Metabolic response to exercise and muscle disease

Physical fitness through exercise is the rage of today. Almost everybody is indulging in various forms of exercise from weight lifting to marathons. These regimens presuppose a normal muscle metabolism. However, a significant number of so-called normals end up with the symptoms of cramps, fatigue, and, in advanced cases, myoglobinuria. Exercise forms the mainstay of rehabilitation of patients with neurologic disorders manifesting as paresis or paralysis, and certain rheumatologic or metabolic problems are also handled via the medium of exercise therapy. It is, thus, imperative that there should be a clear understanding of normal muscle composition and metabolic responses. We will summarize the histology, histochemistry, physiology and metabolic responses of normal muscle to exercise and put this information in perspective in the light of various muscle disorders.     

Oxygen consumption during calisthenic exercise in women with coronary artery disease

The purpose of this study was to compare the oxygen consumption (VO2) during calisthenic exercises in middle-aged women (aged 43-63 years) with and without coronary artery disease (CAD). Indirect calorimetry was used to measure VO2 in 15 healthy women and 15 women with CAD. Four exercises were performed for three minutes each before measurements of VO2 were taken. The exercises were 1) sitting knee extension, 2) standing hip flexion, 3) an upper extremity range-of-motion exercise, and 4) lateral trunk flexion. Using an analysis of covariance, no significant difference was found in VO2 between the two groups; however, there was a significant difference among the four exercises. Oxygen consumption was lowest for both groups during the knee extension and the lateral trunk flexion exercises; both groups demonstrated the highest levels for VO2 during the hip flexion exercise. This study provides evidence that the energy cost of these low-intensity calisthenics is similar for healthy women and women with CAD.     

Group exercise: a nursing therapy in Parkinson's disease

People with Parkinson's disease often exhibit diminished mobility, depression, and social isolation. An exercise regimen is recommended for these people as a means of enhancing mobility, improving balance and coordination, and increasing independence. The purpose of this study was to determine the effect of a nurse-directed group program of non-aerobic flexibility exercise on indices of subjective and objective mobility, functional ability, affect, and perceived social support of a selected group of people with Parkinson's disease. Seven subjects participated in a within-subject-control small-n experimental design study, testing the effect of an eight-week structured group exercise group on indices of physical and psychosocial functioning. Significant differences were seen in objective mobility and subjective overall function. Change in affect was mixed, and improved perception of social support was observed. The small sample size and absence of control groups limit the ability to generalize from this study. However, the positive results in a variety of human responses to a chronic disease encourage further studies to determine the magnitude and consistency of the effects seen in this study. Further demonstration of improved functional status and well-being following a group program of exercise would provide a rationale for a cost-effective nursing therapy for people with Parkinson's disease.     

重症手足口病患儿的氧疗和气道管理

手足口病是以婴幼儿发病为主的常见传染病,大多数患者症状轻微,以发热和手、足、口腔等部位的皮疹或疱疹为主要特征.重症患者可并发无菌性脑膜炎、脑炎、急性迟缓性麻痹、心肌损害、严重肺水肿等,病情进展快,病死率高,以EV71感染引起的重症患者比例较大.2008年4-5月,本院收治手足口病患者200余例,其中重症患儿16例,现将救治结果报告如下.     

Respiratory and circulatory adaptation to isometric and dynamic exercise in chronic lung disease

Summary. Changes at the beginning of isometric and dynamic low level exercise were studied in 23 patients with chronic lung disease. Ventilation, oxygen consumption and vascular pressures in systemic and pulmonary circulation were continuously monitored, and cardiac output was measured by thermodilution every minute. Circulatory changes took place suddenly at the beginning of isometric exercise and gradually during dynamic exercise. Ventilatory changes followed almost the same progressive pattern in both types of exercise. Ventilation increase in relation to oxygen uptake was slightly smaller during isometric exercise. Pulmonary artery pressure showed no further increase after the initial change, although ventilation was still rising.     

Cardiorespiratory response to exercise testing in individuals with Alzheimer's disease

Billinger SA, Vidoni ED, Honea RA, Burns JM. Cardiorespiratory response to exercise testing in individuals with Alzheimer's disease.

Objective

To examine exercise testing response in Alzheimer's disease (AD) and possible disease-related change over time.

Design

Retrospective assessment of a 2-year observational study.

Setting

University medical center.

Participants

Individuals without dementia (n=50) and with AD (n=31).

Interventions

Not applicable.

Main Outcome Measures

Participants underwent a clinical dementia evaluation and performed an incremental exercise test using a treadmill and the modified Bruce protocol at baseline and at a 2-year follow-up. We examined oxygen consumption, minute ventilation, heart rate, and ventilatory equivalents for oxygen and carbon dioxide at submaximal and peak exercise intensities to determine whether the measures were different between groups or over time.

Results

Participants with AD and those without dementia performed similarly at submaximal effort, and both groups showed similar changes in exercise response over 2 years. However, nondemented individuals had consistently higher values of oxygen consumption (P≤.02) and minute ventilation at peak effort at baseline (P=.003).

Conclusions

Individuals with AD demonstrate physiologic responses to submaximal exercise effort that are not significantly different than individuals without dementia. However, differences are apparent at the extreme of effort.     

Ambulatory oxygen therapy, exercise, and survival with advanced chronic obstructive pulmonary disease (the Nocturnal Oxygen Therapy Trial revisited)

The NOTT study showed improved survival in COT patients who received LTOT for longer periods (mean 17.7 h/d, median 19.4 h/d) from an ambulatory oxygen system, compared with the survival of NOT patients who received oxygen for a mean of 11.8 h/d from a stationary system. The differences in survival could have been due to the method or the duration of oxygen therapy, or both. An increase in cardiac output and increased oxygenation of the arterial blood (oxygen content) results in increased tissue oxygen transport. In addition, COT was associated with better survival and reduced hospitalizations, compared with NOT patients who were unable to increase their walking level.     

Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy

Purpose

Peak oxygen consumption (VO_2peak) is an important predictive factor for long-term prognosis in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to investigate whether 8 weeks of exercise training improves exercise capacity, as assessed by VO_2peak, and other related factors in patients with NSCLC receiving targeted therapy.

Methods

A total of 24 participants with adenocarcinoma were randomly assigned to either the control group (n?=?11) or the exercise group (n?=?13). Subjects in the exercise group participated in individualized, high-intensity aerobic interval training of exercise. The outcome measures assessed at baseline and after 8?weeks were as follows: VO_2peak and the percentage of predicted VO_2peak (%predVO_2peak), muscle strength and endurance of the right quadriceps, muscle oxygenation during exercise, insulin resistance as calculated by the homeostasis model, high-sensitivity C-reactive protein, and quality of life (QoL) questionnaire inventory.

Results

No exercise-related adverse events were reported. After exercise training, VO_2peak and %predVO_2peak increased by 1.6?mL?kg^?1?min^?1 and 5.3% (p?<?0.005), respectively; these changes were associated with improvements in circulatory, respiratory, and muscular functions at peak exercise (all p?=?0.001). The exercise group also had less dyspnea (p?=?0.01) and favorably lower fatigue (p?=?0.05) than baseline.

Conclusions

Patients with NSCLC receiving targeted therapy have quite a low exercise capacity, even with a relatively high QoL. Exercise training appears to improve exercise capacity and alleviate some cancer-related symptoms.     

呼吸训练对类风湿关节炎合并间质肺炎患者肺功能指标的影响分析

目的探讨呼吸训练对类风湿关节炎合并间质肺炎患者肺功能康复的影响。方法选择在本院就诊的391例类风湿关节炎患者,其中合并间质肺炎患者51例,将其随机分为观察组与对照组,观察组25例,对照组26例。所有患者均给予抗风湿药物进行基础治疗,同时对观察组进行3个月的呼吸功能锻炼,对照组不接受呼吸功能锻炼。两组进行临床体征评价、肺功能(FEV1%、MMEF、FEV1/FVC、PEF)评价及圣乔治呼吸疾病问卷(SGRQ)评分。结果观察组咳嗽、喘息、腹胀、乏力、厌食和合并感冒等症状明显少于对照组,FEV1%、MMEF、FEV1/FVC、PEF指标及SGRQ评分较对照组改善更明显,差异均具有统计学意义(均P0.05)。结论通过呼吸训练,能够有效降低类风湿关节炎合并间质肺炎患者的临床症状,明显改善肺功能,显著提高患者生活质量并改善其心态,值得临床应用和推广。     

Ventilatory mechanics and expiratory flow limitation during exercise in patients with obstructive lung disease

The interrelationships among transpulmonary pressure, flow, and volume during exhausting exercise were studied in 12 males with chronic obstructive lung disease. Expiratory pressure during exercise was compared with flow-limiting pressure (P(max)) measured at rest. In 11 patients, expiratory pressure during exercise exceeded P(max), indicating that ventilation became mechanically inefficient. P(max) values of the patients were lower than those of normal subjects. Evidence of expiratory flow augmentation during exercise was noted in two subjects. Since 10 subjects achieved maximal expiratory flow predicted from flow-volume curves when heart rate was not maximal, we conclude that exercise capacity in most subjects was clearly limited by the deranged ventilatory apparatus. Elevations in mean intrathoracic pressure during exercise also may interfere with venous return and impose an additional limitation.     

Conventional chest physical therapy for obstructive lung disease

Chest physical therapy (CPT) is a widely used intervention for patients with airway diseases. The main goal is to facilitate secretion transport and thereby decrease secretion retention in the airways. Historically, conventional CPT has consisted of a combination of forced expirations (directed cough or huff), postural drainage, percussion, and/or shaking. CPT improves mucus transport, but it is not entirely clear which groups of patients benefit from which CPT modalities. In general, the patients who benefit most from CPT are those with airways disease and objective signs of secretion retention (eg, persistent rhonchi or decreased breath sounds) or subjective signs of difficulty expectorating sputum, and with progression of disease that might be due to secretion retention (eg, recurrent exacerbations, infections, or a fast decline in pulmonary function). The most effective and important part of conventional CPT is directed cough. The other components of conventional CPT add little if any benefit and should not be used routinely. Alternative airway clearance modalities (eg, high-frequency chest wall compression, vibratory positive expiratory pressure, and exercise) are not proven to be more effective than conventional CPT and usually add little benefit to conventional CPT. Only if cough and huff are insufficiently effective should other CPT modalities be considered. The choice between the CPT alternatives mainly depends on patient preference and the individual patient's response to treatment.