scholarly journals Monitored Exercise and Supplemental Oxygen Improve Exercise Tolerance, Heart Rate Response and Symptoms in Three Females with Post-COVID Syndrome: A Case Series

2021 ◽  
Author(s):  
Noah Greenspan ◽  
Marion Mackles ◽  
Greg Hullstrung ◽  
Wai Chin ◽  
Robert Kaner ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Tolerance ◽  
Blood Pressure Response ◽  
Significant Proportion ◽  
Case Series ◽  
Supplemental Oxygen ◽  
Treatment Protocols ◽  
Patient Response ◽  
Variable Nature ◽  
Individual Patient Response

Abstract Background: It is now recognized that a significant proportion of previously healthy young and middle-aged adults who contract COVID-19 will develop protracted post-viral symptoms including fatigue, dyspnea, cough, post-exertional malaise and autonomic dysfunction. Effective treatment approaches for this post-COVID syndrome (PCS) are crucially needed.Methods: Three previously healthy females (ages 34, 39, and 38) who contracted COVID-19 in Spring 2020 and subsequently developed PCS received monitored aerobic exercise combined with supplemental oxygen beginning seven or eight months following acute-illness. Pre- and post-treatment exercise tolerance was tested using the Bensen treadmill protocol. Treatment consisted of 22 sessions of graduated treadmill exercise during which 6 liters of continuous oxygen was delivered via nasal canula. Findings: All patients demonstrated ~54% improvement in exercise tolerance, improvement in heart rate and systolic blood pressure response during exercise, and remission or improvement of symptoms, including cough, dyspnea on exertion, laryngeal inflammation, chest discomfort, fatigue, and/or post-exertional malaise. Interpretation: We show that measured, monitored exercise combined with supplemental oxygen improved lingering symptoms in three female PCS patients. Supplemental oxygen may reduce post-exercise inflammation, therefore providing the benefits of exercise while reducing the likelihood of PCS symptom exacerbation. Due to the variable nature of PCS, it is crucial to individualize treatment protocols and to continually evaluate and modify each protocol based upon individual patient response. Funding: This work was funded by the Pulmonary Wellness Foundation.

scholarly journals Monitored Exercise and Oxygen Therapy Improves Aerobic and Autonomic Function in Post-Acute Sequelae of SARS-CoV-2 Infection (PASC): A Case Series

2021 ◽  
Author(s):  
Noah Greenspan ◽  
Marion Mackles ◽  
Greg Hullstrung ◽  
Wai Chin ◽  
Robert Kaner ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Tolerance ◽  
Autonomic Function ◽  
Case Series ◽  
Supplemental Oxygen ◽  
Tolerance Test ◽  
Treatment Protocols ◽  
Patient Response ◽  
Variable Nature ◽  
Individualize Treatment

Abstract Case Description: Three females (ages 34, 38, and 38) who contracted COVID-19 in March or April 2020 were treated for post-acute sequelae of SARS-CoV-2 infection (PASC) associated cardiopulmonary and autonomic dysfunction seven to eight months following acute-illness. Exercise tolerance was tested using the Bensen protocol, followed by 22 treatment sessions of graduated treadmill exercise combined with supplemental oxygen two or three times a week, after which the exercise tolerance test was repeated. All patients demonstrated improvement in autonomic function and heart rate response during exercise and demonstrated ~54% improvement in exercise tolerance. Dyspnea remitted or improved in all patients, as did other PASC symptoms, including cough, dyspnea, larynx inflammation, chest tightness, fatigue, and post-exertional malaise. Discussion: It appears that PASC is a multisystemic, inflammation-mediated condition, that affects the respiratory, cardiac, neurologic, gastrointestinal and autonomic nervous systems, with high variability in symptomatology and course, both between patients and within individuals. Patient safety should be maximized by conducting thorough cardiac, respiratory, neurologic and pre-rehabilitation evaluations to rule out potential complications related to activity and exercise. Clinical course and comprehensive monitoring of heart rate and rhythm, blood pressure, and oxygen saturation should be evaluated before exercise time and intensity is increased, very conservatively.Summary: Due to the variable nature of PASC, it is crucial to individualize treatment protocols and to modify the protocol based on patient response; however, we show that gradual, monitored exercise combined with supplemental oxygen may improve lingering symptoms and autonomic function in some PASC patients.

scholarly journals Relationship between blood pressure response during hemodialysis and exercise tolerance or heart rate recovery measured using cardio-pulmonary exercise testing in maintenance hemodialysis patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Hiroki Yabe ◽  
Kenichi Kono ◽  
Ryota Shiraki ◽  
Akiho Masuda ◽  
Yoshifumi Moriyama ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Uptake ◽  
Exercise Testing ◽  
Exercise Tolerance ◽  
Blood Pressure Response ◽  
Heart Rate Recovery ◽  
Cardiopulmonary Exercise Testing ◽  
Pressure Response ◽  
Exercise Intolerance

Abstract Background This study investigated the association between the blood pressure response during hemodialysis (HD) and exercise tolerance or heart rate recovery (HRR) measured with cardiopulmonary exercise testing (CPX). Methods The study enrolled 23 patients who had been undergoing 4-h regular maintenance HD. The maximum workload (Loadpeak), peak oxygen uptake (VO2peak), workload and oxygen uptake at the anaerobic threshold (LoadAT and VO2AT, respectively), and HRR were measured with CPX. The average systolic blood pressure during HD (SBPav) was measured, and the number of times the SBP was less than 100 mmHg was determined in the 2-week period after CPX. Results The SBPav showed a significant correlation with LoadAT (r = 0.46) and Loadpeak (r = 0.43, p < 0.05). The number of times the SBP was less than 100 mmHg showed a significant correlation with the HRR (r = − 0.44, p < 0.05). Conclusion Exercise intolerance and HRR in HD patients may be associated with blood pressure instability during HD.

scholarly journals The effectiveness of supplemental oxygen during exercise training in patients with chronic obstructive pulmonary disease who show severe exercise-induced desaturation: a protocol for a meta-regression analysis and systematic review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Shohei Kawachi ◽  
Shuhei Yamamoto ◽  
Kenichi Nishie ◽  
Takayoshi Yamaga ◽  
Manaka Shibuya ◽  
...  
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Exercise Tolerance ◽  
Supplemental Oxygen ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Severe Exercise ◽  
Meta Regression ◽  
Exercise Induced

Abstract Background Supplemental oxygen during exercise training is used to increase the training effect of an exercise program in patients with chronic obstructive pulmonary disease (COPD) who show exercise-induced desaturation. Exercise-induced desaturation is not clearly defined in the guidelines; however, it is generally defined in clinical studies as a decrease in SpO2 of more than 4% from rest or a decrease to less than 88% during exercise. Although some meta-analyses examined the effectiveness of supplemental oxygen during exercise training, these studies concluded that it does not further improve exercise tolerance compared to exercise training alone. However, supplemental oxygen during exercise training may be effective in improving exercise tolerance in COPD patients with severe exercise-induced desaturation. Therefore, this study will be performed to elucidate the effectiveness of supplemental oxygen during exercise training and the relationship between its effectiveness and severity of exercise-induced desaturation at baseline. Methods We will first assess the effectiveness of supplemental oxygen during exercise training in COPD. The main outcome is the change in exercise tolerance before and after the intervention, indicated by the 6-min walking distance, the walking distance, or the walking time in incremental shuttle walking test, and analyzed as the standardized mean difference (SMD). The quality and risk of bias in individual studies will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and risk-of-bias tool (RoB ver.2). If statistical heterogeneity in terms of the effectiveness of exercise tolerance is shown, we will conduct meta-regression analyses to examine the association between the effectiveness of exercise training with supplemental oxygen and severity of exercise-induced desaturation at baseline. Discussion One strength of this study is that it is a systematic review with meta-regression analysis to elucidate the effectiveness of supplemental oxygen during exercise training in patients with COPD who show severe exercise-induced desaturation. Furthermore, we will assess the severity of exercise-induced desaturation for which exercise training with supplemental oxygen is effective, the influence of acute effects at baseline, and the effect of supplemental oxygen on adverse events. Systematic review registration Registration number, UMIN000039960.

Variability of the haemodynamic responses to laboratory tests employed in assessment of neural cardiovascular regulation in man

1985 ◽  
Vol 69 (5) ◽  
pp. 533-540 ◽  
Author(s):  
Gianfranco Parati ◽  
Guido Pomidossi ◽  
Agustin Ramirez ◽  
Bruno Cesana ◽  
Giuseppe Mancia
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Test Performance ◽  
Blood Pressure Response ◽  
Cold Pressor Test ◽  
Cold Pressor ◽  
Cardiovascular Regulation ◽  
Pressor Test ◽  
Carotid Baroreceptor ◽  
Baroreceptor Stimulation

1. In man evaluation of neural cardiovascular regulation makes use of a variety of tests which address the excitatory and reflex inhibitory neural influences that control circulation. Because interpretation of these tests is largely based on the magnitude of the elicited haemodynamic responses, their reproducibility in any given subject is critical. 2. In 39 subjects with continuous blood pressure (intra-arterial catheter) and heart rate monitoring we measured (i) the blood pressure and heart rate rises during hand-grip and cold-pressor test, (ii) the heart rate changes occurring during baroreceptor stimulation and deactivation by injection of phenylephrine and trinitroglycerine, and (iii) the heart rate and blood pressure changes occurring with alteration in carotid baroreceptor activity by a neck chamber. Each test was carefully standardized and performed at 30 min intervals for a total of six times in each subject. 3. The results showed that the responses to any test were clearly different from one another and that this occurred in all subjects studied. For the group as a whole the average response variability (coefficient of variation) ranged from 10.2% for the blood pressure response to carotid baroreceptor stimulation to 44.2% for the heart rate response to cold-pressor test. The variability of the responses was not related to basal blood pressure or heart rate, nor to the temporal sequence of the test performance. 4. Thus tests employed for studying neural cardiovascular control in man produce responses whose reproducibility is limited. This phenomenon may make it more difficult to define the response magnitude typical of each subject, as well as its comparison in different conditions and diseases.

Role of Topical Oxymetazoline for Management of Erythematotelangiectatic Rosacea

2017 ◽  
Vol 52 (3) ◽  
pp. 263-267 ◽  
Author(s):  
Rebecca M. Hoover ◽  
John Erramouspe
Keyword(s):  
English Language ◽  
Human Subjects ◽  
Data Extraction ◽  
Drug Approval ◽  
Current Data ◽  
Patient Response ◽  
Study Selection ◽  
Cochrane Database ◽  
Drug Approval Process ◽  
Individual Patient Response

Objective: To review and summarize topical oxymetazoline’s pharmacology, pharmacokinetics, efficacy, safety, cost, and place in therapy for persistent redness associated with erythematotelangiectatic rosacea. Data Sources: Literature searches of MEDLINE (1975 to September 2017), International Pharmaceutical Abstracts (1975 to September 2017), and Cochrane Database (publications through September 2017) using the terms rosacea, persistent redness, α -agonist, and oxymetazoline. Study Selection and Data Extraction: Results were limited to studies of human subjects, English-language publications, and topical use of oxymetazoline. Relevant materials from government sources, industry, and reviews were also included. Data Synthesis: Data support the efficacy of oxymetazoline for persistent facial redness. Little study beyond clinical trials cited in the drug approval process has been conducted. Current data suggest that oxymetazoline is similar in safety and efficacy to brimonidine. Head-to-head comparisons of topical α-agonists for erythema caused by rosacea are needed. Conclusion: The topical α-agonist, oxymetazoline, is safe and effective for reducing persistent facial redness associated with erythematotelangiectatic subtype of rosacea. Health care practitioners selecting among treatments should consider not only the subtype of rosacea but also individual patient response, preference, and cost.

Abstract MP016: Innovation in Exercise: Increasing Capacity of Sedentary Obese Women with Cooling

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Stacy T Sims ◽  
Sandra Tsai ◽  
Marcia L Stefanick
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Body Weight ◽  
Waist Circumference ◽  
Body Mass ◽  
Exercise Tolerance ◽  
Thermal Strain ◽  
Walk Test ◽  
Obese Women ◽  
Thermal Discomfort

Background: Barriers to physical activity for obese women include overheating, sweating, fatigue, exhaustion, and rapid heart rate. Adipose tissue acts as a thermal insulator, promoting a greater heat load on the nonfat tissues, reducing heat tolerance; exercise causes a rise in body temperature with an inability to dissipate heat contributing to reduced exercise tolerance. With difficulties of thermoregulation in the sedentary obese population, the aspect of attenuating the discomfort thus associated may encourage continuation of exercise. A heat sink applied to palmar surfaces extracts heat and cools the venous blood, reducing thermal strain by enhancing the volume of cooled venous return. We hypothesized that palmar cooling using a rapid thermal exchange device (RTX) during exercise would attenuate the thermal discomfort of exercise of sedentary obese women, improving exercise tolerance. Methods: To examine whether palmar cooling would impact exercise tolerance in obese women, 24 healthy women aged 30–45 years, with no history of long term structured exercise, a body mass of 120–135% above ideal and/or BMI between 30 and 34.9 were recruited. Women were randomized into a cooling (RXT with 16°C water circulating) or a control (RTX with 37°C water circulating) group and attended 3 exercise sessions a week for 3-months (12 weeks). Each session was comprised of 10 min body weight exercises, 25–45 min treadmill walking at 70–85% HRR with the RTX device, and 10 min of core strengthening exercises. The performance marker was a 1.5 mi walk for time; conducted on the first and last days of the intervention. Mixed models were used to model each of the outcomes as a function of thermal strain, time and treatment with covariates of speed, heart rate, distance, and the interaction of the main effects included in the model. Results: Groups were matched at baseline for key variables (time for 1.5 mile walk test, resting and exercising heart rate [HR], blood pressure [BP], waist circumference [WC], body weight, body mass index [BMI]). Among the cooling group, time to complete the 1.5mile walk test was significantly faster (31.6 ± 2.3 vs. 24.6 ± 2.5 min, pre vs. post, P< 0.01). A greater average exercising HR was observed (136 vs. 154 bpm, pre vs. post, P <0.001), with a significant reduction in WC (41.8 ± 3.1 vs. 39.1 ± 2.2 inches, pre vs. post, P< 0.01) and resting BP (139/84 ± 124/70 mmHg, pre vs. post, P < 0.025). There were no significant differences observed in the control group. Conclusion: Results indicate that exercise tolerance in obese women improved with cooling during exercise, more so than those women who did not have cooling. An improvement in blood pressure, heart rate, waist circumference, and overall aerobic fitness was observed. These findings suggest that by reducing thermal discomfort during exercise, tolerance increases, thus improving cardiovascular parameters of obese women.

scholarly journals Case series and review of Ayurvedic medication induced liver injury

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher M. Karousatos ◽  
Justin K. Lee ◽  
David R. Braxton ◽  
Tse-Ling Fong
Keyword(s):  
Liver Injury ◽  
Plant Extracts ◽  
Significant Proportion ◽  
Case Series ◽  
The United States ◽  
Tinospora Cordifolia ◽  
Individual Plant ◽  
Medicine Use ◽  
Drug Induced ◽  
Drug Induced Liver Injury

Abstract Background Complementary and alternative medicine use among Americans is prevalent. Originating in India, Ayurvedic medicine use in the United States has grown 57% since 2002. CAM accounts for a significant proportion of drug induced liver injury in India and China, but there have been only three reports of drug induced liver injury from Ayurvedic medications in the U.S. We report three cases of suspected Ayurvedic medication associated liver injury seen at a Southern California community hospital and review literature of Ayurvedic medication induced liver injury. Case presentations Three patients presented with acute hepatocellular injury and jaundice after taking Ayurvedic supplements for 90–120 days. First patient took Giloy Kwath consisting solely of Tinospora cordifolia. Second patient took Manjishthadi Kwatham and Aragwadhi Kwatham, which contained 52 and 10 individual plant extracts, respectively. Third patient took Kanchnar Guggulu, containing 10 individual plant extracts. Aminotransferase activities decreased 50% in < 30 days and all 3 patients made a full recovery. Roussel Uclaf Causality Assessment Method (RUCAM) scores were 7–8, indicating probable causality. These products all contained ingredients in other Ayurvedic and traditional Chinese medicines with previously reported associations with drug induced liver injury. Conclusions These patients highlight the risk of drug induced liver injury from Ayurvedic medications and the complexity of determining causality. There is a need for a platform like LiverTox.gov to catalog Ayurvedic ingredients causing liver damage.

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