Fibromyalgia and Responses to Exercise

Abstract

The author examines whether exercise may challenge pathogenic mechanisms in patients with fibromyalgia (FM). Recent studies have shown normal oxygen consumption and no abnormal accumulation of metabolites during exercise. Thus, an early on-set of hypoxia during exercise is not found. Furthermore, little evidence supports the hypothesis that exercise may cause muscle injury. However, a hyporesponsiveness of the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis during exercise might be present. Nevertheless, regular low-intensity exercise does not increase the symptoms in FM. Thus, patients with FM should be stimulated to stay physically active in order to avoid deconditioning and improve general health status.     

Cardiorespiratory Fitness and Metabolic Syndrome in Older Men and Women: The Dose Responses to Exercise Training (DR's EXTRA) study

OBJECTIVE

We studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of metabolic syndrome (MetS) for 2 years in older individuals.

RESEARCH DESIGN AND METHODS

Subjects were a population sample of 1,226 men and women aged 57–78 years. We assessed Vo_2max directly by respiratory gas analysis during maximum exercise testing and used dichotomous and continuous variables for MetS.

RESULTS

One SD increase in baseline Vo_2max associated with 44% (95% CI 24–58) decreased risk of developing MetS. Individuals in the highest third of baseline Vo_2max were 68% (37–84) less likely to develop MetS than those in the lowest third. One SD increase in Vo_2max increased the likelihood to resolve MetS 1.8 (1.2–2.8) times. Individuals in the highest Vo_2max third were 3.9 (1.5–9.9) times more likely to resolve MetS than those in the lowest third.

CONCLUSIONS

Higher levels of cardiorespiratory fitness protect against MetS and may resolve it in older individuals.Cross-sectional population studies have shown an inverse association between cardiorespiratory fitness (CRF) and the metabolic syndrome (MetS) in middle-aged and older men and women (1,2). There are few prospective population studies on the association between CRF and the development of MetS (3–6) and no such studies on the resolution of MetS. None of these studies have been conducted in older men and women. Evidence of the association between changes in CRF and metabolic risk rely on relatively small prospective studies among middle-aged or high-risk individuals (6,7). We therefore studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of MetS and changes in Vo_2max and metabolic risk in a population sample of older men and women.     

Autonomic Mechanisms in Hemodynamic Responses to Isometric Exercise

Selective autonomic blockade with intravenous propranolol, practolol, atropine, and combined atropine-propranolol was utilized to elucidate the role of the autonomic nervous system in the hemodynamic responses in young adult male volunteers to handgrip sustained at 30% of maximal voluntary contraction for 3 min. The initial 30 s of the tachycardia response was found to be mediated by withdrawal of vagal dominance, as evidenced by blockade of this response by prior atropinization. The mid and late portion of the heart rate response curve was demonstrated to be sympathetic in origin, since it was unaffected by atropine, but was suppressed by combined atropine-propranolol blockade. Sympathetic stimulation appears to be a secondary mechanism for increasing the heart rate, however, as it becomes operative only after the first mechanism of vagal withdrawal has been utilized. This was confirmed by the finding that beta adrenergic receptor blockade alone had little effect on the heart rate response curve.The pressor response to handgrip was accompanied by increased cardiac output and no change in calculated systemic vascular resistance. After propranolol, handgrip resulted in increased peripheral resistance and an equivalent rise in arterial pressure, but no increase in cardiac output. It was concluded that the increase in resistance was the result of sympathetically induced vasoconstriction. This response was shown to be independent of peripheral beta adrenergic receptor blockade by the use of practolol, a cardio-selective beta adrenergic receptor-blocking drug which caused identical hemodynamic responses to those observed after propranolol.Left ventricular ejection time (corrected for heart rate) was prolonged by handgrip. The increased afterload imposed on the left ventricle by sustained handgrip may explain the prolongation of ejection time index. Preejection period was prolonged by SHG after propranolol and shortened after atropine. In addition to confirming the previously defined role of the parasympathetic nervous system, this study delineates the role of the sympathetic nervous system in the heart rate and pressor responses to sustained handgrip.     

康复运动训练对急性脑卒中后疲劳患者日常活动能力的影响

目的探讨急性脑卒中后疲劳的有效治疗措施及其对患者日常活动能力的影响。方法对96例急性脑卒中后疲劳患者进行康复运动训练,根据患者实际情况制定康复运动训练内容与强度,并根据训练时日常生活活动能力的改善情况及时调整训练内容及强度。所有患者在康复运动训练治疗前及治疗1个月后均进行日常生活活动能力评分。结果患者经康复运动训练后,日常生活活动能力评分较其治疗前明显增加[(72.28±19.47)分比(15.36±8.09)分,P<0.05]。结论对急性脑卒中后疲劳患者给予针对性的康复运动训练,可改善患者日常生活活动能力。     

Exercise Physiology: Health Indicators and Cardiovascular Risk Factors during Childhood and Adolescence

Low risk strategies use favourable levels of different behavioural and physiological parameters, which may be accepted as health indicators. High risk strategies are oriented to protect people from the potential risk levels of the same behavioural and physiological parameters. Both strategies are first applied to adults; but the established levels of risk in adults cannot be explained only by their living conditions, these factors must have some genetic and educational roots in childhood and adolescence. Based on several cross-sectional and longitudinal studies of 1652 subjects it was shown that trained and untrained adolescents did not differ in family history of CHD but clearly had different behavioural risk factors. The early identification of children and adolescents with a high risk of developing CHD should be intensified using integrated risk indicators. Thus collaboration between exercise physiology and preventive cardiology should be centered more on studies of children and adolescents.     

Abnormal Vascular Responses to Exercise in Patients with Aortic Stenosis

We tested the hypothesis that the normal forearm vasoconstrictor response to leg exercise is inhibited or reversed in patients with aortic stenosis, possibly because of activation of left ventricular baroreceptors. Forearm vascular responses to supine leg exercise were measured in 10 patients with aortic stenosis and in 2 control groups of 6 patients with mitral stenosis and 5 patients without valvular heart disease.Forearm vasoconstriction occurred during exercise in the control groups. In contrast, forearm blood flow increased and forearm vascular resistance did not change in patients with aortic stenosis. In six patients with aortic stenosis and a history of exertional syncope, forearm vasodilatation occurred during the second minute of leg exercise. Inhibition or reversal of forearm vasoconstrictor responses in aortic stenosis was asscociated with significant increases in left ventricular pressure.In three patients with aortic stenosis and exertional syncope, forearm vasodilator responses to exercise changed to vasoconstrictor responses after aortic valve replacement.The results indicate that forearm vasoconstrictor responses to leg exercise are inhibited or reversed in patients with aortic stenosis, possibly because of activation of left ventricular baroreceptors. The observations suggest that reflex vasodilatation resulting from activation of left ventricular baroreceptors may contribute to exertional syncope in patients with aortic stenosis.     

Identifying the Salient Outcomes of Exercise: Application of Marketing Principles to Preventive Health Behavior

This study illustrates an initial step in applying marketing principles to a preventive health behavior-exercise. Attitudinal correlates of the decision to exercise or not were identified among a sample of 135 university faculty and staff. A correlational design was employed to associate intentions to exercise with subsequent behavior. The conceptual framework was the theory of reasoned action. This model posits that perceived outcomes of and social reinforcers for a behavior that are most highly polarized are salient and probable determinants of the behavior. The study revealed that outcomes of exercise that appeared to be most motivating were not directly related to health concerns but to a desire to look and feel good. Nurses who design intervention strategies aimed at increasing exercise among groups similar to the sample should emphasize the likelihood that exercise will lead to a greater sense of well-being.     

External validation of Acute Physiology and Chronic Health Evaluation IV in Dutch intensive care units and comparison with Acute Physiology and Chronic Health Evaluation II and Simplified Acute Physiology Score II

Purpose

The aim of this study was to validate and compare the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the Dutch intensive care unit (ICU) population to the APACHE II and Simplified Acute Physiology Score (SAPS) II.

Materials and Methods

This is a prospective study based on data from a national quality registry between 2006 and 2009 from 59 Dutch ICUs. The validation set consisted of 62?737 patients; the 3 models were compared using 44?112 patients. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R², and ?-statistic) were calculated using bootstrapping. In addition, the standardized mortality ratios were calculated.

Results

The original APACHE IV showed good discrimination and accuracy (AUC = 0.87, Brier score = 0.10, R² = 0.29) but poor calibration (?-statistic = 822.67). Customization significantly improved the performance of the APACHE IV.The overall discrimination and accuracy of the customized APACHE IV were statistically better, and the overall ?-statistic was inferior to those of the customized APACHE II and SAPS II, but these differences were small in perspective of clinical use.

Conclusions

The 3 models have comparable capabilities for benchmarking purposes after customization. Main advantage of APACHE IV is the large number of diagnoses that enable subgroup analysis. The APACHE IV coronary artery bypass grafting (CABG) model has a good performance in the Dutch ICU population and can be used to complement the 3 models.     

急性心肌梗死患者分级等长收缩运动训练的康复护理

目的 研究分级等长收缩运动对急性心肌梗死(AMI)患者的心功能影响。方法 对23例中低危组AMI患者进行分级等长收缩握力试验,应用Acusow-128xP-10彩色多普勒声像仪检测20％、40％、50％运动负荷的各血流动力学参数。结果 患者运动后,心率和平均动脉压较运动前显著增加;舒张功能评价指标、左室射血力及左室射血分数较运动前有所降低,但20％运动负荷时无统计学差异,40％运动负荷时左室射血分数无显著差异。结论 AMI患者可以进行适当的等长收缩运动,运动训练中应注意安全、有效。     

Left-Ventricular Function Quantitative Parameters and Their Relationship to Acute Loading Variation: From Physiology to Clinical Practice

Because of its relevance for patient prognosis, ventricular function is quantified daily by clinicians. This analysis turns out to be complex as a multitude of parameters are available, that all come with their measurement limitations and pitfalls in interpretation, because they are influenced by loading conditions and heart rate. Proper markers of myocardial contractility should indeed be able to detect subtle dysfunction, independent of loading and heart rate. Moreover, in the current multi-modal imaging environment these parameters can be assessed by different modalities, each with their own strengths and weaknesses and variable “normal” values. This report wants to provide an overview of the quantification of ventricular function in perspective to a physiological background of myocardial contractility. We discuss the most routinely used contractility parameters together with their sensitivity to loading modification. We stress the importance of understanding the relationship between loading and contractility, in order not to be misled by numbers, but to globally evaluate these numbers integrated in a hemodynamic context.     

放松训练对接受肾脏穿刺活检患者应激反应的影响

目的探讨放松训练对接受肾脏穿刺活检患者应激反应的影响。方法 将140例患者随机分为实验组与对照组,两组均给予术前健康教育,实验组在此基础上进行放松训练。观察两组患者术前10 min、术中及术后10 min血压、心率、呼吸的改变,以及术前3 d、术前30 min焦虑水平及术后并发症的发生率。结果实验组患者术中、术后10 min的血压、心率、呼吸均低于对照组,差异有统计学意义（P〈0.01）;术前30 min焦虑水平及术后并发症发生率也均低于对照组,差异有统计学意义（P〈0.01）。结论放松训练能减轻接受肾脏穿刺活检患者的应激反应程度,有利于肾脏穿刺活检术的顺利进行,减少术后并发症的发生。     

运动及康复训练改善儿童平衡功能的Scoping综述

对儿童平衡能力的运动及康复训练方案进行Scoping综述分析。