Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease

The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4–6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.

Is the Treadmill Test Safe When Performed Using a Surgical Mask and Are Its Results Reliable In Terms Of Diagnosis?

Aim: Mask use has a substantial role in reducing the spread of COVID-19 in confined spaces. However, the use of masks is controversial in cases where intense effort is required, such as the treadmill exercise test. Since the majority of subjects undergoing this test are elderly individuals with comorbidities, the safety and reliability of the test are critical matters that must be elucidated in the post-COVID-19 era. In this study, the safety of the treadmill exercise test performed using a mask and the diagnostic reliability of the test were questioned. Methods: In our clinic, before March 11, 2020, treadmill exercise tests were performed without a mask; whereas, after this date, patients were supplied with a standard surgical mask during the test. These two groups were compared with regard to various characteristics to assess diagnostic reliability and safety. Results: The diagnostic reliability and the safety of the stress test performed with a mask was found to be similar to that of tests performed without a mask. However, we noted that shortness of breath was more common in the mask-wearing group. Conclusion: The treadmill exercise test performed by wearing surgical masks is safe and its results are reliable for diagnosis.

Significance of Exercise‐Related Ventricular Arrhythmias in Patients With Brugada Syndrome

Background Sinus tachycardia during exercise attenuates ST‐segment elevation in patients with Brugada syndrome, whereas ST‐segment augmentation after an exercise test is a high‐risk sign. Some patients have premature ventricular contractions (PVCs) related to exercise, but the significance of exercise‐related PVCs in patients with Brugada syndrome is still unknown. The objective of this study was to determine the significance of exercise‐related PVCs for predicting occurrence of ventricular fibrillation (VF) in patients with Brugada syndrome. Methods and Results The subjects were 307 patients with Brugada syndrome who performed a treadmill exercise test. We evaluated the occurrence of PVCs at rest, during exercise and at the peak of exercise, and during recovery after exercise (0–5 minutes). We followed the patients for 92±68 months and evaluated the occurrence of VF. PVCs occurred in 82 patients (27%) at the time of treadmill exercise test: PVCs appeared at rest in 14 patients (4%), during exercise in 60 patients (20%), immediately after exercise (0–1.5 minutes) in 28 patients (9%), early after exercise (1.5–3 minutes) in 18 patients (6%), and late after exercise (3–5 minutes) in 12 patients (4%). Thirty patients experienced VF during follow‐up. Multivariable analysis including symptoms, spontaneous type 1 ECG, and PVCs in the early recovery phase showed that these factors were independently associated with VF events during follow‐up. Conclusions PVCs early after an exercise test are associated with future occurrence of VF events. Rebound of vagal nerve activity at the early recovery phase would promote ST‐segment augmentation and PVCs in high‐risk patients with Brugada syndrome.

THE VALUE OF TREADMILL EXERCISE TEST PARAMETERS TO PREDICT THE MARATHON PERFORMANCE OF YOUNG AND MIDDLE-AGED RECREATIONAL ATHLETES IN CHINA

Objectives: This study will evaluate the results of parameters measured during a treadmill exercise test to predict marathon performances. Methods: We studied 171 Chinese recreational athletes who participated in marathons or half-marathons (42.2[Formula: see text]k or 21.1[Formula: see text]k, respectively) between October 2016 and December 2017. The participants completed a survey that included questions about demographics and training, and they underwent a treadmill exercise test according to the Bruce protocol. The number of years in training, mean weekly hours of training, mean weekly training volume, and performance time in subsequent marathon events were recorded and analyzed in this study. Results: The total exercise times achieved on the treadmill test were significantly longer for men compared to women ([Formula: see text]). The performance times in the half-marathons were significantly shorter for men compared to women ([Formula: see text]). Training volume was the only independent predictor of total exercise time on the treadmill and performance time in marathons and half-marathons (all [Formula: see text]). The value of the total exercise time on the treadmill to predict performance times in half-marathons ([Formula: see text]) was superior to full marathons ([Formula: see text]) and significantly better in study subjects aged 30–39 years ([Formula: see text], [Formula: see text]) and 40–49 years ([Formula: see text], [Formula: see text]) compared to study subjects aged 20–29 years and 50–59 years. The percentage of decrease in the maximal heart rate (MHR) at the end of one minute of recovery time was negatively correlated with performance times in marathons. Conclusions: The total exercise time achieved during an exhaustive treadmill exercise test and percentage of decrease in the MHR at the end of one minute of recovery time are accessible parameters that can help athletes manage their expectations and adjust their training plans. A large study that includes additional countries is needed to confirm the value of treadmill exercise test results for predicting marathon performance.

Caffeine supplementation induces higher IL-6 and IL-10 plasma levels in response to a treadmill exercise test

Background An acute bout of exercise induces an inflammatory response characterized by increases in several cytokines. Caffeine ingestion could modify this inflammatory response. The aim of this study was to determine the effects of caffeine supplementation on plasma levels of cytokines, mainly IL-10 and IL-6, in response to exercise. Methods In a randomized, crossover, double-blinded study design, thirteen healthy, well-trained recreational male athletes performed, on two different occasions, a treadmill exercise test (60 min at 70% VO2max) after ingesting 6 mg/kg body mass of caffeine or placebo. Blood samples were taken before exercising, immediately after finishing and 2 h after finishing the exercise. Plasma concentrations of IL-10, IL-6, IL-1β, IL-1ra, IL-4, IL-8, IL-12 and IFN-γ, adrenaline, cortisol and cyclic adenosine monophosphate (cAMP) were determined. The capacity of whole blood cultures to produce cytokines in response to endotoxin (LPS) was also determined. Changes in blood variables were analyzed using a time (pre-exercise, post-exercise, recovery) x condition (caffeine, placebo) within-between subjects ANOVA with repeated measures. Results Caffeine supplementation induced higher adrenaline levels in the supplemented participants after exercise (257.3 ± 53.2 vs. 134.0 ± 25.7 pg·mL− 1, p = 0.03) and higher cortisol levels after recovery (46.4 ± 8.5 vs. 32.3 ± 5.6 pg·mL− 1, p = 0.007), but it did not influence plasma cAMP levels (p = 0.327). The exercise test induced significant increases in IL-10, IL-6, IL-1ra, IL-4, IL-8, IL-12 and IFN-γ plasma levels, with IL-6 and IL-10 levels remaining high after recovery. Caffeine supplementation influenced only IL-6 (3.04 ± 0.40 vs. 3.89 ± 0.62 pg·mL− 1, p = 0.003) and IL-10 (2.42 ± 0.54 vs. 3.47 ± 0.72 pg·mL− 1, p = 0.01) levels, with higher concentrations after exercise in the supplemented condition. No effect of caffeine was observed on the in vitro stimulated cytokine production. Conclusions The results of the present study indicate a significant influence of caffeine supplementation increasing the response to exercise of two essential cytokines such as IL-6 and IL-10. However, caffeine did not influence changes in the plasma levels of other cytokines measured and the in vitro-stimulated cytokine production.