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Dirkes SM, Kozlowski C. Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions. Crit Care Nurse 2020; 39:33-42. [PMID: 31154329 DOI: 10.4037/ccn2019654] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease length of stay in a rehabilitation facility. Yet many barriers exist to implementing early mobility effectively, including patient acuity, uncertainty about when to start mobilizing the patient, staffing and equipment needs, increased costs, and limited nursing time. Implementation of early mobility requires interdisciplinary collaboration, commitment, and tools that facilitate mobility and prevent injury to nurses. This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reducing sedation, monitoring the patient's ability to wean from the ventilator, and encouraging early mobility. It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome them.
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Affiliation(s)
- Susan M Dirkes
- Susan M. Dirkes and Charles Kozlowski are staff nurses at the University of Michigan hospital, Ann Arbor, Michigan.
| | - Charles Kozlowski
- Susan M. Dirkes and Charles Kozlowski are staff nurses at the University of Michigan hospital, Ann Arbor, Michigan
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Nederend I, Schutte NM, Bartels M, Ten Harkel ADJ, de Geus EJC. Heritability of heart rate recovery and vagal rebound after exercise. Eur J Appl Physiol 2016; 116:2167-2176. [PMID: 27614881 PMCID: PMC5118411 DOI: 10.1007/s00421-016-3459-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022]
Abstract
Purpose The prognostic power of heart rate recovery (HRR) after exercise has been well established but the exact origin of individual differences in HRR remains unclear. This study aims to estimate the heritability of HRR and vagal rebound after maximal exercise in adolescents. Furthermore, the role of voluntary regular exercise behavior (EB) in HRR and vagal rebound is tested. Methods 491 healthy adolescent twins and their siblings were recruited for maximal exercise testing, followed by a standardized cooldown with measurement of the electrocardiogram and respiratory frequency. Immediate and long-term HRR (HRR60 and HRR180) and vagal rebound (heart rate variability in the respiratory frequency range) were assessed 1 and 3 min after exercise. Multivariate twin modeling was used to estimate heritability of all measured variables and to compute the genetic contribution to their covariance. Results Heritability of HRR60, HRR180 and immediate and long-term vagal rebound is 60 % (95 % CI: 48–67), 65 % (95 % CI: 54–73), 23 % (95 % CI: 11–35) and 3 % (95 % CI: 0–11), respectively. We find evidence for two separate genetic factors with one factor influencing overall cardiac vagal control, including resting heart rate and respiratory sinus arrhythmia, and a specific factor for cardiac vagal exercise recovery. EB was only modestly associated with resting heart rate (r = −0.27) and HRR (rHRR60 = 0.10; rHRR180 = 0.19) with very high genetic contribution to these associations (88–91 %). Conclusions Individual differences in HRR and immediate vagal rebound can to a large extent be explained by genetic factors. These innate cardiac vagal exercise recovery factors partly reflect the effects of heritable differences in EB.
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Affiliation(s)
- Ineke Nederend
- Department of Biological Psychology, Faculty of behavioral and Movement Sciences, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. .,EMGO + Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Nienke M Schutte
- Department of Biological Psychology, Faculty of behavioral and Movement Sciences, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,EMGO + Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Meike Bartels
- Department of Biological Psychology, Faculty of behavioral and Movement Sciences, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,EMGO + Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, LUMC University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Eco J C de Geus
- Department of Biological Psychology, Faculty of behavioral and Movement Sciences, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.,EMGO + Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Cardiovascular recovery from psychological and physiological challenge and risk for adverse cardiovascular outcomes and all-cause mortality. Psychosom Med 2015; 77:215-26. [PMID: 25829236 PMCID: PMC4397577 DOI: 10.1097/psy.0000000000000171] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Exaggerated cardiovascular (CV) reactivity to laboratory challenge has been shown to predict future CV morbidity and mortality. CV recovery has been less studied and has yielded inconsistent findings, possibly due to the presence of moderators. Reviews on the relationship between CV recovery and CV outcomes have been limited to cross-sectional studies and have not considered methodological factors. We performed a comprehensive meta-analytic review of the prospective literature investigating CV recovery to physical and psychological challenge and adverse CV outcomes. METHODS We searched PsycINFO and PubMed for prospective studies investigating the relationship between CV recovery and adverse CV outcomes. Studies were coded for variables of interest and for effect sizes. We conducted a random-effects weighted meta-analysis. Moderators were examined with analysis of variance-analog and meta-regression analyses. RESULTS Thirty-seven studies met the inclusion criteria (n = 125,386). Impaired recovery from a challenge predicted adverse CV outcomes (summary effect, r = 0.17, p < .001). Physical challenge was associated with larger predictive effects than psychological challenge. Moderator analyses revealed that recovery measured at 1 minute postexercise, passive recovery, use of mortality as an outcome measure, and older sample age were associated with larger effects. CONCLUSIONS Poor recovery from laboratory challenges predicts adverse CV outcomes, with recovery from exercise serving as a particularly strong predictor of CV outcomes. The overall effect size for recovery and CV outcomes is similar to that observed for CV reactivity and suggests that the study of recovery may have incremental value for understanding adverse CV outcomes.
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Dischl B, Engelberger RP, Gojanovic B, Liaudet L, Gremion G, Waeber B, Feihl F. Enhanced diastolic reflections on arterial pressure pulse during exercise recovery. Scand J Med Sci Sports 2011; 21:e325-33. [DOI: 10.1111/j.1600-0838.2011.01298.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hemodynamic responses and linear and non-linear dynamics of cardiovascular autonomic regulation following supramaximal exercise. Eur J Appl Physiol 2008; 105:525-31. [DOI: 10.1007/s00421-008-0930-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2008] [Indexed: 12/22/2022]
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Aktaş A, Yalcin H, Koyuncu A, Aydinalp A, Müderrisoglu H. The influence of post-exercise cardiac changes on thallium-gated myocardial perfusion scintigraphy findings in normal subjects. Nucl Med Commun 2005; 26:109-14. [PMID: 15657502 DOI: 10.1097/00006231-200502000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM During recovery after exercise, the heart rate and blood pressure return to a resting state more rapidly than the end-systolic left ventricular dimensions and fractional shortening. The aim of this study was to assess how exercise-related cardiac changes affect the interpretation of myocardial perfusion images in normal subjects. Systolic cardiac parameters on gated stress and rest images were evaluated in healthy young and elderly subjects. METHODS Twenty-six healthy young and 20 healthy elderly subjects participated in the study. An injection of 111-130 MBq of thallium-201 (201Tl) was given at peak exercise. Rest images were acquired 2.5 h after stress acquisition, 15 min after a second injection of 18.5-37 MBq of 201Tl. Data were analysed using automatic-processing software for quantitative gated single photon emission computed tomography (SPECT) (QGS). The parameters derived from QGS were the end-systolic volume (ESV), end-diastolic volume (EDV), left ventricular ejection fraction (LVEF), end-systolic surface area (ESSA) and end-diastolic surface area (EDSA). The difference between wall thickening in the basal and apical segments (Delta WT) was also calculated. Perfusion images were visually assessed for differences in cardiac size, evidence of reversible hypoperfusion and hot spots. RESULTS In the young group, LVEF was approximately 6% higher at stress than at rest. EDV, ESV, ESSA and EDSA were all significantly lower, and Delta WT was significantly higher, at stress than at rest. In the elderly group, the mean LVEF at stress was slightly higher than the finding at rest (P<0.05). Visual evaluation of perfusion images revealed mild reversible stress hypoperfusion in the inferoseptal region in eight young male subjects. CONCLUSIONS In healthy young subjects, post-exercise cardiac changes affect systolic functions detected on gated thallium myocardial perfusion scintigraphy, resulting in a smaller heart size during stress. This finding, accompanied by a significant difference in apex to base counts during stress, may cause basal portions of the heart to appear ischaemic. The absence of these findings in the elderly suggests a decrease in contractility with age.
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Affiliation(s)
- Ayşe Aktaş
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, 06490 Ankara, Turkey.
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Takahashi T, Hayano J, Okada A, Saitoh T, Kamiya A. Effects of the muscle pump and body posture on cardiovascular responses during recovery from cycle exercise. Eur J Appl Physiol 2005; 94:576-83. [PMID: 15928933 DOI: 10.1007/s00421-005-1369-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2005] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to characterize the effects of muscular contractions (the muscle pump) and body posture on cardiovascular responses during recovery from moderate exercise in the upright-sitting or supine positions. Heart rate (HR), stroke volume (SV), and cardiac output (CO) were measured in seven young male subjects at rest and during 10-min of cycle exercise at 60% of peak oxygen uptake (VO2peak). This was followed by either complete rest for 5 min (inactive recovery) or cycling at VO2peak for 5 min (active recovery) in the upright or supine positions. In the upright position, an initial rapid decrease in HR was followed by a gradual decrease in HR, and this response was similar when comparing inactive and active recoveries. Upright SV during inactive recovery decreased gradually to the pre-exercise resting level, whereas upright SV during active recovery remained significantly elevated. In contrast, in the supine position, the HR during active recovery decreased, but remained significantly higher than that during inactive recovery. Changes in supine SV were similar when comparing inactive and active recovery. Thus, maintenance of SV and HR resulted in significantly greater CO during active recovery than during inactive recovery, regardless of body position. HR was greater during supine active-recovery than during supine inactive-recovery, and there was no difference in SV. These data suggest that the muscle pump is less important in facilitating venous return and vagal resumption in the supine position as compared to the upright position.
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Affiliation(s)
- Tatsuhisa Takahashi
- Department of Mathematical Information Science, Asahikawa Medical College, Asahikawa 078-8510, Japan.
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Crisafulli A, Orrù V, Melis F, Tocco F, Concu A. Hemodynamics during active and passive recovery from a single bout of supramaximal exercise. Eur J Appl Physiol 2003; 89:209-16. [PMID: 12665987 DOI: 10.1007/s00421-003-0796-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2002] [Indexed: 10/22/2022]
Abstract
The aim of this work was to study the differences in cardiovascular response during two modes of recovery [active (AR): pedalling at 40 W; and passive (PR): complete rest seated] from a single bout of supramaximal exercise. Eight male amateur soccer players underwent two supramaximal cycle-ergometer tests, each consisting of pedalling against a resistance equivalent to 150% of the maximum workload achieved in a previous incremental test, followed by randomly assigned AR or PR. Cardiodynamic variables were obtained using an impedance cardiograph. Subjects were also connected to a sphygmomanometer, for systolic and diastolic blood pressure, and to a metabolimeter for oxygen uptake (VO(2)) assessments. We measured: heart rate (HR), stroke volume (SV), cardiac output (CO), the inverse of myocardial contractility calculated as pre-ejection period/left ventricular ejection time ratio (PEP/LVET), mean blood pressure (MBP), thoracic electrical impedance ( Z(0)) as an index of central blood volume, and arterio-venous oxygen difference (A-V O(2) Diff.). PR caused a lower CO compared to AR [mean (SE): 7 (0.7) vs. 10.4 (0.6) l.min(-1 )at the 5th min of recovery] due to lower HR [106.2 (3.6) vs. 121.8 (4.5) bpm at the 5th min of recovery], SV [67.1 (5) vs. 86.1 (4.8) ml at the 5th min of recovery], and PEP/VET values [0.44 (0.007) vs. 0.39 (0.015) at the 5th min of recovery]. No differences were found in MBP and Z(0) between PR and AR [95.1 (1.9) vs. 92.3 (2.7) mmHg and 26.2 (1.1) vs. 26.6 (1) Omega respectively at the 5th min of recovery], while A-V O(2) Diff. values were higher during AR than during PR [108.8 (4.3) vs. 75.2 (5.4) ml.l(-1) at the 5th min of recovery]. Thus, although after a single bout of supramaximal exercise SV and CO are lower during PR than during AR, these differences are not due to an impairment of cardiovascular function, but are fully explained by the lesser muscular engagement that leads to a reduction in stimuli deriving from mechanoreceptors and central commands, thus causing a faster return of myocardial contractility and HR to resting values.
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Affiliation(s)
- Antonio Crisafulli
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy
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Roest AAW, de Roos A, Lamb HJ, Helbing WA, van den Aardweg JG, Doornbos J, van der Wall EE, Kunz P. Tetralogy of Fallot: postoperative delayed recovery of left ventricular stroke volume after physical exercise assessment with fast MR imaging. Radiology 2003; 226:278-84. [PMID: 12511702 DOI: 10.1148/radiol.2261011164] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In six asymptomatic patients with corrected tetralogy of Fallot and nine healthy control subjects, the authors assessed left ventricular (LV) function during recovery from supine bicycle exercise by performing fast magnetic resonance (MR) flow mapping in the ascending aorta. Abnormal recovery of LV function after exercise was observed in the patients. MR flow mapping allows assessment of cardiac recovery after exercise.
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Affiliation(s)
- Arno A W Roest
- Department of Radiology, Leiden University Medical Center, The Netherlands
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Nottin S, Vinet A, Mandigout S, Nguyen LD, Stecken F, Ounissi F, Lecoq AM, Obert P. Left ventricular dynamics during early recovery from maximal exercise in boys and men. Med Sci Sports Exerc 2002; 34:1951-7. [PMID: 12471301 DOI: 10.1097/00005768-200212000-00014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED A transient increase in left ventricular emptying has been reported in adults during the early recovery from submaximal upright exercise. PURPOSE To investigate whether this "overshoot" occurs also after maximal exercise, and whether it is an age-related phenomenon. METHODS Ten healthy young men (mean age: 22.5 +/- 1.5 yr) and 17 healthy prepubertal boys (11.5 +/- 0.8 yr) performed an upright cycle test until exhaustion. Respiratory gas exchange, heart rate, left ventricular dimensions (two-dimensional echocardiography method) as well as blood pressures (manual sphygmomanometry) were assessed and systemic vascular resistances were calculated at rest, during the final minute of the test, and during a 10-min recovery period. RESULTS An improvement of cardiac emptying, characterized by a decrease in left ventricular end-systolic diameter, was observed in adults only. Moreover, during the first minute of recovery, a larger decrease in heart rate -21.8 +/- 7.6% and -13.7 +/- 6.3 beat.min, respectively, in children and adults, P < 0.01) and a larger increase in systemic vascular resistance (+24.1 +/- 18.2% and +6.4 +/- 12.6%, P < 0.05) were observed in the boys rather than in the adults. CONCLUSION Our results suggest that a higher increase in cardiac afterload and a more prominent decrease in heart rate may be responsible in part for the absence of cardiac overshoot in children.
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Affiliation(s)
- Stéphane Nottin
- Laboratoire de Physiologie des Adaptations Cardiovasculaires à L'Exercice, Faculté des Sciences, Département STAPS, 33 rue Louis Pasteur, 84000 Avignon, France.
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11
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Roest AA, Kunz P, Helbing WA, Lamb HJ, Vliegen HW, van den Aardweg JG, Ruitenberg Q, de Roos A, van der Wall EE. Prolonged cardiac recovery from exercise in asymptomatic adults late after atrial correction of transposition of the great arteries: evaluation with magnetic resonance flow mapping. Am J Cardiol 2001; 88:1011-7. [PMID: 11703998 DOI: 10.1016/s0002-9149(01)01979-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
After atrial correction of transposition of the great arteries (TGA), dysfunction of the systemic right ventricle at rest and during exercise has been reported. Information on changes in systemic right ventricular function during recovery from exercise is lacking. This study evaluates cardiac recovery from supine exercise using magnetic resonance (MR) imaging in patients with asymptomatic TGA after atrial correction. Flow in the ascending aorta, representing stroke volume of the systemic ventricle, was assessed with MR flow mapping in 10 asymptomatic patients with atrially corrected TGA and in 12 controls at rest during exercise and an 8-minute recovery period. In response to exercise, the patients had a smaller increase in heart rate, stroke volume, and cardiac output than did controls. After exercise, no significant difference in halftime of heart rate recovery was observed (patients, 48 +/- 7 seconds; controls, 39 +/- 4 seconds [p >0.05]). In the patients, the time course of stroke volume recovery was significantly different (p <0.001). Stroke volume in the patients, as a percent difference from rest, remained significantly elevated, from 2.5 minutes (+16 +/- 5% vs +7 +/- 6%; p <0.05) to 8 minutes (+4 +/- 7% vs -3 +/- 5%; p <0.05) after exercise. Subsequently, cardiac output remained significantly elevated, from 4.5 minutes (+27 +/- 13% vs +15 +/- 11%; p <0.05) to 7 minutes (+22 +/- 11% vs +12 +/- 12%; p <0.05) after exercise. We conclude that heart rate recovery is within normal limits in patients with atrially corrected TGA. Furthermore, cardiac recovery from exercise, assessed with MR flow mapping, is prolonged in patients with asymptomatic TGA after atrial correction. Abnormal recovery may reflect dysfunction of the systemic right ventricle and an altered metabolic response to exercise.
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Affiliation(s)
- A A Roest
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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12
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Becassis P, Hayot M, Frapier JM, Leclercq F, Beck L, Brunet J, Arnaud E, Prefaut C, Chaptal PA, Davy JM, Messner-Pellenc P, Grolleau R. Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis: functional consequence of small-size aortic prosthesis. J Am Coll Cardiol 2000; 36:871-7. [PMID: 10987613 DOI: 10.1016/s0735-1097(00)00815-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by VO2 measurement during an exhaustive cycle ergometer exercise. BACKGROUND The determinants of exercise capacity after mechanical aortic replacement are not well known. The selection of small valve sizes has, however, been described as an independent predictor of exercise intolerance as assessed by exercise duration. Maximal oxygen uptake (VO2max) is a good index of exercise tolerance. METHODS Fourteen patients were eligible, with a mean age of 62 +/- 6 years. Before surgery, the mean left ventricular ejection fraction (LVEF) was 73 +/- 8%. Two valve types with small diameter (19 to 21 mm) were used: Medtronic Hall and St Jude Medical. A healthy sedentary control group (n = 14) paired for age, weight and size was constituted. After one year of follow-up, cardiorespiratory tests were performed. In addition, the gradients through the prostheses were determined by continuous pulse Doppler at rest and immediately after the cardiorespiratory test. RESULTS The exercise tolerance was not significantly different between the control group and patient group: VO2 peak (21.7 vs. 20.4 ml/kg/min; p = 0.42), workloads (115 vs. 93 W; p = 0.13) and ventilatory parameters were similar. The mean and peak gradients at rest and during exercise were not correlated with VO2max. CONCLUSIONS Valve replacement by small aortic prosthesis does not seem to be a factor of exercise intolerance as assessed by VO2max in patients without LVEF dysfunction before surgery.
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Affiliation(s)
- P Becassis
- Services de Cardiologie, Hopital Arnaud de Villeneuve, Montpellier, France
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Tanabe Y, Takahashi M, Hosaka Y, Ito M, Ito E, Suzuki K. Prolonged recovery of cardiac output after maximal exercise in patients with chronic heart failure. J Am Coll Cardiol 2000; 35:1228-36. [PMID: 10758965 DOI: 10.1016/s0735-1097(00)00517-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study was to characterize the kinetics of cardiac output during recovery from maximal exercise in patients with chronic heart failure (CHF). BACKGROUND Recent studies have shown that oxygen uptake kinetics during recovery from exercise are delayed in patients with CHF. However, the kinetics of cardiac output during recovery from maximal exercise in CHF has not been examined. METHODS Thirty patients with CHF performed maximal upright ergometer exercise with respiratory gas analysis. Kinetics of oxygen uptake (VO2) and carbon dioxide output (VCO2) during recovery were characterized by T1/2, the time to reach 50% of the peak values. Cardiac output was measured at 1-min intervals during exercise and recovery. Kinetics of cardiac output during recovery were characterized by the ratios of cardiac output during the first 4 min of recovery to cardiac output at peak exercise. Overshoot of cardiac output was defined as a further increase in cardiac output at 1 min of recovery above the cardiac output at peak exercise. RESULTS Both T1/2 VO2 and T1/2 VCO2 increased as CHF worsened. The ratios of cardiac output during recovery to cardiac output at peak exercise were significantly correlated with T1/2 VO2 (r = 0.47 to 0.62, p < 0.05) and T1/2 VCO2 (r = 0.40 to 0.70, p < 0.05). There was a negative correlation between cardiac index at peak exercise and both T1/2 VO2 (r = -0.65, p < 0.001) and T1/2 VCO2 (r = -0.60, p < 0.001). Overshoot of cardiac output was recognized in 11 of 30 patients. Cardiac index at peak exercise was significantly lower in patients with overshoot (4.5 +/- 0.9 L/min/m2) than in those without overshoot (6.1 +/- 2.1 L/min/m2, p < 0.05). However, because of a continued increase in cardiac output at 1 min of recovery in patients with overshoot, there were no differences in cardiac index after the first minute of recovery. Heart rate at peak exercise and recovery of heart rate did not differ between these groups. Overshoot of cardiac output was caused by a rebound increase in stroke volume which was due to a reduction in systemic vascular resistance. CONCLUSIONS Prolonged kinetics of VO2 or VCO2 during recovery from maximal exercise represent impairment of circulatory response to exercise and delayed recovery of cardiac output after exercise. Overshoot of cardiac output at 1 min of recovery was characteristic of severe CHF with poor cardiac output response to exercise.
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Affiliation(s)
- Y Tanabe
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Shibata City, Japan
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Carter R, Watenpaugh DE, Wasmund WL, Wasmund SL, Smith ML. Muscle pump and central command during recovery from exercise in humans. J Appl Physiol (1985) 1999; 87:1463-9. [PMID: 10517779 DOI: 10.1152/jappl.1999.87.4.1463] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We sought to determine the relative contributions of cessation of skeletal muscle pumping and withdrawal of central command to the rapid decrease in arterial pressure during recovery from exercise. Twelve healthy volunteers underwent three exercise sessions, each consisting of a warm-up, 3 min of cycling at 60% of maximal heart rate, and 5 min of one of the following recovery modes: seated (inactive), loadless pedaling (active), and passive cycling. Mean arterial pressure (MAP), cardiac output, thoracic impedance, and heart rate were measured. When measured 15 s after exercise, MAP decreased less (P < 0.05) during the active (-3 +/- 1 mmHg) and passive (-6 +/- 1 mmHg) recovery modes than during inactive (-18 +/- 2 mmHg) recovery. These differences in MAP persisted for the first 4 min of recovery from exercise. Significant maintenance of central blood volume (thoracic impedance), stroke volume, and cardiac output paralleled the maintenance of MAP during active and passive conditions during 5 min of recovery. These data indicate that engaging the skeletal muscle pump by loadless or passive pedaling helps maintain MAP during recovery from submaximal exercise. The lack of differences between loadless and passive pedaling suggests that cessation of central command is not as important.
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Affiliation(s)
- R Carter
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, Texas 76107, USA.
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Cohen-Solal A, Laperche T, Morvan D, Geneves M, Caviezel B, Gourgon R. Prolonged kinetics of recovery of oxygen consumption after maximal graded exercise in patients with chronic heart failure. Analysis with gas exchange measurements and NMR spectroscopy. Circulation 1995; 91:2924-32. [PMID: 7796502 DOI: 10.1161/01.cir.91.12.2924] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) often complain of prolonged dyspnea after exercise. The determinants of oxygen consumption after exercise in these patients are unknown. We hypothesized that the kinetics of oxygen consumption recovery after graded exercise was prolonged in parallel with the recovery of muscle energy stores, was not affected by the exercise level, and could be used to assess the circulatory response to exercise. METHODS AND RESULTS Seventy-two patients with CHF in Weber's class A (n = 28), B (n = 21), and C/D (n = 23) and 13 healthy subjects performed maximal upright bicycle exercise with breath-by-breath respiratory gas analysis. Kinetics of recovery of ventilation (VE), oxygen consumption (VO2), and CO2 production (VCO2) after exercise were characterized by T1/2, the time to reach 50% of the peak value. T1/2 VO2 (seconds) increased with the severity of CHF (97 +/- 17 for CHF A [P < .05 versus CHF B, P < .05 versus CHF C/D], 119 +/- 22 for CHF B [P < .05 versus control subjects, P < .05 versus CHF A, and P < .05 versus CHF C/D], 155 +/- 55 for CHF C/D [P < .05 versus control subjects, P < .05 versus CHF A, and P < .05 versus CHF B] compared with 77 +/- 17 for control subjects). T1/2 VCO2 and T1/2 VE also increased similarly with the worsening of CHF. T1/2 VO2 was correlated negatively with peak VO2 (r = .65) and was reproducible (r = .96). To study the relation between T1/2 VO2 and the duration of exercise, 10 healthy subjects and 22 patients underwent a second graded test at 75% and/or 50% of peak workload. T1/2 VO2 was minimally shortened, at only 50% of peak workload (P = .02). Finally, 19 patients underwent 31P nuclear magnetic resonance spectroscopy of the anterior compartment of the leg during exercise; the half-time of recovery of the ratio of inorganic phosphate to creatine phosphate (T1/2 Pi/PCr), reflecting the level of involvement of oxidative metabolism in the restoration of energetic metabolites after exercise, was linearly correlated with the half-time of VO2 recovery (r = .70, P < .01). CONCLUSIONS Postexercise T1/2 VO2 increases when CHF worsens, perhaps in part a result of slower kinetics of recovery of muscle energy stores. The time course of oxygen consumption recovery may represent a simple new criterion for measuring the impairment of the circulatory response to exercise in CHF, even submaximal exercise.
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Affiliation(s)
- A Cohen-Solal
- Service de Cardiologie, Hôpital Beaujon, Clichy, France
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Kilgour RD, Mansi JA, Williams PA. Cardiodynamic responses during seated and supine recovery from supramaximal exercise. CANADIAN JOURNAL OF APPLIED PHYSIOLOGY = REVUE CANADIENNE DE PHYSIOLOGIE APPLIQUEE 1995; 20:52-64. [PMID: 7742770 DOI: 10.1139/h95-004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The cardiodynamic responses of 9 healthy men (mean age +/- SD, 22.3 +/- 2.0 yrs) were measured during seated and supine passive recovery following the Wingate Anaerobic Power Test (WAPT). Stroke index (SI) was determined noninvasively using impedance cardiographic techniques. During the initial stages of seated recovery, SI progressively increased (1 min, 60.4 +/- 6.6 ml/m2; 3 min, 64.6 +/- 5.9 ml/m2) and achieved peak levels by 5 min (70.5 +/- 6.2 ml/m2). Between Minutes 3 and 10 of seated recovery, SI was significantly (p < or = 0.05) higher than the preexercise value (46.0 +/- 4.0 ml/m2). A similar response pattern for SI was observed during supine recovery. The systemic vascular resistance index (SVRI) decreased by 101% and 114% from preexercise baseline values after 1 min of recovery in the supine and seated postures, respectively. The persistent rise in SI during the first 10 min of passive seated recovery may be explained by the sustained attenuation in SVRI coupled with the anticipated residual myocardial inotropic effects following the WAPT.
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Affiliation(s)
- R D Kilgour
- Department of Exercise Science, Concordia University, Montréal
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