[Combined exercise training in men with metabolic syndrome after acute coronary event]. / Kombinovaný trénink u muzu s metabolickým syndromem po akutní koronární príhode.

INTRODUCTION: Favourable effect of exercise training on cardiovascular prognosis in patients with metabolic syndrome have been documented in lot of studies. Less information exist about results of cardiovascular rehabilitation in patients with different forms of coronary heart disease and associated diseases and abnormalities within metabolic syndrome. METHODS: The present article evaluates a benefit of combined, aerobic-resistance training in two groups of patients after percutaneous coronary intervention for acute coronary syndrome: with [group MS(+), n = 42] and without [group MS(-), n = 53] metabolic syndrome. The changes in aerobic capacity (VO2 peak, VO2 peak . kg(-1)), physical performance (W peak, W peak . kg(-1)), blood pressure, BMI and waist circumference after 12 weeks of cardiovascular rehabilitation are evaluated. RESULTS: Significant improvement in aerobic capacity and physical performance were found out both in group MS(+) and MS(-) (p < 0.01, resp. p < 0.001). Decrease of systolic blood pressure was significant in MS(+), whereas in MS(-) together with decrease of diastolic BP in both groups were not significant. The increase in aerobic capacity and physical performance in patients of MS(+) is comparable with those in MS(-); the decrease in systolic BP was more intensive in MS(+) compared to MS(-). The changes in waist circumference and BMI were not significant in both groups. CONCLUSION: The results show, that in patients with high number of risk factors associated with metabolic syndrome was demonstrated at least comparable benefit from cardiovascular rehabilitation compared with those without metabolic syndrome.

[Physical activity in the treatment of obesity]. / Fyzictká aktivita v lécbe obezity.

Physical activity is a pivotal component in the treatment of obesity. An increase in energy expenditure through physical activity in combination with a weight reduction diet intensifies negative energy balance, brings a reduction in fat reserves and, simultaneously, prevents loss of an active body mass. The main aim and significance of physical activity in obese individuals is not the weight reduction itself but its positive effects on factors that represent an increased cardiovascular risk. When prescribing a physical activity to an obese individual, selection of a suitable form, intensity, duration and frequency of load should all be considered. Patient cooperation represents an essential factor in the success of a therapy involving physical activity and is concurrently affected by the presence of other obesity complicating diseases. Also important are other negative factors determined by real life: lack of time, lack of support from family and others, bad weather, inaccessibility of suitable equipment or space or aversion to physical activity as such. When these circumstances are overcome, positively motivating reasoning has to be provided. Communication between physicians and non-medical professional community is the only way to influence physical activity of obese patients and minimise adverse effects. Significant increase in physical activity of the entire population is determined by modifications in physical and social environment and revision of healthcare policy.

[Differentiated approach to prescription of physical activity in patients with left ventricular dysfunction]. / Diferencovaný prístup k preskripci fyzické aktivity u nemocných s dysfunkcí levé komory srdecní.

Correctly indicated physical exercise performed and controlled on a regular basis is an inseparable part of treatment and rehabilitation of patients with left ventricular dysfunction. In order to guarantee the best effect and safety of physical exercise, it is necessary to adopt a differential approach to its prescription to patients with different degrees of functional damage. In addition, a number of conditions should be fulfilled, among which, in the first place, the determination of functional classification of patients used in practice and described in the relevant literature (NYHA, AMA, Goldman, Weber). Physical exercise cannot be differentiated only with respect to the degree of dysfunction; other conditioning factors should be taken into consideration, too, among which the relative contraindication of physical strain, somatic condition, physical exercise anamnesis and others (i.e. sex, age, motivation, etc.), causing a high degree of patient heterogeneity. Also described are additional conditions for differentiation and correct application of physical training, which involve the selection of suitable types of exercise and their energetic demands, adequate intensity, frequency and duration; it is also important to determine the available effective and safe methods, programmes and means of training. The article contains examples of the above conditions, as well as classification of physical exercise into functional classes NYHA I-IV. In conclusion, the authors point out the necessity of differentiation of physical training and of cooperation of the cardiologist with the physiotherapist in its indication, implementation and monitoring.

[Exercise therapy for patients with metabolic syndrome]. / Pohybová lécba u pacientu s metabolickým syndromem.

The author presents a list of physical activity effects in metabolic and cardiovascular adaptation and current knowledge of the molecular mechanism of the effect of exercise on insulin resistance. The main principles for the prescription of exercise therapy for patients with metabolic syndrome are presented. The role of patient motivation and compliance is emphasised as part of a complex approach to the treatment of metabolic syndrome; it has a substantial influence on the results of treatment.

CHRONOBIOLOGY OF HIGH BLOOD PRESSURE.

BIOCOS, the project aimed at studying BIOlogical systems in their COSmos, has obtained a great deal of expertise in the fields of blood pressure (BP) and heart rate (HR) monitoring and of marker rhythmometry for the purposes of screening, diagnosis, treatment, and prognosis. Prolonging the monitoring reduces the uncertainty in the estimation of circadian parameters; the current recommendation of BIOCOS requires monitoring for at least 7 days. The BIOCOS approach consists of a parametric and a non-parametric analysis of the data, in which the results from the individual subject are being compared with gender- and age-specified reference values in health.Chronobiological designs can offer important new information regarding the optimization of treatment by timing its administration as a function of circadian and other rhythms.New technological developments are needed to close the loop between the monitoring of blood pressure and the administration of antihypertensive drugs.

[Interval and continuous training in cardiovascular rehabilitation]. / Intervalový a kontinuální trénink v kardiovaskulární rehabilitaci.

The objective of the study was to evaluate the physiological effectiveness and the influence of two modifications of aerobic training (interval and continuous) on the physical performance in the patients with coronary heart disease. 38 males with coronary heart disease (age 60 +/- 10.2 years) passed three months training programme of 60 min 3 times a week (10 min of warm up phase, 25 min of aerobic phase, 15 min of resistance training, 10 min of relaxing phase). Patients with coronarographically verified stenosis > 50% luminal diameter and/or left ventricular ejection fraction lower than 40 % (n = 22) had in terms of aerobic phase interval training prescribed (30 second work phases with work load intensity on the level of anaerobic threshold alternating with 60 second recovery phases with intensity of 5 W); other patients (n = 16) passed aerobic phase of the programme with continual work load of intensity on the level of ventilatory anaerobic threshold. After the determination of three month rehabilitation programme the maximal achieved performance as well as aerobic capacity evaluated by spiroergometric examination statistically significantly increased in the group of patients with interval training and also in the group with continuous training. Despite the group with interval training performed 2.5-3 times less work in each training unit (p < 0.01), the performance and aerobic capacity parameters after the termination of three month programme did not statistically significantly differ from the group with continuous training. The advantage of the continuous training is a possibility to achieve an improvement also in the patients with left ventricular dysfunction and chronic coronary heart disease who could have worse tolerance of the continual work load.

Melatonin protects against ischemia-reperfusion injury and inhibits apoptosis in isolated working rat heart.

INTRODUCTION: Melatonin (MEL), a pineal hormone, is well known as a potent antioxidant in a variety of ischemia-reperfusion models. Recent studies have assumed a pivotal role of reactive oxygen species (ROS) in the development of apoptosis. There are few pieces of information concerning a possible protective role of MEL against apoptosis in ischemia-reperfusion injury of myocardium. METHODS: We conducted an in vitro experiment: (1) to study the effect of MEL in the model of isolated and perfused working rat heart; (2) to evaluate the antioxidant capacity of MEL by a simple fluorescence test; and (3) to analyze the extent of apoptosis inhibition by MEL. Four groups of male Wistar rat were used: (a) group 'MEL 50 muM' (n=8); (b) group 'ischemia 30 min' (n=8); (c) group 'controls' (n=8); and (d) group 'controls+MEL 50 muM' (n=8). The perfusion medium was an oxygenated Krebs-Henseleit buffer (KHB). Hearts in groups (a) and (b) underwent 30 min of global normothermic ischemia and 45 min of reperfusion; 3 min before ischemia the hearts of group (a) received KHB with MEL 50 muM (and MEL 50 muM was also present in KHB solution during reperfusion). Hearts of group (c) were only perfused by KHB, and hearts of group (d) perfused by KHB+MEL 50 muM throughout the experiment. Registered were basic hemodynamic parameters: coronary, aortic, cardiac output and heart rate. At the end of each experiment, a left ventricle samples were taken for in situ detection of apoptosis using a TUNEL in-situ detection kit (POD) and quantitative analysis was performed. Malonedialdehyde concentrations were evaluated from heart homogenate to determine the severity of oxidative damage. To study the antioxidant capacity of MEL, a fluorescence test with allophycocyanin as an indicator was performed. A peroxyl radical generator, 2,2'-azobis(2-amidinopropan)-4-hydrochloride (AAPH) was used, and the antioxidant effect of MEL was expressed in oxygen-radical absorbing capacity (ORAC) units. RESULTS: Treatment by MEL resulted in a significant improvement of hemodynamic parameters and reduction of postischemic arrhythmias during reperfusion. All hearts in group 'ischemia 30 min' developed fatal ventricular fibrillations. MEL significantly reduced the incidence of apoptotic cells (14+/-4.3%; **P<0.01) vs. group 'ischemia 30 min' (58+/-2.1%). No apoptotic cells were detected in both control groups (c) and (d). In the fluorescence test, MEL exhibited a significant dose-dependent protective effect against peroxyl radical; MEL also reduced significantly the level of lipoperoxidation (MDA; *P<0.05). Analysis of hemodynamic parameters in both control groups (c) and (d) did not show any significant differences; the presence of MEL 50 muM in KHB solution did not have any important influence on cardiac performance in this type of experiment. CONCLUSION: We confirmed the previously reported beneficial effects of MEL against ischemia-reperfusion injury, presumably via its antioxidant properties. A significant suppression of apoptosis and the peroxyl radical scavenging properties of MEL in our study could contribute to the hypothesis of a close link between oxidative stress and apoptosis promotion.

[Combined training in patients with systolic left ventricular dysfunction]. / Kombinovaný trénink u nemocných se systolickou dysfunkcí levé komory srdecní.

The objective of the work was to evaluate the effect of eight-week combined training on the performance, aerobic capacity and basic haemodynamic parameters in patients with systolic dysfunction of the left ventricle and to assess its safety. The investigation comprised 26 patients, men mean age (x +/- SD) 61.8 +/- 11.1 years with coronarographically verified chronic ischaemic heart disease and with a left ventricular ejection fraction lower than 40% (EF 35 +/- 4%). Before the beginning and after completion of the rehabilitation programme (eight weeks) a spiroergometric examination was made, up to the symptom-limited maximum. Fitness elements were included after 2 weeks of aerobic training. The lesson lasted 60 mins. and included warming up (10 mins.), aerobic load on an ergometer with an intensity of the load at the level of the anaerobic threshold (20 mins.), the stage of fitness training on a combined training machine (20 mins) and the relaxation stage (10 mins). In the fitness stage the patients started to exercise at the 30% level, after two weeks at the 60% level 1-RM (one repetition maximum) The results showed after eight-week combined training a significant (p < 0.05) increase of the maximum achieved performance (from 104 +/- 27 to 132 +/- 32 W) in patients with systolic left ventricular dysfunction. There was a significant increase in the capacity of the transport system expressed by the value of the maximum oxygen uptake (from 1545 +/- 312 to 1740 +/- 359 ml.min-1) and MET (from 5.3 +/- 1.3 to 6.0 +/- 1.4). There was a significant decrease of the blood pressure at rest, systolic and diastolic, and of the baseline value of the heart rate at rest and of the "product rate, pressure"--RPP. Changes in the EF were not significant.

[The effect of walking exercise on aerobic capacity and serum lipids in type 2 diabetics]. / Vliv tréninku chuzí na aerobní kapacitu a krevní lipidy u diabetiku 2. typu.

Regular physical activity can have a favourable impact on other risk factors of ischaemic heart disease (IHD) and associated diabetes (DM), such as obesity, hypertension, dyslipidaemia, insulin resistance and others. This important part of treatment of diabetes is frequently difficult to implement because of the lack of willingness ("adherence") of type 2 diabetics to practice regular exercise, and unequivocal data are lacking on the intensity of exercise which will influence effectively these risk factors and be at the same time safe, readily available and psychologically acceptable. The objective of the work was to find out whether walking, i.e. locomotor activity with a low to medium intensity can effectively influence parameters of aerobic capacity and blood lipids. The authors submit the results of two groups of type 2 diabetics. The experimental group B (n = 10, age 57 +/- 7 years, BMI 31 +/- 3, duration of DM 8 +/- 5 years) participated in a 12-week training programme of walking; at the beginning and at the end of this period indicators of aerobic capacity at the level of the anaerobic threshold (VO2ANP) were evaluated as well as at the level of the symptom limited maximum (VO2SL, TepO2SL), and the blood lipid levels. In the control group A (n = 6, age 58 +/- 7 years, BMI 32 +/- 4) indicators of aerobic capacity and blood lipids were assessed after a 12-week period of the usual habitual physical activity. In group B the 12-week walking training led to significant improvement of parameters of aerobic capacity at the level of the anaerobic threshold (ANP), oxygen pulse at the level of the symptom limits maximum (SL) and a significant reduction of total and LDL cholesterol. In the control group no significant changes occurred in aerobic capacity nor blood lipid values. The training programme where walking was selected as physical activity with a low to medium intensity can be considered suitable for everyday life of motivated patients with type 2 diabetics, preferably in the form of a domestic training programme. The prerequisite of success is its regular and frequent evaluation by health professionals.

Microvessels of bulbar conjunctiva in UPTAH goats.

Aiming to observe directly the microcirculation after total artificial heart (TAH) implantation, we performed a long-term follow-up in 2 goats using conjunctival angioscopy. A short segment of parallel arteriole and venule was photographed and analyzed on computer picture program (magnification 40x). Three main parameters were measured: arteriole diameter, venule diameter, and arteriovenous ratio (A/V ratio). The intrathoracically implanted TAH was the undulation pump total artificial heart (UPTAH) with cardiac output of 100 ml/kg/min. To stabilize the peripheral hemodynamics a 1/R biofeedback control system was used. Our results provided only elementary data about morphology of bulbar microvessels. The main finding was the tendency to general vasoconstriction, more intensive on the venous side (*P < 0.05 in one goat). We did not observe any pathological shapes (e.g., tortuosities, varicosities, or sludge); this result could be attributed to the high effectivity of 1/R control method. These preliminary results should be considered only as an attempt to apply the widely used clinical method of conjunctival angioscopy to the conditions of TAH.