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/pdf/acc-aha-2005-guideline-update-for-the-diagnosis-and-4hik65ngbe.pdf

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).

Mariell Jessup, MD, FACC, FAHA, Chair [*][1]

William T. Abraham, MD, FACC, FAHA[†][2]

Donald E. Casey, MD, MPH, MBA[‡][3]

Arthur M. Feldman, MD, PhD, FACC, FAHA[§][4]

Gary S. Francis, MD, FACC, FAHA[§][4]

Theodore G. Ganiats, MD[∥][5]

Marvin A. Konstam, MD, FACC[¶][6]

Donna M.

/pdf/2009-focused-update-incorporated-into-the-acc-aha-2005-3z9lhvyqwq.pdf

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation

This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.

/pdf/exercise-as-medicine-evidence-for-prescribing-exercise-as-4ap89k53ch.pdf

Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases

This guideline from the ACP provides clinical recommendations about noninvasive pharmacologic and nonpharmacologic treatment of low back pain.

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

The Wingate Anaerobic Test (WAnT) is generally used to evaluate anaerobic cycling performance, but knowledge of the metabolic profile of WAnT is limited. Therefore the energetics of WAnT was analysed with respect to working efficiency and performance. A group of 11 male subjects [mean (SD), age 21.6 (3.8) years, height 178.6 (6.6) cm, body mass 82.2 (12.1) kg] performed a maximal incremental exercise test and a WAnT. Lactic and alactic anaerobic energy outputs were calculated from net lactate production and the fast component of the kinetics of post-exercise oxygen uptake. Aerobic metabolism was determined from oxygen uptake during exercise. The WAnT mean power of 683 (96.0) W resulted from a total energy output above the value at rest of 128.1 (23.2) kJ·30 s–1 [mean metabolic power=4.3 (0.8) kW] corresponding to a working efficiency of 16.2 (1.6)%. The WAnT working efficiency was lower (P<0.01) than the corresponding value of 24.1 (1.7)% at 362 (41) W at the end of an incremental exercise test. During WAnT the fractions of the energy from aerobic, anaerobic alactic and lactic acid metabolism were 18.6 (2.5)%, 31.1 (4.6)%, and 50.3 (5.1)%, respectively. Energy from metabolism of anaerobic lactic acid explained 83% and 81% of the variance of WAnT peak and mean power, respectively. The results indicate firstly that WAnT requires the use of more anaerobically derived energy than previously estimated, secondly that anaerobic metabolism is dominated by glycolysis, thirdly that WAnT mechanical efficiency is lower than that found in aerobic exercise tests, and fourthly that the latter finding partly explains discrepancies between previously published and the present data about the metabolic profile of WAnT.

How anaerobic is the Wingate Anaerobic Test for humans

The maximal lactate steady state (MLSS) is the highest blood lactate concentration (BLC) that can be identified as maintaining a steady-state during a prolonged submaximal constant workload. Comparative interpretation of published data about MLSS is complicated by the fact that different methods of testing have been utilized. Thus, three methods, corresponding to the time course of changes in BLC incurred during either 30 min (MLSS I) or 20 min (MLSS II and III) of constant submaximal workload exercise, were compared in 26 male subjects [mean (SD) age 24.6 (5.6) years, height 181.6 (4.9) cm, body mass 74.4 (5.2) kg]. MLSS I [5.1 (1.3) mmol·l-1], II [4.9 (1.3) mmol·l-1], and III [4.3 (1.3) mmol·l-1] were different (P<0.01). The workload corresponding to MLSS III [244.8 (44.0) W] was lower (P<0.01) than that at MLSS I [254.0 (40.8) W] and II [251.9 (40.4) W]. No difference could be confirmed between the workloads established for MLSS I and MLSS II. The differences between MLSS I, MLSS II, and MLSS III and corresponding workloads reflect insufficient contribution to lactate kinetics by testing procedures that depend strongly upon the time course of changes in BLC during the initial 20–25 min of constant-workload exercise. Based on the present findings, constant-load tests lasting at least 30 min and a BLC increase of no more than 1.0 mmol·l-1 after the 10th testing minute appear to be the most reasonable with respect to valid testing results.

Methodological aspects of maximal lactate steady state—implications for performance testing

A link between lactate and muscular exercise was seen already more than 200 years ago. The blood lactate concentration (BLC) is sensitive to changes in exercise intensity and duration. Multiple BLC threshold concepts define different points on the BLC power curve during various tests with increasing power (INCP). The INCP test results are affected by the increase in power over time. The maximal lactate steady state (MLSS) is measured during a series of prolonged constant power (CP) tests. It detects the highest aerobic power without metabolic energy from continuing net lactate production, which is usually sustainable for 30 to 60 min. BLC threshold and MLSS power are highly correlated with the maximum aerobic power and athletic endurance performance. The idea that training at threshold intensity is particularly effective has no evidence. Three BLC-orientated intensity domains have been established: (1) training up to an intensity at which the BLC clearly exceeds resting BLC, light- and moderate-intensity training focusing on active regeneration or high-volume endurance training (Intensity MLSS). High-performance endurance athletes combining very high training volume with high aerobic power dedicate 70 to 90% of their training to intensity domain 1 (Intensity < Threshold) in order to keep glycogen homeostasis within sustainable limits.

Blood Lactate Diagnostics in Exercise Testing and Training

It is speculated that anaerobic metabolism is the predominant source of energy in karate kumite. However, no experimental proof is currently available. The metabolic cost and fractions of aerobic and anaerobic energy of karate kumite fighting were investigated. Ten male nationally or internationally ranked karateka [means (SD) age 26.9 (3.8) years, height 1.80 (0.08) m, mass 77.2 (12.8) kg] performed two to four fights scheduled and judged like a championship. Oxygen uptake was measured continuously with a portable spirometric device. Blood lactate was determined immediately before, and minute by minute after, each fight. Aerobic, anaerobic alactic and anaerobic lactic energy were calculated from oxygen uptake during the fight ( VO(2)), the fast component of the post-fight oxygen uptake ( VO(2PCr)) above resting values and changes in blood lactate concentration (Net-BLC), respectively. Altogether, 36 fights lasting 267 (61) s were analysed. The referee's decisions caused an activity-to-break ratio of approximately 2:1. VO(2), VO(2PCr), and Net-BLC per fight were 165.3 (52.4) ml(.)kg(-1), 32.2 (7.2) ml(.)kg(-1)and 4.2 (1.9) mmol(.)l(-1); the overall energy cost above rest was 334.3 (86.3) kJ per fight. Fractions of aerobic, anaerobic alactic, and lactic energy sources were 77.8 (5.8)%, 16.0 (4.6)%, and 6.2 (2.4)%, respectively. The results indicate a high metabolic rate in karate kumite. However, the acyclic activity profile implies that aerobic metabolism is the predominant source of energy and there is anaerobic supplementation, mainly by high-energy phosphates.

Energetics of karate kumite.

Objective: To evaluate the effect of a program of modifi ed Pilates for active individuals with chronic non-specifi c low back pain. Design: A single blind randomized controlled trial. Participants: 49 individuals with chronic low back pain were randomly allocated to control (n = 24) or Pilates group (n = 25). Thirty-four individuals completed the study (14 and 20 individuals for control and Pilates group, respectively). Intervention: The Pilates group undertook a six week program of Pilates. Both groups continued with normal activity. Main Outcome Measures: An assessor blinded to group allocation conducted functional and questionnaire-based assessments pre- and post- intervention. Results: Improvements were seen in the Pilates group post- intervention period with increases (P < 0.05) in general health, sports functioning, fl exibility, proprioception, and a decrease in pain. The control group showed no signifi cant differences in the same measures post- intervention. Conclusions: These data suggest that Pilates used as a specifi c core stability exercise incorporating functional movements can improve non-specifi c chronic low back pain in an active population compared to no intervention. Additionally, Pilates can improve general health, pain level, sports functioning, fl exibility, and proprioception in individuals with chronic low back pain. Key Words: back pain, exercise therapy, rehabilitation. Back pain is one of the most widely experienced health-related problems in the western world. In a recent survey, for the United Kingdom, 40% of 5500 people interviewed had experienced back pain within a single year, with pain existing throughout the year in 15% of these cases. 1 In 1998, the direct health care costs of back pain within the United Kingdom, including visits to the general practitioners and referral to therapists, was estimated to be £1632 million. 2 Even greater, though, is the expense to the economy caused by informal care and lost working days, calculated to be approximately 5.7 million days during 2001. 3 There is a vital need, therefore, for effective but also affordable treatments for back pain and strategies to help prevent it.

Ralph Beneke

Papers

How anaerobic is the Wingate Anaerobic Test for humans

Methodological aspects of maximal lactate steady state—implications for performance testing

Blood Lactate Diagnostics in Exercise Testing and Training

Energetics of karate kumite.

Does a program of pilates improve chronic non-specific low back pain?