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BACKGROUND Patients with aortic coarctation (COA) have a reduced exercise capacity and seem to be more prone to adopt a sedentary lifestyle. During clinical practice, we often observe that patients seem to be overweight. However, data on physical activity and weight status in this population are currently not available. OBJECTIVE This study aimed to describe weight status, self-reported physical activity levels, and self-perceived health status in adults with repaired COA in comparison with healthy counterparts and to investigate the relationships among exercise capacity, physical activity, weight status, and perceived health status. METHODS We studied 103 COA patients who underwent cardiopulmonary exercise testing and who completed the Flemish Physical Activity Computerized Questionnaire and the short-form 36 health survey questionnaire. RESULTS Patients with COA show a significantly lower exercise tolerance than what would be expected in healthy persons (P < .0001). Weight status was similar to the overall Belgian population, but a tendency toward higher body mass index was present. Patients with COA report a lower level of habitual physical activity (P < .05) as well as reductions in perceived vitality, general health, and mental health (P < .05). Parameters of habitual physical activity are related to exercise capacity (total energy expenditure: r = 0.278, P = .0015). The more active COA patients report higher scores of perceived physical functioning, general health, and mental health. Overweight patients did not perform significantly different than patients with a healthy weight did. CONCLUSIONS Adults with repaired COA have a reduced exercise tolerance, which is related to low physical activity levels. Up to one-third of the COA patients we studied are overweight. As a poor exercise capacity identifies patients at risk for hospitalization and death and obesity might adversely influence the development of cardiovascular disease, it is important to improve the exercise capacity in these patients. Guiding patients toward more physical activity in daily life might therefore be the number 1 preventive measure to be taken in this patient group.

We reviewed the effect of resistance training on blood pressure and other cardiovascular risk factors in adults. Randomized, controlled trials lasting ≥4 weeks investigating the effects of resistance training on blood pressure in healthy adults (age ≥18 years) and published in a peer-reviewed journal up to June 2010 were included. Random- and fixed-effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 28 randomized, controlled trials, involving 33 study groups and 1012 participants. Overall, resistance training induced a significant blood pressure reduction in 28 normotensive or prehypertensive study groups [−3.9 (−6.4; −1.2)/−3.9 (−5.6; −2.2) mm Hg], whereas the reduction [−4.1 (−0.63; +1.4)/−1.5 (−3.4; +0.40) mm Hg] was not significant for the 5 hypertensive study groups. When study groups were divided according to the mode of training, isometric handgrip training in 3 groups resulted in a larger decrease in blood pressure [−13.5 (−16.5; −10.5)/−6.1(−8.3; −3.9) mm Hg] than dynamic resistance training in 30 groups [−2.8 (−4.3; −1.3)/−2.7 (−3.8; −1.7) mm Hg]. After dynamic resistance training, V o 2 peak increased by 10.6% ( P =0.01), whereas body fat and plasma triglycerides decreased by 0.6% ( P P

PURPOSE: Although exercise capacity is impaired, atrial septal defect (ASD) patients report satisfactory exercise tolerance. This study aimed at (1) evaluating cardiopulmonary exercise testing (CPX) and (2) evaluating the impact of exercise capacity on perceived health status using a self-reported health questionnaire (SF-36) in patients with open and closed ASD. METHODS: Seventeen patients (mean age 37 ± 17, 9 males) with open ASD and 24 (mean age 37 ± 14, 6 male) with closed ASD were included. All underwent CPX and completed a SF-36 questionnaire. Age- and gender-matched controls were selected for comparison of CPX variables and SF-36 was compared with results from a general population. RESULTS: Patients with open ASD had lower peak oxygen uptake (O2) (27.9 ± 9.7 vs 38.5 ± 9.5 mL · kg−1 · min−1. P = .009) and higher E/CO2 slope (31.0 ± 7.7 vs 24.1 ± 4.8; P = .004) than controls. Patients with closed ASD had lower peak O2 (26.2 ± 8.4 vs 34.8 ± 9.7 mL · kg−1 · min−1. P = .014) and peak heart rate (163 ± 25 vs 178 ± 16 bpm; P = .035) than controls. Perceived health-status was lower in patients with open ASD than the general population. Peak O2 correlated significantly with physical functioning, emotional functioning, and bodily pain in open ASD and with physical functioning, bodily pain, role limitation, vitality, and mental health in closed ASD patients. CONCLUSION: Patients with open and closed ASD had decreased peak O2. Patients with open ASD had lower ventilatory efficiency. Closed ASD patients had chronotropic incompetence because of β-blockers. SF-36 was reduced in patients with open ASD but not closed ASD. Reduced exercise capacity affected several domains of perceived health-status in ASD patients.

Being physically active is often suggested to be important in the prevention and management of low back pain. This simple view does not take into account that the relation between the level of activity and back pain may be a U-shaped curve - i.e. both inactivity and excessive activities (back-unhealthy activity) present an increased risk for back pain. We explored the U-shaped association between physical activity and chronic low back pain (3 months duration) by analyzing cross-sectional data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort study (DMC(3), 1998) of a sex-age stratified sample of 25 years and older (n=3364). Type of activity (daily routine, leisure time and sport activity), intensity of and time spent on these activities, and back exertion of sport activities were taken into account. Physical activity was not associated with chronic low back pain (CLBP) when studied by the dimension of activity, by the intensity or by the duration of physical activity. Only engaging in sport activity was associated with less CLBP (OR 0.78: 95% CI 0.66-0.93). The extremes of the total physical activity pattern were associated with CLBP. A moderate increased risk for CLBP was found for both participants with a sedentary lifestyle (OR 1.31: 95% CI 1.08-1.58) and for those being involved in physical strenuous activities (OR 1.22: 95% CI 1.00-1.49). This was especially true for women (sedentary: OR 1.44: 95% CI 1.10-1.83; physically active: OR 1.36: 95% CI 1.04-1.78). This study provides some evidence that the relation between physical activity and CLBP is U-shaped.

The aim of the present study was to investigate the reproducibility of the exponential method of CO2 rebreathing with the use of automated curve fitting and to determine whether this method is superior to the equilibrium method in terms of reproducibility and clinical practicability.Repeated measurements of cardiac output were performed using the automated equilibrium and exponential methods. These measurements were compared in 12 healthy male subjects at rest and during incremental exercise tests.Estimated cardiac output was not significantly different between duplicate measurements at rest nor at any level of exercise with either method. At rest the exponential method showed a tendency toward larger variability than the equilibrium method. The exponential method produced significantly higher (Por = 0.001) estimates at rest (averaging up to 9.8 L x min(-1)) compared with the equilibrium method (averaging up to 6.5 L x min(-1)). Reproducibility improved for both methods with increasing workloads, and a second measurement at rest also seemed more reproducible and valid than the first. During exercise, both methods produced comparable values for cardiac output, and highly significant relations between cardiac output and oxygen uptake were observed for both methods (ranging from r2 = 0.79 to r2 = 0.88, Por = 0.001). The equilibrium method produced unpleasant side effects more frequently (75% vs 21%, Por = 0.001) compared with the exponential method and lead more subjects to premature interruption of the exercise test because of the rebreathing maneuver (42% vs 17%, P = 0.058).Automated curve fitting for the exponential method gave reproducible and valid results during submaximal and maximal exercise but not at rest. The equilibrium method on the other hand interfered with exercise. Therefore, the equilibrium method is recommended at rest and at lower levels of exercise and the exponential method at higher intensities.

We thank Rossi et al1 for their interest in our work2 and appreciate the opportunity to answer their comments.1 Our recent meta-analysis2 aimed to provide an update of the previously published meta-analysis on the effect of resistance training (RT) on blood pressure (BP).3 We included all of the randomized, controlled trials that reported the effect of RT on BP in healthy adults. By contrast, Rossi et al1 suggested that we should only have included articles in which BP was the primary outcome. They referred to Dwan et al4 to state that the inclusion of secondary outcomes might have influenced the effect estimates in our meta-analysis. Concordant to others,5 Dwan et al4 provide evidence for the fact that studies with statistically significant results, as well as statistically significant outcomes, are more likely to be published than studies that report no statistically significant results or nonsignificant outcomes. …

Beta-adrenoceptor blockade can influence exercise capacity negatively, but data on the effect of converting enzyme inhibition and of calcium entry blockade on exercise capacity in hypertensive sportsmen are scarce. This report deals with the effect of the various types of antihypertensive medication on endurance exercise capacity in 14 hypertensive sportsmen, aged 39 +/- 3 years and weighing 73 +/- 2 kg (mean +/- s.e.m.). The patients were treated for 3 weeks with either placebo, atenolol (50 mg/day) enalapril (10 mg/day) or verapamil (240 mg/day) following a double-blind randomized cross-over design. At the end of each treatment period, they performed an endurance exercise test on the bicycle until exhaustion at 70% of their previously determined exercise capacity. Venous blood was sampled before and after exercise. In comparison with placebo, total exercise duration was not affected by enalapril (-3 +/- 7%) or verapamil (-7 +/- 11%). During treatment with atenolol, two patients had to interrupt their intake of the beta-blocker because of side effects. In the 12 remaining subjects, exercise duration was significantly decreased by 38 +/- 12% (P less than 0.01). Atenolol also induced decreases in plasma-free fatty acid concentration before and after exercise and an increase in potassium concentration after exercise, whereas enalapril and verapamil did not induce metabolic changes. During exercise, systolic blood pressure was decreased by atenolol (P less than 0.001) and enalapril (P less than 0.01) and diastolic blood pressure by enalapril (P less than 0.001), verapamil (P less than 0.05) and atenolol(P = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)