Effect of an acute beta-adrenergic blockade on the relationship between ventilatory and plasma lactate threshold

Physiological and Perceived Exertion Responses during Exercise: Effect of β-blockade

PURPOSE

This study investigated the effect of β-blockade on physiological and perceived exertion (RPE) responses during incremental treadmill exercise.

METHODS

Sixteen healthy participants (n = 8 men; age, 25.3 ± 4.6 yr) performed a maximal treadmill exercise test after ingestion of 100 mg metoprolol or placebo, with a double-blind, randomized, and counterbalanced design. Heart rate (HR), ventilatory, and gas exchange variables were measured continuously, and participants reported RPE at the end of each minute. Physiological and RPE responses during each condition were compared at the ventilatory threshold (VT), respiratory compensation point, and at maximal exercise using repeated-measures ANOVA. Linear regression modeled relationships between perceived exertion and physiological variables.

RESULTS

The HR and V˙O2 at the VT, respiratory compensation point, and maximal exercise were all significantly lower after β-blockade (P < 0.05). However, when standardized to within condition peak values, differences were no longer significant. The RPE associated with VT was higher after β-blockade (12.9 ± 1.0 vs 12.3 ± 1.2, P < 0.05) but lower at maximal exercise (19.1 ± 0.6 vs 19.4 ± 0.5, P < 0.05). Increases in RPE relative to HR were greater after β-blockade and remained significant when expressed relative to peak HR. There was no difference in the growth of the relationship between RPE and V˙O2 across conditions, although the origin of the relationship was higher with β-blockade.

CONCLUSIONS

Although β-blockade resulted in a significant reduction in exercising HR and V˙O2, the RPE for a given relative intensity remained unchanged. The relationship between RPE and V˙O2 was not affected by β-blockade. The results provide evidence that RPE is a useful and reliable measure for exercise testing and prescription in patients prescribed β-blockade therapy.

Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives

Aerobic physical exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Beta-blockade interacts with heart rate, sympathetic tone, maximal workload and local lactate production. In the present randomized-controlled study, we compared the cardiovascular effects of an endurance training programme in elderly hypertensives with or without beta-blockers and developed a first approach to determine a lactate-based training heart rate in presence of beta-blockade. Fifty-two patients (23 with beta-blocker, 29 without beta-blocker) > or =60 years with systolic 24-h ambulatory blood pressure (ABP) > or =140 mm Hg and/or antihypertensive treatment were randomly assigned to sedentary activity or a heart-rate controlled 12-week treadmill exercise programme (lactate 2.0 mmol/l). In the exercise group, the training significantly decreased systolic and diastolic 24-h ABP, blood pressure on exertion (100 W) and increased endothelium-dependent vasodilation (flow-mediated vasodilation, FMD) and physical performance both in the presence and absence of beta-blockade (P<0.05 each). The extent of ABP reduction did not significantly differ in the presence or absence of beta-blockade (Delta systolic ABP 10.6+/-10.5 vs 10.6+/-8.8 mm Hg, Delta diastolic ABP 5.7+/-8.6 vs 5.8+/-4.0 mm Hg). Mean training heart rate was significantly lower in the patients on beta-blockers (97.2+/-7.7 vs 118.3+/-7.5/min, P<0.001). Lactate-based aerobic endurance training evokes comparable cardiovascular benefits in the presence and absence of beta-blockade including a marked improvement of endothelial function. In the present study, target training heart rate with beta-blockers is about 18% lower than without.

Beta1-adrenoceptor mediated origin of the heart rate performance curve deflection

PURPOSE

The deflection of the HR performance curve (HRPC) has been described as an objective marker of submaximal exercise performance. HR response to incremental cycle ergometer exercise is shown to be neither linear nor uniform and a physiological explanation of the deflection phenomenon is lacking. We hypothesized that differences in the beta1-adrenoceptor site are the source of these differences. The aim of the study was to investigate the influence of the highly selective beta1-adrenoceptor (beta1-AR) antagonist bisoprolol (Bi) on the HRPC in young healthy male subjects with different HR response patterns.

METHODS

Sixteen subjects were treated in randomized order with Bi or a placebo (Pl) in two separate trials. HR response during incremental cycle ergometer exercise was compared between the two trials. Blood lactate concentration (La) and ventilatory variables were measured throughout both tests.

RESULTS

Bi changed the direction of the HRPC more in subjects with a regular, s-shaped response pattern under placebo than those with a nonregular or linear pattern. The influence of Bi on the HR at the second lactate turn point was significantly related (R = 0.78; P < 0.001) to the pattern of the HRPC in Pl conditions.

CONCLUSION

We suggest that differences between the subjects with regular s-shaped versus nonregular HRPC may be due to differences at the beta1-AR site. The origin of the HRPC deflection is mediated in part by the beta1-AR sensitivity.

Limiar ventilatório e variabilidade da freqüência cardíaca em adolescentes

As análises da concentração sanguínea de lactato e das trocas gasosas respiratórias são métodos tradicionalmente empregados para identificar a transição de produção de energia pelo metabolismo muscular. No entanto, mais recentemente, vem sendo sugerido método alternativo mediante análise da variabilidade da freqüência cardíaca. Pretendeu-se, com o presente estudo, estabelecer comparações entre o limiar de variabilidade da freqüência cardíaca (LiVFC) e o primeiro limiar ventilatório (LV1), em uma amostra de adolescentes. Para tanto, foram submetidos a teste de esforço físico de carga máxima em esteira ergométrica 41 sujeitos (22 rapazes e 19 moças) com idades entre 15 e 18 anos. O LV1 foi identificado mediante o equivalente ventilatório de oxigênio envolvendo recursos de ergoespirometria. A variabilidade da freqüência cardíaca foi analisada por intermédio dos intervalos R-R, através da plotagem de Poincaré, que oferece informações quanto ao desvio-padrão da variabilidade instantânea batimento-a-batimento (SD1), ao desvio-padrão a longo prazo de intervalos R-R contínuos (SD2) e à razão SD1/SD2. O LiVFC foi identificado pelo SD1 de acordo com três critérios: (1) diferenças entre o SD1 de dois estágios consecutivos menor que 1ms; (2) SD1 menor que 3ms; e (3) ocorrência de ambos os critérios em conjunto. Mediante análise dos resultados verificou-se que os intervalos R-R e SD2 diminuíram progressivamente a cada intervalo de 10% do VO2pico até o final do teste de esforço físico (0,05 < p < 0,01). O SD1 diminuiu significativamente desde 20% até 50% do VO2pico. A partir de 60% até o VO2pico o SD1 não apresentou diferenças significativas. A razão SD1/SD2 aumentou a partir de 60%. O LV1 ocorreu a 54,4 ± 8,8% do VO2pico enquanto o LiVFC, a 52,4 ± 12,5%, 57,0 ± 14,1% e 57,8 ± 13,8% do VO2 pico, para os critérios 1, 2 e 3, respectivamente. Não foram observadas diferenças estatísticas entre o LV1 e os três critérios utilizados para identificação do LiVFC. Observaram-se coeficientes de correlação momento-produto significativos entre o LiVFC identificado mediante os três critérios considerados e o LV1, quando foram utilizados os valores absolutos de VO2. Porém, não foram encontradas correlações estatísticas significativas entre o LiVFC e a identificação do LV1 expresso em proporção do VO2pico. Em assim sendo, concluiu-se que parece ser precipitado tentar empregar o LiVFC como método alternativo na identificação do LV1 de adolescentes.

Nuclear factor-kappa B activation in skeletal muscle of patients with chronic heart failure: correlation with the expression of inducible nitric oxide synthase

BACKGROUND

In the advanced stages of chronic heart failure (CHF) the expression of inducible nitric oxide synthase (iNOS) in skeletal muscle (SM) may contribute to exercise intolerance and early fatigue. Cell culture studies and promoter analysis demonstrated that the transcription factor nuclear factor kappa B (NF-kappaB) is essential for iNOS-expression. The aim of this study was to assess whether NF-kappaB is activated in skeletal muscle of patients with CHF and linked to the expression of iNOS.

METHODS

Skeletal muscle biopsies were obtained from seven CHF patients and seven healthy controls (HC). Nuclear proteins were isolated and the content of activated NF-kappaB was analysed by electrophoretic mobility shift assay (EMSA). Inducible nitric oxide synthase expression in SM was determined by real time polymerase chain reaction (PCR).

RESULTS

The expression of iNOS (1.4 +/- 0.2 versus 0.5 +/- 0.08 arbitrary units, P=0.001) and the activation of NF-kappaB in the SM (0.5 +/- 0.1 versus 0.1 +/- 0.04 arbitrary units, P=0.009) was significantly increased in CHF patients as compared to healthy controls. Furthermore, a linear correlation was observed between NF-kappaB activation and iNOS expression (r=0.78, P<0.001).

CONCLUSIONS

The results of this study indicate for the first time that in the skeletal muscle of patients with chronic heart failure the activation of the transcription factor NF-kappaB is increased and may represent one important regulatory factor for the expression of iNOS in patients. Nevertheless, due to the small sample size this observation has to be confirmed in subsequent studies with more patients.

Carbonic anhydrase inhibition delays plasma lactate appearance with no effect on ventilatory threshold

The effect of carbonic anhydrase (CA) inhibition with acetazolamide (Acz, 10 mg/kg body wt iv) on exercise performance and the ventilatory (VET) and lactate (LaT) thresholds was studied in seven men during ramp exercise (25 W/min) to exhaustion. Breath-by-breath measurements of gas exchange were obtained. Arterialized venous blood was sampled from a dorsal hand vein and analyzed for plasma pH, PCO(2), and lactate concentration ([La(-)](pl)). VET [expressed as O(2) uptake (VO(2)), ml/min] was determined using the V-slope method. LaT (expressed as VO(2), ml/min) was determined from the work rate (WR) at which [La(-)](pl) increased 1.0 mM above rest levels. Peak WR was higher in control (Con) than in Acz sutdies [339 +/- 14 vs. 315 +/- 14 (SE) W]. Submaximal exercise VO(2) was similar in Acz and Con; the lower VO(2) at exhaustion in Acz than in Con (3.824 +/- 0. 150 vs. 4.283 +/- 0.148 l/min) was appropriate for the lower WR. CO(2) output (VCO(2)) was lower in Acz than in Con at exercise intensities >/=125 W and at exhaustion (4.375 +/- 0.158 vs. 5.235 +/- 0.148 l/min). [La(-)](pl) was lower in Acz than in Con during submaximal exercise >/=150 W and at exhaustion (7.5 +/- 1.1 vs. 11.5 +/- 1.1 mmol/l). VET was similar in Acz and Con (2.483 +/- 0.086 and 2.362 +/- 0.110 l/min, respectively), whereas the LaT occurred at a higher VO(2) in Acz than in Con (2.738 +/- 0.223 vs. 2.190 +/- 0.235 l/min). CA inhibition with Acz is associated with impaired elimination of CO(2) during the non-steady-state condition of ramp exercise. The similarity in VET in Con and Acz suggests that La(-) production is similar between conditions but La(-) appearance in plasma is reduced and/or La(-) uptake by other tissues is enhanced after the Acz treatment.

Apoptosis in skeletal myocytes of patients with chronic heart failure is associated with exercise intolerance

OBJECTIVES

The purpose of the study was to investigate if apoptosis occurs in skeletal muscle myocytes and its relation to exercise intolerance in patients with chronic heart failure (CHF).

BACKGROUND

Intrinsic abnormalities of skeletal muscle frequently limit exercise tolerance in CHF patients. Recently, apoptosis has been detected in cardiac myocytes of patients with CHF, suggesting that apoptosis may contribute to the reduced contractile force. The presence and regulation of apoptosis in skeletal myocytes of patients with CHF remains to be defined.

METHODS

Skeletal muscle biopsies (m. vastus lateralis) of 34 CHF patients (New York Heart Association functional class II-III) and eight age-matched healthy control subjects were analyzed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling for the presence of apoptosis, and by immunohistochemistry and videodensitometrical quantification for inducible nitric oxide synthase (iNOS) and Bcl-2 expression. Maximal oxygen consumption (VO2max) was determined by ergospirometry.

RESULTS

Apoptosis was detected in 16/34 (47%) patients with CHF and in none of the healthy subjects. Patients with apoptosis-positive skeletal muscle myocytes exhibited a significantly lower VO2max (12.0 +/- 3.7 vs. 18.2 +/- 4.4 ml/kg/min; p = 0.0005), a higher iNOS expression (6.8 +/- 3.6 vs. 3.7 +/- 2.6% iNOS-positive stained tissue area; p = 0.015) and a lower Bcl-2 expression (1.0 +/- 0.3 vs. 1.4 +/- 0.4% Bcl-2-positive tissue area; p = 0.03) as compared with patients with apoptosis-negative biopsies.

CONCLUSIONS

These results indicate that apoptosis is frequently found in skeletal muscle obtained from CHF patients, which is associated with significant impairment of functional work capacity. In skeletal muscle of these patients, iNOS and Bcl-2 are possibly involved in the regulation of apoptosis.

Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure

BACKGROUND

The purpose of this study was to determine the effects of systemic exercise training on endothelium-mediated arteriolar vasodilation of the lower limb and its relation to exercise capacity in chronic heart failure (CHF). Endothelial dysfunction is a key feature of CHF, contributing to increased peripheral vasoconstriction and impaired exercise capacity. Local handgrip exercise has previously been shown to enhance endothelium-dependent vasodilation in conduit and resistance vessels in CHF.

METHODS AND RESULTS

Twenty patients were prospectively randomized to a training group (n=10, left ventricular ejection fraction [LVEF] 24+/-4%) or a control group (n=10, LVEF 23+/-3%). At baseline and after 6 months, peak flow velocity was measured in the left femoral artery using a Doppler wire; vessel diameter was determined by quantitative angiography. Peripheral blood flow was calculated from average peak velocity (APV) and arterial cross-sectional area. After exercise training, nitroglycerin-induced endothelium-independent vasodilation remained unaltered (271% versus 281%, P=NS). Peripheral blood flow improved significantly in response to 90 microg/min acetylcholine by 203% (from 152+/-79 to 461+/-104 mL/min, P<0.05 versus control group) and the inhibiting effect of L-NMMA increased by 174% (from -46+/-25 to -126+/-19 mL/min, P<0.05 versus control group). Peak oxygen uptake increased by 26% (P<0.01 versus control group). The increase in peak oxygen uptake was correlated with the endothelium-dependent change in peripheral blood flow (r=0.64, P<0. 005).

CONCLUSIONS

Regular physical exercise improves both basal endothelial nitric oxide (NO) formation and agonist-mediated endothelium-dependent vasodilation of the skeletal muscle vasculature in patients with CHF. The correction of endothelium dysfunction is associated with a significant increase in exercise capacity.