The molecular mechanisms by which physical training improves peripheral and coronary artery disease are poorly understood. Bone marrow-derived endothelial progenitor cells (EPCs) are thought to exert ...beneficial effects on atherosclerosis, angiogenesis, and vascular repair.
To study the effect of physical activity on the bone marrow, EPCs were quantified by fluorescence-activated cell sorter analysis in mice randomized to running wheels (5.1+/-0.8 km/d, n=12 to 16 per group) or no running wheel. Numbers of EPCs circulating in the peripheral blood of trained mice were enhanced to 267+/-19%, 289+/-22%, and 280+/-25% of control levels after 7, 14, and 28 days, respectively, accompanied by a similar increase of EPCs in the bone marrow and EPCs expanded from spleen-derived mononuclear cells. eNOS-/- mice and wild-type mice treated with N(G)-nitro-l-arginine methyl ester showed lower EPC numbers at baseline and a significantly attenuated increase of EPC in response to physical activity. Exercise NO dependently increased serum levels of vascular endothelial growth factor and reduced the rate of apoptosis in spleen-derived EPCs. Running inhibited neointima formation after carotid artery injury by 22+/-2%. Neoangiogenesis, as assessed in a subcutaneous disc model, was increased by 41+/-16% compared with controls. In patients with stable coronary artery disease (n=19), moderate exercise training for 28 days led to a significant increase in circulating EPCs and reduced EPC apoptosis.
Physical activity increases the production and circulating numbers of EPCs via a partially NO-dependent, antiapoptotic effect that could potentially underlie exercise-related beneficial effects on cardiovascular diseases.
Background
Exercise training has now become established practice in patients with chronic heart failure. Women are often under-represented in intervention studies compared to men. For this reason it ...was our aim to conduct a combined endurance and muscle strength training program to evaluate its effect on clinical performance data and health-related psychosocial factors in women and men.
Methods
One hundred and sixteen women, mean age 69 ± 9 years, body mass index (BMI) 25.8 ± 4.9, and 169 men, mean age 66 ± 9 years, BMI 26.6 ± 3.6 underwent combined endurance/resistance training. The training program lasted 29 ± 7 days and comprised bicycle ergometer training, a 6-min walk test as a training unit and muscle strength training for the lower and upper extremities.
Results
Differences between women and men were found in clinical parameters. In particular, statistically significant differences were revealed between the women and men with regard to cardiopulmonary performance. Quality of life was significantly improved on discharge with regard to both physical and mental health, whereas anxiety and depression showed no significant alteration.
Conclusion
A specialized in-hospital program for women and men combining endurance/resistance training and education is feasible. But our program revealed a very low level of cardiopulmonary performance in women. Women need to be encouraged and motivated to participate in such programs.
Chronic heart failure (CHF) will become one of the greatest medical challenges during the next decades. This is especially true with regard to elderly patients. Besides medical diagnostics and drug ...therapy, efficient treatment of CHF must also include exercise training.
The purpose of our study was 1) to record health-related quality of life (QOL) in elderly patients with CHF and 2) to assess the efficacy of a training program, as well as to evaluate any changes detected during a six month follow-up.
In our non-randomized study, 116 patients, divided according to age into Group 1 (>70 years) and Group 2 (<70 years), took part in a 4-week training program.
There were differences in the clinical parameters and the QOL between the older and the younger patients both after 4 weeks and at the follow-up. After six months, however, the older patients again recorded having an inferior QOL to that of the younger patients.
Elderly patients can also benefit from physical exercise training, with improvement in clinical parameters and QOL. In order to maintain the subjectively improved QOL in the long term, however, continued special heart failure education and support is required.
Background:
There is now evidence that moderate training plays an important role in the treatment of chronic heart failure. No clear instructions exist to date as to how such training programs should ...be carried out.
Aim:
to assess the efficiency of a training program including bicycle ergometer training, moderate muscle strength training and the 6‐min walk test and their influence on quality of life, anxiety and depression.
Methods and results:
Patients (67 male, 21 female) underwent a standardized 4‐week training program. Baseline data: LVEF=31±8%; LVEDD=143±59 ml; peak VO2=13.9±4.6 kg/ml. No adverse side effects could be observed. At discharge LVEF was 37±9%, (P=0.001); LVEDD=131±44ml (P=0.01); and peak VO2=15.4±5.0 kg/ml. Quality of life improved significantly in nearly all domains and in summary score. There were no significant changes in anxiety and depression. There is a negative correlation between the initial workload and changes in physical health (r=−0.42, P=0.001) and only a weak correlation between age and positive changes in physical health (r=0.26, P=0.05).
Conclusions:
A standardized training program including moderate muscle strength training could be performed safely and demonstrated improvement in clinical parameters and quality of life.
Background
The rate constant for global fatty acid influx (k1) was studied in 12 male patients with dilated cardiomyopathy (DCM). Method: 10 normal subjects served as controls. 201‐Thallium (201TI) ...and 123I‐phenyl‐pentadecanoic acid (IPPA) were administered during bicycle exercise under fasting conditions.
Results
All patients showed non‐homogeneous tracer uptake defects for 201TI and IPPA. k1 was significantly higher in DCM patients than controls. k1 showed significant inverse correlation between cardiac index, left‐ventricular ejection fraction, left‐ventricular enddiastolic pressure and echocardiographic left‐ventricular ejection fraction.
Conclusion
We presume that an increased regional rate constant of IPPA influx into the myocardial tissue in patients with DCM reflects a compensatory mechanism of altered myocardium.
Percutaneous mitral valvulotomy has been shown to be an accept able alternative to surgery as treatment for selected patients with severe mitral stenosis. Uncertainty still exists regarding ...predictors of unsuccessful outcome.
308 patients with severe mitral stenosis underwent Inoue single balloon valvulotomy over a 48-month period and were followed up for a mean of 14.5 +/- 16.8 months (range one to 64 months). Two hundred and sixty-seven (Group I) improved clinically and remained stable throughout the follow up, while subsequent surgery was required in 41 (Group II) after 38.2 +/- 143.5 days (range one to 1,212). Clinical and echocardiographic parameters of the two groups were compared to find significant predictors of an unsuccessful outcome.
Significant differences between the groups were observed for NYHA class (2.7 +/- 0.6 vs. 2.9 +/- 0.6, p < 0.05), mitral valve area (1.0 +/- 0.3 vs. 0.9 +/- 0.2 cm2, p < 0.01), left atrial end-systolic dimension by echo (51.3 +/- 8.0 vs. 55.4 +/- 10.2 mm, p < 0.01) and an echocardiographic scoring system including grading for eccentricity of the mitral orifice and distribution of commissural calcification (7.5 +/- 2.0 for Group I and 8.7 +/- 2.0 for Group II, p < 0.001).
Mitral valves that are more likely to have an unsuccessful outcome can be identified by hemodynamic, clinical and echocardiographic criteria, including grading for eccentricity of the mitral orifice and distribution of commissural calcification.
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