75±3.47） mmHg （P 〈0.01）.But neither right atrial end-systolic diameter （RASD） nor right ventricular end-diastolic diameter （RVDD） in the PE patients had changed when compared with the controls.The 6-minute walk distance was significantly reduced in the PE patients compared with normal subjects,（447.81±79.20） m vs.（513.75±31.45） m （P 〈0.01）.Both anaerobic threshold oxygen consumption （VO2AT） and peak oxygen consumption （VO2peak） were significantly lower in patients with PE,while CO2 equivalent ventilation （VE/VCO2 slope） was higher;VO2AT （9.44±3.82） ml·kg1.min-1 vs.（14.62±2.93） ml.kg-1.min-1 （P 〈0.01） and VO2peak （12.26±4.06） ml.kg-1.min-1 vs.（23.46±6.15） ml.kg-1.min-1 （P 〈0.01） and VE/VCO2 slope 35.47±6.66 vs.26.94±3.16 （P 〈0.01）.There was no significant difference in resting cardiac output （CO） between the PE and normal groups,whereas peak cardiac output （peak CO）and the difference between exercise and resting cardiac output （ACO） were both significantly reduced in the PE group;peak CO （5.97±2.25） L/min to （8.50±3.13） L/min （P〈0.01）,ACO （1.29±1.59） L/min to （3.97±2.02） L/min （P〈0.01）.（2） The 6-minute walk distance did not correlated with CPET except for the VO2 peak in patients with PE,r=0.675 （P 〈0.01）.Conclusions The cardiopulmonary functional reserve was reduced in patients with PE.CPET is an accurate,quantitative evaluation of cardiopulmonary functional reserve for PE patients.