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F-23 Free Communication/Poster - Cardiovascular Rehabilitation

Medicine & Science in Sports & Exercise: May 2013 - Volume 45 - Issue 5S - p 543–545
doi: 10.1249/01.mss.0000433741.92756.b5

May 31, 2013, 1:00 PM - 6:00 PM

Room: Hall C

2323 Board #24 May 31, 2:00 PM - 3:30 PM

Effect of Pulmonary Rehabilitation Program on Exercise Tolerance and Functional Capacity in Patients with Idiopathic Pulmonary Fibrosis

Baruch Vainshelboim1, Jose Oliveira2, Liora Yohoshua1, Israela Wais1, Mordechai R. Kramer1. 1Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel. 2University of Porto, Porto, Portugal.

(No relationships reported)

Idiopathic pulmonary fibrosis (IPF) is characterized by restrictive pathophysiology, impaired gas exchange, exertional dyspnea, hypoxemia and exercise intolerance. However, data is limited regarding to the effect of pulmonary rehabilitation (PR) on IPF patients.

PURPOSE: To examine the effect of exercise training in PR program on exercise tolerance, functional capacity, pulmonary function, dyspnea and health related quality of life in IPF patients.

METHODS: Twenty-six IPF patients male and female aged 50-80 years (67±7 yr) were recruited and randomly allocated to either PR group (n=14) or control group (n=12). PR group participated in outpatient 12 weeks 60 minutes twice weekly group exercise training, while control group continued with regular medical treatment. Pulmonary function test (PFT), cardiopulmonary exercise test (CPET), 6 min walk test (6MWT), modified medical research council (mMRC) dyspnea score and St. George respiratory questionnaire (SGRQ) were assessed at baseline and after 12 weeks.

RESULTS: Peak oxygen consumption, anaerobic threshold, peak work rate and 6MWT were increased significantly only in PR group on average (2.3 ml/kg/min, 2.5 ml/kg/min, 16 watts and 85 m respectively). Forced vital capacity % predicted increased by 4% in PR group and decreased by 4% in control group. mMRC dyspnea score decreased by 0.8 units combined with a significant decrease (8 units) in SGRQ following the program.

CONCLUSION: Exercise training in pulmonary rehabilitation program in patients with IPF improves exercise tolerance and functional capacity, pulmonary function, dyspnea and quality of life.

Table 1

Table 1

2324 Board #25 May 31, 2:00 PM - 3:30 PM

Cardiac Procedure, Weight Loss, Arterial Stiffness & Exercise Hemodynamic Changes in Cardiac Rehab

Peter W. Grandjean, FACSM1, Stephen F. Crouse, FACSM2, Serge P. von Duvillard, FACSM3, Peter Schmid4, Robert Berent4. 1Baylor University, Waco, TX. 2Texas A&M University, College Station, TX. 3University of Primorska, Koper, Slovenia. 4Center for Cardiovascular Rehabilitation, Bad Schallerbach, Austria.

(No relationships reported)

Patients completing a comprehensive cardiac rehabilitation (CR) program generally exhibit improved cardiovascular health and hemodynamic responses to physical exertion. Arterial vascular compliance and exercise blood pressure are important because they correlate with daily ambulatory blood pressure and future risk of cardiovascular morbidity and mortality.

PURPOSE: Our objective was to determine the influence of cardiac procedure and weight loss on changes in arterial stiffness and exercise blood pressure responses in patients completing residential CR.

METHODS: Male CR patients (n = 158; age 63.4 + 9.8 yr; weight 84.4 + 12.3 kg; VO2max 23.7 + 4.8 ml/kg/min) underwent 4 weeks of inpatient CR. Body weight, carotid-femoral pulse wave velocity (PWV), and hemodynamic responses to an incremental cycle ergometry exercise test [heart rate (HR), mean arterial pressure (MAP), rate pressure product (RPP)] were measured before and after CR. For analysis, change variables were calculated as post - pre CR and patients were grouped according to cardiac procedure [coronary artery bypass graft (CABG, n = 46); combined group of percutaneous coronary interventions + myocardial infarct (PCIMI, n = 112)] and body weight change (ΔBW) quartiles (Q1, ΔBW < -2.9 kg, n = 41; Q2, ΔBW < -1.6 to > -2.9 kg, n = 35; Q3, ΔBW <-0.2 > -1.6 kg, n = 45; Q4, ΔBW > -0.2 kg, n = 37). Differences between cardiac procedure groups and ΔBW quartiles were determined using 2 by 4 ANOVAs. Simple correlations established relationships among change variables.

RESULTS: ΔBW with CR was similar in CABG and PCIMI but CABG exhibited a 33% > improvement in VO2max vs. PCIMI (p = 0.005). PWV decreased incrementally up to 1.3 m/s (p = 0.026) and lower HR (-11 to -13 bpm) and RPP (-33 to -35 pts) were observed during submaximal exercise with ΔBW (Q1, Q2, Q3 < Q4) in CABG but not PCIMI patients (p < 0.13). In all patients, ΔBW was related to changes in PWV (r = 0.62, p < 0.0001) and VO2max (r = -0.16, p = 0.045). Changes in BW and PWV, but not VO2max, were significantly correlated with changes in resting and submaximal exercise MAP and RPP (p < 0.05 for each).

CONCLUSION: Weight loss in CR is associated with reduced arterial stiffness. Weight loss and reduced arterial stiffness after CR positively impact hemodynamic responses to exercise and the effects are most pronounced in CABG patients.

2325 Board #26 May 31, 2:00 PM - 3:30 PM

The Influence of Baseline Functional Exercise Capacity on Post Cardiac Rehabilitation Outcomes

Felipe Araya-Ramirez1, Pedro Urena-Bonilla1, Braulio Sanchez-Urena1, Luis Blanco-Romero1, Alejandro Rodriguez-Montero1, Julio Calleja-Gonzales2, John C. Quindry, FACSM3. 1National University of Costa Rica, Heredia, Costa Rica. 2University of the Basque Country, Vitoria, Spain. 3Auburn University, Auburn, AL.

(No relationships reported)

Coronary artery disease (CAD) is a leading cause of morbidity in Costa Rica, while cardiac rehabilitation program (CRP) participation counters CAD and improves functional exercise capacity. Although the benefits of CRP are well established, the impact of baseline fitness changes on post-rehabilitation functional capacity is less well defined.

PURPOSE:To retrospectively examine the effect of baseline functional exercise capacity on 12-week CRP outcomes in patients with CAD.

METHODS: One hundred and twelve cardiac patients (age = 58.5 ± 12 years; height = 1.67 ± 0.8 m; weight = 75.2 ± 11.9 kg; BMI = 26.8 ± 3.7 kg/m2; waist circumference = 95.9 ± 8.9 cm; VO2max = 13.9 ± 5.2 ml/kg/min) from the National University of Costa Rica completed a 6-minute walk test (6MWT) before and after a 12-week CRP. VO2max was estimated from 6MWT sub-maximal exercise performances. Patients were grouped into tertiles based on their initial 6MWT performances and VO2max estimates, and examined for post-rehabilitation outcome differences. Between group differences were examined by one-way ANOVA, p ≤ 0.05 a priori.

RESULTS: Patients improved significantly (P <0.001) in the 6MWT by 34% from (404 ± 99 to 543 ± 93 m, P <0.001); in VO2max by 26% (13.9 ± 5.2 to 17.5 ± 5.4 ml/kg/min, P <0.001), and in walking speed by 36% (2.5 ± 0.6 to 3.4 ± 0.6 mph, P <0.001). Systolic blood pressure was reduced by 3.7 % (109 ± 18 to 105 ± 14 mmHg, P =0.031), and waist circumference was decreased by 1% (95.9 ± 8.9 to 94.9 ± 8.9 cm, P =0.033). Patients in the lowest initial 6MWT tertile exhibited greater improvement in the 6MWT than those in the highest tertile (59.4 ± 46 vs. 18.8 ± 12.9, P <0.001). Likewise, patients in the lowest initial VO2max estimate tertile demonstrated greater improvement in the post-rehabilitation VO2max than those in the highest tertile (44.4 ± 4.3 vs. 14 ± 5.2, P <0.001).

CONCLUSIONS: Across all baseline fitness abilities, cardiac patients exhibited functional capacity and walking speed improvements after a 12-week CRP. Patients in the lowest baseline tertile for functional exercise capacity demonstrated the largest improvement in post-rehabilitation testing performance.

2326 Board #27 May 31, 2:00 PM - 3:30 PM

Heart Rate Variability At Rest, Exercise And Recovery In Stroke Patients

Denise O. Alonso, Maria C A Bortoleto, Jessica A. Gonçalves, Veronica V. Furtado, Carlos A F Brito. Universidade Municipal de Sao Caetano do Sul, Sao Caetano do Sul, Brazil.

(No relationships reported)

Stroke is the second cause of death in world. People with stroke risk factors, like hypertension or dyslipidemia, have reduced heart rate variability (HRV). Aging, which also represents a risk factor for stroke, reduces HRV. HRV evaluation during exercise has been shown as an important tool for understanding autonomic control in healthy or disease conditions.

PURPOSE: This study aimed to evaluate HRV behavior at rest, exercise and recovery in stroke patients.

METHODS: We studied 12 stroke patients (8 men - 63,1±10,7 years-old; 4 women - 70,5±10,7 years-old; p=0,29), during their exercise routine. All patients were informed about the procedures and gave their informed consent. Before and after exercise, they rested for 20 minutes, in supine position, in a 25°C degrees room. After rest, they performed aerobic exercise (AE) for 30 min (exception for one woman, who couldn’t walk in treadmill). AE intensity was determined by reserve heart rate (RHR) and all patients exercised between 50-70% of RHR. Then, all patients performed resistive exercise (RE), with one exercise by greater muscles groups, with 2 series of 15 repetitions, with moderate intensity. HRV was measured by POLAR®RS800CX. We measured heart rate, SD1, SD2, RMSSD, pNN50, total power, VLF, LF, HF, LF/HF ratio. Data were analysed in SPSS software, by one way ANOVA, assuming p<0,05.

RESULTS: Patients presented others conditions than stroke: dyslipidemia (7), hypertension (8), diabetes (3), and cardiovascular disease (3). All used medications to these conditions, but none used beta-blockers. Heart rate augmented from rest to AE and RE and fall at recovery (71,5±10,6; 100,5±13,8; 93,8±14,7; 75,6±11,0 bpm; p=0,000). However, HRV presented change only in LF/HF ratio from rest to AE (258,5±150,1; 644,8±467,9; 541,1±313,9; 343,8±178,1 %; p=0,34). All others variables concerning to HRV didn’t show significant differences between stages.

CONCLUSION: Although stroke patients showed heart rate adaptation to exercise and recovery, we observed an impairment to adjust HRV to this stimulus, specially considering vagal withdrawal, pointing to sympathetic activity dependence to augment heart rate, even at start of exercise. These data suggest that stroke patients have autonomic imbalance at rest, exercise and recovery.

2327 Board #28 May 31, 2:00 PM - 3:30 PM

Community Exercise On Nitric Oxide And Aerobic Endurance In People With Cardiovascular Diseases

Lisa A. Soeiro, Cristina Monteiro, Filomena Carnide, Helena Santa-Clara. Faculty of Human Kinetics - Technical University of Lisbon, Interdisciplinary Centre for the Study of Human Performance - Exercise and Health Laboratory, Lisbon, Portugal.

(No relationships reported)

Atherosclerosis is a chronic inflammatory disease characterized by endothelial dysfunction. Over the past decades it was observed that exercise could improve the biomarkers associated with the dysfunction of the endothelium, namely nitric oxide.

PURPOSE: Analyze the effect of a combined exercise (aerobic + resistance) performed from a low to moderate intensity, over a period of twelve months, in nitric oxide (NO) and aerobic endurance (AE) in participants of both genders, diagnosed with heart disease and various cardiovascular risk factors.


subjects community-dwelling participated in the Exercise Group (EG: 10 men, 28 women; age: 64,87±6,81) and their results were compared with a Control Group of 26 participants (CG: 6 men, 20 women;age:68.15±8.54), who did not participate in any exercise program. In order to evaluate NO blood samples were collected and nitrate was quantified by an adapted Griess Method and was evaluated AE by testing 6 minutes’ walk test (6MWT).

RESULTS: No differences were observed between and within groups for NO, after a year, although the EG exhibit a tendency to improve on 15% while the CG showed a tendency to decrease by 7%. Regarding AE, we found significant differences (p< .05) between groups after the intervention with an increase of 22% (103,0±69,1) in EG and a decrease of 9% (-41,3±50,0) in CG. No association was observed between the NO and the AE either in EG or in CG.

CONCLUSIONS: Combined exercise (aerobic+resistance) performed from a low to moderate intensity over a period of twelve months was sufficient to significantly improve the AE, in patients with metabolic and cardiovascular risk factors, but it wasn`t enough to significantly improve NO.

2328 Board #29 May 31, 2:00 PM - 3:30 PM

Cardiorespiratory Responses to Doubles Pickleball in Low-Risk Cardiac Patients

Brad L. Gliha, Susan Haapaniemi, Kristen Bernacik, Roger Sacks, Noah Eubanks, Drew Domagalski, Barry A. Franklin, FACSM. Beaumont Health System, Royal Oak, MI.

(No relationships reported)

Pickleball (PB), a hybrid-racket game, is rapidly gaining popularity among middle-aged and older adults, with and without known coronary disease.

PURPOSE: To evaluate the cardiorespiratory responses during PB in cardiac patients in relation to peak or symptom-limited exercise test (GXT) results to determine the appropriateness of their participation in this recreational activity.

METHODS: Low-risk (ejection fraction [mean ± SD] = 62% ± 9) male cardiac patients (n = 23; mean ± SD age = 55 years ± 7 years) who had undergone a GXT within one year, were assessed with ambulatory ECG monitoring and a portable oxygen uptake (VO2) measurement system during PB doubles play. Mean active-volley (AV) heart rates (HR) and peak HR in beats per minute (bpm), and mean and peak VO2, expressed as metabolic equivalents (METs), where 1 MET = 3.5 mL O2/kg/min, were directly measured during PB and expressed as a % of the peak HR (142.0 bpm ± 14.5) and estimated METs (11.1 ± 2.6) during GXT. Immediate post-play systolic and diastolic blood pressures (SBP; DBP) and overall rating of perceived exertion (RPE; 6-20 category scale) were also obtained.

RESULTS: Mean AV HR and peak HR during PB were 114.2 ± 20.4 and 121.1 ± 21.9 bpm respectively, representing 80% and 85% of the peak HR attained during GXT. Mean and peak METs during PB were 5.9 ± 1.2 and 6.5 ± 1.3 respectively, corresponding to 53% and 59% of the MET capacity estimated during GXT. During PB, 12 of the 23 (52%) subjects (Ss) exceeded 85% of the peak HR attained during GXT; HR responses for 2 of these Ss briefly exceeded 100% by 4 to 8 bpm. Mean RPE during PB was “12,” corresponding to “fairly light” to “somewhat hard” exertion. Average post-play SBP was 143.6 ± 16.2 mmHg, whereas DBP was 71.7 ± 9.7 mmHg. Complex arrhythmias during PB that were not observed during GXT occurred in 4 Ss; these included ventricular couplets and one 5-beat run of supraventricular tachycardia.

CONCLUSIONS: The present findings suggest that the aerobic requirements of doubles PB in low-risk, fit patients with coronary disease approximate 5.9 METs, corresponding to vigorous physical activity. Due to the stop-and-go activity and competition, HRs during PB may exceed 85% of the peak HR attained during GXT. Accordingly, PB play has recreational potential in exercise-based cardiac rehabilitation, but only in highly selected coronary patients.

2329 Board #30 May 31, 2:00 PM - 3:30 PM

Relationship Between Physical Activity Patterns And Key Cardiopulmonary Exercise Testing Variables In Patients With Heart Failure

Vinicius M. Silva1, Alexandra C. Lima2, Laura T. Neves1, Burke Gurney3, Marianne L. da Silva1, Ross Arena, FACSM4, Gerson C. Jr1. 1University of Brasilia, Brasilia, Brazil. 2Heart Institute of Distrito Federal, Brasilia, Brazil. 3University of New Mexico, Albuquerque, NM. 4University of New Mexico, albuquerque, NM. (Sponsor: Ross Arena, FACSM)

(No relationships reported)

PURPOSE: A hallmark characteristic of heart failure (HF) is reduced physical activity (PA) patterns and functional capacity. The relationship between key cardiopulmonary exercise testing (CPX) variables and PA patterns has not been investigated. To evaluate PA patterns in patients with ischemic HF and its relationship to peak oxygen consumption (VO2), the minute ventilation/dioxide carbon production (VE/VCO2) slope and the oxygen uptake efficiency slope (OUES).

METHODS: A cross sectional study was carried out in 16 patients with ischemic HF (age 57 ± 9 years, percent ejection fraction: 31,84 ± 8,26). Subjects wore an accelerometer (Actigraph® GT3X) for six days to measure total steps/day as well as percent time at light, moderate and vigorous PA. A symptom-limited CPX was performed on a treadmill using a ramping protocol (0.5 metabolic equivalents/min). Oxygen consumption (ml.Kg-1.min-1), VCO2 (L/min) and VE (L/min) were collected (K4 COSMED®, Italy) throughout the CPX. Peak VO2 was expressed as the highest 30-second average value obtained during the last stage of the CPX. The VE/VCO2 slope and OUES were obtained by least squares linear regression. One way analysis of variance was used to assess differences between PA patterns at different intensities. Pearson’s correlation was used to assess the relationship between PA and CPX variables. A p-value < 0.05 was considered statistically significant

RESULTS: Subjects performed an average of 9029 steps/day, with the majority of PA performed at light intensity (66.48 ± 6.24%) compared to moderate (28.75 ± 4.39%) and vigorous (4.32 ± 1.01%) intensities ( p < 0.05). PA patterns demonstrated a significant correlation with key CPX variables. Total steps correlated with peak VO2 (r = 0.64 p < 0.05), the VE/VCO2 slope (r = - 0.72; p < 0.05) and the OUES (0.63; p <0.05). The percent time at light intensity PA correlated with the VE/VCO2 slope (r = 0.58; p < 0.05) and the OUES (- 0.51; p <0.05). The percent time at vigorous intensity PA correlated with peak VO2 (r = 0.55; p < 0.05) and the, VE/VCO2 slope (r = - 0.52; p < 0.05).

CONCLUSIONS: PA assessed by accelerometer is significantly associated with key CPX variables in patients with HF. These findings suggest PA monitoring may provide insight into functional patterns and identify patients with a higher likelihood for a poor CPX response.

© 2013 American College of Sports Medicine