[Physical training in patients with chronic heart failure: functional fitness and the role of the periphery]. / Telesný trénink u nemocných s chronickým srdecním selháním: funkcní zdatnost a úloha periferie.

UNLABELLED: In recent years evidence is increasing on the usefulness of physical loads and controlled physical training in patients with chronic heart failure (CHSS). In the presented work the authors assessed changes of the functional capacity and muscular strength after training on a bicycle ergometer. The group comprised 38 patients with CHSS due to IHD or dilatation cardiomyopathy NYHA II-III, EF lower than 40%, with a peak oxygen consumption (pVO2) lower than 20 ml/kg/min. The group was subdivided in a random fashion to subjects participating in training (T) and the control group (K). The patients were subjected to clinical examination, examination by common laboratory methods, spiroergometry, dynamometry. By the puncture technique a specimen of the m. vastus lateralis was taken for histological and histochemical examination of the muscle. The patients trained on the bicycle ergometer three times per week for a period of eight weeks, one exercise session lasted 30 minutes and was at the level of the anaerobic threshold. After completion of the training period the examinations were repeated. RESULTS: Before the onset of training the groups did not differ in any indicators. After termination of training they increased in group T: pVO2 from 18.9 +/- 4.8 to 22.13 +/- 15.72 ml/kg/min. (p < 0.0004), the oxygen consumption at the level of the anaerobic threshold (VO2AT) from 13.4 +/- 3.4 to 15.96 < or = 3.75 ml/kg/min. (p < 0.0006), the respiratory quotient (RQ) from 0.93 +/- v0.09 to 0.97 +/- 0.006 (p < 0.05), the maximal tolerated load from 0.72 +/- 0.72 to 1.08 +/- 0.33 W/kg (p <0.002), the maximal voluntary contraction of the femoral quadriceps muscle (MVC START) from 291.2 +/- 70.1 to 328.1 +/- 66.0 N (p<0.01), the maximal voluntary contraction of this muscle after 20 mins. of repeated contractions (MVC END) from 157.6 +/- 109 to 290.1 +/- 64.9 N (p < 0.01), the decrease of the maximal contraction after 20 minutes of repeated contractions was from 52.8 +/- 32.1 to 12.4 +/- 5.0% (p < 0.01). After training there were statistically significant differences between groups in VO2AT (p < 0.01), in pVO2 (p < 0.03) and in the decrement of the maximal muscular contraction (p < 0.01). The authors found a trend towards normalization of the diameter of muscle fibres I and II and of their ratio. The ventilation equivalent for carbon dioxide VE/VCO2 during the maximal tolerated load correlated significantly with the systemic and pulmonary vascular resistance, with RQ, VO2AT, pVO2, with the maximal tolerated load and with the blood level of prostaglandin F. CONCLUSION: Controlled physical training in patients with CHSS was safe, led to a significant improvement of spiroergometric indicators, load tolerance and muscular strength. After training there was a trend towards normalization of pathological changes in skeletal muscle. Based on the authors' experience and findings of other authors it is advisable to recommend training as part of treatment of patients with CHSS.

[Physical training in patients with chornic heart failure: haemodynamics, effects]. / Telesný trénink u pacientu s chronickým srdecním selháním: hemodynamika, pusobky.

UNLABELLED: The objective of the investigation is to assess the safety and contribution of physical training in patients with chronic heart failure and to assess the effect of training on central haemodynamics, left ventricular function evaluated by echocardiography and humoral substances. PATIENTS AND METHODS: Patients with cardiac failure NYHA II and III incl. 17 on t he background of IHD and 21 on the background of dilatation cardiomyopathy. All patients had the ejection fraction below 40% and pVO2 below 20 ml/kg/min. They were divided into groups enagaged in training (T) and controls (K). Before training and after its termination the patients were subjected to clinical examination, basic laboratory tests, echocardiography amd dextrolateral catheterization at rest and during ergometry and levels of humoral agents were assessed. The training was pursued three times per week for a period of two months on a bicycle ergometer. RESULTS: Before training there were no statistically significant differences between the groups. After training the groups did not differ in echocardiographic and haemodynamic parameters. In the training group there was as compared with the onset of the experiment a decline of the maximal median pressure (123.6 +/- 11.9 vs. 113 +/- 10.2 mm Hg, p < 0.04) the maximal pulse rate (112.5 +/- 18.7 vs. 108.4 +/- 20.1 p <0.02). In the control group, on the other hand there was an increase of big endothelin (52.2 +/- 4 9.1 vs. 88.0 +/- 76.7 pg/ml, p < 0.04) and an increase of pulmonary vascular resistance (102.8 +/- 71.7 vs. 149.2 +/- 69.5 dyn.s/cm5, p < 0.002). CONCLUSION: Physical training was well tolertaed by patients, it led to a subjective improvement of their conditionn, to a reduction of the chronotropic response to a load and thus to more economical cardiac activity.

[Stress tests in chronic heart failure]. / Zátezové vysetrení u chronického srdecního selhání.

The authors compared two types of spiroergometric tests in 14 patients with chronic heart failure (NYHA II-III, ejection fraction < 40%). Test A: 0.25 W/kg 3 minutes, 1 minute break, increase by 0.25 W/kg á 3 minutes. Test B: 25 W 2 minutes without break, increase by 10 W á 2 minutes. The two tests did not differ as to the achieved heart rate, blood pressure reading, oxygen consumption and biochemical parameters at the end of the load, even at the level of the anaerobic threshold. There was a significant statistical difference in the duration of the load: test A lasted 16.4 minutes, test B 9.7 minutes (p < 0.001). The length of the test B correlated with the peak oxygen consumption per 1 kg body weight (p < 0.001, r 0.9866). The authors recommend for common practice test B with a defined period of the load as sufficient.

Comparison of two protocols used in exercise testing in chronic heart failure patients.

UNLABELLED: Spiroergometrical testing with the load graded upto symptom-limited maximum with the determination of anaerobic threshold begins to be a routine method in exercise testing of cardiac patients. Functional parameters according to available data depend on the source of load and may be influenced by the protocol of testing, too. That is why we decided to compare two protocols used in chronic heart failure patients exercise testing. 11 male and 3 female patients (NYHA II, III) suffering from chronic heart failure were subjected to the symptom-limited tests (protocol A-0.25 W.kg (-1/3 minutes with one minute breaks; protocol B-25 W + 10 W/2 minutes). There was no statistically significant differences in the symptom-limited values of main functional parameters. The AT level parameters did not differ significantly, as well. Anaerobic threshold could be determined in all patients using the protocol A and in 11 cases using the protocol B. The difference in rates was not statistically significant. The workload duration using the protocol B was significantly shorter (9.7 +/- 3.8 minutes vs. 16.4 +/- 3.6 minutes). CONCLUSIONS: Protocol B is less time demanding and therefore it is more suitable for determination of the symptom-limited parameters in the clinical routine. Anaerobic threshold can be determined by protocol A more often than by protocol B. Therefore, protocol A appears to be more suitable for the individual prescription of the appropriate physical activity and for scientific purposes, too.

[Are central hemodynamics the decisive factor in the manifestation of chronic heart failure?]. / Je centrální hemodynamika rozhodující pro projevy chronického srdecního selhání?

In the past some authors revealed that data assembled during examinations of the central haemodynamics, echocardiography, subjective complaints, physical findings and load tolerance in patients with chronic heart failure are not mutually consistent. The authors examined therefore comprehensively 40 patients with different grades of cardiac failure. They revealed very loose relations between the grade of functional classification, echocardiographic and invasive haemodynamic parameters at rest on the one hand and spiroergometric indicators on the other hand. Closer relations with spiroergometric findings were obtained with values of invasive haemodynamic parameters after a load, in particular values of the cardiac index, and systemic vascular resistance. The authors conclude that for clinical manifestations of chronic cardiac failure the peripheral circulation and tissue metabolism is at least equally important as changes of central haemodynamics. Moreover, the importance of the right ventricular function and diastolic cardiac function is not sufficiently appreciated.

[Cardiorespiratory fitness in children with type I diabetes mellitus]. / Kardiorespiracní funkcní zdatnost detí s diabetes mellitus I. typu.

The authors compared indicators of cardiorespiratory functions of 13 boys and 14 girls with insulin-dependent diabetes with the same parameters in a group of their healthy siblings and with mean values of the Czechoslovak population. No significant differences were found. Practically identical values of the decline of bases in the blood stream of healthy and sick children after a load suggest the ability of diabetics to compensate acidosis after a load. From the investigation it is apparent that in child diabetics in the prepubertal period the possibility of developing physical fitness is preserved. The general higher blood level in diabetics after a short intensive load declined, while it rose in siblings. Parameters of the internal environment differed greatly between individual subjects.